2012-03-27T17:50:11-05:00 2011-11-30 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2010-12-01 351065816 UNITED FOOD & COMM WORKERS CALUMET REGION INSURANCE FUND UNIT 8473847000 1300 HIGGINS ROAD PARK RIDGE IL 60068 DAN RYAN 8473847000 2012-03-27 1 LEGACY PROFESSIONALS LLP 3123680500 2010 2016-02-24 21:20:13Z DAN RYAN 1300 HIGGINS ROAD PARK RIDGE IL 60068 11735145 0 X N/A X 1960 IN PROVIDE HEALTH BENEFITS 4 4 0 0 0 0 0 0 7969368 7972114 256933 273826 4120 1414 8230421 8247354 0 0 5895132 6841734 0 0 0 0 0 468627 461959 6363759 7303693 1866662 943661 8765875 9827160 26997 39030 8738878 9788130 HEALTH BENEFIT FUND 0 0 TO PROVIDE HEALTH AND WELFARE, DEATH, AND LOSS OF TIME BENEFITS TO ELIGIBLE PARTICIPANTS AND/OR THEIR DEPENDENTS. 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 0 0 0 0 1 47 0 1 0 0 0 0 0 0 0 0 0 X 4 4 1 1 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 0 0 0 X DAN RYAN 8473847000 1300 HIGGINS ROAD PARK RIDGE IL 60068 X STEVEN POWELL 3.00 X 0 0 0 NANCY CAMP 3.00 X 0 0 0 BRAD POWELL 3.00 X 0 0 0 JEFFREY STRACK 3.00 X 0 0 0 LISA CATANZARO 3.00 X 0 0 0 DAVID WILKINSON 3.00 X 0 0 0 0 0 0 0 0 0 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 450220 1 EMPLOYER CONTRIB. 900099 7680360 7680360 STOP LOSS & REINSURANC 900099 261491 261491 PARTICIPANT CONTRIB 900099 30263 30263 7972114 274319 274319 3487298 3487791 -493 -493 -493 MISCELLANEOUS INCOME 900099 1414 1414 1414 8247354 7972114 0 275240 6841734 284060 5603 48740 42497 58588 7413 738 9028 WEB CLAIMS SERVICE FEE 5292 7303693 367914 382828 762215 564450 198938 285736 37004 38624 7347397 8498635 52407 56887 8765875 9827160 3278 17255 23719 21775 26997 39030 X 0 0 0 0 8738878 9788130 8738878 9788130 8765875 9827160 X 943661 105591 X 0 1 1 X 0 0 DUE FROM BROKER 21775 21775 8247354 7303693 943661 105591 105591 1049252 8310448 105591 105591 8204857 42497 42497 8247354 7261196 0 7261196 42497 42497 7303693 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE 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. FORM 990, PART VI, SECTION A, LINE 2 TRUSTEES STEVEN POWELL AND BRAD POWELL ARE BROTHERS. FORM 990, PART VI, SECTION A, LINE 3 THE 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 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY (TRUSTEES). FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES. ONCE THE FORM IS REVIEWED AND APPROVED, IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE FUND OFFICE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 105,591.