STRATEGY STUDIO / PUBLIC DATA EXPLORER

MIDWEST TEAMSTERS HEALTH REIMBURSEMENT ARRANGEMENT TR FUND: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MIDWEST TEAMSTERS HEALTH REIMBURSEMENT ARRANGEMENT TR FUND (EIN 20-2288018)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-22
IRS object ID
201222969349300712
Schema version
2011v1.2
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)
Timestamp2012-10-22T09:48:53-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

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 Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN202288018EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MIDWEST TEAMSTERS HEALTH REIMBURSEMENTBusinessNameLine1
Business Name Line2ARRANGEMENT TRUST FUNDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlMIDWNameControl
Phone6512561804Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O ZENITH AMER SOLUTIONS 2520AddressLine1
Address Line2PILOT KNOB RD NO 325AddressLine2
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDOUG RUBBELKEName
TitleCHAIRMANTitle
Phone6512561804Phone
Date Signed2012-09-27DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameERIC BAERTSCHName
PTINP00964071PTIN
Phone9528413950Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDOUG RUBBELKENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1C/O ZENITH AMER SOLUTIONS 2520AddressLine1
Address Line2PILOT KNOB RDAddressLine2
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode
FieldValueIRS element (for citing)
Gross Receipts1169760GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2005YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionHEALTH REIMBURSEMENT ARRANGEMENTActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
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 Year812073ProgramServiceRevenuePriorYear
Program Service Revenue CY1091137ProgramServiceRevenueCY
Investment Income Prior Year109194InvestmentIncomePriorYear
Investment Income Current Year78304InvestmentIncomeCurrentYear
Other Revenue Prior Year4902OtherRevenuePriorYear
Other Revenue Current Year319OtherRevenueCurrentYear
Total Revenue Prior Year926169TotalRevenuePriorYear
Total Revenue Current Year1169760TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year955729BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY847002BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year145890OtherExpensePriorYear
Other Expenses Current Year168224OtherExpensesCurrentYear
Total Expenses Prior Year1101619TotalExpensesPriorYear
Total Expenses Current Year1015226TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-175450RevenuesLessExpensesPriorYear
Revenues Less Expenses CY154534RevenuesLessExpensesCY
Total Assets BOY7024716TotalAssetsBOY
Total Assets EOY7179599TotalAssetsEOY
Total Liabilities BOY12715TotalLiabilitiesBOY
Total Liabilities EOY13064TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7012001NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY7166535NetAssetsOrFundBalancesEOY
Mission DescriptionTHIS PLAN IS INTENDED TO PERMIT AN ELIGIBLE EMPLOYEE TO OBTAIN REIMBURSEMENT OF MEDICAL CARE EXPENSE ON A NONTAXABLE BASIS FROM THEIR HRA ACCOUNT.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionREIMBURSEMENT OF MEDICAL EXPENSES THAT QUALIFY UNDER SECTION 213 OF THE INTERNAL REVENUE CODE.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 Securities0ReportInvestOthSecurities
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
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
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 Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
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 Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
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 Line1ZENITH AMERICAN SOLUTIONSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6512561804TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12520 PILOT KNOB ROADAddressLine1
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DOUG RUBBELKE
CHAIRMAN0.50X000
TREVOR LAWRENCE
TRUSTEE0.50X000
SUSAN MAUREN
SECRETARY0.50X000
KEITH GLEASON
TRUSTEE0.50X000
DAVE MIFFLIN
TRUSTEE0.50X000
LISA STENGER
TRUSTEE0.50X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
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

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ZENITH AMERICAN SOLUTIONSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12520 PILOT KNOB ROADAddressLine1
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesADMINISTRATIVEDescriptionOfServices
Compensation119292Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionEMPLOYER CONTRIBUTIONSDescription
Business Code900099BusinessCode
Total Revenue Column1091137TotalRevenueColumn
Related Or Exempt Function Income1091137RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue1091137TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column78304TotalRevenueColumn
Exclusion$78,304ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
LITIGATION SETTLEMENT900099281$281
OTHER REFUNDS90009938$38
FieldValueIRS element (for citing)
Total Other Revenue319TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1169760TotalRevenueColumn
Related Or Exempt Function Income1091137RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$78,623ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total847002Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total119292Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total7783Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total7750Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total3814Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5750Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total19018Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total767Total

Insurance Insurance

FieldValueIRS element (for citing)
Total4050Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1015226Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-29429BOY
EOY-40211EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY6972861BOY
EOY7144659EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY81284BOY
EOY75151EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7024716BOY
EOY7179599EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY12715BOY
EOY13064EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12715BOY
EOY13064EOY
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)
BOY7012001BOY
EOY7166535EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7012001BOY
EOY7166535EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7024716BOY
EOY7179599EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses154534ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue1169760TotalRevenue
Total Expenses1015226TotalExpenses
Excess Or Deficit For Year154534ExcessOrDeficitForYear
Excess Or Deficit Per FS154534ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt1169760TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal1169760RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9901169760TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt1015226TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal1015226ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9901015226TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

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

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11FORM 990 IS PROVIDED TO AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 19ALL 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.