2013-09-12T16:13:31-05:00 2011-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2011-01-01 362365968 UFCW L1546 FOOD HANDLERS WELFARE FUND C/O ZENITH ADMINISTRATORS UFCW 3126491200 18861 90TH AVENUE NO A MOKENA IL 60448 KENNETH BOYD 3126491200 2013-09-12 1 TIMOTHY CIBULKA P00841100 3123680500 2011 2016-02-24 21:20:13Z X KENNETH BOYD 18861 90TH AVENUE NO A MOKENA IL 60448 74742085 0 X N/A X 1956 IL PROVIDE HEALTH BENEFITS. 6 6 0 0 0 0 0 0 12529683 12450993 1752655 1344122 5368 13 14287706 13795128 0 0 11318838 10678243 0 0 0 0 0 1204010 1193880 12522848 11872123 1764858 1923005 25241599 27073530 584304 131520 24657295 26942010 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE MEDICAL, DENTAL, VISION, TEMPORARY DISABILITY, AND ACCIDENTAL DEATH BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 0 0 0 X ZENITH ADMINISTRATORS 3126491200 18861 90TH AVENUE SUITE A MOKENA IL 60448 X KENNETH BOYD 1.00 X 0 0 0 GERALD M KOLB 1.00 X 0 0 0 CHRISTINE BARTHOLMEY 0.50 X 0 0 0 WAYNE CLAVIO 0.50 X 0 0 0 DAVID KALUZNY II 0.50 X 0 0 0 JAMES GOW 0.50 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 438028 ZENITH ADMINISTRATORS 18861 90TH AVE SUITE A MOKENA IL 60448 CONTRACT ADMINISTRATOR 415821 2 EMPLOYER CONTRIBUTIONS 900099 12385107 12385107 SUBROGATION REFUNDS 900099 34374 34374 PARTICIPANTS CONTRIB. 900099 31512 31512 12450993 896930 896930 61394149 60946957 447192 447192 447192 SECURITIES LITIGATION 900099 13 13 13 13795128 12450993 0 1344135 10678243 313522 44586 39726 109183 495875 52540 5039 11603 16596 FIELD REPRESENTATIVE EX 67315 COST CONTAINMENT FEES 37895 11872123 317936 284728 875701 1041465 17456 108579 24285 40690 23830521 25335347 175700 262721 25241599 27073530 117638 113301 8848 18219 457818 0 584304 131520 X 0 0 0 0 24657295 26942010 24657295 26942010 25241599 27073530 X 1923005 361710 X X 0 1 1 X 0 0 13795128 11872123 1923005 361710 361710 2284715 14047655 361710 361710 13685945 109183 109183 13795128 11762940 0 11762940 109183 109183 11872123 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 PLANS RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. FORM 990, PART VI, SECTION A, LINE 3 THE PLAN IS ADMINISTERED AND MANAGED BY ZENITH ADMINISTRATORS, A THIRD PARTY ADMINISTRATOR AS DIRECTED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARDS' THROUGH REVIEW THE FORM IS APPROVED, SIGNED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C A FIDUCIARY TO THE FUND IS REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST TO BOTH THE FUND ADMINISTRATOR AND THE TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE INFORMATION IN QUESTION 19 AVAILABLE UPON REQUEST THROUGH THE FUND'S THIRD PARTY ADMINISTRATOR. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 361,710. FORM 990, SCH R, PART IV: AS PART OF THE NORMAL DAY TO DAY OPERATIONS, THE FUND DOES NOT MAINTAIN THE INFORMATION NECESSARY TO COMPLETE THIS PORTION OF FORM 990. THE FUND HAS REPORTED AS MUCH OF THE INFORMATION AS IS READILY AVAILABLE FROM THE RECORD IN COMPLETING THIS SECTION OF THE FORM. FORM 990, SCH R, PART IV: 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. 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