2011-06-27T11:09:26-05:00 2010-11-30 Legacy Professionals LLP 311 S Wacker Drive Ste 4000 Chicago IL 60606 990 2009-12-01 362440523 U F C W unions & employers MIDWEST HEALTH BENEFITS FUND UFCW 8473847000 1300 HIGGINS ROAD No 300 PARK RIDGE IL 60068 kenneth r boyd 8473847000 2011-06-27 1 3123680500 2009 2016-02-24 21:20:13Z kenneth r boyd 1300 HIGGINS ROAD No 300 PARK RIDGE IL 60068 103843318 0 X www.ufcwmidwest.org X 1960 IL PROVIDE HEALTH BENEFITS 6 6 90 0 0 0 0 77058565 48158438 427618 2925960 6609 83740 77492792 51168138 0 56438946 54377672 6799671 7275305 0 0 2462710 2527209 65701327 64180186 11791465 -13012048 74172940 88626318 655096 26606935 73517844 62019383 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 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 1 1542 0 1 90 1 0 0 0 0 0 0 0 6 6 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 1 0 0 X BOARD OF TRUSTEES 8473847000 1300 HIGGINS ROAD suite 300 park ridge IL 60068 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 156850 0 10700 RON LAMKEY 40.00 X 112332 0 10700 269182 0 21400 2 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH ST CHICAGO IL 60601 PPO provider 2657716 legacy professionals 311 south wacker ste 4000 chiCAGO IL 60602 auditor 242405 QUEST DIAGNOSTICS INC LLC 1355 MITTEL BLVD WOOD DALE IL 60191 HEALTHCARE PROVIDER 213903 MEDICAL INSURANCE CONSULTING GROUP INC 4949 N WESTERN AVENUE CHICAGO IL 60625 MEDICAL CONSULTANT 170392 the segal company PO BOX 4092 CHURCH STREET STATION NEW YORK NY 10261 actuary 127348 5 EMpl. contributions 900099 43767427 43767427 REIMB EXP UFCW MW Pens 900099 2829532 2829532 PART. CONTRIBUTIONS 900099 600478 600478 PERSCRIPTION DRUG REBA 900099 579384 579384 REIMB EXPS UFCW Calume 900099 277207 277207 104410 104410 48158438 2222077 2222077 53379063 52675180 703883 703883 703883 MISCELLANEOUS INCOME 900099 50735 50735 CLASS ACTION RECOVERY 900099 33005 33005 83740 51168138 48158438 0 3009700 54377672 166465 4837271 1114766 787431 369372 110169 82074 249578 348126 348730 183006 759666 7189 50624 129000 110710 MISCELLANEOUS PERSONNEL 50509 DOCUMENT STORAGE EXPENS 49010 wEB CLAIMS SERVICE FEE 48818 64180186 692696 -467228 16953059 14754449 6749054 5649153 65239 146794 1053250 652385 414215 400865 48963537 67778838 335140 363447 74172940 88626318 280309 361516 374787 26245419 655096 26606935 X 0 0 0 0 73517844 62019383 73517844 62019383 74172940 88626318 X 0 1 1 X 0 1053250 652385 400865 400865 due to participants of DEFERRED COMPENSATION PLANS 410314 MAINTENANCE OF RESERVE POLICY REFUNDS 25600105 DUE TO BROKER 235000 26245419 51168138 64180186 -13012048 1513587 1513587 -11498461 49602615 1513587 1513587 48089028 249578 2829532 3079110 51168138 61101076 0 61101076 249578 2829532 3079110 64180186 Part X: Description of Uncertain Tax Positions Under FIN 48: 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: 2829532. Part XIII, Line 4b - Other Adjustments: REIMBURSED ADMIN EXPENSE - UFCW PENSION FUND: 2829532. X 0 0 0 DANIEL W RYAN 156850 0 0 0 0 0 1374 0 9326 0 167550 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 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. 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 1 1 0 1 0 0 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND M 435804 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND N 2393728 UNITED FOOD AND COMMERICAL WORKERS UNIONS & EMPLOYERS MIDWEST PENSION FUND P 2567918