2011-08-08T16:18:36-05:00 2010-12-31 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2010-01-01 366158494 SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS WELFARE FUND SUBU 6302935218 1171 COMMERCE DR UNIT 1 WEST CHICAGO IL 60185 MARK KENNEDY 6302935218 2011-08-08 1 3123680500 2010 2016-02-24 21:20:13Z MARK KENNEDY 1171 COMMERCE DR UNIT 1 WEST CHICAGO IL 60185 51229874 0 X N/A X 1951 IL PROVIDE HEALTH BENEFITS 6 6 129 0 0 0 0 0 50356608 48226214 1054139 1232394 1879 3805 51412626 49462413 0 0 52089322 48684525 967521 892220 0 0 0 965138 863194 54021981 50439939 -2609355 -977526 104604873 105146325 88815 86676 104516058 105059649 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 1 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 1 0 0 0 1 740 0 1 129 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X JOSE COLIN - FUND MANAGER 6302930390 1171 COMMERCE DR UNIT 1 WEST CHICAGO IL 60185 PHILLIP STANOCH 1.00 X 0 0 0 MARK KENNEDY 2.00 X 0 0 0 RICH GIERUT 1.00 X 0 0 0 WILLIAM BRACH 1.00 X 0 0 0 DOMINIC ROMANAZZI 2.00 X 0 0 0 ROGER KOHLER 1.00 X 0 0 0 JOSE COLIN 40.00 X 0 110552 24055 0 110552 24055 0 0 0 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 PPO NETWORK PROVIDER 1534818 PROVENA HOSPITALS 75 REMITTANCE DRIVE CHICAGO IL 60675 MEDICAL PROVIDER 163427 METROPOLITAN LIFE INSURANCE COMPANY DEPT CH 10579 PALATINE IL 60055 DENTAL NETWORK PROVIDER 133263 MEDCARE MANAGEMENT 2090 PALM BEACH LAKES BLVD 900 WEST PALM BEACH FL 33409 MEDICAL REVIEW 132799 4 EMPLOYER CONTRIB. 900099 39886807 39886807 PARTIC & RETIREE CONT 900099 5925770 5925770 COBRA SUBSIDY 900099 1989464 1989464 EARLY RETIREE REINS. 900099 424173 424173 48226214 1140754 1140754 1859101 1767461 91640 91640 91640 MISCELLANEOUS 900099 3805 3805 3805 49462413 48226214 0 1236199 48684525 536584 115332 155475 84829 125129 90970 97931 53653 143350 33940 165346 2484 13000 87590 41972 MISCELLANEOUS EXPENSE 7829 50439939 2840487 4684732 4369717 5661318 367156 244844 12878 14649 452076 288297 232722 163779 63480844 58481286 33301069 35895717 104604873 105146325 69790 72894 19025 13782 88815 86676 X 0 0 0 0 104516058 105059649 104516058 105059649 104604873 105146325 X -977526 1521117 X 0 1 1 X 0 452076 288297 163779 163779 PRUDENTIAL TRUST COMPANY 35895717 F 35895717 DUE TO SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND 13782 13782 49462413 50439939 -977526 1521117 1521117 543591 50885599 1521117 1521117 49364482 97931 97931 49462413 50342008 0 50342008 97931 97931 50439939 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 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES AND EMPLOYEES OF THE HEALTH AND WELFARE FUND. THE BOARD OF TRUSTEES MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES APPROVES COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL (OFFICER), THE FUND MANAGER, WHO OVERSEES THE ORGANIZATIONS DAILY OPERATIONS. THE FUND MANAGER IS PAID BY THE THE RELATED PENSION FUND AND AN ESTIMATED AMOUNT IS ALLOCATED TO THE WELFARE FUND AND REIMBURSED BACK TO THE PENSION FUND BASED ON ESTIMATED TIME SPENT WORKING FOR THE RESPECTIVE FUNDS. THE APPROVAL IS DOCUMENTED IN THE ORGANIZATIONS MINUTES. TRUSTEES OF THE ORGANIZATION ARE NOT COMPENSATED. FORM 990, PART VI, SECTION C, LINE 19 THE HEALTH AND WELFARE FUND MAKES GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT ITS HOME OFFICE, UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,521,117. FORM 990, PART V, LINE 2A THE NUMBER OF EMPLOYEES REPORTED ON FORM W-3, TRANSMITTAL OF WAGE AND TAX STATEMENTS, FILED FOR THE CALENDAR YEAR ENDING WITH OR WITHIN THE YEAR COVERED BY THIS RETURN INCLUDES BOTH EMPLOYEES OF THE FUND OFFICE AND PARTICIPANTS OF THE FUND THAT HAVE RECEIVED DISABILITY PAYMENTS DURING THE YEAR. SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND 1171 COMMERCE DRIVE UNIT 1 WEST CHICAGO IL 60185 366155778 DEFINED BENEFIT PENSION PLAN IL 401(A) NOT APPLICABLE 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND J 117120 SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND M 49221 SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND N 581088 SUBURBAN TEAMSTERS OF NORTHERN ILLINOIS PENSION FUND O 635551