2016-12-09T09:30:13-06:00 2016-02-29 362152389 BANSLEY AND KIENER LLP 8745 W HIGGINS RD STE 200 CHICAGO IL 606312704 990 2015-03-01 237194891 MIDWESTERN TEAMSTERS HEALTH & WELFARE FUND MIDW 3126491200 18861-90TH AVENUE SUITE A MOKENA IL 60448 MICHAEL NEUDECKER TRUSTEE 3126491200 2016-11-23 1 DANIELLE M TYLER P01433924 3122632700 2015 2017-02-10 21:41:12Z TONY BARR 18861-90TH AVENUE SUITE A MOKENA IL 60448 1271514 0 X N/A X 1971 IL TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS X 4 0 0 0 0 0 0 0 3842073 1253482 8487 1027 0 17005 3850560 1271514 0 0 3820950 1055184 0 0 0 0 0 691572 314467 4512522 1369651 -661962 -98137 838132 72846 739074 72846 99058 0 TO PROVIDE ACCIDENT, HOSPITAL, MEDICAL, SURGICAL, DENTAL, VISION, PERSCRIPTION, DEATH, PREPAID LEGAL ASSISTANCE AND DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS 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 1 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 X 4 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 6309673091 18861-90TH AVE SUITE A MOKENA IL 60448 SCOTT ALEXANDER TRUSTEE 1.00 40.00 X 0 122201 4989 MARK BIEL TRUSTEE 1.00 40.00 X 0 109871 3330 EDWARD BRENNAN TRUSTEE 1.00 0.00 X 0 0 0 MIKE NEUDECKER TRUSTEE 1.00 0.00 X 0 0 0 MARC ARCHER TRUSTEE - FORMER 1.00 40.00 X 0 44513 2089 0 276585 10408 0 0 0 0 ZENITH AMERICAN SOLUTIONS 18861 90TH AVE SUITE A MOKENA IL 60448 CONTRACT ADMINISTRATION 113370 1 EMPLOYER CONTRIBUTIONS 900099 1123395 1123395 PARTICIPANT CONTRIBUTI 900099 118456 118456 PRESCRIPTION DRUG REBA 900099 11631 11631 1253482 1027 1027 OTHER INCOME 900099 6330 6330 LIQUIDATED DAMAGES AND 900099 5675 5675 SUBROGATION INCOME 900099 5000 5000 17005 1271514 1270487 0 1027 1055184 107284 41619 38874 8333 42227 5475 2031 20594 TRANSITIONAL REINSURANC 43472 PCORI FEE 3221 MISCELLANEOUS 1337 1369651 152927 69550 194922 0 3717 0 467106 0 19460 3296 838132 72846 23245 47593 715829 25253 739074 72846 X 0 0 0 0 99058 0 99058 0 838132 72846 -98137 -921 0 X X 0 1 X 0 0 0 DUE TO MIDWESTERN TEAMSTERS PENSION TRUST FUND 11164 TRANSITIONAL REINSURANCE FEE 10868 PATIENT CENTERED OUTCOMES RESEARCH INSTITUTE FEE 3221 25253 X 1270593 -921 -921 1271514 0 1271514 2057701 0 2057701 -688050 -688050 1369651 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN ADMINISTRATOR TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY FOR ANY UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD 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 YEARS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2013. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN OBLIGATION FOR HEALTH CLAIMS PAYABLE -688,050. SEE SCHEDULE O 0 0 0 0 FORM 990 - PART IV - LINE 32 AND FORM 990 - SCHEDULE N - PART II: ON JUNE 30, 2015, THE TRUSTEES VOTED TO TERMINATE THE PLAN EFFECTIVE AUGUST 1, 2015. THE ORGANIZATION IS STILL IN THE PROCESS OF WINDING UP ITS AFFAIRS AS OF THE END OF THE TAX YEAR, BUT HAS NOT COMPLETELY LIQUIDATED ALL ASSETS. BENEFIT PAYMENTS TO PARTICIPANTS AND ADMINISTRATIVE EXPENSES TO SERVICE PROVIDERS TO WIND UP THE PLAN AND TO LIQUIDATE ALL REMAINING ASSETS OF THE PLAN ARE BEING ADMINISTERED BY THE TRUSTEES OF THE PLAN IN ACCORDANCE WITH PLAN DOCUMENTS. FOR THE YEAR ENDED FEBRUARY 29, 2016, THE ACCOUNTS REPORTED ON FORM 990 ARE PRESENTED ON THE LIQUIDATION BASIS OF ACCOUNTING. UNDER THIS BASIS OF ACCOUNTING, ASSETS ARE VALUED AT THEIR ESTIMATED REALIZABLE VALUES AND LIABILITIES ARE VALUED AT THE AMOUNT OF CASH EXPECTED TO BE PAID. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENGAGES A THIRD PARTY ADMINISTRATOR TO HANDLE THE DAY TO DAY OPERATIONS. THE THIRD PARTY ADMINISTRATOR IS PRIMARILY RESPONSIBLE FOR PAYING HEALTH CLAIM BENEFITS, COLLECTING EMPLOYER CONTRIBUTIONS, PAYING EXPENSES AND HANDLING ALL OTHER ORGANIZATION MATTERS. THE THIRD PARTY ADMINISTRATOR REPORTS TO THE TRUSTEES AT REGULAR BOARD MEETINGS AND IS UNDER THE DIRECT SUPERVISION OF THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 THE THIRD PARTY ADMINISTRATOR IS RESPONSIBLE FOR THE REVIEW AND FILING OF FORM 990. A COPY OF THE FINAL FORM 990 IS PROVIDED TO THE TRUSTEES OF THE FUND. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE EXPECTED TO PERFORM THEIR DUTIES CONSCIENTIOUSLY, HONESTLY AND IN ACCORDANCE WITH THE BEST INTEREST OF THE FUND. TRUSTEES MUST NOT USE THEIR POSITION OR KNOWLEDGE GAINED AS A RESULT OF THEIR POSITION FOR PRIVATE OR PERSONAL ADVANTAGE. REGARDLESS OF THE CIRCUMSTANCES, IF A TRUSTEE SUSPECTS THAT A COURSE OF CONDUCT HE/SHE HAS PURSUED, IS PRESENTLY PURSUING OF IF CONTEMPLATED PURSUING MAY INVOLVE THE TRUSTEE IN A CONFLICT OF INTEREST WITH THE FUND, THE TRUSTEE MUST IMMEDIATELY COMMUNICATE ALL THE FACTS TO THE OTHER TRUSTEES AND FUND COUNSEL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS FORM 990, FORM 5500 (WHICH INCLUDES AUDITED FINANCIAL STATEMENTS) AND SUMMARY ANNUAL REPORT AVAILABLE FOR INSPECTION UPON REQUEST. OTHER GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY AND DOCUMENT RETENTION AND DESTRUCTION POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 1: ON JUNE 30, 2015, THE TRUSTEES VOTED TO TERMINATE THE PLAN EFFECTIVE AUGUST 1, 2015. IN ACCORDANCE WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA, THE PLAN HAS CHANGED ITS BASIS OF ACCOUNTING FROM AN ONGOING PLAN BASIS USED IN PRESENTING THE FEBRUARY 28, 2015 FINANCIAL STATEMENTS TO THE LIQUIDATION BASIS USED IN PRESENTING THE FEBRUARY 29, 2016 FINANCIAL STATEMENTS. FOR THIS REASON, FOR THE YEAR ENDED FEBRUARY 29, 2016, THE ACCOUNTS ARE PRESENTED ON FORM 990 ON THE LIQUIDATION BASIS OF ACCOUNTING. UNDER THIS BASIS OF ACCOUNTING, ASSETS ARE VALUED AT THEIR ESTIMATED REALIZABLE VALUES AND LIABILITIES ARE VALUED AT THE AMOUNT OF CASH EXPECTED TO BE PAID. FOR THE YEAR ENDED FEBRUARY 28, 2015 THE ACCOUNTS WERE PRESENTED ON FORM 990 ON THE ACCRUAL BASIS OF ACCOUNTING. FORM 990, PART XII, LINE 2C: THE TRUSTEES SELECT THE INDEPENDENT AUDITORS. THE OVERSIGHT OF THE AUDIT IS PERFORMED BY THE THIRD PARTY ADMINISTRATOR. FORM 990 - PART B - LINE F: ON JULY 15, 2016 THE PRINCIPAL OFFICER OF THE PLAN (SCOTT ALEXANDER) WAS REPLACED BY TONY BARR. INTERNATIONAL BROTHERHOOD OF TEAMSTERS LOCAL NO 50 1609 NORTH ILLINOIS STREET BELLEVILLE IL 62221 370347465 LABOR UNION IL 501(C)(5) 0 MIDWESTERN TEAMSTERS PENSION TRUST FUND 18861-90TH AVENUE SUITE A MOKENA IL 60448 376117130 PENSION TRUST FUND IL 401(A) 0 BOARD OF TRUSTEES MIDWESTERN TEAMSTERS HEALTH AND WELFARE FUND 18861-90TH AVENUE SUITE A MOKENA IL 60448 237134831 PLAN SPONSOR AND ADMINISTRATOR IL 0 B GARCIA TRUCKING MISC BELLEVILLE TOWNSHIP OFFICE OF GENERAL ASSISTANCE BOB BROCKLAND PONTIAC-GMC INC BRECKENRIDGE OF ILLINOIS LLC BRENNAN JONES & BRENNAN BRUTTO TRUCK SERVICE INC BUILDING PRODUCTS CONCRETE SUPPLY OF ILLINOIS LLC DUCLOS EXCAVATING INC GEORGE WEBER GRANITE CITY CHEVROLET H C PARRISH TRUCKING HAYDEN WRECKING COMPANY KILLIAN CORPORATION KILLIAN TRANSPORTATION KMK SALES MOBILE HOME PARK INVESTMENTS ROBERTS MOTORS INC ZENITH AMERICAN SOLUTIONS ENGINEERED FLUID EXTERIOR INTERIOR SPECIALISTS JAX ASPHALT CO KIENSTRA ST CLAIR LLC LIESE LUMBER CO INC MECKFESSEL TIRE COMPANY MILLER EXCAVATING & TRUCKING PRAXAIR DISTRIBUTION INC QUALITY PONTIAC INC RAY LAFORE EXCAVATING INC RED-E-MIX LLC ROGER'S REDI-MIX INC STEEL REBAR MANUFACTURING LLC STEFFY HOME FURNISHINGS INC SWANSEA BUILDING PRODUCTS CORPORATION TRICKEY'S SERVICE INC TURK FURNITURE UPCHURCH CONCRETE UPCHURCH READY MIX CONCRETE 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 FORM,990 - SCHEDULE R - PART IV: THE ORGANIZATION IS A MULTIEMPLOYER COLLECTIVELY BARGAINED EMPLOYEE BENEFIT PLAN THAT IS SUBJECT TO THE PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). AS REQUIRED, ONLY THE NAMES OF THE CONTRIBUTING EMPLOYERS OF THE ORGANIZATION ARE LISTED IN PART IV SCHEDULE R.