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MIDDLETOWN WORKS HOURLY & SALARIED UNION RETIREES HEALTH CARE FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MIDDLETOWN WORKS HOURLY & SALARIED UNION RETIREES HEALTH CARE FUND (EIN 36-7485085)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-05
IRS object ID
201342179349300514
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-05T09:56:26-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN320043599EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LEGACY PROFESSIONALS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line16800 FRANCE AVENUE SO SUITE 550AddressLine1
CityEDINACity
StateMNState
ZIP Code55435ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN367485085EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MIDDLETOWN WORKS HOURLY & SALARIED UNIONBusinessNameLine1
Business Name Line2RETIREES HEALTH CARE FUNDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlMIDDNameControl
Phone8778295500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1ZENITH AMER SOLUTIONS 2100 MAYFAIRAddressLine1
Address Line2RD NO 100AddressLine2
CityMILWAUKEECity
StateWIState
ZIP Code53226ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRONNIE BANKSName
TitleTRUSTEETitle
Phone8778295500Phone
Date Signed2013-07-29DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameERIC C BAERTSCHName
PTINP00964071PTIN
Phone9528413950Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRONNIE BANKSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1ZENITH AMER SOLUTIONS 2100 MAYFAIRAddressLine1
Address Line2RD NO 1AddressLine2
CityMILWAUKEECity
StateWIState
ZIP Code53226ZIPCode
FieldValueIRS element (for citing)
Gross Receipts83510051GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2008YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH BENEFITSActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year75020260ProgramServiceRevenuePriorYear
Program Service Revenue CY9743743ProgramServiceRevenueCY
Investment Income Prior Year17524588InvestmentIncomePriorYear
Investment Income Current Year17855282InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year92544848TotalRevenuePriorYear
Total Revenue Current Year27599025TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year48029940BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY45273105BenefitsPaidToMembersCY
Salaries Etc Prior Year92500SalariesEtcPriorYear
Salaries Etc Current Year92500SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1530047OtherExpensePriorYear
Other Expenses Current Year3178773OtherExpensesCurrentYear
Total Expenses Prior Year49652487TotalExpensesPriorYear
Total Expenses Current Year48544378TotalExpensesCurrentYear
Revenues Less Expenses Prior Year42892361RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-20945353RevenuesLessExpensesCY
Total Assets BOY595614055TotalAssetsBOY
Total Assets EOY631367881TotalAssetsEOY
Total Liabilities BOY250921TotalLiabilitiesBOY
Total Liabilities EOY351956TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY595363134NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY631015925NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH BENEFITS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO PROVIDE MEDICAL, PRESCRIPTION DRUG AND/OR LIFE INSURANCE BENEFITS FOR ELIGIBLE RETIREES AND THEIR DEPENDENTS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10967NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KAREN MAY ZENITH AMERICAN SOLUTIONSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8778295500TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12100 N MAYFAIR ROAD STE 100AddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53226ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JAY YOUNGDAHL
TRUSTEE8.00X3200000
ROGER MCCLOW
TRUSTEE8.00X3000000
RONNIE BANKS
TRUSTEE8.00X1150000
BRIAN DALEY
TRUSTEE8.00X950000
STEPHEN LAWSON
TRUSTEE8.00X950000
FieldValueIRS element (for citing)
Total Reportable Comp From Org92500TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ZENITH AMERICAN SOLUTIONS INC
2100 N MAYFAIR RD SUITE 100MILWAUKEEWI53226THIRD PARTY ADMINISTRATOR & CLAIMS PROCE812331
UNITED HEALTHCARE SERVICES INC
185 ASYLUM STREETHARTFORDCT06103MEDICAL NETWORK ACCESS423533
EXPRESS SCRIPTS
100 PARSONS POND DRIVEFRANKLIN LAKESNJ07417PHARMACY BENEFIT MANAGER291262
PIMCO
840 NEWPORT CENTER DRIVE SUITE 100NEWPORT BEACHCA92660INVESTMENT MANAGER278187
WESTERN ASSET MANAGEMENT CO
385 EAST COLORADO BLVDPASADENACA91101INVESTMENT MANAGER276070
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
SELF PAY CONTRIBUTIONS90009945949034594903
RETIREE DRUG SUBSIDY90009926114962611496
MEDCO REBATES90009925373442537344
FieldValueIRS element (for citing)
Total Program Service Revenue9743743TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column12690294TotalRevenueColumn
Exclusion$12,690,294ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities61076014Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities55911026Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities5164988Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5164988TotalRevenueColumn
Exclusion$5,164,988ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column27599025TotalRevenueColumn
Related Or Exempt Function Income9743743RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$17,855,282ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total45273105Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total92500Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total370967Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24229Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total22525Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1113906Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1411503Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total137940Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total16885Total

Insurance Insurance

FieldValueIRS element (for citing)
Total80818Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total48544378Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY3513025BOY
EOY10129EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY72357594BOY
EOY15933528EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2071621BOY
EOY1940167EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY289678BOY
EOY199116EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY254902703BOY
EOY267738026EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY262479434BOY
EOY345546915EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY595614055BOY
EOY631367881EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY250921BOY
EOY351956EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY250921BOY
EOY351956EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY595363134BOY
EOY631015925EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY595363134BOY
EOY631015925EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY595614055BOY
EOY631367881EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-20945353ReconcilationRevenueExpenses
Reconciliation Unrealized Invest56598144ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
COMMON/COLLECTIVE TRUSTS208056509F
REGISTERED INVESTMENT COMPANIES - NON PUBLICLY TRADED129225431F
LIMITED PARTNERSHIP INTERESTS8264975F
FieldValueIRS element (for citing)
Total Of Book Value Securities345546915TotalOfBookValueSecurities
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt83083263TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments56598144NetUnrealizedGainsInvestments
Revenue Not Rptd F99056598144RevenueNotRptdF990
Revenue Subtotal26485119RevenueSubtotal
Investment Expenses Not Included1113906InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt1113906RevenueNotRptdOnFinStmt
Total Revenue Per Form99027599025TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt47430472TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal47430472ExpensesSubtotal
Investment Expenses Not Included21113906InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt1113906ExpensesNotRptdOnFinStmt
Total Expenses Per Form99048544378TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationTHE 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 3ALTHOUGH 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 11A 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.
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 19THE 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.