2018-11-02T11:03:34-05:00 2017-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2017-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 6309603322 18861 90TH AVENUE NO A MOKENA IL 60448 DAN AUSSEM TRUSTEE 6309603322 2018-11-02 1 RENEE SPECK P00201492 3123680500 12.235.239.120 2018-11-02 11:03:48 CD P D458F851A7B76F6041B1E5C0FC4AE3DB83C9F751 DBF743AF1216C3B70D6C9C598EE47CA4DBC4F1E6 2017 2018-06-14 16:35:46Z DAN AUSSEM 18861 90TH AVENUE NO A MOKENA IL 60448 31186590 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 14 7 34 0 0 0 0 0 21617490 23604370 1166911 1335800 20137 27 22804538 24940197 0 0 21556413 22228946 0 0 0 0 0 1519518 1557904 23075931 23786850 -271393 1153347 50297269 54293745 822376 621682 49474893 53672063 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 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 1 34 1 0 0 0 0 0 0 0 0 0 0 X 14 7 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 18861 90TH AVENUE SUITE A MOKENA IL 60448 BRIAN DISKIN TRUSTEE - PAST 2.00 40.00 X 0 97433 76917 BRIAN STANLEY TRUSTEE 2.00 40.00 X 0 107689 51915 BRIAN ATKINS TRUSTEE 2.00 40.00 X 0 75852 47278 KENNETH KOBUS TRUSTEE 2.00 40.00 X 0 141038 116487 ROY WACKERLIN TRUSTEE - PAST 2.00 40.00 X 0 118187 115110 KEVIN HRAY TRUSTEE 2.00 40.00 X 0 106330 106255 DANIEL AUSSEM TRUSTEE 2.00 X 0 0 0 DANA OAKS TRUSTEE 2.00 X 0 0 0 CHRIS KUHNE TRUSTEE - PAST 2.00 X 0 0 0 MARK RICHESON TRUSTEE 2.00 40.00 X 0 63966 70833 RON STONE TRUSTEE 2.00 X 0 0 0 MICHAEL TESTA TRUSTEE 2.00 X 0 0 0 BILL PAXTON TRUSTEE 2.00 X 0 0 0 DAVID ANSPAUGH TRUSTEE 2.00 X 0 0 0 CHUCK BLACK TRUSTEE - NEW 2.00 2.00 X 0 1031 841 DIRK ENGER TRUSTEE - NEW 2.00 40.00 X 0 103738 102207 CODY GERDES TRUSTEE - NEW 2.00 X 0 0 0 0 815264 687843 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 573843 ZENITH AMERICAN SOLUTIONS 18861 90TH AVENUE SUITE A MOKENA IL 60447 THIRD PARTY ADMINISTRATOR 453231 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 339242 MCGANN KETTERMAN & RIOUX 111 E WACKER DRIVE SUITE 2600 CHICAGO IL 60601 FUND ATTORNEY 122480 4 EMPLOYER CONTRIBUTIONS 900099 20531162 20531162 STOP-LOSS INSURANCE PROCEEDS 900099 1342064 1342064 PARTICIPANT CONTRIBUTIONS 900099 868877 868877 PRESCRIPTION DRUG REBATE 900099 661522 661522 SUBROGATION INCOME 900099 158290 158290 42455 42455 23604370 1171315 1171315 6410878 6246393 164485 164485 164485 MISCELLANEOUS 900099 27 27 27 24940197 23604370 0 1335827 22228946 122480 159767 174306 637030 59459 13583 26395 26404 UTILIZATION REVIEW EXPE 158612 DISEASE MANAGEMENT 94297 COLLECTOR EXPENSE 75000 FEES MANDATED BY ACA 9121 1450 23786850 1499456 2195784 2664386 3080100 49304 59408 31992782 29044351 14091341 19914102 50297269 54293745 646926 546600 75188 75082 100262 0 822376 621682 X 0 0 0 0 49474893 53672063 49474893 53672063 50297269 54293745 1153347 3043823 0 X 0 1 X 1 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 2039788 F AMERICAN STRATEGIC VALUE REALTY FUND 6274208 F INVESCO INSTITUTIONAL TRUST BALANCED RISK ALLOCATION FUND 4243555 F PRUDENTIAL FIXED RATE FUND 2955091 F EATON VANCE SENIOR INSTITUTIONAL LOAN FUND 4401460 F 19914102 X 27879714 3043823 3043823 24835891 104306 104306 24940197 23682544 0 23682544 104306 104306 23786850 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 IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIOD IN PROGRESS. 0 0 0 BRIAN DISKIN TRUSTEE - PAST 0 97433 0 0 0 0 0 56519 0 20398 0 174350 0 0 BRIAN STANLEY TRUSTEE 0 107689 0 0 0 0 0 31164 0 20751 0 159604 0 0 KENNETH KOBUS TRUSTEE 0 141038 0 0 0 0 0 93215 0 23272 0 257525 0 0 ROY WACKERLIN TRUSTEE - PAST 0 118187 0 0 0 0 0 44909 0 70201 0 233297 0 0 KEVIN HRAY TRUSTEE 0 106330 0 0 0 0 0 81644 0 24611 0 212585 0 0 DIRK ENGER TRUSTEE - NEW 0 103738 0 0 0 0 0 39875 0 62332 0 205945 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THEY HAVE 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 11B THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARD'S THOROUGH REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FUND OFFICE. 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