2026-03-03T07:53:46-06:00 2025-04-30 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE SUITE 1200 WEST BETHESDA MD 20814 990 2024-05-01 586041908 UNITED FOOD & COMMERICAL WORKERS UNIONS & EMPLOYERS HEALTH & WELFARE FUND UNIT 7709979910 1740 PHOENIX PARKWAY ATLANTA GA 30349 ERIC TAYLOR CHAIRMAN 7709979910 2026-03-03 1 1 SCOTT E HALLBERG CPA P01081188 2023319880 2024 2025-03-06 01:10:19Z ERIC TAYLOR 3302 MCGINNIS FERRY RD SUWANEE GA 30024 213231332 0 X N/A X EMPLOYEE BENEFIT PLAN 1964 GA TO PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS. 8 0 0 0 0 0 0 0 176668918 199603046 1000260 1427715 7992 9316541 177677170 210347302 0 0 159914701 184771243 0 0 0 0 0 5051032 5008146 164965733 189779389 12711437 20567913 49159983 72174364 3809075 6049752 45350908 66124612 TO PROVIDE HEALTH AND WELFARE BENEFITS TO PARTICIPANTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO 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 6 0 1 0 0 0 0 0 0 0 0 0 X 8 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X MARK MURPHY 7079979910 1740 PHOENIX PKWY ATLANTA GA 30349 ERIC TAYLOR CHAIRMAN 1.00 40.00 X 0 324196 0 MARIA DAVENPORT UNION TRUSTEE 1.00 40.00 X 0 217042 0 ERIC LOMAX UNION TRUSTEE 1.00 40.00 X 0 153043 0 PEGGY PRESCOTT SECRETARY 2.00 40.00 X 0 0 0 HENRY TAYLOR EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 LEE KUNSELMAN EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 KAREN HILL ALTERNATE UNION TRUSTEE 1.00 40.00 X 0 0 0 W BRANDON HOPKINS UNION TRUSTEE 1.00 40.00 X 0 0 0 REBECCA CLARK EMPLOYER TRUSTEE 1.00 40.00 X 0 0 0 0 694281 0 0 0 1 0 ANTHEM BLUE CROSS BLUE SHIELD 3075 VANDERCAR WAY CINCINNATI OH 45209 PPO 6196222 OPTUMRX INC PO BOX 888765 LOS ANGELES CA 90088 FEES 306824 SLEVIN & HART PC 1625 MASSACHUSETS AVE NW STE 450 WASHINGTON DC 20036 LEGAL 257196 BHA CONSULTING LLC 5400 LAUREL SPRINGS PKWY STE 1306 SUWANEE GA 30024 CONSULTING 230749 REINHART BOERNER VAN DEUREN SC 1000 N WATER ST SUITE 1700 MILWAUKEE WI 53202 LEGAL 199027 5 EMPLOYER AND EMPLOYEE CONTRIBUTIO 525100 199489057 199489057 SUBROGATION RECOVERY 525100 107874 107874 SPOUSAL FEES 525100 6115 6115 199603046 1380777 1380777 2930968 2884030 46938 46938 46938 MERGER INCOME 525100 9314640 9314640 1901 1901 9316541 210347302 210347302 0 0 184771243 389287 131000 34162 463223 278530 24665 19675 ALLOCATED ADMINISTRATIV 3610803 PCORI FEE 56801 189779389 15286844 9524300 13258538 37888617 7051511 10402149 13563090 14359298 49159983 72174364 3809075 6049752 3809075 6049752 X 45350908 66124612 0 0 0 0 45350908 66124612 49159983 72174364 20567913 205791 0 X X 0 1 X 1 0 0 X 210518931 205791 205791 210313140 34162 34162 210347302 189745227 0 189745227 34162 34162 189779389 PART X, LINE 2: THE PLAN OBTAINED ITS MOST RECENT DETERMINATION LETTER ON OCTOBER 1, 1964, STATING THAT THE PLAN WAS IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC) AND WAS, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(C)(9). THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. THE PLAN HAS PERFORMED AN EVALUATION OF ITS TAX POSITIONS AND, AS OF APRIL 30, 2025, THERE WERE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. AS OF APRIL 30, 2025, THE STATUTE OF LIMITATIONS FOR TAX YEARS 2022 THROUGH 2024 REMAIN OPEN WITH THE U.S. FEDERAL JURISDICTION IN WHICH THE PLAN FILES TAX RETURNS. 0 0 0 ERIC TAYLOR CHAIRMAN 0 274196 0 49904 0 96 0 0 0 0 0 324196 0 0 MARIA DAVENPORT UNION TRUSTEE 0 137681 0 79265 0 96 0 0 0 0 0 217042 0 0 ERIC LOMAX UNION TRUSTEE 0 109272 0 43675 0 96 0 0 0 0 0 153043 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS ON FILE AT THE FUND OFFICE TO BE REVIEWED BY THE BOARD OF TRUSTEES. PART VI, SECTION B, LINES 12 - 14 ALTHOUGH THE FUND HAS NO FORMAL WRITTEN POLICIES ON CONFLICT OF INTEREST, WHISTLEBLOWERS AND DOCUMENT RETENTION, THE FUND IS GOVERNED BY ERISA. ERISA CONTAINS PRUDENCE AND PROHIBITED TRANSACTIONS RULES THAT, IN PRACTICE, ACT AS THE FUND'S CONFLICT OF INTEREST POLICY, RECORD RETENTION REQUIREMENTS THAT ACT AS THE FUND'S RECORD RETENTION POLICY, AND CO-FIDUCIARY REPORTING OBLIGATIONS THAT ACT AS A WHISTLEBLOWER POLICY FOR THE FUND. FORM 990, PART VI, SECTION C, LINE 19 THE FUND IS ESTABLISHED AND MAINTAINED PURSUANT TO ERISA. IT OPERATES IN COMPLIANCE WITH REPORTING REQUIREMENTS OF ITS GOVERNING DOCUMENTS AND FINANCIAL INFORMATION. NO DOCUMENTS OR FINANCIAL INFORMATION IS AVAILABLE TO THE GENERAL PUBLIC OTHER THAN THOSE FINANCIAL STATEMENTS REQUIRED TO BE DISCLOSED AS PART OF GOVERNMENTAL FILINGS. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UFCW LEGAL ASSISTANCE FUND 1740 PHOENIX PARKWAY ATLANTA GA 30349 581370485 LEGAL ASSISTANCE GA 501(C)(9) N/A 0 UFCW LOCAL 1996 3302 MCGINNIS FERRY RD SUWANEE GA 30024 582141936 LABOR UNION GA 501(C)(5) N/A 0 UFCW BENEFITS ADMINISTRATION LLC 1740 PHOENIX PARKWAY ATLANTA GA 30349 770613772 PROVIDE ADMINISTRATIVE SUPPORT GA N/A 0 THE BOARD OF TRUSTEES 1740 PHOENIX PARKWAY ATLANTA GA 30349 586041908 TRUSTEES GA 501(C)(9) N/A 0 THE KROGER CO SHENANDOAH FLEET SPARTA HEALTHCARE HAC INC TITAN PCSI HOSPITAL HOUSEKEEPING SYSTEMS LLC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0