2015-01-12T11:04:14-06:00 2014-02-28 362152389 BANSLEY AND KIENER LLP 8745 W HIGGINS RD STE 200 CHICAGO IL 606312704 990 2013-03-01 237194891 MIDWESTERN TEAMSTERS HEALTH & WELFARE FUND MIDW 3126491200 18861-90TH AVENUE SUITE A MOKENA IL 60448 SCOTT ALEXANDER TRUSTEE 3126491200 2014-12-02 1 DANIELLE M TYLER P01433924 3122632700 2013 2016-02-25 16:41:14Z SCOTT ALEXANDER 18861-90TH AVENUE SUITE A MOKENA IL 60448 3926038 0 X N/A X 1971 IL TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 5 0 0 0 0 0 0 0 3942953 3923953 921 2067 1117 18 3944991 3926038 0 0 3859294 3786666 0 0 0 0 0 742757 742823 4602051 4529489 -657060 -603451 2201773 1493382 859213 743017 1342560 750365 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 0 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 1 0 0 0 0 0 0 0 X 5 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 3126491200 18861-90TH AVE SUITE A MOKENA IL 60448 SCOTT ALEXANDER TRUSTEE 1.00 40.00 X 0 101477 2243 MARK BIEL TRUSTEE 1.00 40.00 X 0 93189 2774 EDWARD BRENNAN TRUSTEE 1.00 X 0 0 0 MIKE NEUDECKER TRUSTEE 1.00 X 0 0 0 MARC ARCHER TRUSTEE 1.00 40.00 X 0 81960 1909 0 276626 6926 0 0 0 0 ZENITH AMERICAN SOLUTIONS 18861 90TH AVE SUITE A MOKENA IL 60448 CONTRACT ADMINISTRATION 627107 1 EMPLOYER CONTRIBUTIONS 900099 3596476 3596476 PARTICIPANT CONTRIBUTI 900099 297887 297887 PRESCRIPTION DRUG REBA 900099 29235 29235 LIQUIDATED DAMAGES 900099 355 355 3923953 2067 2067 MISCELLANEOUS INCOME 900099 18 18 18 3926038 3923971 0 2067 3786666 610000 36850 20092 1875 44693 15037 1625 7368 MISCELLANEOUS 4565 I.F.E.B.P. DUES 718 4529489 1107706 210754 219882 191575 4190 3876 856203 1073003 13792 14174 2201773 1493382 26592 17919 832621 725098 859213 743017 X 0 0 0 0 1342560 750365 1342560 750365 2201773 1493382 -603451 11256 0 X X 0 1 X 0 0 0 ESTIMATED LIABILITY FOR BENEFIT PAYMENTS 703400 DEFERRED CONTRIBUTIONS 20228 DUE TO MIDWESTERN TEAMSTERS PENSION TRUST FUND 1470 725098 3935419 11256 11256 3924163 1875 1875 3926038 4584414 0 4584414 1875 -56800 -54925 4529489 PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN OBLIGATION FOR HEALTH CLAIMS PAYABLE -56,800. 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 2C: THE TRUSTEES SELECT THE INDEPENDENT AUDITORS. THE OVERSIGHT OF THE AUDIT IS PERFORMED BY THE THIRD PARTY ADMINISTRATOR. 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 EXTERIOR INTERIOR SPECIALISTS JAX ASPHALT CO DARLING INTERNATIONAL DUCLOS EXCAVATING INC EARL QUIRIN TRUCK SERVICE ENGINEERED FLUID FELLER OILFIELD SERV GEORGE WEBER GRANITE CITY CHEVROLET H C PARRISH TRUCKING HAYDEN WRECKING COMPANY KMK SALES LAFORE TRUCK SERVICE INC KILLIAN TRANSPORTATION KILLIAN CORPORATION LIESE LUMBER CO INC MECKFESSEL TIRE COMPANY MOBILE HOME PARK INVESTMENTS PRAXAIR DISTRIBUTION INC QUALITY PONTIAC INC RAY LAFORE EXCAVATING INC RED-E-MIX LLC ROBERTS MOTORS INC ROGER'S REDI-MIX INC STEFFY HOME FURNISHINGS INC SWANSEA BUILDING PRODUCTS CORPORATION ZENITH AMERICAN SOLUTIONS TRICKEY'S SERVICE INC TURK FURNITURE UPCHURCH CONCRETE UPCHURCH READY MIX CONCRETE METRO CONCRETE LLC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 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 OF SCHEDULE R.