2015-07-22T15:11:39-05:00 2014-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2014-01-01 362196729 CEMENT MASONS INSTITUTE LOCAL 502 WELFARE TRUST FUND CEME 7085449105 739 25TH AVENUE BELLWOOD IL 60104 PATRICK J LA CASSA TRUSTEE 7085449105 2015-07-22 1 BRUCE A PAVLIK P00748405 3123680500 2014 2016-02-25 16:41:14Z PATRICK J LA CASSA 739 25TH AVENUE BELLWOOD IL 60104 22149730 0 X N/A X 1950 IL PROVIDE HEALTH BENEFITS 12 6 32 0 0 0 0 0 15747716 14644991 272964 888461 0 0 16020680 15533452 0 0 14553973 13194738 1030423 1204722 0 0 0 741152 922550 16325548 15322010 -304868 211442 35252436 41728745 763741 1753328 34488695 39975417 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 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 1 741 0 1 32 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 40.00 X 0 136158 94408 LAWRENCE PICARDI SR TRUSTEE 2.00 40.00 X 0 134691 93517 CURT ERICKSON TRUSTEE - PAST 2.00 X 1143 0 0 DOMINIC FARRELL TRUSTEE - PAST 2.00 X 1143 2888 661 SANDRA HUNT TRUSTEE 2.00 X 3643 0 2166 JOSEPH RIVECCO TRUSTEE - PAST 2.00 X 1040 2734 548 DONALD DEETJEN TRUSTEE 2.00 X 0 0 0 MICHAEL PIRRON TRUSTEE 2.00 X 0 0 0 ANTONIO ACEVEDO TRUSTEE 2.00 X 2845 2888 0 GARY LUNDSBERG TRUSTEE 2.00 X 0 0 0 ROBERT KRUG TRUSTEE 2.00 X 0 0 0 MICHAEL KOLBERG 0502 2.00 X 0 0 0 PHIL DIEKEMPER TRUSTEE 2.00 X 0 0 0 JAY LA SALA TRUSTEE 2.00 X 2845 3232 1712 ADAM HIGGINS TRUSTEE 2.00 X 2845 2888 1712 WILLIAM BEEMAN ADMINISTRATOR 21.00 19.00 X 112403 1805 45921 DUANE EXLINE EMPLOYEE 17.00 23.00 X 111325 382 45921 239232 287666 286566 2 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 PPO PROVIDER 466795 ARNOLD & KADJAN 203 N LASALLE ST SUITE 1650 CHICAGO IL 60601 LEGAL 170384 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE SUITE 4000 CHICAGO IL 60606 ACCOUNTING 148813 3 CONTRACTOR CONTRIBUTIONS 900099 13713805 13713805 REIMBURSED ADMINISTRATIVE EXPENSE 900099 525741 525741 PARTICIPANT SELF-CONTRIBUTIONS 900099 262318 262318 PRESCRIPTION DRUG REBATES 900099 139863 139863 MEDICARE PART D SUBSIDY 900099 3264 3264 14644991 634976 634976 6869763 6616278 253485 253485 253485 15533452 14119250 0 1414202 13194738 177908 598592 248369 122766 57087 170384 211340 16344 61748 108498 44881 85203 8051 40771 21539 29418 FEES MANDATED BY ACA 124373 15322010 183444 847979 1919697 1645294 1771170 2480137 215519 173042 18086 19595 184837 134182 45057 50655 31099463 36512043 35252436 41728745 763741 1003328 0 750000 763741 1753328 X 0 0 0 0 34488695 39975417 34488695 39975417 35252436 41728745 X 211442 341724 4933556 X 0 1 X 1 0 34001 21922 12079 132806 103245 29561 18030 9015 9015 50655 ASSET TRANSFER DUE TO LOCAL 502 RETIREE WELFARE FUND 750000 750000 X 15333091 341724 341724 14991367 16344 525741 542085 15533452 14779925 0 14779925 16344 525741 542085 15322010 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 525,741. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES 525,741. X 0 0 0 PATRICK LA CASSA TRUSTEE 0 136158 0 0 0 0 0 60670 0 33738 0 230566 0 0 LAWRENCE PICARDI SR TRUSTEE 0 134691 0 0 0 0 0 60077 0 33440 0 228208 0 0 WILLIAM BEEMAN ADMINISTRATOR 112403 1805 0 0 0 0 33445 0 12476 0 158324 1805 0 0 DUANE EXLINE EMPLOYEE 111325 382 0 0 0 0 33445 0 12476 0 157246 382 0 0 FORM 990, PART VI, SECTION B, LINE 11 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 XI, LINE 9: TRANSFER OF NET ASSETS FROM LOCAL 5 WELFARE FUND 8,933,556. TRANSFER OF NET ASSETS TO LOCAL 502 RETIREE WELFARE FUND -4,000,000. PART XI, LINE 9 CHANGES IN NET ASSETS: IN ACCORDANCE WITH MERGER AGREEMENTS, LOCAL 5 WELFARE FUND'S ASSETS AND LIABILITIES WERE TRANSFERRED INTO THIS PLAN AND THE CEMENT MASONS' LOCAL 502 RETIREE WELFARE FUND (RETIREE PLAN). THE NET ASSETS OF THE PLAN WERE ALLOCATED BETWEEN THIS PLAN AND THE RETIREE PLAN BASED ON THE DEMOGRAPHICS OF LOCAL 5 WELFARE FUND'S PARTICIPANTS. ALL OF LOCAL 5 WELFARE FUND'S ASSETS AND LIABILITIES WERE INITIALLY TRANSFERRED TO THIS PLAN, WHICH SUBSEQUENTLY TRANSFERRED A PORTION TO THE RETIREE PLAN. PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 739 25TH AVENUE BELLWOOD IL 60104 516034597 PROVIDE DEATH AND RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 401(A) N/A N/A 0 CEMENT MASONS LOCAL NO 502 SAVINGS FUND 739 25TH AVENUE BELLWOOD IL 60104 366411337 SAVINGS PLAN IL 501(C)(9) N/A N/A 0 CEMENT MASONS LOCAL NO 502 APPRENTICE EDUCATIONAL & TRAINING 739 25TH AVENUE BELLWOOD IL 60104 362487783 TO TRAIN AND EDUCATE APPRENTICES AS CEMENT MASONS. IL 501(C)(5) N/A N/A 0 CEMENT MASONS UNION LOCAL NO 502 739 25TH AVENUE BELLWOOD IL 60104 360881245 LABOR UNION IL 501(C)(5) N/A N/A 0 CEMENT MASONS' 502(B) PENSION FUND 739 25TH AVENUE BELLWOOD IL 60104 366136496 PROVIDE DEATH, DISABILITY & RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 401(A) N/A N/A 0 DUPAGE COUNTY CEMENT MASONS' 502(C) ANNUITY FUND 739 25TH AVENUE BELLWOOD IL 60104 611705870 PROVIDE DEATH, DISABILITY & RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 401(A) N/A N/A 0 CEMENT MASONS' LOCAL NO 502 RETIREE WELFARE FUND 739 25TH AVENUE BELLWOOD IL 60104 800967048 PROVIDE HEALTH CARE BENEFITS FOR ELIGIBLE RETIRED PARTICIPANTS IL 501(C)(9) N/A N/A 0 BUILDERS CONCRETE SERVICES LLC CONTRIBUTING EMPLOYER N/A 0 0 CHICAGO STRUCTURES LLC CONTRIBUTING EMPLOYER N/A 0 0 D'LAND CONSTRUCTION LLC CONTRIBUTING EMPLOYER N/A 0 0 G A PAVING LLC CONTRIBUTING EMPLOYER N/A 0 0 MATRIX CONCRETE CONSTRUCTION LLC CONTRIBUTING EMPLOYER N/A 0 0 PASCHEN F H S N NIELSEN & ASSOCIATES LLC 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