2017-06-06T16:10:58-05:00 2016-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2016-01-01 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 2017-06-06 1 BRUCE A PAVLIK P00748405 3123680500 12.197.118.215 2017-06-06 16:10:39 CD P D56625F7C0621E1EB8BA8C5A7372C18F0F4BC985 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z BOB O'TOOLE 18861 90TH AVENUE NO A MOKENA IL 60448 122988717 0 X N/A X 1956 IL PROVIDE HEALTH BENEFITS. 6 6 0 0 0 0 0 0 16324382 17419303 693276 958228 0 104 17017658 18377635 0 0 14379671 15274926 0 0 0 0 0 1685966 1679558 16065637 16954484 952021 1423151 26830559 27721457 353476 193726 26477083 27527731 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 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 KENNETH BOYD TRUSTEE 1.00 X 0 0 0 GERALD M KOLB TRUSTEE 1.00 X 0 0 0 CHRISTINE BARTHOLMEY ALTERNATE TRUSTEE 0.50 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 0.50 X 0 0 0 KENNETH URZEDOWSKI TRUSTEE 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 602710 ZENITH AMERICAN SOLUTIONS 18861 90TH AVE SUITE A MOKENA IL 60448 CONTRACT ADMINISTRATOR 586824 2 EMPLOYER CONTRIBUTIONS 900099 17260539 17260539 PRESCRIPTION DRUG REBATES 900099 112130 112130 PARTICIPANTS CONTRIB. 900099 35400 35400 LIQUIDATED DAMAGES 900099 6000 6000 SUBROGATION REFUNDS 900099 5234 5234 17419303 724324 724324 104844986 104611082 233904 233904 233904 MISCELLANEOUS 900099 104 104 104 18377635 17419303 0 958332 15274926 456634 60459 40939 120559 678335 58650 4432 18093 FIELD REPRESENTATIVE EX 100373 FEES MANDATED BY ACA 90076 COST CONTAINMENT FEES 51008 16954484 144009 294187 1333525 425714 41904 71382 57838 57825 25026121 26670758 227162 201591 26830559 27721457 59800 87484 3270 16216 290406 90026 353476 193726 X 0 0 0 0 26477083 27527731 26477083 27527731 26830559 27721457 1423151 -372503 0 X 0 1 X 1 0 0 FEES MANDATED BY ACA 90026 90026 X 17884573 -372503 -372503 18257076 120559 120559 18377635 16833925 0 16833925 120559 120559 16954484 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLANS RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. 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 THE INFORMATION IN QUESTION 19 AVAILABLE UPON REQUEST THROUGH THE FUND'S THIRD PARTY ADMINISTRATOR. 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