2020-11-05T13:31:54-06:00 2019-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2019-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 8475191880 953 AMERICAN LANE NO 100 SCHAUMBURG IL 60173 DAN AUSSEM TRUSTEE 8475191880 2020-11-05 1 RENEE BERG-SPECK P00201492 3123680500 2020-11-03 12.235.239.120 2020-11-05 13:31:49 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 013BD4BEA457AB31DE8385915B9401809CC4B7ED 2019 2021-04-22 16:20:28Z DAN AUSSEM 953 AMERICAN LANE NO 100 SCHAUMBURG IL 60173 40685849 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 14 7 39 0 0 0 0 0 25269057 25225898 1397950 3372280 90228 0 26757235 28598178 0 0 22019208 25913181 0 0 0 0 0 1561769 1402747 23580977 27315928 3176258 1282250 55765701 60098687 705369 650507 55060332 59448180 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 0 0 39 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 2.00 40.00 X 0 109169 94709 BRIAN ATKINS TRUSTEE 2.00 40.00 X 0 72050 69052 PAUL ARAMBASICH TRUSTEE 2.00 1.00 X 0 4908 3064 KEVIN HRAY TRUSTEE 2.00 55.00 X 0 155822 145843 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 119450 118520 CODY GERDES TRUSTEE 2.00 X 0 0 0 0 655009 619425 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 664045 GROUP ADMINISTRATORS LTD 953 AMERICAN LANE SUITE 100 SCHAUMBURG IL 60173 THIRD PARTY ADMINISTRATOR 372277 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 256390 ZENITH AMERICAN SOLUTIONS 18861 90TH AVENUE SUITE A MOKENA IL 60447 THIRD PARTY ADMINISTRATOR 110887 MCGANN KETTERMAN & RIOUX 111 E WACKER DRIVE SUITE 2600 CHICAGO IL 60601 FUND ATTORNEY 103561 5 EMPLOYER CONTRIBUTIONS 900099 22022982 22022982 STOP-LOSS INSURANCE PROCEEDS 900099 1578151 1578151 PARTICIPANT CONTRIBUTIONS 900099 906702 906702 PRESCRIPTION DRUG REBATE 900099 671470 671470 AUDIT FEE INCOME 900099 34268 34268 12325 12325 25225898 1655181 1655181 13804770 12087671 1717099 1717099 1717099 28598178 25225898 0 3372280 25913181 103561 111750 174715 728843 38506 29627 26799 DISEASE MANAGEMENT 97570 UTILIZATION REVIEW EXPE 65262 COLLECTOR EXPENSE 12500 FEES MANDATED BY ACA 9434 4180 27315928 3844456 2312930 3928858 3244685 24353 81305 28582930 33695939 19385104 20763828 55765701 60098687 630631 575151 74738 75356 705369 650507 X 0 0 0 0 55060332 59448180 55060332 59448180 55765701 60098687 1282250 3105598 0 X 0 1 X 1 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 2002845 F AMERICAN STRATEGIC VALUE REALTY FUND 6157203 F INVESCO INSTITUTIONAL TRUST BALANCED RISK ALLOCATION FUND 4659797 F PRUDENTIAL FIXED RATE FUND 3080506 F EATON VANCE SENIOR INSTITUTIONAL LOAN FUND 4863477 F 20763828 X 31529061 3105598 3105598 28423463 174715 174715 28598178 27141213 0 27141213 174715 174715 27315928 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 BRIAN STANLEY TRUSTEE 0 109169 0 0 0 0 0 70927 0 23782 0 203878 0 0 KEVIN HRAY TRUSTEE 0 155822 0 0 0 0 0 114099 0 31744 0 301665 0 0 MARK RICHESON TRUSTEE 0 111851 0 0 0 2925 0 96246 0 29154 0 240176 0 0 DIRK ENGER TRUSTEE 0 119450 0 0 0 0 0 90355 0 28165 0 237970 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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