SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
BAKERY AND CONFECTIONERY UNION AND
INDUSTRY INTERNATIONAL HEALTH BENEFITS FUND
Employer identification number

53-0227042
Return Reference Explanation
PART V, LINE 2B - FEDERAL EMPLOYMENT TAX RETURNS: THE FUND FILES 941'S UNDER THE NAME BAKERY & CONFECTIONERY INDUSTRY INTERNATIONAL HEALTH BENEFITS AND PENSION FUNDS UNDER A SEPARATE EIN FROM THE FUNDS, AS THE HEALTH AND PENSION FUND EMPLOY THE PERSONNEL JOINTLY AND EACH FUND PAY THEIR ALLOCATED SHARE OF WAGES AND PAYROLL TAXES FOR EACH EMPLOYEE THAT PERFORMS SERVICES FOR THEM.
PART VI, SECTION A, LINE 2 - BUSINESS RELATIONSHIPS: TRUSTEES DAVID B DURKEE, STEVE BERTELLI, JETHRO A HEAD, ART MONTMINY, SHAD CLARK AND ANTHONY SHELTON SERVE AS OFFICERS OF BCTGM INTERNATIONAL UNION. TRUSTEES LOU MINELLA AND PHIL PATURZO SERVE AS AN OFFICER AND AN EMPLOYEE OF BIMBO BAKERIES USA.
PART VI, SECTION A, LINE 7A - SELECTION OF TRUSTEES: THE TRUSTEES ARE APPOINTED BY THE UNION AND EMPLOYERS, WHO PARTICIPATE IN THE HEALTH BENEFIT PLAN. EACH GROUP HAS THE RIGHT TO SELECT UP TO EIGHT TRUSTEES TO SERVE ON THE BOARD. IN THE EVENT THERE IS AN UNEQUAL NUMBER OF EMPLOYER TRUSTEES AND UNION TRUSTEES AT ANY TIME, THE EMPLOYER AND UNION TRUSTEES SHALL NONETHELESS HAVE EQUAL VOTING STRENGTH.
PART VI, SECTION A, LINE 8B - OTHER COMMITTEES: THE BENEFIT PLAN HAS NO OTHER COMMITTEE THAT CAN ACT ON THE BEHALF OF THE GOVERNING BODY.
PART VI, SECTION B, LINE 11B - REVIEW PROCESS OF FORM 990: THE BOARD OF TRUSTEES HAS DELEGATED THE RESPONSIBILITY TO REVIEW THE FORM 990 PRIOR TO FILING TO THE MANAGER OF ADMINISTRATIVE SERVICES AND THE EXECUTIVE DIRECTOR.
PART VI, SECTION C, LINE 19 - AVAILABILITY OF GOVERNING DOCUMENTS & F/S: THE BENEFIT PLAN DOES MAKE ITS PLAN DOCUMENT, TRUST DOCUMENT AND SUMMARY PLAN DESCRIPTION AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
PART XI, LINE 9 - OTHER CHANGE IN NET ASSETS: PENSION-RELATED CHANGES OTHER Than Net Periodic Pension COST OF $(126,854)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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