2021-10-07T14:52:13-05:00 2020-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2020-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 6309603322 953 AMERICAN LANE NO 100 SCHAUMBURG IL 60173 DAN AUSSEM TRUSTEE 6309603322 2021-10-07 1 DAN AUSSEM 999009999 RENEE BERG-SPECK P00201492 3123680500 2021-10-07 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DAN AUSSEM 953 AMERICAN LANE NO 100 SCHAUMBURG IL 60173 43561865 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 14 7 25 0 0 0 0 0 25225898 26126131 3372280 2113452 0 0 28598178 28239583 0 0 25913181 22466208 0 0 0 0 0 1402747 1479262 27315928 23945470 1282250 4294113 60098687 68112789 650507 952997 59448180 67159792 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH & WELFARE BENEFITS, INCLUDING MEDICAL, DENTAL, VISION, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFIT COVERAGE FOR ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3 0 1 25 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 7 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0 0 0 X GROUP ADMINISTRATORS LTD 8475191880 953 AMERICAN LANE SUITE 100 SCHAUMBURG IL 60173 BRIAN STANLEY TRUSTEE - PAST 2.00 40.00 X 0 111227 93728 BRIAN ATKINS TRUSTEE 2.00 40.00 X 0 76467 54725 PAUL ARAMBASICH TRUSTEE 2.00 1.00 X 0 4908 3064 KEVIN HRAY TRUSTEE 2.00 55.00 X 0 155822 145743 DANIEL AUSSEM TRUSTEE 2.00 X 0 0 0 DANA OAKS TRUSTEE 2.00 X 0 0 0 MARK RICHESON TRUSTEE 2.00 40.00 X 0 114776 125400 RON STONE TRUSTEE 2.00 X 0 0 0 MICHAEL TESTA TRUSTEE 2.00 X 0 0 0 BILL PAXTON TRUSTEE 2.00 X 0 0 0 DAVID ANSPAUGH TRUSTEE 2.00 X 0 0 0 CHUCK BLACK TRUSTEE 2.00 40.00 X 0 78834 62837 DIRK ENGER TRUSTEE 2.00 40.00 X 0 117699 133983 CODY GERDES TRUSTEE 2.00 X 0 0 0 JASON EMERICK TRUSTEE - NEW 2.00 40.00 X 0 77397 60778 0 737130 680258 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 588175 GROUP ADMINISTRATORS LTD 953 AMERICAN LANE SUITE 100 SCHAUMBURG IL 60173 THIRD PARTY ADMINISTRATOR 447770 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 270686 MACNELL ACCOUNTING & CONSULTING LLP 9436 SPRINGFIELD AVENUE EVANSTON IL 60203 PAYROLL COMPLIANCE AUDITOR 134150 4 EMPLOYER CONTRIBUTIONS 900099 23181323 23181323 STOP-LOSS INSURANCE PROCEEDS 900099 1006093 1006093 PARTICIPANT CONTRIBUTIONS 900099 932743 932743 PRESCRIPTION DRUG REBATES 900099 865804 865804 SUBROGATION INCOME 900099 80284 80284 59884 59884 26126131 2067885 2067885 15367849 15322282 45567 45567 45567 28239583 26126131 0 2113452 22466208 73708 199150 179012 720895 21037 4671 28810 UTILIZATION REVIEW 134051 DISEASE MANAGEMENT 104361 FEES MANDATED BY THE AC 9180 DUES & SUBSCRIPTIONS 4387 23945470 2312930 4453614 3244685 4211731 81305 107471 33695939 42245387 20763828 17094586 60098687 68112789 575151 872359 75356 80638 650507 952997 X 0 0 0 0 59448180 67159792 59448180 67159792 60098687 68112789 4294113 3417499 0 X 0 1 X 1 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 2343263 F AMERICAN STRATEGIC VALUE REALTY FUND 6185742 F INVESCO INSTITUTIONAL TRUST BALANCED RISK ALLOCATION FUND 5413428 F PRUDENTIAL FIXED RATE FUND 3152153 F 17094586 X 31478070 3417499 3417499 28060571 179012 179012 28239583 23766458 0 23766458 179012 179012 23945470 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. 0 0 0 KEVIN HRAY TRUSTEE 0 155822 0 0 0 0 0 113999 0 31744 0 301565 0 0 DIRK ENGER TRUSTEE 0 117699 0 0 0 0 0 54868 0 79115 0 251682 0 0 MARK RICHESON TRUSTEE 0 111851 0 0 0 2925 0 96246 0 29154 0 240176 0 0 BRIAN STANLEY TRUSTEE - PAST 0 111227 0 0 0 0 0 72559 0 21169 0 204955 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO GROUP ADMINISTRATORS LTD, AS THIRD PARTY ADMINISTRATOR OF THE FUND. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARD'S THOROUGH REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. 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