2014-10-01T12:01:56-05:00 2013-12-31 320043599 LEGACY PROFESSIONALS LLP 222 INDIANAPOLIS BOULEVARD SCHERERVILLE IN 46375 990 2013-01-01 366599036 IRONWORKERS TRI-STATE WELFARE PLAN IRON 6309603322 18861 90TH AVENUE NO A MOKENA IL 60448 BRIAN DISKIN TRUSTEE 6309603322 2014-10-01 1 RENEE BERG-SPECK P00201492 3123680500 2013 2015-11-30 17:44:51Z BRIAN DISKIN 18861 90TH AVENUE NO A MOKENA IL 60448 21850099 0 X N/A X 1957 IL PROVIDE HEALTH BENEFITS 12 6 23 0 0 0 0 0 17204679 13618320 1317749 424716 1473 77 18523901 14043113 0 0 13443196 13382439 0 0 0 0 0 1257977 1087191 14701173 14469630 3822728 -426517 40923034 42288736 376765 338301 40546269 41950435 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 23 1 0 0 0 0 0 0 0 0 0 0 X 12 6 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 7084749902 18861 9OTH AVENUE SUITE A MOKENA IL 60448 MIKE WILCHER TRUSTEE-PAST 2.00 X 0 0 0 BRIAN STANLEY TRUSTEE 2.00 40.00 X 0 102685 43576 BRIAN DISKIN TRUSTEE 2.00 40.00 X 0 88064 37366 DANIEL AUSSEM TRUSTEE 2.00 X 0 0 0 JACK KECK TRUSTEE 2.00 40.00 X 0 131442 90188 HOWARD NORBERG TRUSTEE 2.00 40.00 X 0 172999 113664 DANA OAKS TRUSTEE 2.00 X 0 0 0 STUART BROEREN TRUSTEE-PAST 2.00 X 0 0 0 RICHARD P CASEY TRUSTEE 2.00 X 0 0 0 KENNETH KOBUS TRUSTEE 2.00 40.00 X 0 116137 87884 TIM BAUGH TRUSTEE 2.00 X 0 0 0 MICHAEL TESTA TRUSTEE 2.00 X 0 0 0 BRIAN ATKINS TRUSTEE - NEW 2.00 40.00 X 0 42251 41745 CHRIS KUHNE TRUSTEE - NEW 2.00 X 0 0 0 0 653578 414423 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 60601 CLAIMS PROCESSOR 438726 ZENITH AMERICAN SOLUTIONS 18861 90TH AVENUE SUITE A MOKENA IL 60447 THIRD PARTY ADMINISTRATOR 362178 THE SEGAL CO 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 FUND CONSULTANT 288842 3 EMPLOYER CONTRIBUTIONS 900099 12349431 12349431 PARTICIPANT CONTRIBUTIONS 900099 966296 966296 PRESCRIPTION DRUG REBATE 900099 234551 234551 STOP-LOSS INSURANCE PROCEEDS 900099 64038 64038 LIQUIDATED DAMAGES 900099 4004 4004 13618320 738815 738815 7492887 7806986 -314099 -314099 -314099 MISCELLANEOUS 900099 77 77 77 14043113 13618320 0 424793 13382439 46146 97452 103315 551064 37905 9200 19897 18301 DISEASE MANAGEMENT 80445 COLLECTOR EXPENSE 75150 UTILIZATION REVIEW EXPE 41726 DUES & SUBSCRIPTIONS 4020 2570 14469630 4434998 3203515 2588434 1566158 16426 23593 27743335 23230121 6139841 14265349 40923034 42288736 376765 338301 376765 338301 X 0 0 0 0 40546269 41950435 40546269 41950435 40923034 42288736 -426517 1830683 0 X 0 1 X 1 0 0 ULLICO DIVERSIFIED INTERNATIONAL EQUITY FUND 2379628 F AMERICAN STRATEGIC VALUE REALTY FUND 3558525 F INVESCO INSTITUTIONAL TRUST BALANCED RISK ALLOCATION FUND 3185017 F LOOMIS SAYLES WORLD BOND TRUST 5142179 F 14265349 X 15795481 1830683 1830683 13964798 78315 78315 14043113 14391315 0 14391315 78315 78315 14469630 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 JACK KECK TRUSTEE 0 131442 0 0 0 0 0 33588 0 56600 0 221630 0 0 HOWARD NORBERG TRUSTEE 0 172999 0 0 0 0 0 87522 0 26142 0 286663 0 0 KENNETH KOBUS TRUSTEE 0 116137 0 0 0 0 0 65028 0 22856 0 204021 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 11 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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