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IRON WORKS TRI-STATE WELFARE FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
IRON WORKS TRI-STATE WELFARE FUND (EIN 36-6599036)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-06-20
IRS object ID
201121719349300522
Schema version
2010v3.2
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)
Timestamp2011-06-20T15:26:45-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LEGACY PROFESSIONALS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line19301 CALUMET AVENUEAddressLine1
CityMUNSTERCity
StateINState
ZIP Code46321ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

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 Signed2011-06-20DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLEGACY PROFESSIONALS LLPName
Phone3123680500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
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 Receipts27245533GrossReceipts
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 Members11NbrIndependentVotingMembers
Total Nbr Employees23TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year14274592ProgramServiceRevenuePriorYear
Program Service Revenue CY13486630ProgramServiceRevenueCY
Investment Income Prior Year666881InvestmentIncomePriorYear
Investment Income Current Year1338917InvestmentIncomeCurrentYear
Other Revenue Prior Year15706OtherRevenuePriorYear
Other Revenue Current Year2839OtherRevenueCurrentYear
Total Revenue Prior Year14957179TotalRevenuePriorYear
Total Revenue Current Year14828386TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year14582513BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY13871303BenefitsPaidToMembersCY
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 Year1214398OtherExpensePriorYear
Other Expenses Current Year1202820OtherExpensesCurrentYear
Total Expenses Prior Year15796911TotalExpensesPriorYear
Total Expenses Current Year15074123TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-839732RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-245737RevenuesLessExpensesCY
Total Assets BOY33690892TotalAssetsBOY
Total Assets EOY33775907TotalAssetsEOY
Total Liabilities BOY302665TotalLiabilitiesBOY
Total Liabilities EOY336353TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY33388227NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY33439554NetAssetsOrFundBalancesEOY
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
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 With1096453NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees23NumberOfEmployees
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 Members11NumberIndependentVotingMembers
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 Line1OBA MIDWESTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6309603322TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1333 WEST PIERCE ROAD SUITE 410AddressLine1
CityITASCACity
StateILState
ZIP Code60143ZIPCode

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
TRUSTEE2.00X93600
TIM BAUGH
TRUSTEE2.00X000
MICHAEL TESTA
TRUSTEE2.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org936TotalReportableCompFromOrg
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 (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
THE SEGAL CO
101 NORTH WACKER DRIVE SUITE 500CHICAGOIL60606FUND CONSULTANT464899
BLUE CROSS BLUE SHIELD
300 EAST RANDOLPH STREETCHICAGOIL60601CLAIMS PROCESSOR414775
OBA MIDWEST LTD
333 W PIERCE ROADITASCAIL60143THIRD PARTY ADMINISTRATOR217783
LEGACY PROFESSIONALS
311 SOUTH WACKER DRIVE SUITE 4000CHICAGOIL60606FUND ACCOUNTANT101288
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS9000991200784612007846
PARTICIPANT CONTRIBUTI900099954249954249
PRESCRIPTION DRUG REBA900099226061226061
STOP LOSS INCOME900099115942115942
COBRA SUBSIDY INCOME900099104111104111

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column78421TotalRevenueColumn
Related Or Exempt Function Income78421RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue13486630TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1009243TotalRevenueColumn
Exclusion$1,009,243ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities12746821Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities12417147Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities329674Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column329674TotalRevenueColumn
Exclusion$329,674ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column2839TotalRevenueColumn
Exclusion$2,839ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue2839TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14828386TotalRevenueColumn
Related Or Exempt Function Income13486630RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,341,756ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total13871303Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total72873Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total111001Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total48729Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total641206Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total46381Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8078Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total48082Total

Insurance Insurance

FieldValueIRS element (for citing)
Total25076Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
DISEASE MANAGEMENT87489
UTILIZATION REVIEW EXPE56804
COLLECTOR EXPENSE56211
DUES & SUBSCRIPTIONS890

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total15074123Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY12583298BOY
EOY10068449EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1718500BOY
EOY2276015EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY77562BOY
EOY21466EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY17786817BOY
EOY17977636EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1524715BOY
EOY3432341EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33690892BOY
EOY33775907EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY299033BOY
EOY330656EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3632BOY
EOY5697EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY302665BOY
EOY336353EOY
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)
BOY33388227BOY
EOY33439554EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33388227BOY
EOY33439554EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33690892BOY
EOY33775907EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-245737ReconcilationRevenueExpenses
Reconcilation Other Changes297064ReconcilationOtherChanges
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 FUND1671025F
AMERICAN STRATEGIC VALUE REALTY FUND1761316F
FieldValueIRS element (for citing)
Total Of Book Value Securities3432341TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO IRON WORKERS' MID-AMERICA PENSION FUNDDescription
Amount$5,697Amount
FieldValueIRS element (for citing)
Total Of Amounts5697TotalOfAmounts
Total Revenue14828386TotalRevenue
Total Expenses15074123TotalExpenses
Excess Or Deficit For Year-245737ExcessOrDeficitForYear
Net Unrealized GL On Investments297064NetUnrealizedGLOnInvestments
Total Adjustments297064TotalAdjustments
Excess Or Deficit Per FS51327ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt15091721TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments297064NetUnrealizedGainsInvestments
Revenue Not Rptd F990297064RevenueNotRptdF990
Revenue Subtotal14794657RevenueSubtotal
Investment Expenses Not Included33729InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt33729RevenueNotRptdOnFinStmt
Total Revenue Per Form99014828386TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt15040394TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal15040394ExpensesSubtotal
Investment Expenses Not Included233729InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt33729ExpensesNotRptdOnFinStmt
Total Expenses Per Form99015074123TotalExpensesPerForm990

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)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 3THE BOARD OF TRUSTEES HAS DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO OBA MIDWEST, 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 BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARDS REVIEW, THE FORM IS APPROVED AND FILED.
THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 297,064.FORM 990, PART XI, LINE 5: