2024-02-13T16:56:38-06:00 2023-03-31 363168081 SIKICH LLP 17335 GOLF PARKWAY SUITE 500 BROOKFIELD WI 53045 990 2022-04-01 382427401 MICHIGAN UFCW UNIONS & EMPLOYERS RETIREE HEALTH & WELFARE FUND MICH 2485859610 7250 POE AVENUE 300 DAYTON OH 45414 DANIEL PEDERSEN TRUSTEE 2485859610 2024-02-13 1 DANIEL PEDERSEN 999009999 0 BRIDGETTE MUGGE P00671418 2627549400 2024-02-13 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z DANIEL PEDERSEN 7250 POE AVENUE 300 DAYTON OH 45414 343466 0 X N/A X 1958 MI PROVIDING HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 6 6 0 6 0 0 0 0 42283552 304250 3419 38573 0 643 42286971 343466 0 0 39952595 1824451 1315908 0 0 0 0 9982410 208437 51250913 2032888 -8963942 -1689422 6565819 4889373 88191 101167 6477628 4788206 PROVIDING HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 PROVIDING HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 5 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KATY MACIK 8004331204 7250 POE AVENUE 300 DAYTON OH 45414 DANIEL PEDERSEN TRUSTEE & SECRETARY 1.00 54.00 X X 0 275674 38931 DOUG FINDLAY TRUSTEE (THRU 12/5/22) 1.00 54.00 X 0 220789 17265 DAVID WAY TRUSTEE (THRU 12/5/22) 1.00 50.00 X 0 194853 26574 ROWENA GREEN TRUSTEE 1.00 54.00 X 0 181721 28146 DEVIN SENNEKER TRUSTEE (START 3/15/23) 1.00 40.00 X 0 0 0 STEVE YANCEY TRUSTEE & CHAIRMAN 1.00 40.00 X X 0 0 0 KIMBERLY WELCH-HARLAN TRUSTEE 1.00 40.00 X 0 0 0 JESSICA OFFENBACHER TRUSTEE 1.00 40.00 X 0 0 0 STEPHANIE VILLALPANDO ALTERNATE TRUSTEE (START 12/5/22) 1.00 54.00 X 0 94594 11093 NATE CLARK ALTERNATE TRUSTEE (START 12/5/22) 1.00 40.00 X 0 0 0 MARISA DIDUR ALTERNATE TRUSTEE 1.00 50.00 X 0 195245 18395 RYLAN NORRIS ALTERNATE TRUSTEE 1.00 40.00 X 0 0 0 0 1162876 140404 0 0 1 0 HEARTLAND BENEFIT PLAN ADMINISTRATORS L 7250 POE AVENUE NO 300 DAYTON OH 45414 MANAGEMENT FEE 106211 1 RETIREE CONTRIBUTIONS 525100 304250 304250 304250 38573 38573 OTHER INCOME 900099 643 643 643 343466 304893 0 38573 1824451 106210 63946 19232 1337 14579 COMMUNICATION EXPENSES 2638 PCORI FEES 495 2032888 6526917 4836226 30803 44574 8099 8573 6565819 4889373 65441 78167 22750 23000 88191 101167 X 0 0 0 0 6477628 4788206 6477628 4788206 6565819 4889373 -1689422 0 X 0 1 X 1 0 0 X 343466 0 343466 0 343466 2032888 0 2032888 0 2032888 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S ASSETS IS INTENDED TO QUALIFY PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC) AND IS, THEREFORE, NOT SUBJECT TO TAX UNDER PRESENT INCOME TAX LAWS. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER IN 1958 FROM THE INTERNAL REVENUE SERVICE ("IRS") AND THE TRUSTEES BELIEVE THAT THE TRUST AND THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH THE APPLICABLE PROVISION OF THE IRC. U.S. GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 DANIEL PEDERSEN TRUSTEE & SECRETARY 0 275674 0 0 0 0 0 10040 0 28891 0 314605 0 0 DOUG FINDLAY TRUSTEE (THRU 12/5/22) 0 220789 0 0 0 0 0 8316 0 8949 0 238054 0 0 DAVID WAY TRUSTEE (THRU 12/5/22) 0 194853 0 0 0 0 0 0 0 26574 0 221427 0 0 MARISA DIDUR ALTERNATE TRUSTEE 0 195245 0 0 0 0 0 0 0 18395 0 213640 0 0 ROWENA GREEN TRUSTEE 0 181721 0 0 0 0 0 6940 0 21206 0 209867 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FUND'S OFFICERS AND THIRD PARTY LAW FIRM AND ACCOUNTING FIRM PREPARE A DRAFT OF THE FORM 990. THE DRAFT IS THEN DISTRIBUTED TO THE BOARD OF TRUSTEES AND DISCUSSED AT THE SUBSEQUENT BOARD OF TRUSTEES MEETING. FOLLOWING A DISCUSSION OF ANY COMMENTS, THE FORM 990 IS FINALIZED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE FUND ANNUALLY REQUIRES TRUSTEES TO DISCUSS ANY RELATIONSHIPS THAT COULD GIVE RISE TO A CONFLICT OF INTEREST UNDER THE "CONFLICT OF INTEREST POLICY" REGARDING THE FUND. ANY IDENTIFIED POTENTIAL CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE AFFECTED INDIVIDUAL AND APPROPRIATELY ADDRESSED, INCLUDING THE PERSON RECUSING HIMSELF OR HERSELF FROM ANY INVOLVEMENT REGARDING THE AFFECTED ENTITY OR TRANSACTION. THE TRUSTEES ARE ALSO ENCOURAGED TO BE WATCHFUL OF CONFLICT OF INTEREST ISSUES AND BRING SUCH ISSUES TO THE ATTENTION OF EITHER THE CHAIRMAN OF THE BOARD OF TRUSTEES OR THE THIRD PARTY LAW FIRM. ANY IDENTIFIED CONFLICTS OF INTEREST ARE DEALT WITH BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 15 ALL TRUSTEES ARE UNCOMPENSATED AND EACH TRUSTEE IS APPOINTED BY THE PARTICIPATING UNION(S) OR EMPLOYER(S) UNDER THE FUND. FORM 990, PART VI, SECTION C, LINE 19 THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). IT OPERATES IN COMPLIANCE WITH THE REPORTING AND DISCLOSURE REQUIREMENTS OF SUBTITLE B, PART 1 OF ERISA WITH RESPECT TO DISCLOSURE OF ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION. NO DOCUMENTS ARE AVAILABLE TO THE GENERAL PUBLIC OTHER THAN THOSE FINANCIAL STATEMENTS WHICH ARE REQUIRED TO BE DISCLOSED IN GOVERNMENTAL FILINGS. UFCW UNION LOCAL 876 26495 AMERICAN DR SOUTHFIELD MI 48034 380513037 LABOR UNION MI 501(C)(5) 0 UFCW LOCAL 951 4045 60TH STREET SE KENTWOOD MI 49512 381651820 LABOR UNION MI 501(C)(5) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0