2019-10-02T11:12:14-05:00 2018-11-30 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CTR 700 WESTCHESTER IL 60154 990 2017-12-01 351065816 UNITED FOOD & COMM WORKERS CALUMET REGION INSURANCE FUND UNIT 8006215133 18861 90TH AVENUE NO A MOKENA IL 60448 STEVE POWELL TRUSTEE 8006215133 2019-10-02 1 BRUCE A PAVLIK P00748405 3123680500 12.235.239.120 2019-10-02 11:12:50 CD P 93A4F84426990A9A61EBC632D98786EB8E4F1B1D DBF743AF1216C3B70D6C9C598EE47CA4DBC4F1E6 2017 2019-02-21 02:37:17Z X STEVE POWELL 18861 90TH AVENUE NO A MOKENA IL 60448 6548635 0 X N/A X 1960 IL PROVIDE HEALTH BENEFITS 4 4 0 0 0 0 0 0 6813661 4209792 158817 107066 91 0 6972569 4316858 0 0 8173353 5382819 0 0 0 0 0 439253 401785 8612606 5784604 -1640037 -1467746 5303173 3907115 26048 27448 5277125 3879667 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH AND WELFARE, DEATH, AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND/OR THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 33 0 1 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 8006215133 18861 90TH AVENUE SUITE A MOKENA IL 60448 X STEVEN POWELL TRUSTEE 1.00 X 0 0 0 SAMUEL VAN TIL TRUSTEE 1.00 X 0 0 0 LISA CATANZARO TRUSTEE 1.00 X 0 0 0 JEFFREY STRACK TRUSTEE 1.00 X 0 0 0 HARRY GROW TRUSTEE - ALTERNATE 1.00 X 0 0 0 DEREK KINNEY TRUSTEE - ALTERNATE 1.00 X 0 0 0 RICHARD BUGAJSKI TRUSTEE - ALTERNATE 1.00 X 0 0 0 0 0 0 0 0 0 0 0 EMPLOYER CONTRIBUTIONS 900099 4136720 4136720 PARTICIPANT CONTRIBUTIONS 900099 59401 59401 STOP LOSS REFUNDS 900099 13671 13671 4209792 103292 103292 2235551 2231777 3774 3774 3774 4316858 4209792 0 107066 5382819 178516 34470 31230 28550 86908 14163 2608 12713 WEB CLAIMS SERVICE FEE 9878 FEES MANDATED BY ACA 2749 5784604 74716 207709 199614 128527 39882 18543 15098 3580 4933501 3529466 40362 19290 5303173 3907115 26048 27448 26048 27448 X 0 0 0 0 5277125 3879667 5277125 3879667 5303173 3907115 -1467746 70288 0 X 0 1 X 1 0 0 X 4358596 70288 70288 4288308 28550 28550 4316858 5756054 0 5756054 28550 28550 5784604 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE ITS 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 PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 3 THROUGH JULY 1, 2018, THE PLAN WAS ADMINISTERED AND MANAGED BY THE UNITED FOOD AND COMMERCIAL WORKERS UNION AND EMPLOYERS (UFCW) MIDWEST HEALTH BENEFITS FUND. THE PLAN REIMBURSED THE UFCW MIDWEST HEALTH BENEFITS FUND FOR CERTAIN COMMON ADMINISTRATIVE EXPENSES BASED ON A PER MEMBER FEE AGREEMENT. EFFECTIVE AUGUST 1, 2018, THE TRUSTEES HAVE DELEGATED THE DAY TO DAY MANAGEMENT DUTIES TO ZENITH AMERICAN SOLUTIONS, A THIRD PARTY ADMINISTRATOR. THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY FOR THE ADMINISTRATION OF THE FUND. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY (TRUSTEES). FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES. ONCE THE FORM IS REVIEWED AND APPROVED, IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE FUND OFFICE. INDIANA GROCERY GROUP CONTRIBUTING EMPLOYER 0 STRACK-ULTRA LLC CONTRIBUTING EMPLOYER 0 LAKE COUNTY NURSING INC CONTRIBUTING EMPLOYER 0 HAPPY FOODS INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1