TY 2020 Form 990

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CENTRAL ILLINOIS CARPENTERS HEALTH
AND WELFARE FUND

Employer identification number

37-1117215

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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" on 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 7/25/06, 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 FASB 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)

Revenue included on 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 FASB ASC 958 relating to these items:

Revenue included on 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) 2020

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability? ...

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(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

Term endowment SchDMd Bullet

The percentages on 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" on 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" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	70,014		70,014
b	Buildings ....	665,256	267,485	397,771
c	Leasehold improvements			0
d	Equipment ....	679,024	437,474	241,550
e	Other .....	32,838	32,838	0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				709,335

Schedule D (Form 990) 2020

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on 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........
(3) Other (A) POOLED SEPARATE ACCOUNT	3,471,365	F
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	3,471,365

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on 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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	20,789,453
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) 2020

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	32,214,962
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	4,337,131
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	4,337,131
3	Subtract line 2e from line 1..................			3	27,877,831
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	90,730
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	90,730
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	27,968,561

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	24,875,799
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
e	Add lines 2a through 2d....................			2e	0
3	Subtract line 2e from line 1...................			3	24,875,799
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	90,730
b	Other (Describe in Part XIII.) ............	4b	-199,104
c	Add lines 4a and 4b.....................			4c	-108,374
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	24,767,425

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 TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE DATED AUGUST 27, 1982, AND THE PLAN'S BOARD OF TRUSTEES BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. THE TOTAL AMOUNTS OF INTEREST AND PENALTIES RECOGNIZED IN THE STATEMENTS OF CHANGES IN NET ASSETS AVAILABLE FOR BENEFITS AND THE TOTAL AMOUNTS OF INTEREST AND PENALTIES RECOGNIZED IN THE STATEMENTS OF NET ASSETS AVAILABLE FOR BENEFITS ARE $0. 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 ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2020 AND 2019, THERE ARE NO UNCERTAIN TAX 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. THE PLAN HAS NEVER HAD UNRELATED BUSINESS INCOME TAX (UBIT). FOR YEARS IN WHICH THE FORM 990-T HAS BEEN FILED, THOSE YEARS ARE OPEN FOR EXAMINATION FOR THREE YEARS FROM THE DATE OF THE FILING. ALL OTHER TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	CHANGE IN CLAIMS INCURRED BUT NOT REPORTED -229,896. CHANGE IN ACCUMULATED ELIGIBILITY 30,792.

Return Reference

Explanation

PART X, LINE 2:

THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE DATED AUGUST 27, 1982, AND THE PLAN'S BOARD OF TRUSTEES BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. THE TOTAL AMOUNTS OF INTEREST AND PENALTIES RECOGNIZED IN THE STATEMENTS OF CHANGES IN NET ASSETS AVAILABLE FOR BENEFITS AND THE TOTAL AMOUNTS OF INTEREST AND PENALTIES RECOGNIZED IN THE STATEMENTS OF NET ASSETS AVAILABLE FOR BENEFITS ARE $0. 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 ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2020 AND 2019, THERE ARE NO UNCERTAIN TAX 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. THE PLAN HAS NEVER HAD UNRELATED BUSINESS INCOME TAX (UBIT). FOR YEARS IN WHICH THE FORM 990-T HAS BEEN FILED, THOSE YEARS ARE OPEN FOR EXAMINATION FOR THREE YEARS FROM THE DATE OF THE FILING. ALL OTHER TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES.

PART XII, LINE 4B - OTHER ADJUSTMENTS:

CHANGE IN CLAIMS INCURRED BUT NOT REPORTED -229,896. CHANGE IN ACCUMULATED ELIGIBILITY 30,792.

Schedule D (Form 990) 2020

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2020

Open to Public
Inspection

Name of the organization

CENTRAL ILLINOIS CARPENTERS HEALTH
AND WELFARE FUND

Employer identification number

37-1117215

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11B	THE AUDITOR PROVIDES THE COMPLETED FORM TO THE PLAN ADMINISTRATOR FOR REVIEW. ONCE THE PLAN ADMINISTRATOR HAS APPROVED THE FORM, SHE SIGNS FORM 8879 AND SENDS IT BACK TO THE AUDITOR, WHO THEN ELECTRONICALLY FILES THE RETURN.
FORM 990, PART VI, SECTION C, LINE 19	UPON REQUEST

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2020

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2020

Open to Public Inspection

Name of the organization

CENTRAL ILLINOIS CARPENTERS HEALTH
AND WELFARE FUND

Employer identification number

37-1117215

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)BOARD OF TRUSTEES SEE PART VII FOR LISTING

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

Cat. No. 50135Y

Schedule R (Form 990) 2020

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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) SEE PART IV

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) 4MC CORPORATION
(2) A & R SERVICES INC
(3) A M KERNS CONSTRUCTION LLC
(4) AALCO MANUFACTURING COMPANY
(5) ACOUSTICAL CEILING SPECIALIST
(6) ACOUSTICAL CEILINGS INC
(7) AECOM ENERGY & CONSTRUCTION
(8) AFL-AGC BUILDING TRADES
(9) AIRTITEE&K CHICAGO
(10) AL SMITH MECHANICAL LTD
(11) ALBERICI CONSTRUCTORS
(12) ALLENDALE GRAVEL CO INC
(13) ALLIED CONSTRUCTION
(14) ALLIED POWER SERVICES LLC
(15) AME CONSTRUCTORS INC
(16) APACHE INDUSTRIAL UNITED
(17) APCOM POWER INC
(18) ASSOCIATED CONSTRUCTORS CO IN
(19) ATLANTIC PLANT MAINTENANCE
(20) AUPPERLE WILLIAM & SONS INC
(21) AZCO INC
(22) BADGER SWIMPOOLS INC
(23) BALLARD-TAYLORR JV
(24) BARBER & DEATLEY INC
(25) BARTON MALOW COMPANY
(26) BEAR CONSTRUCTION COMPANY
(27) BENCHMARK CABINETS & MILLWORK
(28) BERCO CONSTRUCTION INC
(29) BEYNON SPORT SURFACES INC
(30) BIG O SERVICES LLC
(31) BISHOP BROTHERS INC
(32) BISMARCK-MANDAN CARPENTERS
(33) BORCHERS' DECORATING
(34) BOWEN ENGINEERING CORPORATION
(35) BRANDSAFWAY INDUSTRIES LLC
(36) BROCK INDUSTRIAL SERVICES
(37) BROEREN RUSSO CONSTRUCTIONIN
(38) BRUCE CONCRETE CONST INC
(39) BUILDERS SALES & SERVICE CO
(40) BVCI
(41) BYRNE & JONES CONSTRUCTION
(42) CH GARMONG AND SON INC
(43) CL RHODES CONCRETE CONST CO
(44) CAD CONSTRUCTION
(45) CADEIRA GROUP (THE)
(46) CARPENTERS & JOINERS-ANNUITY
(47) CARPENTERS & MW ANNUITY FUND
(48) CARPENTERS ANNUITY - DETROIT
(49) CARPENTERS ANNUITY FUND
(50) CARPENTERS ANNUITY TRUST FUND
(51) CARPENTERS FUND NORTHERN CALI
(52) CARPENTERS H & W TRUST FUND
(53) CARPENTERS H&W FUND OF PHILAD
(54) CARPENTERS HEALTH FUND OF WV
(55) CARPENTERS LOCAL #237
(56) CARPENTERS LOCAL #243
(57) CARPENTERS LOCAL #270
(58) CARPENTERS LOCAL 496 SUPP RET
(59) CARPENTERS TRUST OF WESTERN W
(60) CARPENTERS' H&W OF ST LOUIS
(61) CARPET WEAVERS COMMERCIAL IN
(62) CARR FLOORING LLC
(63) CASE BUILDING SOLUTIONS LLC
(64) CECO CONCRETE CONSTRUCTIONLL
(65) CEILING TILE SERVICES
(66) CENTENNIAL CONTRACTORS
(67) CENTRAL CEILING SYSTEMS INC
(68) CENTRAL IL COMMERCIAL FLOORIN
(69) CENTRAL STATES CONSTRUCTION
(70) CHICAGO DC - ANNUITY
(71) CHICAGO DC - WELFARE
(72) CHICAGO RC - SOUTHERN REGION
(73) CHRISTY-FOLTZ
(74) CITY WATER LIGHT POWER-PMC
(75) CJI INC
(76) CLARK CORPORATION
(77) CLOYD BUILDERS INC
(78) CMF GROUP
(79) COM'L FLOORING INSTALLATION
(80) COMMERCIAL BUILDERS
(81) COMPLETE VALVE REPAIR SRVCS
(82) CONSTRUCTION IND FUND(ROCKFOR
(83) CONSTRUCTION IND RETIREMENT
(84) CONTEGRA CONSTRUCTION CO LLC
(85) CONTOUR SYSTEMS CORPORATION
(86) CONVEYING CONVENIENCE INC
(87) CORE CONSTRUCTION
(88) COSGROVE CONSTRUCTION INC
(89) COUNTRY BOYS CONSTRUCTION LLC
(90) COUNTY CONTRACTORS
(91) CRAFT CONSTRUCTION LLC
(92) CULVER DEVELOPMENT
(93) CUSHING'S COMMERCIAL CARPETS
(94) CUSTOM SERVICE CRANE INC
(95) D CONSTRUCTION
(96) D JOSEPH CONSTRUCTION CO
(97) DE MARTIN ROOFING INC
(98) DASHCOINC DBA RAINGUARD
(99) DAVID M SCHMITT AKA
(100) DAVIS & DAVIS GENERAL CONST
(101) DEPEW & OWEN BUILDERS INC
(102) DETROIT CARP WELFARE FUND-MRC
(103) DRAPERY INSTALLATION SPEC IN
(104) DUCE CONSTRUCTION CO INC
(105) DUKE & DUKE CONSTRUCTION CO
(106) DURR SYSTEMS
(107) EE INSTALLATIONS
(108) ENGLISH BROTHERS COMPANY
(109) EPIK INDUSTRIAL LLC
(110) EPPEL & CO INC
(111) EVAN & RYAN ELECTRICAL CONTR
(112) EVANS CONSTRUCTION COMPANY
(113) FH PASCHEN SN NIELSEN
(114) FELMLEY DICKERSON CO
(115) FINELINE
(116) FIRE STOP TECHNOLOGIES
(117) FIRST BUILD ASSOCIATES INC
(118) FIVE RIVERS CARPENTERS H&W
(119) FIXTURE CONTRACTING INC
(120) FLANNIGAN CONTRACTING LLC
(121) FLOORING SYSTEMS INC
(122) FLORIDA MILLWRIGHTS ANNUITY
(123) FLORIDA UBC HEALTH FUND
(124) FLUOR MAINTENANCE SERVICE
(125) FOSLER CONSTRUCTION
(126) FRANK MILLARD & CO INC
(127) FRED SHOWALTER CONST INC
(128) FREESEN A DIV OF UNITED
(129) FREITAG-WEINHARDT INC
(130) FRIEND ACOUSTICAL CEILING CO
(131) GA RICH & SONS INC
(132) GEORGE H RUMP CONSTR CO
(133) GEORGE ROTHAN COMPANY
(134) GIVSCO CONSTRUCTION COMPANY
(135) GLOBAL SCAFFOLD CONST SERVICE
(136) GLOBAL WIND SERVICE US
(137) GOLEY INC
(138) GOULD FLOORING SERVICES INC
(139) GRAYCOR INDUSTRIAL CONSTRUCTO
(140) GREATER PENNSYLVANIA ANNUITY
(141) GREATER PENNSYLVANIA HEALTH
(142) GRP MECHANICAL CO INC
(143) GRUNLOH CONSTRUCTION INC
(144) GUNTHER CONSTRUCTION CO
(145) H & H BUILDERS INC
(146) H & S MECHANICAL INC
(147) HALVERSON CONSTRUCTION INC
(148) HALYARD CORPORATION
(149) HARDSURFACING INC
(150) HAROLD O'SHEA BUILDERS
(151) HART CONSTRUCTION SUPPLY INC
(152) HART ERECTORS INC
(153) HAYES MECHANICAL INC
(154) HEARTLAND HEATHCARE FUND
(155) HEIN CONSTRUCTION CO INC
(156) HELMKAMP CONSTRUCTION CO
(157) HOELSCHER INTERIORS INC
(158) HOELSCHER WOODWORX UNLIMITED
(159) HOERR P J INC
(160) HOWELL ASPHALT & PAVING INC
(161) HUIZINGA BROS CONST CO INC
(162) HUNTER CONSTRUCTION SERVICES
(163) IBUILDERS CORP
(164) ICC GROUP INC
(165) ICON INDUSTRIAL SERVICES
(166) ILLINI SUPPLY INC
(167) ILLINOIS CIVIL CONTRACTORS IN
(168) ILLINOIS STATE UNIVERSITY
(169) IMPERIAL CONCRETE CO INC
(170) INKYOH RCC DEFINED CONTR FN
(171) INDIANAKENTUCKY CARPENTERS
(172) INSTALLATION SPECIALISTS INC
(173) INTEGRITY CONCRETE & EXC
(174) INTERIOR CONSTRUCTION SVCS
(175) INTERIOR SPECIALTY CONST INC
(176) INTERNATIONAL QUALITY CONT
(177) INTERNATIONAL SPORT SURFACES
(178) IROQUOIS PAVING CORPORATION
(179) J G STEWART CONTRACTOR INC
(180) J LANE COMMERCIAL FLOORS LLC
(181) J SPENCER CONSTRUCTION LLC
(182) JF BRENNAN CO INC
(183) JH FINDORFF & SON INC
(184) JAY HENGES ENTERPRISES INC
(185) JOHN BURNS CONSTRUCTION CO
(186) JOHNCO CONSTRUCTION INC
(187) JOHNSON BROTHERS CORP
(188) JOINER SHEET METAL & ROOFING
(189) JONES & SULLIVAN
(190) JONES-BLYTHE CONSTRUCTION CO
(191) JUN CONSTRUCTION
(192) JUST RITE ACOUSTICS
(193) KB LOGUE CONTRACTING INC
(194) KAMP COMPANY (THE)
(195) KANKAKEE VALLEY CONSTRUCTION
(196) KEEN COMPANY INC
(197) KEMPER CONSTRUCTION INC
(198) KEVIN NUGENT CONSTRUCTION INC
(199) KIEFER SPECIALTY FLOORING
(200) KIEWIT INFASTRUCTURE CO (POWE
(201) KINGSTON TILE CO LTD
(202) KINNEY CONTRACTORS INC
(203) KNAPP CONCRETE CONTRACTORS
(204) KNIGHT FLOORING INC
(205) KNUDSEN CONSTRUCTION INC
(206) KO-ON SERVICES
(207) KORTE & LUITJOHAN CONTRACTORS
(208) KWCC INC
(209) L KEELEY CONSTRUCTION CO
(210) LAKES AND RIVERS CONTRACTING
(211) LANDGREBE INTERIOR CONST
(212) LANKFORD CONSTRUCTION COMPANY
(213) LAVERDIERE CONSTRUCTION INC
(214) LEANDER LAND COMPANY
(215) LESCO DESIGN & MANUFACTURING
(216) LIMBAUGH CONSTRUCTION CO INC
(217) LITTEKEN CONSTRUCTION COMPANY
(218) LRB CONSTRUCTION INC
(219) LYNCHCO CONSTRUCTION INC
(220) M A MORTENSON GENERAL CONTR
(221) MAS RIGGING
(222) MATRIX SERVICE INDUSTRIAL
(223) MCCARTHY IMPROVEMENT COMPANY
(224) MCCOY CONSTRUCTION COMPANY
(225) MCDOWELL BUILDERS INC
(226) MCGRATH & ASSOCIATES INC
(227) MICHELS FOUNDATIONS A DIV
(228) MICHUDA CONSTRUCTION
(229) MID ILLINOIS CONCRETE &
(230) MID-AMERICA SYSTEMS INC
(231) MID-ATLANTIC CARP ANNUITY FUN
(232) MID-ATLANTIC CARP H&W FUND
(233) MID-CENTRAL IL RC-JATC
(234) MID-CENTRAL IL RC-JATC
(235) MID-ILLINOIS COMPANIES CORP
(236) MID-SOUTH CARPENTERS RC H&W
(237) MIDDENDORF & REUSS CONST
(238) MIDWEST ASPHALT COMPANY
(239) MIDWEST CONCRETE INC
(240) MIDWEST DIVE SERVICE DBA
(241) MIDWEST SPORT AND TURF SYSTEM
(242) MILLWRIGHT 1102 ANNUITY
(243) MILLWRIGHT SERVICE INC
(244) MISSOURI FLOOR CO
(245) MORRISSEY CONSTRUCTION CO
(246) MR DAVID'S CARPET SERVICE LTD
(247) NE FINCH CO
(248) NEFF COLVIN INC
(249) NEVERMAN FLOOR ARTISANS INC
(250) NORTH CENTRAL STATES RC(AN)
(251) NORTH CENTRAL STATES RC(WL)
(252) NORTH TEXAS CARP RETIREMENT
(253) NORTHEAST CARPENTERS ANNUITY
(254) NORTHEAST CARPENTERS WELFARE
(255) NOVAK CONSTRUCTION COMPANY
(256) NW OHIO CARPENTERS-ANNUITY
(257) OHIO CARPENTERS ANNUITY FUND
(258) OHIO CARPENTERS H&WTRANSFER
(259) OLYMPIC CONSTRUCTION CO LLC
(260) OREGON WASHINGTON CARPENTERS
(261) OTTO BAUM COMPANY INC
(262) PARAMOUNT MILLWRIGHT SERVICES
(263) PARIC CORPORATION
(264) PEORIA CIVIC CENTER
(265) PEORIA HOUSING AUTHORITY
(266) PEORIA METRO CONSTRUCTION INC
(267) PEREZ & ASSOCIATES INC
(268) PERFORMANCE CONTRACTING
(269) PETERSBURG PLMBG & EXCAVATING
(270) PETRY-KUHNE COMPANY
(271) PHIL SCHINDLER & SONS INC
(272) PHOENIX CORPORATION OF THE
(273) PIGGUSH SIMONEAU INC
(274) PINTER GENERAL CONTRACTING
(275) PLATINUM SCAFFOLDING SERVICES
(276) PLOCHER CONSTRUCTION CO
(277) POETTKER CONSTRUCTION COMPANY
(278) POWER TECHNIQUES
(279) PRECISION BUILDERS
(280) PRECISION BUILDERS & ASSOCIAT
(281) PRECISION COOLING TOWERS INC
(282) PRECISION FURNITURE INSTALL
(283) PRICELESS FLOORS INC
(284) PRODIGY CONSTRUCTION LLC
(285) PROSTAR SURFACES INC
(286) PSC MILLWRIGHT SERVICES LLC
(287) QUAD CITY ACOUSTICAL CEILINGS
(288) RD LAWRENCE CONSTRUCTION CO
(289) RG CONSTRUCTION SERVICES IN
(290) RJ UNES INC
(291) RATHBUN & SON CARPENTRY INC
(292) RAVENSBERG INC
(293) RCS CONSTRUCTION INC
(294) REDBUD RIDGE CUSTOM SHOP INC
(295) RICE EQUIPMENT
(296) RICHARD GOETTLE INC
(297) RICHARDET FLOOR COVERING
(298) RINGLAND JOHNSON CONSTRUCTION
(299) RIVER CITY CONSTRUCTION
(300) RIVER VALLEY CONSTRUCTION
(301) RIVERSIDE INTERIORS LLC
(302) RIVERSIDE WOODWORKING INC
(303) ROECKER CABINETS-COM'L DIV
(304) ROULAND TRUCKING
(305) ROYAL CONSTRUCTION SERVICES
(306) S & H FLOORCOVERING INC
(307) ST COTTER TURBINE SVCS INC
(308) SAFWAY - DAVENPORT IA
(309) SAMRON MIDWEST CONTRACTINGIN
(310) SANGAMO CONSTRUCTION COMPANY
(311) SCHLEIS FLOOR COVERING INC
(312) SCHOMBURG & SCHOMBURG CONST
(313) SCOTT RICHMAN CONSTRUCTION
(314) SEITHER & CHERRY - KEOKUK
(315) SENCO CONSTRUCTION INC
(316) SERVICE DRYWALL COMPANY
(317) SHORES BUILDERS INC
(318) SICILIANO INC
(319) SIEMENS GENERATION SERVICES
(320) SIGNATURE CRAFT
(321) SNS CONSTRUCTION SERVICES INC
(322) SOLID PLATFORMS INC
(323) SOPER CONSTRUCTION
(324) SOUTHEASTERN CARPENTERS-AN
(325) SOUTHEASTERN CARPENTERS-HW
(326) SOUTHERN ILLINOIS CABINETS
(327) SOUTHWEST CARPENTERS H&W TRUS
(328) ST JOHNS HOSPITAL
(329) ST LOUIS BRIDGE CONSTRUCTION
(330) ST LOUIS KC REG ANNITY FUND
(331) STARK EXCAVATING INC
(332) STRODE CONSTRUCTION LLC
(333) STUTZ EXCAVATING INC
(334) SYSTEMS ENTERPRISE
(335) T&G CONSTRUCTION OF STILLWATE
(336) TAYLOR BROS CONST CO INC
(337) TEPRAC INC
(338) TEXAS CARPENTERS & MILLWRIGHT
(339) THATCHER FOUNDATIONS INC
(340) THE BOLDT COMPANY
(341) THIENEMAN CONSTRUCTION INC
(342) THOMPSON BROTHERS INC
(343) TIEMAN BUILDERS INC
(344) TIM LIPE CONSTRUCTION INC
(345) TIPTON CONCRETE CONSTRUCTION
(346) TJ WIES CONTRACTING
(347) TMF CONSTRUCTION
(348) TOBEYS CONSTR & CARTAGE
(349) TOMMY LEE ARBUCKLE III
(350) TRACK SURFACES COMPANY
(351) TRADE-MARK CONST SERVICES IN
(352) TSI COMMERCIAL FLOOR COVERING
(353) TURBINE PROS
(354) TWIN CITY CARPENTERS H&W
(355) UNION FLOORING SERVICES INC
(356) UNION SITE SERVICES LLC
(357) UNIVERSAL PLANT SERVICES
(358) US INSULATION LLC (GOLEY IND)
(359) VALLEY CONSTRUCTION COMPANY
(360) VANGUARD CONTRACTORS INC
(361) VERMILION MILLWORKS LLC
(362) VIGO INTERIORS
(363) VISSERING CONSTRUCTION
(364) VON ALST OPERATING LLC
(365) WAGNER INSULATION
(366) WATER COOLING EQUIPMENT INC
(367) WATERHOUT CONSTRUCTION INC
(368) WATERKOTTE CONSTRUCTION INC
(369) WEEDMAN DOOR & HARDWARE
(370) WENGER TRAFFIC CORPORATION
(371) WESTPORT POOLS INC
(372) WHEELER CONSTRUCTION CO
(373) WHITE CONSTRUCTION INC
(374) WICK CONCRETE
(375) WIES DRYWALL AND CONSTRUCTION
(376) WIL-BOND CONSTRUCTION LLC
(377) WILLIAMS BROS CONST INC
(378) WINGLE CONSTRUCTION
(379) WOODS CONSTRUCTION INC
(380) WRIGHT-WAY INTERIOR SYS LLC
(381) ZOBRIST N & SONS INC

Schedule R (Form 990) 2020

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) 2020

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2020

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation
PART IV	THIS PLAN IS A VEBA EXEMPT UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE. PER THE INSTRUCTIONS FOR SCHEDULE R, VEBA TRUSTS ARE ONLY REQUIRED TO LIST THE NAMES OF THE SPONSORING ORGANIZATIONS AND CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE PLAN DOES NOT KNOW THE TAXABLE STATUS OF EVERY CONTRIBUTING EMPLOYER AND THEREFORE IS UNABLE TO SPLIT UP THE INFORMATION BETWEEN THE VARIOUS SECTIONS OF SCHEDULE R.

Return Reference

Explanation

PART IV

THIS PLAN IS A VEBA EXEMPT UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE. PER THE INSTRUCTIONS FOR SCHEDULE R, VEBA TRUSTS ARE ONLY REQUIRED TO LIST THE NAMES OF THE SPONSORING ORGANIZATIONS AND CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE PLAN DOES NOT KNOW THE TAXABLE STATUS OF EVERY CONTRIBUTING EMPLOYER AND THEREFORE IS UNABLE TO SPLIT UP THE INFORMATION BETWEEN THE VARIOUS SECTIONS OF SCHEDULE R.

Schedule R (Form 990) 2020

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: HEALTH AND WELFARE PLAN
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2020 (Part V, line 2a) ......	5	43
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 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	27,092,382	26,506,077
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,129,982	1,154,819
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	397,282	307,665
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	28,619,646	27,968,561
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).....	25,221,724	22,982,270
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	647,219	674,225
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)....	1,187,308	1,110,930
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	27,056,251	24,767,425
19	Revenue less expenses. Subtract line 18 from line 12.......	1,563,395	3,201,136
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	59,334,892	66,773,838
21	Total liabilities (Part X, line 26).............	22,165,575	22,066,254
22	Net assets or fund balances. Subtract line 21 from line 20.....	37,169,317	44,707,584

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	TO PROVIDE HEALTH & WELFARE BENEFITS TO 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) NATHAN GERMAN...................................................................... CHAIRMAN	0.00 .................	X	X	0	0	0
(2) CARL BIMM...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(3) RANDY JOHNSON...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(4) JOHN SUTHERLAND...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(5) JASON BREWER...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(6) JEFF FUERST...................................................................... SECRETARY	0.00 .................	X	X	0	0	0
(7) STEVE AUPPERLE...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(8) RIKI DIAL...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(9) MATT BENDER...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(10) JOE HART...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(11) JEFF BORT...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(12) JOSH ROBERTSON...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(13) MIKE SUNLEY...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(14) NICK HART...................................................................... TRUSTEE	0.00 .................	X		0	0	0
(15) MELISSA SALLEE OHL...................................................................... ADMIN	40.00 .................		X	99,432	0	26,935

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	99,432	0	26,935

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

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 above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	EMPLOYER CONTRIBUTIONS	900099	23,934,033	23,934,033
b	PARTICIPANT CONTRIBUTIONS	900099	2,572,044	2,572,044
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		26,506,077

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,020,792			1,020,792
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		8,899,024	7a
b	Less: cost or other basis and sales expenses		8,764,997	7b
c	Gain or (loss)		134,027	7c
d	Net gain or (loss).........			134,027			134,027
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	SERVICE FEE		900099	166,642	166,642
b	REIMBURSEMENT FROM RSF		900099	110,501	110,501
c	EXPENSE REIMBURSED		900099	18,692	18,692
d	All other revenue ....			11,830	11,830
e	Total. Add lines 11a–11d ......			307,665
12	Total revenue. See instructions.....			27,968,561	26,813,742	0	1,154,819

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......	22,982,270
5	Compensation of current officers, directors, trustees, and key employees ...........	126,594
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........	323,840
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	58,029
9	Other employee benefits .......	124,897
10	Payroll taxes ...........	40,865
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	95,573
c	Accounting ...........	24,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	90,730
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	179,938
12	Advertising and promotion ....
13	Office expenses .......	151,762
14	Information technology ......	103,782
15	Royalties ..
16	Occupancy ...........	35,161
17	Travel ............	3,358
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 ..	52,947
23	Insurance ...	26,737
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	BCBS ADMINISTRATIVE FEE	304,067
b	VISION ADMINISTRATIVE E	28,513
c	PCORI FEES	12,678
d	MEMBERSHIP DUES	1,684
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	24,767,425
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).

1	Cash–non-interest-bearing ........			500	1	500
2	Savings and temporary cash investments .........			11,029,043	2	9,703,554
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			3,184,274	4	3,637,830
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			90,684	9	27,637
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,447,132
b	Less: accumulated depreciation	10b	737,797	625,174	10c	709,335
11	Investments—publicly traded securities .			41,007,779	11	49,223,617
12	Investments—other securities. See Part IV, line 11 .....			3,397,438	12	3,471,365
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			59,334,892	16	66,773,838

17	Accounts payable and accrued expenses .....	761,131	17	835,819
18	Grants payable ...		18
19	Deferred revenue .........	415,887	19	440,982
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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	20,988,557	25	20,789,453
26	Total liabilities. Add lines 17 through 25..	22,165,575	26	22,066,254

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	37,169,317	27	44,707,584
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	37,169,317	32	44,707,584
33	Total liabilities and net assets/fund balances ........	59,334,892	33	66,773,838