2014-09-19T14:37:14-05:00 2013-11-30 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2012-12-01 390979166 UNITED FOOD & COMMERICAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN UNIT 4144761220 3333 NORTH MAYFAIR ROAD NO 201 WAUWATOSA WI 53222 JOHN EIDEN 4144761220 2014-09-10 1 JAMES M ASHLAND CPA P00241858 2627846210 2012 2015-11-30 17:44:51Z X JOHN EIDEN 2001 N MAYFAIR RD MILWAUKEE WI 53226 4493255 0 X N/A X 1960 WI TO PROVIDE ELIGIBLE PARTICIPANTS ADDICENT, HEALTH, VISION, DENTAL, PRESCRIPTION DRUGS, LIFE INSURANCE, LOSS OF TIME, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS. 6 0 0 0 0 0 0 0 5702401 4492255 0 0 19936 1000 5722337 4493255 0 0 5105016 3768977 0 0 0 0 0 674386 571087 5779402 4340064 -57065 153191 4246933 4373011 584191 557078 3662742 3815933 TO PROVIDE ELIGIBLE PARTICIPANTS ADDICENT, HEALTH, VISION, DENTAL, PRESCRIPTION DRUGS, LIFE INSURANCE, LOSS OF TIME, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS. 0 0 3184665 ACCIDENT, HEALTH, LOSS-OF-TIME, DENTAL, VISION CARE BENEFIT PAYMENTS TO OR ON BEHALF OF PARTICIPANTS. ALSO INCLUDED ARE THE RELATED ADMINISTRATION FEES CHARGED BY THE BENEFIT PROVIDERS AND COST CONTROLS. 713769 PRESCRIPTION DRUG PROGRAM BENEFITS PAID ON BEHALF OF PARTICIPANTS. 10000 LIFE INSURANCE BENEFITS PAID ON BEHALF OF PARTICIPANTS. 3908434 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 ROAD SUITE 201 WAUWATOSA WI 53222 JOHN EIDEN 1.00 40.00 X X 0 115188 15609 GRANT WITHERS 1.00 40.00 X 0 104944 15609 PAUL BUTERA 1.00 X 0 0 0 MARK CULOTTA 1.00 40.00 X 0 86519 15609 CHAD WHITESIDE 1.00 40.00 X 0 87884 15609 DARREN HORNDASCH 1.00 X X 0 0 0 PAUL BUTERA JR 1.00 X 0 0 0 0 394535 62436 0 0 0 0 ZENITH AMERICAN SOLUTIONS 3333 NORTH MAYFAIR ROAD SUITE 201 WAUWATOSA WI 53222 ADMINISTRATION 248000 BLUE CROSS BLUE SHIELD OF WISCONSIN PO BOX 951254 CLEVELAND OH 44193 CLAIMS PROCESSING 111638 2 EMPLOYER CONTRIBUTIONS 525100 4437445 4437445 SELF-PAY CONTRIBUTIONS 525100 54810 54810 4492255 WITHDRAWAL LIABILITY 525100 1000 1000 1000 4493255 4493255 0 0 3768977 248000 55586 23300 60730 7216 547 11226 CLAIMS ADMIN FEES 111638 COST CONTAINMENT PROGRA 25925 BANK SERVICE FEES 10954 POSTAGE 8363 7602 4340064 4131421 4289317 77747 73746 37765 9948 4246933 4373011 214191 221978 370000 335100 584191 557078 X 0 0 0 0 3662742 3815933 3662742 3815933 4246933 4373011 153191 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE 335100 335100 X 4493255 0 4493255 0 4493255 4374964 0 4374964 -34900 -34900 4340064 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN CURRENT YEAR CLAIMS PAYABLE -34,900. FORM 990, PART VI, SECTION A, LINE 2 PAUL 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. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII JOHN EIDEN - 2001 NORTH MAYFAIR ROAD, MILWAUKEE, WI 53226. GRANT WITHERS - 2001 NORTH MAYFAIR ROAD, MILWAUKEE, WI 53226. PAUL BUTERA - 1 CLOCK TOWER PLAZA, ELGIN, IL 60120. MARK CULOTTA - 2001 NORTH MAYFAIR ROAD, MILWAUKEE, WI 53226. CHAD WHITESIDE - 1602 S PARK ST. SUITE 103, MADISON, WI 53715. DARREN HORNDASCH - 16800 W. CLEVELAND AVENUE, NEW BERLIN, WI 53151. PAUL BUTERA, JR. - 1 CLOCK TOWER PLAZA, ELGIN, IL 60120. 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, 2013. 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 RICK & VICS FOODS INC LBC OPTICS INC WISCONSIN VISION INC METCALFE INC METCALFE FOODS - TOSA INC CONSOLIDATED ELECTRICAL DISTRIBUTORS INC SUPERVALU INC L AND M MEATS INC RUEBEN'S COUNTY MARKET INC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0