2016-11-14T09:32:08-06:00 2015-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2015-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 6142377618 4150 EAST MAIN STREET COLUMBUS OH 43213 RANDY QUICKEL CHAIRMAN 6142377618 2016-11-14 1 THOMAS M POWERS CPA P00241729 2627846210 2015 2017-02-10 21:41:12Z RANDY QUICKEL 4150 EAST MAIN STREET COLUMBUS OH 43213 74784793 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 14 0 0 0 0 0 51927842 44311592 639477 521248 0 0 52567319 44832840 0 0 55184990 56173543 777443 933903 0 0 0 3907930 3189315 59870363 60296761 -7303044 -15463921 33028514 16138116 3691633 2578662 29336881 13559454 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 58374574 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. 58374574 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 72 0 1 14 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 DAVE MCALLISTER 6142377618 4150 E MAIN ST COLUMBUS OH 43213 RANDY QUICKEL CHAIRMAN 2.00 45.00 X X 0 156250 24983 STEVE LOEFFLER SECRETARY 2.00 X X 0 0 0 PAUL SMITHBERGER TRUSTEE 2.00 45.00 X 0 124800 19133 MARK FLUHARTY TRUSTEE 2.00 45.00 X 0 136393 24189 KATHY WAGENKNECHT TRUSTEE 2.00 X 0 0 0 OLENA MALEKCYJ TRUSTEE 2.00 X 0 0 0 LLOYD BLAKE ADMINISTRATIVE MANAGER 40.00 X 100408 0 18729 100408 417443 87034 1 0 1 0 HEALTHSMART 6730 ROOSEVELT FRANKLIN OH 45005 MEDICAL CASE MANAGEMENT 272127 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 266515 MEDEXPERT INTERNATIONAL INC 2688 MIDDLEFIELD ROAD REDWOOD CITY CA 94063 DISEASE MANAGEMENT 169013 BENESYS 700 TOWER DRIVE SUITE 300 TROY MI 48098 IT 156456 BUCK CONSULTANTS LLC 485 LEXINGTON AVENUE 10TH FLOOR NEW YORK NY 100172630 CONSULTANT 134731 5 EMPLOYER CONTRIBUTIONS 900099 43842535 43842535 SELF-PAYMENT CONTRIBUTI 900099 468497 468497 560 560 44311592 458442 458442 30014759 29951953 62806 62806 62806 44832840 44311592 0 521248 56173543 568932 27782 285419 51770 248590 34475 19844 140239 329238 82991 56880 17220 1786 22301 ACCIDENT, HEALTH AND DE 1705104 MEDICAL REVIEW SERVICES 269948 DISEASE MANAGEMENT PREM 169013 VISION CARE FEES 56966 34720 60296761 424378 1971063 230106 64144 1957861 144322 27347 137652 334658 332274 3938 2384 30384884 13818551 33028514 16138116 2107562 1429215 2147 3570 1581924 1145877 3691633 2578662 X 0 0 0 0 29336881 13559454 29336881 13559454 33028514 16138116 -15463921 -313506 0 X X 0 1 X 1 0 334658 332274 2384 2384 CLAIMS PAYABLE 1085000 CASH OVERDRAFT 60877 1145877 X 44499490 -313506 -313506 44812996 19844 19844 44832840 60256917 0 60256917 19844 20000 39844 60296761 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 20,000. 0 0 0 RANDY QUICKEL CHAIRMAN 0 148500 0 7750 0 0 0 0 0 24983 0 181233 0 0 MARK FLUHARTY TRUSTEE 0 129918 0 6475 0 0 0 0 0 24189 0 160582 0 0 FORM 990, PART VI, SECTION B, LINE 11 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 3 SOLE PROPRIETORS AS CONTRIBUTING EMPLOYERS DURING 2015. 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