2020-08-21T13:12:00-05:00 2019-12-31 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CENTER STE 700 WESTCHESTER IL 60154 990 2019-01-01 362365968 UFCW L1546 FOOD HANDLERS WELFARE FUND C/O ZENITH AMERICAN SOLUTIONS UFCW 3126491200 18861 90TH AVENUE NO A MOKENA IL 60448 BOB O'TOOLE BOARD CHAIRMAN 3126491200 2020-08-21 1 ADAM SIMAGA P01649025 3123680500 2020-08-13 12.235.239.120 2020-08-21 13:11:56 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 013BD4BEA457AB31DE8385915B9401809CC4B7ED 2019 2020-11-19 02:30:22Z BOB O'TOOLE 18861 90TH AVENUE NO A MOKENA IL 60448 108575455 0 X N/A X 1956 IL PROVIDE HEALTH BENEFITS. 6 6 0 0 0 0 0 0 21039538 23696193 401633 1299270 0 1150 21441171 24996613 0 0 19724430 21935274 0 0 0 0 0 1882177 1918188 21606607 23853462 -165436 1143151 26157712 27694567 124539 156609 26033173 27537958 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 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 0 0 1 0 0 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 AMERICAN SOLUTIONS 3126491200 18861 90TH AVENUE SUITE A MOKENA IL 60448 X GERALD M KOLB TRUSTEE 1.00 X 0 0 0 DAVID KALUZNY II TRUSTEE 0.50 X 0 0 0 JAMES GOW TRUSTEE 0.50 X 0 0 0 BOB O'TOOLE TRUSTEE 1.00 X 0 0 0 KENNETH URZEDOWSKI TRUSTEE 0.50 X 0 0 0 JONATHAN WILLIGMAN TRUSTEE 0.50 X 0 0 0 MARIO MARIN ALTERNATE TRUSTEE 0.50 X 0 0 0 KIMBERLY ZUBRICKAS ALTERNATE TRUSTEE - NEW 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 825206 ZENITH AMERICAN SOLUTIONS 18861 90TH AVE SUITE A MOKENA IL 60448 CONTRACT ADMINISTRATOR 648504 2 EMPLOYER CONTRIBUTIONS 900099 22532508 22532508 PRESCRIPTION DRUG REBATES 900099 1099864 1099864 PARTICIPANTS CONTRIB. 900099 55940 55940 SUBROGATION REFUNDS 900099 7881 7881 23696193 798284 798284 84079828 83578842 500986 500986 500986 MISCELLANEOUS 900099 1150 1150 1150 24996613 23696193 0 1300420 21935274 546025 47596 41876 114577 901771 49240 5422 4396 18203 FIELD REPRESENTATIVE EX 94838 COST CONTAINMENT FEES 82988 FEES MANDATED BY ACA 11256 23853462 285761 319812 1191062 1355661 226955 2548 39667 51599 23931953 25241283 482314 723664 26157712 27694567 108019 141169 6235 4400 10285 11040 124539 156609 X 0 0 0 0 26033173 27537958 26033173 27537958 26157712 27694567 1143151 361634 0 X 0 1 X 1 0 0 FEES MANDATED BY ACA 11040 11040 X 25243670 361634 361634 24882036 114577 114577 24996613 23738885 0 23738885 114577 114577 23853462 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 3 EVEN THOUGH THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THE PLAN IS ADMINISTERED AND MANAGED ON A DAY TO DAY BASIS BY ZENITH AMERICAN SOLUTIONS, 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 11B THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. AFTER THE BOARDS' THOROUGH 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 ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST THROUGH THE FUND'S THIRD PARTY ADMINISTRATOR. 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