2013-11-14T13:18:25-06:00 2012-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2012-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 6142377618 4150 EAST MAIN STREET COLUMBUS OH 43213 RANDY QUICKEL 6142377618 2013-11-14 1 THOMAS M POWERS CPA P00241729 2627846210 2012 2016-02-25 16:41:14Z RANDY QUICKEL 4150 EAST MAIN STREET COLUMBUS OH 43213 88538244 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 16 0 0 0 0 0 42194943 56602259 997174 587444 0 0 43192117 57189703 0 0 47106150 48212915 847218 793026 0 0 0 3146121 2926939 51099489 51932880 -7907372 5256823 28682609 33651156 2513312 1740538 26169297 31910618 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 50230272 BENEFITS PAID TO OR FOR MEMBERS CONSIST OF ACCIDENT, HEALTH, DENTAL, LOSS OF TIME, VISION CARE, PRESCRIPTION DRUG AND LIFE. ALSO INCLUDED ARE THE RELATED ADMINISTRATION FEES CHARGED BY THE BENEFIT PROVIDERS AND COST CONTROLS. 50230272 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 78 0 1 16 1 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 0 0 X DAVE MCALLISTER 6142377618 4150 E MAIN ST COLUMBUS OH 43213 RANDY QUICKEL 2.00 X X 0 135010 0 STEVE LOEFFLER 2.00 X X 0 0 0 JESSICA MILES 2.00 X 0 0 0 DOUG WHITNEY 2.00 X 0 0 0 PAUL SMITHBERGER 2.00 X 0 101859 0 SUE VANDERSALL 2.00 X 0 0 0 MARK FLUHARTY 2.00 X 0 122924 0 0 359793 0 0 0 0 0 HEALTH SERVICE REVIEW OF OHIO INC 6730 ROOSEVELT FRANKLIN OH 45005 MEDICAL CASE MANAGEMENT 216216 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 172092 BENESYS INC 700 TOWER DRIVE SUITE 300 TROY MI 480982808 IT 138999 3 EMPLOYER CONTRIBUTIONS 900099 56155854 56155854 SELF-PAYMENT CONTRIBUTI 900099 446405 446405 56602259 571626 571626 31364359 31348541 15818 15818 15818 57189703 56602259 0 587444 48212915 48212915 523477 523477 29098 29098 197286 197286 43165 43165 205278 205278 36600 36600 26817 26817 114756 114756 271613 271613 109555 109555 37576 37576 14283 14283 18714 18714 21144 21144 ACCIDENT, HEALTH AND DE 1777050 1777050 MEDICAL REVIEW SERVICES 195328 195328 VISION CARE FEES 44979 44979 TEMPORARY HELP 37836 37836 15410 15410 51932880 50230272 1702608 0 4114064 3283186 1179343 874392 798689 532077 30469 26137 330904 304195 50349 26709 22509695 28908655 28682609 33651156 1593916 801506 396 3032 919000 936000 2513312 1740538 X 0 0 0 0 26169297 31910618 26169297 31910618 28682609 33651156 5256823 484498 0 X X 0 1 X 1 0 330904 304195 26709 26709 CLAIMS PAYABLE 936000 936000 X 57647384 484498 484498 57162886 26817 26817 57189703 51889063 0 51889063 26817 17000 43817 51932880 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX YEARS IN PROGRESS. PLAN MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2009. PART XII, LINE 4B - OTHER ADJUSTMENTS: CURRENT YEAR INCREASE IN CLAIMS PAYABLE 17,000. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 GOES THROUGH A PRELIMINARY REVIEW BY THE ADMINISTRATIVE MANAGER AND DIRECTOR OF FINANCE. ONCE THEY APPROVE THE FORM 990 IT IS PRESENTED TO A COMMITTEE OF TRUSTEES FOR APPROVAL PRIOR TO SIGNING AND FILING. FORM 990, PART VI, SECTION B, LINE 12C TRUSTEES ARE EXPECTED TO FULLY DISCLOSE ANY OWNERSHIP OR OTHER FINANCIAL RELATIONSHIPS THEY HAVE WITH OTHER PARTIES THAT DEAL WITH THE PLAN. FORM 990, PART VI, SECTION B, LINE 15A THE CHAIRMAN OF THE BOARD OF TRUSTEES EVALUATES THE ADMINISTRATIVE MANAGER AND DETERMINES COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT TO PERFORM THE AUDIT OF THE PLAN'S FINANCIAL STATEMENTS. FORM 990, SCHEDULE R, PARTS II-IV: IN ADDITION TO THE CONTRIBUTING EMPLOYERS REPORTED AS RELATED ORGANIZATIONS ON SCHEDULE R, PARTS II-IV, THE PLAN ALSO HAD 4 SOLE PROPRIETORS AS CONTRIBUTING EMPLOYERS DURING 2012. UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 4150 E MAIN STREET COLUMBUS OH 43213 314392482 LABOR UNION OH 501(C)(5) N/A 0 BOARD OF TRUSTEES OF THE UFCW UNIONS AND EMPLOYERS H&W PLAN OF CENTRAL OHIO 4150 E MAIN STREET COLUMBUS OH 43213 310656412 PLAN SPONSOR AND PLAN ADMINISTRATOR OH 501(C)(9) N/A 0 CVSCAREMARK GREAT SCOT INC THE KROGER CO INTERSTATE BRANDS CORP 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 K 58368 FAIR MARKET VALUE