2014-11-05T08:44:01-06:00 2013-12-31 391423894 HARMANN & CROSSETT SC 6855 MARINER DRIVE RACINE WI 53406 990 2013-01-01 391604675 PIONEER PRODUCTS INC EMPLOYEE HEALTH & WELFARE TRUST PION 2626336304 1917 SOUTH MEMORIAL DRIVE RACINE WI 53403 VALERIE RATKOWSKI V PRES & CHIEF FINANCIAL OFFICER 2626336304 2014-11-03 1 W THOMAS HARMANN CPA P00176060 2628868660 2013 2015-11-30 17:44:51Z VALERIE RATKOWSKI 1917 S MEMORIAL DRIVE RACINE WI 53403 2240414 0 X N/A X 1988 WI THE ORGANIZATION IS CREATED TO PROVIDE FUNDS FOR THE PAYMENT OF HEALTH CARE BENEFITS TO EMPLOYEES OF PIONEER PRODUCTS, INC., U.S. COMPETITION ARMS, INC. AND TARGET ARMS, INC., ALL OF WHICH ARE WISCONSIN BUSINESS CORPORATIONS. BENEFITS TO BE PROVIDED INCLUDE GROUP LIFE INSURANCE, ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE, SHORT-TERM DISABILITY INCOME, DENTAL, VISION AND MEDICAL BENEFITS. ALL OF THESE BENEFITS ARE DESCRIBED IN THE "SUMMARY PLAN DESCRIPTION" DOCUMENTS OF THE ORGANIZATION. THE ORGANIZATION WILL PAY PREMIUMS FOR THE INSURED PORTION OF THE PLAN, AND WILL DELIVER PAYMENT DIRECTLY TO MEMBERS UNDER THE SELF-INSURED PORTION OF THE PLAN. 2 0 0 0 0 0 0 0 2850304 2240414 0 0 0 0 2850304 2240414 0 0 2850304 2240414 0 0 0 0 0 0 0 2850304 2240414 0 0 0 0 0 0 0 0 X THE COMPANY DESIRES TO PROMOTE HEALTH AND EFFICIENCY OF ITS EMPLOYEES. THE COMPANY FROM TIME TO TIME ADOPTS HEALTH CARE AND WELFARE PLANS FOR THE BENEFIT OF ITS EMPLOYEES. THE COMPANY DESIRES TO FUND THE BENEFITS PROVIDED FOR SUCH PLANS BY MEANS OF A VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION. 0 0 2240414 2240414 TO PROVIDE HEALTH CARE BENEFITS FOR THE COMPANY EMPLOYEES THROUGH A VOLUNTARY EMPLOYEE BENEFIT ASSOCIATION. 2240414 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 1 0 1 0 0 0 0 0 0 0 0 0 X 2 0 0 1 0 0 0 1 1 0 0 0 0 1 0 0 0 0 0 0 X PIONEER PRODUCTS INC 2626336304 1917 SOUTH MEMORIAL DRIVE RACINE WI 53403 X VALERIE RATKOWSKI TRUSTEE 1.00 X 0 0 0 DONALD MAINLAND TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 UNITED HEALTHCARE INSURANCE COMPANY P O BOX 30555 SALT LAKE CITY UT 841306730 CONTRACT ADMIN. MEDICAL 141950 1 HEALTH BENEFIT CONTRIB 900099 2240414 2240414 2240414 2240414 2240414 0 0 2240414 2240414 0 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 X 0 1 X 0 0 0 2240414 0 2240414 0 2240414 2319153 78739 78739 2240414 0 2240414 PART XII, LINE 2D - OTHER ADJUSTMENTS: TO ADJUST CASH BASIS FORM 990 TO ACCRUAL BASIS FINANCIAL STATEMENTS FORM 990, PART VI, SECTION A, LINE 3 OPERATIONAL MANAGEMENT IS DELEGATED TO THE HUMAN RESOURCE PERSONNEL. FORM 990, PART VI, SECTION A, LINE 7A THE TRUSTEES ARE THE GOVERNING BODY OF THE ORGANIZATION AND ALSO DIRECTORS OF THE PLAN SPONSOR. FORM 990, PART VI, SECTION A, LINE 7B THE TRUSTEES HAVE DELEGATED THE GOVERNANCE DECISIONS TO THE HUMAN RESOURCE PERSONNEL. FORM 990, PART VI, SECTION A, LINE 8A THE HUMAN RESOURCE PERSONNEL MAKE DECISIONS ON THE PLAN/TRUST. THEY SEEK GUIDANCE ON ISSUES FROM PROFESSIONAL ADVISORS IF NEEDED. FORM 990, PART VI, SECTION A, LINE 8B THE HUMAN RESOURCE PERSONNEL MAKE THE DAY TO DAY DECISIONS OF THE PLAN/TRUST. FORM 990, PART VI, SECTION B, LINE 11 THE HUMAN RESOURCE PERSONNEL REVIEW FORM 990 BEFORE FILING. FORM 990, PART VI, SECTION C, LINE 18 PIONEER PRODUCTS, INC. 1917 S MEMORIAL DRIVE, RACINE, WI 53403, 262-633-6304, VALERIE RATKOWSKI. FORM 990, PART VI, SECTION C, LINE 19 THE HUMAN RESOURCE PERSONNEL MAKE THE ORGANIZATION'S DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PIONEER PRODUCTS INC 1917 S MEMORIAL DRIVE RACINE WI 53403 391078454 MANUFACTURING WI N/A S 1 US COMPETITION ARMS INC 1925 ROOSEVELT AVENUE RACINE WI 53406 391644703 MANUFACTURING WI N/A S 1 TARGET ARMS INC 1925 ROOSEVELT AVENUE RACINE WI 53406 391371478 MANUFACTURING WI N/A S 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 ALL RELATED COMPANIES LISTED ON SCHEDULE R PART IV Q 2240414 CASH PAYMENT ALL RELATED COMPANIES LISTED ON SCHEDULE R PART IV S 2240414 CASH PAYMENT