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← UNITED FOOD & COMMERCIAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN

Form 990 for tax year 2022

Filed by UNITED FOOD & COMMERCIAL WORKERS UNIONS & EMPLOYERS HEALTH PLAN.

Totals

Total revenue
$2,879,414
Total expenses
$3,063,080
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$2,809,708
Investment income
$69,623
Other revenue
$83
Total assets, end of year
$3,600,567
Total liabilities, end of year
$612,843
Net assets or fund balances, end of year
$2,987,724
Program services expenses (Part IX)
not reported
Management and general expenses
not reported
Fundraising expenses
not reported
Program service expenses (Part III)
not reported

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: EMPLOYER CONTRIBUTIONS

    total $2,801,284 · related or exempt $2,801,284

  • 2b · Program service revenue: SELF PAY CONTRIBUTIONS

    total $8,424 · related or exempt $8,424

  • 3 · Investment income

    total $69,623 · excluded $69,623

  • 11a · Other revenue: CLASS ACTION LITIGATIO

    total $83 · related or exempt $83

  • 11e · Other revenue, total

    $83

Functional expenses

Part IX, the statement of functional expenses.

  • 4 · Benefits paid to or for members

    total $2,557,033

  • 11a · Fees: management

    total $90,000

  • 11b · Fees: legal

    total $67,069

  • 11g · Fees: other

    total $90,737

  • 13 · Office expenses

    total $8,693

  • 19 · Conferences, conventions and meetings

    total $7,611

  • 23 · Insurance

    total $11,391

  • 24a · Other expenses: STOP LOSS PREMIUMS

    total $105,132

  • 24b · Other expenses: ACCIDENT & HEALTH FEES

    total $89,794

  • 24c · Other expenses: BANK SERVICE FEES

    total $19,976

  • 24d · Other expenses: PROGRAM EXPENSE

    total $14,618

  • 24e · All other expenses

    total $1,026

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,254,976 · end of year $1,095,326

  • 2 · Savings and temporary cash investments

    beginning of year $2,923 · end of year $2,923

  • 4 · Accounts receivable

    beginning of year $278,857 · end of year $359,469

  • 9 · Prepaid expenses and deferred charges

    beginning of year $14,586 · end of year $5,513

  • 11 · Investments: publicly traded securities

    beginning of year $2,060,433 · end of year $2,137,336

  • 17 · Accounts payable and accrued expenses

    beginning of year $139,200 · end of year $187,862

  • 19 · Deferred revenue

    beginning of year $175,466 · end of year $93,981

  • 25 · Other liabilities

    beginning of year $133,000 · end of year $331,000

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $3,164,109 · end of year $2,987,724

Mission and programs · 2022

Mission

TO PROVIDE ELIGIBLE PARTICIPANTS ACCIDENT, HEALTH, VISION, DENTAL, PRESCRIPTION DRUG, LIFE INSURANCE, LOSS OF TIME, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS.

Activities or mission (Part I)

HEALTH PLAN

  • ACCIDENT, HEALTH, LOSS-OF-TIME, DENTAL, LIFE, VISION CARE BENEFIT PAYMENTS TO PARTICIPANTS.

  • PRESCRIPTION DRUG PROGRAM BENEFITS PAID ON BEHALF OF PARTICIPANTS.

  • LIFE INSURANCE BENEFITS PAID ON BEHALF OF PARTICIPANTS.

As filed on the 2022 return.

Listed in Part VII

  • Jacob Bailey

    CHAIRMAN/UNION TRUSTEE

    Total calculated
    $180,034
    From this org
    $0
    From related orgs
    $159,369
    Other
    $20,665
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $159,369 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $4,995 related
    Nontaxable benefits
    $0 + $15,670 related
    Filer's total
    $0 + $180,034 related

  • Chad Whiteside

    ALTERNATE UNION TRUSTEE

    Total calculated
    $142,940
    From this org
    $0
    From related orgs
    $122,275
    Other
    $20,665
    Hours/week
    1 + 40 related

  • Melanie Bartholf

    UNION TRUSTEE

    Total calculated
    $166,620
    From this org
    $0
    From related orgs
    $145,955
    Other
    $20,665
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $145,955 related
    Bonus
    $0
    Other
    $0
    Deferred
    $0 + $4,995 related
    Nontaxable benefits
    $0 + $15,670 related
    Filer's total
    $0 + $166,620 related

  • Darren Horndasch

    SECRETARY/EMPLOYER TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Timothy Lamers

    EMPLOYER TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Sherri Bryant-Smith

    EMPLOYER TRUSTEE

    Total calculated
    $0
    Hours/week
    1

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • UNION FIRST LASER TECHNOLOGIES INC

  • PIGGLY WIGGLY MIDWEST

  • SUPERIOR NATIONAL BANK & TRUST COMPANY

  • WISCONSIN VISION

  • FRED USINGER INC

Provenance

Return type
form_990
Tax year
2022
Filed
15 October 2024
IRS schema version
2022v5.0
Source object
202432899349301978

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