2014-06-19T09:57:26-05:00 2013-11-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-12-01 362440523 U F C W UNIONS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND UFCW 8473847000 9801 WEST HIGGINS ROAD NO 500 ROSEMONT IL 60018 DAN RYAN 8473847000 2014-06-19 1 CRAIG RESCH P00844633 3123680500 2012 2015-11-30 17:44:51Z X DAN RYAN 9801 WEST HIGGINS ROAD NO 500 ROSEMONT IL 60018 96185390 0 X WWW.UFCWMIDWEST.ORG X 1960 IL PROVIDE HEALTH BENEFITS 6 3 86 0 0 0 0 0 73462853 69837397 1324136 599464 42675 24937 74829664 70461798 0 0 60683852 59533791 7021782 6695256 0 0 0 2573093 2717145 70278727 68946192 4550937 1515606 44052477 44988980 3449487 2048890 40602990 42940090 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 1001 0 1 86 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 BRIAN JORDAN 3.00 X 0 0 0 KEVIN J BECKERLE 3.00 X 0 0 0 KENNETH R BOYD 3.00 55.00 X 0 186082 21994 TERRY KRAMER 3.00 45.00 X 0 164397 19322 STEVEN M POWELL 3.00 40.00 X 0 203376 20513 BRYAN SMITH 3.00 X 0 0 0 KRISTEN HEIDEN 3.00 X 0 0 0 DANIEL W RYAN 40.00 X 165323 0 37435 JOSEPH R CALI 40.00 X 124539 0 25709 289862 553855 124973 2 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 2603134 MEDICAL INSURANCE CONSULTING GROUP INC 4949 N WESTERN AVENUE CHICAGO IL 60625 MEDICAL CONSULTANT 223760 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER STE 4000 CHICAGO IL 60606 AUDITOR 182587 THE SEGAL COMPANY PO BOX 4092 CHURCH STREET STATION NEW YORK NY 10261 ACTUARY 141389 CATAMARAN 1600 MCCONNOR PARKWAY SCHAUMBURG IL 60173 PHARMACY BENEFIT MANAGER 122028 5 EMPLOYER CONTRIBUTIONS 900099 65486485 65486485 REIMB EXP UFCW MW PENSION 900099 2813417 2813417 PARTICIPANT CONTRIBUTIONS 900099 592946 592946 PRESCRIPTION DRUG REBATES 900099 575731 575731 REIMB EXPS UFCW CALUMET FUND 900099 270077 270077 98741 98741 69837397 792598 792598 25530458 25723592 -193134 -193134 -193134 CLASS ACTION RECOVERY 900099 18349 18349 MISCELLANEOUS INCOME 900099 6588 6588 24937 70461798 69837397 0 624401 59533791 174344 4679838 740950 732615 367509 155055 145040 107702 412888 391177 133646 749541 5822 46395 289381 104086 OTHER PERSONNEL COSTS 84429 WEB CLAIMS SERVICE FEE 47628 STORAGE OF DOCUMENTS 44355 68946192 736434 306170 5382008 4384405 6925013 7089310 163824 76511 645523 302246 326467 343277 30317454 32558259 201277 231048 44052477 44988980 399731 331801 3049756 1717089 3449487 2048890 X 0 0 0 0 40602990 42940090 40602990 42940090 44052477 44988980 1515606 821494 0 X 0 1 X 1 0 645523 302246 343277 343277 DUE TO PARTICIPANTS OF DEFERRED COMPENSATION PLANS 284800 MAINTENANCE OF RESERVE POLICY REFUNDS 1377403 DUE TO BROKER 29815 DEFERRED LEASE INCENTIVE 25071 1717089 X 68362173 821494 821494 67540679 107702 2813417 2921119 70461798 66025073 0 66025073 107702 2813417 2921119 68946192 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2,813,417. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,813,417. X 0 0 0 KENNETH R BOYD 0 186082 0 0 0 0 0 6640 0 15354 0 208076 0 0 TERRY KRAMER 0 164397 0 0 0 0 0 6205 0 13117 0 183719 0 0 STEVEN M POWELL 0 195945 0 7431 0 0 0 6657 0 13856 0 223889 0 0 DANIEL W RYAN 165323 0 0 0 0 0 28061 0 9374 0 202758 0 0 0 JOSEPH R CALI 124539 0 0 0 0 0 16010 0 9699 0 150248 0 0 0 SUPPLEMENTAL INFORMATION PART III 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 AND JOSEPH R. CALI 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. 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