2017-09-05T11:10:17-05:00 2016-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2016-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 6309603322 18861 90TH AVENUE NO A MOKENA IL 60448 DAN AUSSEM TRUSTEE 6309603322 2017-09-05 1 RENEE SPECK P00201492 3123680500 12.197.118.215 2017-09-05 11:08:56 CD P D56625F7C0621E1EB8BA8C5A7372C18F0F4BC985 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z DAN AUSSEM 18861 90TH AVENUE NO A MOKENA IL 60448 31254330 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 14 7 31 0 0 0 0 0 16984395 21617490 724241 1166911 1901 20137 17710537 22804538 0 0 15325294 21556413 0 0 0 0 0 1534723 1519518 16860017 23075931 850520 -271393 48900752 50297269 591511 822376 48309241 49474893 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 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 0 0 1 31 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 2.00 40.00 X 0 91158 72728 BRIAN STANLEY TRUSTEE 2.00 40.00 X 0 110562 48906 BRIAN ATKINS TRUSTEE 2.00 40.00 X 0 75454 45467 KENNETH KOBUS TRUSTEE 2.00 40.00 X 0 116132 118663 ROY WACKERLIN TRUSTEE 2.00 40.00 X 0 117793 100663 KEVIN HRAY TRUSTEE - NEW 2.00 40.00 X 0 106706 72418 DANIEL AUSSEM TRUSTEE 2.00 X 0 0 0 DANA OAKS TRUSTEE 2.00 X 0 0 0 CHRIS KUHNE TRUSTEE 2.00 X 0 0 0 MARK RICHESON TRUSTEE - NEW 2.00 40.00 X 0 62179 67557 RON STONE TRUSTEE - NEW 2.00 X 0 0 0 MICHAEL TESTA TRUSTEE 2.00 X 0 0 0 BILL PAXTON TRUSTEE - NEW 2.00 X 0 0 0 DAVID ANSPAUGH TRUSTEE - NEW 2.00 X 0 0 0 HOWARD NORBERG TRUSTEE - PAST 2.00 40.00 X 0 124148 113357 NORMAN SANDBERG TRUSTEE - PAST 2.00 X 0 0 0 RICHARD CASEY TRUSTEE - PAST 2.00 X 0 0 0 0 804132 639759 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 645960 ZENITH AMERICAN SOLUTIONS 18861 90TH AVENUE SUITE A MOKENA IL 60447 THIRD PARTY ADMINISTRATOR 434348 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 330964 WHITFIELD MCGANN & KETTERMAN 111 E WACKER DRIVE SUITE 2600 CHICAGO IL 60601 FUND ATTORNEY 133528 4 EMPLOYER CONTRIBUTIONS 900099 19163779 19163779 STOP-LOSS INSURANCE PROCEEDS 900099 864778 864778 PARTICIPANT CONTRIBUTIONS 900099 839695 839695 PRESCRIPTION DRUG REBATE 900099 645225 645225 LIQUIDATED DAMAGES 900099 50633 50633 53380 53380 21617490 1082803 1082803 8533900 8449792 84108 84108 84108 MISCELLANEOUS 900099 20137 20137 20137 22804538 21617490 0 1187048 21556413 133528 123524 170145 602914 58744 42375 31134 25582 DISEASE MANAGEMENT 92390 UTILIZATION REVIEW EXPE 81289 FEES MANDATED BY ACA 79693 COLLECTOR EXPENSE 75150 3050 23075931 1059324 0 1336851 1499456 2712225 2664386 62977 49304 32926519 31992782 10802856 14091341 48900752 50297269 526013 646926 65498 75188 0 100262 591511 822376 X 0 0 0 0 48309241 49474893 48309241 49474893 48900752 50297269 -271393 1437045 0 X 0 1 X 1 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 1618633 F AMERICAN STRATEGIC VALUE REALTY FUND 5869375 F INVESCO INSTITUTIONAL TRUST BALANCED RISK ALLOCATION FUND 3701212 F PRUDENTIAL FIXED RATE FUND 2902121 F 14091341 DUE TO BROKER 100262 100262 X 24141438 1437045 1437045 22704393 100145 100145 22804538 22975786 0 22975786 100145 100145 23075931 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 BRIAN DISKIN TRUSTEE 0 91158 0 0 0 0 0 53439 0 19289 0 163886 0 0 BRIAN STANLEY TRUSTEE 0 110562 0 0 0 0 0 29106 0 19800 0 159468 0 0 KENNETH KOBUS TRUSTEE 0 116132 0 0 0 0 0 94085 0 24578 0 234795 0 0 ROY WACKERLIN TRUSTEE 0 117293 0 0 0 500 0 33886 0 66777 0 218456 0 0 KEVIN HRAY TRUSTEE - NEW 0 106706 0 0 0 0 0 50285 0 22133 0 179124 0 0 HOWARD NORBERG TRUSTEE - PAST 0 124148 0 0 0 0 0 102915 0 10442 0 237505 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 BOARDS THROUGH 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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