2015-09-15T13:22:09-05:00 2014-11-30 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2013-12-01 390979166 UNITED FOOD & COMMERICAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN UNIT 4144761220 3333 N MAYFAIR ROAD NO 201 MILWAUKEE WI 53222 JOHN EIDEN CHAIRMAN 4144761220 2015-09-03 1 JAMES M ASHLAND CPA P00241858 2627846210 2013 2016-02-25 16:41:14Z JOHN EIDEN 2001 N MAYFAIR RD MILWAUKEE WI 53226 3534948 0 X N/A X 1960 WI HEALTH PLAN 6 0 0 0 0 0 0 0 4492255 3532943 0 0 1000 2005 4493255 3534948 0 0 3768977 3852334 0 0 0 0 0 571087 608077 4340064 4460411 153191 -925463 4373011 3642820 557078 752350 3815933 2890470 TO PROVIDE ELIGIBLE PARTICIPANTS ADDICENT, HEALTH, VISION, DENTAL, PRESCRIPTION DRUGS, LIFE INSURANCE, LOSS OF TIME, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS. 0 0 3446963 ACCIDENT, HEALTH, LOSS-OF-TIME, DENTAL, LIFE, VISION CARE BENEFIT PAYMENTS TO PARTICIPANTS. 605597 PRESCRIPTION DRUG PROGRAM BENEFITS PAID ON BEHALF OF PARTICIPANTS. 20000 LIFE INSURANCE BENEFITS PAID ON BEHALF OF PARTICIPANTS. 4072560 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 2 0 1 0 0 0 0 0 0 0 X 6 0 1 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 4144761220 3333 N MAYFAIR RPAD SUITE 201 MILWAUKEE WI 53222 JOHN EIDEN CHAIRMAN/UNION TRUSTEE 1.00 40.00 X X 0 117088 16282 GRANT WITHERS UNION TRUSTEE 1.00 40.00 X 0 107247 16282 PAUL BUTERA EMPLOYER TRUSTEE 1.00 X 0 0 0 PAUL BUTERA JR ALTERNATE EMPLOYER TRUSTEE 1.00 X 0 0 0 CHAD WHITESIDE ALTERNATE UNION TRUSTEE 1.00 40.00 X 0 90584 16282 DARREN HORNDASCH SECRETARY/EMPLOYER TRUSTEE 1.00 X X 0 0 0 JUDY BUTERA ALTERNATE EMPLOYER TRUSTEE 1.00 X 0 0 0 0 314919 48846 0 0 0 0 ZENITH AMERICAN SOLUTIONS 3333 NORTH MAYFAIR ROAD SUITE 201 WAUWATOSA WI 53222 ADMINISTRATION 248000 1 EMPLOYER CONTRIBUTIONS 525100 3448250 3448250 SELF-PAY CONTRIBUTIONS 525100 84693 84693 3532943 WITHDRAWAL LIABILITY 525100 2005 2005 2005 3534948 3534948 0 0 3852334 248000 26710 29400 47230 2686 407 10889 STOP-LOSS PREMIUMS 108595 ACCIDENT, HEALTH, AND D 88325 COST CONTAINMENT PROGRA 20791 BANK SERVICE FEES 12404 12640 4460411 4289317 3430771 73746 206720 9948 5329 4373011 3642820 221978 531424 335100 220926 557078 752350 X 0 0 0 0 3815933 2890470 3815933 2890470 4373011 3642820 -925463 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE 220926 220926 X 3534948 0 3534948 0 3534948 4574585 0 4574585 -114174 -114174 4460411 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. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO NOVEMBER 30, 2011. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN CURRENT YEAR CLAIMS PAYABLE -114,174. FORM 990, PART VI, SECTION A, LINE 2 PAUL BUTERA, JUDY BUTERA, AND PAUL BUTERA JR. HAVE A FAMILY RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11 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 JOHN EIDEN - 2001 N. MAYFAIR ROAD, MILWAUKEE, WI 53226. GRANT WITHERS - 2001 N. MAYFAIR ROAD, MILWAUKEE, WI 53226. PAUL BUTERA - ONE CLOCK TOWER PLAZA, ELGIN, IL 60120. PAUL BUTERA JR. - 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. JUDY BUTERA - ONE CLOCK TOWER PLAZA, ELGIN, IL 60010. 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. 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 ONE SOLE PROPREITOR AS A CONTRIBUTING EMPLOYER FOR THE FISCAL YEAR ENDING NOVEMBER 30, 2014. 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 3333 NORTH MAYFAIR ROAD SUITE 201 WAUWATOSA WI 53222 390979166 PLAN SPONSOR AND PLAN ADMINISTRATOR WI 501(C)(9) N/A 0 BKT ENTERPRISES INC OFFICE SOLUTIONS - USA INC UNION FIRST LASER TECHNOLOGIES INC STINEBRINK'S LAKE GENEVA FOODS LLC PIGGLY WIGGLY MIDWEST LLC SUPERIOR NATIONAL BANK & TRUST COMPANY METCALFE INC METCALFE FOODS - TOSA INC L AND M MEATS INC RUEBEN'S COUNTY MARKET INC SUPERVALU INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0