2021-02-26T15:50:32-06:00 2020-04-30 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CTR 700 WESTCHESTER IL 60154 990 2019-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 800022815 KEVIN SCHNEIDER TRUSTEE 3034301118 2021-02-26 1 ADAM SIMAGA P01649025 3123680500 2021-02-26 2019 2022-09-23 18:48:47Z KEVIN SCHNEIDER 5511 W 56TH AVE NO 250 ARVADA CO 800022815 145374932 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 8 4 0 0 0 0 0 0 117023707 122545038 743196 658056 144283 74672 117911186 123277766 0 0 113879571 122895383 0 0 0 0 0 9122975 6475590 123002546 129370973 -5091360 -6093207 45762361 40352739 800079 1476484 44962282 38876255 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 STEVE DICROCE TRUSTEE - PAST 1.00 X 0 0 0 BOB MCLAUCHLIN TRUSTEE 1.00 X 0 0 0 DANNY MA TRUSTEE 1.00 X 0 0 0 LEROY WESTMORELAND TRUSTEE 1.00 X 0 0 0 SEAN HAMMOND TRUSTEE - NEW 1.00 X 0 0 0 KIM CORDOVA TRUSTEE 1.00 45.00 X 0 202671 12485 KEVIN SCHNEIDER TRUSTEE 1.00 45.00 X 0 173537 11076 MARTIN GARCIA TRUSTEE 1.00 45.00 X 0 160416 11076 DALE LEE TRUSTEE - PAST 1.00 45.00 X 0 166596 11076 ADRIANA ESCOBAR TRUSTEE - NEW 1.00 45.00 X 0 169493 10866 0 872713 56579 0 0 1 0 ZENITH AMERICAN SOLUTIONS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 2404960 THE SEGAL COMPANY INC 101 N WACKER DRIVE STE 500 CHICAGO IL 60606 CONSULTING SERVICES 399605 REINHART BOERNER VAN DEUREN SC 1000 N WATER ST STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 351632 SPENCER FANE LLP 1700 LINCOLN ST STE 2000 DENVER CO 80203 LEGAL SERVICES 188160 HORIZON ACTUARIAL SERVICES LLC 420 EXCHANGE STE 260 IRVINE CA 92602 ACTUARIAL SERVICES 158063 6 EMPLOYER CONTRIBUTIONS 900099 106215225 106215225 PARTICIPANT CONTRIBUTIONS 900099 11698792 11698792 PRESCRIPTION REBATES 900099 4627493 4627493 MEDICARE PT. D RETIREE DRUG SUBSI 900099 3528 3528 122545038 615980 615980 22139242 22097166 42076 42076 42076 COMMISSION CREDITS 900099 72967 72967 MISCELLANEOUS INCOME 900099 1705 1705 74672 123277766 122545038 0 732728 122895383 2091976 489882 131068 21145 3314212 305167 33427 52053 FEES MANDATED BY ACA 36660 129370973 6601094 3477943 13944799 12746655 8724038 12055765 49027 1825 16443403 12070551 45762361 40352739 385219 1073824 414860 402660 800079 1476484 X 0 0 0 0 44962282 38876255 44962282 38876255 45762361 40352739 -6093207 7180 0 X X 0 1 X 1 0 0 X 115279134 7180 7180 115271954 21145 7984667 8005812 123277766 122118108 0 122118108 21145 7231720 7252865 129370973 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 - EMPLOYER CONTRIBUTIONS 2,710,440. RETIREE PLAN - INVESTMENT INTEREST 61,041. RETIREE PLAN - RETIREE CONTRIBUTIONS 4,953,092. RETIREE PLAN - PRESCRIPTION REBATES 183,599. RETIREE PLAN - MEDICARE PT. D RETIREE DRUG SUBSIDIES 3,528. RETIREE PLAN - COMMISSION CREDITS 72,967. PART XII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN - MEDICAL BENEFITS 2,320,636. RETIREE PLAN - PRESCRIPTION BENEFITS 722,448. RETIREE PLAN - MEDICAL PREMIUMS 3,503,928. RETIREE PLAN - HMO PREMIUMS 367,861. RETIREE PLAN - PPO FEES & PROVIDER FEES 70,493. RETIREE PLAN - ADMINISTRATIVE EXPENSES 242,318. RETIREE PLAN - FEES MANDATED BY ACA 4,036. 0 0 0 KIM CORDOVA TRUSTEE 0 190081 0 0 0 12590 0 2184 0 10301 0 215156 0 0 KEVIN SCHNEIDER TRUSTEE 0 160947 0 0 0 12590 0 2184 0 8892 0 184613 0 0 MARTIN GARCIA TRUSTEE 0 160416 0 0 0 0 0 2184 0 8892 0 171492 0 0 DALE LEE TRUSTEE - PAST 0 154206 0 0 0 12390 0 2184 0 8892 0 177672 0 0 ADRIANA ESCOBAR TRUSTEE - NEW 0 157103 0 0 0 12390 0 1974 0 8892 0 180359 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 CONTRIBUTION 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 3813205 COST