2024-03-15T11:37:57-05:00 2023-05-31 470900880 CALIBRE CPA GROUP PLLC 230 WEST MONROE ST STE310 CHICAGO IL 60606 990 2022-06-01 361264190 NECA IBEW 176 HEALTH & WELFARE FUND NECA 8157292666 1100 N E FRONTAGE ROAD JOLIET IL 60431 ANDY RICO TRUSTEE 8157292666 2024-03-15 1 ANDY RICO 999009999 0 AARON PLATH P01360263 3126550037 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID RUDER 1100 N E FRONTAGE ROAD JOLIET IL 60431 65617292 0 X N/A X 1975 IL TO PROVIDE MEDICAL, DISABILITY, LIFE, AND AD&D BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 6 3 95 0 0 0 0 0 31415345 31248320 822208 342327 0 0 32237553 31590647 0 0 30260865 30089534 60098 63769 0 0 0 2003537 1794839 32324500 31948142 -86947 -357495 60369090 61398406 28477943 29661115 31891147 31737291 TO PROVIDE MEDICAL, DISABILITY, LIFE, AND AD&D BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 PAYMENTS OF MEDICAL, DENTAL, VISION, DISABILITY, LIFE, AND ACCIDENTAL DEATH & DISMEMBERMENT BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 6 0 1 95 1 0 0 0 0 0 0 0 0 X 6 3 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 X NICHOLE CASSEM 8157292666 1100 NE FRONTAGE ROAD JOLIET IL 60431 DAVID RUDER TRUSTEE 3.00 X 0 0 0 NICK OLSEN TRUSTEE 3.00 6.00 X 0 15502 12669 PAUL ROLIH TRUSTEE 3.00 X 0 0 0 ANDRES RICO TRUSTEE 3.00 40.00 X 0 139244 87102 JEFF KEAST TRUSTEE 3.00 X 0 0 0 RYAN ALDRICH TRUSTEE 3.00 40.00 X 0 73548 44633 0 228294 144404 0 0 1 0 BLUE CROSSBLUE SHIELD 300 E RANDOLPH STREET CHICAGO IL 60601 CLAIMS PAYER/NETWORK 649126 ZENITH-AMERICAN 2625 BUTTERFIELD ROAD OAK BROOK IL 60523 THIRD-PARTY ADMIN 587767 ARNOLD & KADJAN 203 N LASALLE SUITE 1650 CHICAGO IL 60601 LEGAL SERVICES 244405 3 EMPLOYER CONTRIBUTIONS 900099 30791585 30791585 PARTICIPANT CONTRIBUTIONS 900099 456735 456735 31248320 859226 859226 33509746 34026645 -516899 -516899 -516899 31590647 31248320 0 342327 30089534 63769 521996 219162 73677 104883 814089 41722 15897 3413 31948142 6435535 6450841 3926650 4197998 301838 242312 1448445 258130 1270209 1190315 36866923 37323174 11501139 11526559 66796 467207 60369090 61398406 4195843 3688976 24282100 25972139 28477943 29661115 X 0 0 0 0 31891147 31737291 31891147 31737291 60369090 61398406 -357495 203639 0 X X 0 1 X 1 0 1433111 242796 1190315 15334 15334 0 1190315 COMMON COLLECTIVE TRUSTS - NIS 11526559 F 11526559 CLAIMS INCURRED BUT NOT REPORTED 2039000 EXTENDED ELIGIBILITY 12737000 ACCUM PART MED SAV ACCOUNTS 10671700 INSURANCE PREMIUMS DUE 180000 LEASE LIABILITIES 344439 25972139 X 31689403 203639 203639 31485764 104883 104883 31590647 30497659 -1345600 -1345600 31843259 104883 104883 31948142 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE AS A TAX-EXEMPT ORGANIZATION. THE PLAN HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE, AND THE PLAN SPONSOR BELIEVES THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF MAY 31, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. AT MAY 31, 2023, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS PRIOR TO THE YEAR ENDED MAY 31, 2020. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS -1,345,600. 0 0 0 ANDRES RICO TRUSTEE 0 138644 0 0 0 600 0 43071 0 44031 0 226346 0 0 FORM 990, PART VI, SECTION A, LINE 3 LINE 3 EXPLANATION - ZENITH-AMERICAN IS THE THIRD PARTY ADMINISTRATOR HIRED TO ADMINISTER THE FUND'S DAY-TO-DAY OPERATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES AUTHORIZE THE FUND'S THIRD-PARTY ADMINISTRATOR AND A DESIGNATED TRUSTEE TO REVIEW THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES ARE GOVERNED BY THE TRUST DOCUMENT AND A WRITTEN POLICY AND HAVE A FIDUCIARY RESPONSIBILITY UNDER ERISA TO ADMINISTER THE PLAN IN THE BEST INTEREST OF THE MEMBERSHIP. THE U.S. DEPARTMENT OF LABOR REQUIRES ALL LABOR TRUSTEES TO REPORT ON FORM LM-30 POTENTIAL SITUATIONS WHERE THERE MAY BE CONFLICTS OF INTEREST. THIS INFORMATION IS OPEN TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 A SUMMARY ANNUAL REPORT IS DISTRIBUTED TO ALL PARTICIPANTS. PARTICIPANTS ARE ABLE TO REQUEST THE AUDITOR'S REPORT AND OTHER FINANCIAL INFORMATION FROM THE PLAN ADMINISTRATOR AND/OR THE U.S. DEPARTMENT OF LABOR. ALSO, FORM 5500 IS OPEN TO PUBLIC INSPECTION THROUGH THE U.S. DEPARTMENT OF LABOR. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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