2018-03-09T12:13:24-06:00 2017-05-31 470900880 CALIBRE CPA GROUP PLLC 566 W LAKE ST SUITE 300 CHICAGO IL 60661 990 2016-06-01 366147408 FOX VALLEY & VICIN CONSTRUCTION WEL FUND FOXV 8475191880 915 NATIONAL PARKWAY No F SCHAUMBURG IL 60173 Art Sturms TRUSTEE 8475191880 2018-03-09 1 COREY BILKEY P00499751 3126550037 38.100.43.100 2018-03-09 12:13:15 CS P DD2F5A6855584BEFBC68452237D9336111CE352F DD2F5A6855584BEFBC68452237D9336111CE352F 2016 2021-01-29 14:40:06Z ART STURMS 915 NATIONAL PARKWAY No F SCHAUMBURG IL 60173 9628478 0 X N/A X 1961 WI TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS. 10 6 0 0 0 0 0 0 7468400 8002652 436546 648077 0 0 7904946 8650729 0 0 7784799 7103990 0 0 0 0 0 641019 718020 8425818 7822010 -520872 828719 21987525 24039108 3373273 3758073 18614252 20281035 X TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 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 3 0 1 0 0 0 0 0 0 0 X 10 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X GROUP ADMINISTRATORS LTD 8475191880 915 NATIONAL PARKWAY SUITE F SCHAUMBURG IL 60173 DONALD DEETJEN FORMER TRUSTEE 2.00 X 0 0 0 DAN AUSSEM CHAIRMAN 2.00 X 0 0 0 KENNETH SANDENO TRUSTEE 2.00 X 0 0 0 ART STURMS SECRETARY 2.00 40.00 X 0 120148 68000 ANTHONY FRESCURA JR TRUSTEE 2.00 40.00 X 0 104525 70000 PETE NIELSEN TRUSTEE 2.00 X 0 0 0 RICHARD LANGE TRUSTEE 2.00 40.00 X 0 109443 62000 DAVID HENDERSON TRUSTEE 2.00 X 0 0 0 TROY COX TRUSTEE 2.00 40.00 X 0 107431 67500 PAUL NAGEL FORMER TRUSTEE 2.00 X 0 0 0 BOB MORREALE TRUSTEE 2.00 X 0 0 0 ERIC MROWICKI TRUSTEE 2.00 X 0 0 0 0 441547 267500 0 0 1 0 GROUP ADMINISTRATORS LTD 915 NATIONAL PARKWAY SUITE F SCHAUMBURG IL 60173 ADMINISTRATOR 232010 BCBS 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO CLAIMS PROVIDER 209665 2 EMPLOYER CONTRIBUTIONS 525100 7673255 7673255 EMPLOYEE CONTRIBUTIONS 525100 329397 329397 8002652 530349 530349 1095477 977749 117728 117728 117728 8650729 8002652 0 648077 7103990 230508 31405 33530 44094 348122 16852 3054 10455 7822010 464968 538936 806198 835388 9398 10881 19672378 20491766 1020443 2144256 14140 17881 21987525 24039108 3373273 3758073 3373273 3758073 X 0 0 0 0 18614252 20281035 18614252 20281035 21987525 24039108 828719 838064 0 X X 0 1 X 1 0 0 limited partnerships 2144256 F 2144256 EXTENDED ELIGIBILITY 3077200 EST LIAB FUT CLMS INCRRD NOT REPRTD 536100 CLAIMS PAYABLE 134000 DUE TO ASSOCIATED FUNDS 10773 3758073 X 9444699 838064 838064 8606635 44094 44094 8650729 7393116 0 7393116 44094 384800 428894 7822010 Part X, Line 2: AS OF MAY 31, 2017, THERE WERE NO UNCERTAIN 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 THE TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD 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 XII, Line 4b - Other Adjustments: CHANGE IN CURRENT BENEFIT OBLIGATIONS 384,800. 0 0 0 ART STURMS SECRETARY 0 120148 0 0 0 0 0 68000 0 0 0 188148 0 0 ANTHONY FRESCURA JR TRUSTEE 0 104525 0 0 0 0 0 70000 0 0 0 174525 0 0 RICHARD LANGE TRUSTEE 0 109443 0 0 0 0 0 62000 0 0 0 171443 0 0 TROY COX TRUSTEE 0 107431 0 0 0 0 0 67500 0 0 0 174931 0 0 Form 990, Part VI, Section B, line 11b THE TRUSTEES AUTHORIZE THE FUND'S THIRD-PARTY ADMINISTRATOR AND A DESIGNATED TRUSTEE TO REVIEW THE FORM 990 BEFORE IT IS FILED. Form 990, Part VI, Section B, line 12c THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND HAVE A FIDUCIARY RESPONSIBILITY UNDER ERISA TO ADMINISTER THE PLAN IN THE BEST INTEREST OF THE MEMBERSHIP. THE US DEPARTMENT OF LABOR REQUIRES ALL LABOR TRUSTEES TO REPORT ON FORM LM-30 POTENTIAL SITUATIONS WHERE THERE MAY BE CONFLICTS OF INTEREST. THIS INFORMATION IS OPEN TO THE PUBLIC. Form 990, Part VI, Section C, line 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE PLAN ADMINISTRATOR AND/OR THE US DEPARTMENT OF LABOR. ALSO, FORM 5500 IS OPEN TO PUBLIC INSPECTION THROUGH THE US DEPARTMENT OF LABOR. Form 990, Part XII, Line 2c: The process has not changed from the prior year. 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