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FOX VALLEY LABORERS HEALTH AND WELFARE FUND: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
FOX VALLEY LABORERS HEALTH AND WELFARE FUND (EIN 36-6219639)
Tax period
2009-06-01 to 2010-05-31
Filed
2011-01-05
IRS object ID
201140129349300799
Schema version
2009v1.3
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)
Timestamp2011-01-05T12:02:21-08:00Timestamp
Tax Period End Date2010-05-31TaxPeriodEndDate

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 Date2009-06-01TaxPeriodBeginDate

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 Signed2011-01-04DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameAndrew HeinName
Phone3126550037Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts34128425GrossReceipts
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 Employees84TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year25526042ProgramServiceRevenuePriorYear
Program Service Revenue CY21471596ProgramServiceRevenueCY
Investment Income Prior Year-2585104InvestmentIncomePriorYear
Investment Income Current Year2448364InvestmentIncomeCurrentYear
Other Revenue Prior Year216731OtherRevenuePriorYear
Other Revenue Current Year238815OtherRevenueCurrentYear
Total Revenue Prior Year23157669TotalRevenuePriorYear
Total Revenue Current Year24158775TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year26234404BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY14224596BenefitsPaidToMembersCY
Salaries Etc Prior Year630199SalariesEtcPriorYear
Salaries Etc Current Year738225SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1310192OtherExpensePriorYear
Other Expenses Current Year1529533OtherExpensesCurrentYear
Total Expenses Prior Year28174795TotalExpensesPriorYear
Total Expenses Current Year16492354TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-5017126RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7666421RevenuesLessExpensesCY
Total Assets BOY31133766TotalAssetsBOY
Total Assets EOY37469341TotalAssetsEOY
Total Liabilities BOY14834858TotalLiabilitiesBOY
Total Liabilities EOY10533607TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY16298908NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY26935734NetAssetsOrFundBalancesEOY
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 1530 ELIGIBLE PARTICIPANTS AT MAY 31, 2010.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
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
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
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10961769NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees84NumberOfEmployees
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
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
VERN BAUMAN
Trustee3.00X000
TOBY KOTH
Trustee3.00X000
PATRICIA M SHALES
ADMINISTRATOR40.00124051029494X
MIKE SHALES
Chairman3.00X000
JOHN BRYAN SR
TRUSTEE3.00X000
DAN BREJC
Secretary3.00X000
AL OROSZ
Trustee3.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org124051TotalReportableCompFromOrg
Total Other Compensation29494TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
SEI INVESTMENT
ONE FREEDOM DRIVEOAKSPA19456INV MGMNT/CONSULTING159761
HORIZON ACTUARIAL SERVICES LLC
6120 ROLLING ROAD DRIVEMIAMIFL331565629PLAN CONSULTING134483
HEALTH CARE FINEST NETWORK
1315 W 22ND ST STE 300OAK BROOKIL605232062PPO ACCESS FEES143291
DOWD BLOCH & BENNETT
8 SOUTH MICHIGAN AVE 19TH FLOORCHICAGOIL60603LEGAL131251
BLUE CROSS BLUE SHIELD
300 EAST RANDOLPH STCHICAGOIL60601PPO ACCESS FEES332572
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEMBER CONTRIBUTIONS90009914638661463866
MEDICARE D SUBSIDIES9000995289952899
EMPLOYER CONTRIBUTIONS9000991995483119954831
FieldValueIRS element (for citing)
Total Program Service Revenue21471596TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1268568TotalRevenueColumn
Exclusion$1,268,568ExclusionAmount

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)
Securities11149446Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities9969650Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1179796Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1179796TotalRevenueColumn
Exclusion$1,179,796ExclusionAmount

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 EXP900099238815238815
FROM FV PENSION FUND
FieldValueIRS element (for citing)
Total Other Revenue238815TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column24158775TotalRevenueColumn
Related Or Exempt Function Income21710411RelatedOrExemptFunctionIncome
Exclusion$2,448,364ExclusionAmount

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)
Total14224596Total

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)
Total431363Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total136914Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total105037Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total64911Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total178791Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total58912Total

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)
Total205682Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total865656Total

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total122631Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total32624Total

Travel Travel

FieldValueIRS element (for citing)
Total2600Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total16868Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total20450Total

Insurance Insurance

FieldValueIRS element (for citing)
Total25319Total

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16492354Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-461465BOY
EOY54648EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2010607BOY
EOY1578319EOY

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)
BOY64062BOY
EOY54363EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis294274LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec219247LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY70074BOY
EOY75027EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY29373307BOY
EOY35428058EOY

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)
BOY77181BOY
EOY278926EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY31133766BOY
EOY37469341EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY97855BOY
EOY69000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY14737003BOY
EOY10464607EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY14834858BOY
EOY10533607EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY16298908BOY
EOY26935734EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY16298908BOY
EOY26935734EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY31133766BOY
EOY37469341EOY
FieldValueIRS element (for citing)
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
Depreciation28665Depreciation
Book Value12285BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis253324OtherCostOrOtherBasis
Depreciation190582Depreciation
Book Value62742BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings75027TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
EST LIAB FUTR CLAIMS INCURRED BUT UNPAID$2,129,000
EST LIAB FUTR CLAIMS EXTENDED ELIGIBLTY$8,282,000
DUE TO AFFILIATED FUNDS$43,639
DEPOSITS HELD$9,968
FieldValueIRS element (for citing)
Total Of Amounts10464607TotalOfAmounts
Total Revenue24158775TotalRevenue
Total Expenses16492354TotalExpenses
Excess Or Deficit For Year7666421ExcessOrDeficitForYear
Net Unrealized GL On Investments2970405NetUnrealizedGLOnInvestments
Total Adjustments2970405TotalAdjustments
Excess Or Deficit Per FS10636826ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt27129180TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments2970405NetUnrealizedGainsInvestments
Revenue Not Rptd F9902970405RevenueNotRptdF990
Revenue Subtotal24158775RevenueSubtotal
Total Revenue Per Form99024158775TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt16492354TotExpensesEtcAuditedFinclStmt
Expenses Subtotal16492354ExpensesSubtotal
Total Expenses Per Form99016492354TotalExpensesPerForm990

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 Org110113BaseCompensationFilingOrg
Bonus Filing Org3000BonusFilingOrg
Other Compensation Filing Org10938OtherCompensationFilingOrg
Deferred Comp Filing Org15278DeferredCompFilingOrg
Nontaxable Benefits Filing Org14216NontaxableBenefitsFilingOrg
Total Compensation Filing Org153545TotalCompensationFilingOrg

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
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