2015-10-27T11:56:52-05:00 2014-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2014-01-01 316041107 HEARTLAND HEALTH & WELLNESS FUND HEAR 9376651900 7250 POE AVENUE NO 300 DAYTON OH 45414 JOE CHORPENNING SECRETARY 9376651900 2015-10-21 1 THOMAS M POWERS CPA P00241729 2627846210 2014 2016-02-25 16:41:14Z JOE CHORPENNING 7250 POE AVENUE NO 300 DAYTON OH 45414 160766355 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 36 0 0 0 0 0 112107951 104619203 1072869 2739448 262429 220283 113443249 107578934 0 0 104667022 122341417 1555125 1867865 0 0 0 7543455 10391943 113765602 134601225 -322353 -27022291 58785943 38283493 4723551 8937265 54062392 29346228 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 128244101 THE PLAN PROVIDES ACCIDENT, HEALTH, VISION, PRESCRIPTION, DENTAL, LIFE, AND DEATH BENEFITS TO ITS MEMBERS AND DEPENDENTS. 128244101 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 1 349 0 1 36 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 283771 29545 STEVE CULTER TRUSTEE 1.00 50.00 X 0 299169 31120 STEVE LOEFFLER CHAIRPERSON 1.00 X X 0 0 0 STEVE HENDRICKSON TRUSTEE 1.00 X 0 56723 0 KATHERINE LEV TRUSTEE 1.00 X 0 0 0 JOE CHORPENNING SECRETARY/TREASURER 1.00 X X 0 0 0 STEVE YANCEY TRUSTEE 1.00 X 0 0 0 JESSICA MILES TRUSTEE 1.00 X 0 0 0 JON MCPHERSON TRUSTEE 1.00 X 0 0 0 KATHY WAGENKNECHT TRUSTEE 1.00 X 0 0 0 OLENA MALECKYJ TRUSTEE 1.00 X 0 0 0 HENRY TAYLOR TRUSTEE 1.00 X 0 0 0 JERRY EVANS ADMINISTRATOR 40.00 X 116981 0 19721 116981 639663 80386 1 0 1 0 THE SEGAL COMPANY 101 NORTH WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARY 759686 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 490877 MEDEXPERT INTERNATIONAL INC 2688 MIDDLEFIELD RD REDWOOD CITY CA 94063 DISEASE MANAGEMENT 456829 EPLAN LLC 22601 N 19TH AVE SUITE 202 PHOENIX AZ 85027 CLAIMS REVIEW 452539 BASYS INC 857 ELKRIDGE LANDING 7TH FLOOR LINTHICUM MD 21090 COMPUTER CONSULTING 317754 7 EMPLOYER CONTRIBUTIONS 900099 103122769 103122769 SELF-PAYMENT CONTRIB. 900099 1496434 1496434 104619203 969134 969134 54957735 53187421 1770314 1770314 1770314 SHARED EXPENSE REIMBURSEMENT 900099 186321 186321 MISCELLANEOUS 900099 33962 33962 220283 107578934 104839486 0 2739448 122341417 122341417 1225148 1225148 87898 87898 450555 450555 104264 104264 461592 461592 69138 69138 58912 58912 697872 697872 715708 715708 367234 367234 117806 117806 57355 57355 17544 17544 47660 47660 PPO FEES AND MEDICAL RE 5738405 5738405 TRANSITIONAL REINSURANC 1660365 1660365 VISION SERVICE PLAN PRO 117332 117332 ADMINISTRATIVE EXPENSES 92500 92500 172520 46947 125573 134601225 128244101 6357124 0 13833 21544946 15830547 5806457 1072303 1027853 39105 33346 105969 76192 37104 29777 31247882 8839821 10545169 1001293 58785943 38283493 1940946 5133924 49905 23841 2732700 3779500 4723551 8937265 X 0 0 0 0 54062392 29346228 54062392 29346228 58785943 38283493 X -27022291 -1020484 3326611 X X 0 1 X 1 0 105969 76192 29777 29777 CLAIMS PAYABLE 3779500 3779500 X 106499538 -1020484 -1020484 107520022 58912 58912 107578934 133495513 0 133495513 58912 1046800 1105712 134601225 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: INCREASE IN CURRENT YEAR CLAIMS PAYABLE 1,046,800. X X 1 0 0 LENNIE WYATT TRUSTEE 0 179543 0 74751 0 29477 0 0 0 29545 0 313316 0 0 STEVE CULTER TRUSTEE 0 201304 0 65289 0 32576 0 0 0 31120 0 330289 0 0 PART I, LINE 4A PART I, LINE 4A: LENNIE WYATT, SEVERANCE PAYMENT FROM RELATED ORGANIZATION, $29,477 STEVE CULTER, SEVERANCE PAYMENT FROM RELATED ORGANIZATION, $32,576 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 3,326,611. 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 2014. 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. 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 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 GOOD SHEPHERD HOME HAMILTON COUNTY DEMOCRATIC PARTY HARBOR BEHAVIORAL HEALTH INT'L ASSOC OF MACHINISTS & AEROSPACE WORKERS LOCAL LODGE 1943 LUTHERAN HOMES SOCIETY INC CHAMPAIGN RESIDENTIAL SERVICES INC PLUMBERS & PIPEFITTERS LOCAL 162 APPRENTICESHIP TRAINING TR FUND UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 23 CONSOLIDATED HEALTHCARE SOLUTIONS LLC MAXWELL MEDICAL LLC SNYDER & GAST LLC EUGENE STEWART DBA SPECTRUM PRINTING & DESIGN SYNERGY HOLISTIC HEALTH CENTER LLC CUNDIFF TOWN & COUNTRY TREE SERV LLC KROEGER LIMITED PARTNERSHIP 1 LEONARD A BLEH LLC JAS ELECTRIC LLC WEBER DICKEY BELLMAN CLERMONTS BEST DRIVING ACADEMY LLC CREATIVE WALL SOLUTIONS MICHAEL P KELLY REALTY AGAPE INSTRUMENTS SERVICE INC AMERICAN BUSINESS TECHNOLOGIES RUBLE ARTISTIC FURNITURE RESTORATION INC AVI FOOD SYSTEMS INC BILLOW CONSTRUCTION INC JIM BITZENHOFER REFRIGERATION AND AC INC BLUE GRASS PROVISIONS BRUSH & LADDER PAINTING INC CHIEF SUPER MARKET INC COOK & LOGOTHETIS LLC DON CARTER & ASSOC INC DR ELLEN C TORBECK DMD PSC FROZEN SPECIALTIES INC GOERGE F MOELLER LPA GERTH MEATS G&G TRANSPORTATION SERVICE INC G&S DISTRIBUTING GREAT SCOT INC GR FEHR COMPANY INC FRANK L HARTER & SONS INC FOUNDATIONS HEALTH SOLUTIONS INC DBM & SONS INC INDUSTRIAL MECHANICAL CONTRACTORS INC JOHN J DUFFY & ASSOCIATES INC KIRCHER SUETHOLZ & GRAYSON CO LPA RON KLEI & SONS INC KUHL TILE & MARBLE INC LANGEN MEATS INC LEE WILLIAMS MEATS INC MANLEY BURKE LPA MICHAEL DAVIS-BARDEN CPA LLC RITE PRICE FOODS INC RUDOLPH FOODS COMPANY INC THE DOOR GROUP INC SEVEN HILLS COFFEE COMPANY SILGAN CAN COMPANY JOHN STEHLIN & SONS CO INC UNION EYE CARE DON VONDERHAAR'S MARKET & CATERING INC WASSLER MEATS INC THE GRANDMA CO WUNDERLAND INC BRIDGETOWN FINER MEATS INC SKYHAVEN FARMS INC THE KROGER CO ROMY'S PLUMBING INC BRENNAN INDUSTRIAL TRUCK CO GARY LORD WALL OPTIONS AND ASSOCIATES INC NEWMAN & MEEKS CO LPA SUGAR CREEK PACKING CO INNOVATIVE FOOD TECHNOLOGIES CVS PHARMACY INC ROBERT WHOLEY & CO INC BOROWIAKS IGA ROZIER'S CHESTER MARKET PLACE WE CARE FOOD STORES INC GRACE FOODS INC BAY VALLEY FOODS LLC 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 117806 FAIR MARKET VALUE UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL NO 75 P 63537 ACTUAL EXPENSE REIMBURSEMENTS