2011-04-11T13:56:16-05:00 2010-06-30 legacy professionals llp 311 South Wacker Drive Suite 4000 Chicago IL 60606 990 2009-07-01 366136495 DUPAGE COUNTY CEMENT MASONS WELFARE FUND DUPA 6305307083 240 WEST ST CHARLES ROAD VILLA PARK IL 60181 Jim Rossi 6305307051 2011-04-11 1 3123680500 2009 2016-02-24 21:20:13Z Jim Rossi 240 WEST ST CHARLES ROAD VILLA PARK IL 60181 9594803 0 X N/A X 1965 IL PROVIDE HEALTH BENEFITS 6 6 1 0 0 0 0 3235177 2520865 309184 295016 9832 6318 3554193 2822199 0 3065682 3270420 319154 347977 0 0 345838 311807 3730674 3930204 -176481 -1108005 9709505 8911867 771060 862260 8938445 8049607 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 To provide medical, life, temporary disability, accidental death and dismemberment, prescription drug, dental and vision benefits to eligible participants, dependents and beneficiaries. 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 1 130 0 1 1 1 0 0 0 0 0 0 0 6 6 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X Duane Exline 6305307083 240 WEST ST CHARLES ROAD villa park IL 60181 X mICHAEL DERRICO 1.00 X 0 0 0 rOBERT elliot 1.00 X 0 0 0 rOBERT DANNER 1.00 X 0 4655 1240 steve baumgartner 1.00 X 0 0 0 john hallberg 1.00 X 0 0 0 james rossi 1.00 X 0 0 0 duane exline 22.00 X 0 23760 18343 HAROLD RIFE 22.00 X 0 95715 12635 0 124130 32218 0 0 0 0 blue cross blue shield 300 east randolph street chicago IL 606015099 ppo provider 123888 1 CONTRACTOR CONTRIB. 900099 2393316 2393316 COBRA PAYMENTS 900099 87531 87531 rebate income 900099 40018 40018 2520865 241096 241096 6826524 6772604 53920 53920 53920 MISCELLANEOUS INCOME 900099 6318 6318 6318 2822199 2520865 0 301334 3270420 93128 135220 65665 34979 18985 19029 94641 31207 45936 34510 30754 11308 2411 15300 14256 12455 3930204 1479033 894044 401641 325230 415208 399091 24824 17466 111180 85681 39756 25499 5878346 5870914 1470697 1379623 9709505 8911867 23081 38599 747979 823661 771060 862260 X 0 0 0 0 8938445 8049607 8938445 8049607 9709505 8911867 X 0 1 1 X 0 61221 44645 16576 49959 41036 8923 25499 Comerica Large Cap Index Fund 1379623 F 1379623 Due to Related Organizations 581986 Amounts Held in Escrow 28877 DUE TO BROKER 212798 823661 2822199 3930204 -1108005 219167 219167 -888838 3010159 219167 219167 2790992 31207 31207 2822199 3898997 0 3898997 31207 31207 3930204 Part X: Description of Uncertain Tax Positions Under FIN 48: 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 8b The Fund has no committees with the authority to act on behalf of the trustees. 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 board's review, the form is approved and filed. Form 990, Part VI, Section C, line 19 The governing documents and financial statements are available to any participant in the plan upon request at the fund office. FORM 990, PART VII, SECTION A, COLUMN E: SALARIES AND BENEFITS ARE ORIGINALLY PAID BY THE CEMENT MASONS 803 PENSION FuND, A RELATED ENTITY, AND THEN REIMBURSED BY THE welfare FUND. W-2S ARE ISSUED BY CEMENT MASONS 803 PENSION FUND. FORM 990, PART VI, SECTION B, LINE 15: The salaries are paid by a related entity. The organization reimburses the related entity for its allocated portion of salaries. Salaries are annually reviewed and approved by the Board of Trustees. Cement Masons Local 803 Pension Fund 240 W St Charles Road Villa Park IL 60181 366136495 To provide retirement and disability benefits for eligible participants IL 401(a) N/A N/A Dupage County Cement Masons 803 Apprentice Fund 240 W St Charles Road villa Park IL 60181 366541537 To provide a training program for apprentices IL 501(c)5 N/A N/A Dupage county vacation savings fund 240 W St Charles Road villa Park IL 60181 364510669 To provide employees with savings benefits IL 501(c)9 N/A N/A 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 Cement Masons Local 803 Pension Fund N 344541