2014-09-22T10:17:23-05:00 2013-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2013-01-01 366158494 SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS WELFARE FUND SUBU 6302935218 1171 COMMERCE DR UNIT 1 WEST CHICAGO IL 60185 MARK KENNEDY TRUSTEE 6302935218 2014-09-22 1 COLIN THOMPSON P01460524 3123680500 2013 2015-11-30 17:44:51Z MARK KENNEDY 1171 COMMERCE DR UNIT 1 WEST CHICAGO IL 60185 62364277 0 X N/A X 1951 IL PROVIDE HEALTH BENEFITS 6 0 117 0 0 0 0 0 46539049 45285510 3561073 2210892 7878 156 50108000 47496558 0 0 42399517 46311648 807948 887517 0 0 0 1066268 1076414 44273733 48275579 5834267 -779021 116795908 119714345 740911 136132 116054997 119578213 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 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 1 671 0 1 117 0 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X JOSE COLIN - FUND MANAGER 6302930390 1171 COMMERCE DR UNIT 1 WEST CHICAGO IL 60185 X PHILLIP STANOCH TRUSTEE 1.00 X 0 0 0 MARK KENNEDY TRUSTEE 2.00 X 0 0 0 TOM FLYNN TRUSTEE 1.00 65.00 X 0 148273 29825 WILLIAM BRACH TRUSTEE 1.00 X 0 0 0 DOMINIC ROMANAZZI TRUSTEE 2.00 40.00 X 0 135650 41818 PAUL HAWKINS TRUSTEE 1.00 65.00 X 0 127935 46725 JOSE COLIN FUND MANAGER 12.00 28.00 X 0 124342 27398 0 536200 145766 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 PPO NETWORK PROVIDER 1414266 BIOPARTNERS IN CARE INC 13258 COLLECTION CTR DR CHICAGO IL 60693 MEDICAL PROVIDER 516129 PROVENA HOSPITALS 75 REMITTANCE DR CHICAGO IL 60675 MEDICAL PROVIDER 214394 USRC BOLINGBROOK LLC 396 REMINGTON BLVD BOLINGBROOK IL 60440 MEDICAL PROVIDER 142188 PRUDENTIAL FINANCIAL 2 GATEWAY CENTER NEWARK NJ 07102 INVESTMENT MANAGER 131920 5 EMPLOYER CONTRIBUTIONS 900099 38711798 38711798 PARTIC & RETIREE CONTRIBUTIONS 900099 5037305 5037305 PRESCRIPTION REBATES 900099 1053894 1053894 RETIREE DRUG SUBSIDY 900099 482513 482513 45285510 2228481 2228481 14850130 14867719 -17589 -17589 -17589 MISCELLANEOUS 900099 156 156 156 47496558 45285510 0 2211048 46311648 43625 498654 105863 160504 78871 147945 96695 250562 79671 152950 68851 173763 1855 18138 37619 40751 PCORI FEES 7614 48275579 10721181 6307463 115387 2099297 5767895 4024061 292779 143928 13436 13145 544036 486958 88697 57078 39519395 38680807 60277138 68388566 116795908 119714345 124119 91409 616792 44723 740911 136132 X 0 0 0 0 116054997 119578213 116054997 119578213 116795908 119714345 -779021 4302237 0 X 0 1 X 1 0 544036 486958 57078 57078 IR&M SHORT FUND LLC 20739407 F INSTITUTIONAL STRUCTURED MATURITY BOND FUND 23087165 F INSTITUTIONAL ALL CAP EQUITY FUND 24561994 F 68388566 DUE TO SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND 44723 44723 X 51548233 4302237 4302237 47245996 250562 250562 47496558 48025017 0 48025017 250562 250562 48275579 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 LIMITATIONS EXPIRES. 0 0 0 TOM FLYNN TRUSTEE 0 129873 0 0 0 18400 0 13925 0 15900 0 178098 0 0 DOMINIC ROMANAZZI TRUSTEE 0 104790 0 5000 0 25860 0 25918 0 15900 0 177468 0 0 PAUL HAWKINS TRUSTEE 0 127935 0 0 0 0 0 30825 0 15900 0 174660 0 0 JOSE COLIN FUND MANAGER 0 124342 0 0 0 0 0 11798 0 15600 0 151740 0 0 FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR THEIR REVIEW AND APPROVAL PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES AND EMPLOYEES OF THE HEALTH AND WELFARE FUND. THE BOARD OF TRUSTEES MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES APPROVES COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL (OFFICER), THE FUND MANAGER, WHO OVERSEES THE ORGANIZATIONS DAILY OPERATIONS. THE FUND MANAGER IS PAID BY THE RELATED PENSION FUND AND AN AMOUNT IS ALLOCATED TO THE WELFARE FUND AND REIMBURSED BACK TO THE PENSION FUND BASED ON TIME SPENT WORKING FOR THE RESPECTIVE FUNDS. APPROVAL IS DOCUMENTED IN THE ORGANIZATIONS MINUTES. TRUSTEES OF THE ORGANIZATION ARE NOT COMPENSATED. FORM 990, PART VI, SECTION C, LINE 19 THE HEALTH AND WELFARE FUND MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT ITS HOME OFFICE, UPON REQUEST. FORM 990, PART VII, LINE 1A THE ORGANIZATION'S ADMINISTRATOR IS ALSO THE ADMINSITRATOR OF THE RELATED PENSION FUND. REIMBURSEMENTS ARE DISBURSED BETWEEN THE TWO ORGANIZATIONS FOR THEIR ALLOCATED PORTION OF HIS SALARY, FRINGE BENEFITS, AND PAYROLL TAXES. FORM 990, PART V, LINE 2A THE NUMBER OF EMPLOYEES REPORTED ON FORM W-3, TRANSMITTAL OF WAGE AND TAX STATEMENTS, FILED FOR THE CALENDAR YEAR ENDING WITH OR WITHIN THE YEAR COVERED BY THIS RETURN INCLUDES PARTICIPANTS OF THE FUND THAT HAVE RECEIVED DISABILITY PAYMENTS DURING THE YEAR. 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