2022-11-09T13:30:46-06:00 2021-12-31 363168081 SIKICH LLP 17335 GOLF PARKWAY BROOKFIELD WI 53045 990 2021-01-01 316041107 HEARTLAND HEALTH & WELLNESS FUND HEAR 9376651900 7250 POE AVENUE 300 DAYTON OH 45414 HENRY TAYLOR CHAIRPERSON 9376651900 2022-11-08 1 HENRY TAYLOR 999009999 BRIDGETTE MUGGE P00671418 2627549400 2022-10-31 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z HENRY TAYLOR 7250 POE AVENUE 300 DAYTON OH 45414 280117384 0 X WWW.HEARTLANDWELLNESSFUND.COM X EMPLOYEE BENEFIT PLAN 1957 OH THE PLAN PROVIDES MEDICAL, DENTAL, AND LIFE BENEFITS TO ITS MEMBERS AND DEPENDENTS. 13 8 60 8 0 0 0 0 233324485 274065573 334985 732610 526038 257787 234185508 275055970 0 0 221408841 270049797 2310295 2774429 0 0 0 12678183 15276202 236397319 288100428 -2211811 -13044458 39238218 48145303 39397945 45639807 -159727 2505496 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 THE PLAN PROVIDES ACCIDENT, HEALTH, VISION, PRESCRIPTION, DENTAL, LIFE, AND DEATH BENEFITS TO ITS MEMBERS AND DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 53 0 60 1 0 0 0 0 0 0 0 0 X 13 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JERRY EVANS 9376651900 7250 POE AVENUE SUITE 300 DAYTON OH 45414 KEVIN GARVEY TRUSTEE 1.00 40.00 X 0 323427 39891 BRYON O'NEAL ALTERNATE TRUSTEE 1.00 40.00 X 0 273416 38189 RANDY QUICKEL TRUSTEE 1.00 40.00 X 0 256100 35073 JOE CHORPENNING TRUSTEE 1.00 X X 0 0 0 HENRY TAYLOR CHAIRPERSON 1.00 X X 0 0 0 STEVEN SPRINGER TRUSTEE 1.00 X 0 0 0 ROB FRANCIN TRUSTEE 1.00 X 0 0 0 STEVE YANCEY TRUSTEE 1.00 X 0 0 0 BOB BLAIR TRUSTEE 1.00 X 0 233647 0 DAN PEDERSEN TRUSTEE 1.00 X 0 0 0 DAVID BLITZSTEIN TRUSTEE 1.00 X 0 0 0 DON SATTLER ALTERNATE TRUSTEE 1.00 X 0 0 0 TONY HELFER ALTERNATE TRUSTEE (THRU 3/12/21) 1.00 40.00 X 0 83788 0 WENDELL YOUNG ALTERNATE TRUSTEE (START 6/25/21) 1.00 40.00 X 0 371052 0 JERRY EVANS ADMINISTRATOR 40.00 X 214115 0 28579 MELISSA STEED EMPLOYEE 40.00 X 129531 0 35106 RICHARD MAINS JR EMPLOYEE 40.00 X 126548 0 34996 470194 1541430 211834 3 0 1 0 EPLAN LLC 22601 N 19TH AVE SUITE 240 PHOENIX AZ 85027 CLAIMS REVIEW 1045391 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 637448 THE SEGAL COMPANY 101 NORTH WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARY 585578 SLEVIN AND HART PC 1625 MASSACHUSETTS AVE NW SUITE 45 WASHINGTON DC 20036 ATTORNEY 310147 EUGENE STEWART 5671 WEBSTER ST DAYTON OH 45414 PRINTING AND DESIGN SERVICES 290134 7 EMPLOYER CONTRIBUTIONS 900099 272469983 272469983 SELF-PAYMENT CONTRIBUTIONS 900099 1595590 1595590 274065573 793732 793732 4999967 325 4999967 61447 0 -61122 -61122 -61122 SHARED EXPENSE REIMBURSEMENT 900099 229489 229489 MISCELLANEOUS 900099 28298 28298 257787 275055970 274323360 0 732610 270049797 242694 2074118 266877 190740 942110 22941 852162 917825 800205 243566 35682 50237 98116 PPO FEES AND MEDICAL RE 10945192 VISION SERVICE PLAN PRO 160192 PCORI FEE 112608 PRESCRIPTION DRUG PROGR 58548 36818 288100428 13037780 7385743 5155856 6262064 10663719 13546751 69855 89301 364344 169093 197888 195251 10113120 20666193 39238218 48145303 9038958 9278376 168071 158231 30190916 36203200 39397945 45639807 X 0 0 0 0 -159727 2505496 -159727 2505496 39238218 48145303 X -13044458 -239723 15949404 X X 0 1 X 1 0 364344 169093 195251 195251 BENEFIT OBLIGATIONS CURRENTLY PAYABLE 36203200 36203200 X 274793306 -239723 -239723 275033029 22941 22941 275055970 281836987 0 281836987 22941 6240500 6263441 288100428 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC) AND IS, THEREFORE, NOT SUBJECT TO TAX UNDER PRESENT INCOME TAX LAWS. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) AND THE TRUSTEES BELIEVE THAT THE TRUST AND THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE AS DESIGNED. U.S. GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN TAX 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 PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCREASE IN CURRENT YEAR'S CLAIMS PAYABLE 6,240,500. X X 0 0 0 WENDELL YOUNG ALTERNATE TRUSTEE (START 6/25/21) 0 356134 0 0 0 14918 0 0 0 0 0 371052 0 0 KEVIN GARVEY TRUSTEE 0 221990 0 101437 0 0 0 12075 0 27816 0 363318 0 0 BRYON O'NEAL ALTERNATE TRUSTEE 0 189037 0 84379 0 0 0 10373 0 27816 0 311605 0 0 RANDY QUICKEL TRUSTEE 0 246450 0 9650 0 0 0 0 0 35073 0 291173 0 0 JERRY EVANS ADMINISTRATOR 214115 0 0 0 0 0 19234 0 9345 0 242694 0 0 0 BOB BLAIR TRUSTEE 0 233647 0 0 0 0 0 0 0 0 0 233647 0 0 MELISSA STEED EMPLOYEE 129531 0 0 0 0 0 7290 0 27816 0 164637 0 0 0 RICHARD MAINS JR EMPLOYEE 126548 0 0 0 0 0 7180 0 27816 0 161544 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 GOES THROUGH A PRELIMINARY REVIEW BY THE ADMINISTRATIVE MANAGER AND ACCOUNTANT. 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 ADMINISTRATIVE MANAGER'S PAY RANGE IS DETERMINED BY THE BOARD OF TRUSTEES. THE TRUSTEES HAD A SALARY STUDY PERFORMED BY THE PLAN'S CONSULTANTS. THE TRUSTEES APPROVE INCREASES IN 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 XI, LINE 9: TRANSFER OF NET ASSETS FROM UFCW LOCAL 227 EMPLOYERS HEALTH & WELFARE PLAN 15,949,404. 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. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. PART XI, LINE 9 THE TRUSTEES OF THE FUND ENTERED INTO A MERGER AGREEMENT WITH THE TRUSTEES OF THE 227 PLAN. THE EFFECTIVE DATE OF THE MERGER WAS JANUARY 1, 2021 AS OF 12:01 A.M. THE 227 PLAN IS THE SOLE MEMBER AND CONTROLLING ENTITY OF THE UFCW AND EMPLOYERS MID-AMERICAN BENEFIT PLAN SERVICES, LLC (227 LLC). THE MERGER RESULTED IN THE DISSOLUTION OF THE 227 LLC AS OF JANUARY 31, 2021. THE NET ASSETS AVAILABLE FOR BENEFITS OF THE 227 PLAN TRANSFERRED INTO THE FUND DURING THE MONTH ENDING JANUARY 31, 2021 WAS $15,949,404. IN ADDITION, BENEFIT OBLIGATIONS ASSUMED BY THE FUND PURSUANT TO THE MERGER WERE $8,475,743 AND CONSIST OF CURRENT OBLIGATIONS OF $6,333,819 AND POSTRETIREMENT BENEFIT OBLIGATIONS, NET OF AMOUNTS CURRENTLY PAYABLE, OF $2,141,924. HEARTLAND BENEFIT PLAN ADMINISTRATORS LLC 7250 POE AVENUE NO 300 DAYTON OH 45414 475593281 PROVIDE MEDICAL AND LIFE BENEFITS TO ITS MEMBERS OH BOARD OF TRUSTEES OF HEARTLAND HEALTH & WELLNESS FUND 7250 POE AVENUE DAYTON OH 45414 316173363 PLAN SPONSOR AND PLAN ADMINISTRATOR OH 501(C)(9) N/A 0 CHAMPAIGN RESIDENTIAL SERVICES INC CINCINNATI AFO-CIO LABOR COUNCIL CINCINNATI INTERFAITH WORKERS GOOD SHEPHERD HOME HARBOR BEHAVIORAL HEALTH HEARTLAND BENEFIT PLAN ADMINISTRATORS LLC UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL 1059 UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL 23 FCU UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 1776KS UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 75 UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL 951 UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL 227 IAM AND AW LOCAL 1943 CLERMONTS BEST DRIVING ACADEMY LLC CONSOLIDATED HEALTHCARE SOLUTIONS LLC CUNDIFF TOWN & COUNTRY TREE SERV LLC GRAPHIC FINISHING LLC JAS ELECTRIC LLC MAXWELL MEDICAL LLC MICHAEL P KELLY REALTY PIPCO LLC SNYDER & GAST LLC WEBER DICKEY BELLMAN LAW LEONARD A BLEH LLC LAW OFFICES OF LEONARD SIGALL AMERICAN BUSINESS TECHNOLOGIES AVI FOOD SYSTEMS INC BILLOW CONSTRUCTION INC BLUE GRASS PROVISIONS BRIDGETOWN FINER MEATS INC BRUSH & LADDER PAINTING INC C-FAB LLC COOK & LOGOTHETIS LLC CVS PHARMACY INC DBM & SONS INC DON CARTER & ASSOC INC DR ELLEN C TORBECK DMD PSC FRESH ENCOUNTER - CHIEFS FRESH ENCOUNTER - GREAT SCOT INC FROZEN SPECIALTIES INC G&G TRANSPORTATION SERVICE INC GR FEHR COMPANY INC GOERGE F MOELLER LPA GRACE FOODS INC HILLTOP PHYSICIANS INC JIM BITZENHOFER REFRIGERATION AND AC INC JOHN STEHLIN & SONS CO INC KISSEL BROS KUHL TILE & MARBLE INC LANGEN MEATS INC LEE WILLIAMS MEATS INC MANLEY BURKE LPA MULLEN VAN HOUTEN NEWMAN & MEEKS CO LPA OUR HARVEST ROBERT WHOLEY & CO INC RUBLE ARTISTIC FURNITURE RESTORATION INC RUDOLPH FOODS COMPANY INC SEVEN HILLS COFFEE COMPANY SILGAN CAN COMPANY SKYHAVEN FARMS INC SMARTCAT MARKETING SOLUTIONS THE KROGER CO UNION EYE CARE WASSLER MEATS INC WE CARE FOOD STORES INC 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 FORM 990, SCHEDULE R, PARTS II-IV IN ADDITION TO THE CONTRIBUTING EMPLOYERS REPORTED AS RELATED ORGANIZATIONS ON SCHEDULE R, PARTS II-IV, THE FUND HAD ADDITIONAL EMPLOYERS THAT HAVE NOT YET RESPONDED TO THE FUNDS EFFORT TO OBTAIN THE TAX CLASSIFICATION. THE CONTRIBUTING EMPLOYERS ARE BANKS GROCERY COMPANY, CINCINNATI POOL MANAGEMENT LLC, DAWN FOODS, FRANK L HARTER & SONS INC, GENACROSS LUTHERAN SERVICES, IAM LOCAL LODGE 1943, INDUSTRIAL MECHANICAL CONTRACTORS INC, IRENE DONNER DBA DONNER REPORTING, JACKSON HOUSE, JAMES WEINGARTNER, LORI FOSTER, LAWRENCE CO CAREER & TECH CENTER, PEASLEE NEIGHBORHOOD CENTER, PRAIRIE DAIRY FARMS, RUSSELL IMMIGRATION, SHELDON REDER, SPECTRUM PRINTING & DESIGN, SYSCO FOOD SERVICES, WISCONSIN VISION, WASIKS MARKET, INC.