2011-11-15T14:52:52-06:00 2010-12-31 FREYBERG HINKLE ASHLAND POWERS & STOWELL 15420 W CAPITOL DR BROOKFIELD WI 530052621 990 2010-01-01 310656412 UFCW UNIONS & EMPLOYERS HEALTH & WELFARE PLAN OF CENTRAL OHIO UFCW 6142377618 4150 EAST MAIN STREET COLUMBUS OH 43213 RANDY QUICKEL 6142377618 2011-11-15 1 THOMAS M POWERS CPA 2627846210 2010 2016-03-07 17:11:31Z RANDY QUICKEL 4150 EAST MAIN STREET COLUMBUS OH 43213 104774301 0 X WWW.UFCWCENTRALOHIOHW.COM X 1956 OH PROVIDE INSURANCE BENEFITS FOR MEMBERS 6 6 19 0 0 0 0 0 47113371 47899794 1287236 1356639 0 708204 48400607 49964637 0 0 45299268 41526733 664227 799723 0 0 0 3190880 3533259 49154375 45859715 -753768 4104922 32147439 36588742 2305864 2513305 29841575 34075437 TO PROVIDE FOR A UNIFORM HEALTH AND WELFARE PROGRAM FOR EMPLOYEES EMPLOYED UNDER CERTAIN COLLECTIVE BARGAINING AGREEMENTS. 0 0 44066836 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. 44066836 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 86 0 1 19 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 GREGORY BEHNKE 2.00 X X 0 0 0 STEVE LOEFFLER 2.00 X 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 RANDY QUICKEL 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 1604994 ALERE HEALTH IMPROVEMENT CO PO BOX 403393 ATLANTA GA 303843393 DISEASE MANAGEMENT 429838 REINHART BOERNER VAN DEUREN SC PO BOX 2965 MILWAUKEE WI 532012965 ATTORNEY 268502 HEALTH SERVICE REVIEW INC 6730 ROOSEVELT FRANKLIN OH 45005 MEDICAL CASE MANAGEMENT 235524 DELTA DENTAL 1300 EAST 9TH STREET CLEVELAND OH 44114 CLAIMS PROCESSING 170860 7 EMPLOYER CONTRIBUTIONS 900099 47421578 47421578 SELF-PAYMENT CONTRIBUT 900099 478216 478216 47899794 983535 983535 55182768 54809664 373104 373104 373104 GOVERNMENT REIMBURSEME 900099 708204 708204 708204 49964637 48607998 0 1356639 41526733 41526733 513884 513884 30796 30796 212587 212587 42456 42456 261319 261319 30549 30549 39142 39142 163705 163705 220701 220701 159786 159786 37467 37467 31960 31960 14081 14081 15116 15116 ACCIDENT, HEALTH AND DE 1776397 1776397 DISEASE MANAGEMENT 398249 398249 MEDICAL REVIEW SERVICES 316235 316235 VISION CARE FEES 49222 49222 ELECTRONIC ENROLLMENT S 18500 18500 830 830 45859715 44066836 1792879 0 6960955 4147662 940216 918673 1290849 21890 21016 461958 384985 29211 76973 27030003 27298733 32147439 36588742 1415864 1697305 890000 816000 2305864 2513305 X 0 0 0 0 29841575 34075437 29841575 34075437 32147439 36588742 X 4104922 128940 X X 0 1 1 X 0 461958 384985 76973 76973 CLAIMS PAYABLE 816000 816000 49964637 45859715 4104922 128940 128940 4233862 50054435 128940 128940 49925495 39142 39142 49964637 45894573 0 45894573 39142 -74000 -34858 45859715 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, 2010 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 2007. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CURRENT YEAR DECREASE IN CLAIMS PAYABLE -74,000. 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: 128,940. 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 D, PART XI, LINE 10: THE $4,233,862 REPORTED HERE DOES NOT AGREE WITH THE NET INCREASE IN NET ASSETS AVAILABLE FOR BENEFITS PER THE AUDITED FINANCIAL STATEMENTS AMOUNT OF $4,159,862. THE DIFFERENCE OF $74,000 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.