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IRON WORKS TRI-STATE WELFARE FUND: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
IRON WORKS TRI-STATE WELFARE FUND (EIN 36-6599036)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-06-12
IRS object ID
201241649349300624
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)
Timestamp2012-06-12T11:47:10-05:00Timestamp
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 Line1222 INDIANAPOLIS BOULEVARDAddressLine1
CitySCHERERVILLECity
StateINState
ZIP Code46375ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN366599036EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1IRONWORKERS TRI-STATE WELFARE PLANBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlIRONNameControl
Phone6309603322Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1333 W PIERCE ROAD NO 410AddressLine1
CityITASCACity
StateILState
ZIP Code60143ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAN AUSSEMName
TitleTRUSTEETitle
Phone6309603322Phone
Date Signed2012-06-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRENEE BERG-SPECKName
PTINP00201492PTIN
Phone3123680500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAN AUSSEMNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1333 W PIERCE ROAD NO 410AddressLine1
CityITASCACity
StateILState
ZIP Code60143ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16395464GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1957YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionPROVIDE HEALTH BENEFITSActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees22TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year13486630ProgramServiceRevenuePriorYear
Program Service Revenue CY13850054ProgramServiceRevenueCY
Investment Income Prior Year1338917InvestmentIncomePriorYear
Investment Income Current Year936788InvestmentIncomeCurrentYear
Other Revenue Prior Year2839OtherRevenuePriorYear
Other Revenue Current Year1439OtherRevenueCurrentYear
Total Revenue Prior Year14828386TotalRevenuePriorYear
Total Revenue Current Year14788281TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year13871303BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY12353518BenefitsPaidToMembersCY
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 Year1202820OtherExpensePriorYear
Other Expenses Current Year1143845OtherExpensesCurrentYear
Total Expenses Prior Year15074123TotalExpensesPriorYear
Total Expenses Current Year13497363TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-245737RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1290918RevenuesLessExpensesCY
Total Assets BOY33775907TotalAssetsBOY
Total Assets EOY35428409TotalAssetsEOY
Total Liabilities BOY336353TotalLiabilitiesBOY
Total Liabilities EOY321967TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY33439554NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY35106442NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH BENEFITSMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO PROVIDE HEALTH & WELFARE BENEFITS, INCLUDING MEDICAL, DENTAL, VISION, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFIT COVERAGE FOR ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES.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 Liabilities1ReportOtherLiabilities
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 With1096450NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees22NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Excess Business Holdings0ExcessBusinessHoldings
Taxable Distributions0TaxableDistributions
Distribution To Donor0DistributionToDonor
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
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 Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement0RegularMonitoringEnforcement
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 Number6309603322TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1333 WEST PIERCE ROAD SUITE 410AddressLine1
CityITASCACity
StateILState
ZIP Code60143ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MIKE WILCHER
TRUSTEE2.00X000
BRIAN STANLEY
TRUSTEE2.00X000
BRIAN DISKIN
TRUSTEE2.00X000
DANIEL AUSSEM
TRUSTEE2.00X000
JACK KECK
TRUSTEE2.00X000
HOWARD NORBERG
TRUSTEE2.00X000
DANA OAKS
TRUSTEE2.00X000
STUART BROEREN
TRUSTEE2.00X000
RICHARD P CASEY
TRUSTEE2.00X000
KENNETH KOBUS
TRUSTEE2.00X000
TIM BAUGH
TRUSTEE2.00X000
MICHAEL TESTA
TRUSTEE2.00X000
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 (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
THE SEGAL CO
101 NORTH WACKER DRIVE SUITE 500CHICAGOIL60606FUND CONSULTANT426657
BLUE CROSS BLUE SHIELD
300 EAST RANDOLPH STREETCHICAGOIL60601CLAIMS PROCESSOR422620
ZENITH AMERICAN SOLUTIONS
333 W PIERCE ROADITASCAIL60143THIRD PARTY ADMINISTRATOR241059
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS9000991262735012627350
PARTICIPANT CONTRIBUTI900099944235944235
PRESCRIPTION DRUG REBA900099214362214362
COBRA SUBSIDY INCOME9000996271362713
LIQUIDATED DAMAGES900099767767

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column627TotalRevenueColumn
Related Or Exempt Function Income627RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue13850054TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column947485TotalRevenueColumn
Exclusion$947,485ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1596486Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1607183Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-10697Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-10697TotalRevenueColumn
Exclusion-$10,697ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column1439TotalRevenueColumn
Exclusion$1,439ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1439TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14788281TotalRevenueColumn
Related Or Exempt Function Income13850054RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$938,227ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total12353518Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total64520Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total80526Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total68279Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total628407Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total44288Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total34Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total20106Total

Insurance Insurance

FieldValueIRS element (for citing)
Total25473Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
DISEASE MANAGEMENT82798
COLLECTOR EXPENSE70385
UTILIZATION REVIEW EXPE56550
DUES & SUBSCRIPTIONS2479

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13497363Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY10068449BOY
EOY2320777EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2276015BOY
EOY2057682EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY21466BOY
EOY26122EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17977636BOY
EOY26704678EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY3432341BOY
EOY4319150EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33775907BOY
EOY35428409EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY330656BOY
EOY309476EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5697BOY
EOY12491EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY336353BOY
EOY321967EOY
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)
BOY33439554BOY
EOY35106442EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33439554BOY
EOY35106442EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33775907BOY
EOY35428409EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1290918ReconcilationRevenueExpenses
Reconcilation Other Changes375970ReconcilationOtherChanges
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

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND1410587F
AMERICAN STRATEGIC VALUE REALTY FUND2908563F
FieldValueIRS element (for citing)
Total Of Book Value Securities4319150TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO IRON WORKERS' MID-AMERICA PENSION FUNDDescription
Amount$12,491Amount
FieldValueIRS element (for citing)
Total Of Amounts12491TotalOfAmounts
Total Revenue14788281TotalRevenue
Total Expenses13497363TotalExpenses
Excess Or Deficit For Year1290918ExcessOrDeficitForYear
Net Unrealized GL On Investments375970NetUnrealizedGLOnInvestments
Total Adjustments375970TotalAdjustments
Excess Or Deficit Per FS1666888ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt15120972TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments375970NetUnrealizedGainsInvestments
Revenue Not Rptd F990375970RevenueNotRptdF990
Revenue Subtotal14745002RevenueSubtotal
Investment Expenses Not Included43279InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt43279RevenueNotRptdOnFinStmt
Total Revenue Per Form99014788281TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13454084TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal13454084ExpensesSubtotal
Investment Expenses Not Included243279InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt43279ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013497363TotalExpensesPerForm990

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 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 (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE BOARD OF TRUSTEES HAS DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO ZENITH AMERICAN SOLUTIONS, AS THIRD PARTY ADMINISTRATOR OF THE FUND.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARDS THROUGH REVIEW, THE FORM IS APPROVED AND FILED.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 375,970.CHANGES IN NET ASSETS OR FUND BALANCES: