2016-10-03T15:07:33-05:00 2015-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2015-01-01 202288018 MIDWEST TEAMSTERS HEALTH REIMBURSEMENT ARRANGEMENT TR FUND MIDW 6512561804 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 DOUG RUBBELKE CHAIRMAN 6512561804 2016-09-14 1 ERIC C BAERTSCH P00964071 9528413950 2015 2017-02-10 21:41:12Z DOUG RUBBELKE 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 907420 0 X N/A X 2005 MN HEALTH REIMBURSEMENT ARRANGEMENT 5 5 0 0 0 0 0 0 738861 757263 58144 148508 77 1649 797082 907420 0 0 685978 643163 0 0 0 0 0 175512 173621 861490 816784 -64408 90636 6986080 6873995 17032 22441 6969048 6851554 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 X 5 5 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 SUITE 325 MENDOTA HEIGHTS MN 55120 X DOUG RUBBELKE CHAIRMAN 0.50 X 0 0 0 MARTIN 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 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 129080 1 EMPLOYER CONTRIBUTIONS 900099 757263 757263 757263 148508 148508 LITIGATION SETTLEMENT 900099 1440 1440 OTHER REFUNDS 900099 209 209 1649 907420 757263 0 150157 643163 122180 8728 15650 3841 12217 5978 PCORI FEE 4997 STOP PAY FEE REIMBURSEM 30 816784 143687 191040 5981432 3779840 63148 47064 797813 2856051 6986080 6873995 17032 22441 17032 22441 X 0 0 0 0 6969048 6851554 6969048 6851554 6986080 6873995 90636 -208130 0 X 0 1 X 1 0 0 X 699290 -208130 -208130 907420 0 907420 816784 0 816784 0 816784 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 PLANS RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. 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 APPONITED BY CONTRIBUTING EMPLOYERS. UNION TRUSTEES ARE APPOINTED BY UNIONS. FORM 990, PART VI, SECTION B, LINE 11 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 AND NOT TO THE PUBLIC. THESE DOCUMENTS CAN BE OBTAINED BY REQUEST AT THE PLAN ADMINISTRATOR'S OFFICE IN MENDOTA HEIGHTS, MN. 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