2012-04-13T11:59:25-05:00 2011-11-30 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2010-12-01 362440523 U F C W UNIONS & EMPLOYERS MIDWEST HEALTH BENEFITS FUND UFCW 8473847000 1300 HIGGINS ROAD NO 300 PARK RIDGE IL 60068 DAN RYAN 8473847000 2012-04-13 1 LEGACY PROFESSIONALS LLP 3123680500 2010 2016-02-24 21:20:13Z DAN RYAN 1300 HIGGINS ROAD NO 300 PARK RIDGE IL 60068 134664496 0 X WWW.UFCWMIDWEST.ORG X 1960 IL PROVIDE HEALTH BENEFITS 6 6 87 0 0 0 0 0 48158438 43073797 2925960 1517123 83740 98202 51168138 44689122 0 0 54377672 63508916 7275305 6619667 0 0 0 2527209 2427928 64180186 72556511 -13012048 -27867389 88626318 52247171 26606935 17094448 62019383 35152723 PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1471 0 1 87 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 1 0 0 X JOE CALI 8473847000 1300 HIGGINS ROAD SUITE 300 PARK RIDGE IL 60068 X BRIAN JORDAN 3.00 X 0 0 0 JOHN DOUGHERTY 3.00 X 0 0 0 KENNETH R BOYD 3.00 X 0 0 0 TERRY KRAMER 3.00 X 0 0 0 STEVEN M POWELL 3.00 X 0 0 0 JAMES V MORGAN 3.00 X 0 0 0 DANIEL W RYAN 40.00 X 144462 0 111807 RON LAMKEY 40.00 X 114401 0 32404 JOSEPH R CALI 40.00 X 106031 0 24477 364894 0 168688 3 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO PROVIDER 2705096 MEDICAL INSURANCE CONSULTING GROUP INC 4949 N WESTERN AVENUE CHICAGO IL 60625 MEDICAL CONSULTANT 238518 THE SEGAL COMPANY PO BOX 4092 CHURCH STREET STATION NEW YORK NY 10261 ACTUARY 231445 QUEST DIAGNOSTICS INC LLC 1355 MITTEL BLVD WOOD DALE IL 60191 HEALTHCARE PROVIDER 197990 LEGACY PROFESSIONALS LLP 311 SOUTH WACKER STE 4000 CHICAGO IL 60602 AUDITOR 109106 5 EMPL. CONTRIBUTIONS 900099 38874139 38874139 REIMB EXP UFCW MW PENS 900099 2628255 2628255 PART. CONTRIBUTIONS 900099 597793 597793 PERSCRIPTION DRUG REBA 900099 594260 594260 REIMB EXPS UFCW CALUME 900099 284060 284060 95290 95290 43073797 1562126 1562126 89930371 89975374 -45003 -45003 -45003 CLASS ACTION RECOVERY 900099 94103 94103 MISCELLANEOUS INCOME 900099 4099 4099 98202 44689122 43073797 0 1615325 63508916 167206 4716923 986491 387950 361097 74948 88428 151383 359338 366110 144400 758097 8911 33924 131445 111646 MISCELLANEOUS PERSONNEL 96240 DOCUMENT STORAGE EXPENS 54989 WEB CLAIMS SERVICE FEE 48069 72556511 -467228 2401033 14754449 4116403 5649153 5483711 146794 248268 1044676 692206 400865 352470 67778838 39459363 363447 185923 88626318 52247171 361516 274799 26245419 16819649 26606935 17094448 X 0 0 0 0 62019383 35152723 62019383 35152723 88626318 52247171 X -27867389 1000729 X 0 1 1 X 0 1044676 692206 352470 352470 DUE TO PARTICIPANTS OF DEFERRED COMPENSATION PLANS 234728 MAINTENANCE OF RESERVE POLICY REFUNDS 16559951 DUE TO BROKER 24970 16819649 44689122 72556511 -27867389 1000729 1000729 -26866660 42910213 1000729 1000729 41909484 151383 2628255 2779638 44689122 69776873 0 69776873 151383 2628255 2779638 72556511 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. PART XII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,628,255. PART XIII, LINE 4B - OTHER ADJUSTMENTS: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND 2,628,255. X 0 0 0 DANIEL W RYAN 144462 0 0 0 0 0 103534 0 8273 0 256269 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B THE PLAN DOES NOT HAVE ANY SEPARATE COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR REVIEW AND APPROVAL BEFORE IT IS SIGNED AND FILED. FORM 990, PART VI, SECTION B, LINE 15A SALARIES ARE ANNUALLY REVIEWED AND APPROVED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE FUND OFFICE. FORM 990, SCHEDULE J, PART II, COLUMN C: RETIREMENT AND OTHER DEFERRED COMPENSATION INCLUDES THE INCREASE IN THE PRESENT VALUE OF A DEFINED BENEFIT PENSION PLAN AS DETERMINED BY THE FUND'S ACTUARY. FORM 990, SCHEDULE J, PART II, COLUMN D: NON-TAXABLE BENEFITS INCLUDE THE VALUE OF HEALTH AND WELFARE PREMIUMS PAID ON BEHALF OF THE INDIVIDUALS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,000,729. UNITED FOOD & COMERCIAL WKRS UNIONS & EMPRS MW PENSION FUND 1300 HIGGINS ROAD SUITE 300 PARK RIDGE IL 60068 366508328 RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS IL 501(A) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND M 400901 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND N 2227354 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND P 2634194