2018-02-12T16:55:14-06:00 2017-05-31 470900880 CALIBRE CPA GROUP PLLC 230 W MONROE STE 310 CHICAGO IL 606064701 990 2016-06-01 366219639 FOX VALLEY LABORERS HEALTH & WELFARE FND FOXV 8477420900 2371 BOWES ROAD No 500 ELGIN IL 601235523 MIKE SHALES Chairman 8477420900 2018-02-08 1 ANDREW HEIN P00499757 3126550037 38.100.43.100 2018-02-12 16:54:57 CS P DD2F5A6855584BEFBC68452237D9336111CE352F DD2F5A6855584BEFBC68452237D9336111CE352F 2016 2021-01-29 14:40:06Z MIKE SHALES 2371 BOWES ROAD No 500 ELGIN IL 601235523 46849627 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 72 0 0 0 0 0 36364531 35645523 3616487 2909555 325288 300544 40306306 38855622 0 0 30153656 29997167 887885 900110 0 0 0 2086228 2246975 33127769 33144252 7178537 5711370 84403228 94092176 19218941 19950141 65184287 74142035 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 1,829 ELIGIBLE PARTICIPANTS AT MAY 31, 2017. 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 1 831 0 1 72 1 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 PAT SHALES 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 125897 89706 AL OROSZ TRUSTEE 3.00 X 0 0 0 COREY R JOHNSON SECRETARY 3.00 50.00 X 0 130391 85886 MARTIN D DWYER FMR TRUSTEE 3.00 50.00 X 0 133565 85886 DAVE SHEAHAN TRUSTEE 3.00 40.00 X 0 122529 89706 PATRICIA M SHALES ADMINISTRATOR 40.00 X 137074 0 44976 137074 512382 396160 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO ACCESS FEES 862077 SEI INVESTMENT ONE FREEDOM DRIVE OAKS PA 19456 INV MGMNT/CONSULTING 243392 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DRIVE MIAMI FL 331565629 PLAN CONSULTING 122690 3 EMPLOYER CONTRIBUTIONS 900099 34087284 34087284 MEMBER CONTRIBUTIONS 900099 1401032 1401032 Stop Loss Reimbursements 900009 99329 99329 MEDICARE D SUBSIDIES 900099 57878 57878 35645523 1828983 1828983 9074577 7994005 1080572 1080572 1080572 REIMB SAL & RELATED EXPENSES FROM 900099 300544 300544 300544 38855622 35946067 0 2909555 29997167 491741 204892 116875 86602 166281 66083 448641 1249674 166727 69491 1033 21040 18497 33068 PATIENT PROTECTION & AF 6440 33144252 7589 29489 4024362 3921080 43340 79138 345554 274850 81086 70704 80163860 89804083 82991 187682 84403228 94092176 60421 64428 19158520 19885713 19218941 19950141 X 0 0 0 0 65184287 74142035 65184287 74142035 84403228 94092176 5711370 3246378 0 X X 0 1 X 1 0 22481 20233 2248 323073 254617 68456 70704 EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY 15829000 EST LIAB FUTR CLAIMS INCURRED BUT UNPAID 3815000 DEPOSITS HELD 177421 Due to Affliated Funds 64292 19885713 X 41195608 3246378 3246378 37949230 448641 457751 906392 38855622 31590860 -157207 -157207 31748067 448641 947544 1396185 33144252 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, 2017, 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, 2017, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2014. Part XI, Line 4b - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED 57,878. REIMBURSED FV PENSION SALARY EXPENSE 300,544. STOP LOSS INSURANCE REIMBURSEMENTS 99,329. Part XII, Line 2d - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED -57,878. STOP LOSS INSURANCE REIMBURSEMENTS -99,329. Part XII, Line 4b - Other Adjustments: REIMBURSED FV PENSION SALARY EXPENSE 300,544. CHANGE IN PLAN BENEFIT OBLIGATION 647,000. X 0 0 0 VERN BAUMAN TRUSTEE 0 121511 0 0 0 4386 0 58720 0 30986 0 215603 0 0 COREY R JOHNSON SECRETARY 0 129533 0 0 0 858 0 57868 0 28018 0 216277 0 0 MARTIN D DWYER FMR TRUSTEE 0 129825 0 0 0 3740 0 57868 0 28018 0 219451 0 0 DAVE SHEAHAN TRUSTEE 0 121462 0 0 0 1067 0 58720 0 30986 0 212235 0 0 PATRICIA M SHALES ADMINISTRATOR 127625 0 0 0 9449 0 24777 0 20199 0 182050 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 3 L K CONSTRUCTION LLC A HORN INC AAT PIPELINE TESTING INC ABBOTT RA EXCAVATING INC ABITUA SEWER WATER & PLUMB ALBERICI J 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 BENCHMARK CONSTRUCTION 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