2014-08-05T14:59:15-05:00 2013-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2013-01-01 367485085 MIDDLETOWN WORKS HOURLY & SALARIED UNION RETIREES HEALTH CARE FUND MIDD 8778295500 ZENITH AMER SOLUTIONS 3333 N MAYFAIR RD NO 201 WAUWATOSA WI 53222 JAY YOUNGDAHL TRUSTEE 8778295500 2014-08-05 1 ERIC C BAERTSCH P00964071 9528413950 2013 2015-11-30 17:44:51Z X JAY YOUNGDAHL ZENITH AMER SOLUTIONS 3333 N MAYFAIR RD N WAUWATOSA WI 53222 202561348 0 X N/A X 2008 OH TO PROVIDE HEALTH BENEFITS 5 0 0 0 0 0 0 0 9743743 12521237 17855282 22091111 0 0 27599025 34612348 0 0 45273105 46073274 92500 89750 0 0 0 3178773 3294607 48544378 49457631 -20945353 -14845283 631367881 673550190 351956 355157 631015925 673195033 TO PROVIDE HEALTH BENEFITS. 0 0 TO PROVIDE MEDICAL, PRESCRIPTION DRUG AND/OR LIFE INSURANCE BENEFITS FOR ELIGIBLE RETIREES AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 1 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 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 X 5 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X KAREN MAY ZENITH AMERICAN SOLUTIONS 8778295500 3333 N MAYFAIR ROAD STE 201 WAUWATOSA WI 53222 JAY YOUNGDAHL TRUSTEE 8.00 X 32000 0 0 ROGER MCCLOW TRUSTEE 8.00 X 30000 0 0 RONNIE BANKS TRUSTEE 8.00 X 11500 0 0 BRIAN DALEY TRUSTEE 8.00 X 9500 0 0 STEPHEN LAWSON TRUSTEE-PAST 8.00 X 0 0 0 MICHAEL BAILEY TRUSTEE 8.00 X 6750 0 0 89750 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 3333 N MAYFAIR RD STE 201 WAUWATOSA WI 53222 THIRD PARTY ADMINISTRATOR & CLAIMS PROCE 813259 EXPRESS SCRIPTS 100 PARSONS POND DRIVE FRANKLIN LAKES NJ 07417 PHARMACY BENEFIT MANAGER 586339 UNITED HEALTHCARE SERVICES INC 185 ASYLUM STREET HARTFORD CT 06103 MEDICAL NETWORK ACCESS 390329 PIMCO 840 NEWPORT CENTER DRIVE SUITE 100 NEWPORT BEACH CA 92660 INVESTMENT MANAGER 269270 WESTERN ASSET MANAGEMENT CO 385 EAST COLORADO BLVD PASADENA CA 91101 INVESTMENT MANAGER 263763 10 SELF PAY CONTRIBUTIONS 900099 4485085 4485085 RETIREE DRUG SUBSIDY 900099 4259446 4259446 MEDCO REBATES 900099 3518102 3518102 REFUND FROM INSURANCE PROVIDER 900099 258604 258604 12521237 6116781 6116781 183923330 167949000 15974330 15974330 15974330 34612348 12521237 0 22091111 46073274 89750 355984 25492 23115 1199498 1412106 168753 21388 81779 PCORI TAX 6492 49457631 10129 -165312 15933528 26992917 1940167 4725613 199116 195397 267738026 37962015 345546915 603839560 631367881 673550190 351956 291275 63882 351956 355157 X 0 0 0 0 631015925 673195033 631015925 673195033 631367881 673550190 -14845283 57024391 0 X 0 1 X 1 0 0 COMMON/COLLECTIVE TRUSTS 507034342 F REGISTERED INVESTMENT COMPANIES - NON PUBLICLY TRADED 82273295 F LIMITED PARTNERSHIP INTERESTS 14531923 F 603839560 X 90437241 57024391 57024391 33412850 1199498 1199498 34612348 48258133 0 48258133 1199498 1199498 49457631 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 LIMITATION EXPIRES. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES MAINTAIN ULTIMATE CONTROL AND RESPONSIBILITY FOR THE PLAN, THEY HAVE DELEGATED THE DAY-TO-DAY ADMINISTRATIVE DUTIES TO ZENITH AMERICAN SOLUTIONS, INC. AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR THEIR REVIEW. FORM 990 IS SIGNED AND FILED ONLY AFTER ALL QUESTIONS ARE ANSWERED AND ANY REVIEW CHANGES ARE MADE. FORM 990, PART VI, SECTION B, LINE 15 ALTHOUGH THE PLAN HAS NOT USED THE METHODS LISTED IN PART VI, SECTION B, NUMBER 15 TO DETERMINE COMPENSATION, THE PLAN HAS ADOPTED A FORMAL COMPENSATION POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN DISTRIBUTES THE SUMMARY PLAN DESCRIPTION TO PLAN PARTICIPANTS AND PLAN PARTICIPANTS MAY REQUEST A COPY OF FORM 5500 ANNUAL REPORT, INCLUDING A FINANCIAL STATEMENT, FROM THE PLAN. OTHER PLAN DOCUMENTS THAT ARE REQUIRED TO BE DISCLOSED UNDER FEDERAL LAW, INCLUDING THE EMPLOYEE RETIREMENT AND INCOME SECURITY ACT OF 1974, AS AMENDED, ARE AVAILABLE UPON REQUEST.