2012-06-12T11:47:10-05:00 2011-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2011-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 6309603322 333 W PIERCE ROAD NO 410 ITASCA IL 60143 DAN AUSSEM 6309603322 2012-06-12 1 RENEE BERG-SPECK P00201492 3123680500 2011 2016-02-24 21:20:13Z DAN AUSSEM 333 W PIERCE ROAD NO 410 ITASCA IL 60143 16395464 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 12 12 22 0 0 0 0 0 13486630 13850054 1338917 936788 2839 1439 14828386 14788281 0 0 13871303 12353518 0 0 0 0 0 1202820 1143845 15074123 13497363 -245737 1290918 33775907 35428409 336353 321967 33439554 35106442 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH & WELFARE BENEFITS, INCLUDING MEDICAL, DENTAL, VISION, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFIT COVERAGE FOR ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 1 450 0 1 22 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 6309603322 333 WEST PIERCE ROAD SUITE 410 ITASCA IL 60143 X MIKE WILCHER 2.00 X 0 0 0 BRIAN STANLEY 2.00 X 0 0 0 BRIAN DISKIN 2.00 X 0 0 0 DANIEL AUSSEM 2.00 X 0 0 0 JACK KECK 2.00 X 0 0 0 HOWARD NORBERG 2.00 X 0 0 0 DANA OAKS 2.00 X 0 0 0 STUART BROEREN 2.00 X 0 0 0 RICHARD P CASEY 2.00 X 0 0 0 KENNETH KOBUS 2.00 X 0 0 0 TIM BAUGH 2.00 X 0 0 0 MICHAEL TESTA 2.00 X 0 0 0 0 0 0 0 0 0 0 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 426657 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 422620 ZENITH AMERICAN SOLUTIONS 333 W PIERCE ROAD ITASCA IL 60143 THIRD PARTY ADMINISTRATOR 241059 3 EMPLOYER CONTRIBUTIONS 900099 12627350 12627350 PARTICIPANT CONTRIBUTI 900099 944235 944235 PRESCRIPTION DRUG REBA 900099 214362 214362 COBRA SUBSIDY INCOME 900099 62713 62713 LIQUIDATED DAMAGES 900099 767 767 627 627 13850054 947485 947485 1596486 1607183 -10697 -10697 -10697 MISCELLANEOUS 900099 1439 1439 1439 14788281 13850054 0 938227 12353518 64520 80526 68279 628407 44288 34 20106 25473 DISEASE MANAGEMENT 82798 COLLECTOR EXPENSE 70385 UTILIZATION REVIEW EXPE 56550 DUES & SUBSCRIPTIONS 2479 13497363 10068449 2320777 2276015 2057682 21466 26122 17977636 26704678 3432341 4319150 33775907 35428409 330656 309476 5697 12491 336353 321967 X 0 0 0 0 33439554 35106442 33439554 35106442 33775907 35428409 X 1290918 375970 X 0 1 1 X 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 1410587 F AMERICAN STRATEGIC VALUE REALTY FUND 2908563 F 4319150 DUE TO IRON WORKERS' MID-AMERICA PENSION FUND 12491 12491 14788281 13497363 1290918 375970 375970 1666888 15120972 375970 375970 14745002 43279 43279 14788281 13454084 0 13454084 43279 43279 13497363 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 THE 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 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE 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 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 375,970.