2018-10-11T15:37:42-05:00 2017-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2017-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 6142377618 4150 EAST MAIN STREET COLUMBUS OH 43213 RANDY QUICKEL CHAIRMAN 6142377618 2018-10-08 1 THOMAS M POWERS CPA P00241729 2627846210 2017 2022-09-23 18:48:47Z RANDY QUICKEL 4150 EAST MAIN STREET COLUMBUS OH 43213 74251142 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 13 0 0 0 0 0 62379291 63236805 326355 282060 0 0 62705646 63518865 0 0 60654460 61282739 897687 936433 0 0 0 3121917 3292254 64674064 65511426 -1968418 -1992561 15386128 13966944 3739869 4308777 11646259 9658167 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 51 0 1 13 1 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 LLOYD BLAKE 6142377618 4150 E MAIN ST COLUMBUS OH 43213 RANDY QUICKEL CHAIRMAN 2.00 45.00 X X 0 184712 29638 STEVE LOEFFLER SECRETARY 2.00 X X 0 0 0 PAUL SMITHBERGER TRUSTEE 2.00 45.00 X 0 144086 28568 MARK FLUHARTY TRUSTEE 2.00 45.00 X 0 162319 28377 KATHY WAGENKNECHT TRUSTEE 2.00 X 0 0 0 ROB FRANCIN TRUSTEE 2.00 X 0 0 0 LLOYD BLAKE ADMINISTRATIVE MANAGER 40.00 X 109186 0 22696 109186 491117 109279 1 0 1 0 E PLAN LLC 22601 N 19TH AVENUE 240 PHOENIX AZ 85027 CLAIMS REVIEW 437689 HEALTHSMART CARE MGMT SOLUTIONS LP 6303 COMMMERCE DR SUITE 180 IRVING TX 75063 MEDICAL CASE MANAGEMENT 297018 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 210470 CONDUENT CONSULTANTS LLC 6000 FREEDOM SQUARE SUITE 100 INDEPENDENCE OH 44131 CONSULTANT 171906 BENESYS 700 TOWER DRIVE SUITE 300 TROY MI 48098 IT 145794 6 EMPLOYER CONTRIBUTIONS 900099 62770487 62770487 SELF-PAYMENT CONTRIBUTI 900099 466318 466318 63236805 240544 240544 10773793 10732277 41516 41516 41516 63518865 63236805 0 282060 61282739 512412 26393 354699 42929 265031 36475 29050 178440 297062 277979 62880 11706 958 22528 ACCIDENT, HEALTH AND DE 1726047 MEDICAL REVIEW SERVICES 288650 VISION CARE FEES 57190 GOVERNMENTAL FEES AND A 24570 13688 65511426 2581222 2102617 56554 37338 517866 1798193 22792 19445 335534 334349 2143 1185 12205551 10008166 15386128 13966944 2488148 3046462 1251721 1262315 3739869 4308777 X 0 0 0 0 11646259 9658167 11646259 9658167 15386128 13966944 -1992561 4469 0 X X 0 1 X 1 0 335534 334349 1185 1185 CLAIMS PAYABLE 1196000 CASH OVERDRAFT 66315 1262315 X 63494284 4469 4469 63489815 29050 29050 63518865 65461376 0 65461376 29050 21000 50050 65511426 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 21,000. 0 0 0 RANDY QUICKEL CHAIRMAN 0 176384 0 8328 0 0 0 0 0 29638 0 214350 0 0 PAUL SMITHBERGER TRUSTEE 0 138424 0 5662 0 0 0 0 0 28568 0 172654 0 0 MARK FLUHARTY TRUSTEE 0 141596 0 20723 0 0 0 0 0 28377 0 190696 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 2017. 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 67680 FAIR MARKET VALUE