2020-01-27T12:41:54-06:00 2019-05-31 470900880 CALIBRE CPA GROUP PLLC 230 W MONROE STE 310 CHICAGO IL 606064701 990 2018-06-01 366219639 FOX VALLEY LABORERS HEALTH & WELFARE FND FOXV 8477420900 2371 BOWES ROAD No 500 ELGIN IL 601235523 VERNON BAUMAN Chairman 8477420900 2020-01-21 1 ANDREW HEIN P00499757 3126550037 38.100.43.100 2020-01-27 12:41:14 CS P 099BB351ED5C43DB8E4A0DD96B056B1430213725 099BB351ED5C43DB8E4A0DD96B056B1430213725 2018 2020-09-23 17:36:50Z VERNON BAUMAN 2371 BOWES ROAD No 500 ELGIN IL 601235523 64461628 0 X N/A X 1968 IL TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 6 3 69 0 0 0 0 0 37464332 37603665 4646129 5516647 384264 405738 42494725 43526050 0 0 32622834 38089821 1100109 1238772 0 0 0 2270568 2503417 35993511 41832010 6501214 1694040 103869536 104662668 23471258 25529371 80398278 79133297 TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. THERE WERE 1,965 ELIGIBLE PARTICIPANTS AT MAY 31, 2019. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 813 0 1 69 1 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 1 1 0 0 X DEBORAH FRENCH 8477420900 2371 BOWES ROAD SUITE 500 ELGIN IL 601235523 JOHN PBRYAN TRUSTEE 3.00 X 0 0 0 MIKE SHALES Chairman 3.00 X 0 0 0 VERN BAUMAN TRUSTEE 3.00 40.00 X 0 128452 88920 AL OROSZ FMR TRUSTEE 3.00 X 0 0 0 DAVE SHEAHAN TRUSTEE 3.00 40.00 X 0 125900 88920 MARK CSTELVECCHI FMR TRUSTEE 3.00 50.00 X 0 127690 88757 MARTIN D DWYER SECRETARY 3.00 50.00 X 0 148819 93001 Brian T Rausch TRUSTEE 3.00 X 0 0 0 PATRICIA M SHALES ADMINISTRATOR 40.00 X 137682 0 49496 137682 530861 409094 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO ACCESS FEES 930767 SEI INVESTMENT ONE FREEDOM DRIVE OAKS PA 19456 INV MGMNT/CONSULTING 305567 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DRIVE MIAMI FL 331565629 PLAN CONSULTING 158007 3 EMPLOYER CONTRIBUTIONS 900099 35236525 35236525 MEMBER CONTRIBUTIONS 900099 1490651 1490651 Stop Loss Reimbursements 900009 753625 753625 MEDICARE D SUBSIDIES 900099 122864 122864 37603665 2880372 2880372 23559853 12000 20935578 0 2624275 12000 2636275 2636275 REIMB SAL & RELATED EXPENSES FROM 900099 405738 405738 405738 43526050 38009403 0 5516647 38089821 646977 299581 188406 103808 152504 69543 500704 1434828 196268 71938 1396 17142 20130 30821 PATIENT PROTECTION & AF 8143 41832010 41447 139613 3315534 3267166 91227 94537 352035 291760 64660 60275 99288039 100218962 1068629 882115 103869536 104662668 83837 83859 23387421 25445512 23471258 25529371 X 0 0 0 0 80398278 79133297 80398278 79133297 103869536 104662668 1694040 -2959021 0 X X 0 1 X 1 0 352035 291760 60275 60275 EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY 19440000 EST LIAB FUTR CLAIMS INCURRED BUT UNPAID 5676000 DEPOSITS HELD 202421 Due to Affiliated Funds 127091 25445512 X 38784098 -2959021 -2959021 41743119 500704 1282227 1782931 43526050 38108079 -876489 -876489 38984568 500704 2346738 2847442 41832010 Part X, Line 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGMENT TO EVALUATE TAX POSISTIONS 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 TAXING AUTHORITIES. AS OF MAY 31, 2019, THERE WERE NO UNCERTAIN TAX POSISTIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION IF 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. AT MAY 31, 2019, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2016. Part XI, Line 4b - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED 122,864. REIMBURSED FV PENSION SALARY EXPENSE 405,738. STOP LOSS INSURANCE REIMBURSEMENTS 753,625. Part XII, Line 2d - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED -122,864. STOP LOSS INSURANCE REIMBURSEMENTS -753,625. Part XII, Line 4b - Other Adjustments: REIMBURSED FV PENSION SALARY EXPENSE 405,738. CHANGE IN PLAN BENEFIT OBLIGATION 1,941,000. X 0 0 0 VERN BAUMAN TRUSTEE 0 124273 0 0 0 4179 0 60278 0 28642 0 217372 0 0 DAVE SHEAHAN TRUSTEE 0 124081 0 0 0 1819 0 60278 0 28642 0 214820 0 0 MARK CSTELVECCHI FMR TRUSTEE 0 127159 0 0 0 531 0 60115 0 28642 0 216447 0 0 MARTIN D DWYER SECRETARY 0 146739 0 0 0 2080 0 64359 0 28642 0 241820 0 0 PATRICIA M SHALES ADMINISTRATOR 133504 0 0 0 4178 0 28170 0 21326 0 187178 0 0 0 Form 990, Part VI, Section A, line 8b THE ORGANIZATION DOES NOT HAVE COMMITTEES TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11b THE TRUSTEES OF THE FOX VALLEY AND VICINITY LABORERS HEALTH AND WELFARE FUND HAVE AUTHORIZED THE CHAIRMAN OF THE FUND TO REVIEW THE FORM 990 PRIOR TO FILING. A COPY OF THE FILED RETURN IS MADE AVAILABLE TO ALL TRUSTEES TO REVIEW SUBSEQUENT TO FILING. Form 990, Part VI, Section B, line 12c THE ACTIONS OF THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND ERISA. BOTH ESTABLISH STANDARDS OF CONDUCT FOR PLAN FIDUCIARIES. IN ADDITION, THE ADMINISTRATOR OF THE PLAN HAS SIGNED AN EMPLOYMENT CONTRACT WITH THE FUND WHICH ALSO ESTABLISHES STANDARDS OF CONDUCT. THE TRUSTEES AND ADMINISTRATOR ARE RQUIRED TO DISCLOUSE ANY POSSIBLE CONFLICTS OF INTREST TO THE ENTIRE BOARD. Form 990, Part VI, Section B, line 15a THE TRUSTEES OF THE FUND ANNUALLY REVIEW THE PERFORMANCE OF THE FUND'S TOP MANAGEMENT OFFICIAL (ADMINISTRATOR) AND APPROVE ANY COMPENSATION ADJUSTMENTS. Form 990, Part VI, Section C, line 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS ANNUALLY. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE FUND OFFICE AND/OR THE US DEPARTMENT OF LABOR. FORM 990 PART XII LINE 2C THERE HAS BEEN NO CHANGE IN THE PROCESS FROM THE PRIOR YEAR FOX VALLEY & VICINITY LABORERS PENSION 2371 BOWES Rd NO 500 ELGIN IL 601235523 366147409 PENSION FUND IL 401(a) 0 LABORERS LOCAL #1035 3819 N Route 23 Suite A MARENGO IL 601520211 362063944 LABOR UNION IL 501(c)(5) 0 LABORERS LOCAL #582 2400 BIG TIMBER ROAD BLDG B ELGIN IL 601247812 361265047 LABOR UNION IL 501(c)(5) 0 FOX VALLEY ASSOCIATED GENERAL CONTRACTORS 2020 DEAN ST NO I ST CHARLES IL 60174 362244731 CONTRACTORS ASSOCIATION IL 501(c)(6) 0 ILLINOIS ROAD AND TRANSPORTATION BUILDERS ASSOCIATION 500 PARK BLVD 1250 ITASCA IL 60143 361257695 CONTRACTORS ASSOCIATION IL 501(c)(6) 0 ABITUA SEWER WATER & PLUMB ALLAN MACK & SONS INC ALLIANCE CONCR SAW & DRILL ALLIANCE CONTRACTORS INC AMERICAN VACTOR SERVICES LL APRIL COBRA ENTERPRISES INC ARROW ROAD CONSTRUCTION CO ARTLOW SYSTEMS INC ASC INSULATION & FIREPROOFI BELROCK ASPHALT PAVING INC BERGER EXCAVATING CONTRACTORS BERGQUIST & ZIMMERMAN CON INC BUILDERS 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LLC GENEVA CONST CO GESKE AND SONS INC H & S CONCRETE CONSTRUCTION H LINDEN & SONS WATR & SEWR H R STEWART INC HEELS AND HARDHATS CONTRACT HEITKOTTER INC HENKS & MC COY INC HUGH HENRY CONSTRUCTION ICC GROUP INC IHC CONSTRUCTION CO LLC ILLINOIS VALLEY EXCAVATING INTREN INC IWS INC J & R 1ST IN ASPHALT J & S CONSTRUCTION SEWER & J ALBERICI DBA ALBERICI CON J C HARRIS & SONS INC J L ALLEN SERVICES INC J NARDULLI CONCRETE INC J P CULLEN & SONS JACK HALL CONSTRUCTION JENSENS PLUMBING & HEATING JIMMY Z MASONRY CORP JMI 2 CORPORATION K R MILLER CONTR INC KANE COUNTY EXCAVATING INC KELLENBERGER PLUMB & HEAT I KENDALL EXC & SEPTIC LLC K-FIVE CONSTRUCTION KIRBY CABLE SERVICES INC KR&G EXCAVATING PARTNERS KWCC INC L J MORSE CONSTRUCTION LAMP INC LANAS CONSTRUCTION LANDMARK CONTRACTORS INC LANG MECHANICAL INC LASSWELL MASONRY INC LIBERTY PAVING CO INC LITE CONSTRUCTION LORIG CONSTRUCTION COMPANY M & M WELDING INC M L & L EXCAVATING INC MM PETERS CONSTRUCTION MAGILL CONSTRUCTION INC MARC KRESMERY 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