2020-07-31T10:55:15-05:00 2019-12-31 271235638 MCM CPAS & ADVISORS LLP 462 S FOURTH ST SUITE 2600 LOUISVILLE KY 402023445 990 2019-01-01 237017526 KENTUCKY LABORERS DISTRICT COUNCIL HEALTH & WELFARE FUND KENT 5028398166 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 JAMES BLEVINS CHAIRMAN 5028398166 2020-07-30 1 REBECCA L PHILLIPS CPA P00024055 5027491900 2020-07-29 69.135.99.226 2020-07-30 12:00:35 ED P 695EE37D0681D5614A9C40BAE0A81AB709F0C4AA 275FC94D0D69C364907A46926FF5A376C6A99BC7 2019 2021-01-29 14:40:06Z MARK ISAACS 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 59124737 0 X N/A X 1967 KY EMPLOYEE BENEFIT PLAN PROVIDING ACCIDENT, SICKNESS, VISION, DENTAL, DEATH AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS FOR ACTIVE PARTICIPANTS AND ACCIDENT, SICKNESS, VISION, DENTAL AND DEATH BENEFITS FOR RETIRED PARTICIPANTS. 9 9 9 9 0 0 0 0 21612700 23135360 1156264 2939259 54188 61349 22823152 26135968 0 0 22386944 19659836 943680 994150 0 0 0 1228476 1130986 24559100 21784972 -1735948 4350996 23016317 25441958 1029134 554884 21987183 24887074 EMPLOYEE BENEFIT PLAN PROVIDING ACCIDENT, SICKNESS, VISION, DENTAL, DEATH AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS FOR ACTIVE PARTICIPANTS AND ACCIDENT, SICKNESS, VISION, DENTAL AND DEATH BENEFITS FOR RETIRED PARTICIPANTS. 0 0 EMPLOYEE BENEFIT PLAN PROVIDING ACCIDENT, SICKNESS, VISION, DENTAL, DEATH AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS FOR ACTIVE PARTICIPANTS AND ACCIDENT, SICKNESS, VISION, DENTAL AND DEATH BENEFITS FOR RETIRED PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 714 0 1 9 1 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X D CROUCH FUND ADMINISTRATORS GRIFFIETH FUND ASSISTANT 5028398166 1996 BY-PASS SOUTH LAWRENCEBURG KY 40342 X MARK ISAACS CHAIRMAN 1.00 X X 0 0 0 DOUG HACKER SECRETARY/TREASURER 1.00 X X 0 0 0 PERRY BLADES TRUSTEE 1.00 X 0 0 0 DONALD TRAVIS TRUSTEE 1.00 X 0 0 0 JEFF STORY TRUSTEE 1.00 X 0 0 0 ANTHONY WICKLINE TRUSTEE 1.00 X 0 0 0 LARRY HENDERSON TRUSTEE 1.00 X 0 0 0 DWAYNE MCCAULEY TRUSTEE 1.00 X 0 0 0 JEREMY JENKINS ALTERNATE TRUSTEE (ALTERNATE) 1.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA PO BOX 644546 PITTSBURGH PA 152644546 REPRICING OF CLAIMS, PRE-CERTIFICATION 391040 BENESYS 700 TOWER DR SUITE 300 TROY MI 48098 CONSULTING AND ELIGIBILITY AND CLAIMS PR 156799 CIGN HEALTH & LIFE INS CO 2 CROSSROADS DRIVE BEDMINSTER NJ 07921 REPRICING OF NON-PPO CLAIMS 141474 3 EMPLOYER CONTRIBUTIONS 900099 21754528 21754528 EMPLOYEE CONTRIBUTIONS 900099 1380832 1380832 23135360 720128 720128 35207900 32988769 2219131 2219131 2219131 CONTRIBUTION RECORDS F 900099 61349 61349 61349 26135968 23196709 0 2939259 19659836 590384 212285 145045 46436 72959 66130 37923 579593 110467 135255 40889 305 10879 7978 13938 INTERNATIONAL FOUNDATIO 29429 EMPLOYEE ASSISTANCE PLA 14236 PCORI TAX 7306 MAINTENANCE & SERVICE C 2803 896 21784972 192455 298955 2296287 2285544 37538 35642 129171 102679 9936 26492 20480101 22795325 23016317 25441958 1029134 554884 1029134 554884 X 21987183 24887074 0 0 0 0 21987183 24887074 23016317 25441958 4350996 -1451105 0 X 0 1 X 1 0 28610 28610 0 100561 74069 26492 26492 X 24684863 -1451105 -1451105 26135968 0 26135968 21784972 0 21784972 0 21784972 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE ("IRC"), AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER DATED MAY 14, 1969 FROM THE INTERNAL REVENUE SERVICE ("IRS"), AND THE PLAN ADMINISTRATOR AND THE PLAN'S TAX COUNSEL BELIEVE THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. U.S. GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2018 AND 2017, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE FUND AUDITOR. IT IS REVIEWED BY THE FUND ATTORNEY, FUND CONSULTANT AND FUND ADMINISTRATOR PRIOR TO PRESENTATION TO THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES THEN REVIEW THE FORM 990 BEFORE APPROVAL AND SIGNING. AFTER APPROVAL AND EXECUTION BY BOARD OF TRUSTEES, THE FORM 990 IS FILED. (IN THIS CASE, IT IS E-FILED BY THE FUND AUDITOR) FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE OR EMPLOYEE OF THE FUND HAS THE DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST. EACH TRUSTEE OR EMPLOYEE MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE TRUSTEES DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, THE BOARD OF TRUSTEES WILL DISCUSS AND VOTE TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST IS DETERMINED TO EXIST, THE CHAIRPERSON OF THE BOARD OF TRUSTEES SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. THE BOARD OF TRUSTEES SHALL THEN DETERMINE WHETHER THE FUND CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OF TRUSTEES SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE FUND'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING WAGE INCREASES FOR FUND EMPLOYEES, THE TRUSTEES REVIEW THE CURRENT AND PROJECTED FINANCIAL STATUS OF THE FUND, INCLUDING CURRENT AND PROJECTED ADMINISTRATIVE COSTS, AND TAKE INTO CONSIDERATION THE WAGES FOR SIMILAR POSITIONS IN OTHER TAFT-HARTLEY TRUST FUNDS, PROJECTED COST OF LIVING TRENDS, AND EMPLOYEES' WORK HISTORIES AND JOB PERFORMANCES. THE TRUSTEES HAVE ALSO IMPLEMENTED A POLICY WHEREIN THE ADMINISTRATOR WILL PERFORM ANNUAL JOB PERFORMANCE REVIEWS FOR EACH FUND EMPLOYEE. THE FUND TRUSTEES DO NOT RECEIVE COMPENSATION OF ANY KIND. THERE IS NO CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL OF THIS FUND. FORM 990, PART VI, SECTION C, LINE 19 THEY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. 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