ADMINISTRATOR

2013-06-17T10:32:06-05:00 2012-11-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2011-12-01 362440523 U F C W UNIONS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND UFCW 8473847000 1300 HIGGINS ROAD NO 300 PARK RIDGE IL 60068 DAN RYAN ADMINISTRATOR 8473847000 2013-06-17 1 CRAIG RESCH P00844633 3123680500 2011 2016-03-07 17:11:31Z DAN RYAN 1300 HIGGINS ROAD NO 300 PARK RIDGE IL 60068 112157151 0 X WWW.UFCWMIDWEST.ORG X 1960 IL PROVIDE HEALTH BENEFITS 6 3 82 0 0 0 0 0 43073797 73462853 1517123 1324136 98202 42675 44689122 74829664 0 0 63508916 60683852 6619667 7021782 0 0 0 2427928 2573093 72556511 70278727 -27867389 4550937 52247171 44052477 17094448 3449487 35152723 40602990 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 0 1 1517 0 1 82 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 JOE CALI 8473847000 1300 HIGGINS ROAD SUITE 300 PARK RIDGE IL 60068 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 X 0 186677 21007 TERRY KRAMER TRUSTEE 3.00 X 0 164842 18321 STEVEN M POWELL TRUSTEE 3.00 X 0 203043 19338 KRISTEN A HEIDEN TRUSTEE 3.00 X 0 0 0 JAMES V MORGAN TRUSTEE - PAST 3.00 X 0 0 0 DANIEL W RYAN ADMINISTRATOR 40.00 X 159774 0 82321 RON LAMKEY DATA PROCESSING SUPERVISOR 40.00 X 113966 0 11363 JOSEPH R CALI FINANCIAL DIRECTOR 40.00 X 118844 0 23826 392584 554562 176176 3 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 2990505 MEDICAL INSURANCE CONSULTING GROUP INC 4949 N WESTERN AVENUE CHICAGO IL 60625 MEDICAL CONSULTANT 236990 QUEST DIAGNOSTICS INC LLC 1355 MITTEL BLVD WOOD DALE IL 60191 HEALTHCARE PROVIDER 211457 THE SEGAL COMPANY PO BOX 4092 CHURCH STREET STATION NEW YORK NY 10261 ACTUARY 141664 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER STE 4000 CHICAGO IL 60602 AUDITOR 133898 6 EMPL. CONTRIBUTIONS 900099 68870468 68870468 REIMB EXP UFCW MW PENS 900099 2838333 2838333 PRESCRIPTION DRUG REBA 900099 819161 819161 PART. CONTRIBUTIONS 900099 581580 581580 REIMB EXPS UFCW CALUME 900099 276807 276807 76504 76504 73462853 992996 992996 37658627 37327487 331140 331140 331140 MISCELLANEOUS INCOME 900099 24477 24477 CLASS ACTION RECOVERY 900099 18198 18198 42675 74829664 73462853 0 1366811 60683852 177565 4836198 874765 768097 365157 87852 102655 117565 433621 363756 203683 785505 7085 49153 121183 105425 MISCELLANEOUS PERSONNEL 87434 DOCUMENT STORAGE EXPENS 60548 WEB CLAIMS SERVICE FEE 47628 70278727 2401033 736434 4116403 5382008 5483711 6925013 248268 163824 1058555 732088 352470 326467 39459363 30317454 185923 201277 52247171 44052477 274799 399731 16819649 3049756 17094448 3449487 X 0 0 0 0 35152723 40602990 35152723 40602990 52247171 44052477 X 4550937 899330 X 0 1 1 X 0 1058555 732088 326467 326467 DUE TO PARTICIPANTS OF DEFERRED COMPENSATION PLANS 252933 MAINTENANCE OF RESERVE POLICY REFUNDS 2663828 DUE TO BROKER 132995 3049756 74829664 70278727 4550937 899330 899330 5450267 72773096 899330 899330 71873766 117565 2838333 2955898 74829664 67322829 0 67322829 117565 2838333 2955898 70278727 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,838,333. PART XIII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,838,333. X 0 0 0 KENNETH R BOYD 0 186677 0 0 0 0 0 6846 0 14161 0 207684 0 0 TERRY KRAMER 0 164842 0 0 0 0 0 6411 0 11910 0 183163 0 0 STEVEN M POWELL 0 195612 0 7431 0 0 0 6426 0 12912 0 222381 0 0 DANIEL W RYAN 159774 0 0 0 0 0 72785 0 9536 0 242095 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 899,330. 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THE FUND HAS REPORTED AS MUCH OF THE INFORMATION AS IS READILY AVAILABLE FROM FUND RECORDS IN COMPLETING THIS SECTION OF THE FORM. PART IV, COLUMN A: THE FUND HAS OMITTED THE EMPLOYER IDENTIFICATION NUMBER OF ITS CONTRIBUTING EMPLOYERS BECAUSE OF THE SENSITIVE NATURE OF THIS INFORMATION. THE INFORMATION MAY BE AVAILABLE AT THE FUND OFFICE.