2016-01-11T08:10:06-06:00 2015-05-31 470900880 CALIBRE CPA GROUP PLLC 566 W LAKE ST STE 300 CHICAGO IL 606611414 990 2014-06-01 366219639 FOX VALLEY LABORERS HEALTH & WELFARE FND FOXV 8477420900 2371 BOWES ROAD No 500 ELGIN IL 601235523 MIKE SHALES Chairman 8477420900 2015-12-31 1 ANDREW HEIN P00499757 3126550037 2014 2016-04-25 22:37:26Z MIKE SHALES 2371 BOWES ROAD No 500 ELGIN IL 601235523 50184712 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 39 0 0 0 0 0 27803015 33430964 2831720 2979254 295670 617112 30930405 37027330 0 0 27192597 28007579 802471 886304 0 0 0 1758867 2043107 29753935 30936990 1176470 6090340 68249473 76546889 12464785 14973576 55784688 61573313 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 1,629 ELIGIBLE PARTICIPANTS AT MAY 31, 2015. 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 1 757 0 1 39 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 DAN BREJC FMR SECRETARY 3.00 40.00 X 0 102609 69320 JOHN BRYAN JR TRUSTEE 3.00 X 0 0 0 MIKE SHALES Chairman 3.00 X 0 0 0 VERN BAUMAN SECRETARY 3.00 40.00 X 0 121233 91213 JEFF FROST FMR TRUSTEE 3.00 50.00 X 0 166748 91529 AL OROSZ Trustee 3.00 X 0 0 0 COREY R JOHNSON TRUSTEE 3.00 50.00 X 0 51992 27206 DAVE SHEEHAN TRUSTEE 3.00 40.00 X 0 117590 91213 PATRICIA M SHALES ADMINISTRATOR 40.00 X 128058 0 38435 128058 560172 408916 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO ACCESS FEES 817232 SEI INVESTMENT ONE FREEDOM DRIVE OAKS PA 19456 INV MGMNT/CONSULTING 175756 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DRIVE MIAMI FL 331565629 PLAN CONSULTING 132039 3 EMPLOYER CONTRIBUTIONS 900099 32159782 32159782 MEMBER CONTRIBUTIONS 900099 1107780 1107780 MEDICARE D SUBSIDIES 900099 163402 163402 33430964 1443885 1443885 14692751 13157382 1535369 1535369 1535369 REIMB SAL & RELATED EXPENSES FROM 900099 330385 330385 STOP LOSS INSURANCE REIMBURSEMENT 900099 286727 286727 617112 37027330 34048076 0 2979254 28007579 487808 191367 152616 54513 72704 63981 377022 1068051 154308 67165 940 19347 18412 28360 PATIENT PROTECTION & AF 172817 30936990 -90585 57266 44954 3088427 3899842 80613 76874 339433 251109 38847 88324 64968429 72270202 118788 154381 68249473 76546889 69785 48576 12395000 14925000 12464785 14973576 X 0 0 0 0 55784688 61573313 55784688 61573313 68249473 76546889 6090340 -301715 0 X X 0 1 X 1 0 22481 11240 11241 316952 239869 77083 88324 EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY 12320000 EST LIAB FUTR CLAIMS INCURRED BUT UNPAID 2535000 DEPOSITS HELD 70000 14925000 X 35568079 -301715 -301715 35869794 377022 780514 1157536 37027330 27274454 -450129 -450129 27724583 377022 2835385 3212407 30936990 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, 2015, 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, 2015, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2012. Part XI, Line 4b - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED 163,402. REIMBURSED FV PENSION SALARY EXPENSE 330,385. STOP LOSS INSURANCE REIMBURSEMENTS 286,727. Part XII, Line 2d - Other Adjustments: MEDICARE D SUBSIDIES RECEIVED -163,402. STOP LOSS INSURANCE REIMBURSEMENTS -286,727. Part XII, Line 4b - Other Adjustments: REIMBURSED FV PENSION SALARY EXPENSE 330,385. CHANGE IN PLAN BENEFIT OBLIGATION 2,505,000. X 0 0 0 DAN BREJC FMR SECRETARY 0 100597 0 0 0 2012 0 46706 0 22614 0 171929 0 0 VERN BAUMAN SECRETARY 0 116184 0 0 0 5049 0 56816 0 34397 0 212446 0 0 JEFF FROST FMR TRUSTEE 0 165636 0 0 0 1112 0 64177 0 27352 0 258277 0 0 DAVE SHEEHAN TRUSTEE 0 116132 0 0 0 1458 0 56816 0 34397 0 208803 0 0 PATRICIA M SHALES ADMINISTRATOR 114907 0 3500 0 9651 0 21322 0 17113 0 166493 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 #149 2418 W INDIAN TRAIL AURORA IL 60506 361264214 LABOR UNION IL 501(c)(5) 0 LABORERS LOCAL #1035 110 N STATE PO BOX 211 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 BUILDERS CONCRETE SERVICES LLC CONSOLIDATED CONSTR SERV LLC COOLING LAND CONCEPTS LLC CROUCH-SERANKO MASONRY LLC DOUGAL BUILDING MAINT LLC GFS CONSTRUCTION LLC H D BACKHOE SERVICE LLC IHC CONSTRUCTION CO LLC JACK COFFEY LLC JIM GEORGE AND SONS LLC KENDALL EXC & SEPTIC LLC KRAEMER NORTH AMERICA LLC KRESMERY MARC CONSTRUCTION LLC MECCOR INDUSTRIES LTD MID-AMERICA UNDERGROUND LLC MIDWEST UNDERGROUND CONTR LLC MTH UNDERLAYMENT LLC N-TRAK GROUP LLC ORANGE CRUSH LLC RAGNAR BENSON LLC RAUSCH INFRASTRUCTURE LLC SCHROEDER ASPHALT COMPANY LLC SHALES MCNUTT LLC V3 CONSTRUCTION TRADES LDT WALSH CONSTRUCTION CO II LLC WILLIAM CHARLES CONST CO LLC AAT PIPELINE TESTING INC ABBOTT RA EXCAVATING INC ABITUA SEWERWATER&PLUMB INC ACCESS CONTROL CO INC ALBERICI J ALLIANCE CONCR SAW & DRILL IV ALLIANCE CONTRACTORS INC ARROW ROAD CONSTRUCTION CO ARTLOW SYSTEMS INC ASC INSULATION & FIREPROOFING BAKER PETER & SON COMPANY BARONE CONTRACTING LLC 0814 BENCHMARK CONSTRUCTION BERGER EXCAVATING BERGQUIST & ZIMMERMAN CON INC BLACKHAWK FOUNDATION CO INC BLOCKER G A GRADING CONTR INC BOHR DON & SONS INC BOWEN ENGINEERING CORP BRAVO CONSTRUCTION CO INC BUESING BROTHER INC BULLEY & ANDREWS BURROAK MASONRY INC C & H EXCAVATING INC CAMOSY INCORPORATED CAMPTON CONSTRUCTION CARLSON ALBIN & CO CARMICHAEL CONSTRUCTION INC CELLCRETE 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