2017-11-06T16:04:58-06:00 2015-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2015-01-01 316041107 HEARTLAND HEALTH & WELLNESS FUND HEAR 9376651900 7250 POE AVENUE NO 300 DAYTON OH 45414 JOE CHORPENNING SECRETARY 9376651900 2017-11-03 1 THOMAS M POWERS CPA P00241729 2627846210 2015 2017-02-10 21:41:12Z X JOE CHORPENNING 7250 POE AVENUE NO 300 DAYTON OH 45414 146898126 0 X WWW.HEARTLANDWELLNESSFUND.COM X EMPLOYEE BENEFIT PLAN 1957 OH THE PLAN PROVIDES MEDICAL, DENTAL, AND LIFE BENEFITS TO ITS MEMBERS AND DEPENDENTS. 8 8 37 0 0 0 0 0 104619203 142472587 2739448 285267 220283 855959 107578934 143613813 0 0 122341417 137865849 1867865 2069742 0 0 0 10391943 8989053 134601225 148924644 -27022291 -5310831 38283493 29766012 8937265 6185333 29346228 23580679 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 144424187 THE PLAN PROVIDES ACCIDENT, HEALTH, VISION, PRESCRIPTION, DENTAL, LIFE, AND DEATH BENEFITS TO ITS MEMBERS AND DEPENDENTS. 144424187 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 63 0 1 37 1 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 1 1 1 0 0 X JERRY EVANS 9376651900 7250 POE AVENUE SUITE 300 DAYTON OH 45414 LENNIE WYATT TRUSTEE 1.00 50.00 X 0 467880 31156 STEVE CULTER TRUSTEE 1.00 50.00 X 0 499380 32144 STEVE LOEFFLER TRUSTEE 1.00 X 0 0 0 STEVE HENDRICKSON TRUSTEE 1.00 X 0 12326 0 JOE CHORPENNING CHAIRPERSON 1.00 X X 0 0 0 KATHY WAGENKNECHT TRUSTEE 1.00 X 0 0 0 OLENA MALECKYJ TRUSTEE 1.00 X 0 0 0 HENRY TAYLOR SECRETARY/TREASURER 1.00 X X 0 0 0 JERRY EVANS ADMINISTRATOR 40.00 X 140080 0 21347 140080 979586 84647 1 0 1 0 EPLAN LLC 22601 N 19TH AVE SUITE 202 PHOENIX AZ 85027 CLAIMS REVIEW 624299 MEDEXPERT INTERNATIONAL INC 2688 MIDDLEFIELD RD REDWOOD CITY CA 94063 DISEASE MANAGEMENT 505056 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 419619 THE SEGAL COMPANY 101 NORTH WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARY 405995 BASYS INC 857 ELKRIDGE LANDING 7TH FLOOR LINTHICUM MD 21090 COMPUTER CONSULTING 356128 7 EMPLOYER CONTRIBUTIONS 900099 141155446 141155446 SELF-PAYMENT CONTRIB. 900099 1317141 1317141 142472587 285267 285267 3284313 3284313 0 MISCELLANEOUS 900099 564560 564560 SHARED EXPENSE REIMBURSEMENT 900099 291399 291399 855959 143613813 143328546 0 285267 137865849 137865849 1378376 1378376 101549 101549 466978 466978 122839 122839 420512 420512 82675 82675 21683 21683 417116 417116 676819 676819 380357 380357 120017 120017 76365 76365 15726 15726 60008 60008 PPO FEES AND MEDICAL RE 6340635 6340635 VISION SERVICE PLAN PRO 143175 143175 ONLINE OPEN ENROLLMENT 102105 102105 PRESCRIPTION DRUG PROGR 74528 74528 57332 57332 148924644 144424187 4500457 0 21544946 8179092 5806457 6022032 1027853 6013509 33346 23796 147591 91919 29777 55672 8839821 8452958 1001293 1018953 38283493 29766012 5133924 3198242 23841 92491 3779500 2894600 8937265 6185333 X 0 0 0 0 29346228 23580679 29346228 23580679 38283493 29766012 X -5310831 -454866 148 X X 0 1 X 1 0 147591 91919 55672 55672 CLAIMS PAYABLE 2894600 2894600 X 143137264 -454866 -454866 143592130 21683 21683 143613813 149787861 0 149787861 21683 -884900 -863217 148924644 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. THE DOL IS CURRENTLY AUDITING THE PLAN. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN CURRENT YEAR'S CLAIMS PAYABLE -884,900. X X 1 0 0 LENNIE WYATT TRUSTEE 0 189513 0 130983 0 147384 0 0 0 31156 0 499036 0 0 STEVE CULTER TRUSTEE 0 203992 0 132508 0 162880 0 0 0 32144 0 531524 0 0 JERRY EVANS ADMINISTRATOR 140080 0 0 0 0 0 0 0 21347 0 161427 0 0 0 PART I, LINE 4A PART I, LINE 4A: LENNIE WYATT, SEVERANCE PAYMENT FROM RELATED ORGANIZATION, $147,384 STEVE CULTER, SEVERANCE PAYMENT FROM RELATED ORGANIZATION, $162,880 FORM 990, LINE B RETURN IS AMENDED TO CORRECT THE 12/31/15 EMPLOYER CONTRIBUTIONS RECEIVABLE AND OTHER RELATED ACCOUNTS TO REFLECT A CHANGE IN THE CONTRIBUTION STRUCTURE AND TIMING OF BILLINGS TO THE ASSOCIATED CONTRIBUTING EMPLOYERS WHICH WERE NOT RECORDED PRIOR TO THE FILING OF THE ORIGINALLY FILED TAX RETURN. THE INTERCOMPANY ACCOUNTS ARE ALSO NETTED IN THIS AMENDED RETURN. THE AMENDMENT CHANGES ARE REFLECTED ON FORM 990 PARTS I, VIII, X, AND XI, AND SCHEDULE D PART XI. FORM 990, PART VI, SECTION B, LINE 11 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 MERGER WITH INDIANA AREA UFCW HEALTH AND WELFARE PLAN 148. 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. 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 EIGHT SOLE PROPRIETORS AS CONTRIBUTING EMPLOYERS DURING 2015. THE PLAN HAD THREE EMPLOYERS PROVIDE "LLC" RATHER THAN THE TAX CLASSIFICATION. THE PLAN MADE A RESONABLE EFFORT TO OBTAIN THE TAX CLASSIFICATION FROM ALL CONTRIBUTING EMPLOYERS, BUT THREE OF THE CONTRIBUTING EMPLOYERS HAVE NOT YET RESPONDED TO THE MULTIPLE REQUESTS. 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 GOOD SHEPHERD HOME HAMILTON COUNTY DEMOCRATIC PARTY HARBOR BEHAVIORAL HEALTH INT'L ASSOC OF MACHINISTS & AEROSPACE WORKERS LOCAL LODGE 1943 LUTHERAN HOMES SOCIETY INC PLUMBERS & PIPEFITTERS LOCAL 162 APPRENTICESHIP TRAINING TR FUND UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 23 UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 75 7250 POE AVENUE DAYTON OH 45414 310621221 LABOR UNION OH 501(C)(5) N/A 0 CLERMONTS BEST DRIVING ACADEMY LLC CONSOLIDATED HEALTHCARE SOLUTIONS LLC CUNDIFF TOWN & COUNTRY TREE SERV LLC EUGENE STEWART DBA SPECTRUM PRINTING & DESIGN JAS ELECTRIC LLC KROGER LIMITED PARTNERSHIP 1 LEONARD A BLEH LLC MAXWELL MEDICAL LLC MICHAEL P KELLY REALTY SNYDER & GAST LLC SYNERGY HOLISTIC HEALTH CENTER LLC WEBER DICKEY BELLMAN AMERICAN BUSINESS TECHNOLOGIES AVI FOOD SYSTEMS INC BAY VALLEY FOODS LLC BILLOW CONSTRUCTION INC BLUE GRASS PROVISIONS BOROWIAKS IGA BRIDGETOWN FINER MEATS INC BRUSH & LADDER PAINTING INC CHIEF SUPER MARKET INC COOK & LOGOTHETIS LLC CVS PHARMACY INC DBM & SONS INC DON CARTER & ASSOC INC DON VONDERHAAR'S MARKET & CATERING INC DR ELLEN C TORBECK DMD PSC FOUNDATIONS HEALTH SOLUTIONS INC FRANK L HARTER & SONS INC FROZEN SPECIALTIES INC G&G TRANSPORTATION SERVICE INC G&S DISTRIBUTING GR FEHR COMPANY INC GARY LORD WALL OPTIONS AND ASSOCIATES INC GOERGE F MOELLER LPA GRACE FOODS INC GREAT SCOT INC INDUSTRIAL MECHANICAL CONTRACTORS INC INNOVATIVE FOOD TECHNOLOGIES JIM BITZENHOFER REFRIGERATION AND AC INC JOHN J DUFFY & ASSOCIATES INC JOHN STEHLIN & SONS CO INC KIRCHER SUETHOLZ & GRAYSON CO LPA KUHL TILE & MARBLE INC LANGEN MEATS INC LEE WILLIAMS MEATS INC MANLEY BURKE LPA NEWMAN & MEEKS CO LPA RITE PRICE FOODS INC ROBERT WHOLEY & CO INC ROMY'S PLUMBING INC RUBLE ARTISTIC FURNITURE RESTORATION INC RUDOLPH FOODS COMPANY INC SEVEN HILLS COFFEE COMPANY SILGAN CAN COMPANY SKYHAVEN FARMS INC SUGAR CREEK PACKING CO THE DOOR GROUP INC THE KROGER CO UNION EYE CARE WASSLER MEATS INC WE CARE FOOD STORES INC WUNDERLAND INC 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 75 K 120017 FAIR MARKET VALUE UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 75 P 18423 ACTUAL EXPENSE REIMBURSEMENTS