2012-11-14T12:29:35-06:00 2011-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2011-01-01 356045880 INDIANA AREA UFCW HEALTH AND WELFARE PLAN INDI 3172477381 5420 WEST SOUTHERN AVENUE NO 407 INDIANAPOLIS IN 46241 JOE CHORPENNING 3172477381 2012-11-14 1 VICTOR ANCICH P00201493 3123680500 2011 2016-02-24 21:20:13Z JOE CHORPENNING 5420 WEST SOUTHERN AVENUE NO 407 INDIANAPOLIS IN 46241 42786430 0 X N/A X 1968 IN PROVIDE HEALTH BENEFITS 8 8 0 0 0 0 0 0 39150634 40960900 1006957 336916 3810 14179 40161401 41311995 0 0 37569216 42331607 0 0 0 0 0 1804301 1500244 39373517 43831851 787884 -2519856 18652134 16259784 273515 197604 18378619 16062180 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE ACCIDENT, HEALTH, DENTAL, VISION, PRESCRIPTION DRUG, LIFE & LOSS OF TIME BENEFITS FOR ELIGIBLE PARTICIPANTS AND/OR THEIR DEPENDENTS IN ACCORDANCE WITH THE PLAN DOCUMENT AND THE SCHEDULE OF BENEFITS. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 6 0 1 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 1 0 0 0 IN X VICKIE STEINMETZ CO ZENITH AMERICAN SOLUTIONS 3172483242 5420 WEST SOUTHERN AVE STE 407 INDIANAPOLIS IN 46241 X X JOE CHORPENNING 1.00 X 0 0 0 CINDY BONDAR 1.00 X 0 0 0 SCOTT BARNETT 1.00 X 0 0 0 MICHAEL MURDOCK 1.00 X 0 0 0 MICHAEL MERRELL 1.00 X 0 0 0 THOMAS CEBULKO 1.00 X 0 0 0 RICHARD FITZGERALD 1.00 X 0 0 0 MARCIE DULEY 1.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM 220 VIRGINIA AVENUE INDIANAPOLIS IN 46204 BENEFIT CLAIMS ADMINISTRATOR 1511965 ZENITH ADMINISTRATORS 5420 WEST SOUTHERN AVENUE SUITE 407 INDIANAPOLIS IN 46241 ADMINISTRATIVE SERVICES 1016455 INFORMED 1596 WHITEHALL ROAD ANNAPOLIS MD 21409 CARE MANAGEMENT SERVICES 788408 DELTA DENTAL 5875 CASTLE CREEK PARKWAY N DR 19 INDIANAPOLIS IN 46250 BENEFIT CLAIMS ADMINISTRATOR 152020 4 EMPLOYER CONTRIBUTIONS 900099 37029008 37029008 PARTICIPANT CONTRIB. 900099 3568490 3568490 PRESCRIPTION DRUG REBA 900099 359208 359208 COBRA STIMULUS RECOVER 900099 4194 4194 40960900 311351 311351 1500000 1474435 25565 25565 25565 MISCELLANEOUS 900099 14179 14179 14179 41311995 40960900 0 351095 42331607 181032 30902 5000 1085478 161599 11275 8087 16036 MEMBERSHIP DUES 835 43831851 2543569 960340 3299346 3456227 8812 9310 12490500 11530833 309907 303074 18652134 16259784 273515 197604 273515 197604 X 0 0 0 0 18378619 16062180 18378619 16062180 18652134 16259784 X -2519856 203417 X 0 1 1 X 0 0 41311995 43831851 -2519856 203417 203417 -2316439 41510412 203417 -5000 198417 41311995 0 41311995 43826851 0 43826851 5000 5000 43831851 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE PLAN IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, EXCEPT ON NET INCOME DERIVED FROM UNRELATED BUSINESS ACTIVITIES. FOR THE YEAR ENDED DECEMBER 31, 2011, THE PLAN HAS DETERMINED THAT NO INCOME TAXES ARE DUE FROM ITS ACTIVITIES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN RECORDED IN THE FINANCIAL STATEMENTS. 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 STATUE OF LIMITATION EXPIRES. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSES PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES FORM 990, PART VI, SECTION A, LINE 3 WHILE THE BOARD OF TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY MANAGEMENT OF THE FUND TO A THIRD PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR THEIR REVIEW AND APPROVAL PRIOR TO ITS FILING. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE INFORMATION IN QUESTION 19 AVAILABLE UPON REQUEST THROUGH THE PLAN'S THIRD PARTY ADMINISTRATOR - ZENITH AMERICAN SOLUTIONS. SCHEDULES R AND J AND PART VII: THE INFORMATION NECESSARY TO DETERMINE AND PROPERLY REPORT RELATED ORGANIZATIONS POTENTIALLY REPORTABLE ON SCHEDULES R AND J AND PART VII OF THIS FORM IS NOT DETERMINABLE USING CURRENT PLAN RECORDS. THE INFORMATION IS BEING OBTAINED. ONCE THE APPROPRIATE RECORDS ARE AVAILABLE AND REVIEWED, AN AMENDED RETURN MAY BE SUBMITTED TO COMPLY WITH ANY REQUIRED REPORTING. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 203,417. INDIANA AREA UFCW UNIONS & RETAIL FOOD EMPLOYERS JT PENS PLAN 5420 W SOUTHERN AVE INDIANAPOLIS IN 46241 356244695 DEFINED BENEFIT PENSION PLAN IN 401(A) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 THE INFORMATION NECESSARY TO DETERMINE AND PROPERLY REPORT RELATED ORGANIZATIONS POTENTIALLY REPORTABLE ON SCHEDULES R AND J AND PART VII OF THIS FORM IS NOT DETERMINABLE USING CURRENT PLAN RECORDS. THE INFORMATION IS BEING OBTAINED. ONCE THE APPROPRIATE RECORDS ARE AVAILABLE AND REVIEWED, AN AMENDED RETURN MAY BE SUBMITTED TO COMPLY WITH ANY REQUIRED REPORTING.