2019-09-11T15:48:55-05:00 2018-11-30 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2017-12-01 390979166 UNITED FOOD & COMMERICAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN UNIT 4144762523 2001 NORTH MAYFAIR ROAD MILWAUKEE WI 53226 JOHN EIDEN CHAIRMAN 4144762523 2019-09-11 1 JAMES M ASHLAND CPA P00241858 2627846210 70.61.53.194 2019-09-11 15:19:22 CD P CCA3FFBDE7687CE42E9EA09D506C5024DA3E21F0 7456D36014A6CBF084659659171A6618C5CD14F2 2017 2019-02-21 02:37:17Z JOHN EIDEN 2001 N MAYFAIR RD MILWAUKEE WI 53226 2299298 0 X N/A X 1960 WI HEALTH PLAN 7 0 0 0 0 0 0 0 2428473 2298093 0 0 0 1205 2428473 2299298 0 0 1683704 1882631 0 0 0 0 0 396938 374781 2080642 2257412 347831 41886 3018451 3119438 308810 367911 2709641 2751527 TO PROVIDE ELIGIBLE PARTICIPANTS ACCIDENT, HEALTH, VISION, DENTAL, PRESCRIPTION DRUG, LIFE INSURANCE, LOSS OF TIME, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS. 0 0 1506883 ACCIDENT, HEALTH, LOSS-OF-TIME, DENTAL, LIFE, VISION CARE BENEFIT PAYMENTS TO PARTICIPANTS. 520276 PRESCRIPTION DRUG PROGRAM BENEFITS PAID ON BEHALF OF PARTICIPANTS. LIFE INSURANCE BENEFITS PAID ON BEHALF OF PARTICIPANTS. 2027159 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 0 0 0 0 0 0 0 X 7 0 1 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 4144761220 2001 N MAYFAIR ROAD MILWAUKEE WI 53226 JOHN EIDEN CHAIRMAN/UNION TRUSTEE 1.00 40.00 X X 0 131395 18240 GRANT WITHERS UNION TRUSTEE 1.00 40.00 X 0 120206 18240 PAUL BUTERA SR EMPLOYER TRUSTEE 1.00 X 0 0 0 CHAD WHITESIDE ALTERNATE UNION TRUSTEE 1.00 40.00 X 0 100959 18240 DARREN HORNDASCH SECRETARY/EMPLOYER TRUSTEE 1.00 X X 0 0 0 PAUL BUTERA JR ALTERNATE EMPLOYER TRUSTEE 1.00 X 0 0 0 JAKE BAILEY ALTERNATE UNION TRUSTEE 1.00 40.00 X 0 101467 18240 0 454027 72960 0 0 0 0 0 EMPLOYER CONTRIBUTIONS 525100 2279933 2279933 SELF-PAY CONTRIBUTIONS 525100 18160 18160 2298093 CLASS ACTION LITIGATIO 525100 1205 1205 1205 2299298 2299298 0 0 1882631 90000 16432 40925 49124 1046 622 7786 STOP-LOSS PREMIUMS 77223 ACCIDENT, HEALTH, AND D 60281 BANK SERVICE FEES 15063 RECORD STORAGE EXPENSES 6488 9791 2257412 3009660 3100095 4639 11376 4152 7967 3018451 3119438 115961 97240 57162 63671 135687 207000 308810 367911 X 0 0 0 0 2709641 2751527 2709641 2751527 3018451 3119438 41886 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE 207000 207000 X 2299298 0 2299298 0 2299298 2186099 0 2186099 71313 71313 2257412 PART X, LINE 2: U.S. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES REQUIRE THE MANAGEMENT OF AN ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND TO RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION 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 CLAIMS PAYABLE 71,313. FORM 990, PART VI, SECTION A, LINE 2 PAUL BUTERA SR. AND PAUL BUTERA JR. HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE FUND'S RECORDKEEPER. THEY REVIEW IT AND APPROVE IT, THEN PRESENT THE FORM 990 TO THE BOARD OF TRUSTEES FOR REVIEW AND FILING APPROVAL. FORM 990, PART VI, SECTION C, LINE 19 THEY ARE AVAILABLE UPON REQUEST. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC PAUL BUTERA SR. - ONE CLOCK TOWER PLAZA, ELGIN, IL 60120. CHAD WHITESIDE - 1602 S. PARK ST., SUITE 103, MADISON, WI 53715. DARREN HORNDASCH - 16800 W. CLEVELAND AVE., NEW BERLIN, WI 53151. PAUL BUTERA JR. - ONE CLOCK TOWER PLAZA, ELGIN, IL 60120. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, THE PLAN'S FINANCIAL STATEMENTS, AND FOR THE SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1473 2001 NORTH MAYFAIR ROAD MILWAUKEE WI 53226 562585698 LABOR UNION WI 501(C)(5) N/A 0 BOARD OF TRUSTEES OF WI UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2001 NORTH MAYFAIR ROAD MILWAUKEE WI 53226 390979166 PLAN SPONSOR AND PLAN ADMINISTRATOR WI 501(C)(9) N/A 0 OFFICE SOLUTIONS - USA INC UNION FIRST LASER TECHNOLOGIES INC STINEBRINK'S LAKE GENEVA FOODS LLC PIGGLY WIGGLY MIDWEST LLC SUPERIOR NATIONAL BANK & TRUST COMPANY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0