2016-11-10T13:02:41-06:00 2015-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2015-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 6309603322 18861 90TH AVENUE NO A MOKENA IL 60448 BRIAN DISKIN TRUSTEE 6309603322 2016-11-10 1 RENEE SPECK P00201492 2198361065 2015 2017-02-10 21:41:12Z BRIAN DISKIN 18861 90TH AVENUE NO A MOKENA IL 60448 35435429 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 12 6 29 0 0 0 0 0 16049005 16984395 1029941 724241 373 1901 17079319 17710537 0 0 13275751 15325294 0 0 0 0 0 1490954 1534723 14766705 16860017 2312614 850520 46039116 48900752 652089 591511 45387027 48309241 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 1 29 1 0 0 0 0 0 0 0 0 0 0 X 12 6 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 6309603322 18861 90TH AVENUE SUITE A MOKENA IL 60448 BRIAN DISKIN TRUSTEE 2.00 40.00 X 0 99152 74073 BRIAN STANLEY TRUSTEE 2.00 40.00 X 0 104096 78533 BRIAN ATKINS TRUSTEE 2.00 40.00 X 0 73871 43513 KENNETH KOBUS TRUSTEE 2.00 40.00 X 0 90207 90056 ROY WACKERLIN TRUSTEE 2.00 40.00 X 0 112055 86616 HOWARD NORBERG TRUSTEE 2.00 40.00 X 0 167360 112030 DANIEL AUSSEM TRUSTEE 2.00 X 0 0 0 DANA OAKS TRUSTEE 2.00 X 0 0 0 CHRIS KUHNE TRUSTEE 2.00 X 0 0 0 NORMAN SANDBERG TRUSTEE - NEW 2.00 X 0 0 0 RICHARD CASEY TRUSTEE 2.00 X 0 0 0 MICHAEL TESTA TRUSTEE 2.00 X 0 0 0 TIM BAUGH TRUSTEE - PAST 2.00 X 0 0 0 0 646741 484821 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 467056 ZENITH AMERICAN SOLUTIONS 18861 90TH AVENUE SUITE A MOKENA IL 60447 THIRD PARTY ADMINISTRATOR 413877 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 350676 WHITFIELD MCGANN & KETTERMAN 111 E WACKER DRIVE SUITE 2600 CHICAGO IL 60601 FUND ATTORNEY 173128 4 EMPLOYER CONTRIBUTIONS 900099 15578913 15578913 PARTICIPANT CONTRIBUTIONS 900099 587675 587675 PRESCRIPTION DRUG REBATE 900099 533471 533471 STOP-LOSS INSURANCE PROCEEDS 900099 241464 241464 LIQUIDATED DAMAGES 900099 25061 25061 17811 17811 16984395 1360432 1360432 17088701 17724892 -636191 -636191 -636191 MISCELLANEOUS 900099 1901 1901 1901 17710537 16984395 0 726142 15325294 173128 72803 180292 635239 36246 21150 50947 23443 FEES MANDATED BY ACA 116059 DISEASE MANAGEMENT 79389 COLLECTOR EXPENSE 75000 UTILIZATION REVIEW EXPE 69227 1800 16860017 1059324 3544809 1336851 2543401 2712225 65876 62977 25482228 32926519 14402802 10802856 46039116 48900752 652089 526013 0 65498 652089 591511 X 0 0 0 0 45387027 48309241 45387027 48309241 46039116 48900752 X 850520 -113773 2185467 X 0 1 X 1 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 1976106 F AMERICAN STRATEGIC VALUE REALTY FUND 5541239 F INVESCO INSTITUTIONAL TRUST BALANCED RISK ALLOCATION FUND 3285511 F 10802856 X 17487722 -113773 -113773 17601495 109042 109042 17710537 16750975 0 16750975 109042 109042 16860017 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. 0 0 0 BRIAN DISKIN TRUSTEE 0 99152 0 0 0 0 0 55616 0 18457 0 173225 0 0 BRIAN STANLEY TRUSTEE 0 96653 0 0 0 7443 0 58984 0 19549 0 182629 0 0 KENNETH KOBUS TRUSTEE 0 90207 0 0 0 0 0 69223 0 20833 0 180263 0 0 ROY WACKERLIN TRUSTEE 0 112055 0 0 0 0 0 28948 0 57668 0 198671 0 0 HOWARD NORBERG TRUSTEE 0 167360 0 0 0 0 0 86067 0 25963 0 279390 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 ZENITH AMERICAN SOLUTIONS, 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 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARDS THROUGH 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. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS DUE TO MERGER 2,185,467. 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