2013-11-14T15:41:12-06:00 2012-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-01-01 356045880 INDIANA AREA UFCW HEALTH AND WELFARE PLAN INDI 3172477381 5420 WEST SOUTHERN AVENUE NO 407 INDIANAPOLIS IN 46241 JOE CHORPENNING 3172477381 2013-11-14 1 VICTOR ANCICH P00201493 3123680500 2012 2016-02-24 21:20:13Z JOE CHORPENNING 5420 WEST SOUTHERN AVENUE NO 407 INDIANAPOLIS IN 46241 46046343 0 X N/A X 1968 IN PROVIDE HEALTH BENEFITS 8 8 0 0 0 0 0 0 40960900 41440406 336916 760058 14179 2843 41311995 42203307 0 0 42331607 43735884 0 0 0 0 0 1500244 1619600 43831851 45355484 -2519856 -3152177 16259784 13146188 197604 145700 16062180 13000488 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE ACCIDENT, HEALTH, DENTAL, VISION, PRESCRIPTION DRUG, LIFE & LOSS OF TIME BENEFITS FOR ELIGIBLE PARTICIPANTS AND/OR THEIR DEPENDENTS IN ACCORDANCE WITH THE PLAN DOCUMENT AND THE SCHEDULE OF BENEFITS. 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 28 0 1 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 1 0 0 0 IN X VICKIE STEINMETZ CO ZENITH AMERICAN SOLUTIONS 3172483242 5420 WEST SOUTHERN AVE STE 407 INDIANAPOLIS IN 46241 X JOE CHORPENNING 1.00 X 0 0 0 CINDY BONDAR 1.00 X 0 0 0 SCOTT BARNETT 1.00 X 0 0 0 MICHAEL MURDOCK 1.00 X 0 0 0 MICHAEL MERRELL 1.00 X 0 0 0 THOMAS CEBULKO 1.00 X 0 0 0 RICHARD FITZGERALD 1.00 X 0 0 0 MARCIE DULEY 1.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM 220 VIRGINIA AVENUE INDIANAPOLIS IN 46204 BENEFIT CLAIMS ADMINISTRATOR 1371992 ZENITH AMERICAN SOLUTIONS 5420 WEST SOUTHERN AVENUE SUITE 407 INDIANAPOLIS IN 46241 ADMINISTRATIVE SERVICES 1049335 INFORMED 1596 WHITEHALL ROAD ANNAPOLIS MD 21409 CARE MANAGEMENT SERVICES 740103 MILLIMAN 111 MONUMENT CIRCLE SUITE 601 INDIANAPOLIS IN 46204 BENEFIT AND ACTUARIAL SERVICES 164149 DELTA DENTAL 5875 CASTLE CREEK PARKWAY N DR 19 INDIANAPOLIS IN 46250 BENEFIT CLAIMS ADMINISTRATOR 158684 6 EMPLOYER CONTRIBUTIONS 900099 37337649 37337649 PARTICIPANT CONTRIB. 900099 3708032 3708032 PRESCRIPTION DRUG REBATES 900099 394725 394725 41440406 603094 603094 4000000 3843036 156964 156964 156964 MISCELLANEOUS 900099 2843 2843 2843 42203307 41440406 0 762901 43735884 208198 42149 5000 1192355 139046 4973 11164 15860 MEMBERSHIP DUES 855 45355484 960340 1009215 3456227 3452075 9310 8989 11530833 8381377 303074 294532 16259784 13146188 197604 145700 197604 145700 X 0 0 0 0 16062180 13000488 16062180 13000488 16259784 13146188 -3152177 90485 0 X 0 1 X 1 0 0 X 42288792 90485 90485 42198307 5000 5000 42203307 45350484 0 45350484 5000 5000 45355484 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PLAN IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, EXCEPT ON NET INCOME DERIVED FROM UNRELATED BUSINESS ACTIVITIES. FOR THE YEAR ENDED DECEMBER 31, 2012, THE PLAN HAS DETERMINED THAT NO INCOME TAXES ARE DUE FROM ITS ACTIVITIES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED IN THE FINANCIAL STATEMENTS. 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 STATUE OF LIMITATION EXPIRES. FORM 990, PART VI, SECTION A, LINE 3 WHILE THE BOARD OF TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY MANAGEMENT OF THE FUND TO A THIRD PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR THEIR REVIEW AND APPROVAL PRIOR TO ITS FILING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE INFORMATION IN QUESTION 19 AVAILABLE UPON REQUEST THROUGH THE PLAN'S THIRD PARTY ADMINISTRATOR - ZENITH AMERICAN SOLUTIONS. HEARTLAND VISION CONTRIBUTING EMPLOYER 0 WE CARE FOOD STORES INC CONTRIBUTING EMPLOYER 0 GRACE FOODS CONTRIBUTING EMPLOYER 0 WISEWAY CONTRIBUTING EMPLOYER 0 BAY VALLEY FOODS CONTRIBUTING EMPLOYER 0 BOROWIAKS IGA CONTRIBUTING EMPLOYER 0 SALEM IGA CONTRIBUTING EMPLOYER 0 PERRY COUNTY MARKET PLACE CONTRIBUTING EMPLOYER 0 ROZIER'S CHESTER MARKET PLACE CONTRIBUTING EMPLOYER 0 SIMPSONS SUPERMARKET CONTRIBUTING EMPLOYER 0 ELDORADO BIG JOHNS CONTRIBUTING EMPLOYER 0 NORRENBERNS FOODS INC CONTRIBUTING EMPLOYER 0 KROGER CENTRAL DIVISION CONTRIBUTING EMPLOYER 0 KROGER CINCINNATI DIVISION CONTRIBUTING EMPLOYER 0 HOSTESS BRANDS DBAINTERSTATE BRANDS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1