2015-03-03T09:32:21-06:00 2014-05-31 341087273 LublinSussman Group 3166 N Republic Blvd Toledo OH 43615 990 2013-06-01 344442536 Union Construction Workers Health Plan UNIO 4192482401 P O Box 1330 Holland OH 43528 Donald Huss Chairman 4192482401 2015-02-14 1 Lee D Wunschel P00088726 4198412848 2013 2016-03-07 17:11:31Z Brian Outland P O Box 1330 Holland OH 43528 42303595 0 X N/A The fund provides health benefits for eligible members of the construction trade unions covered by the fund. 10 10 0 0 0 0 0 0 19651985 19626221 1461227 1415594 12976 10220 21126188 21052035 0 0 20725228 21283637 0 0 0 0 0 1814775 1591464 22540003 22875101 -1413815 -1823066 46465060 47954637 13088896 15472891 33376164 32481746 The fund provides health benefits for eligible members of the construction trade unions covered by the fund. 0 0 22875101 The fund provides health benefits for eligible members of the construction trade unions covered by the fund. 22875101 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 0 0 0 1 480 0 1 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Nicholas C Madden 4192482401 7142 Nightingale Drive Suite 1 Holland OH 43528 X John Schlagheck Trustee 0.00 0.00 X 0 0 0 James Nicholson Secretary 0.00 0.00 X X 0 0 0 Greg Myers Trustee 0.00 0.00 X 0 0 0 Kevin Smith Trustee 0.00 0.00 X 0 0 0 Brian Seeger Trustee 0.00 0.00 X 0 0 0 Ken Gabel Trustee 0.00 0.00 X 0 0 0 Joseph Blaze III Trustee 0.00 0.00 X 0 0 0 Brian Outland Trustee 0.00 0.00 X 0 0 0 Michael Kujawa Trustee 0.00 0.00 X 0 0 0 Donald Huss Chairman 0.00 0.00 X X 0 0 0 0 0 0 0 0 0 0 Northwestern Ohio Administrators 7142 Nightingale Dr Suite 1 Holland OH 43528 Administrative Mgr 1194437 Vision Service Plan PO Box 60000 San Francisco CA 94160 Vision Insurance 167398 Aetna PO Box 70944 Chicago IL 60673 Health Care Provider 154156 Shumaker Loop & Kendrick 1000 Jackson Street Toledo OH 43604 Attorney 108129 4 Contributions 19626221 19626221 19626221 1553586 1553586 21113568 21251560 -137992 -137992 -137992 Liquidated Damages 10220 10220 10220 21052035 19498449 0 1553586 21283637 21283637 108535 108535 42667 42667 8655 8655 9222 9222 Administrative Expenses 1170070 1170070 Custodial Trust Fees 114064 114064 Consultant 78264 78264 Miscellaneous 32362 32362 27625 27625 22875101 22875101 0 0 1398353 3351583 1891554 2241433 2937823 3574418 39997622 38540891 239708 246312 46465060 47954637 375756 489001 12713140 14983890 13088896 15472891 X 33376164 32481746 33376164 32481746 46465060 47954637 -1823066 928648 0 X 0 1 X 1 0 0 IBNR 3729000 Reserve for Extended Eligibility 11254890 14983890 X 21866616 928644 928644 20937972 114064 114064 21052036 20490284 0 20490284 114064 2270753 2384817 22875101 Part X, Line 2: The Plan has determined that there are no uncertain tax positions that require disclosure in these financial statements under the FASB Accounting Standards Codification topic, Income Taxes. The tax years 2009 through 2013 are subject to possible examination by the Internal Revenue Service. Part XII, Line 4b - Other Adjustments: Change in Estimated Future Benefits Change - Estimated Unpaid Claims Incurred Form 990, Part VI, Section B, line 11 Each trustee is provided with a copy of the Form 990 either at a Board meeting or via mail or email for their review and approval prior to the filing of the form. Form 990, Part VI, Section B, line 12c The plan administrator and attorney follow up with each trustee to ensure that each completes the annual conflict of interest disclosure. Form 990, Part VI, Section C, line 19 All governing documents, policies and financial statements are available upon request to Northwestern Ohio Administrators, Inc., the plan administrator.