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UNITED FOOD & COMMERCIAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
UNITED FOOD & COMMERCIAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN (EIN 39-0979166)
Tax period
2011-12-01 to 2012-11-30
Filed
2013-07-12
IRS object ID
201311939349300731
Schema version
2011v1.5
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)
Timestamp2013-07-12T12:26:21-05:00Timestamp
Tax Period End Date2012-11-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN391531945EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1FREYBERG HINKLE ASHLAND POWERS & STOWELLBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line115420 W CAPITOL DRAddressLine1
CityBROOKFIELDCity
StateWIState
ZIP Code530052621ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-12-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN390979166EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UNITED FOOD & COMMERICAL WORKERSBusinessNameLine1
Business Name Line2UNIONS & EMPLOYERS HEALTH PLANBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUNITNameControl
Phone4144762523Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12100 NORTH MAYFAIR ROADAddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53226ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN EIDENName
TitleCHAIRMANTitle
Phone4144762523Phone
Date Signed2013-07-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJAMES M ASHLAND CPAName
PTINP00241858PTIN
Phone2627846210Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN EIDENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12001 N MAYFAIR RDAddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53226ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12039560GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1960YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionHEALTH PLANActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
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 Year6954096ProgramServiceRevenuePriorYear
Program Service Revenue CY5702401ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year26564OtherRevenuePriorYear
Other Revenue Current Year19936OtherRevenueCurrentYear
Total Revenue Prior Year6980660TotalRevenuePriorYear
Total Revenue Current Year5722337TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year4395758BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY5105016BenefitsPaidToMembersCY
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 Year824299OtherExpensePriorYear
Other Expenses Current Year674386OtherExpensesCurrentYear
Total Expenses Prior Year5220057TotalExpensesPriorYear
Total Expenses Current Year5779402TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1760603RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-57065RevenuesLessExpensesCY
Total Assets BOY4238388TotalAssetsBOY
Total Assets EOY4246933TotalAssetsEOY
Total Liabilities BOY518581TotalLiabilitiesBOY
Total Liabilities EOY584191TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3719807NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3662742NetAssetsOrFundBalancesEOY
Mission DescriptionNONEMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense4327039Expense
DescriptionACCIDENT, HEALTH, LOSS-OF-TIME, DENTAL, LIFE, VISION CARE BENEFIT PAYMENTS TO PARTICIPANTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense813805Expense
DescriptionPRESCRIPTION DRUG PROGRAM BENEFITS PAID ON BEHALF OF PARTICIPANTS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
DescriptionLIFE INSURANCE BENEFITS PAID ON BEHALF OF PARTICIPANTS.Description
FieldValueIRS element (for citing)
Total Program Service Expense5140844TotalProgramServiceExpense
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 Liabilities1ReportOtherLiabilities
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 Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096118NumberFormsTransmittedWith1096
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
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
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 Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
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 Line1ZENITH AMERICAN SOLUTIONSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4144762523TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12100 N MAYFAIR ROADAddressLine1
CityMILWAUKEECity
StateWIState
ZIP Code53226ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOHN EIDEN
CHAIRMAN/UNION TRUSTEE0.00XX000
GRANT WITHERS
UNION TRUSTEE0.00X000
PAUL BUTERA
EMPLOYER TRUSTEE0.00X000
MARK CULOTTA
ALTERNATE UNION TRUSTEE0.00X000
CHAD WHITESIDE
ALTERNATE UNION TRUSTEE0.00X000
DARREN HORNDASCH
SECRETARY/EMPLOYER TRUSTEE0.00XX000
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
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS52510056871015687101
SELF-PAY CONTRIBUTIONS5251001530015300
FieldValueIRS element (for citing)
Total Program Service Revenue5702401TotalProgramServiceRevenue

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6317223Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6317223Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PRESCRIPT PROG REBATE5251001621116211
WITHDRAWAL LIABILITY52510037253725
FieldValueIRS element (for citing)
Total Other Revenue19936TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column5722337TotalRevenueColumn
Related Or Exempt Function Income5722337RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total5105016Total
Program Services5105016ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total450717Total
Management And General450717ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total50343Total
Management And General50343ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total23100Total
Management And General23100ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1500Total
Management And General1500ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total15283Total
Management And General15283ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1224Total
Management And General1224ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total13129Total
Management And General13129ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
CONSULTANT FEES4893048930
COST CONTAINMENT PROGRA3489534895
BANK SERVICE FEES1085910859
FIELD AUDIT FEES1061510615

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total13791Total
Program Services933ProgramServices
Management And General12858ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5779402Total
Program Services5140844ProgramServices
Management And General638558ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY42464BOY
EOY4131421EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY81247BOY
EOY77747EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY41747BOY
EOY37765EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4072930BOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4238388BOY
EOY4246933EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY196182BOY
EOY214191EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY322399BOY
EOY370000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY518581BOY
EOY584191EOY
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)
BOY3719807BOY
EOY3662742EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3719807BOY
EOY3662742EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4238388BOY
EOY4246933EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-57065ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCLAIMS PAYABLEDescription
Amount$370,000Amount
FieldValueIRS element (for citing)
Total Of Amounts370000TotalOfAmounts
Total Revenue5722337TotalRevenue
Total Expenses5779402TotalExpenses
Excess Or Deficit For Year-57065ExcessOrDeficitForYear
Excess Or Deficit Per FS-57065ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt5720837TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal5720837RevenueSubtotal
Investment Expenses Not Included1500InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt1500RevenueNotRptdOnFinStmt
Total Revenue Per Form9905722337TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt5730301TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal5730301ExpensesSubtotal
Investment Expenses Not Included21500InvestmentExpensesNotIncluded2
Other Expenses Not Included47601OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt49101ExpensesNotRptdOnFinStmt
Total Expenses Per Form9905779402TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X: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. PLAN MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF NOVEMBER 30, 2012 THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PLAN MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR CLOSED YEARS FOR WHICH THE STATUTE OF LIMITATIONS HAS EXPIRED.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:INCREASE IN CURRENT YEAR CLAIMS PAYABLE

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION B, LINE 11THE 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 19THEY ARE AVAILABLE UPON REQUEST.
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.