2017-09-05T11:09:02-05:00 2016-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SUITE 103 SCHERERVILLE IN 46375 990 2016-01-01 356327302 IRONWORKERS LOCAL 395 TRUST FUND IRON 2197696944 2111 WEST LINCOLN HIGHWAY MERRILLVILLE IN 46410 JEFFREY CHIDESTER CHAIRMAN 2197696944 2017-09-05 1 RENEE SPECK P00201492 3123680500 12.197.118.215 2017-09-05 11:07:44 CD P D56625F7C0621E1EB8BA8C5A7372C18F0F4BC985 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z JEFFREY CHIDESTER 2111 WEST LINCOLN HIGHWAY MERRILLVILLE IN 46410 43455068 0 X N/A X 1977 IN PROVIDE HEALTH BENEFITS 4 2 42 0 0 0 0 0 14007085 13282358 1167004 1613556 0 0 15174089 14895914 0 0 15180896 14533938 0 0 0 0 0 877655 868950 16058551 15402888 -884462 -506974 51007604 50735623 421702 206801 50585902 50528822 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH, LIFE, ACCIDENTAL DEATH & DISMEMBERMENT, DENTAL, AND VISION BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 1 194 0 1 42 1 0 0 0 0 0 0 0 0 X 4 2 0 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 X STEWART C MILLER INC 2197696944 2111 W LINCOLN HIGHWAY MERRILLVILLE IN 46410 JEFFREY CHIDESTER UNION TRUSTEE 2.00 40.00 X 0 132129 56930 STEVE MICHAELS EMP TRUSTEE 1.00 X 0 0 0 SAMUEL TIPTON EMP TRUSTEE 1.00 X 0 0 0 RON WARE JR UNION TRUSTEE 2.00 40.00 X 0 133162 56930 0 265291 113860 0 0 1 0 BENISTAR PO BOX 36029 NEWARK NJ 07188 MEDICARE PREMIUM FEE 1544991 UNITED HEALTH CARE GROUP PO BOX 329675 HOT SPRINGS AR 71903 MEDICARE PREMIUM FEE 860068 ANTHEM BLUE CROSS BLUE SHIELD 220 VIRGINIA AVE INDIANAPOLIS IN 46204 FEE FOR PROVIDING PPO ACCESS 389772 STEWART C MILLER & CO INC 2111 WEST LINCOLN HIGHWAY MERRILLVILLE IN 46410 PROVIDES ADMINISTRATIVE SERVICES 366618 FIDELITY SECURITY LIFE INSURANCE CORP 16132 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 STOP-LOSS PREMIUMS 307421 5 EMPLOYER CONTRIB. 900099 11061893 11061893 PARTICIPANT CONTRIB. 900099 1863206 1863206 PRESCRIPTION REBATES 900099 341759 341759 SUBROGATION 900099 15500 15500 13282358 1275777 1275777 28896933 28559154 337779 337779 337779 14895914 13282358 0 1613556 14533938 344009 13633 36657 258843 93556 45084 3821 11033 FEES MANDATED BY ACA 62314 15402888 2904550 3544242 803497 917203 1465847 1417767 85140 13676 45573184 44656942 175386 185793 51007604 50735623 198180 130006 223522 76795 421702 206801 X 0 0 0 0 50585902 50528822 50585902 50528822 51007604 50735623 -506974 449894 0 X 0 1 X 1 0 0 DUE TO BROKER 76795 76795 X 15086965 449894 449894 14637071 258843 258843 14895914 15144045 0 15144045 258843 258843 15402888 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 PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. 0 0 0 JEFFREY CHIDESTER UNION TRUSTEE 0 132129 0 0 0 0 0 36468 0 20462 0 189059 0 0 RON WARE JR UNION TRUSTEE 0 133162 0 0 0 0 0 36468 0 20462 0 190092 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO STEWART C. MILLER, INC., 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 BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. THE TRUSTEES REVIEW THE FORM AND UPON FULLY UNDERSTANDING THE COMPLETED FORM 990, THE FORM IS APPROVED AND SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO ANY PARTICIPANT IN THE PLAN WHO COMES INTO THE FUND OFFICE AND REQUESTS TO SEE THEM. 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