2019-10-15T16:03:24-05:00 2018-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2018-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 9376651900 7250 POE AVENUE NO 300 DAYTON OH 45414 JOE CHORPENNING CHAIRMAN 9376651900 2019-10-15 1 THOMAS M POWERS CPA P00241729 2627846210 70.61.53.194 2019-10-15 16:01:28 CD P CCA3FFBDE7687CE42E9EA09D506C5024DA3E21F0 CCA3FFBDE7687CE42E9EA09D506C5024DA3E21F0 2018 2020-01-14 16:20:31Z X JOE CHORPENNING 7250 POE AVENUE NO 300 DAYTON OH 45414 81151809 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 10 0 0 0 0 0 63236805 72601259 282060 211117 0 725 63518865 72813101 0 0 61282739 74683251 936433 956113 0 0 0 3292254 3291387 65511426 78930751 -1992561 -6117650 13966944 12895877 4308777 9513247 9658167 3382630 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 BENEFITS PAID TO OR FOR MEMBERS CONSIST OF ACCIDENT, HEALTH, DENTAL, LOSS OF TIME, VISION CARE, PRESCRIPTION DRUG AND LIFE. ALSO INCLUDED ARE THE RELATED ADMINISTRATION FEES CHARGED BY THE BENEFIT PROVIDERS AND COST CONTROLS. 0 0 0 0 0 0 0 0 0 1 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 71 0 1 10 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 0 0 X JERRY EVANS 9376651900 7250 POE AVENUE SUITE 300 DAYTON OH 45414 RANDY QUICKEL CHAIRMAN 2.00 45.00 X X 0 199033 27242 PAUL SMITHBERGER TRUSTEE 2.00 45.00 X 0 167690 26456 KATHY WAGENKNECHT TRUSTEE 2.00 X 0 0 0 ROB FRANCIN TRUSTEE 2.00 X 0 0 0 MIKE NICOLS TRUSTEE 2.00 45.00 X 0 82530 24545 DON SATTLER SECRETARY 2.00 X X 0 0 0 STEVEN SPRINGER TRUSTEE 2.00 X 0 0 0 RYLAN NORRIS SECRETARY 2.00 X 0 0 0 MARK FLUHARTY TRUSTEE 2.00 45.00 X 0 133803 26615 ANGIE BRUBAKER TRUSTEE 2.00 X 0 0 0 LLOYD BLAKE ADMINISTRATIVE MANAGER 40.00 X 137076 0 23290 137076 583056 128148 1 0 1 0 E PLAN LLC 22601 N 19TH AVENUE 240 PHOENIX AZ 85027 CLAIMS REVIEW 312321 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 276784 HEALTHSMART CARE MGMT SOLUTIONS LP 6303 COMMMERCE DR SUITE 180 IRVING TX 75063 MEDICAL CASE MANAGEMENT 232038 BEACON TECHNOLOGIES GROUP INC 250 E 96TH STREET SUITE 420 INDIANAPOLIS IN 46240 IT 147057 BENESYS 700 TOWER DRIVE SUITE 300 TROY MI 48098 IT 137582 6 EMPLOYER CONTRIBUTIONS 900099 72214895 72214895 SELF-PAYMENT CONTRIBUTI 900099 386364 386364 72601259 222098 222098 8327727 8338708 -10981 -10981 -10981 MISCELLANEOUS INCOME 900099 725 725 725 72813101 72601984 0 211117 74683251 538045 25028 353106 39934 207593 43970 27040 171230 388311 270723 60960 8598 689 21109 ACCIDENT, HEALTH AND DE 1769137 MEDICAL REVIEW SERVICES 225476 VISION CARE FEES 58581 GOVERNMENTAL FEES AND A 24960 13010 78930751 2102617 2912990 37338 8559 1798193 1873649 19445 7819 335784 335037 1185 747 10008166 8092113 13966944 12895877 3046462 1105045 1262315 8408202 4308777 9513247 X 0 0 0 0 9658167 3382630 9658167 3382630 13966944 12895877 -6117650 -157887 0 X X 0 1 X 1 0 335784 335037 747 747 BENEFIT OBLIGATIONS CURRENTLY PAYABLE 8266000 CASH OVERDRAFT 142202 8408202 X 72628174 -157887 -157887 72786061 27040 27040 72813101 71833711 0 71833711 27040 7070000 7097040 78930751 PART X, LINE 2: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX YEARS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CURRENT YEAR INCREASE IN CLAIMS PAYABLE 7,070,000. 0 0 0 RANDY QUICKEL CHAIRMAN 0 190372 0 8661 0 0 0 0 0 27242 0 226275 0 0 PAUL SMITHBERGER TRUSTEE 0 161528 0 6162 0 0 0 0 0 26456 0 194146 0 0 MARK FLUHARTY TRUSTEE 0 105600 0 28203 0 0 0 0 0 26615 0 160418 0 0 LLOYD BLAKE ADMINISTRATIVE MANAGER 137076 0 0 0 0 0 0 0 23290 0 160366 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 GOES THROUGH A PRELIMINARY REVIEW BY THE ADMINISTRATIVE MANAGER AND DIRECTOR OF FINANCE. ONCE THEY APPROVE THE FORM 990 IT IS PRESENTED TO A COMMITTEE OF TRUSTEES FOR APPROVAL PRIOR TO SIGNING AND FILING. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE EXPECTED TO FULLY DISCLOSE ANY OWNERSHIP OR OTHER FINANCIAL RELATIONSHIPS THEY HAVE WITH OTHER PARTIES THAT DEAL WITH THE PLAN. FORM 990, PART VI, SECTION B, LINE 15A THE CHAIRMAN OF THE BOARD OF TRUSTEES EVALUATES THE ADMINISTRATIVE MANAGER AND DETERMINES COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT TO PERFORM THE AUDIT OF THE PLAN'S FINANCIAL STATEMENT. FORM 990, SCHEDULE R, PARTS II-IV: IN ADDITION TO THE CONTRIBUTING EMPLOYERS REPORTED AS RELATED ORGANIZATIONS ON SCHEDULE R, PARTS II-IV, THE PLAN ALSO HAD 2 SOLE PROPRIETORS AS CONTRIBUTING EMPLOYERS DURING 2018. UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 4150 E MAIN STREET COLUMBUS OH 43213 314392482 LABOR UNION OH 501(C)(5) N/A 0 BOARD OF TRUSTEES OF THE UFCW UNIONS AND EMPLOYERS H&W PLAN OF CENTRAL OHIO 4150 E MAIN STREET COLUMBUS OH 43213 310656412 PLAN SPONSOR AND PLAN ADMINISTRATOR OH 501(C)(9) N/A 0 CVSCAREMARK GREAT SCOT INC THE KROGER CO 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 K 66843 FAIR MARKET VALUE