2014-08-14T17:03:37-05:00 2013-09-30 470900880 CALIBRE CPA GROUP PLLC 19615 SOUTH LAGRANGE ROAD MOKENA IL 60448 990 2012-10-01 362947574 TRUSTEES OF LIQUOR & ALLIED WORKER LOCAL NO 3 HEALTH & WELFARE LOCA 3122434300 1640 WEST VAN BUREN STREET CHICAGO IL 60612 PATRICK G DUFF 3122434300 2014-08-15 1 CHARLES DIGIOVANNI P00284901 7089957180 2012 2015-11-30 17:44:51Z PATRICK DUFF 1640 WEST VAN BUREN STREET CHICAGO IL 60612 7986902 0 X N/A X 1976 IL TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND DISABILITY BENEFITS TO ALL ELIGIBLE MEMBERS OF LOCAL 3 LIQUOR AND ALLIED WORKERS 4 4 1 0 0 0 0 0 7193119 7984166 2563 2736 0 0 7195682 7986902 0 0 8050713 8838468 0 0 0 0 0 80565 80477 8131278 8918945 -935596 -932043 4070030 2709292 2191170 1762475 1878860 946817 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND DISABILITY BENEFITS TO ALL ELIGIBLE MEMBERS OF LOCAL 3 LIQUOR AND ALLIED WORKERS 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, LIFE AND DISABILITY BENEFITS TO ALL ELIGIBLE MEMBERS OF LOCAL 3 LIQUOR AND ALLIED WORKERS 0 0 0 0 0 0 0 0 0 0 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 1000 0 1 1 1 0 0 0 0 0 0 0 0 X 4 4 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 X X THOMAS SLOTTA 3122434300 1640 WEST VAN BUREN STREET CHICAGO IL 60612 PATRICK DUFF 5.00 40.00 X 0 221904 43978 JOHN DUFF III PAST 5.00 40.00 X 0 203380 43635 DALE HUHNKE 3.00 X 0 0 0 KARIN MATURA 3.00 X 0 0 0 THOMAS SLOTA -NEW 5.00 40.00 X 0 177598 13828 0 602882 101441 0 0 1 0 BLUE CROSS BLUE SHIELD 300 E RANDOLH CHICAGO IL 60601 PROVIDER NETWORK 287736 ELITE ADMINISTRATION 1211 W 22ND STREET STE 820 OAK BROOK IL 60154 CLAIM ADMINISTRATOR 123952 2 EMPLOYER CONTRIBUTIONS 900099 7964973 7964973 PARTICIPANT CONTRIBUTI 900099 19193 19193 7984166 2736 2736 7986902 7984166 0 2736 8838468 15750 1049 11418 REIMBURSEMENT TO LOCAL 39660 REIMBURSEMENT TO LOCAL 12600 8918945 198543 229223 1897938 1315891 1913457 1104086 60092 60092 4070030 2709292 73670 84975 2117500 1677500 2191170 1762475 X 0 0 0 0 1878860 946817 1878860 946817 4070030 2709292 -932043 0 X X 0 1 X 1 0 0 RESERVE FOR UNREPORTED CLAIMS 1677500 1677500 X 7986902 0 7986902 0 7986902 9358945 0 9358945 -440000 -440000 8918945 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PLAN MANAGEMENT HAS ANALYZED THE POSITIONS TAKEN BY THE PLAN, AND HAVE CONCLUDED THAT AS OF SEPTEMBER 30, 2013, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN CLAIMS RESERVE -440,000. 0 0 0 PATRICK DUFF 0 194904 0 16424 0 10576 0 33257 0 10721 0 265882 0 0 JOHN DUFF III PAST 0 183439 0 15287 0 4654 0 32914 0 10721 0 247015 0 0 THOMAS SLOTA -NEW 0 163937 0 13661 0 0 0 3107 0 10721 0 191426 0 0 PART V LINE 1A NUMBER OF 1099'S ARE ESTIMATED. THE PLAN FILES 1099'S FOR VARIOUS MEDICAL PROVIDERS. FORM 990, PART VI, SECTION A, LINE 2 JOHN DUFF III, TRUSTEE AND PATRICK DUFF, TRUSTEE ARE BROTHERS. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO SUBCOMMITTEES. FORM 990, PART VI, SECTION B, LINE 11 THE PLAN ADMINISTRATOR REVIEWS THE RETURN WITH THE PLAN'S INDEPENDENT ACCOUNTING FIRM FORM 990, PART VI, SECTION B, LINE 15 NO COMPENSATION IS PAID TO TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, DOCUMENTS ARE PROVIDED TO INDIVIDUALS. THE FORM 990 IS ALSO AVAILABLE ON THE GUIDESTAR WEBSITE. PART XII LINE 2(C) THE PROCESS HAS NOT CHANGED. LOCAL 3 HEALTH AND WELFARE- SALES 1640 W VAN BUREN CHICAGO IL 60612 363265979 INSURANCE IL 501(C)(9) N/A 0 LOCAL 3 PENSION FUND 1640 W VAN BUREN CHICAGO IL 60612 516035372 DB PENSION IL 401 N/A 0 LOCAL 3 PENSION FUND SALES DIVISION 1640 W VAN BUREN CHICAGO IL 60612 366527340 DB PENSION IL 401 N/A 0 LOCAL 3 401K PLAN 1640 W VAN BUREN CHICAGO IL 60612 367270398 401K PLAN IL 401 N/A 0 LOCAL 3 UNION 1640 W VAN BUREN CHICAGO IL 60612 364044987 UNION IL 501(C)(5) N/A 0 WENTWORTH TIRE TIRE SALES AND SERVICE C 0 ARLINGTON HEATING AND COOLING HVAC 0 ARRP TRUCKING AND HAULING TRUCKING 0 BERRY TIRE TIRE SALES AND SERVICE 0 CHICAGO BANDAG INC TIRE SALES AND SERVICE 0 DIAGEO LIQUOR DISTRIBUTOR 0 HERITAGE WINE & SPIRITS LIQUOR DISTRIBUTOR 0 JYOTSNA AND DAXA LOCAL 3 UNION LABOR UNION 0 LOCAL 3 SALES PENSION FUND PENSION FUND 0 SOUTHERN WINE AND SPIRITS LIQUOR DISTRIBUTOR 0 WIRTZ BEVERAGE LIQUOR DISTRIBUTOR 0 WM CASSIDY TIRE TIRE SALES AND SERVICE 0 NEMEH ZUGHAYER 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0