2015-08-27T12:49:20-05:00 2014-10-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2013-11-01 362265130 CONSTRUCTION INDUSTRY WELFARE FUND OF ROCKFORD ILLINOIS CONS 8153974267 1322 EAST STATE STREET ROCKFORD IL 61104 DAVE FLEURY TRUSTEE 8153974267 2015-08-27 1 TIMOTHY CIBULKA P00841100 3123680500 2013 2016-02-25 16:41:14Z DAVE FLEURY 1322 EAST STATE STREET ROCKFORD IL 61104 20314851 0 X N/A X 1954 IL TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 8 0 23 0 34482 -5901 0 0 15453811 16350850 257554 255682 73748 58482 15785113 16665014 0 0 15427841 16691032 112070 124509 0 0 0 759709 851821 16299620 17667362 -514507 -1002348 14650776 14072529 622651 1044281 14028125 13028248 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 23 1 1 1 0 0 0 0 0 0 0 0 0 X 8 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 DAVE FLEURY TRUSTEE 3.00 40.00 X 0 185825 38476 SAM GIARDONO TRUSTEE 3.00 0.00 X 7140 0 0 DAN JANSEN TRUSTEE 3.00 40.00 X 0 100478 31776 ART STURMS TRUSTEE 3.00 40.00 X 0 102694 65876 LYNN ULRICH TRUSTEE 3.00 0.00 X 0 0 0 TODD STEFFEN TRUSTEE 3.00 0.00 X 0 0 0 GLEN TURPOFF TRUSTEE - PAST 3.00 6.00 X 0 46000 0 DAVID ANSPAUGH TRUSTEE - NEW 3.00 0.00 X 0 0 0 JEFF BOCKHOP TRUSTEE - NEW 3.00 0.00 X 0 0 0 SHELLI MCPEEK ADMINISTRATOR 40.00 0.00 X 54083 0 17808 61223 434997 153936 0 0 1 0 GROUP ADMINISTRATORS LTD 915 NATIONAL PARKWAY SUITE F SCHAUMBURG IL 60173 THIRD PARTY ADMINISTRATOR 391258 BLUE CROSS BLUE SHIELD OF IL 300 E RANDOLPH STREET CHICAGO IL 60601 PPO PROVIDER 366629 HINES & ASSOCIATES 20 DOUGLAS AVENUE ELGIN IL 60120 UTILIZATION REVIEW 106514 3 CONTRACTOR CONTRIBUTIONS 900099 15432964 15432964 PARTICIPANT CONTRIBUTIONS 900099 917886 917886 16350850 275939 275939 3629580 3649837 -20257 -20257 -20257 PROCESSING FEES 900099 34482 34482 SHARED SERVICE FEES 900099 24000 24000 58482 16665014 16350850 34482 279682 16691032 60961 52775 173 10600 380935 101845 74149 48546 43356 14239 1709 6269 13120 ACA REINSURANCE FEES 160665 PCORI FEES 6988 17667362 2607816 1986292 3609506 2639370 2298816 3284542 8505 0 8102 73226 130251 98704 37817 31547 6080214 6057552 14650776 14072529 4624 185432 326196 376631 291831 482218 622651 1044281 X 0 0 0 0 14028125 13028248 14028125 13028248 14650776 14072529 -1002348 2471 0 X 0 1 X 1 0 0 1 X 10977 1098 9879 119274 97606 21668 31547 EMPLOYER RECIPROCAL CONTRIBUTIONS 482218 482218 X 16667485 2471 2471 16665014 0 16665014 17667362 0 17667362 0 17667362 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. 0 0 0 DAVE FLEURY TRUSTEE 0 185825 0 0 0 0 0 21100 0 17376 0 224301 0 0 ART STURMS TRUSTEE 0 102694 0 0 0 0 0 48204 0 17672 0 168570 0 0 FORM 990, PART V, LINE 2A THE NUMBER OF EMPLOYEES 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 AN EMPLOYEE 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 SUCH CONFLICT. 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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CONTRIBUTING EMPLOYER 0 GARBER HEATING & A C CONTRIBUTING EMPLOYER 0 HARDIN SIGNS INC CONTRIBUTING EMPLOYER 0 HERMES SERVICE & SALES CONTRIBUTING EMPLOYER 0 J A FRITCH & SONS INC CONTRIBUTING EMPLOYER 0 KREILING RFG CO INC CONTRIBUTING EMPLOYER 0 MEISTER BROS HTG & A C CONTRIBUTING EMPLOYER 0 MONTEFUSCO HTG & SHEET METAL CONTRIBUTING EMPLOYER 0 PEORIA RFG & SHEET METAL CONTRIBUTING EMPLOYER 0 PIPCO COMPANIES LTD CONTRIBUTING EMPLOYER 0 RUYLE CORPORATION CONTRIBUTING EMPLOYER 0 STANDARD HEATING & COOLING CONTRIBUTING EMPLOYER 0 TEMCO HEATING & A C CONTRIBUTING EMPLOYER 0 UNION ROOFING CONTRIBUTING EMPLOYER 0 WILLIAM MASTERS INC CONTRIBUTING EMPLOYER 0 STARK EXCAVATING INC CONTRIBUTING EMPLOYER 0 R G CONSTRUCTION SERVICES INC CONTRIBUTING EMPLOYER 0 CANDLEWICK LAKE ASSOC CONTRIBUTING EMPLOYER 0 AREA RIGGING & MILLWRIGHT CONTRIBUTING EMPLOYER 0 J & E DUFF INC CONTRIBUTING EMPLOYER 0 PREFERRED CONCRETE & EXCV CONTRIBUTING EMPLOYER 0 WINTER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 SINGLEY 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EMPLOYER 0 VALLEY CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 WILLMAN CONSTRUCTION CONTRIBUTING EMPLOYER 0 WOODS CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 ENTEC SERVICES INC CONTRIBUTING EMPLOYER 0 GUSTAFSON CONSTRUCTION CONTRIBUTING EMPLOYER 0 STANDARD SHEET METAL WORK CONTRIBUTING EMPLOYER 0 S B C HEATING & A C CONTRIBUTING EMPLOYER 0 MIDDLETON CONSTRUCTION CONTRIBUTING EMPLOYER 0 CRUZ CONCRETE CONTRIBUTING EMPLOYER 0 H J EPPEL & CO INC CONTRIBUTING EMPLOYER 0 OPPERMAN CONSTRUCTION CONTRIBUTING EMPLOYER 0 ORDAZ CONSTRUCTION CONTRIBUTING EMPLOYER 0 DOORS INC CONTRIBUTING EMPLOYER 0 E L PRUITT CO CONTRIBUTING EMPLOYER 0 R & D THIEL CARP COMP CONTRIBUTING EMPLOYER 0 SUMMIT MASONRY & STONEWORK CONTRIBUTING EMPLOYER 0 MONARCH CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 RIBER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 T R EXCAVATING CONTRIBUTING EMPLOYER 0 GOETZ CONCRETE CONSTRUCT CONTRIBUTING EMPLOYER 0 ROCKFORD CONCRETE PAVING CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 ROCKEYS 3R MASONRY CONTRIBUTING EMPLOYER 0 ROGERS AUTOMATED ENTRANCE CONTRIBUTING EMPLOYER 0 RAYNOR DOOR AUTHORITY OF DEKALB CONTRIBUTING EMPLOYER 0 INSTALLATION SERVICES OF IL INC CONTRIBUTING EMPLOYER 0 MECHANICAL SERVICE INC CONTRIBUTING EMPLOYER 0 KEITH MCCHURCH MASONRY CONTRIBUTING EMPLOYER 0 MID-STATE TERRAZZO TILE CONTRIBUTING EMPLOYER 0 ARMOR METAL FABRICATION CONTRIBUTING EMPLOYER 0 EAGLE VENTILATION CONTRIBUTING EMPLOYER 0 MARSEILLES SHEET METAL 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 WOZNIAK CONCRETE FINISHING CONTRIBUTING EMPLOYER 0 H & M MASONRY CONTRIBUTING EMPLOYER 0 MIDWEST BEST WATERPROOFING CONTRIBUTING EMPLOYER 0 ADVANCED DISPOSAL CONTRIBUTING EMPLOYER 0 REDBUD RIDGE CUSTOM SHOP CONTRIBUTING EMPLOYER 0 EAST COAST MANAGMENT INC CONTRIBUTING EMPLOYER 0 RIVER VALLEY CONSTRUCTION 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EMPLOYER 0 SHEET METAL CONNECTORS IN CONTRIBUTING EMPLOYER 0 WILLIAMS PLANT SERVICES CONTRIBUTING EMPLOYER 0 WALGREEN COMPANY CONTRIBUTING EMPLOYER 0 CITY WIDE INSULATION CONTRIBUTING EMPLOYER 0 ARTISAN CONTRACTING LLC CONTRIBUTING EMPLOYER 0 RABINE PAVING CONTRIBUTING EMPLOYER 0 PROSEALANTS INC CONTRIBUTING EMPLOYER 0 LAVERDIERE CONSTRUCTION CONTRIBUTING EMPLOYER 0 ADIRONDACK SERVICE LLC CONTRIBUTING EMPLOYER 0 BG BRECKE INC CONTRIBUTING EMPLOYER 0 SWINSON MATERIAL INC CONTRIBUTING EMPLOYER 0 MIDLAND GEN CONTRACTORS I CONTRIBUTING EMPLOYER 0 PRIME CONSTRUCTION SERVIC CONTRIBUTING EMPLOYER 0 DOCS EXCAVATING INC CONTRIBUTING EMPLOYER 0 CREATIVE ERECTORS INC CONTRIBUTING EMPLOYER 0 FRANK MILLARD & COMPANY I CONTRIBUTING EMPLOYER 0 J SQUARED MASONRY INC CONTRIBUTING EMPLOYER 0 TRADEMARK FLOORING INC CONTRIBUTING EMPLOYER 0 J W SCHULTZ CONSTRUCTION CONTRIBUTING EMPLOYER 0 HALVERSON CARPET CENTER CONTRIBUTING EMPLOYER 0 FIELDSTONE BUILDING SERVICES CONTRIBUTING EMPLOYER 0 JOHNSON-DOWNS CONSTRUCTION CONTRIBUTING EMPLOYER 0 JAMES MC HUGH CONST CO CONTRIBUTING EMPLOYER 0 ADVANTAGE INDUSTRIAL SYSTEM CONTRIBUTING EMPLOYER 0 R A SEATON CONTRACTOR SERV CONTRIBUTING EMPLOYER 0 COMMERCIAL CARPET CO CONTRIBUTING EMPLOYER 0 SUITABLE BUILDERS INC CONTRIBUTING EMPLOYER 0 HOFFMAN BUILDERS INC CONTRIBUTING EMPLOYER 0 FAUSTO MORBIDELLI STONE AND TILE INC CONTRIBUTING EMPLOYER 0 MORENO TILE & STONE CONTRIBUTING EMPLOYER 0 GEORGE YOUNG & SONS INC CONTRIBUTING EMPLOYER 0 CENTRAL IL FLOORCOVERING INC CONTRIBUTING EMPLOYER 0 MICHEL BROTHERS MASONRY INC CONTRIBUTING EMPLOYER 0 QUALITY AGGREGATES OF ILLINOIS LLC CONTRIBUTING EMPLOYER 0 A & M ROKEY CONTRIBUTING EMPLOYER 0 SPORTS SURFACING INC CONTRIBUTING EMPLOYER 0 STAINLESS SPECIALISTS INC CONTRIBUTING EMPLOYER 0 MIKE MUELLER INSTALLATIONS INC CONTRIBUTING EMPLOYER 0 PYRO INDUSTRIAL SERVICES CONTRIBUTING EMPLOYER 0 ST COTTER TURBINE SERVICES CONTRIBUTING EMPLOYER 0 CARPETLAND USA ROCKFORD CONTRIBUTING EMPLOYER 0 JAMES G STAAT TUCKPOINTING 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