2025-01-14T14:20:38-06:00 2024-02-29 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2023-03-01 416051513 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1189 & ST PAUL FOOD EMPLOYEE UNIT 9528540795 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 ADAM EVENSTAD TRUSTEE 9528540795 2025-01-14 1 0 LARRY WOOD P00634996 9528413950 2023 2024-10-15 13:58:12Z ADAM EVENSTAD 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 34476157 0 X N/A X 1966 MN PROVIDE HEALTH AND WELFARE BENEFITS 8 0 60 0 0 0 0 0 22775913 23677854 83828 270778 0 0 22859741 23948632 0 0 20724218 19085452 0 0 0 0 0 331286 311716 21055504 19397168 1804237 4551464 10787370 15676860 78663 69791 10708707 15607069 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 THE PLAN PROVIDES COMPREHENSIVE MEDICAL BENEFITS INCLUDING DENTAL, VISION, PRESCRIPTION DRUG, LIFE INSURANCE, ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) AND SHORT-TERM DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS OR BENEFICIARIES. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3 0 1 60 1 0 0 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 X WILSON-MCSHANE CORPORATION 9528540795 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 JAMES GLEB TRUSTEE 1.00 50.00 X 0 114689 15419 ABRAHAM WANGNOO TRUSTEE 1.00 50.00 X 0 96669 15724 CHRIS THIENES TRUSTEE 1.00 X 0 0 0 KENT DIXON TRUSTEE 1.00 X 0 0 0 MICHAEL OASE TRUSTEE 1.00 X 0 0 0 JON BORN ALTERNATE TRUSTEE 1.00 X 0 0 0 FRED MILLER ALTERNATE TRUSTEE 1.00 X 0 0 0 TAMI DENN-BAUER TRUSTEE 1.00 50.00 X 0 92414 14537 ROBERT JORDAN TRUSTEE 1.00 50.00 X 0 82794 14606 RAYMOND GANDY ALTERNATE TRUSTEE 1.00 50.00 X 0 83971 15682 JAMES WESTIN ALTERNATE TRUSTEE 1.00 50.00 X 0 88702 15984 LAURA DALY TRUSTEE 1.00 X 0 0 0 0 559239 91952 0 0 0 0 WILSON-MCSHANE CORPORATION 3001 METRO DRIVE SUITE 500 BLOOMINGTON MN 55425 CLAIMS PROCESSING AND ADMINISTRATIVE FEE 635767 UMR INC 400 E BUSINESS WAY SUITE 100 CINCINNATI OH 45241 NETWORK ACCESS FEES 511862 2 EMPLOYER CONTRIBUTIONS 900099 22599305 22599305 PARTICIPANT AND RETIREE CONTRIBUT 900099 665134 665134 PRESCRIPTION DRUG REBATES 900099 347789 347789 SUBROGATION SETTLEMENTS 900099 65626 65626 23677854 249826 249826 10548477 10527525 20952 20952 20952 23948632 23677854 0 270778 19085452 162000 37889 22675 21041 41000 13984 1290 3447 FEES MANDATED BY ACA 8390 19397168 4044622 2200903 41847 158695 2237870 1904472 4463031 11412790 10787370 15676860 23010 26990 55653 42801 78663 69791 X 0 0 0 0 10708707 15607069 10708707 15607069 10787370 15676860 4551464 346898 0 X 0 1 X 1 0 0 X 24274489 346898 346898 23927591 21041 21041 23948632 19376127 0 19376127 21041 21041 19397168 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN UNCERTAIN TAX POSITIONS THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGESS. FORM 990, PAGE 1, LINE F AND PART II THE FUND APPOINTED A NEW UNION TRUSTEE SUBSEQUENT TO YEAR END AND A NEW CHAIRMAN WAS SEATED. ADAM EVENSTAD, THE NEW CHAIRMAN, IS LISTED AS THE PLAN'S PRINCIPAL OFFICER AND HAS SIGNED THIS FORM 990. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE BOARD OF TRUSTEES RETAINS ULTIMATE CONTROL AND RESPONSIBILITY FOR THE PLAN, THE TRUSTEES HAVE DELEGATED THE DAY-TO-DAY ADMINISTRATIVE DUTIES TO WILSON-MCSHANE CORPORATION AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A THE PLAN IS GOVERNED BY EIGHT TRUSTEES; FOUR TRUSTEES ARE APPOINTED BY THE UNION AND FOUR TRUSTEES ARE APPOINTED BY THE EMPLOYERS. THE UNION AND THE EMPLOYERS MAY ALSO APPOINT ALTERNATE TRUSTEES WHO WILL BE QUALIFIED TO ACT ONLY IN THE ABSENCE OF A TRUSTEE. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. THESE DOCUMENTS ARE LOCATED AT THE THIRD PARTY ADMINISTRATOR'S OFFICE IN BLOOMINGTON, MN. UFCW 1189 AND ST PAUL FOOD EMPLOYERS DEFINED CONTRIBUTION PLAN C/O WILSON-MCSHANE CORPORATION 3001 BLOOMINGTON MN 554251617 411930820 PROVIDE PENSION BENEFITS TO MEMBERS AND BENEFICIARIES MN 401(A) 0 UFCW LOCAL UNION 1189 CONTRIBUTING EMPLOYER 0 ANGUS MEAT CONTRIBUTING EMPLOYER 0 J & L ENTERPRISES CONTRIBUTING EMPLOYER 0 JERRY'S ENTERPRISES CONTRIBUTING EMPLOYER 0 KNOWLAN'S FESTIVAL FOODS CONTRIBUTING EMPLOYER 0 KOWALSKI'S CONTRIBUTING EMPLOYER 0 LUND FOOD HOLDINGS CONTRIBUTING EMPLOYER 0 VIREO HEALTH CONTRIBUTING EMPLOYER 0 OXENDALES CONTRIBUTING EMPLOYER 0 UNITED NATURAL FOODS (UNFI) CONTRIBUTING EMPLOYER 0 US FOODS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1