2012-11-15T09:02:29-06:00 2011-12-31 391531945 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2011-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 6142377618 4150 EAST MAIN STREET COLUMBUS OH 43213 RANDY QUICKEL 6142377618 2012-11-15 1 THOMAS M POWERS CPA P00241729 2627846210 2011 2016-02-24 21:20:13Z RANDY QUICKEL 4150 EAST MAIN STREET COLUMBUS OH 43213 88049071 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 18 0 0 0 0 0 47899794 42194943 1356639 997174 708204 0 49964637 43192117 0 0 41526733 47106150 799723 847218 0 0 0 3533259 3146121 45859715 51099489 4104922 -7907372 36588742 28682609 2513305 2513312 34075437 26169297 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 49371580 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. 49371580 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 0 1 88 0 1 18 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 X RANDY QUICKEL 2.00 X X 0 0 0 STEVE LOEFFLER 2.00 X X 0 0 0 GREGORY BEHNKE 2.00 X 0 0 0 LANCE CAMPBELL 2.00 X 0 0 0 REBECCA A BERROYER 2.00 X 0 0 0 SUE VANDERSALL 2.00 X 0 0 0 MARK KNIGHT 2.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM INSURANCE COMPANY INC PO BOX 182361 COLUMBUS OH 432182361 CLAIMS PROCESSING 1614759 HEALTH SERVICE REVIEW INC 6730 ROOSEVELT FRANKLIN OH 45005 MEDICAL CASE MANAGEMENT 207857 ALERE HEALTH IMPROVEMENT CO PO BOX 403393 ATLANTA GA 303843393 DISEASE MANAGEMENT 200377 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 194987 DELTA DENTAL 1300 EAST 9TH STREET CLEVELAND OH 44114 CLAIMS PROCESSING 170594 6 EMPLOYER CONTRIBUTIONS 900099 41754501 41754501 SELF-PAYMENT CONTRIBUT 900099 440442 440442 42194943 758173 758173 45095955 44856954 239001 239001 239001 43192117 42194943 0 997174 47106150 47106150 546199 546199 31690 31690 221281 221281 48048 48048 192138 192138 30500 30500 28898 28898 137168 137168 187195 187195 205029 205029 38626 38626 11625 11625 18938 18938 19914 19914 ACCIDENT, HEALTH AND DE 1784999 1784999 MEDICAL REVIEW SERVICES 264949 264949 DISEASE MANAGEMENT 166977 166977 VISION CARE FEES 48505 48505 10660 10660 51099489 49371580 1727909 0 6960955 4114064 940216 1179343 1290849 798689 21016 30469 328813 278464 76973 50349 27298733 22509695 36588742 28682609 1697305 1593916 396 816000 919000 2513305 2513312 X 0 0 0 0 34075437 26169297 34075437 26169297 36588742 28682609 X -7907372 1232 X X 0 1 1 X 0 328813 278464 50349 50349 CLAIMS PAYABLE 919000 919000 43192117 51099489 -7907372 2529 -1297 1232 -7906140 43165748 2529 2529 43163219 28898 28898 43192117 50968888 1297 1297 50967591 28898 103000 131898 51099489 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 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 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FURNITURE & EQUIPMENT -1,297. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CURRENT YEAR INCREASE IN CLAIMS PAYABLE 103,000. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,529. LOSS ON DISPOSAL OF FURNITURE & EQUIPMENT -1,297. TOTAL TO FORM 990, PART XI, LINE 5: 1,232. 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 STATEMENTS. FORM 990, SCHEDULE R, PARTS II-IV: ALL EMPLOYER INFORMATION IS AVAILABLE AT THE PLAN OFFICE UPON REQUEST. FORM 990, SCHEDULE D, PART XI, LINE 10: THE $-7,906,140 REPORTED HERE DOES NOT AGREE WITH THE NET DECREASE IN NET ASSETS AVAILABLE FOR BENEFITS PER THE AUDITED FINANCIAL STATEMENTS AMOUNT OF $-7,803,140. THE DIFFERENCE OF $103,000 IS THE CHANGE IN BENEFITS PAYABLE. THE BENEFITS PAYABLE ARE INCLUDED IN THE FORM 990, BUT ARE ONLY DISCLOSED IN THE NOTES TO THE AUDITED FINANCIAL STATEMENTS. UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 4150 E MAIN STREET COLUMBUS OH 43213 314392482 LABOR UNION OH 501(C)(5) N/A 0 UFCW UNIONS AND FOOD EMPLOYERS PENSION PLAN OF CENTRAL OHIO 4150 E MAIN STREET COLUMBUS OH 43213 316089168 MULTIEMPLOYER PENSION PLAN OH 401(A) N/A 0 CENTRAL OHIO UFCW UNIONS AND RETAIL EMPLOYERS PENSION PLAN 4150 E MAIN STREET COLUMBUS OH 43213 316089169 MULTIEMPLOYER PENSION PLAN OH 401(A) N/A 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1059 J 58368 FAIR MARKET VALUE UFCW UNIONS AND FOOD EMPLOYERS PENSION PLAN OF CENTRAL OHIO P 268899 ACTUAL EXPENSE REIMBURSEMENTS CENTRAL OHIO UFCW UNIONS AND RETAIL EMPLOYERS PENSION PLAN P 79860 ACTUAL EXPENSE REIMBURSEMENTS