TY 2013 Form 990

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	1,785,734	2	2,014,045
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	1,281,791	4	1,194,945
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............		8
9	Prepaid expenses and deferred charges ..........	3,050	9	3,050
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation .....	10b			10c
11	Investments—publicly traded securities ..........	12,736,658	11	14,490,810
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	53,776	15	51,602
16	Total assets. Add lines 1 through 15 (must equal line 34)......	15,861,009	16	17,754,452
	17	Accounts payable and accrued expenses .........	163,745	17	197,291
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................		25
26	Total liabilities. Add lines 17 through 25.........	163,745	26	197,291
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............		27
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........	0	30	0
31	Paid-in or capital surplus, or land, building or equipment fund .....	0	31	0
32	Retained earnings, endowment, accumulated income, or other funds	15,697,264	32	17,557,161
33	Total net assets or fund balances ...........	15,697,264	33	17,557,161
34	Total liabilities and net assets/fund balances ........	15,861,009	34	17,754,452

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

OPERATING ENGINEERS LOCAL NO 965
HEALTH BENEFIT FUND

Employer identification number

36-6121856

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(d) Book value
1a	Land .................
b	Buildings ................
c	Leasehold improvements ............
d	Equipment ................
e	Other .................
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......		0

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes









Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	11,918,267
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	323,828
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	323,828
3	Subtract line 2e from line 1.....................			3	11,594,439
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	65,606
b	Other (Describe in Part XIII.) ...........	4b	263,996
c	Add lines 4a and 4b.......................			4c	329,602
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	11,924,041

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	10,058,370
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	-263,996
e	Add lines 2a through 2d......................			2e	-263,996
3	Subtract line 2e from line 1.....................			3	10,322,366
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	65,606
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................			4c	65,606
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	10,387,972

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	THE PLAN HAS RECOGNIZED IN THE FINANCIAL STATEMENTS THE EFFECTS OF ALL TAX POSITIONS AND CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATIONS, AUDITS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE PLAN IS NOT AWARE OF ANY CIRCUMSTANCES OR EVENTS THAT MAKE IT REASONABLY POSSIBLE THAT UNRECOGNIZED TAX BENEFITS MAY INCREASE OR DECREASE WITHIN 12 MONTHS OF THE DATE OF THE STATEMENT OF NET ASSETS AVAILABLE FOR BENEFITS. PENALTIES AND INTEREST ASSESSED BY TAXING AUTHORITIES ARE INCLUDED IN THE ADMINISTRATIVE EXPENSES, IF APPLICABLE. THERE WERE NO INTEREST OR PENALTIES PAID DURING 2014 OR 2013.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	PRESCRIPTION CLAIMS REBATES
PART XII, LINE 2D - OTHER ADJUSTMENTS:	PRESCRIPTION CLAIMS REBATES

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

OPERATING ENGINEERS LOCAL NO 965
HEALTH BENEFIT FUND

Employer identification number

36-6121856

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2013

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)MIKE ZAHNCHAIRMAN	(i) (ii)	0 115,009	0 0	0 0	0 29,603	0 25,553	0 170,165	0 0
(2)DENNIS MINICKTRUSTEE	(i) (ii)	0 104,111	0 0	0 0	0 29,603	0 25,553	0 159,267	0 0
(3)VINCE SHAWTRUSTEE	(i) (ii)	0 104,111	0 0	0 0	0 29,603	0 25,553	0 159,267	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

OPERATING ENGINEERS LOCAL NO 965
HEALTH BENEFIT FUND

Employer identification number

36-6121856

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11	A COPY OF THE FORM 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED. MIKE ZAHN, CHAIRMAN, REVIEWS THE FORM AND SIGNS IT BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C	EACH NEW EMPLOYEE OR MEMBER OF THE BOARD MUST REVIEW THE CONFLICT OF INTEREST POLICY AND DETAIL ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES THAT COULD BE CONSIDERED A CONFLICT OF INTEREST. ADDITIONALLY, THIS POLICY MUST BE REVIEWED AND FILLED OUT AGAIN BY EMPLOYEES OR BOARD MEMBERS ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19	INFORMATION IS MADE AVAILABLE UPON REQUEST.
FORM 990, PART XII, LINE 2C:	NO CHANGES TO THE OVERSIGHT OR SELECTION PROCESS WERE NOTED DURING THE TAX YEAR.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

OPERATING ENGINEERS LOCAL NO 965
HEALTH BENEFIT FUND

Employer identification number

36-6121856

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) INTERNATIONAL UNION OF OPERATING ENGINEERS LOCAL UNION NO 965 3520 EAST COOK STREET SPRINGFIELD,IL62703 37-0347820	TO REPRESENT MEMBERS OF THE INTERNATIONAL UNION OF OPERATING ENGINEERS.	IL	501(C)(5)				No
(2) IUOE LOCAL 965 PEC 3520 EAST COOK STREET SPRINGFIELD,IL62703 26-2407673	ATTEMPTING TO INFLUENCE ELECTIONS OF LOCAL PUBLIC OFFICES.	IL	527				No
(3) OPERATING ENG APPRENTICESHIP & SKILL IMPROVEMENT COMMMITTEE FOR CENTRAL IL 3208 YOUNG ROAD MECHANICSBURG,IL62545 37-0918073	PROVIDE APPRENTICESHIP TRAINING PROGRAM FOR NEW UNION MEMBERS.	IL	501(C)(3)	SCHOOL	INTERNATIONAL UNION OF OPERATING ENGINEERS LOCAL 965		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) 1 WAY SERVICE INC BLDG		IL
(2) A C JONES TRUCKING INC BLDG		IL
(3) A J WALKER CONSTRUCTION OH		IL
(4) ACCESS CONTROL COMPANY INC OH		IL
(5) ACE CONTRACTING OF IL BLDG		IL
(6) ADVANCED COMMERCIAL ROOFING BLDG		IL
(7) ALBERICI CONSTRUCTORS INC BLDG		IL
(8) ALDRIDGE ELECTRIC INC OH NO PEF		IL
(9) ALLIANCE CONCRETE SAWING BLDG		IL
(10) ANCHORING INC APP CIBIAF PEF DUES		IL
(11) ANDERSON BACKHOE SERVICES OH		IL
(12) ANTIGO CONSTRUCTION OH		IL
(13) ARNOLDS CUSTOM SEEDLING LLC PIPE SPEC PEN NO DC		IL
(14) ASPHALT STONE CO OH		IL
(15) ATLANTIC PLANT MAINT BLDG		IL
(16) B&T DRAINAGE INC OH		IL
(17) BADGER DAYLIGHTING PIPE CUR RATES NO DIAAF OR PEF		IL
(18) BANKS EXCAVATING BLDG		IL
(19) BARNHART CRANE & RIGGING OH		IL
(20) BARR & ROBISON SERVICES INC OO		IL
(21) BEER BROS CONCRETE CUTTING OH NO PEF		IL
(22) BENIACH CONSTRUCTION COMPANY OH		IL
(23) BERCO CONSTRUCTION INC OH		IL
(24) BERCO INDUSTRIAL INC BLDG		IL
(25) BEYERS CONSTRUCTION COMPANY OH		IL
(26) BIERLEIN SERVICES INC BLDG		IL
(27) BIG INCH FABRICATORS PIPE SPECIAL PEN RATE		IL
(28) BLACKHAWK FOUNDATION COMPANY BLDG		IL
(29) BLANKENSHIP CONSTRUCTION CO OH		IL
(30) BLOOMSDALE EXCAVATING CO INC OH		IL
(31) BODINE ELECTRIC OF DECATUROO BLDG		IL
(32) BOLLMEIER CRANE & LIFT OH		IL
(33) BOOTH HEATING AND AIR - GEOTHERMAL BLDG		IL
(34) BRAD AGNEY BACKHOE SERVICE OH		IL
(35) BRANDENBURG DRAINAGE PIPE HW PEN DC APP PEF DUES		IL
(36) BRIESER CONSTRUCTION CO PIPE NO DIAAF CURRATES		IL
(37) BSB DEVELOPMENT INC OH		IL
(38) BUCKHART SAND & GRAVEL COMPANY HEALTH ONLY		IL
(39) BUCKLEYS PRAIRIE LANDSCAPING BLDG		IL
(40) BUDROVICH CONTRACTING OH		IL
(41) BULLOCK BROTHERS EXC OH		IL
(42) BYRNE & JONES ENTERPRISES INC OH		IL
(43) CADY AQUASTORE INC OH		IL
(44) CBS PILING SOLUTIONS BLDG		IL
(45) CENTRAL ILLINOIS TILE CO OH		IL
(46) CENTRAL LANDSCAPING COMPANY OH		IL
(47) CHRISTY-FOLTZ INC BLDG		IL
(48) CITY OF SPRINGFIELD PUBLIC WORKS TEMP		IL
(49) CL RHODES CONCRETE CONSTRUCTION APP DUES		IL
(50) CLEAN CUT TREE SERVICE OH		IL
(51) CLEVENGER CONTRACTORS INC OH		IL
(52) CLOUSE CONCRETE PUMPING OH		IL
(53) CLOYD BUILDERS INC BLDG		IL
(54) CNS FORESTRY & LANDSCAPING LLC OH		IL
(55) COLLINS & HERMANN INC OH		IL
(56) COMMERCIAL IRRIGATION AND TURF BLDG		IL
(57) COMMERCIAL REFRIGERATION OF CENTRAL IL BLDG		IL
(58) COMPLETE ASPHALT SERVICE COMPANY OH		IL
(59) CONCRETE CUTTING & BREAKING CO OH		IL
(60) CONCRETE STRATEGIES OH		IL
(61) COULTER CONSTRUCTION COMPANY OH		IL
(62) COUNTY CONTRACTORS INC OH		IL
(63) COWAN ELECTRIC INC OH		IL
(64) CROSS CONSTRUCTION INC OH		IL
(65) CRYSTAL SEWER & WATER INC OH		IL
(66) CUSTOM CURBS INC BLDG		IL
(67) CUSTOM SERVICE CRANE BLDG		IL
(68) D E GIBBS CONTRACTING BLDG NO HW OR PEN		IL
(69) DAWES RIGGING & CRANE BLDG		IL
(70) DE MARTIN ROOFING BLDG		IL
(71) DEEP FOUNDATIONS LLC OH		IL
(72) DELAURENT CONSTRUCTION OH		IL
(73) DENTON GUNTHER UNDERGROUND OH		IL
(74) DIAMOND CONSTRUCTION COMPANY OH		IL
(75) DREAMSCAPES BY DENNIS OH		IL
(76) DRILLING SERVICE COMPANY OH		IL
(77) DUCE CONSTRUCTION COMPANY BLDG		IL
(78) DUKANE ASPHALT CO OH		IL
(79) DUN TRANSPORTATION&STRINGPIPESPEC HW APP PEF DUES		IL
(80) DUNN COMPANY OH		IL
(81) DYKON BLASTING CORP OH		IL
(82) E J CATTANI & SON OH		IL
(83) EAGLE EXCAVATION INC BLDG		IL
(84) EARTH CARE UNLIMITED INC OH		IL
(85) EDMUND COMPANY OH		IL
(86) EDWARDS CRANE SERVICE BLDG		IL
(87) EILERS EXCAVATING APP DUES		IL
(88) ENERFAB INC GEN PRES AGRMNT INTL NO PEF		IL
(89) ENGINEERING & CONSTRUCTION INNOVATIONS OH		IL
(90) ENTLER EXCAVATING CO INC OH		IL
(91) ERIC M VIEBACK LAND IMPROVEMENT OH NO PEN		IL
(92) EYER CONSTRUCTION INC APP PEF DUES		IL
(93) FALKEN CONSTRUCTION OH		IL
(94) FENCE CONNECTION INC OH		IL
(95) FEUTZ CONTRACTORS INC BLDG		IL
(96) FOLTZ WELDING LTD PIPE DC APP PEF DUES CUR RATES		IL
(97) FOUNDATION SERVICE CORP BLDG		IL
(98) FOUR STAR CONST PIPE HW PEN ANNUITY APP PEF DUES		IL
(99) FREESEN INC OH		IL
(100) FREITAG CONTRACTORS INC OH APP DUES		IL
(101) FUDDCO BLDG		IL
(102) G A RICH & SONS INC BLDG		IL
(103) G M SIPES CONSTRUCTION INC OH		IL
(104) GARDENSCAPE CONTRACTORS INC OH		IL
(105) GARDNER EXCAVATING LLC BLDG		IL
(106) GEEDING CONSTRUCTION INC OH		IL
(107) GFS CONSTRUCTION LLC OH		IL
(108) GLOBAL ENVIRONMENTAL SOLUTIONS PIPE NO DIAAF		IL
(109) GOODMAN EXCAVATION INC OH		IL
(110) GRABER INDUSTRIAL LLC OH		IL
(111) GRE CONSTRUCTION OH		IL
(112) GREAT LAKES DREDGE & DOCKPLA NO APP OLD RATES		IL
(113) GREENTRAC LLC BLDG		IL
(114) GRUNLOH CONSTRUCTION INC OH		IL
(115) H STARK CONSTRUCTION OH		IL
(116) HALVERSON CONSTRUCTION COMPANY OH		IL
(117) HAMEL SUPPLY INC OH		IL
(118) HANNIBAL CRANE SERVICE OH		IL
(119) HARDSURFACING INC OH		IL
(120) HAROLD O'SHEA BUILDERS BLDG		IL
(121) HAYES CONTRACTING OH		IL
(122) HAYWARD BAKER INC BLDG		IL
(123) HELMKAMP CONSTRUCTION BLDG		IL
(124) HENDERSON CONSTRUCTION BLDG		IL
(125) HENRY F TEICHMANN INC BLDG		IL
(126) HILLTOP GARDENS NURSERY AND LANDSCAPE CO HW PEN		IL
(127) HOERR CONSTRUCTION INC OH		IL
(128) HOHULIN BROTHERS FENCE OH		IL
(129) HOMER TREE SERVICE INC OH		IL
(130) HOOD DEMOLITION & EXCAVATION BLDG		IL
(131) HOWARD CONCRETE PUMPING COMPANY INC OH		IL
(132) HOWELL PAVING INC OH		IL
(133) HUPP EXCAVATING OH		IL
(134) HYDRO-EXC INC BLDG		IL
(135) I & I CONSTRUCTION OH		IL
(136) ILLIANA CONSTRUCTION OH		IL
(137) ILLINI DRILLED FOUNDATIONS OH		IL
(138) ILLINOIS CONSTRUCTORS CORP OH		IL
(139) ILLINOIS FOREST PRODUCTS CO INC OH		IL
(140) ILLINOIS VALLEY PAVING CO OH		IL
(141) IMPERIAL CONCRETE CONSTRUCTION OH		IL
(142) INFRASOURCE CONSTRUCTION LLC OH		IL
(143) INSITUFORM TECH USA OH		IL
(144) INTERCON CONSTRUCTION INC OH		IL
(145) INTERRA INNOVATION OH		IL
(146) IUOE LOCAL 965 HEALTHPEFDUES		IL
(147) J C DILLON OH		IL
(148) J F BRENNAN COMPANY OH		IL
(149) J K SNYDER COMPANY INC OH NO PEF		IL
(150) J L NELSON CONSTRUCTION OH		IL
(151) J M BURKE INC BLDG		IL
(152) JAVELINA CONSTRUCTION OH		IL
(153) JCF BRIDGE & CONCRETE INC OH		IL
(154) JOE COLEMAN SALVAGE BLDG		IL
(155) JONES-BLYTHE CONSTRUCTION COMPANY BLDG		IL
(156) K & L EQUIPMENT & MECHANICAL OH NO PEF		IL
(157) K E VAS COMPANY OH		IL
(158) KAMADULSKI EXCAVATING & GRADING OH		IL
(159) KAMKADE CONSTRUCTION BLDG		IL
(160) KIEWIT POWER CONSTRUCTORS CO BLDG		IL
(161) KING-LAR COMPANY BLDG		IL
(162) KINNEY CONTRACTORS INC OH		IL
(163) KISSICK CONSTRUCTION CO OH		IL
(164) KNAPP CONCRETE CONTRACTORS BLDG		IL
(165) KOLB GRADING LLC BLDG		IL
(166) KONECRANES NUCLEAR EQUIP & SERVICES BLDG		IL
(167) KORTE & LUITJOHAN CONTRACTORS OH		IL
(168) KS ENERGY SERIVCES PIPE CURRENT RATES		IL
(169) L KEELEY CONSTRUCTION OH		IL
(170) LAESCH ELECTRIC INC OH		IL
(171) LANEY DIRECTIONAL PIPE SPECIAL APP PEF DUES NO DC		IL
(172) LAVERDIERE CONSTRUCTION INC OH		IL
(173) LAYNE CHRISTENSEN COMPANY OH		IL
(174) LEANDER CONSTRUCTION INC BLDG		IL
(175) LG BARCUS & SONS INC OH		IL
(176) LINCOLNLAND CONCRETE INDEPENDENT		IL
(177) LITTLETON STORM & TIMBER SERVICES INC OH		IL
(178) LOWE'S PAVING & SEALCOATING INC OH		IL
(179) LUHR BROTHERS INC OH		IL
(180) LUKA COMPANY INC OH		IL
(181) LUNDA CONSTRUCTION CO PIPE HW PEN DC APP PEF DUES		IL
(182) LW ROULAND TRUCKING SERVICE INC OH		IL
(183) MACC OF ILLINOIS INC OH		IL
(184) MALTBY EXCAVATING INC OH		IL
(185) MARTIN EQUIPMENT OF ILLINOIS SHOP		IL
(186) MASSMAN CONSTRUCTION		IL
(187) MATHIS & SONS INC OH		IL
(188) MBC EXCAVATING BLDG		IL
(189) MCCLOUGHAN CONTRACTORS OO NO PEF		IL
(190) MCCRITE MILLING & CONSTRUCTION OH		IL
(191) MCINTIRE & COMPANY OH		IL
(192) MCT SERVICES LLC BLDG		IL
(193) MEADE ELECTRIC PIPELINE NO DIAAF OR PEF CURRATES		IL
(194) MECHLING BACKHOE OH		IL
(195) MICHEL CONCRETE CONSTRUCTION BLDG		IL
(196) MICHELS CORP PLA PIPE SPECIAL APP PEF DUES		IL
(197) MID AMERICA UNDERGROUND LLC OH		IL
(198) MID ILLINOIS CONCRETE & EXCAVATION OH		IL
(199) MIDAMERICA SAND & GRAVELCOQUARRY OH		IL
(200) MID-STATES GENERAL & MECHANICAL BLDG		IL
(201) MIDWEST BRIDGE & CRANE INC OH		IL
(202) MIDWEST FENCE CORPORATION OH		IL
(203) MIDWEST FOUNDATION CORPORATION OH		IL
(204) MIDWEST LTD BLDG		IL
(205) MIDWEST MOLE INC PIPE DC APP PEF DUES		IL
(206) MIDWEST SEEDLING SUPPLY OH		IL
(207) MIKE BATEMAN EXCAVATING OH NO PEN		IL
(208) MILLENNIA PROFESSIONAL SERVICES OH		IL
(209) MILLSTONE WEBER LLC OH		IL
(210) MOE'S REPAIR SERVICE BLDG		IL
(211) MT CARMEL STABILIZATION GROUP INC OH		IL
(212) MURPHY PAVING AND SEALCOATING OH		IL
(213) N & W HORIZONTAL BORING COMPANY OH		IL
(214) NASH CRANE SERVICE BLDG		IL
(215) NATIONAL STEEL & GLASS BLDG		IL
(216) NE-CO ASPHALT COMPANY OH		IL
(217) NET INSTALLATIONS DBA HUE LEASING OH		IL
(218) NOKOMIS EXCAVATING & TRUCKING OH		IL
(219) NORTHERN CLEARINGPIPE ANNUITY APP DUES		IL
(220) NOVA CONSTRUCTORS BLDG		IL
(221) OMEGA DEMOLITION PLA BLDG		IL
(222) OPEN ROAD PAVING CO LLC OH		IL
(223) OPERATING ENGINEERS APPRENTICE HW DC DIAAF DUES		IL
(224) OTTO BAUM COMPANY INC OH		IL
(225) OWENS EXCAVATING & TRUCKING OH		IL
(226) P H BROUGHTON & SONS INC OH		IL
(227) PANA LIMESTONE QUARRY COMPANY HEALTH ONLY		IL
(228) PAULY JAIL BUILDING CO BLDG		IL
(229) PEBEN USA PIPE SPECIAL PEN RETE NO DC		IL
(230) PEDIGO SOD INC OH DC APP DIAAF PEF DUES		IL
(231) PERRY BROUGHTON TRUCKING & EXCAVATING OH		IL
(232) PETERSBURG PLUMBING & EXCAVATING OH		IL
(233) PHALTLESS INC DBA TERRA FIRMA OH		IL
(234) PHOENIX CORPORATION OF THE QUAD CITIES OH		IL
(235) PJ HOERR INC BLDG		IL
(236) PLEASANT NURSERY INC OH		IL
(237) PLOCHER CONSTRUCTION CO INC OH		IL
(238) PRAIRIE STATE P & H INC OH		IL
(239) PULLIAM MASONRY INC OO BLDG		IL
(240) Q3 CONTRACTING PIPE SPECIAL PEN NO DC OR PEF		IL
(241) QUALITY CONCRETE REPAIR & EXCAVATING OH OO NO PEF		IL
(242) R D LAWRENCE CONSTRUCTION BLDG		IL
(243) R GINGERICH CRANE BLDG		IL
(244) R L VOLLINTINE CONSTRUCTION INC OO BLDG		IL
(245) RAUSCH CONSTRUCTION CO OH		IL
(246) REES CONSTRUCTION COMPANY OH		IL
(247) RICH GULLET & SONS INC OH		IL
(248) RIVER CITY CONSTRUCTION BLDG		IL
(249) RIVER CITY DEMOLITION OH		IL
(250) RIVERSIDE LANDSCAPING INC OH		IL
(251) RJ UNDERGROUND INC OH		IL
(252) ROBERT KING EXCAVATING OO APP DUES NEW		IL
(253) ROCK SOLID STABILIZATION & RECLAMATION OH		IL
(254) ROLAND MACHINERY COMPANY SHOP		IL
(255) RON HUNSCHE EXCAVATING OH		IL
(256) ROSCH COMPANY OH		IL
(257) RUSS ERLINGER CRANE SERVICE OH		IL
(258) RW DUNTEMAN OH		IL
(259) RYAN INCORPORATED CENTRAL OH		IL
(260) S & S TILING INC FARM		IL
(261) S K DAVISON OH		IL
(262) S&W CONTRACTORS OF IL OH		IL
(263) SAK CONSTRUCTION LLC OH		IL
(264) SALLENGER INC OH		IL
(265) SANGAMO CONSTRUCTION CO OH		IL
(266) SARTO CONTRACTORS BLDG		IL
(267) SCHAEFER CONTRACTING INC OH		IL
(268) SCHECK INDUSTRIAL CORP BLDG NATL MAINT AGREEMT		IL
(269) SCHMIDT CONSTRUCTION INC OH		IL
(270) SCHNABEL FOUNDATION COMPANY OH		IL
(271) SCHOMBURG & SCHOMBURG CONST BLDG		IL
(272) SCOTT'S CRANE RENTAL INC OH		IL
(273) SEITHER AND CHERRY CO PIPELINE NO DIAAF		IL
(274) SELVAGGIO STEEL INC BLDG		IL
(275) SEVENSON ENVIRONMENTAL SERVICES OH		IL
(276) SEXTONS LANSCAPING CONCEPTS INC OH		IL
(277) SHORES BUILDERS INC OH		IL
(278) SICILIANO INC BLDG		IL
(279) SOIL INSTALLERS DBA HELITECH BLDG NO PEF		IL
(280) SPECIALTIES COMPANY LLC OH		IL
(281) SPIRTAS WRECKING COMPANY BLDG		IL
(282) ST COTTER TURBINE SERVICES BLDG		IL
(283) ST JACOB GLASS OH		IL
(284) STARK EXCAVATING INC OH		IL
(285) STATE HIGHWAY CONSTRUCTION OH		IL
(286) STERETT CONSTRUCTION CO OH		IL
(287) STEVENSON CRANE SERVICE INC OH		IL
(288) STONE & WEBSTER GEN PRES AGREEMENT		IL
(289) STUTZ EXCAVATING INC OH		IL
(290) SUBSURFACE CONSTRUCTORS INC BLDG		IL
(291) SUNBELT RENTALS CHAMPAIGN SHOP PEN DUES		IL
(292) SURFACERS INC OH		IL
(293) TARLTON CORPORATION OH		IL
(294) TAYLOR EXCAVATING CO INC OH		IL
(295) TAYLOR RIDGE DRILLED FOUNDATION OH		IL
(296) TERRY BROWN EXCAVATING OH		IL
(297) TERRY LAIBLE EXCAVATING APP PEF DUES		IL
(298) THE RED ANTS BORING CO OH		IL
(299) TMF CONSTRUCTION COMPANY OH		IL
(300) TOOL EXCAVATING OO BLDG		IL
(301) TOP QUALITY ROOFING COMPANY APP DUES		IL
(302) TR SERVICES PIPE HW PEN DC APP PEF DUES		IL
(303) TRUMAN L FLATT & SONS OH		IL
(304) TYCE MAHANNAH EXCAVATING OO APP DUES		IL
(305) UNITED IRONWORKERS INC OH		IL
(306) UNIVERSAL ASPHALT & EXCAVATING OH		IL
(307) US PIPELINE INCPIPE SPECIAL PEN RATE NO DC NO PEF		IL
(308) VALLEY CONSTRUCTION CO OH		IL
(309) VEE-JAY CEMENT CONTRACTING CO OH		IL
(310) V-J CONTRACTORS OH		IL
(311) VULCAN AGGREGATES CO HEALTH ONLY		IL
(312) W & W TRUCKING & EXCAVATING OH		IL
(313) W L ROBERTSON & SONS OH NO PEN		IL
(314) WALSHMIRON JOINT VENTURE BLDG		IL
(315) WAS CON CO OH		IL
(316) WATERKOTTE CONSTRUCTION COMPANY BLDG		IL
(317) WAUBONSEE DEVELOPMENT OH		IL
(318) WESTERN ASPHALT INC OH		IL
(319) WESTERN ILLINOIS FEED LLC HW		IL
(320) WESTERN WATERPROOFING BLDG		IL
(321) WHITE CONSTRUCTION OH		IL
(322) WHITES DOZER SERVICE OH		IL
(323) WILLIAMS BROTHERS CONSTRUCTION BLDG		IL
(324) WILLOUGHBY EXCAVATING ANNUITY APP DIAAF PEF DUES		IL
(325) WINBCO TANK COMPANY BLDG		IL
(326) WINSTEAD EXCAVATING INCOH		IL
(327) WL MILLER CO OH		IL
(328) WORTH CUTTING OH		IL
(329) XTREME SEEDING INC OH		IL

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HEALTH AND TEMPORARY DISABILITY BENEFITS TO QUALIFIED PARTICIPANTS FOR WHOM REQUIRED CONTRIBUTIONS HAVE BEEN MADE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	6
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	5
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	2
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	10,123,836	11,197,197
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	499,900	726,844
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	10,623,736	11,924,041
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	9,014,730	9,835,889
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	591,655	552,083
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	9,606,385	10,387,972
19	Revenue less expenses. Subtract line 18 from line 12.......	1,017,351	1,536,069
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	15,861,009	17,754,452
21	Total liabilities (Part X, line 26).............	163,745	197,291
22	Net assets or fund balances. Subtract line 21 from line 20.....	15,697,264	17,557,161

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	PROVIDE HEALTH AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE MEMBERS

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(1) MIKE ZAHN........................................................................ CHAIRMAN	5.00 .......................	X	X	0	115,009	55,156
(2) DAVID MIFFLIN........................................................................ SECRETARY/TREASURER	2.00 .......................	X	X	0	0	0
(3) ROBERT BRUNER........................................................................ TRUSTEE	1.00 .......................	X		0	0	0
(4) STEVE HALVERSON........................................................................ TRUSTEE	1.00 .......................	X		0	0	0
(5) DENNIS MINICK........................................................................ TRUSTEE	1.00 .......................	X		0	104,111	55,156
(6) VINCE SHAW........................................................................ TRUSTEE	1.00 .......................	X		0	104,111	55,156

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	323,231	165,468

(A) Name and business address	(B) Description of services	(C) Compensation
BENEFITS MANAGEMENT GROUP INC903 COMMERCE DRIVE SUITE 304OAK BROOKIL60523	MANAGE THE BOOKS FOR THE HEALTH BENEFIT	170,400
BLUE CROSS BLUE SHIELD OF ILLINOIS300 EAST RANDOLPH STREETCHICAGOIL60601	PROCESS CLAIMS	170,391



2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 2

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......
			Business Code
2a	EMPLOYER CONTRIBUTION		525100	9,301,479	9,301,479
b	PARTICIPANT CONTRIBUTION		525100	1,629,461	1,629,461
c	PRESCRIPTION CLAIM REBATES		525100	263,996	263,996
d	SUBROGATION		525100	2,261	2,261
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			11,197,197
3	Investment income (including dividends, interest, and other similar amounts).......			454,875	454,875
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	2,081,487
b	Less: cost or other basis and sales expenses	1,809,518
c	Gain or (loss)	271,969
d	Net gain or (loss)..........			271,969	271,969
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions......			11,924,041	11,924,041	0	0

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members	9,835,889
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	13,854
c	Accounting ...........	17,313
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	65,606
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........
12	Advertising and promotion ....
13	Office expenses .......	23,792
14	Information technology ......
15	Royalties ..
16	Occupancy ...........
17	Travel ............	2,527
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....
23	Insurance ..............	6,299
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PPO & WELLNESS PROGRAM	199,919
b	HEALTH PLAN ADMINISTRAT	170,400
c	CONSULTANT FEE	32,388
d	MISCELLANEOUS	19,985
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	10,387,972
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).


			(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			1
2	Savings and temporary cash investments .........		1,785,734	2	2,014,045
3	Pledges and grants receivable, net ...........			3
4	Accounts receivable, net .............		1,281,791	4	1,194,945
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				6
7	Notes and loans receivable, net .............			7
8	Inventories for sale or use ..............			8
9	Prepaid expenses and deferred charges ..........		3,050	9	3,050
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation .....	10b		10c
11	Investments—publicly traded securities ..........		12,736,658	11	14,490,810
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 .....			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........		53,776	15	51,602
16	Total assets. Add lines 1 through 15 (must equal line 34)......		15,861,009	16	17,754,452
17	Accounts payable and accrued expenses .........		163,745	17	197,291
18	Grants payable .................			18
19	Deferred revenue ................			19
20	Tax-exempt bond liabilities .............			20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........			22
23	Secured mortgages and notes payable to unrelated third parties ..			23
24	Unsecured notes and loans payable to unrelated third parties ....			24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			25
26	Total liabilities. Add lines 17 through 25.........		163,745	26	197,291
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			27
28	Temporarily restricted net assets ...........			28
29	Permanently restricted net assets ...........			29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		0	30	0
31	Paid-in or capital surplus, or land, building or equipment fund .....		0	31	0
32	Retained earnings, endowment, accumulated income, or other funds		15,697,264	32	17,557,161
33	Total net assets or fund balances ...........		15,697,264	33	17,557,161
34	Total liabilities and net assets/fund balances ........		15,861,009	34	17,754,452