2011-03-08T14:45:58-06:00 2010-04-30 BANSLEY AND KIENER LLP 8745 WEST HIGGINS ROAD SUITE 200 CHICAGO IL 606312704 990 2009-05-01 510245220 CHICAGO PAINTERS AND DECORATORS WELFARE FUND CHIC 6309603322 333 PIERCE ROAD No 410 ITASCA IL 60143 TERRENCE P FITZMAURICE 6309603322 2011-02-28 1 MICHAEL D HUELS 3122632700 2009 2016-02-24 21:20:13Z TERRENCE P FITZMAURICE 333 PIERCE ROAD ITASCA IL 60143 267400035 0 X N/A X 1953 IL TO PROVIDE HOSPITALIZATION, MEDICAL, AND OTHER RELATED BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS 6 6 0 0 0 0 0 40122617 33560201 1067904 3239350 130514 662132 41321035 37461683 0 36592785 38225939 0 0 0 1789997 1924745 38382782 40150684 2938253 -2689001 83819237 89892483 22917470 23895642 60901767 65996841 SEE BELOW 0 0 TO PROVIDE HOSPITALIZATION, MEDICAL AND OTHER RELATED BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 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 0 0 0 1 1799 0 1 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 Edward OTSTOTT 6309603322 333 PIERCE ROAD NO 410 ITASCA IL 60143 X MARTIN TEW 2.00 X 0 0 0 RICHARD TAMBORSKI 2.00 X 0 0 0 SCOTT HALL 2.00 X 0 0 0 TERRENCE FITZMAURICE 2.00 X 0 0 0 andrew perch 2.00 X 0 0 0 NORBERT SOLTYSIAK 2.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD 300 E RANDOLPH CHICAGO IL 60601 HEALTH CARE PROVIDER 686788 ARNOLD AND KADJAN 19 WEST JACKSON BLVD CHICAGO IL 60604 LEGAL and collection 631765 OBA MIDWEST 333 PIERCE ROAD ITASCA IL 60143 THIRD PARTY ADMINISTRATOR 559632 Unicare 233 S Wacker - Ste 3900 cHICAGO IL 60606 hEALTH CARE PROVIDER 210920 Delta Dental 801 Ogden Avenue Lisle IL 60532 hEALTH CARE PROVIDER 149061 7 EMPLOYER CONTRIBUTIONS 900099 31432860 31432860 EMPLOYEE CONTRIBUTIONS 900099 2127341 2127341 33560201 2298900 2298900 230878802 229938352 940450 940450 940450 COBRA SUBSIDY 900099 652920 652920 MEDICARE REIMBURSEMENT 900099 9212 9212 662132 37461683 34222333 0 3239350 38225939 571095 236383 178277 133039 136430 183142 9910 2820 40278 Collection fees 433371 40150684 221738 363683 3102834 2873311 270900 268285 67724646 68588196 11485690 16946592 1013429 852416 83819237 89892483 139571 140617 22777899 23755025 22917470 23895642 X 0 0 0 0 60901767 65996841 60901767 65996841 83819237 89892483 X 0 1 1 X 0 0 Common Trust Funds 16946592 F 16946592 EMPLOYER BONDS PAYABLE 143295 DUE TO RELATED ORGANIZATIONS 13035 DUE TO BROKER FOR SECURITIES PURCHASED 249651 CLAIMS AND PREMIUMS PAYABLE 903730 CLAIMS INCURRED, NOT REPORTED 1358270 ACCRUED ELIGIBILITY 15731000 FURTURE INSURANCE PREMIUMS 40000 COBRA BENEFITS 4870038 BANK OVERDRAFT 446006 23755025 37461683 40150684 -2689001 7784075 7784075 5095074 45112719 7784075 7784075 37328644 133039 133039 37461683 38034543 0 38034543 133039 1983102 2116141 40150684 Part XIII, Line 4b - Other Adjustments: INCREASE IN CHANGES IN BENEFIT OBLIGATIONS: 1983102. Form 990, Part VI, Section A, line 8b THERE ARE NO OTHER COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11 FORM 990 IS PREPARED BY AN INDEPENDENT CPA AND IS REVIEWED AND APPROVED BY THE FUND REPRESENTATIVE PRIOR TO FILING WITH THE IRS. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS FORM 990 AND FORM 5500 (WHICH INCLUDES AUDITED ANNUAL FINANCIAL STATEMENTS) AND SUMMARY ANNUAL REPORT AVAILABLE FOR INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 2C THE ORGANIZATION'S BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS. THERE HAS BEEN NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR.