2014-10-07T12:11:20-05:00 2013-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2013-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 6142377618 4150 EAST MAIN STREET COLUMBUS OH 43213 PAUL SMITHBERGER TRUSTEE 6142377618 2014-10-07 1 THOMAS M POWERS CPA P00241729 2627846210 2013 2015-11-30 17:44:51Z RANDY QUICKEL 4150 EAST MAIN STREET COLUMBUS OH 43213 100540411 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 15 0 0 0 0 0 56602259 58563064 587444 552481 0 0 57189703 59115545 0 0 48212915 49948907 793026 773076 0 0 0 2926939 3351525 51932880 54073508 5256823 5042037 33651156 39101391 1740538 2684771 31910618 36416620 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 52124414 BENEFITS PAID TO OR FOR MEMBERS CONSIST OF ACCIDENT, HEALTH, DENTAL, LOSS OF TIME, VISION CARE, PRESCRIPTION DRUG AND LIFE. ALSO INCLUDED ARE THE RELATED ADMINISTRATION FEES CHARGED BY THE BENEFIT PROVIDERS AND COST CONTROLS. 52124414 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 75 0 1 15 1 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 0 0 X DAVE MCALLISTER 6142377618 4150 E MAIN ST COLUMBUS OH 43213 RANDY QUICKEL CHAIRMAN 2.00 45.00 X X 0 124740 20164 STEVE LOEFFLER SECRETARY 2.00 X X 0 0 0 JESSICA MILES TRUSTEE 2.00 X 0 0 0 DOUG WHITNEY TRUSTEE 2.00 X 0 0 0 PAUL SMITHBERGER TRUSTEE 2.00 45.00 X 0 99900 18354 MARK FLUHARTY TRUSTEE 2.00 45.00 X 0 110240 19815 0 334880 58333 0 0 0 0 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 310578 HEALTH SERVICE REVIEW OF OHIO INC 6730 ROOSEVELT FRANKLIN OH 45005 MEDICAL CASE MANAGEMENT 194340 BENESYS INC 700 TOWER DRIVE SUITE 300 TROY MI 480982808 IT 158895 BUCK CONSULTANTS LLC 485 LEXINGTON AVENUE NEW YORK NY 10017 CONSULTANT 142371 MEDEXPERT INTERNATIONAL INC 2688 MIDDLEFIELD ROAD REDWOOD CITY CA 94063 DISEASE MANAGEMENT 132376 6 EMPLOYER CONTRIBUTIONS 900099 57844301 57844301 SELF-PAYMENT CONTRIBUTI 900099 718763 718763 58563064 545204 545204 41432143 41424866 7277 7277 7277 59115545 58563064 0 552481 49948907 486478 27343 218888 40367 361653 32200 35004 183414 280683 174639 42884 14742 13021 21699 ACCIDENT, HEALTH AND DE 1730356 MEDICAL REVIEW SERVICES 256709 DISEASE MANAGEMENT PREM 132376 VISION CARE FEES 56066 16079 54073508 3283186 8071636 874392 135914 532077 1200414 26137 34164 333668 321989 26709 11679 28908655 29647584 33651156 39101391 801506 1720642 3032 1129 936000 963000 1740538 2684771 X 0 0 0 0 31910618 36416620 31910618 36416620 33651156 39101391 5042037 -536035 0 X X 0 1 X 1 0 333668 321989 11679 11679 CLAIMS PAYABLE 963000 963000 X 58544506 -536035 -536035 59080541 35004 35004 59115545 54011504 0 54011504 35004 27000 62004 54073508 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; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX YEARS IN PROGRESS. PLAN MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CURRENT YEAR INCREASE IN CLAIMS PAYABLE 27,000. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 GOES THROUGH A PRELIMINARY REVIEW BY THE ADMINISTRATIVE MANAGER AND DIRECTOR OF FINANCE. 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 CHAIRMAN OF THE BOARD OF TRUSTEES EVALUATES THE ADMINISTRATIVE MANAGER AND DETERMINES 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 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 STATEMENT. 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 2 SOLE PROPRIETORS AS CONTRIBUTING EMPLOYERS DURING 2013. UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 4150 E MAIN STREET COLUMBUS OH 43213 314392482 LABOR UNION OH 501(C)(5) N/A 0 BOARD OF TRUSTEES OF THE UFCW UNIONS AND EMPLOYERS H&W PLAN OF CENTRAL OHIO 4150 E MAIN STREET COLUMBUS OH 43213 310656412 PLAN SPONSOR AND PLAN ADMINISTRATOR OH 501(C)(9) N/A 0 CVSCAREMARK GREAT SCOT INC THE KROGER CO 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 K 66128 FAIR MARKET VALUE UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 P 2938 ACTUAL EXPENSE REIMBURSEMENT