2018-11-06T09:42:50-06:00 2017-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SUITE 103 SCHERERVILLE IN 46375 990 2017-01-01 367485085 MIDDLETOWN WORKS HOURLY & SALARIED UNION RETIREES HEALTH CARE FUND MIDD 8778295500 1201 CRAWFORD STREET MIDDLETOWN OH 45044 BRIAN DALEY CHAIR 8778295500 2018-11-06 1 RENEE SPECK P00201492 3123680500 12.235.239.120 2018-11-06 09:42:56 CS P 93A4F84426990A9A61EBC632D98786EB8E4F1B1D DBF743AF1216C3B70D6C9C598EE47CA4DBC4F1E6 2017 2019-02-21 02:37:17Z BRIAN DALEY 1201 CRAWFORD STREET MIDDLETOWN OH 45044 275905354 0 X N/A X 2008 OH TO PROVIDE HEALTH BENEFITS 5 0 0 0 0 0 0 0 12947247 13959870 32619157 22529353 400000 0 45966404 36489223 0 0 48709997 50303457 92500 92500 0 0 0 3286419 2333516 52088916 52729473 -6122512 -16240250 641611730 675366551 277679 240692 641334051 675125859 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE MEDICAL, PRESCRIPTION DRUG, DENTAL, VISION AND/OR LIFE INSURANCE BENEFITS FOR ELIGIBLE RETIREES 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 X 12 0 1 0 0 1 DA HU IS BE NO PO SW SZ 0 0 0 0 0 0 X 5 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 8778295500 1201 CRAWFORD STREET MIDDLETOWN OH 45044 BRIAN DALEY CHAIR 8.00 X 11500 0 0 ROGER MCCLOW CO-CHAIR 8.00 X 31000 0 0 JAY YOUNGDAHL TRUSTEE 8.00 X 31000 0 0 ROGER MINOR TRUSTEE 8.00 X 9500 0 0 MICHAEL BAILEY TRUSTEE 8.00 X 9500 0 0 92500 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 3333 N MAYFAIR RD STE 201 WAUWATOSA WI 53222 THIRD PARTY ADMINISTRATOR & CLAIMS PROCE 783315 EXPRESS SCRIPTS 100 PARSONS POND DRIVE FRANKLIN LAKES NJ 07417 PHARMACY BENEFIT MANAGER 555446 UNITED HEALTHCARE SERVICES INC 185 ASYLUM STREET HARTFORD CT 06103 MEDICAL NETWORK ACCESS 253882 AMALGAMATED BANK 275 7TH AVENUE NEW YORK NY 10001 INVESTMENT MANAGER 160322 GALLAGHER FIDUCIARY ADVISORS 1667 K STREET NW SUITE 1270 WASHINGTON DC 20006 INVESTMENT CONSULTANT 106895 5 EMPLOYER GROUP WAIVER PLAN REBATE 900099 5802033 5802033 PRESCRIPTION DRUG REBATES 900099 4238078 4238078 SELF PAY CONTRIBUTIONS 900099 3845372 3845372 SUBROGATION REFUND 900099 74387 74387 13959870 14955087 14955087 246990397 239416131 7574266 7574266 7574266 36489223 13959870 0 22529353 50303457 92500 364311 14851 23883 345933 1316424 155537 37406 60464 FEES MANDATED BY ACA 12552 RETIREE ASSISTANCE COMM 2141 CLAIMS ASSESSMENT TAX 14 52729473 91938 -57175 16879209 16504127 6926119 4733544 21282 21281 617693182 654164774 641611730 675366551 198054 158167 79625 82525 277679 240692 X 0 0 0 0 641334051 675125859 641334051 675125859 641611730 675366551 -16240250 50032058 0 X 0 1 X 1 0 0 X 86175348 50032058 50032058 36143290 345933 345933 36489223 52383540 0 52383540 345933 345933 52729473 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN WAS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES MAINTAIN ULTIMATE CONTROL AND RESPONSIBILITY FOR THE PLAN, THEY HAVE DELEGATED THE DAY-TO-DAY ADMINISTRATIVE DUTIES TO ZENITH AMERICAN SOLUTIONS, INC. AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR THEIR REVIEW. FORM 990 IS SIGNED AND FILED ONLY AFTER ANY QUESTIONS ARE ANSWERED AND ANY REVIEW CHANGES ARE MADE. FORM 990, PART VI, SECTION B, LINE 15 ALTHOUGH THE PLAN HAS NOT USED THE METHODS LISTED IN PART VI, SECTION B, NUMBER 15 TO DETERMINE COMPENSATION, THE PLAN HAS ADOPTED A FORMAL COMPENSATION POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN DISTRIBUTES THE SUMMARY PLAN DESCRIPTION TO PLAN PARTICIPANTS AND PLAN PARTICIPANTS MAY REQUEST A COPY OF FORM 5500 ANNUAL REPORT, INCLUDING A FINANCIAL STATEMENT, FROM THE PLAN. OTHER PLAN DOCUMENTS THAT ARE REQUIRED TO BE DISCLOSED UNDER FEDERAL LAW, INCLUDING THE EMPLOYEE RETIREMENT AND INCOME SECURITY ACT OF 1974, AS AMENDED, ARE AVAILABLE UPON REQUEST.