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UNITED FOOD & COMM WORKERS INTL UNION & EMP INSURANCE FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
UNITED FOOD & COMM WORKERS INTL UNION & EMP INSURANCE FUND (EIN 35-1065816)
Tax period
2012-12-01 to 2013-11-30
Filed
2014-03-05
IRS object ID
201440649349300014
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-03-05T09:43:48-06:00Timestamp
Tax Period End Date2013-11-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN320043599EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LEGACY PROFESSIONALS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1311 S WACKER DRIVE STE 4000AddressLine1
CityCHICAGOCity
StateILState
ZIP Code60606ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-12-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351065816EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNITED FOOD & COMM WORKERSBusinessNameLine1
Business Name Line2CALUMET REGION INSURANCE FUNDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUNITNameControl
Phone8473847000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line19801 WEST HIGGINS ROAD NO 500AddressLine1
CityROSEMONTCity
StateILState
ZIP Code60018ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAN RYANName
TitleFUND ADMINISTRATORTitle
Phone8473847000Phone
Date Signed2014-03-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBRUCE A PAVLIKName
PTINP00748405PTIN
Phone3123680500Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonDAN RYANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line19801 WEST HIGGINS ROAD NO 500AddressLine1
CityROSEMONTCity
StateILState
ZIP Code60018ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12496153GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1960YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionPROVIDE HEALTH BENEFITSActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7907931ProgramServiceRevenuePriorYear
Program Service Revenue CY7453334ProgramServiceRevenueCY
Investment Income Prior Year316715InvestmentIncomePriorYear
Investment Income Current Year166681InvestmentIncomeCurrentYear
Other Revenue Prior Year71OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year8224717TotalRevenuePriorYear
Total Revenue Current Year7620015TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year7371197BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY7590065BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year459194OtherExpensePriorYear
Other Expenses Current Year488137OtherExpensesCurrentYear
Total Expenses Prior Year7830391TotalExpensesPriorYear
Total Expenses Current Year8078202TotalExpensesCurrentYear
Revenues Less Expenses Prior Year394326RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-458187RevenuesLessExpensesCY
Total Assets BOY10596171TotalAssetsBOY
Total Assets EOY10645896TotalAssetsEOY
Total Liabilities BOY56135TotalLiabilitiesBOY
Total Liabilities EOY28627TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10540036NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10617269NetAssetsOrFundBalancesEOY
Mission DescriptionPROVIDE HEALTH BENEFITSMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO PROVIDE HEALTH AND WELFARE, DEATH, AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND/OR THEIR DEPENDENTS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109619NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement0RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAN RYANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8473847000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line19801 WEST HIGGINS ROADAddressLine1
CityROSEMONTCity
StateILState
ZIP Code60018ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
STEVEN POWELL
TRUSTEE3.00X000
SAMUEL VAN TIL
TRUSTEE3.00X000
LISA CATANZARO
TRUSTEE3.00X000
JEFFREY STRACK
TRUSTEE3.00X000
HARRY GROW
TRUSTEE - ALTERNATE3.00X000
DAVID WILKINSON
TRUSTEE - ALTERNATE3.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BLUE CROSS BLUE SHIELDBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1300 EAST RANDOLPH STAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60601ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesPPO PROVIDERDescriptionOfServices
Compensation436038Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS90009972125247212524
STOP LOSS & REINSURANCE900099179430179430
PARTICIPANT CONTRIBUTIONS9000996138061380
FieldValueIRS element (for citing)
Total Program Service Revenue7453334TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column264321TotalRevenueColumn
Exclusion$264,321ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4778498Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities4876138Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-97640Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-97640TotalRevenueColumn
Exclusion-$97,640ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7620015TotalRevenueColumn
Related Or Exempt Function Income7453334RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$166,681ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total7590065Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total270077Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5006Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total53341Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total54259Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total68728Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9971Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total9814Total

Insurance Insurance

FieldValueIRS element (for citing)
Total8979Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
WEB CLAIMS SERVICE FEE5292
MISCELLANEOUS2670

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8078202Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY330378BOY
EOY63732EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY704712BOY
EOY427017EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY263975BOY
EOY211133EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY39570BOY
EOY41906EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY9203669BOY
EOY9853843EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY53867BOY
EOY48265EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10596171BOY
EOY10645896EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY38539BOY
EOY28627EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY17596BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY56135BOY
EOY28627EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY10540036BOY
EOY10617269EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10540036BOY
EOY10617269EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10596171BOY
EOY10645896EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-458187ReconcilationRevenueExpenses
Reconciliation Unrealized Invest535420ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt8101176TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments535420NetUnrealizedGainsInvestments
Revenue Not Rptd F990535420RevenueNotRptdF990
Revenue Subtotal7565756RevenueSubtotal
Investment Expenses Not Included54259InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt54259RevenueNotRptdOnFinStmt
Total Revenue Per Form9907620015TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8023943TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal8023943ExpensesSubtotal
Investment Expenses Not Included254259InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt54259ExpensesNotRptdOnFinStmt
Total Expenses Per Form9908078202TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationTHE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 3THE PLAN IS ADMINISTERED AND MANAGED BY THE UNITED FOOD AND COMMERCIAL WORKERS UNION AND EMPLOYERS (UFCW) MIDWEST HEALTH BENEFITS FUND. THE PLAN REIMBURSES THE UFCW MIDWEST HEALTH BENEFITS FUND FOR CERTAIN COMMON ADMINISTRATIVE EXPENSES BASED ON A PER MEMBER FEE AGREEMENT.
FORM 990, PART VI, SECTION A, LINE 8BTHE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY (TRUSTEES).
FORM 990, PART VI, SECTION B, LINE 11THE COMPLETED FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES. ONCE THE FORM IS REVIEWED AND APPROVED, IT IS SIGNED AND FILED.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE FUND OFFICE.

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)

Primary ActivityPrimaryActivityControlled OrgControlledOrg
STRACK-ULTRA LLC
CONTRIBUTING EMPLOYER0
WISE WAY SUPER CENTERS LLC
CONTRIBUTING EMPLOYER0
MILLER GROCER MARKET LLC
CONTRIBUTING EMPLOYER0
LAKE COUNTY NURSING INC
CONTRIBUTING EMPLOYER0
HAPPY FOODS INC
CONTRIBUTING EMPLOYER0
CENTRAL MARKET
CONTRIBUTING EMPLOYER0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg