STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

FOX VALLEY LABORERS HEALTH AND WELFARE FUND: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FOX VALLEY LABORERS HEALTH AND WELFARE FUND (EIN 36-6219639)
Tax period
2011-06-01 to 2012-05-31
Filed
2013-01-07
IRS object ID
201330079349300118
Schema version
2011v1.2
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)
Timestamp2013-01-07T05:46:07-08:00Timestamp
Tax Period End Date2012-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Levinson Simon Hein & Bilkey PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1566 West Lake Street Suite 300AddressLine1
CityChicagoCity
StateILState
ZIP Code606611414ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-06-01TaxPeriodBeginDate

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 BAddressLine1
CityELGINCity
StateILState
ZIP Code60124ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMIKE SHALESName
TitleChairmanTitle
Date Signed2013-01-04DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameAndrew HeinName
Phone3126550037Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1425 RENNER DRIVEAddressLine1
CityELGINCity
StateILState
ZIP Code60123ZIPCode
FieldValueIRS element (for citing)
Gross Receipts28823499GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
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 Employees60TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21839838ProgramServiceRevenuePriorYear
Program Service Revenue CY24293349ProgramServiceRevenueCY
Investment Income Prior Year2612349InvestmentIncomePriorYear
Investment Income Current Year1466800InvestmentIncomeCurrentYear
Other Revenue Prior Year247026OtherRevenuePriorYear
Other Revenue Current Year277523OtherRevenueCurrentYear
Total Revenue Prior Year24699213TotalRevenuePriorYear
Total Revenue Current Year26037672TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year14146867BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY16625170BenefitsPaidToMembersCY
Salaries Etc Prior Year751081SalariesEtcPriorYear
Salaries Etc Current Year765587SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1469969OtherExpensePriorYear
Other Expenses Current Year1556360OtherExpensesCurrentYear
Total Expenses Prior Year16367917TotalExpensesPriorYear
Total Expenses Current Year18947117TotalExpensesCurrentYear
Revenues Less Expenses Prior Year8331296RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7090555RevenuesLessExpensesCY
Total Assets BOY46078753TotalAssetsBOY
Total Assets EOY52315828TotalAssetsEOY
Total Liabilities BOY8484249TotalLiabilitiesBOY
Total Liabilities EOY8157789TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY37594504NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY44158039NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionTO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY,AND DEATH BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS.THERE WERE 1331 ELIGIBLE PARTICIPANTS AT MAY 31, 2012.Description
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096627NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees60NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPAT SHALESNamePerson
Telephone Number8477420900TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12400 BIG TIMBER BLDG B STE 206BAddressLine1
CityELGINCity
StateILState
ZIP Code601217812ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
TOBY KOTH
Trustee3.00X000
AL OROSZ
Trustee3.00X000
VERN BAUMAN
Trustee3.00X000
MIKE SHALES
Chairman3.00X000
JOHN BRYAN JR
TRUSTEE3.00X000
DAN BREJC
Secretary3.00X000
PATRICIA M SHALES
ADMINISTRATOR40.00120266034088X
FieldValueIRS element (for citing)
Total Reportable Comp From Org120266TotalReportableCompFromOrg
Total Other Compensation34088TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SEI INVESTMENT
ONE FREEDOM DRIVEOAKSPA19456INV MGMNT/CONSULTING208579
HORIZON ACTUARIAL SERVICES LLC
6120 ROLLING ROAD DRIVEMIAMIFL331565629PLAN CONSULTING119399
DOWD BLOCH & BENNETT
8 SOUTH MICHIGAN AVENUECHICAGOIL60603LEGAL SERVICES104397
BLUE CROSS BLUE SHIELD
300 EAST RANDOLPH STCHICAGOIL60601PPO ACCESS FEES597441
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEMBER CONTRIBUTIONS90009912966291296629
MEDICARE D SUBSIDIES9000995106251062
EMPLOYER CONTRIBUTIONS9000992294565822945658
FieldValueIRS element (for citing)
Total Program Service Revenue24293349TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1176885TotalRevenueColumn
Exclusion$1,176,885ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities3075742Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2785827Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities289915Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column289915TotalRevenueColumn
Exclusion$289,915ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
REIMB SAL & RELATED EXP900099277523277523
FROM FV PENSION FUND
FieldValueIRS element (for citing)
Total Other Revenue277523TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column26037672TotalRevenueColumn
Related Or Exempt Function Income24570872RelatedOrExemptFunctionIncome
Exclusion$1,466,800ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total16625170Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total436822Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total148602Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total125760Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total54403Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total190263Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total75117Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total259281Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total798507Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total132399Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total33359Total

Travel Travel

FieldValueIRS element (for citing)
Total2779Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total15946Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total22341Total

Insurance Insurance

FieldValueIRS element (for citing)
Total26368Total

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total18947117Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-8536BOY
EOY-34273EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4951BOY
EOY4956EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2005109BOY
EOY2424195EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY51243BOY
EOY42898EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis308590LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec272700LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY56178BOY
EOY35890EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY43723401BOY
EOY49651853EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY246407BOY
EOY190309EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY46078753BOY
EOY52315828EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY47249BOY
EOY79789EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8437000BOY
EOY8078000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8484249BOY
EOY8157789EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY37594504BOY
EOY44158039EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY37594504BOY
EOY44158039EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY46078753BOY
EOY52315828EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7090555ReconcilationRevenueExpenses
Reconcilation Other Changes-527020ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis40950OtherCostOrOtherBasis
Depreciation40950Depreciation

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis267640OtherCostOrOtherBasis
Depreciation231750Depreciation
Book Value35890BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings35890TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
EST LIAB FUTR CLAIMS INCURRED BUT UNPAID$1,918,000
EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY$6,155,000
DEPOSITS HELD$5,000
FieldValueIRS element (for citing)
Total Of Amounts8078000TotalOfAmounts
Total Revenue26037672TotalRevenue
Total Expenses18947117TotalExpenses
Excess Or Deficit For Year7090555ExcessOrDeficitForYear
Net Unrealized GL On Investments-527020NetUnrealizedGLOnInvestments
Total Adjustments-527020TotalAdjustments
Excess Or Deficit Per FS6563535ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt25510652TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-527020NetUnrealizedGainsInvestments
Revenue Not Rptd F990-527020RevenueNotRptdF990
Revenue Subtotal26037672RevenueSubtotal
Total Revenue Per Form99026037672TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt18947117TotExpensesEtcAuditedFinclStmt
Expenses Subtotal18947117ExpensesSubtotal
Total Expenses Per Form99018947117TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonPATRICIA M SHALESNamePerson
Base Compensation Filing Org110877BaseCompensationFilingOrg
Bonus Filing Org3500BonusFilingOrg
Other Compensation Filing Org5889OtherCompensationFilingOrg
Deferred Comp Filing Org18392DeferredCompFilingOrg
Nontaxable Benefits Filing Org15696NontaxableBenefitsFilingOrg
Total Compensation Filing Org154354TotalCompensationFilingOrg

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part VI, Line 19Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableA 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 VI, Line 15bForm 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key EmployeesTHE 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, Line 12cForm 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsTHE 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, Line 11Form 990, Part VI, Line 11: Form 990 Review ProcessTHE 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1FOX VALLEY & VICINITY LABORERS PENSIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12400 BIG TIMBER ROAD BLDG B 206BAddressLine1
CityELGINCity
StateILState
ZIP Code601247812ZIPCode
FieldValueIRS element (for citing)
EIN366147409EIN
Primary ActivitiesPENSION FUNDPrimaryActivities
Legal Domicile StateILLegalDomicileState
Exempt Code Section401(a)ExemptCodeSection
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg