2019-11-13T14:45:34-06:00 2018-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2018-01-01 202288018 MIDWEST TEAMSTERS HEALTH REIMBURSEMENT ARRANGEMENT TR FUND MIDW 6512561804 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 DOUG RUBBELKE CHAIRMAN 6512561804 2019-11-07 1 ERIC C BAERTSCH P00964071 9528413950 12.235.239.120 2019-11-07 15:59:12 CS P 0938D8DB5C4DDE853E46E76E68F7A068926B230F E2C35A8318D24212DDF67D3AF46D54948B54095C 2018 2020-03-31 21:24:44Z DOUG RUBBELKE 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 991252 0 X N/A X 2005 MN HEALTH REIMBURSEMENT ARRANGEMENT 6 6 0 0 0 0 0 0 625140 736792 179246 254390 0 70 804386 991252 0 0 636021 568725 0 0 0 0 0 180711 194430 816732 763155 -12346 228097 7343926 7261091 17860 17120 7326066 7243971 THIS PLAN IS INTENDED TO PERMIT ELIGIBLE EMPLOYEES TO OBTAIN REIMBURSEMENT OF MEDICAL CARE EXPENSES ON A NONTAXABLE BASIS FROM THEIR HRA ACCOUNT. 0 0 REIMBURSEMENT OF MEDICAL EXPENSES THAT QUALIFY UNDER SECTION 213 OF THE INTERNAL REVENUE CODE. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561804 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 X DOUG RUBBELKE CHAIRMAN 0.50 X 0 0 0 TREVOR LAWRENCE UNION TRUSTEE 0.50 X 0 0 0 SUSAN MAUREN SECRETARY 0.50 X 0 0 0 KEITH GLEASON UNION TRUSTEE 0.50 X 0 0 0 DAVE MIFFLIN EMPLOYER TRUSTEE - PAST 0.50 X 0 0 0 LAWRENCE YOSWA EMPLOYER TRUSTEE 0.50 X 0 0 0 FRANK KAZENSKE EMPLOYER TRUSTEE 0.50 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 ADMINISTRATION AND PAYROLL AUDITS 130793 1 EMPLOYER CONTRIBUTIONS 900099 736792 736792 736792 254390 254390 LITIGATION FROM IL CON 900099 70 70 70 991252 736792 0 254460 568725 107793 26085 32900 3055 10674 1050 10122 PCORI FEE 2751 763155 102232 37685 3317946 3281278 55897 182058 6559 6674 3861292 3753396 7343926 7261091 17860 17120 17860 17120 X 0 0 0 0 7326066 7243971 7326066 7243971 7343926 7261091 228097 -310192 0 X 0 1 X 1 0 0 X 681060 -310192 -310192 991252 0 991252 763155 0 763155 0 763155 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN TAX 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 PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES RETAIN ULTIMATE RESPONSIBILITY, THE BOARD HAS DELEGATED THE DAY TO DAY ADMINISTRATIVE DUTIES TO ZENITH AMERICAN SOLUTIONS AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A EMPLOYER TRUSTEES ARE APPOINTED BY CONTRIBUTING EMPLOYERS. UNION TRUSTEES ARE APPOINTED BY PARTICIPATING UNIONS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES EVALUATE ANY POSSIBLE CONFLICTS OF INTEREST ANNUALLY WITH THE PLAN'S ATTORNEY. IN ADDITION, PERIODIC REVIEWS OF COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ARE CONDUCTED BY THE BOARD OF TRUSTEES TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH NONPROFIT PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS LAWFUL STATUS AND FIDUCIARY OBLIGATIONS. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO PARTICIPANTS. THESE DOCUMENTS CAN BE OBTAINED BY REQUEST AT THE PLAN ADMINISTRATOR'S OFFICE IN MENDOTA HEIGHTS, MN. 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