TY 2023 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.
right arrow

Attach to Form 990.
right arrow

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

NORTHERN ILLINOIS AND IOWA LABORERS'
HEALTH & WELFARE TRUST

Employer identification number

36-6157689

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 July 25, 2006, 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 right arrow

Number of states where property subject to conservation easement is located right arrow

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
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Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
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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 ......................... right arrow

(ii)

Assets included in Form 990, Part X ............................... right arrow

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 .......................... right arrow

Assets included in Form 990, Part X ............................... right arrow

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

Cat. No. 52283D

Schedule D (Form 990) 2022

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 right arrow

Permanent endowment right arrow

Term endowment right arrow

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 .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....	36,511	34,024	2,487
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				2,487

Schedule D (Form 990) 2022

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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
ESTIMATED FUTURE BENEFITS - PARTICIPANTS ELIGIBILITY	7,346,836








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	7,346,836
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) 2022

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	10,140,828
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	2,333,669
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	2,333,669
3	Subtract line 2e from line 1..................			3	7,807,159
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	209,536
b	Other (Describe in Part XIII.) ...........	4b	265,416
c	Add lines 4a and 4b....................			4c	474,952
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	8,282,111

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	7,824,906
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	7,824,906
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	209,536
b	Other (Describe in Part XIII.) ...........	4b	294,454
c	Add lines 4a and 4b.....................			4c	503,990
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	8,328,896

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 OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE DATED AUGUST 28, 1967, STATING THAT THE PLAN IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC), AND, ACCORDINGLY, THE PLAN'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE PLAN SPONSOR BELIEVES THAT THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE INTERNAL REVENUE CODE. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. U.S. GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT, MORE LIKELY THAN NOT, WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE DEPARTMENT OF LABOR OR INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. GENERALLY, FOR UNITED STATES FEDERAL INCOME TAXES, THE PLAN IS ONLY SUBJECT TO EXAMINATION FOR THE CURRENT YEAR'S TAX RETURN AND THE PRECEDING THREE YEARS' RETURNS.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	RECIPROCAL AGREEMENTS 265,416.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	RECIPROCAL AGREEMENTS 265,416. CHANGE IN BENEFIT OBLIGATIONS PAYABLE 29,038.

Schedule D (Form 990) 2022

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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.
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2023

Open to Public
Inspection

Name of the organization

NORTHERN ILLINOIS AND IOWA LABORERS'
HEALTH & WELFARE TRUST

Employer identification number

36-6157689

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	THE PLAN AND RELATED TRUST WERE ESTABLISHED PURSUANT TO A COLLECTIVE BARGAINING AGREEMENT BETWEEN THE LABORERS' INTERNATIONAL UNION OF NORTH AMERICA, LOCAL UNION NO. 309, AFL-CIO THE QUAD CITY BUILDERS ASSOCIATION, INC., AND THE ASSOCIATED CONTRACTORS OF THE QUAD CITIES. THE PLAN PROVIDES HEALTH AND WELFARE BENEFITS TO FULLTIME PARTICIPANTS AND TO THEIR BENEFICIARIES AND COVERED DEPENDENTS. RETIRED MEMBERS ARE ENTITLED TO SIMILAR HEALTH BENEFITS PROVIDED THEY CONTINUE TO REMIT THE MONTHLY PREMIUMS DETERMINED PERIODICALLY BY THE PLAN AS A SELF-PAY MEMBER. FOR EVERY HOUR THAT A PARTICIPANT WORKS, THE UNION CONTRACTOR IS REQUIRED TO PAY A CONTRACTUAL RATE TO FUND THE HEALTH AND WELFARE PLAN.
FORM 990, PART VI, SECTION B, LINE 11B	THERE IS A FORMAL REVIEW OF THE AUDIT REPORT WHERE BY ALL BOARD MEMBERS ARE PRESENT. FINANCIAL INFORMATION USED IN THE PREPARATION OF THE FORM 990 COMES DIRECTLY FROM THE FINAL AUDIT REPORT AND ITS DISCLOSURES.
FORM 990, PART VI, SECTION B, LINE 15	IN DECEMBER OF EACH YEAR THE COMPENSATION COMMITTEE CONDUCTS PERFORMANCE REVIEWS OF ALL ITS EMPLOYEES. RECOMMENDATIONS FOR INCREASE IN COMPENSATION AND BENEFITS PACKAGES ARE PRESENTED TO THE FULL BOARD FOR FINAL APPROVAL. THE COMPENSATION IS THEN DOCUMENTED IN THE MINUTES.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION SENDS ALL OF ITS PARTICIPANTS A SUMMARY OF THE ANNUAL REPORT FOR THE NORTHERN ILLINOIS & IOWA LABORERS HEALTH & WELFARE TRUST PLAN BASED ON THE FORM 5500. INCLUDED IN THE REPORT IS A SECTION EXPLAINING THE PARTICIPANT'S RIGHTS TO ADDITIONAL INFORMATION AND HOW TO OBTAIN ADDITIONAL INFORMATION FROM THE PLAN ADMINISTRATOR. PARTICIPANTS MAY WRITE OR REQUEST IN PERSON A COPY OF THE REPORT AT NO ADDITIONAL CHARGE. GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, TAX RETURNS, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:	NET CHANGE IN ACCUMULATED ELIGIBILITY CREDITS 461,834.
990, PART XII, LINE 2C	NO CHANGES HAVE BEEN MADE TO THE PROCESS INVOLVING THE OVERSIGHT OF THE AUDIT.

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

Cat. No. 51056K

Schedule O (Form 990) 2023

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.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2023

Open to Public Inspection

Name of the organization

NORTHERN ILLINOIS AND IOWA LABORERS'
HEALTH & WELFARE TRUST

Employer identification number

36-6157689

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)LABORERS INT'L UNION OF NORTH AMERICA LOCAL NO 309 2835 7TH AVENUE ROCK ISLAND,IL61201 36-1265055	PROMOTES SAFE UNION WORK, BROTHERHOOD & TRAINING FOR ITS LABORERS	IL	501(C)(5)	N/A			No
(2)TRI-CITIES CEMENT MASONS LOCAL #544 7909 42ND STREET WEST ROCK ISLAND,IL61201 37-1355734	OPERATION OF LOCAL UNION FOR BENEFITS OF ITS MEMBERS	IL	501(C)(5)	N/A			No

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

Cat. No. 50135Y

Schedule R (Form 990) 2023

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) ALLIED POWER SERVICES LLC 36400 S ESSEX ROAD WILMINGTON,IL60481	CONTRIBUTING EMPLOYER	IL					No			No
(2) CORRECTIVE ASPHALT MATERIALS LLC 300 DANIEL BOONE TRIAL SOUTH ROXANA,IL62087	CONTRIBUTING EMPLOYER	IL					No			No
(3) EVERSOLE FLOORING LLC 1353 W 3RD STREET DAVENPORT,IA52803	CONTRIBUTING EMPLOYER	IA					No			No
(4) FIVE STAR ENERGY SERVICES LLC 1581 E RACINE AVE WAUKESHA,WI53186	CONTRIBUTING EMPLOYER	WI					No			No
(5) KRAEMER NORTH AMERICA LLC ONE PLAINVIEW ROAD PLAIN,WI53577	CONTRIBUTING EMPLOYER	WI					No			No
(6) OTIS MINNESOTA SERVICES LLC 2971 ANDOVER RD WELLSVILLE,NY14895	CONTRIBUTING EMPLOYER	NY					No			No
(7) PRECISION PIPELINE LLC 1119 REGIS COURT SUITE 210 EAU CLAIRE,WI54701	CONTRIBUTING EMPLOYER	WI					No			No
(8) RIVER CITY CONSTRUCTION LLC 101 HOFFER LANE EAST PEORIA,IL61611	CONTRIBUTING EMPLOYER	IL					No			No
(9) ROCKY MOUNTAIN SPECIALTY SRVCS 1824 SUMNER STREET HAMMOND,IN46320	CONTRIBUTING EMPLOYER	IN					No			No
(10) WEITZ INDUSTRIAL LLC 1161 63RD AVENUE SW CEDAR RAPIDS,IA52404	CONTRIBUTING EMPLOYER	IA					No			No
(11) ZINSER WRECKING LLC 3355 SOUTHRIDGE DRIVE AMANA,IA52203	CONTRIBUTING EMPLOYER	IA					No			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	(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) 3P CONCRETE INC 8 QUINN COURT DAVENPORT,IA52802	CONTRIBUTING EMPLOYER	IA							No
(2) API INC 535 S 18 STREET WEST DES MOINES,IA50265	CONTRIBUTING EMPLOYER	IA							No
(3) ACCESS CONTROL CO INC 511 44TH STREET ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(4) ADVANCED ASPHALT PO BOX 234 PRINCETON,IL61356	CONTRIBUTING EMPLOYER	IL							No
(5) AMERICAN ASPHALT SURFACE RECYCLING INC 13301 SOUTHWEST HIGHWAY ORLAND PARK,IL60462	CONTRIBUTING EMPLOYER	IL							No
(6) AMERICAN DEMOLITION CORPORATION 305 RAMONA AVENUE ELGIN,IL60120	CONTRIBUTING EMPLOYER	IL							No
(7) ANDERSON COMMERCIAL CONCRETE 21254 BRADY STREET DAVENPORT,IA52806	CONTRIBUTING EMPLOYER	IA							No
(8) ATLANTIC PLANT MAINTENANCE 3225 PASADENA BLVD PASADENA,TX77503	CONTRIBUTING EMPLOYER	TX							No
(9) B & B MASONRY & RESTORATION INC 2723 N CLARK STREET DAVENPORT,IA52804	CONTRIBUTING EMPLOYER	IA							No
(10) BARTON MALOW CO 26500 AMERICAN DRIVE SOUTHFIELD,MI48034	CONTRIBUTING EMPLOYER	MI							No
(11) BEAVER CONCRETE PO BOX 127 BLUE GRASS,IA527260127	CONTRIBUTING EMPLOYER	IA							No
(12) BENIACH CONSTRUCTION CO INC 307 S MAIN PO BOX 20 TUSCOLA,IL61953	CONTRIBUTING EMPLOYER	IL							No
(13) BILL MILLER EXCAVATING 565 CLEVELAND ROAD COLONA,IL61254	CONTRIBUTING EMPLOYER	IL							No
(14) BLACKHAWK FOUNDATION CO INC PO BOX 29 GENESEO,IL61254	CONTRIBUTING EMPLOYER	IL							No
(15) BLOOMSDALE EXCAVATING CO INC PO BOX 86 BLOOMSDALE,MO63627	CONTRIBUTING EMPLOYER	MO							No
(16) BLUE BIRD CONTRACTING INC 401 ADA STREET ROCK FALLS,IL61071	CONTRIBUTING EMPLOYER	IL							No
(17) BUILDERS SALES AND SERVICE PO BOX 890 MOLINE,IL612660890	CONTRIBUTING EMPLOYER	IL							No
(18) CH LANGMAN & SON INC 220 - 34TH AVENUE ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(19) CPI OF THE MIDWEST INC 127 - 31ST AVENUE ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(20) CENTENNIAL CONTRACTORS 1505 - 46TH AVENUE MOLINE,IL61265	CONTRIBUTING EMPLOYER	IL							No
(21) CENTRAL EXCAVATING INC PO BOX 1738 BETTENDORF,IA52722	CONTRIBUTING EMPLOYER	IA							No
(22) CENTRAL LANDSCAPING RR 1 PRINCEVILLE,IL61559	CONTRIBUTING EMPLOYER	IL							No
(23) CIVIL CONSTRUCTION PO BOX 868 EAST MOLINE,IL61244	CONTRIBUTING EMPLOYER	IL							No
(24) COLLINS & HERMANN INC PO BOX 13579 ST LOUIS,MO13579	CONTRIBUTING EMPLOYER	MO							No
(25) COLLINS CONCRETE LTD 1129 WEST 3RD STREET DAVENPORT,IA52802	CONTRIBUTING EMPLOYER	IA							No
(26) CORN CRIB NURSERY 6924 ROUTE 150 COAL VALLEY,IL61240	CONTRIBUTING EMPLOYER	IL							No
(27) CORNERSTONE CONSTRUCTION PO BOX 515 704 WEST MAYNE STREET BLUE GRASS,IA52726	CONTRIBUTING EMPLOYER	IA							No
(28) CUPERTINO ELECTRIC 1220 W FULTON ST EDGERTON,WI53534	CONTRIBUTING EMPLOYER	WI							No
(29) CURNYN CONSTRUCTION CO BOX 106 GENESEO,IL61254	CONTRIBUTING EMPLOYER	IL							No
(30) D CONSTRUCTION INC 1488 S BROADWAY COAL CITY,IL60416	CONTRIBUTING EMPLOYER	IL							No
(31) DIAMOND CUT 3104 WEST 76TH STREET DAVENPORT,IA52806	CONTRIBUTING EMPLOYER	IA							No
(32) DREAMSCAPES BY DENNIS 1114 STERLING ROAD DIXON,IL61021	CONTRIBUTING EMPLOYER	IL							No
(33) DUNN COMPANT 724 N MERCER STREET DECATUR,IL62522	CONTRIBUTING EMPLOYER	IL							No
(34) E & H RESTORATION INC 7926 COMENITZ DRIVE DAVENPORT,IA52802	CONTRIBUTING EMPLOYER	IA							No
(35) ELDER CORPORATION 5088 E UNIVERSITY AVENUE DES MOINES,IA50327	CONTRIBUTING EMPLOYER	IA							No
(36) ESTES COMPANY 131 W 2ND STREET SUITE 400 DAVENPORT,IA52801	CONTRIBUTING EMPLOYER	IA							No
(37) FIVE CITIES CONSTRUCTION COMPANY PO BOX 18 COAL VALLEY,IL61240	CONTRIBUTING EMPLOYER	IL							No
(38) GM SIPES CONSTRUCTION INC PO BOX 109 RUSHVILLE,IL62681	CONTRIBUTING EMPLOYER	IL							No
(39) GAGNON INC 2286 CAPP ROAD ST PAUL,MN55114	CONTRIBUTING EMPLOYER	MN							No
(40) GEEDING CONSTRUCTION INC 600 HIGHWAY H TROY,MO63379	CONTRIBUTING EMPLOYER	MO							No
(41) GENERAL CONSTRUCTORS 480 - 42ND STREET BETTENDORF,IA52722	CONTRIBUTING EMPLOYER	IA							No
(42) GENSINI EXCAVATING 10602 IL-26 PRINCETON,IL61356	CONTRIBUTING EMPLOYER	IL							No
(43) GILLESPIE & POWERS INC 9550 TRUE DRIVE ST LOUIS,MO63132	CONTRIBUTING EMPLOYER	MO							No
(44) GOETZ CONCRETE CONSTRUCTION 1409 NE 3RD AVENUE MILAN,IL61264	CONTRIBUTING EMPLOYER	IL							No
(45) GUNTHER CONSTRUCTION 816 N HENDERSON STREET GALESBURG,IL614022518	CONTRIBUTING EMPLOYER	IL							No
(46) H COOPMAN TRUCKING & EXCAVATING INC 3302 - 9TH STREET A MOLINE,IL61265	CONTRIBUTING EMPLOYER	IL							No
(47) HEIN CONSTRUCTION CO INC 56 N CEDAR STREET GALESBURG,IL61401	CONTRIBUTING EMPLOYER	IL							No
(48) HENKELS & MCCOY INC 985 JOLLY ROAD BLUE BELL,PA194220900	CONTRIBUTING EMPLOYER	PA							No
(49) HODGE CONSTRUCTION COMPANY 31416 BLACKHAWK ROAD ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(50) HOERR CONSTRUCTION INC PO BOX 65 GOODFIELD,IL61742	CONTRIBUTING EMPLOYER	IL							No
(51) HOOD DEMOLITION AND EXCAVATION 17382 OLD AIRPORT RD RUSHVILLE,IL62681	CONTRIBUTING EMPLOYER	IL							No
(52) I & I CONSTRUCTION 21050 NORTH BRADY STREET STE A DAVENPORT,IA52804	CONTRIBUTING EMPLOYER	IA							No
(53) ICC GROUP INC 39W866 FABYAN PKWY ELBURN,IL60119	CONTRIBUTING EMPLOYER	IL							No
(54) ILLINOIS DEPT OF TRANSPORTATION 2300 S DIRKSEN PKWY SPRINGFIELD,IL62764	CONTRIBUTING EMPLOYER	IL							No
(55) INSTITUFORM TECHNOLOGIES 12897 MAIN STREET LEMONT,IL60439	CONTRIBUTING EMPLOYER	IL							No
(56) INTERCON CONSTRUCTION INC 5512 STATE ROAD 19 113 WAUNAKEE,WI53597	CONTRIBUTING EMPLOYER	WI							No
(57) JC DILLON INC PO BOX 3590 PEORIA,IL616123590	CONTRIBUTING EMPLOYER	IL							No
(58) JJ BRAKER AND SONS INC 520 E HIGHLAND STREET MORTON,IL61550	CONTRIBUTING EMPLOYER	IL							No
(59) JIMMY Z MASONRY CORP 8550 RIDGEFIELD ROAD SUITE B CRYSTAL LAKE,IL60012	CONTRIBUTING EMPLOYER	IL							No
(60) JONES TILE INC 2471 DOC RIDGEWAY RD MACKS CREEK,MO65786	CONTRIBUTING EMPLOYER	MO							No
(61) K & D CUTTING AND CORING INC PO BOX 183 MILAN,IL612640183	CONTRIBUTING EMPLOYER	IL							No
(62) KCM CONSTRUCTION PO BOX 425 COLONA,IL61241	CONTRIBUTING EMPLOYER	IL							No
(63) KEN CURRY CONSTRUCTION INC 1518 - 12TH STREET EAST MOLINE,IL61244	CONTRIBUTING EMPLOYER	IL							No
(64) KIRBY CABLE SERVICES PO BOX 37 PECATONICA,IL61063	CONTRIBUTING EMPLOYER	IL							No
(65) KS ENERGY SERVICES 19705 W LINCOLN AVENUE NEW BERLIN,WI53146	CONTRIBUTING EMPLOYER	WI							No
(66) L KEELEY CONSTRUCTION 2901 FALLING SPRINGS ROAD SAUGET,IL62206	CONTRIBUTING EMPLOYER	IL							No
(67) LABORERS' LOCAL 309 2835 - 7TH AVENUE ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(68) LAVERDIERE CONSTUCTION INC 4055 WEST JACKSON STREET MACOMB,IL61455	CONTRIBUTING EMPLOYER	IL							No
(69) LAW EXCAVATING 510 E BENTON STREET MT CARROLL,IL61053	CONTRIBUTING EMPLOYER	IL							No
(70) LEANDER CONSTRUCTION INC 24472 N COUNTY HWY 6 CANTON,IL61520	CONTRIBUTING EMPLOYER	IL							No
(71) LEWIS CONSTRUCTION INC 9307 BIRCH STREET SCHOFIELD,WI54476	CONTRIBUTING EMPLOYER	WI							No
(72) LUNDA CONSTRUCTION PO BOX 669 BLACK RIVER FALLS,WI546150699	CONTRIBUTING EMPLOYER	WI							No
(73) M & O ENVIRONMENTAL PO BOX 759 HOMEWOOD,IL60430	CONTRIBUTING EMPLOYER	IL							No
(74) MATHY CONSTRUCTION COMPANY BOX 189 ONALASKA,WI54601	CONTRIBUTING EMPLOYER	WI							No
(75) MCCARTHY IMPROVEMENT CO 5401 VICTORIA AVENUE DAVENPORT,IA52807	CONTRIBUTING EMPLOYER	IA							No
(76) MCCLINTOCK TRUCKING & EXCAVATING INC 1701 - 1ST AVENUE SILVIS,IL61282	CONTRIBUTING EMPLOYER	IL							No
(77) MICHELS PIPELINE CONST INC PO BOX 128 BROWNSVILLE,WI53006	CONTRIBUTING EMPLOYER	WI							No
(78) MICRO-SURFACING INC 13940 ST CHARLES ROCK ROAD ST LOUIS,MO63044	CONTRIBUTING EMPLOYER	MO							No
(79) MID AMERICA ENERGY SERVICES INC 1606 EASTPORT PLAZA DRIVE COLLINSVILLE,IL62234	CONTRIBUTING EMPLOYER	IL							No
(80) MID STATES CONCRETE PRODUCTS 500 SOUTH PARK AVENUE BELOIT,WI61080	CONTRIBUTING EMPLOYER	IL							No
(81) MILLER TRUCKING & EXCAVATING 3303 JOHN DEERE ROAD SILVIS,IL61282	CONTRIBUTING EMPLOYER	IL							No
(82) MINNESOTA LIMITED INC 14485 NORTHDALE BLVD ROGERS,MN55374	CONTRIBUTING EMPLOYER	MN							No
(83) NICKELSON INDUSTRIAL SERVICES INC 8504 S BALTIMORE AVENUE CHICAGO,IL60617	CONTRIBUTING EMPLOYER	IL							No
(84) NORTHWEST STEEL ERECTION 6285 NE INDUSTRY DRIVE DES MOINES,IA50313	CONTRIBUTING EMPLOYER	IA							No
(85) OPPERMAN CONSTRUCTION CO 16535 N 1650 EAST RD PONTIAC,IL61764	CONTRIBUTING EMPLOYER	IL							No
(86) OTTO BAUM COMPANY INC 866 NORTH MAIN STREET MORTON,IL61550	CONTRIBUTING EMPLOYER	IL							No
(87) PHOENIX CORPORATION PO BOX 445 RAPIDS CITY,IL61278	CONTRIBUTING EMPLOYER	IL							No
(88) PORTER BROTHERS ASPHALT 9904 FREEPORT ROAD ROCK FALLS,IL610719502	CONTRIBUTING EMPLOYER	IL							No
(89) PORTZEN CONSTRUCTION INC 205 STONE VALLEY DRIVE DUBUQUE,IA52003	CONTRIBUTING EMPLOYER	IA							No
(90) QC FFC TRUST 420 - 34TH AVENUE ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(91) RIVER CITY CUTTING & CORING PO BOX 5042 DAVENPORT,IA52808	CONTRIBUTING EMPLOYER	IA							No
(92) RIVER VALLEY CONSTRUCTION 444 DEVILS GLEN ROAD S BETTENDORF,IA527226476	CONTRIBUTING EMPLOYER	IA							No
(93) RUSSELL CONSTRUCTION 4700 EAST 53RD STREET DAVENPORT,IA528073479	CONTRIBUTING EMPLOYER	IA							No
(94) RYAN & ASSOCIATES 10955 - 160TH STREET DAVENPORT,IA52804	CONTRIBUTING EMPLOYER	IA							No
(95) RYAN COMPANIES US INC 533 S 3RD STREET SUITE 100 MINNEAPOLIS,MN55415	CONTRIBUTING EMPLOYER	MN							No
(96) SCHOMBURG & SCHOMBURG CONSTRUCTION INC 923 N COLLETT STREET DANVILLE,IL61832	CONTRIBUTING EMPLOYER	IL							No
(97) SIEMENS WESTINGHOUSE 5101 WESTINGHOUSE BLVD CHARLOTTE,NC28273	CONTRIBUTING EMPLOYER	NC							No
(98) SJOSTROM & SONS INC 1129 HARRISON AVE ROCKFORD,IL61104	CONTRIBUTING EMPLOYER	IL							No
(99) STEVE MOYLE MASONRY INC 112 E FAYETTE STREET SUITE 1 MANCHESTER,IA52057	CONTRIBUTING EMPLOYER	IA							No
(100) STITCHER CONSTRUCTION CO IN 10070 MAIN STREET FENTON,IL61251	CONTRIBUTING EMPLOYER	IL							No
(101) SURFACE PREP INC PO BOX 470 PEWANKEE,WI53072	CONTRIBUTING EMPLOYER	WI							No
(102) TMF CONSTRUCTION COMPANY 803 PRINCETON AVENUE SPRINGFIELD,IL62708	CONTRIBUTING EMPLOYER	IL							No
(103) TAYLOR RIDGE DRILLED FOUND 6710 - 134TH AVENUE WEST TAYLOR RIDGE,IL61284	CONTRIBUTING EMPLOYER	IL							No
(104) TREIBER CONSTRUCTION COMPANY 2723 NORTH CLARK DAVENPORT,IA52804	CONTRIBUTING EMPLOYER	IA							No
(105) TRI CITIES CEMENT MASONS 544 7909 - 42ND STREET WEST ROCK ISLAND,IL61201	CONTRIBUTING EMPLOYER	IL							No
(106) TSCHIGGFRIE EXCAVATING CO 425 JULIEN DUBUQUE DR DUBUQUE,IA52003	CONTRIBUTING EMPLOYER	IA							No
(107) UNITED PIPING INC 4510 AIRPORT RD DULUTH,MN55811	CONTRIBUTING EMPLOYER	MN							No
(108) VALLEY CONSTRUCTION 3610 - 78TH AVENUE WEST ROCK ISLAND,IL612042020	CONTRIBUTING EMPLOYER	IL							No
(109) VEIT & COMPANY INC 14000 VEIT PLACE ROGERS,MN55374	CONTRIBUTING EMPLOYER	MN							No
(110) VISSERING CONSTRUCTION COMPANY 175 BENCHMARK INDUSTRIAL DR STREATOR,IL61364	CONTRIBUTING EMPLOYER	IL							No
(111) WALSH CONSTRUCTION COMPANY 929 WEST ADAMS CHICAGO,IL60607	CONTRIBUTING EMPLOYER	IL							No
(112) WALTER D LAUD INC PO BOX 88 EAST MOLINE,IL61244	CONTRIBUTING EMPLOYER	IL							No
(113) WARNING LITES OF ILLINOIS 9441 LEBANON ROAD EAST ST LOUIS,IL62203	CONTRIBUTING EMPLOYER	IL							No
(114) WHITE CONSTRUCTION PO BOX 249 CLINTON,IN47842	CONTRIBUTING EMPLOYER	IA							No
(115) WHITE CONSTRUCTION INC 205 COOPER ST BEAVER DAM,WI53916	CONTRIBUTING EMPLOYER	WI							No
(116) WILLIAM AUPPERLE & SONS INC 190 E WASHINGTON ST MORTON,IL615501945	CONTRIBUTING EMPLOYER	IL							No
(117) WILLIAMS BROTHERS CONSTRUCTIONS INC PO BOX 1366 PEORIA,IL61654	CONTRIBUTING EMPLOYER	IL							No
(118) XCEL ENERGY INC 414 NICOLLET MALL MINNEAPOLIS,MN55401	CONTRIBUTING EMPLOYER	MN							No

Schedule R (Form 990) 2023

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) ......................

Yes

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
(1) LOCAL NO 309	K	7,800	FMV

Schedule R (Form 990) 2023

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) 2023

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) 2023

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE PLAN PROVIDES HEALTH AND WELFARE BENEFITS FOR ELIGIBLE EMPLOYEES REPRESENTED BY THE UNION AND FOR OTHER EMPLOYEES FOR WHOM CONTRIBUTIONS ARE OR HAVE BEEN PAID INTO AND ACCEPTED BY THE PLAN. THE SPOUSES AND OTHER DEPENDENTS OF QUALIFYING EMPLOYEES ARE ALSO ELIGIBLE FOR BENEFITS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	7
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2023 (Part V, line 2a) ......	5	8
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, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	6,025,303	5,844,801
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,798,640	837,949
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,567,076	1,599,361
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	9,391,019	8,282,111
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).....	5,892,678	6,958,818
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	212,284	223,812
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)....	1,207,570	1,146,266
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	7,312,532	8,328,896
19	Revenue less expenses. Subtract line 18 from line 12.......	2,078,487	-46,785
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	37,322,144	39,713,009
21	Total liabilities (Part X, line 26).............	7,950,432	7,592,579
22	Net assets or fund balances. Subtract line 21 from line 20.....	29,371,712	32,120,430

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 8,328,896 including grants of $ ) (Revenue $ 7,444,162 )
	TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES REPRESENTED BY UNIONS LOCAL NO. 309, NO. 544, AND FOR OTHER ELIGIBLE EMPLOYEES FOR WHOM CONTRIBUTIONS ARE OR HAVE BEEN PAID INTO THE TRUST BY CONTRACTORS.

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 expenses8,328,896

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) MIKE HOWARD...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(2) BJ SORENSEN...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(3) CLINT HOEGER...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(4) TIMOTHY FOSTER...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(5) DAVID ADAMS...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(6) BRADLY LONG...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(7) PAUL FOLEY...................................................................... TRUSTEE	3.00 .................	X		0	0	0
(8) JULIE LAGE...................................................................... ADMINISTRATOR	40.00 .................		X	102,500	0	32,773

1b	Sub-Total..............
c	Total from continuation sheets to Part VII, Section A..
d	Total (add lines 1b and 1c).........	102,500	0	32,773

(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	525100	5,443,876	5,443,876
b	SELF PAY CONTRIBUTIONS	525100	400,925	400,925
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		5,844,801

3 Investment income (including dividends, interest, and othersimilar amounts) ......			909,677			909,677
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
			(i) Real	(ii) Personal
6a	Gross rents	6a
b	Less: rental expenses	6b
c	Rental income or (loss)	6c
d	Net rental income or (loss).......
			(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	7a	6,998,498
b	Less: cost or other basis and sales expenses	7b	7,070,226
c	Gain or (loss)	7c	-71,728
d	Net gain or (loss).........			-71,728			-71,728
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
11a	RECIPROCAL TRANSFERS		525100	973,818	973,818
b	RETIREE SUPPLEMENT		525100	592,349	592,349
c	MISCELLANEOUS		525100	33,194	33,194
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,599,361
12	Total revenue. See instructions.....			8,282,111	7,444,162	0	837,949

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 .......	6,958,818	6,958,818
5	Compensation of current officers, directors, trustees, and key employees ...........	135,273	135,273
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........	49,264	49,264
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	27,456	27,456
9	Other employee benefits .......
10	Payroll taxes ...........	11,819	11,819
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	62,801	62,801
c	Accounting ...........	28,300	28,300
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	209,536	209,536
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 .......	34,879	34,879
14	Information technology ......	6,223	6,223
15	Royalties ..
16	Occupancy ...........	7,800	7,800
17	Travel ............	3,893	3,893
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 ..	1,051	1,051
23	Insurance ...	19,414	19,414
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	CLAIMS ADMINISTRATION	403,799	403,799
b	RECIPROCAL TRANSFER	265,416	265,416
c	CONSULTING	38,700	38,700
d	PREFERRED PROVIDER OPTI	36,089	36,089
e	All other expenses	28,365	28,365
25	Total functional expenses. Add lines 1 through 24e	8,328,896	8,328,896	0	0
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 ........			20	1	20
2	Savings and temporary cash investments .........			1,085,611	2	1,098,292
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			734,778	4	682,981
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 ......			15,331	9	13,947
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	36,511
b	Less: accumulated depreciation	10b	34,024	3,538	10c	2,487
11	Investments—publicly traded securities .			34,813,788	11	37,760,968
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 ...........			669,078	15	154,314
16	Total assets. Add lines 1 through 15 (must equal line 33)...			37,322,144	16	39,713,009

17	Accounts payable and accrued expenses .....	170,800	17	245,743
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 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	7,779,632	25	7,346,836
26	Total liabilities. Add lines 17 through 25..	7,950,432	26	7,592,579

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	29,371,712	27	32,120,430
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 ...........	29,371,712	32	32,120,430
33	Total liabilities and net assets/fund balances ........	37,322,144	33	39,713,009