2023-03-03T12:46:58-06:00 2022-04-30 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CTR STE 700 WESTCHESTER IL 60154 990 2021-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE 250 ARVADA CO 800022815 MARTIN GARCIA TRUSTEE 3034301118 2023-03-03 1 MARTIN GARCIA 999009999 ADAM SIMAGA P01649025 3123680500 2023-03-03 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z MARTIN GARCIA 5511 W 56TH AVE 250 ARVADA CO 800022815 145385593 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 8 4 0 0 0 0 0 0 129009893 131199729 340018 -5796 118244 182193 129468155 131376126 0 0 124109788 121298970 0 0 0 0 0 7411726 6791982 131521514 128090952 -2053359 3285174 37244117 40164714 540357 525056 36703760 39639658 TO PROVIDE HEALTH BENEFITS TO THE ELIGIBLE PARTICIPANTS AND DEPENDENTS OF ROCKY MOUNTAIN UFCW & EMPLOYERS HEALTH BENEFIT PLAN. 0 0 TO PROVIDE HEALTH, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DENTAL, VISION, PRESCRIPTION AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 8 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 80002 BOB MCLAUCHLIN TRUSTEE 1.00 X 0 0 0 LEROY WESTMORELAND TRUSTEE 1.00 X 0 0 0 SEAN HAMMOND TRUSTEE 1.00 X 0 0 0 ANDY LUKES TRUSTEE 1.00 X 0 0 0 KIM CORDOVA TRUSTEE 1.00 45.00 X 0 215932 15413 KEVIN SCHNEIDER TRUSTEE 1.00 45.00 X 0 191217 13653 MARTIN GARCIA TRUSTEE 1.00 45.00 X 0 170773 13755 LEAH DOWODZENKA TRUSTEE 1.00 45.00 X 0 121649 13627 0 699571 56448 0 0 1 0 ZENITH AMERICAN SOLUTIONS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 2348261 REINHART BOERNER VAN DEUREN SC 1000 N WATER ST STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 255020 THE SEGAL COMPANY INC 101 N WACKER DRIVE STE 500 CHICAGO IL 60606 CONSULTING SERVICES 239955 SPENCER FANE LLP 1700 LINCOLN ST STE 2000 DENVER CO 80203 LEGAL SERVICES 202317 4 EMPLOYER CONTRIBUTIONS 900099 113890072 113890072 PARTICIPANT CONTRIBUTIONS 900099 11046920 11046920 PRESCRIPTION REBATES 900099 6262737 6262737 131199729 185677 185677 13817994 14009467 -191473 -191473 -191473 COMMISSION CREDITS 900099 182193 182193 182193 131376126 131199729 0 176397 121298970 2066112 473027 91224 17891 3673026 352413 20639 64211 FEES MANDATED BY THE AC 33439 128090952 2538753 3257672 12414887 9207430 12676353 13628193 45575 56615 9568549 14014804 37244117 40164714 142677 150271 397680 374785 540357 525056 X 0 0 0 0 36703760 39639658 36703760 39639658 37244117 40164714 3285174 -349276 0 X X 0 1 X 1 0 0 X 123296778 -219270 -219270 123516048 17277 7842801 7860078 131376126 121989544 0 121989544 17277 6084131 6101408 128090952 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION 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 PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN - RETIREE CONTRIBUTIONS 4,752,824. RETIREE PLAN - EMPLOYER CONTRIBUTIONS 2,651,517. RETIREE PLAN - PRESCRIPTION REBATES 245,291. RETIREE PLAN - COMMISSION CREDITS 182,193. RETIREE PLAN - INVESTMENT INTEREST 10,976. PART XII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN - MEDICAL PREMIUMS 2,454,232. RETIREE PLAN - MEDICAL BENEFITS 1,862,025. RETIREE PLAN - PRESCRIPTION BENEFITS 858,561. RETIREE PLAN - HMO PREMIUMS 438,117. RETIREE PLAN - ADMINISTRATIVE EXPENSES 387,160. RETIREE PLAN - PPO FEES & PROVIDER FEES 82,733. RETIREE PLAN - FEES MANDATED BY ACA 689. RETIREE PLAN - INVESTMENT FEES 614. 0 0 0 KIM CORDOVA TRUSTEE 0 202922 0 0 0 13010 0 3328 0 12085 0 231345 0 0 KEVIN SCHNEIDER TRUSTEE 0 178207 0 0 0 13010 0 3226 0 10427 0 204870 0 0 MARTIN GARCIA TRUSTEE 0 170773 0 0 0 0 0 3328 0 10427 0 184528 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS DELEGATED THE RECORD KEEPING AND DAY TO DAY ADMINISTRATION OF THE PLAN TO ZENITH AMERICAN SOLUTIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARD'S REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES IS REQUIRED TO DISCLOSE ANY NONADHERENCE TO THE ADOPTED POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE PLAN OFFICE. FORM 990, PART XII, LINE 2B: FINANCIAL STATEMENTS: THE ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS HEALTH BENEFIT FUND - ACTIVES AND ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS HEALTH BENEFIT FUND - RETIREES OPERATE UNDER ONE TRUST AGREEMENT. EACH PLAN ISSUES SEPARATE AUDITED FINANCIAL STATEMENTS. BOTH PLANS ARE REPORTED ON THIS FORM 990 ON A CONSOLIDATED BASIS. ROCKY MTN UFCW UNIONS AND EMPRS RETAIL AND MEAT PENSION PLAN 5511 W 56TH AVE SUITE 250 ARVADA CO 80002 846045986 PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS AND BENEFICIARIES CO 401(A) N/A 0 UNITED FOOD AND COMMERCIAL WORKERS INTERNATIONAL UNION 7R LOCAL CONTRIBUTING EMPLOYER 0 ALBERTSONS SAFEWAY CONTRIBUTING EMPLOYER 0 ALMAGNO FREELANCE CONTRIBUTING EMPLOYER 0 DARLING INTERNATIONAL CONTRIBUTING EMPLOYER 0 DEBONAIRE HAIR CONTRIBUTING EMPLOYER 0 DENVER PROCESSING (KS - MEAT PLANT) CONTRIBUTING EMPLOYER 0 KING SOOPERSCITY MARKETSMITH FOODS CONTRIBUTING EMPLOYER 0 ZENITH AMERICAN SOLUTIONS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS RETAIL AND MEAT PENSION PLAN S 3577945 COST