2017-05-31T15:20:02-05:00 2016-10-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2015-11-01 362265130 CONSTRUCTION INDUSTRY WELFARE FUND OF ROCKFORD ILLINOIS CONS 8153974267 1322 EAST STATE STREET ROCKFORD IL 61104 ART STURMS TRUSTEE 8153974267 2017-05-31 1 TIMOTHY CIBULKA P00841100 3123680500 2015 2021-01-29 14:40:06Z ART STURMS 1322 EAST STATE STREET ROCKFORD IL 61104 21005048 0 X N/A X 1954 IL TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 7 0 31 0 48133 -1607 0 0 17921430 17851423 218316 179298 71587 95433 18211333 18126154 0 0 16534803 18667140 123898 123236 0 0 0 829969 781802 17488670 19572178 722663 -1446024 14790353 13000809 1115942 793709 13674411 12207100 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 6 0 1 31 1 1 1 0 0 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 119833 67500 RICHARD BOYD LABOR TRUSTEE - NEW 3.00 40.00 X 0 65753 46628 SAMUEL GIARDONO LABOR TRUSTEE 3.00 X 8663 0 0 DANIEL JANSEN LABOR TRUSTEE 3.00 40.00 X 0 102913 35088 DAVID ANSPAUGH MGMT - CO-CHAIR - NEW 3.00 40.00 X 0 104966 20231 JEFF BOCKHOP MGMT TRUSTEE 3.00 X 0 0 0 GLEN TURPOFF MGMT TRUSTEE - NEW 3.00 40.00 X 0 14400 0 TODD STEFFEN MGMT - CO-CHAIR - PAST 3.00 X 0 0 0 LYNN ULRICH MGMT - TRUSTEE - PAST 3.00 X 0 0 0 SHELLI MCPEEK ADMINISTRATOR 40.00 X 60726 0 21768 69389 407865 191215 0 0 1 0 GROUP ADMINISTRATORS LTD 915 NATIONAL PARKWAY SUITE F SCHAUMBURG IL 60173 THIRD PARTY ADMINISTRATOR 462230 BLUE CROSS BLUE SHIELD OF IL 300 E RANDOLPH STREET CHICAGO IL 60601 PPO PROVIDER 421741 HINES & ASSOCIATES PO BOX 0327 ELGIN IL 60121 UTILIZATION REVIEW 128771 3 CONTRACTOR CONTRIBUTIONS 900099 16980056 16980056 PARTICIPANT CONTRIBUTIONS 900099 871367 871367 17851423 198192 198192 2860000 2878894 -18894 -18894 -18894 PROCESSING FEES 900099 48133 48133 SHARED SERVICE FEES 900099 24000 24000 SHARED SERVICE REIMBURSEMENT 900099 23300 23300 95433 18126154 17851423 48133 226598 18667140 72849 39905 2076 8406 392681 91363 63852 75609 23732 16581 2730 6250 14101 FEES MANDATED BY THE AC 86120 OTHER 8783 19572178 4353865 4106231 2551835 3070022 3204289 2181201 17245 2709 2791 45375 26347 25278 19028 4652377 3604291 14790353 13000809 114999 99996 0 81824 504750 338952 496193 272937 1115942 793709 X 0 0 0 0 13674411 12207100 13674411 12207100 14790353 13000809 -1446024 -21287 0 X 0 1 X 1 0 0 1 X 10977 1829 9148 34398 24518 9880 19028 EMPLOYER RECIPROCAL CONTRIBUTIONS 272937 272937 X 18081567 -21287 -21287 18102854 23300 23300 18126154 19548878 0 19548878 23300 23300 19572178 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: 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 LIMITATION EXPIRES. PART XI, LINE 4B - OTHER ADJUSTMENTS: SHARED SERVICE REIMBURSEMENT 23,300. PART XII, LINE 4B - OTHER ADJUSTMENTS: SHARED SERVICE REIMBURSEMENT 23,300. X 0 0 0 ART STURMS LABOR CO-CHAIR 0 119833 0 0 0 0 0 47688 0 19812 0 187333 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 11 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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WILLIAM CHARLES CONSTRUCTION CONTRIBUTING EMPLOYER 0 ROCKFORD CENTRAL TILETER CONTRIBUTING EMPLOYER 0 NORTHERN ILL TERRAZZO & T CONTRIBUTING EMPLOYER 0 CIVIL CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 RINGLAND-JOHNSON CONSTRUCTION CONTRIBUTING EMPLOYER 0 CECO CONCRETE CONSTRUCTIO CONTRIBUTING EMPLOYER 0 J P CULLEN & SONS INC CONTRIBUTING EMPLOYER 0 ROCKFORD CEMENT PRODUCTS CONTRIBUTING EMPLOYER 0 MCARTHY IMPROVEMENT CONTRIBUTING EMPLOYER 0 ROCKFORD STRUCTURES CONST CONTRIBUTING EMPLOYER 0 KLOBUCAR CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 VERN LUNDBERG INC CONTRIBUTING EMPLOYER 0 ALLIED CONST SERVICES INC CONTRIBUTING EMPLOYER 0 BUILDERS SALES & SERVICE CONTRIBUTING EMPLOYER 0 SWANSON CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 MATHEY MASONRY INC CONTRIBUTING EMPLOYER 0 SEEDORFF MASONRY INC CONTRIBUTING EMPLOYER 0 SCHMELING CONST CO CONTRIBUTING EMPLOYER 0 DON OTT CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 HUSSMANN CORPORATION CONTRIBUTING EMPLOYER 0 BABCOCK & WILCOX CONSTRUCTION CO INC 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0 RAYNOR DOOR CO INC OF QUAD CITIES CONTRIBUTING EMPLOYER 0 INSTALLATION SERVICES OF IL INC CONTRIBUTING EMPLOYER 0 MECHANICAL SERVICE INC CONTRIBUTING EMPLOYER 0 W F JOHNSTON CONTRIBUTING EMPLOYER 0 KEITH MCCHURCH MASONRY CONTRIBUTING EMPLOYER 0 MID-STATE TERRAZZO TILE CONTRIBUTING EMPLOYER 0 ARMOR METAL FABRICATION CONTRIBUTING EMPLOYER 0 MARSEILLES SHEET METAL CONTRIBUTING EMPLOYER 0 SOUTHERN AIR TESTBALANCE CONTRIBUTING EMPLOYER 0 TRI-CITY SHEET METAL CONTRIBUTING EMPLOYER 0 EAST IOWA DECKS CONTRIBUTING EMPLOYER 0 GM SIPES CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 HERITAGE CONSTRUCTION CONTRIBUTING EMPLOYER 0 M R MASON CONTRACTOR CONTRIBUTING EMPLOYER 0 J W OSSOLA CO CONTRIBUTING EMPLOYER 0 WOZNIAK CONCRETE FINISHIN CONTRIBUTING EMPLOYER 0 MIDWEST BEST WATERPROOFING CONTRIBUTING EMPLOYER 0 ADVANCED DISPOSAL CONTRIBUTING EMPLOYER 0 EAST COAST MANAGMENT INC AKA POWER PLANT FIELD SE CONTRIBUTING EMPLOYER 0 LINDBLAD CONST CO CONTRIBUTING EMPLOYER 0 JB CONTRACTING CORPORATION 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