2017-01-08T20:42:25-06:00 2016-05-31 470900880 CALIBRE CPA GROUP PLLC 566 W LAKE ST STE 300 CHICAGO IL 606611414 990 2015-06-01 366219639 FOX VALLEY LABORERS HEALTH & WELFARE FND FOXV 8477420900 2371 BOWES ROAD No 500 ELGIN IL 601235523 MIKE SHALES Chairman 8477420900 2017-01-05 1 ANDREW HEIN P00499757 3126550037 2015 2017-02-10 21:41:12Z MIKE SHALES 2371 BOWES ROAD No 500 ELGIN IL 601235523 41891132 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 52 0 0 0 0 0 33430964 36364531 2979254 3616487 617112 325288 37027330 40306306 0 0 28007579 30153656 886304 887885 0 0 0 2043107 2086228 30936990 33127769 6090340 7178537 76546889 84403228 14973576 19218941 61573313 65184287 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 1,774 ELIGIBLE PARTICIPANTS AT MAY 31, 2016. 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 1 771 0 1 52 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 BRYAN JR 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 124066 94342 AL OROSZ TRUSTEE 3.00 X 0 0 0 COREY R JOHNSON SECRETARY 3.00 40.00 X 0 129575 83327 MARTIN D DWYER TRUSTEE 3.00 40.00 X 0 132295 83327 DAVE SHEAHAN FMR TRUSTEE 3.00 40.00 X 0 120063 94342 PATRICIA M SHALES ADMINISTRATOR 40.00 X 133854 0 39995 133854 505999 395333 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO ACCESS FEES 841410 SEI INVESTMENT ONE FREEDOM DRIVE OAKS PA 19456 INV MGMNT/CONSULTING 197399 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DRIVE MIAMI FL 331565629 PLAN CONSULTING 127166 3 EMPLOYER CONTRIBUTIONS 900099 34828813 34828813 MEMBER CONTRIBUTIONS 900099 1314930 1314930 MEDICARE D SUBSIDIES 900099 115976 115976 Stop Loss Reimbursements 900009 104812 104812 36364531 1626253 1626253 3575060 1584826 1990234 1990234 1990234 REIMB SAL & RELATED EXPENSES FROM 900099 325288 325288 325288 40306306 36689819 0 3616487 30153656 471442 190700 157128 68615 92079 62142 411193 1204923 169128 69613 1209 22466 18732 29037 PATIENT PROTECTION & AF 5706 33127769 57266 7589 3899842 4024362 76874 43340 353175 272089 88324 81086 72270202 80163860 154381 82991 76546889 84403228 48576 60421 14925000 19158520 14973576 19218941 X 0 0 0 0 61573313 65184287 61573313 65184287 76546889 84403228 7178537 -3567563 0 X X 0 1 X 1 0 22481 15737 6744 330694 256352 74342 81086 EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY 16075000 EST LIAB FUTR CLAIMS INCURRED BUT UNPAID 2922000 DEPOSITS HELD 115000 Due to Affliated Funds 46520 19158520 X 35781474 -3567563 -3567563 39349037 411193 546076 957269 40306306 28028500 -220788 -220788 28249288 411193 4467288 4878481 33127769 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, 2016, 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, 2016, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2013. Part XI, Line 4b - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED 115,976. REIMBURSED FV PENSION SALARY EXPENSE 325,288. STOP LOSS INSURANCE REIMBURSEMENTS 104,812. Part XII, Line 2d - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED -115,976. STOP LOSS INSURANCE REIMBURSEMENTS -104,812. Part XII, Line 4b - Other Adjustments: REIMBURSED FV PENSION SALARY EXPENSE 325,288. CHANGE IN PLAN BENEFIT OBLIGATION 4,142,000. X 0 0 0 VERN BAUMAN TRUSTEE 0 119310 0 0 0 4756 0 59450 0 34892 0 218408 0 0 COREY R JOHNSON SECRETARY 0 128701 0 0 0 874 0 55413 0 27914 0 212902 0 0 MARTIN D DWYER TRUSTEE 0 128740 0 0 0 3555 0 55413 0 27914 0 215622 0 0 DAVE SHEAHAN FMR TRUSTEE 0 119252 0 0 0 811 0 59450 0 34892 0 214405 0 0 PATRICIA M SHALES ADMINISTRATOR 124819 0 0 0 9035 0 21322 0 18673 0 173849 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 11 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 COOLING LAND CONCEPTS LLC CROUCH-SERANKO MASONRY LLC DOUGAL BUILDING MAINT LLC IHC CONSTRUCTION CO LLC IHC CONSTRUCTION CO LLC JACK COFFEY LLC JIM GEORGE AND SONS LLC KENDALL EXC & SEPTIC LLC KRAEMER NORTH AMERICA LLC MID-AMERICA UNDERGROUND LLC MTH UNDERLAYMENT LLC N-TRAK GROUP LLC ORANGE CRUSH LLC RAGNAR BENSON LLC RAUSCH INFRASTRUCTURE LLC SHALES MCNUTT LLC MECCOR INDUSTRIES LTD V3 CONSTRUCTION TRADES LTD AAT PIPELINE TESTING INC ABBOTT RA EXCAVATING INC ABITUA SEWERWATER&PLUMB IN 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 BAKER PETER & SON COMPANY BENCHMARK CONSTRUCTION CO BERGER EXCAVATING BERGQUIST & ZIMMERMAN CON I BLACKHAWK FOUNDATION CO INC BLOCKER G A GRADING CONTR I BOHR DON & SONS INC BOWEN ENGINEERING CORP BRAVO CONSTRUCTION CO INC BUESING BROTHER INC BUILDERS CONCRETE SERVICES BULLEY & ANDREWS BURROAK MASONRY INC C & H EXCAVATING INC CAMOSY INCORPORATED CAMPTON CONSTRUCTION CARMICHAEL CONSTRUCTION INC CELLCRETE DECKS CENTRAL BLACKTOP CO INC CHADWICK CONTRACTING CHAMPION PAVING CORP CHICAGOLAND PAVING CIVIL CONSTRUCTORS INC OF I CONCRETE SYSTEMS INC CONTINENTAL LAND & INFRASTR CONTRACTING & MATERIAL CO CORRECTIVE ASPHALT MATERIAL COZMO PAVING CULLEN J P & SONS INC CURRAN CONTRACTING CO CYBERDYNE MASONRY DYNAMICS D CONSTRUCTION INC DE GRAF CONCRETE CONST INC DIAMOND MASONRY DN TANKS INC DOHERTY CONSTRUCTION INC DOUBLE HEADERS CONCRETE DREAMSCAPES BY DENNIS INC DRIESSEN CONSTR COMPANY DUNN COMPANY EAGLE CONCRETE INC ELECTRIC CONDUIT CONST ENGSTROM CONSTRUCTION CO EVANS & SON BLACKTOP EVEREST EXCAVATING INC FABCON INC FISCHER EXCAVATING INC FLOOR SYSTEMS OF CHICAGO IN FLOOR TECH SOLUTIONS INC FOSS LANDSCAPES INC FOX EXCAVATING INC FREEHILL ASPHALT INC G C MASONRY GENEVA CONST CO GEODYNAMICS INC GESKE AND SONS INC H & S CONCRETE CONSTR H LINDEN & SONS WATR & SEWR HARRIS J C & SONS INC HEELS AND HARDHATS CONTRACT HEITKOTTER INC HENKELS & MC COY INC HERBIG BLACKTOP INC HUGH HENRY CONSTRUCTION ILLINOIS CONSTR CORP INTEGRITY MECH PIPING & PLU INTREN INC IVAN RICE & SONS INC IWS INC J & R 1ST IN ASPHALT J E M MORRIS CONSTRUCTION I J F BRENNAN CO INC J L ALLEN SERVICES INC J SQUARED MASONRY INC J&S CONSTRUCTION WATER & SE JACK HALL CONSTRUCTION JENSENS PLUMBING & HEATING JIM BURKE EXCAVATING INC JIMMY Z MASONRY CORP JMI 2 CORPORATION JOHNSTON W F CONSTR INC K R G EXCAVATING PARTNERS KARL-STEFANS CONST CO INC KELLENBERGER PLUMB & HEAT I K-FIVE KIRBY CABLE SERVICES INC LAMP INC LAMP INCORPORATED LANAS CONSTRUCTION LANDMARK CONTRACTORS INC LANG MECHANICAL INC LASSWELL MASONRY INC LAWRENCE J DODD CONSTRUCTIO LIBERTY PAVING CO INC LITE CONSTRUCTION LORIG CONSTRUCTION COMPANY M & M WELDING INC M L & L EXCAVATING INC M&M CONCRETE INC MAGILL CONSTRUCTION INC MANEVAL CONSTRUCTION MANNING T CONCRETE INC MARC KRESMERY CONSTRUCTION MARTIN & CO EXCAVATING MARTIN CEMENT MERRYMAN EXCAVATING INC MEYER CONTRACTING INC MICHELS PIPEDIV MICHELS CO MID-AMERICA REGIONAL BARGAI MID-VALLEY CONCRETE INC MIDWEST UNDERGROUND CONTR L MILLER K R CONTR INC MJ TRACK WORKS MOHAWK CONTRACTING MONTEMAYOR CONSTRUCTION INC MONTICELLO MASONRY INC MORSE L J CONSTRUCTION NKC CONVEYOR INSTALLATIO NERI CONTRACTORS & EXCAVATI NESLUND & ASSOCIATES INC NORTHERN CONTRACTING INC NORTHERN ILLINOIS SERVICE C NORTHERN PIPELINE CONST CO NORTHWEST CONTRACTORS INC OLSON R CONST CO CONTR INC O'NEIL W E CONSTRUCTION CO OSWEGO BUILDING SUPPLIES IN PALLERA CONSTRUCTION INC PARKWAY FORMING INC PEPPER CONSTRUCTION PERFORMANCE CONST & ENG LL PETERS MM CONSTRUCTION PHOENIX CORP OF THE QUAD CI PLAINFIELD GRADING & EXCAVA PLOTE CONSTRUCTION INC PRECISION EXCAVATING PREFERRED CONCRETE & EXCAVA PREMIER STAFFING SOLUTIONS R BROWN CART dba TRAFFC SOL RAY EDWARDS CONTRACTORS RICO RINGLAND-JOHNSON INC RIVER CITY CONSTRUCTION RIVER VALLEY LAND IMP CO IN RIZZA CONCRETE RJ O'NEIL INC ROCK ROAD OF ILLINOIS ROCKFORD CONCRETE PAVING CO ROSE FARM PAVING INC RYAN COMPANIES US INC S & K EXCAVATING & TRUCKING S & K POOL SERVICE INC SCANDROLI CONSTRUCTION CO SCHNEIDER EXCAVATING INC SCHROEDER ASPHALT COMPANY L SCHROEDER ASPHALT SERVICES SCORPIO CONSTRUCTION SCURTO CEMENT CONSTRUCTION SEYLLERS INC SINGLEY CONSTRUCTION SJN SUBSURFACE INC SJOSTROM & SONS INC SOIL INSTALLERS STARK & SON TRENCHING INC STENSTROM EXCAV & BLACKTOP STEWART H R INC STOKES EX CO I MEJIA SUBSURFACE UNDERGROUND CONS SURE INT'L OF CRYSTAL LAKE T B S CONSTRUCTION INC T C I INC TAT ENTERPRISES INC TERPSTRA MASONRY THE BOLDT COMPANY THE PENA GROUP INC THOM GRAVEL & EXCAVATING IN TNT CONSTRUCTION TOBIN BROS INC TONYAN WILLIAM & SONS INC TRIGGI CONSTRUCTION INC TROY LEE EXCAVATING INC VIRIDIAN ENTERPRISES INC VISSERING CONSTRUCTION CO WAGNER EXCAVATING WALSH CONSTRUCTION CO WALSH CONSTRUCTION CO II LL WEAVER CONSTRUCTION INC WEGMAN R C CONST CO WHEATLAND CONCRETE INC WHITTAKER CONST & EXCAVAT WILKINSON EXCAVATING WILLIAM CHARLES CONST CO LL WILLIAMS BROTHERS CONST CO WORKFORCE 312 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0