2011-11-14T08:01:26-06:00 2010-12-31 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2010-01-01 356045880 INDIANA AREA UFCW HEALTH AND WELFARE PLAN INDI 3172477381 5420 WEST SOUTHERN AVENUE NO 407 INDIANAPOLIS IN 46241 JOE CHORPENNING 3172477381 2011-11-14 1 LEGACY PROFESSIONALS LLP 3123680500 2010 2016-03-07 17:11:31Z JOE CHORPENNING 5420 WEST SOUTHERN AVENUE NO 407 INDIANAPOLIS IN 46241 40161401 0 X N/A X 1968 IN PROVIDE HEALTH BENEFITS 7 7 0 0 0 0 0 0 36182211 39150634 678052 1006957 1520 3810 36861783 40161401 0 0 34812794 37569216 0 0 0 0 0 1729578 1804301 36542372 39373517 319411 787884 18063445 18652134 362783 273515 17700662 18378619 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 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 0 0 X 7 7 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 ADMINIS 3172483242 5420 WEST SOUTHERN AVE STE 407 INDIANAPOLIS IN 46241 X JOE CHORPENNING 1.00 X 0 0 0 CINDY BONDAR 1.00 X 0 0 0 DOUG VAN OSDALE 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 DAVID BLITZSTEIN 1.00 X 0 0 0 0 0 0 0 0 0 0 ANTHEM 220 VIRGINIA AVENUE INDIANAPOLIS IN 46204 BENEFIT CLAIMS ADMINISTRATOR 1532201 ZENITH ADMINISTRATORS 5420 WEST SOUTHERN AVENUE SUITE 407 INDIANAPOLIS IN 46241 ADMINISTRATIVE SERVICES 1035024 INFORMED 1596 WHITEHALL ROAD ANNAPOLIS MD 21409 CARE MANAGEMENT SERVICES 765921 MILLIMAN 111 MONUMENT CIRCLE SUITE 601 INDIANAPOLIS IN 46204 BENEFIT AND ACTUARIAL SERVICES 288794 DELTA DENTAL 5875 CASTLE CREEK PARKWAY N DR 19 INDIANAPOLIS IN 46250 BENEFIT CLAIMS ADMINISTRATOR 157674 7 EMPLOYER CONTRIBUTIONS 900099 35094163 35094163 PARTICIPANT CONTRIB. 900099 3683173 3683173 PRESCRIPTION DRUG REBA 900099 362575 362575 COBRA STIMULUS RECOVER 900099 10723 10723 39150634 1006957 1006957 MISCELLANEOUS 900099 3810 3810 3810 40161401 39150634 0 1010767 37569216 271634 26016 5000 1323818 155168 4439 16397 MISCELLANEOUS 1029 MEMBERSHIP DUES 800 39373517 2404196 2543569 689422 3082544 3299346 9334 8812 11594213 12490500 283736 309907 18063445 18652134 362783 273515 362783 273515 X 0 0 0 0 17700662 18378619 17700662 18378619 18063445 18652134 X 787884 -109927 X 0 1 1 X 0 0 40161401 39373517 787884 -109927 -109927 677957 40046474 -109927 -5000 -114927 40161401 0 40161401 39368517 0 39368517 5000 5000 39373517 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: PART X, LINE 2: 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, 2010, 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 ADMINISTRATORS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS PROVIDED TO THE BOARD OF TRUSTEES PRIOR TO 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 ADMINISTRATORS, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -109,927. 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