2023-03-06T12:50:08-06:00 2022-04-30 410746749 CLIFTONLARSONALLEN LLP 2875 MICHELLE DRIVE 300 IRVINE CA 92606 990 2021-05-01 916049498 UNITED FOOD AND COMMERCIAL WORKERS WELFARE TRUST UNIT 5095340600 1322 N POST SPOKANE WA 99201 ERIC RENNER CHAIRMAN 5095340600 2023-02-28 1 ERIC RENNER XXX-XX-XXXX LISA N RYSSEL CPA P00643670 7149781300 2023-02-28 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ERIC RENNER 1322 N POST SPOKANE WA 99201 85662097 0 X N/A X 1963 WA PROVIDE A HEALTH AND WELFARE PLAN TO THE UNITED FOOD AND COMMERCIAL WORKERS UNION PURSUANT TO A COLLECTIVE BARGAINING AGREEMENT. 8 8 0 8 0 0 0 0 47443216 45415623 1067894 186847 3520 0 48514630 45602470 0 0 39642139 39532619 0 0 0 0 0 1430490 1443315 41072629 40975934 7442001 4626536 45040678 47661813 5434132 5049344 39606546 42612469 PROVIDE A HEALTH AND WELFARE PLAN TO THE UNITED FOOD AND COMMERCIAL WORKERS UNION PERSUANT TO A COLLECTIVE BARGAINING AGREEMENT. 0 0 THE PLAN PROVIDES HEALTH AND WELFARE BENEFITS TO PARTICIPANTS AND THEIR DEPENDENTS. PREMIUMS TO UNDERWRITERS FOR HEALTH AND WELFARE BENEFITS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 43 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X AW REHN & ASSOCIATES 5095340600 1322 N POST SPOKANE WA 99201 X ERIC RENNER CHAIRMAN 2.00 X X 0 0 0 SCOTT POWERS SECRETARY 2.00 X X 0 0 0 BRENT BOHN TRUSTEE 2.00 X 0 0 0 JEFF HOFSTADER TRUSTEE 2.00 X 0 0 0 SCOTT HABENICHT TRUSTEE 2.00 X 0 0 0 CRAIG CUDE TRUSTEE 2.00 X 0 0 0 FAYE GUENTHER TRUSTEE 2.00 X 0 0 0 ROBERT MCLAUCHLIN TRUSTEE 2.00 X 0 0 0 0 0 0 0 0 0 0 AETNA 151 FARMINGTON AVENUE HARTFORD CT 06156 PPO NETWORK CLAIMS ADMINISTRATOR 815737 A W REHN & ASSOCIATES INC 1322 N POST ST SPOKANE WA 99201 ADMIN AND CLAIMS FEES 795855 DELTA DENTAL 400 FAIRVIEW AVE N STE 800 SEATTLE WA 98109 DENTAL SERVICES 127944 3 EMPLOYER CONTRIBUTIONS 900099 42303667 42303667 PARTICIPANT CONTRIBUTIONS 900099 3111956 3111956 45415623 525608 525608 39720866 40059627 -338761 -338761 -338761 45602470 45415623 0 186847 39532619 994934 26950 48553 135670 97844 90199 18369 PCORI TAXES 13531 CONFERENCE 9714 CYBER LIABILITY 5340 IFEBP DUES 1310 901 40975934 7730532 12486613 3383282 3099492 3926245 3844116 30000619 28231592 45040678 47661813 417532 575844 5016600 4473500 5434132 5049344 X 0 0 0 0 39606546 42612469 39606546 42612469 45040678 47661813 X 4626536 -2163713 543100 X X 0 1 X 1 0 0 CLAIMS INCURRED BUT NOT REPORTED 4473500 4473500 X 43309705 -2163713 -2163713 45473418 129052 129052 45602470 40846882 0 40846882 129052 129052 40975934 PART X, LINE 2: THE VEBA TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED DECEMBER 18, 1989, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME, THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2022 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRES TRUST MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE TRUST AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE TRUST HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE TRUST 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: CONFERENCE MEETING REFUND CREDIT CARD REFUND PART XII, LINE 2D - OTHER ADJUSTMENTS: CONFERENCE MEETING REFUND CREDIT CARD REFUND FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE PLAN ARE MANAGED BY AW REHN & ASSOCIATES FORM 990, PART VI, SECTION B, LINE 11B THE ADMINISTRATOR REVIEWS THE COMPLETED 990 AND TAKES THE FORM TO THE CHAIRMAN FOR REVIEW AND SIGNATURE. FORM 990, PART VI, SECTION C, LINE 18 NO GOVERNMENT DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC; ONLY TO THOSE REQUIRED BY ERISA. FORM 990, PART VI, SECTION C, LINE 19 NO GOVERNMENT DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC; ONLY TO THOSE REQUIRED BY ERISA. FORM 990, PART XI, LINE 9: CHANGE IN INCURRED BUT NOT REPORTED CLAIMS 543,100. PART XII, LINE 2C: THE OVERSIGHT PROCESS AND METHOD OF SELECTING THE INDEPENDENT AUDITOR HAS NOT CHANGED FROM THE PRIOR YEAR. UFCW LOCAL 1439 UNITED WAY OF SPOKANE ACTION PROCESS SERVICE LLC AW REHN & ASSOCIATES BLUE OAK LLC REDSERGE VENTURES A & B MORTGAGE CROWN FOODS DEER PARK COUNTRY CLUB DUZAN FRED MEYERKROGER GENE'S JOHN STERK KENNETH KATO MARK'S GOLF MS MAURA GIBSON RAY'S MEATS RIVERLINKS GOLF INC RON'S THRIFT ROSAUERSURM SAFEWAY SAFEWAY PORTLAND ABS SAFEWAY PORTLAND DIVISION SAFEWAY SEATTLE ABS SAV MART SIGN WORKS CUSTOM CONCEPTS LLC SPOKANE RENDERING THE MARKETS LLC WINCO FOODS LLC WRAY'S LINKEDUNION CORPORATION 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0