2018-01-25T16:01:55-06:00 2017-05-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2016-06-01 510210922 NATIONAL ROOFERS UNION & EMPLOYERS JOINT HEALTH & WELFARE FUND NATI 9528540795 3001 METRO DRIVE NO 500 BLOOMINGTON MN 55425 JOHN PLESCIA TRUSTEE 9528540795 2018-01-25 1 CRAIG RESCH P00844633 3123680500 12.197.118.215 2018-01-25 16:00:43 CS P 364336ECC3CE6D3D6456A426FDC83316B085AA17 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z JOHN PLESCIA 3001 METRO DRIVE NO 500 BLOOMINGTON MN 55425 9817819 0 X WWW.NATIONALROOFERSHEALTH.COM X 1976 MN TO PROVIDE HEALTH BENEFITS 6 4 0 0 0 0 0 0 8326042 9417006 330541 329670 6269 39731 8662852 9786407 0 0 7393897 7428145 0 0 0 0 0 646622 558443 8040519 7986588 622333 1799819 13016807 15310516 41942 51648 12974865 15258868 PROVIDE HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X WILSON MCSHANE CORP 9528540795 3001 METRO DRIVE SUITE 500 BLOOMINGTON MN 55425 KINSEY ROBINSON TRUSTEE 1.00 35.00 X 0 317706 54299 JOHN PLESCIA TRUSTEE 1.00 0.00 X 0 0 0 DENNIS CONWAY TRUSTEE 1.00 0.00 X 0 0 0 MARK REEVES TRUSTEE 1.00 0.00 X 0 0 0 PAUL BLASKI TRUSTEE 1.00 0.00 X 0 0 0 DOUGLAS ZIEGLER TRUSTEE 1.00 18.00 X 0 73022 24634 0 390728 78933 0 0 1 0 CIGNA 8505 EAST ORCHARD ROAD GREENWOOD VILLAGE CO 80111 MEDICAL PPO PROVIDER 262468 FRINGE BENEFIT SERVICES INC 7010 N BROADWAY SUITE 106 DENVER CO 80221 THIRD PARTY ADMINISTRATOR 125354 2 EMPLOYER CONTRIBUTIONS 900099 8823988 8823988 STOP LOSS REFUNDS 900099 316096 316096 PRESCRIPTION DRUG REBA 900099 245506 245506 PARTICIPANT AND RETIRE 900099 31416 31416 9417006 332027 332027 29055 31412 -2357 -2357 -2357 TERMINATION PROCEEDS F 900099 36445 36445 MISCELLANEOUS REVENUE 900099 3286 3286 39731 9786407 9417006 0 369401 7428145 217260 122785 43532 23431 66603 24781 12978 9907 FEES MANDATED BY ACA 28744 MISCELLANEOUS 8422 7986588 324328 1509358 880835 1382035 1080186 955718 5034 5667 10027892 10769555 698532 688183 13016807 15310516 41942 51648 41942 51648 X 0 0 0 0 12974865 15258868 12974865 15258868 13016807 15310516 1799819 484184 0 X 0 1 X 1 0 0 X 10247160 484184 484184 9762976 23431 23431 9786407 7963157 0 7963157 23431 23431 7986588 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRES. 0 0 0 KINSEY ROBINSON TRUSTEE 0 204889 0 0 0 112817 0 27660 0 26639 0 372005 0 0 FORM 990, PART VI, SECTION A, LINE 3 WHILE THE BOARD OF TRUSTEES RETAINS THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO WILSON MCSHANE CORP (FRINGE BENEFIT SERVICES PRIOR TO 12/31/16), AS THIRD PARTY ADMINISTRATOR OF THE FUND. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO AND REVIEWED BY THE ORGANIZATION'S ENTIRE GOVERNING BODY BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C FUND PERSONNEL HAVE THE CONTINUING RESPONSIBILITY TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. IN ANY DETERMINATION BY THE TRUSTEES OF A CONFLICT OF INTEREST, THE PERSON WITH THE CONFLICT OF INTEREST SHALL BE EXCLUDED FROM THE DISCUSSION AND DETERMINATION OF SUCH CONFLICT. DISCLOSURE OF A CONFLICT OF INTEREST SHOULD BE MADE TO THE ADMINISTRATIVE MANAGER, WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF. DISCLOSURE INVOLVING TRUSTEES SHOULD BE MADE TO THE CHAIRMAN OF THE BOARD OF TRUSTEES, WHO SHALL BRING THESE MATTERS TO THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF. THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF SHALL DETERMINE WHETHER A CONFLICT EXISTS AND, IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR AND REASONABLE TO THE FUND. THE DECISION OF THE TRUSTEES OR A DULY CONSTITUTED COMMITTEE THEREOF ON THESE MATTERS WILL REST IN THEIR SOLE DISCRETION, AND THEIR CONCERN SHALL BE THE WELFARE OF THE PLAN AND THE ADVANCEMENT OF ITS PURPOSE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. 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