2022-10-19T12:43:36-05:00 2021-12-31 470900880 CALIBRE CPA GROUP PLLC 230 WEST MONROE ST STE310 CHICAGO IL 60606 990 2021-01-01 367485085 MIDDLETOWN WORKS HOURLY & SALARIED UNION RETIREES HEALTH CARE FUND MIDD 8778295500 CO BMGI 1201 CRAWFORD STREET MIDDLETOWN OH 45044 ROGER MCCLOW CHAIRMAN 8778295500 2022-10-19 1 ROGER MCCLOW 999009999 HOWARD SIMON P00158008 3126550037 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROGER MCCLOW C/O BMGI 1201 CRAWFORD STREET MIDDLETOWN OH 45044 287129158 0 X N/A X 2008 OH TO PROVIDE HEALTH BENEFITS 5 0 0 0 0 0 0 0 5129279 3288267 14564325 33676717 0 651260 19693604 37616244 0 0 35574216 40708922 98300 97250 0 0 0 1564476 1606173 37236992 42412345 -17543388 -4796101 716937269 736520021 209893 1872908 716727376 734647113 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE MEDICAL, PRESCRIPTION DRUG, DENTAL, VISION, AND/OR LIFE INSURANCE BENEFITS FOR ELIGIBLE RETIREES AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 889 0 1 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 X BENEFITS MANAGEMENT GROUP INC 6302303928 1201 CRAWFORD ST MIDDLETOWN OH 45044 BRIAN DALEY TRUSTEE 8.00 X 10550 0 0 ROGER MCCLOW CHAIRMAN 8.00 X 35500 0 0 JAY YOUNGDAHL TRUSTEE 8.00 X 31000 0 0 ROGER MINOR TRUSTEE 8.00 X 10550 0 0 MICHAEL BAILEY CO-CHAIRMAN 8.00 X 12550 0 0 100150 0 0 0 0 0 0 BENEFITS MANAGEMENT GROUP INC 625 ENTERPRISE DRIVE OAK BROOK IL 60523 THIRD PARTY ADMINISTRATOR 561443 UMR 11 SCOTT STREET WAUSAU WI 54403 MEDICAL CLAIMS ADMINISTRATOR 222856 AMALGAMATED BANK 275 7TH AVENUE NEW YORK NY 10001 INVESTMENT MANAGER/CUSTODIAN 148408 3 PARTICIPANT CONTRIBUTIONS 900099 2793970 2793970 PRESCRIPTION DRUG REBATES 900099 404354 404354 PERFORMANCE GUARANTEE REBATES 900099 89943 89943 3288267 15209736 15209736 267979895 249512914 18466981 18466981 18466981 SETTLEMENT INCOME 900099 603107 603107 OTHER INCOME 900099 48153 48153 651260 37616244 3939527 0 33676717 40708922 97250 820674 30778 294418 185896 185516 15600 64388 PCORI FEES 8903 42412345 16523106 11138964 2184353 364400 20859 141764 698208951 724550191 0 324702 716937269 736520021 209893 129068 0 1743840 209893 1872908 X 0 0 0 0 716727376 734647113 716727376 734647113 716937269 736520021 -4796101 22715838 0 X X 0 1 X 1 0 0 CLAIMS INCURRED BUT NOT REPORTED AND CLAIMS PAYABLE 1743840 1743840 X 60037664 22715838 22715838 37321826 294418 294418 37616244 40374087 0 40374087 294418 1743840 2038258 42412345 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE TRUSTEES TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY FOR ANY UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAX AUTHORITIES, HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN CLAIMS LIABILITY 1,743,840. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR THEIR REVIEW. FORM 990 IS SIGNED AND FILED ONLY AFTER ANY QUESTIONS ARE ANSWERED AND ANY REVIEW CHANGES ARE MADE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL VENDORS, CONSULTANTS AND OTHERS DOING BUSINESS WITH THE ORGANIZATION, AS WELL AS MEMBERS OF THE GOVERNING BODY, TO DISCLOSE CONFLICTS AND REVIEWS ALL ARRANGEMENTS IT ENTERS INTO ON AN ONGOING BASIS. FORM 990, PART VI, SECTION B, LINE 15 ALTHOUGH THE ORGANIZATION DOES NOT USE THE METHODS LISTED IN PART VI, SECTION B, LINE 15 TO DETERMINE COMPENSATION, THE ORGANIZATION HAS ADOPTED A FORMAL COMPENSATION POLICY. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. ANY PARTICIPANT WILL BE PROVIDED A COPY UPON REQUEST. FORM 990, PART XII, LINE 2C NO CHANGE FROM THE PRIOR YEAR