2015-07-06T15:34:55-05:00 2014-11-30 510435869 Needles & Associates LLC 350 Interlocken Blvd STE 360 Broomfield CO 80021 990 2013-12-01 736104291 Mid-South Iron Workers Welfare Plan MID- 4056822323 1300 South Meridian Street Oklahoma City OK 73108 Walter Ashford Trustee 4056822323 2015-07-01 Kurt Needles P00850236 3034304225 2015-07-06 2013 2016-02-25 16:41:14Z Walter Ashford 1300 South Meridian Street Oklahoma City OK 73108 4373325 0 X N/A X 1964 OK To provide health benefits to participants and their dependents. 6 0 0 0 0 0 0 0 2508652 3137599 52280 70504 59427 0 2620359 3208103 0 0 2484071 2617336 0 0 0 0 0 351059 439092 2835130 3056428 -214771 151675 3614468 3836141 1337205 1414521 2277263 2421620 To provide health benefits to participants and their dependents. 0 0 2268567 Benefits paid. 290840 Insurance premiums. 57929 Change in hour bank liability and claims incurred but not reported. 2617336 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 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Board of Trustees 4056822323 1300 South Meridian Street Oklahoma City OK 73108 X Michael Richards Trustee 1.00 X 0 0 0 Tom Lambert Co-Chairman 1.00 X 0 0 0 Chris Kinder Trustee 1.00 X 0 0 0 Walter Ashford Chairman 1.00 X 0 0 0 Dave Bennett Trustee 1.00 X 0 0 0 Kenneth Beatty Trustee 1.00 X 0 0 0 0 0 0 0 0 0 0 Zenith American Solutions 1300 S Meridian Street Oklahoma City OK 73108 Administrative 136983 Blue Cross Blue Shield 225 North Michigan Ave Chicago IL 60601 PPO/Access Fees 131250 2 Employers' Contributions 525100 2964335 2964335 Reciprocity In 525100 196916 196916 Employees' Contributions 525100 129910 129910 Reciprocity Out 525100 -153562 -153562 3137599 20413 20413 1215313 1165222 50091 50091 50091 3208103 3187690 0 20413 2617336 2617336 126770 126770 36040 36040 24570 24570 178782 178782 12731 12731 418 418 14238 14238 Transitional Reinsuranc 41927 41927 Misc. 3616 3616 3056428 2617336 439092 0 349936 163084 951285 630747 351721 381799 1961526 2660511 3614468 3836141 141924 161312 1195281 1253209 1337205 1414521 X 2277263 2421620 2277263 2421620 3614468 3836141 151675 -7318 0 X 0 1 X 1 0 0 Hour Bank Liability 813209 Claims Incurred but Not Reported 440000 1253209 X 3200785 -7318 -7318 3208103 0 3208103 2998499 0 2998499 57929 57929 3056428 Part X, Line 2: The Trust, established under the Plan to hold the Plan's assets, is qualified under Section 501(c)(9) of the Internal Revenue Code, and, accordingly, the Trust's net investment income is exempt from income taxes. The Plan has obtained a favorable tax determination letter. The trust has been amended since receiving the determination letter. However, the Plan's administrator and tax counsel believe that the trust is currently designed and being operated in compliance with the applicable requirements of the Internal Revenue Code. Management has evaluated the Plan's tax positions and concluded that the Plan has maintained its tax exempt status and had taken no uncertain tax positions that would require financial statement adjustment or disclosure for the years ended November 30, 2014 and 2013. With few exceptions, the Plan is no longer subject to income tax examinations by tax authorities for years preceding November 30, 2010. Part XII, Line 4b - Other Adjustments: Change in Hour Bank and IBNR liabilities 57,929. Form 990, Part VI, Section B, line 11 Form 990 was provided to the Trustees prior to filing. Form 990, Part VI, Section B, line 12c During Board of Trustee meetings, Trustees discuss and enforce compliance with the conflict of interest policy. Form 990, Part VI, Section C, line 18 The Form 990 is available for public inspection upon request. Form 990, Part VI, Section C, line 19 Governing documents are available to the public upon request. Oklahoma Iron Workers Direct Contribution Plan 1300 S Meridian STE 200 Oklahoma City OK 73108 736278639 The Plan provides pension benefits. OK 403(b) 0 Info not available for Sch R Part III & IV N/A NA OK 73108 000000000 N/A OK 0 0 Info not available for Sch R Part III & IV N/A NA OK 73108 000000000 N/A OK 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 Oklahoma Iron Workers Direct Contribution Plan Q 2539 Cost