2017-06-22T12:04:27-05:00 2016-11-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2015-12-01 362440523 U F C W UNIONS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND UFCW 8473847000 9801 WEST HIGGINS ROAD NO 500 ROSEMONT IL 60018 ROBERT NIKSA ADMINISTRATOR 8473847000 2017-06-22 1 CRAIG RESCH P00844633 3123680500 2015 2021-01-29 14:40:06Z ROBERT NIKSA 9801 WEST HIGGINS ROAD NO 500 ROSEMONT IL 60018 39270559 0 X WWW.UFCWMIDWEST.ORG X 1960 IL PROVIDE HEALTH BENEFITS 6 3 52 0 0 0 0 0 27449089 28019352 725589 341873 50109 25059 28224787 28386284 0 0 31120908 24548491 4726283 4572555 0 0 0 2002676 2025088 37849867 31146134 -9625080 -2759850 23592511 20576817 1140701 811358 22451810 19765459 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 1 513 0 1 52 1 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 1 0 0 X DAVID MINEAU 8473847000 9801 WEST HIGGINS ROAD SUITE 500 ROSEMONT IL 60018 BRIAN JORDAN TRUSTEE 3.00 X 0 0 0 KEVIN J BECKERLE TRUSTEE 3.00 X 0 0 0 DEREK KINNEY TRUSTEE 3.00 X 0 0 0 KENNETH R BOYD TRUSTEE 3.00 55.00 X 0 187068 23450 STEVEN M POWELL TRUSTEE 3.00 40.00 X 0 247188 21765 KENNETH URZEDOWSKI TRUSTEE 3.00 45.00 X 0 165169 21752 ROBERT NIKSA ADMINISTRATOR 40.00 X 144132 0 38026 DAVID MINEAU FINANCE DIRECTOR 40.00 X 103029 0 21329 NANCY MAIZE PENSION DIRECTOR 40.00 X 104592 0 35827 CHRISTINE KLUK CAPONIGRI HEALTH INFORMATION SERVICES DIRECTOR 40.00 X 105383 0 38029 457136 599425 200178 4 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 1201600 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER STE 4000 CHICAGO IL 60606 AUDITOR 197796 MEDICAL INSURANCE CONSULTING GROUP INC 4949 N WESTERN AVENUE CHICAGO IL 60625 MEDICAL CONSULTANT 159986 THE SEGAL COMPANY 101 N WACKER DR SUITE 500 CHICAGO IL 60606 ACTUARY 140000 WELLDYNE 7472 S TUCSON WAY 100 ENGLEWOOD CO 80112 PHARMACY BENEFIT MANAGER 125049 5 EMPLOYER CONTRIBUTIONS 900099 25307043 25307043 REIMB EXP UFCW MW PENSION 900099 2112778 2112778 REIMB EXPS UFCW CALUMET FUND 900099 319215 319215 PARTICIPANT CONTRIBUTIONS 900099 140947 140947 PRESCRIPTION DRUG REBATES 900099 129919 129919 9450 9450 28019352 429266 429266 10796882 10884275 -87393 -87393 -87393 MISCELLANEOUS INCOME 900099 25059 25059 25059 28386284 28019352 0 366932 24548491 160769 2888086 539160 721492 263048 250042 84455 60606 289263 172131 179787 396466 25389 196174 251356 WEB CLAIMS SERVICE FEE 47628 STORAGE OF DOCUMENTS 34742 OTHER PERSONNEL COSTS 28586 FEES MANDATED BY ACA 8463 31146134 350482 496611 1365561 1871607 2253666 2237667 97361 128989 629026 424507 256683 204519 19268758 15637424 23592511 20576817 622238 259243 518463 552115 1140701 811358 X 0 0 0 0 22451810 19765459 22451810 19765459 23592511 20576817 -2759850 73499 0 X 0 1 X 1 0 629026 424507 204519 204519 DUE TO PARTICIPANTS OF DEFERRED COMPENSATION PLANS 236683 DEFERRED LEASE INCENTIVE 299369 DUE TO BROKER - PENDING INVESTMENT TRADES 16063 552115 X 26276949 73499 73499 26203450 60606 2122228 2182834 28386284 28963300 0 28963300 60606 2122228 2182834 31146134 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 PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. PART XI, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,112,778. REIMBURSED ADMIN EXPENSE - UFCW STAFF PENSION FUND 9,450. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,112,778. REIMBURSED ADMIN EXPENSE - UFCW STAFF PENSION FUND 9,450. X 0 1 0 KENNETH R BOYD TRUSTEE 0 187068 0 0 0 0 0 8583 0 14867 0 210518 0 0 STEVEN M POWELL TRUSTEE 0 201487 0 7618 0 38083 0 3060 0 18705 0 268953 0 0 KENNETH URZEDOWSKI TRUSTEE 0 165169 0 0 0 0 0 8145 0 13607 0 186921 0 0 ROBERT NIKSA ADMINISTRATOR 144132 0 0 0 0 0 27993 0 10033 0 182158 0 0 0 FORM 990, SCHEDULE J, PART II, COLUMN C RETIREMENT AND OTHER DEFERRED COMPENSATION INCLUDES THE INCREASE IN THE PRESENT VALUE OF A DEFINED BENEFIT PENSION PLAN FOR ROBERT NIKSA, NANCY MAIZE, CHRISTINE KLUK CAPONIGRI AND DAVID MINEAU AS DETERMINED BY THE FUND'S ACTUARY. FORM 990, SCHEDULE J, PART II, COLUMN D NON-TAXABLE BENEFITS INCLUDE THE VALUE OF HEALTH AND WELFARE PREMIUMS PAID ON BEHALF OF THE INDIVIDUAL. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN DOES NOT HAVE ANY SEPARATE COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR REVIEW AND APPROVAL BEFORE IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION B, LINE 15A SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE FUND OFFICE. UNITED FOOD & COMMERICAL WORKERS & EMPRS MIDWEST PENSION FUND 9801 WEST HIGGINS ROAD ROSEMONT IL 60018 366508328 RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 501(A) N/A 0 UNITED FOOD & COMMERICAL WORKERS LOCAL 881 CONTRIBUTING EMPLOYER 0 UNITED FOOD & COMMERICAL WORKERS LOCAL 1546 CONTRIBUTING EMPLOYER 0 UNITED FOOD & COMMERCIAL WORKERS LOCAL 536 CONTRIBUTING EMPLOYER 0 UNITED STEEL WORKERS OF AMERICA LOCAL 6787 CONTRIBUTING EMPLOYER 0 A & G LAUNDROMAT CONTRIBUTING EMPLOYER 0 ANICHINI BROS INC CONTRIBUTING EMPLOYER 0 ANTON'S FRUIT RANCH CONTRIBUTING EMPLOYER 0 APPLE MARKET CONTRIBUTING EMPLOYER 0 ARAMARK UNIFORM SERVICES CONTRIBUTING EMPLOYER 0 ARLINGTON GOURMET MARKET CONTRIBUTING EMPLOYER 0 ASCOT MEATS INC CONTRIBUTING EMPLOYER 0 ASHMANN PRESCRIPTIONS CONTRIBUTING EMPLOYER 0 ATHENA SCHOOL CONTRIBUTING EMPLOYER 0 BAJA SERVICES CONTRIBUTING EMPLOYER 0 BLUE GOOSE STORE CONTRIBUTING EMPLOYER 0 BUEDEL'S FOOD PRODUCTS CONTRIBUTING EMPLOYER 0 BUNGE FOODS CONTRIBUTING EMPLOYER 0 C & F PACKING CO CONTRIBUTING EMPLOYER 0 CP MEAT MARKET CONTRIBUTING EMPLOYER 0 CERTIFIED WAREHOUSE FOODS CONTRIBUTING EMPLOYER 0 CHASE UNIVERSAL SRVCS INC CONTRIBUTING EMPLOYER 0 CHIPAIN'S FINER FOODS CONTRIBUTING EMPLOYER 0 CONSUMER'S PACKING CONTRIBUTING EMPLOYER 0 D & D FINER FOODS CONTRIBUTING EMPLOYER 0 D & S INC CONTRIBUTING EMPLOYER 0 D & S MEAT MARKET CONTRIBUTING EMPLOYER 0 DARLING INTERNATIONAL INC CONTRIBUTING EMPLOYER 0 DE VRIES MEAT MARKET CONTRIBUTING EMPLOYER 0 DISCOUNT MEATS CONTRIBUTING EMPLOYER 0 DOMANI CNSTRCTN & DVLPMNT INC CONTRIBUTING EMPLOYER 0 ER SMITH ENTERPRISESINC CONTRIBUTING EMPLOYER 0 EGYPTIAN STATIONERS INC CONTRIBUTING EMPLOYER 0 ELEGANCE IN MEATS INC CONTRIBUTING EMPLOYER 0 EX-CEL CORNED BEEF INC CONTRIBUTING EMPLOYER 0 FARMER'S MARKET INC CONTRIBUTING EMPLOYER 0 FELICIA'S CONTRIBUTING EMPLOYER 0 FRESH LINE FOODS CONTRIBUTING EMPLOYER 0 GENE'S TIRE SERVICE INC CONTRIBUTING EMPLOYER 0 GEPPERTH'S MARKET CONTRIBUTING EMPLOYER 0 GLENVIEW GOURMET MEATS CONTRIBUTING EMPLOYER 0 GREAT WESTERN BEEF CONTRIBUTING EMPLOYER 0 HADDAD'S MARKET CONTRIBUTING EMPLOYER 0 HAPPY FOODS INC CONTRIBUTING EMPLOYER 0 HARI LLC CONTRIBUTING EMPLOYER 0 HOLZKOPF'S MEAT CONTRIBUTING EMPLOYER 0 HOME FURNITURE LLC CONTRIBUTING EMPLOYER 0 HONEY BAKED HAM CONTRIBUTING EMPLOYER 0 ILL FD RET ASSN CONTRIBUTING EMPLOYER 0 INTERNATIONAL MEAT CO INC CONTRIBUTING EMPLOYER 0 JT AMUSEMENTS LTD CONTRIBUTING EMPLOYER 0 JACK & PAT'S CERT INC CONTRIBUTING EMPLOYER 0 JERRY'S QUALITY MEATS CONTRIBUTING EMPLOYER 0 JOHNNY G'S QUALITY MEATS CONTRIBUTING EMPLOYER 0 KINGDOM FARMS CONTRIBUTING EMPLOYER 0 KRAMER FOODS CONTRIBUTING EMPLOYER 0 LAKE AREA UNITED WAY CONTRIBUTING EMPLOYER 0 LEGACY HEALTHCARE CONTRIBUTING EMPLOYER 0 MARCO CONSULTING GROUP CONTRIBUTING EMPLOYER 0 MIKE'S MEAT MARKET CONTRIBUTING EMPLOYER 0 MILLER GROCERY MARKET LLC CONTRIBUTING EMPLOYER 0 MINELLI DELI & MEATS CONTRIBUTING EMPLOYER 0 MR BEEF CONTRIBUTING EMPLOYER 0 MR CKGK INC CONTRIBUTING EMPLOYER 0 MURPHY & ASSOCIATES LTD CONTRIBUTING EMPLOYER 0 NORTHWESTERN INDIANA CONTRIBUTING EMPLOYER 0 ONE STOP FOOD & LIQUORS CONTRIBUTING EMPLOYER 0 ONE STOP PACEMAKER CONTRIBUTING EMPLOYER 0 ORCHARD PRIME MEATS CONTRIBUTING EMPLOYER 0 P & V CATERING CONTRIBUTING EMPLOYER 0 PARAMOUNT TRUCK BODY CONTRIBUTING EMPLOYER 0 PARKSHORE MARKET LTD CONTRIBUTING EMPLOYER 0 PAULINA MARKET CONTRIBUTING EMPLOYER 0 PERSONAL CHEF SERVICES CONTRIBUTING EMPLOYER 0 PIATAK MEATS CONTRIBUTING EMPLOYER 0 POTASH BROTHERS CONTRIBUTING EMPLOYER 0 PRIME'N TENDER MEATS CONTRIBUTING EMPLOYER 0 RABER PACKING CO CONTRIBUTING EMPLOYER 0 RIVERSIDE FOODS CONTRIBUTING EMPLOYER 0 ROIN'S PRODUCE CONTRIBUTING EMPLOYER 0 RUSSO WHOLESALE CONTRIBUTING EMPLOYER 0 SNN INC CONTRIBUTING EMPLOYER 0 SAURO & ASSOC INC CONTRIBUTING EMPLOYER 0 SCHWEGEL'S MARKET CONTRIBUTING EMPLOYER 0 SHOELESS JOE'S CONTRIBUTING EMPLOYER 0 STEINBACH MEATS CONTRIBUTING EMPLOYER 0 STRACK-ULTRA CONTRIBUTING EMPLOYER 0 SUNSET FOOD MART CONTRIBUTING EMPLOYER 0 SUPERVALU CONTRIBUTING EMPLOYER 0 TED'S AUTO CLINIC CONTRIBUTING EMPLOYER 0 THE KROGER COMPANY CONTRIBUTING EMPLOYER 0 TRANSPORT PRODUCTION SYSTEMS CONTRIBUTING EMPLOYER 0 TREASURE ISLAND CONTRIBUTING EMPLOYER 0 TRISTATE SECURITY OF AMERICA CONTRIBUTING EMPLOYER 0 WELCH'S STOP & SHOP CONTRIBUTING EMPLOYER 0 WHEATON MEAT CO CONTRIBUTING EMPLOYER 0 WINSTON'S SAUSAGE CONTRIBUTING EMPLOYER 0 YESTER YEARS MEAT SHOPPE CONTRIBUTING EMPLOYER 0 ZENITH AMERICAN SOLUTIONS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND N 417382 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND O 1695396 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND Q 2248395