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← UFCW HEALTH INSURANCE PLAN FOR RETIREES

Form 990 for tax year 2022

Filed by UFCW HEALTH INSURANCE PLAN FOR RETIREES.

Totals

Total revenue
$22,743,924
Total expenses
$22,606,379
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$22,743,924
Investment income
$0
Other revenue
$0
Total assets, end of year
$220,000
Total liabilities, end of year
$0
Net assets or fund balances, end of year
$220,000
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 $20,027,358 · related or exempt $20,027,358

  • 2b · Program service revenue: MEDICARE PART D REIMBURSEMENT

    total $1,552,802 · related or exempt $1,552,802

  • 2c · Program service revenue: PARTICIPANT CONTRIBUTIONS

    total $1,163,764 · related or exempt $1,163,764

Functional expenses

Part IX, the statement of functional expenses.

  • 4 · Benefits paid to or for members

    total $21,840,881

  • 11b · Fees: legal

    total $45,744

  • 11c · Fees: accounting

    total $22,415

  • 11g · Fees: other

    total $225,804

  • 13 · Office expenses

    total $1,719

  • 24a · Other expenses: CLAIMS PROCESSING

    total $469,816

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $82,455 · end of year $220,000

  • 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 $82,455 · end of year $220,000

Mission and programs · 2022

Mission

TO PROVIDE HEALTH AND MEDICAL BENEFITS AND SERVICES

Activities or mission (Part I)

TO PROVIDE HEALTH AND MEDICAL BENEFITS AND SERVICES.

  • THE PLAN PROVIDED HEALTH, DENTAL, DISABILITY, AND LIFE INSURANCE TO ALL ELIGIBLE PARTICIPANTS.

As filed on the 2022 return.

Listed in Part VII

  • Anthony M Perrone

    INTERNATIONAL PRESIDENT

    Total calculated
    $371,460
    From this org
    $0
    From related orgs
    $301,501
    Other
    $69,959
    Hours/week
    0.2 + 39.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $298,177 related
    Bonus
    $0
    Other
    $0 + $3,324 related
    Deferred
    $0 + $43,543 related
    Nontaxable benefits
    $0 + $26,416 related
    Filer's total
    $0 + $371,460 related

  • Warren S Barclay

    INTERNATIONAL SECRETARY-TR

    Total calculated
    $316,557
    From this org
    $0
    From related orgs
    $248,223
    Other
    $68,334
    Hours/week
    0.2 + 39.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $244,020 related
    Bonus
    $0
    Other
    $0 + $4,203 related
    Deferred
    $0 + $41,918 related
    Nontaxable benefits
    $0 + $26,416 related
    Filer's total
    $0 + $316,557 related

  • Paul Meinema

    EXECUTIVE VICE PRESIDENT

    Total calculated
    $226,098
    From this org
    $0
    From related orgs
    $178,813
    Other
    $47,285
    Hours/week
    0.2 + 39.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $177,274 related
    Bonus
    $0
    Other
    $0 + $1,539 related
    Deferred
    $0 + $36,432 related
    Nontaxable benefits
    $0 + $10,853 related
    Filer's total
    $0 + $226,098 related

  • Stuart Appelbaum

    EXECUTIVE VICE PRESIDENT

    Total calculated
    $33,450
    From this org
    $0
    From related orgs
    $0
    Other
    $33,450
    Hours/week
    0.2 + 39.8 related

  • Milton L Jones

    INTERNATIONAL VICE PRESIDENT

    Total calculated
    $301,472
    From this org
    $0
    From related orgs
    $233,506
    Other
    $67,966
    Hours/week
    0.2 + 39.8 related

    Schedule J breakdown matched by us

    Base
    $0 + $231,759 related
    Bonus
    $0
    Other
    $0 + $1,747 related
    Deferred
    $0 + $41,550 related
    Nontaxable benefits
    $0 + $26,416 related
    Filer's total
    $0 + $301,472 related

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.

Provenance

Return type
form_990
Tax year
2022
Filed
16 January 2024
IRS schema version
2022v5.0
Source object
202420169349303267

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