2014-01-08T13:31:59-06:00 2013-05-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-06-01 356059199 BRICKLAYERS OF INDIANA WELFARE FUND BRIC 8592261783 333 WEST VINE STREET NO 500 LEXINGTON KY 40507 TED CHAMP 8592261783 2014-01-08 1 RENEE BERG-SPECK P00201492 3123680500 2012 2015-11-30 17:44:51Z TED CHAMP 333 WEST VINE STREET NO 500 LEXINGTON KY 40507 7683634 0 X N/A X 1964 IN PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS. 12 7 10 0 0 0 0 0 7380090 7661888 13240 21746 0 0 7393330 7683634 0 0 5878310 7006007 0 0 0 0 0 629498 590999 6507808 7597006 885522 86628 7051928 7134144 150838 146426 6901090 6987718 TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS. 0 0 TO PROVIDE HEALTH BENEFITS, INCLUDING MEDICAL, DENTAL, VISION, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFITS FOR PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 6 0 1 10 1 0 0 0 0 0 0 0 0 0 0 X 12 7 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X UMR 8592261783 333 WEST VINE STREET LEXINGTON KY 40507 MIKE AVILA 1.00 40.00 X 0 58945 35791 TED CHAMP 1.00 40.00 X 0 93317 44272 WILLIAM CLARK 1.00 40.00 X 0 54484 31150 STEVE KNOWLES 1.00 40.00 X 0 56790 37375 KEVIN MCCLANAHAN 1.00 40.00 X 0 58227 35864 MATT SINGER 1.00 X 0 0 0 DARYL DEMUYT 1.00 X 0 0 0 GARY HUBBUCH 1.00 X 0 0 0 TERRY RIGGINS 1.00 X 0 0 0 RANDALL WEAVER 1.00 X 0 0 0 TROY SCHREIBER 1.00 X 0 0 0 DENNIS BERGER 1.00 X 0 0 0 PAT SCHRODER 1.00 40.00 X 0 18930 15508 RALEIGH JOHNSON 1.00 40.00 X 0 31345 23602 0 372038 223562 0 0 0 0 UNITED HEALTHCARE 22561 NETWORK PLACE CHICAGO IL 60673 THIRD PARTY ADMINISTRATOR/CLAIMS PROCESS 353944 1 EMPLOYER CONTRIBUTIONS 900099 5951098 5951098 STOP LOSS INCOME 900099 815298 815298 PARTICPANT CONTRIB. 900099 690492 690492 PRESCRIPTION DRUG REBA 900099 96052 96052 OTHER INCOME 900099 93842 93842 15106 15106 7661888 21746 21746 7683634 7661888 0 21746 7006007 51772 45677 470316 11526 6198 5510 7597006 88402 75201 5828812 5875494 1130179 1179161 4535 4288 7051928 7134144 150838 146426 150838 146426 X 0 0 0 0 6901090 6987718 6901090 6987718 7051928 7134144 86628 0 X 0 1 X 1 0 0 X 7683634 0 7683634 0 7683634 7597006 0 7597006 0 7597006 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO UMR, AS THIRD PARTY ADMINISTRATOR OF THE FUND. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARD'S REVIEW AND APPROVAL THE FORM IS SIGNED AND FILED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. 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VALLEY & VICINITY CONTRIBUTING EMPLOYER 0 IN BAC LOCAL 35&25 H&W CONTRIBUTING EMPLOYER 0 INTERNATIONAL BRICKLAYERS HEALTH FUND CONTRIBUTING EMPLOYER 0 KANSAS BAC LOCAL 15 WELFARE CONTRIBUTING EMPLOYER 0 MASS BRICKLAYERS & MASONS CONTRIBUTING EMPLOYER 0 MICHIGAN BAC HEALTH CARE FUND CONTRIBUTING EMPLOYER 0 MN&ND BAC LOCAL 1 MN H&W CONTRIBUTING EMPLOYER 0 NEW JERSEY BAC HEALTH FUND CONTRIBUTING EMPLOYER 0 NORTHWESTERN OHIO BRICKLAYERS CONTRIBUTING EMPLOYER 0 OHIO BRICKLAYERS H&W FUND CONTRIBUTING EMPLOYER 0 SOUTHWEST ILLINOIS BRICKLAYER CONTRIBUTING EMPLOYER 0 TUCKPOINTERS LOCAL 52 CONTRIBUTING EMPLOYER 0 UNION CONSTRUCTION WORKERS HEALTH PLAN CONTRIBUTING EMPLOYER 0 UNION TROWEL TRADES CONTRIBUTING EMPLOYER 0 ANESE MASONRY LLC CONTRIBUTING EMPLOYER 0 0 K INDUSTRIAL OF INDIANA LLC CONTRIBUTING EMPLOYER 0 0 LOCKWOOD BROTHERS CONTRIBUTING EMPLOYER 0 0 TONN & BLANK CONSTRUCTION CONTRIBUTING EMPLOYER 0 0 YOUNG FINAL FINISH LLC CONTRIBUTING EMPLOYER 0 0 ABP MASONRY CONTRIBUTING EMPLOYER 0 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