2014-01-14T11:38:21-06:00 2013-05-31 470900880 CALIBRE CPA GROUP PLLC 566 W LAKE ST STE 300 CHICAGO IL 606611414 990 2012-06-01 366219639 FOX VALLEY LABORERS HEALTH & WELFARE FND FOXV 8477420900 2400 BIG TIMBER RD BLDG B No 206B ELGIN IL 601247812 Mike Shales 8477420900 2014-01-08 1 ANDREW HEIN P00499757 3126550037 2012 2015-11-30 17:44:51Z MIKE SHALES 2400 BIG TIMBER RD BLDG B No 206B ELGIN IL 601247812 32452161 0 X N/A X 1968 IL TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 6 6 54 0 0 0 0 0 24293349 25243963 1466800 2003979 277523 284716 26037672 27532658 0 0 16625170 19795277 765587 790666 0 0 0 1556360 1564291 18947117 22150234 7090555 5382424 52315828 61944759 8157789 9011114 44158039 52933645 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 1,302 ELIGIBLE PARTICIPANTS AT MAY 31, 2013. 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 1 661 0 1 54 1 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 1 1 0 0 X PAT SHALES 8477420900 2400 BIG TIMBER BLDG B STE 206B ELGIN IL 601217812 DAN BREJC 3.00 40.00 X 0 105530 71866 JOHN BRYAN JR 3.00 X 0 0 0 MIKE SHALES 3.00 X 0 0 0 VERN BAUMAN 3.00 40.00 X 0 115890 84635 JEFF FROST 3.00 50.00 X 0 136169 95120 AL OROSZ 3.00 X 0 0 0 TOBY KOTH 3.00 50.00 X 0 154294 99730 PATRICIA M SHALES 40.00 X 120458 0 34950 120458 511883 386301 1 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO ACCESS FEES 596323 SEI INVESTMENT ONE FREEDOM DRIVE OAKS PA 19456 INV MGMNT/CONSULTING 142566 HORIZON ACTUARIAL SERVICES LLC 6120 ROLLING ROAD DRIVE MIAMI FL 331565629 PLAN CONSULTING 114210 3 EMPLOYER CONTRIBUTIONS 900099 23925663 23925663 MEMBER CONTRIBUTIONS 900099 1236451 1236451 MEDICARE D SUBSIDIES 900099 81849 81849 25243963 1332378 1332378 5591104 4919503 671601 671601 671601 REIMB SAL & RELATED EX 900099 284716 284716 284716 27532658 25528679 0 2003979 19795277 446529 155129 128312 60696 115320 70456 309274 833395 130841 33899 3057 24732 16462 26855 22150234 -34273 -41660 4956 19932 2424195 2595463 42898 45314 293313 243537 35890 49776 49651853 59199814 190309 76120 52315828 61944759 79789 62114 8078000 8949000 8157789 9011114 X 0 0 0 0 44158039 52933645 44158039 52933645 52315828 61944759 5382424 3393182 0 X X 0 1 X 1 0 22480 2248 20232 270833 241289 29544 49776 EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY 6325000 EST LIAB FUTR CLAIMS INCURRED BUT UNPAID 2604000 DEPOSITS HELD 20000 8949000 X 30250001 3393182 -309274 3083908 27166093 366565 366565 27532658 20618395 -81849 -81849 20700244 1449990 1449990 22150234 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. X 0 0 0 DAN BREJC 0 102345 0 0 0 3185 0 45896 0 25970 0 177396 0 0 VERN BAUMAN 0 110902 0 0 0 4988 0 52688 0 31947 0 200525 0 0 JEFF FROST 0 132753 0 0 0 3416 0 37077 0 58043 0 231289 0 0 TOBY KOTH 0 141097 0 0 0 13197 0 41687 0 58043 0 254024 0 0 PATRICIA M SHALES 110727 0 3500 0 6231 0 19086 0 15864 0 155408 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: NO CHANGE IN PROCESS FROM PRIOR YEAR. Form 990, Part VI, Line 15b THE ORGANIZATION DOES NOT COMPENSATE ITS TRUSTEES. FOX VALLEY & VICINITY LABORERS PENSION 2400 BIG TIMBER ROAD BLDG B 206B ELGIN IL 601247812 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 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 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