2012-11-12T10:01:45-06:00 2011-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2011-01-01 362196729 CEMENT MASONS INSTITUTE LOCAL 502 WELFARE TRUST FUND CEME 7085449105 739 25TH AVENUE BELLWOOD IL 60104 PATRICK J LA CASSA 7085449105 2012-11-12 1 BRUCE A PAVLIK P00748405 3123680500 2011 2016-02-24 21:20:13Z PATRICK J LA CASSA 739 25TH AVENUE BELLWOOD IL 60104 24594098 0 X N/A X 1950 IL PROVIDE HEALTH BENEFITS 12 12 19 0 0 0 0 0 8485530 10320364 826663 409396 6964 3258 9319157 10733018 0 0 11599335 10209107 563831 494027 0 0 0 817098 815846 12980264 11518980 -3661107 -785962 26460563 26065331 319757 254252 26140806 25811079 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE MEDICAL AND LIFE INSURANCE TO PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 1 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 0 1 4 0 1 19 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X PATRICK J LA CASSA 7085449105 739 S 25TH AVENUE BELLWOOD IL 60104 X MICHAEL PIRRON 2.00 X 0 0 0 SANDRA HUNT 2.00 X 3892 0 1954 PAUL REDMANN 2.00 X 3934 0 1975 GARY LUNDSBERG 2.00 X 0 0 0 ROBERT KRUG 2.00 X 0 0 0 CURT ERICKSON 2.00 X 3892 0 0 DOMINIC FARRELL 2.00 X 3892 0 1954 DONALD DEETJEN 2.00 X 0 0 0 DONALD MOSS SR 2.00 X 0 0 0 PATRICK WILHARM 2.00 X 0 0 0 RUSSEL SIMONCELLI 2.00 X 0 0 0 MICHAEL KOLBERG 2.00 X 0 0 0 PATRICK LA CASSA 50.00 X X 48235 0 7685 63845 0 13568 0 0 0 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 PPO PROVIDER 318741 GROUP ADMINISTRATORSLTD 915 NATIONAL PARKWAY SCHAUMBURG IL 60173 CONTRACT CLAIMS ADMINISTRATOR 196002 ARNOLD & KADJAN 203 N LASALLE ST STE 1650 CHICAGO IL 60601 LEGAL 138559 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE SUITE 4000 CHICAGO IL 60606 AUDITOR AND PAYROLL COMPLIANCE AUDITOR 117036 4 CONTRACTOR CONTRIB. 900099 9523188 9523188 PARTICIPANT SELF-CONTR 900099 365448 365448 REIMBURSED ADMN EXP 900099 300083 300083 PRESCRIPTION DRUG REBA 900099 101894 101894 MEDICARE PART D SUBSID 900099 29751 29751 10320364 500964 500964 13769512 13861080 -91568 -91568 -91568 MISCALLENOUS INCOME 900099 3258 3258 3258 10733018 10020281 0 712737 10209107 77413 251493 92286 47212 25623 138559 169949 27510 275538 34559 20580 58122 8079 40725 22946 19279 11518980 299812 450522 1399106 1624291 1037315 1127809 87766 81609 179819 134881 54985 44938 16098119 16852836 7483460 5883326 26460563 26065331 319757 254252 319757 254252 X 0 0 0 0 26140806 25811079 26140806 25811079 26460563 26065331 X -785962 456235 X X 0 1 1 X 0 87646 78302 9344 67713 52502 15211 24460 4077 20383 44938 NORTHERN TRUST MONTHLY STRUCTURED SMALL CAP FUND 510511 F NORTHERN TRUST DAILY S&P 500 TAX EXEMPT FUND 5372815 F 5883326 10733018 11518980 -785962 456235 456235 -329727 10861660 456235 456235 10405425 27510 300083 327593 10733018 11191387 0 11191387 27510 300083 327593 11518980 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 LIMITATIONS EXPIRE. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES PART XIII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMINISTRATIVE EXPENSES FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND FUND ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARDS' REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES AND THE FUND ADMINISTRATOR SHALL REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THIS POLICY TAKING ALL STEPS THEY DEEM NECESSARY TO ENSURE SUCH MONITORING AND ENFORCEMENT. FORM 990, PART VI, SECTION B, LINE 15 SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMETNS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. FORM 990, PART VII SECTION A, LINE 1A: THE FUND'S ADMINISTRATOR IS ALSO THE ADMINISTRATOR OF TWO OTHER RELATED ENTITIES. THE WELFARE FUND IS REIMBURSED BY THESE ENTITIES FOR THEIR ALLOCATED PORTION OF HIS SALARY AND SALARY RELATED EXPENSES. THE AVERAGE HOURS PER WEEK REPORTED ON LINE 1A IS THE WEEKLY AMOUNT DEDICATED TO ALL THREE ORGANIZATIONS. IN JUNE 2011, THE FUND'S ADMINISTRATOR WAS APPOINTED TO SERVE AS A TRUSTEE OF THIS FUND AND THE TWO OTHER RELATED ENTITIES. THE FUND ADMINISTRATOR DID NOT RECEIVE A SALARY AND SALARY RELATED EXPENSES AS A TRUSTEE IN THAT CAPACITY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 456,235. FORM 990, SCHEDULES R AND J, AND PART VII: THE INFORMATION NECESSARY TO DETERMINE AND PROPERLY REPORT RELATED ORGANIZATIONS POTENTIALLY REPORTABLE ON SCHEDULES R AND J AND PART VII OF THIS FORM IS NOT DETERMINABLE USING CURRENT FUND RECORDS. THE INFORMATION IS BEING OBTAINED. ONCE THE APPROPRIATE RECORDS ARE AVAILABLE AND REVIEWED, AN AMENDED RETURN MAY BE SUBMITTED TO COMPLY WITH ANY REQUIRED REPORTING. PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 739 25TH AVENUE BELLWOOD IL 60104 516034597 PROVIDE DEATH AND RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 401(A) N/A N/A 0 CEMENT MASONS LOCAL NO 502 SAVINGS FUND 739 25TH AVENUE BELLWOOD IL 60104 366411337 SAVINGS PLAN IL 501(C)(9) N/A N/A 0 CEMENT MASONS LOCAL NO 502 APPRENTICE EDUCATIONAL & TRAINING 739 25TH AVENUE BELLWOOD IL 60104 362487783 TO TRAIN AND EDUCATE APPRENTICES AS CEMENT MASONS. IL 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 N 144482 FMV PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 P 50907 FMV PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 R 9484938 FMV PENSION FUND OF CEMENT MASONS' UNION LOCAL NO 502 Q 87963 FMV CEMENT MASONS LOCAL NO 502 SAVINGS FUND Q 110782 FMV