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FOX VALLEY LABORERS HEALTH AND WELFARE FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
FOX VALLEY LABORERS HEALTH AND WELFARE FUND (EIN 36-6219639)
Tax period
2012-06-01 to 2013-05-31
Filed
2014-01-14
IRS object ID
201410149349300831
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-01-14T11:38:21-06:00Timestamp
Tax Period End Date2013-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN470900880EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CALIBRE CPA GROUP PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1566 W LAKE ST STE 300AddressLine1
CityCHICAGOCity
StateILState
ZIP Code606611414ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN366219639EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FOX VALLEY LABORERS HEALTH & WELFARE FNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFOXVNameControl
Phone8477420900Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12400 BIG TIMBER RD BLDG B No 206BAddressLine1
CityELGINCity
StateILState
ZIP Code601247812ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMike ShalesName
TitleChairmanTitle
Phone8477420900Phone
Date Signed2014-01-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameANDREW HEINName
PTINP00499757PTIN
Phone3126550037Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonMIKE SHALESNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12400 BIG TIMBER RD BLDG B No 206BAddressLine1
CityELGINCity
StateILState
ZIP Code601247812ZIPCode
FieldValueIRS element (for citing)
Gross Receipts32452161GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1968YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees54TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year24293349ProgramServiceRevenuePriorYear
Program Service Revenue CY25243963ProgramServiceRevenueCY
Investment Income Prior Year1466800InvestmentIncomePriorYear
Investment Income Current Year2003979InvestmentIncomeCurrentYear
Other Revenue Prior Year277523OtherRevenuePriorYear
Other Revenue Current Year284716OtherRevenueCurrentYear
Total Revenue Prior Year26037672TotalRevenuePriorYear
Total Revenue Current Year27532658TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year16625170BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY19795277BenefitsPaidToMembersCY
Salaries Etc Prior Year765587SalariesEtcPriorYear
Salaries Etc Current Year790666SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1556360OtherExpensePriorYear
Other Expenses Current Year1564291OtherExpensesCurrentYear
Total Expenses Prior Year18947117TotalExpensesPriorYear
Total Expenses Current Year22150234TotalExpensesCurrentYear
Revenues Less Expenses Prior Year7090555RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5382424RevenuesLessExpensesCY
Total Assets BOY52315828TotalAssetsBOY
Total Assets EOY61944759TotalAssetsEOY
Total Liabilities BOY8157789TotalLiabilitiesBOY
Total Liabilities EOY9011114TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY44158039NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY52933645NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. THERE WERE 1,302 ELIGIBLE PARTICIPANTS AT MAY 31, 2013.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096661NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees54NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PAT SHALESBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8477420900TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12400 BIG TIMBER BLDG B STE 206BAddressLine1
CityELGINCity
StateILState
ZIP Code601217812ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
DAN BREJC
Secretary3.0040.00X010553071866
JOHN BRYAN JR
TRUSTEE3.00X000
MIKE SHALES
Chairman3.00X000
VERN BAUMAN
Trustee3.0040.00X011589084635
JEFF FROST
Trustee3.0050.00X013616995120
AL OROSZ
Trustee3.00X000
TOBY KOTH
Fmr Trustee3.0050.00X015429499730
PATRICIA M SHALES
ADMINISTRATOR40.00120458034950X
FieldValueIRS element (for citing)
Total Reportable Comp From Org120458TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs511883TotalReportableCompFrmRltdOrgs
Total Other Compensation386301TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BLUE CROSS BLUE SHIELD
300 EAST RANDOLPH STCHICAGOIL60601PPO ACCESS FEES596323
SEI INVESTMENT
ONE FREEDOM DRIVEOAKSPA19456INV MGMNT/CONSULTING142566
HORIZON ACTUARIAL SERVICES LLC
6120 ROLLING ROAD DRIVEMIAMIFL331565629PLAN CONSULTING114210
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS9000992392566323925663
MEMBER CONTRIBUTIONS90009912364511236451
MEDICARE D SUBSIDIES9000998184981849
FieldValueIRS element (for citing)
Total Program Service Revenue25243963TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1332378TotalRevenueColumn
Exclusion$1,332,378ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities5591104Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4919503Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities671601Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column671601TotalRevenueColumn
Exclusion$671,601ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionREIMB SAL & RELATED EXDescription
Business Code900099BusinessCode
Total Revenue Column284716TotalRevenueColumn
Related Or Exempt Function Income284716RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue284716TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column27532658TotalRevenueColumn
Related Or Exempt Function Income25528679RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,003,979ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total19795277Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total446529Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total155129Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total128312Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total60696Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total115320Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total70456Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total309274Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total833395Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total130841Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total33899Total

Travel Travel

FieldValueIRS element (for citing)
Total3057Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total24732Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total16462Total

Insurance Insurance

FieldValueIRS element (for citing)
Total26855Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22150234Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-34273BOY
EOY-41660EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4956BOY
EOY19932EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2424195BOY
EOY2595463EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY42898BOY
EOY45314EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis293313LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec243537LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY35890BOY
EOY49776EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY49651853BOY
EOY59199814EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY190309BOY
EOY76120EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY52315828BOY
EOY61944759EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY79789BOY
EOY62114EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8078000BOY
EOY8949000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8157789BOY
EOY9011114EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY44158039BOY
EOY52933645EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY44158039BOY
EOY52933645EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY52315828BOY
EOY61944759EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses5382424ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3393182ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis22480OtherCostOrOtherBasis
Depreciation2248Depreciation
Book Value20232BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis270833OtherCostOrOtherBasis
Depreciation241289Depreciation
Book Value29544BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings49776TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY$6,325,000
EST LIAB FUTR CLAIMS INCURRED BUT UNPAID$2,604,000
DEPOSITS HELD$20,000
FieldValueIRS element (for citing)
Total Of Amounts8949000TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt30250001TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments3393182NetUnrealizedGainsInvestments
Other Revenues-309274OtherRevenues
Revenue Not Rptd F9903083908RevenueNotRptdF990
Revenue Subtotal27166093RevenueSubtotal
Other Revenues Not Included366565OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt366565RevenueNotRptdOnFinStmt
Total Revenue Per Form99027532658TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt20618395TotExpensesEtcAuditedFinclStmt
Other Expenses Included-81849OtherExpensesIncluded
Expenses Not Rptd F990-81849ExpensesNotRptdF990
Expenses Subtotal20700244ExpensesSubtotal
Other Expenses Not Included1449990OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1449990ExpensesNotRptdOnFinStmt
Total Expenses Per Form99022150234TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48: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, 2013, 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, 2013, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO THE FISCAL YEAR ENDED MAY 31, 2010.
Part XI, Line 2d - Other Adjustments:INVESTMENT MANAGEMENT EXPENSE -309274.
Part XI, Line 4b - Other Adjustments:MEDICARE D SUBSIDIES RECEIVED 81849. REIMBURSED FV PENSION SALARY EXPENSE 284716.
Part XII, Line 2d - Other Adjustments:MEDICARE D SUBSIDIES RECEIVED -81849.
Part XII, Line 4b - Other Adjustments:REIMBURSED FV PENSION SALARY EXPENSE 284716. INVESTMENT MANAGEMENT EXPENSE 309274. CHANGE IN PLAN BENEFIT OBLIGATION 856000.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAN BREJC
Secretary01023450003185045896025970017739600
VERN BAUMAN
Trustee01109020004988052688031947020052500
JEFF FROST
Trustee01327530003416037077058043023128900
TOBY KOTH
Fmr Trustee014109700013197041687058043025402400
PATRICIA M SHALES
ADMINISTRATOR11072703500062310190860158640155408000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Section A, line 8bTHE ORGANIZATION DOES NOT HAVE COMMITTEES TO ACT ON BEHALF OF THE GOVERNING BODY.
Form 990, Part VI, Section B, line 11THE 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 12cTHE 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 15aTHE 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 19A 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:NO CHANGE IN PROCESS FROM PRIOR YEAR.
Form 990, Part VI, Line 15bTHE ORGANIZATION DOES NOT COMPENSATE ITS TRUSTEES.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionControlled OrgControlledOrg
FOX VALLEY & VICINITY LABORERS PENSION
2400 BIG TIMBER ROAD BLDG B 206BELGINIL601247812366147409PENSION FUNDIL401(a)0
LABORERS LOCAL #149
2418 W INDIAN TRAILAURORAIL60506361264214LABOR UNIONIL501(c)(5)0
LABORERS LOCAL #1035
110 N STATE PO BOX 211MARENGOIL601520211362063944LABOR UNIONIL501(c)(5)0
LABORERS LOCAL #582
2400 BIG TIMBER ROAD BLDG BELGINIL601247812361265047LABOR UNIONIL501(c)(5)0
FOX VALLEY ASSOCIATED GENERAL CONTRACTORS
2020 DEAN ST NO IST CHARLESIL60174362244731CONTRACTORS ASSOCIATIONIL501(c)(6)0
ILLINOIS ROAD AND TRANSPORTATION BUILDERS ASSOCIATION
500 PARK BLVD 1250ITASCAIL60143361257695CONTRACTORS ASSOCIATIONIL501(c)(6)0

Form990 Schedule R Part III Form990ScheduleRPartIII (19 entries)

IHC CONSTRUCTION CO LLC
OSWEGO EXCAVATING LP
MECCOR INDUSTRIES LTD
PAUL HERRERA CONSTR CO LTD
ORANGE CRUSH LLC
RUBLOFF EXCAVATION LLC
KRESMERY MARC CONSTRUCTION LLC
SABO MASONRY LLC
BUILDERS CONCRETE SERVICES LLC
COOLING LANDSCAPE CONSTR LLC
CROUCH-SERANKO MASONRY LLC
MID-AMERICA UNDERGROUND LLC
KENDALL EXC & SEPTIC LLC
MIDWEST UNDERGROUND CONTR LLC
WILLIAM CHARLES CONST CO LLC
CONSOLIDATED CONSTR SERV LLC
N-TRAK GROUP LLC
CORRECTIVE ASP MATERIALS LLC
JACK COFFEY LLC

Form990 Schedule R Part IV Form990ScheduleRPartIV (200 entries)

ILLINOIS CONSTR CORP
WEGMAN R C CONST CO
DRIESSEN CONSTR COMPANY
DODD LAWRENCE J CONST INC
D & H EXCAVATING INC
LINDEN HARRY AND SON
ALLIANCE CONTRACTORS INC
CULLEN J P & SONS INC
GENEVA CONST CO
HEITKOTTER INC
THOM GRAVEL & EXCAVATING INC
NORTHERN PIPELINE CONST CO
LAMP INC
FERRO P T CONSTRUCTION
WALSH CONSTRUCTION CO
HARRIS J C & SONS INC
O'NEIL RJ INC
SWEDBERG & ASSOCIATES INC
J E M MORRIS CONSTRUCTION INC
HENKELS & MC COY INC
SCHNEIDER EXCAVATING INC
CURRAN CONTRACTING CO
PLOTE CONSTRUCTION
CAMOSY INCORPORATED
BAKER PETER & SON COMPANY
LORIG CONSTRUCTIONS COMPANY
SCANDROLI CONSTRUCTION CO
ARROW HEAD CONSTRUCTION CO
PEPPER CONSTRUCTION
SJOSTROM & SONS INC
TONYAN WILLIAM & SONS INC
CENTRAL BLACKTOP
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BALLOU MASONRY INC
ALBERICI J
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ELECTRIC CONDUIT CONST
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RINGLAND-JOHNSON INC
CHAMPION PAVING CORP
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BUESING BROTHER INC
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PEASE J INC
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MORTENSON CO
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BENNET CONSTRUCTION INC
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FISCHER EXCAVATING INC
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CARMICHAEL CONSTRUCTION INC
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STEWART H R INC
T C I INC
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FLOOR TECH SOLUTIONS INC
GARY RABINE & SONS INC
LIBERTY PAVING CO INC
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STENSTROM EXCAV & BLACKTOP GRP
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DREAMSCAPES BY DENNIS INC
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MAXIM CONSTRUCTION CORP INC
C & H EXCAVATING INC
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JLN PAVING
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PARKWAY FORMING INC
ARRP PAVING AND TRUCKING INC
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ANDERSON BROTHERS EXCAV INC
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ENGSTROM CONSTRUCTION CO
FLOOR SYSTEMS OF CHICAGO INC
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FIVE STAR CONCRETE CONTR INC
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NORWEST CONSTRUCTION INC
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THE PENA GROUP INV
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FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg