2015-05-13T12:09:05-05:00 2014-11-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2013-12-01 362440523 U F C W UNIONS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND UFCW 8473847000 9801 WEST HIGGINS ROAD NO 500 ROSEMONT IL 60018 ROBERT NIKSA ADMINISTRATOR 8473847000 2015-05-13 1 CRAIG RESCH P00844633 3123680500 2013 2016-04-25 22:37:26Z ROBERT NIKSA 9801 WEST HIGGINS ROAD NO 500 ROSEMONT IL 60018 72627546 0 X WWW.UFCWMIDWEST.ORG X 1960 IL PROVIDE HEALTH BENEFITS 6 3 84 0 0 0 0 0 69837397 41415320 599464 385370 24937 71309 70461798 41871999 0 0 59533791 45306432 6695256 5880988 0 0 0 2717145 2293076 68946192 53480496 1515606 -11608497 44988980 33395682 2048890 1245184 42940090 32150498 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 1206 0 1 84 1 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 1 0 0 X DAVID MINEAU 8473847000 9801 WEST HIGGINS ROAD SUITE 500 ROSEMONT IL 60018 X BRIAN JORDAN TRUSTEE 3.00 X 0 0 0 KEVIN J BECKERLE TRUSTEE 3.00 X 0 0 0 KENNETH R BOYD TRUSTEE 3.00 55.00 X 0 172687 22178 STEVEN M POWELL TRUSTEE 3.00 40.00 X 0 202999 20767 DONALD SCHAPER TRUSTEE 3.00 0.00 X 0 0 0 KENNETH URZEDOWSKI TRUSTEE 3.00 40.00 X 0 111130 18751 TERRY KRAMER TRUSTEE - PAST 3.00 45.00 X 0 152701 19582 BRYAN SMITH TRUSTEE - PAST 3.00 X 0 0 0 ROBERT NIKSA ADMINISTRATOR 40.00 X 0 0 0 DANIEL W RYAN ASSISTANT ADMINISTRATOR 40.00 X 165461 0 156532 JOSEPH R CALI FINANCIAL DIRECTOR - PAST 40.00 X 137968 0 26200 MICHAEL T WILCHER ASSISTANT ADMINISTRATOR - PAST 40.00 X 116553 0 11502 ANNETTE DIFINO CLAIMS SUPERVISOR - PAST 40.00 X 102130 0 82479 CHRISTINE KLUK CAPONIGRI HEALTH SERVICES SUPERVISOR 40.00 X 101853 0 34551 623965 639517 392542 5 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 2672998 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER STE 4000 CHICAGO IL 60606 AUDITOR 249312 THE SEGAL COMPANY PO BOX 4092 CHURCH STREET STATION NEW YORK NY 10261 ACTUARY 231498 MEDICAL INSURANCE CONSULTING GROUP INC 4949 N WESTERN AVENUE CHICAGO IL 60625 MEDICAL CONSULTANT 180022 CATAMARAN 1600 MCCONNOR PARKWAY SCHAUMBURG IL 60173 PHARMACY BENEFIT MANAGER 147108 6 EMPLOYER CONTRIBUTIONS 900099 36311547 36311547 REIMB EXP UFCW MW PENSION 900099 2480387 2480387 PARTICIPANT CONTRIBUTIONS 900099 1666400 1666400 PRESCRIPTION DRUG REBATES 900099 569282 569282 REIMB EXPS UFCW CALUMET FUND 900099 338204 338204 49500 49500 41415320 673648 673648 30467269 30755547 -288278 -288278 -288278 CLASS ACTION RECOVERY 900099 61580 61580 MISCELLANEOUS INCOME 900099 9729 9729 71309 41871999 41415320 0 456679 45306432 208307 3940071 721259 694967 316384 84802 110966 100958 312421 250359 148941 385147 399 36840 212843 119390 FEES MANDATED BY ACA 368257 OTHER PERSONNEL COSTS 71329 WEB CLAIMS SERVICE FEE 47628 STORAGE OF DOCUMENTS 42796 53480496 306170 392082 4384405 1668687 7089310 2902330 76511 84109 669634 351840 343277 317794 32558259 28030680 231048 0 44988980 33395682 331801 753516 1717089 491668 2048890 1245184 X 0 0 0 0 42940090 32150498 42940090 32150498 44988980 33395682 -11608497 818905 0 X 0 1 X 1 0 669634 351840 317794 317794 DUE TO PARTICIPANTS OF DEFERRED COMPENSATION PLANS 281924 MAINTENANCE OF RESERVE POLICY REFUNDS 25582 DUE TO BROKER 25851 DEFERRED LEASE INCENTIVE 158311 491668 X 40109559 818905 818905 39290654 100958 2480387 2581345 41871999 50899151 0 50899151 100958 2480387 2581345 53480496 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. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,480,387. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,480,387. X 1 1 0 KENNETH R BOYD TRUSTEE 0 172687 0 0 0 0 0 6586 0 15592 0 194865 0 0 STEVEN M POWELL TRUSTEE 0 195568 0 7431 0 0 0 6970 0 13797 0 223766 0 0 TERRY KRAMER TRUSTEE - PAST 0 152701 0 0 0 0 0 6186 0 13396 0 172283 0 0 DANIEL W RYAN ASSISTANT ADMINISTRATOR 165461 0 0 0 0 0 147128 0 9404 0 321993 0 0 0 JOSEPH R CALI FINANCIAL DIRECTOR - PAST 137968 0 0 0 0 0 16796 0 9404 0 164168 0 0 0 ANNETTE DIFINO CLAIMS SUPERVISOR - PAST 102130 0 0 0 0 0 73075 0 9404 0 184609 0 0 0 PART I, LINES 4A-B ANNETTE DIFINO RECEIVED A SEVERANCE PACKAGE AT THE TIME OF HER RETIREMENT FROM THE UFCW UNIONS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND. THE PACKAGE INCLUDED 15 WEEKS OF REGULAR PAY ALONG WITH CONTINUING HEALTH BENEFITS. THE SEVERANCE BENEFITS PAID IN 2014 TOTALED $27,958.65. PART I, LINES 4A-B DAN W. RYAN ELECTED TO DEFER A PORTION OF HIS SALARY TO THE DEFERRED COMPENSATION PLAN ESTABLISHED UNDER SECTION 457(F) OF THE IRS CODE. FORM 990, SCHEDULE J, PART II, COLUMN C: RETIREMENT AND OTHER DEFERRED COMPENSATION INCLUDES THE INCREASE IN THE PRESENT VALUE OF A DEFINED BENEFIT PENSION PLAN FOR DANIEL W. RYAN, JOSEPH R. CALI, AND ANNETTE DIFINO AS DETERMINED BY THE FUND'S ACTUARY. FORM 990, SCHEDULE J, PART II, COLUMN D: NON-TAXABLE BENEFITS INCLUDE THE VALUE OF HEALTH AND WELFARE PREMIUMS PAID ON BEHALF OF THE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN DOES NOT HAVE ANY SEPARATE COMMITTEES WITH THE 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 FOR REVIEW AND APPROVAL BEFORE IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION B, LINE 15A SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. 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. FORM 990, PART VII, SECTION A: IN JUNE OF 2014, ROBERT NIKSA WAS HIRED AS THE FULL TIME FUND ADMINISTRATOR AND DANIEL RYAN WAS NAMED AS THE ASSISTANT ADMINISTRATOR. UNITED FOOD & COMMERICAL WORKERS & EMPRS MIDWEST PENSION FUND 9801 WEST HIGGINS ROAD ROSEMONT IL 60018 366508328 RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 501(A) N/A 0 UNITED FOOD & COMMERCIAL WORKERS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND CONTRIBUTING EMPLOYER 0 UNITED FOOD & COMMERICAL WORKERS LOCAL 881 CONTRIBUTING EMPLOYER 0 UNITED FOOD & COMMERICAL WORKERS LOCAL 1546 CONTRIBUTING EMPLOYER 0 UNITED FOOD & COMMERCIAL WORKERS LOCAL 536 CONTRIBUTING EMPLOYER 0 UNITED STEEL WORKERS OF AMERICA LOCAL 6787 CONTRIBUTING EMPLOYER 0 A & G LAUNDROMAT CONTRIBUTING EMPLOYER 0 A & J MEATS CONTRIBUTING EMPLOYER 0 ANICHINI BROS INC CONTRIBUTING EMPLOYER 0 ANTON'S FRUIT RANCH & THE BRANCH INC CONTRIBUTING EMPLOYER 0 APPLE MARKET CONTRIBUTING EMPLOYER 0 ARAMARK UNIFORM SERVICES CONTRIBUTING EMPLOYER 0 ARLINGTON GOURMET MARKET (DBA -THURINGER MEATS) CONTRIBUTING EMPLOYER 0 ASCOT MEATS INC CONTRIBUTING EMPLOYER 0 ASHMANN PRESCRIPTIONS PHARMACY INC CONTRIBUTING EMPLOYER 0 ATHENA SCHOOL CONTRIBUTING EMPLOYER 0 AURORA PAC LLC CONTRIBUTING EMPLOYER 0 AURORA REHABILITATON & LIVING CENTER CONTRIBUTING EMPLOYER 0 BAJA SERVICES (DBA - FUN SERVICES) CONTRIBUTING EMPLOYER 0 BASIC HARDWARE CENTER CONTRIBUTING EMPLOYER 0 BAYSIDE TERRACE CONTRIBUTING EMPLOYER 0 BLUE GOOSE STORE CONTRIBUTING EMPLOYER 0 BRIICK MEATS INC CONTRIBUTING EMPLOYER 0 BUEDEL'S FOOD PRODUCTS CONTRIBUTING EMPLOYER 0 BUNGE FOODS CONTRIBUTING EMPLOYER 0 BURGESS SQUARE HEALTHCARE & REHAB CENTRE LLC CONTRIBUTING EMPLOYER 0 C & F PACKING COMPANY CONTRIBUTING EMPLOYER 0 CP MEAT MARKET CONTRIBUTING EMPLOYER 0 CENTRAL MARKET CONTRIBUTING EMPLOYER 0 CERTIFIED WAREHOUSE FOODS CONTRIBUTING EMPLOYER 0 CHASE UNIVERSAL SERVICE INC CONTRIBUTING EMPLOYER 0 CHIPAIN'S FINER FOODS CONTRIBUTING EMPLOYER 0 CONSUMER'S PACKING CONTRIBUTING EMPLOYER 0 D & D FINER FOODS CONTRIBUTING EMPLOYER 0 D & S INC CONTRIBUTING EMPLOYER 0 D & S MEAT MARKET CONTRIBUTING EMPLOYER 0 DARLING INTERNATIONAL INC CONTRIBUTING EMPLOYER 0 DE VRIES MEAT MARKET CONTRIBUTING EMPLOYER 0 DISCOUNT MEATS CONTRIBUTING EMPLOYER 0 DOMANI CONSTRUCTION & DEVELOPMENT INC CONTRIBUTING EMPLOYER 0 ER SMITH ENTERPRISESINC CONTRIBUTING EMPLOYER 0 EGYPTIAN STATIONERS INC CONTRIBUTING EMPLOYER 0 ELEGANCE IN MEATS INC CONTRIBUTING EMPLOYER 0 EX-CEL CORNED BEEF INC CONTRIBUTING EMPLOYER 0 FARMER'S MARKET INC CONTRIBUTING EMPLOYER 0 FELICIA'S MEAT MARKET DELI & CATERING CONTRIBUTING EMPLOYER 0 FRESH LINE FOODS CONTRIBUTING EMPLOYER 0 GENE'S TIRE SERVICE INC CONTRIBUTING EMPLOYER 0 GEPPERTH'S MARKET CONTRIBUTING EMPLOYER 0 GILLMORES CORNER MARKET CONTRIBUTING EMPLOYER 0 GLENVIEW GOURMET MEATS (DBA - REAGAN MEATS) CONTRIBUTING EMPLOYER 0 GREAT WESTERN BEEF CONTRIBUTING EMPLOYER 0 HADDAD'S MARKET CONTRIBUTING EMPLOYER 0 HAPPY FOODS INC CONTRIBUTING EMPLOYER 0 HARI LLC (DBA - ILLINOIS VALLEY FOODS) CONTRIBUTING EMPLOYER 0 HARMON'S FOODS CONTRIBUTING EMPLOYER 0 HOLZKOPF'S MEAT MARKET LLC CONTRIBUTING EMPLOYER 0 HOME FURNITURE LLC CONTRIBUTING EMPLOYER 0 HONEY BAKED HAM CONTRIBUTING EMPLOYER 0 ILLINOIS FOOD RETAILERS ASSOCIATION CONTRIBUTING EMPLOYER 0 INTERNATIONAL MEAT COMPANY INC CONTRIBUTING EMPLOYER 0 JT AMUSEMENTS LTD CONTRIBUTING EMPLOYER 0 JACK & PAT'S CERTIFIED INC CONTRIBUTING EMPLOYER 0 JERRY'S QUALITY MEATS CONTRIBUTING EMPLOYER 0 JOHNNY G'S QUALITY MEATS CONTRIBUTING EMPLOYER 0 JONDEB CORPORATION (DBA - PAN'S FOOD CENTER) CONTRIBUTING EMPLOYER 0 K & S WHOLESALE MEATS INC CONTRIBUTING EMPLOYER 0 KINGDOM FARMS WHOLESALE MEATS INC CONTRIBUTING EMPLOYER 0 KRAMER FOODS CONTRIBUTING EMPLOYER 0 LAKE AREA UNITED WAY CONTRIBUTING EMPLOYER 0 LUESSE GROCERIES INC (DBA - LEROY'S A & J MARKET) CONTRIBUTING EMPLOYER 0 M & K FOODS (DBA - SEVEN ELEVEN) CONTRIBUTING EMPLOYER 0 MARCO CONSULTING GROUP CONTRIBUTING EMPLOYER 0 MARIO'S BUTCHER SHOP CONTRIBUTING EMPLOYER 0 MAXON SHOOTERS SUPPLIES INC CONTRIBUTING EMPLOYER 0 MC CHESNEY & MILLER CONTRIBUTING EMPLOYER 0 MIKE'S MEAT MARKET (DBA - CASEY'S FOODS & MARKET) CONTRIBUTING EMPLOYER 0 MILLER GROCERY MARKET LLC (DBA - MILLER K MARKETS) CONTRIBUTING EMPLOYER 0 MINELLI DELI & MEATS CONTRIBUTING EMPLOYER 0 MR BEEF CONTRIBUTING EMPLOYER 0 MR CKG INC CONTRIBUTING EMPLOYER 0 MURPHY & ASSOCIATES LTD CONTRIBUTING EMPLOYER 0 NORTHWESTERN INDIANA BUILDING & TRADES COUNCIL CONTRIBUTING EMPLOYER 0 ONE STOP FOOD & LIQUORS CONTRIBUTING EMPLOYER 0 ONE STOP PACEMAKER CONTRIBUTING EMPLOYER 0 ORCHARD PRIME MEATS OF CARY INC CONTRIBUTING EMPLOYER 0 P & V CATERING CONTRIBUTING EMPLOYER 0 PARAMOUNT TRUCK BODY CONTRIBUTING EMPLOYER 0 PARKSHORE MARKET LTD CONTRIBUTING EMPLOYER 0 PAULINA MARKET CONTRIBUTING EMPLOYER 0 PERSONAL CHEF SERVICES CONTRIBUTING EMPLOYER 0 PIATAK MEATS CONTRIBUTING EMPLOYER 0 POTASH BROTHERS CONTRIBUTING EMPLOYER 0 PRIME'N TENDER MEATS CONTRIBUTING EMPLOYER 0 RABER PACKING COMPANY CONTRIBUTING EMPLOYER 0 RIVERSIDE FOODS CONTRIBUTING EMPLOYER 0 RUSSO OF ITALY CONTRIBUTING EMPLOYER 0 RUSSO WHOLESALE CONTRIBUTING EMPLOYER 0 SNN INC (DBA - HOWARD & SONS QUALITY MEATS) CONTRIBUTING EMPLOYER 0 SAFEWAY INC CONTRIBUTING EMPLOYER 0 SALEM VILLAGE NURSING HOME CONTRIBUTING EMPLOYER 0 SAURO & ASSOCIATES INC CONTRIBUTING EMPLOYER 0 SCHWEGEL'S MARKET CONTRIBUTING EMPLOYER 0 SHOELESS JOE'S CONTRIBUTING EMPLOYER 0 SODEXO INC CONTRIBUTING EMPLOYER 0 STEINBACH MEATS CONTRIBUTING EMPLOYER 0 STRACK & VAN TIL CONTRIBUTING EMPLOYER 0 SUNSET FOOD MARTS CONTRIBUTING EMPLOYER 0 SUPERVALUE FOODS CONTRIBUTING EMPLOYER 0 SV CARE LLC (DBA - SOUTHVIEW MANOR NURSING CENTER) CONTRIBUTING EMPLOYER 0 SYMPHONY HEALTHCARE CONTRIBUTING EMPLOYER 0 TED'S AUTO CLINIC INC CONTRIBUTING EMPLOYER 0 TERRACE NURSING HOME CONTRIBUTING EMPLOYER 0 THE CALUMET PROJECT FOR INDUSTRIAL JOBS CONTRIBUTING EMPLOYER 0 THE KROGER COMPANY CONTRIBUTING EMPLOYER 0 THORNTON HEIGHTS TERRACE CONTRIBUTING EMPLOYER 0 TRANSPORT PRODUCTION SYSTEMS (DBA - PTO SERVICES INC) CONTRIBUTING EMPLOYER 0 TREASURE ISLAND CONTRIBUTING EMPLOYER 0 TRISTATE SECURITY OF AMERICA (DBA - HICKORY POINT MALL) CONTRIBUTING EMPLOYER 0 US FOODS (DBA - NEW CITY PACKING COMPANY) CONTRIBUTING EMPLOYER 0 WATSON'S OFFICE SUPPLY CONTRIBUTING EMPLOYER 0 WELCH'S STOP & SHOP CONTRIBUTING EMPLOYER 0 WHEATON MEAT COMPANY CONTRIBUTING EMPLOYER 0 WINSTON'S SAUSAGE CONTRIBUTING EMPLOYER 0 WISE WAY SUPER CENTERS CONTRIBUTING EMPLOYER 0 YESTER YEARS MEAT SHOPPE CONTRIBUTING EMPLOYER 0 ZENITH AMERICAN SOLUTIONS CONTRIBUTING EMPLOYER 0 ZVI FISHBANE INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND N 287552 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND O 2192835 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND Q 2709036