2014-09-15T16:14:00-05:00 2013-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2013-01-01 202288018 MIDWEST TEAMSTERS HEALTH REIMBURSEMENT ARRANGEMENT TRUST FUND MIDW 6512561804 C/O ZENITH AMER SOLUTIONS 2520 PILOT KNOB RD NO 325 MENDOTA HEIGHTS MN 55120 DOUG RUBBELKE CHAIRMAN 6512561804 2014-09-16 1 ERIC C BAERTSCH P00964071 9528413950 2013 2015-11-30 17:44:51Z DOUG RUBBELKE C/O ZENITH AMER SOLUTIONS 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 849034 0 X N/A X 2005 MN HEALTH REIMBURSEMENT ARRANGEMENT 6 6 0 0 0 0 0 0 868994 790977 70256 57856 112 201 939362 849034 0 0 761586 781989 0 0 0 0 0 170237 198626 931823 980615 7539 -131581 7185320 7059860 11246 17367 7174074 7042493 THIS PLAN IS INTENDED TO PERMIT AN ELIGIBLE EMPLOYEE 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 6 6 0 1 0 0 0 0 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 TRUSTEE 0.50 X 0 0 0 SUSAN MAUREN SECRETARY 0.50 X 0 0 0 KEITH GLEASON TRUSTEE 0.50 X 0 0 0 DAVE MIFFLIN TRUSTEE 0.50 X 0 0 0 LISA STENGER TRUSTEE-PAST 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 & PAYROLL AUDITS 123652 1 EMPLOYER CONTRIBUTIONS 900099 790977 790977 790977 57856 57856 LITIGATION SETTLEMENT 900099 201 201 201 849034 790977 0 58057 781989 121352 31644 8250 3116 2300 27101 813 4050 980615 -26719 66077 7148632 6930501 63407 63282 7185320 7059860 11246 17367 11246 17367 X 0 0 0 0 7174074 7042493 7174074 7042493 7185320 7059860 -131581 0 X 0 1 X 1 0 0 X 849034 0 849034 0 849034 980615 0 980615 0 980615 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 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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