2017-07-20T10:12:01-05:00 2016-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2016-01-01 362196729 CEMENT MASONS INSTITUTE LOCAL 502 WELFARE TRUST FUND CEME 7085449105 739 25TH AVENUE BELLWOOD IL 60104 PATRICK J LA CASSA TRUSTEE 7085449105 2017-07-20 1 BRUCE A PAVLIK P00748405 3123680500 12.197.118.215 2017-07-20 10:09:15 CD P D56625F7C0621E1EB8BA8C5A7372C18F0F4BC985 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z PATRICK J LA CASSA 739 25TH AVENUE BELLWOOD IL 60104 51051842 0 X N/A X 1950 IL PROVIDE HEALTH BENEFITS 12 6 26 0 0 0 0 0 20202414 21550314 731152 1078196 0 4090 20933566 22632600 0 0 15273873 17836564 1461874 1482973 0 0 0 965624 885422 17701371 20204959 3232195 2427641 42955874 46354839 750833 608308 42205041 45746531 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE MEDICAL AND LIFE INSURANCE TO 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 447 0 1 26 1 0 0 0 0 0 0 0 0 X 12 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X WILLIAM BEEMAN 7085449105 739 S 25TH AVENUE BELLWOOD IL 60104 PATRICK LA CASSA TRUSTEE 2.00 68.00 X 0 170581 134976 LAWRENCE PICARDI SR TRUSTEE 2.00 66.00 X 0 161889 128522 STEVE BAUMGARTNER TRUSTEE 2.00 2.00 X 0 0 0 SANDRA HUNT TRUSTEE 2.00 2.00 X 3748 0 2434 DONALD DEETJEN TRUSTEE - PAST 2.00 2.00 X 0 0 0 MICHAEL PIRRON TRUSTEE 2.00 2.00 X 0 0 0 ANTONIO ACEVEDO TRUSTEE 2.00 2.00 X 3748 0 2434 JOHN HALLBERG TRUSTEE - NEW 2.00 2.00 X 0 0 0 ROBERT KRUG TRUSTEE 2.00 2.00 X 0 0 0 MICHAEL KOLBERG TRUSTEE 2.00 2.00 X 0 0 0 PHIL DIEKEMPER TRUSTEE 2.00 2.00 X 0 0 0 JAY LA SALA TRUSTEE 2.00 2.00 X 3748 0 2434 ADAM HIGGINS TRUSTEE 2.00 2.00 X 3748 0 2434 WILLIAM BEEMAN ADMINISTRATOR 22.00 18.00 X 133034 456 56845 DUANE EXLINE EMPLOYEE 17.00 23.00 X 119048 0 52582 267074 332926 382661 2 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 PPO PROVIDER 607681 ARNOLD & KADJAN 203 N LASALLE ST SUITE 1650 CHICAGO IL 60601 LEGAL 409163 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE SUITE 4000 CHICAGO IL 60606 ACCOUNTING 272099 3 CONTRACTOR CONTRIBUTIONS 900099 20351153 20351153 REIMBURSED ADMINISTRATIVE EXPENSE 900099 687140 687140 PARTICIPANT SELF-CONTRIBUTIONS 900099 261541 261541 PRESCRIPTION DRUG REBATES 900099 250480 250480 21550314 654817 654817 28842621 28419242 423379 423379 423379 MISCALLENOUS INCOME 900099 4090 4090 4090 22632600 21550314 0 1082286 17836564 211182 713391 330676 160996 66728 143546 239289 62531 31975 99036 81367 126474 5517 34991 20752 35318 FEES MANDATED BY ACA 4626 20204959 2934617 1843793 1959119 1261639 3046437 2337582 386049 157499 27783 52797 212330 147596 62289 64734 34539580 40636795 42955874 46354839 750833 608308 750833 608308 X 0 0 0 0 42205041 45746531 42205041 45746531 42955874 46354839 2427641 1113849 0 X 0 1 X 1 0 34001 27291 6710 157966 110124 47842 20363 10181 10182 64734 X 22996778 1113849 1113849 21882929 62531 687140 749671 22632600 19455288 0 19455288 62531 687140 749671 20204959 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES 687,140. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES 687,140. X 0 0 0 PATRICK LA CASSA TRUSTEE 0 169509 0 0 0 1072 0 86738 0 48238 0 305557 0 0 LAWRENCE PICARDI SR TRUSTEE 0 160867 0 0 0 1022 0 82505 0 46017 0 290411 0 0 WILLIAM BEEMAN ADMINISTRATOR 131997 456 0 0 1037 0 43444 0 13401 0 189879 456 0 0 DUANE EXLINE EMPLOYEE 119048 0 0 0 0 0 39181 0 13401 0 171630 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND FUND ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARDS' REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES AND THE FUND ADMINISTRATOR SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY TAKING ALL STEPS THEY DEEM NECESSARY TO ENSURE SUCH MONITORING AND ENFORCEMENT. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. FORM 990, PART VII, SECTION A, LINE 1A: THE ORGANIZATION'S ADMINISTRATOR AND HIGHEST COMPENSATED EMPLOYEE ARE SHARED WITH NUMEROUS RELATED ORGANIZATIONS. THE REPORTING ORGANIZATION IS RESPONSIBLE FOR PAYROLL AND IS REIMBURSED BY THE RELATED ORGANIZATIONS FOR THEIR ALLOCATED PORTION OF THE SALARY AND RELATED EXPENSES. 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