2019-05-15T11:45:21-05:00 2018-10-31 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CTR 700 WESTCHESTER IL 60154 990 2017-11-01 362265130 CONSTRUCTION INDUSTRY WELFARE FUND OF ROCKFORD ILLINOIS CONS 8153974267 1322 EAST STATE STREET ROCKFORD IL 61104 ART STURMS TRUSTEE 8153974267 2019-05-15 1 BRANDON WOLBER P01460460 3123680500 12.235.239.120 2019-05-15 11:45:53 CD P DBF743AF1216C3B70D6C9C598EE47CA4DBC4F1E6 DBF743AF1216C3B70D6C9C598EE47CA4DBC4F1E6 2017 2019-02-21 02:37:17Z ART STURMS 1322 EAST STATE STREET ROCKFORD IL 61104 24331751 0 X N/A X 1954 IL TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 7 0 32 0 70251 0 0 0 18614328 20099389 173646 256086 100599 94251 18888573 20449726 0 0 15563536 16363608 118509 121978 0 0 0 716693 700878 16398738 17186464 2489835 3263262 17987978 19453446 2852309 1256703 15135669 18196743 TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, PRESCRIPTION DRUGS, LIFE, AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 1 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 X 4 0 1 32 1 1 1 0 0 0 0 0 0 0 X 7 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X SHELLI MCPEEK - ADMINISTRATOR 8153974267 1322 EAST STATE STREET ROCKFORD IL 61104 ART STURMS LABOR CO-CHAIR 3.00 40.00 X 0 120148 44283 RICHARD BOYD LABOR TRUSTEE 3.00 40.00 X 0 90295 66229 SAMUEL GIARDONO LABOR TRUSTEE 3.00 X 1680 0 0 DANIEL JANSEN LABOR TRUSTEE 3.00 40.00 X 0 107008 39158 DAVID ANSPAUGH MGMT - CO-CHAIR 3.00 40.00 X 0 120860 21082 JEFF BOCKHOP MGMT TRUSTEE 3.00 X 0 0 0 GLEN TURPOFF MGMT TRUSTEE 5.00 40.00 X 0 14400 0 SHELLI MCPEEK ADMINISTRATOR 40.00 X 62671 0 23804 64351 452711 194556 0 0 1 0 BLUE CROSS BLUE SHIELD OF IL 300 E RANDOLPH STREET CHICAGO IL 60601 PPO PROVIDER 439942 GROUP ADMINISTRATORS LTD 915 NATIONAL PARKWAY SUITE F SCHAUMBURG IL 60173 THIRD PARTY ADMINISTRATOR 435917 HINES & ASSOCIATES PO BOX 0327 ELGIN IL 60121 UTILIZATION REVIEW 111173 3 CONTRACTOR CONTRIBUTIONS 900099 19249508 19249508 PARTICIPANT CONTRIBUTIONS 900099 849881 849881 20099389 256957 256957 3881154 3882025 -871 -871 -871 PROCESSING FEES 900099 70251 70251 SHARED SERVICES 900099 24000 24000 94251 20449726 20099389 70251 280086 16363608 69418 41661 2595 8304 371855 121777 68823 53983 22024 17581 464 5126 15133 MISCELLANEOUS 17403 FEES MANDATED BY THE AC 6709 17186464 6479151 1018031 4353892 9731056 3148823 2956131 16622 45375 36959 13542 8416 3992570 5721190 0 2000 17987978 19453446 18891 31716 82695 71818 467349 2283374 1153169 2852309 1256703 X 0 0 0 0 15135669 18196743 15135669 18196743 17987978 19453446 3263262 -202188 0 X 0 1 X 1 0 0 1 X 10977 2561 8416 34398 34398 0 8416 EMPLOYER RECIPROCAL CONTRIBUTIONS 576635 DUE TO AFFILIATED ORGANIZATIONS 576534 1153169 X 20247538 -202188 -202188 20449726 0 20449726 17186464 0 17186464 0 17186464 PART IV, LINE 2B: THE PLAN SERVES AS A CONDUIT TO COLLECT REMITTANCES ON BEHALF OF AFFILIATED BENEFIT FUNDS AND ORGANIZATIONS. SUCH REMITTANCES ARE INITIALLY RECEIVED THROUGH A LOCKBOX ARRANGEMENT AND TRANSFERRED INTO A SEGREGATED CHECKING ACCOUNT HELD BY THE PLAN UNTIL DISBURSEMENT TO THE AFFILIATED ENTITY IS MADE. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. X 0 0 0 ART STURMS LABOR CO-CHAIR 0 120148 0 0 0 0 0 22495 0 21788 0 164431 0 0 RICHARD BOYD LABOR TRUSTEE 0 90295 0 0 0 0 0 44653 0 21576 0 156524 0 0 FORM 990, PART V, LINE 2A THE NUMBER OF MEMBERS REPORTED ON LINE 2A INCLUDE PARTICIPANTS RECEIVING LOSS OF TIME BENEFITS. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARD'S REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICT OF INTEREST POLICY - THE FUND IS A WELFARE BENEFIT PLAN GOVERNED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). UNDER ERISA, IT IS THE CONTINUING RESPONSIBILITY OF EACH MEMBER OF THE BOARD OF TRUSTEES TO REVIEW TRANSACTIONS FOR POTENTIAL CONFLICTS OF INTEREST, IMMEDIATELY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, AND TAKE APPROPRIATE ACTION UPON DISCOVERY OF ANY SUCH CONFLICTS. TO ASSIST THE TRUSTEES IN IDENTIFYING ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, THE FUND DISTRIBUTES TO EACH TRUSTEE AN ANNUAL QUESTIONNAIRE REQUESTING INFORMATION REGARDING INTERESTS THAT COULD GIVE RISE TO A CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. 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