2025-03-11T08:49:20-05:00 2024-04-30 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2023-05-01 586041908 UNITED FOOD & COMMERICAL WORKERS UNIONS & EMPLOYERS HEALTH & WELFARE FUND UNIT 7709979910 1740 PHOENIX PARKWAY ATLANTA GA 30349 ERIC TAYLOR CHAIRMAN 7709979910 2025-03-11 1 1 ERIN CRANMER P01712644 2023319880 2025-03-11 2023 2025-03-06 01:10:19Z ERIC TAYLOR 3302 MCGINNIS FERRY RD SUWANEE GA 30024 196307610 0 X N/A X EMPLOYEE BENEFIT PLAN 1964 GA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS. 8 0 0 0 0 0 0 0 108769412 176668918 297797 1000260 10189 7992 109077398 177677170 0 0 109395755 159914701 0 0 0 0 0 4288380 5051032 113684135 164965733 -4606737 12711437 43019694 49159983 324827 3809075 42694867 45350908 TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS. 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 5 0 1 0 0 0 0 0 0 0 0 0 0 0 X 8 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X MARK MURPHY 7079979910 1740 PHOENIX PKWY ATLANTA GA 30349 STEVE LOMAX CHAIRMAN (THROUGH 6-30-23) 2.00 40.00 X 0 523700 0 ERIC TAYLOR CHAIRMAN 1.00 40.00 X 0 350511 0 MARIA DAVENPORT UNION TRUSTEE 1.00 40.00 X 0 179889 0 ERIC LOMAX UNION TRUSTEE 1.00 40.00 X 0 147945 0 RALPH PORRAS ALTERNATE UNION TRUSTEE 1.00 40.00 X 0 139478 0 PEGGY PRESCOTT SECRETARY 2.00 40.00 X 0 0 0 HENRY TAYLOR EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 LEE KUNSELMAN EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 KAREN HILL ALTERNATE UNION TRUSTEE 1.00 40.00 X 0 0 0 W BRANDON HOPKINS UNION TRUSTEE 1.00 40.00 X 0 0 0 REBECCA CLARK EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 DONALD SATTLER EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 0 1341523 0 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD 3075 VANDERCAR WAY CINCINNATI OH 45209 PPO 7063004 BHA CONSULTING LLC 5400 LAUREL SPRINGS PKWY STE 1306 SUWANEE GA 30024 CONSULTING 428426 HMC HEALTHWORKS LLC 2 PARK PLAZA SUITE 1200 IRVINE CA 92614 DISEASE MANAGEMENT 341180 SLEVIN & HART PC 1625 MASSACHUSETS AVE NW STE 450 WASHINGTON DC 20036 LEGAL 272216 REINHART BOERNER VAN DEUREN SC 1000 N WATER ST SUITE 1700 MILWAUKEE WI 53202 LEGAL 195317 5 EMPLOYER AND EMPLOYEE CONTRIBUTIO 525100 176073755 176073755 SUBROGATION RECOVERY 525100 589625 589625 SPOUSAL FEES 525100 5538 5538 176668918 995298 995298 18635402 18630440 4962 4962 4962 7992 7992 7992 177677170 177672208 0 4962 159914701 544062 53484 37000 292052 118105 27448 49631 ALLOCATED ADMINISTRATIV 3870875 PCORI FEE 58375 164965733 16447630 15286844 24077 13258538 13519249 7051511 5786 13022952 13563090 43019694 49159983 324827 3809075 324827 3809075 X 42694867 45350908 0 0 0 0 42694867 45350908 43019694 49159983 12711437 39184 -10094580 0 X X 0 1 X 1 0 0 X 177679354 39184 39184 177640170 37000 37000 177677170 164928733 0 164928733 37000 37000 164965733 PART X, LINE 2: THE PLAN OBTAINED ITS MOST RECENT DETERMINATION LETTER ON OCTOBER 1, 1964, STATING THAT THE PLAN WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC) AND WAS, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(9). THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. THE PLAN HAS PERFORMED AN EVALUATION OF ITS TAX POSITIONS AND, AS OF APRIL 30, 2024, THERE WERE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. AS OF APRIL 30, 2024, THE STATUTE OF LIMITATIONS FOR TAX YEARS 2021 THROUGH 2023 REMAIN OPEN WITH THE U.S. FEDERAL JURISDICTION IN WHICH THE PLAN FILES TAX RETURNS. 0 0 0 STEVE LOMAX CHAIRMAN (THROUGH 6-30-23) 0 251733 0 157337 0 114630 0 0 0 0 0 523700 0 0 ERIC TAYLOR CHAIRMAN 0 240896 0 109615 0 0 0 0 0 0 0 350511 0 0 MARIA DAVENPORT UNION TRUSTEE 0 94746 0 85143 0 0 0 0 0 0 0 179889 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS ON FILE AT THE FUND OFFICE TO BE REVIEWED BY THE BOARD OF TRUSTEES. PART VI, SECTION B, LINES 12 - 14 ALTHOUGH THE FUND HAS NO FORMAL WRITTEN POLICIES ON CONFLICT OF INTEREST, WHISTLEBLOWERS AND DOCUMENT RETENTION, THE FUND IS GOVERNED BY ERISA. ERISA CONTAINS PRUDENCE AND PROHIBITED TRANSACTIONS RULES THAT, IN PRACTICE, ACT AS THE FUND'S CONFLICT OF INTEREST POLICY, RECORD RETENTION REQUIREMENTS THAT ACT AS THE FUND'S RECORD RETENTION POLICY, AND CO-FIDUCIARY REPORTING OBLIGATIONS THAT ACT AS A WHISTLEBLOWER POLICY FOR THE FUND. FORM 990, PART VI, SECTION C, LINE 19 THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO ERISA. IT OPERATES IN COMPLIANCE WITH REPORTING REQUIREMENTS OF ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION. NO DOCUMENTS OR FINANCIAL INFORMATION IS AVAILABLE TO THE GENERAL PUBLIC OTHER THAN THOSE FINANCIAL STATEMENTS REQUIRED TO BE DISCLOSED AS PART OF GOVERNMENTAL FILINGS. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UFCW LEGAL ASSISTANCE FUND 1740 PHOENIX PARKWAY ATLANTA GA 30349 581370485 LEGAL ASSISTANCE GA N/A 0 UFCW LOCAL 1996 3302 MCGINNIS FERRY RD SUWANEE GA 30024 582141936 LABOR UNION GA N/A 0 UFCW BENEFITS ADMINISTRATION LLC 1740 PHOENIX PARKWAY ATLANTA GA 30349 770613772 PROVIDE ADMINISTRATIVE SUPPORT GA N/A 0 THE BOARD OF TRUSTEES 1740 PHOENIX PARKWAY ATLANTA GA 30349 586041908 TRUSTEES GA N/A 0 THE KROGER CO 1014 VINE ST CINCINNATI OH 45202 310345740 RETAIL GROCERY OH N/A C 0 SHENANDOAH FLEET 6101 W COURTYARD DR BLDG 4 AUSTIN TX 78730 208162398 ADVISORY SERVICES TX N/A C 0 SPARTA HEALTHCARE PO BOX 237 SPARTA GA 30187 391297018 HEALTHCARE GA N/A C 0 HAC INC 390 NE 36TH ST OKLAHOMA CITY OK 73105 431969314 OH N/A C 0 TITAN PO BOX 5097 CONCORD CA 94524 452403008 CA N/A C 0 PCSI 718 W FM 1626 BLDG 100 AUSTIN TX 78748 742786094 TX N/A C 0 HOSPITAL HOUSEKEEPING SYSTEMS LLC 12495 SILVER CREEK ROAD DRIPPING SPRINGS TX 78620 742983259 TX N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0