2025-08-05T17:27:56-05:00 2024-09-29 420714325 RSM US LLP 400 LOCUST ST STE 640 DES MOINES IA 503092372 990 2023-10-02 421170511 HY-VEE AND AFFILIATES' BENEFIT PLAN AND TRUST HY-V 5152672800 5820 WESTOWN PARKWAY WEST DES MOINES IA 50266 ANDREW SCHREINER TRUSTEE 5152672800 2025-07-31 1 0 TY P DOGGETT P00810916 5155586600 2025-07-29 2023 2025-03-06 01:10:19Z ANDREW SCHREINER 5820 WESTOWN PARKWAY WEST DES MOINES IA 50266 213249431 0 X N/A X 1981 IA IT IS THE MISSION OF THE HY-VEE AND AFFILIATES BENEFIT PLAN TO MAKE EMPLOYEE'S LIVES EASIER, HEALTHIER, AND HAPPIER BY PROVIDING FOR THE HEALTH AND RELATED BENEFIT NEEDS OF THE ADOPTING COMPANIES' EMPLOYEES AND THEIR DEPENDENTS. 3 0 0 3 0 0 0 0 216490887 212696263 658503 553168 0 0 217149390 213249431 0 0 193691573 205517301 0 0 0 0 0 12343792 12287166 206035365 217804467 11114025 -4555036 32189368 27178762 24343147 27588292 7846221 -409530 TO PROVIDE QUALITY, COST-EFFECTIVE AND COMPREHENSIVE MEDICAL, DENTAL, LIFE AND DISABILITY BENEFITS; TO PROVIDE MEANINGFUL INFORMATION, RESOURCES, AND ASSISTANCE; AND TO PROVIDE PREVENTIVE AND WELLNESS-RELATED INTERVENTIONS AND PROGRAMS. 0 0 THIS TRUST IS ESTABLISHED TO PROVIDE FOR THE HEALTH AND RELATED BENEFIT NEEDS OF THE ADOPTING COMPANIES' EMPLOYEES AND THEIR DEPENDENTS. DURING THE YEAR, THE PLAN PROVIDED BENEFITS TO ABOUT 16,000 EMPLOYEES. 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 0 0 0 1 1 0 0 0 0 0 0 0 X 3 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X ANDREW SCHREINER 5152672800 5820 WESTOWN PARKWAY WEST DES MOINES IA 50266 X KRISTINE JONES TRUSTEE 1.00 40.00 X 0 0 0 ANDREW SCHREINER TRUSTEE 1.00 40.00 X 0 0 0 MICHAEL JURGENS TRUSTEE 1.00 40.00 X 0 0 0 0 0 0 0 0 0 0 WELLMARK INC 636 GRAND AVE DES MOINES IA 503092565 CONTRACT ADMINISTRATOR 6893592 UMR INC 400 E BUSINESS WAY SUITE 100 CINCINNATI OH 45241 CONTRACT ADMINISTRATOR 2029659 VIVID CLEAR RX 13220 BIRCH DRIVE SUITE 200 OMAHA NE 68164 ADMINISTRATOR 752790 DELTA DENTAL 2401 SE TONES DR 13 ANKENY IA 500218665 ADMINISTRATOR 695111 APLOS HEALTH PLANS INC 7300 WESTOWN PKWY SUITE 330 WEST DES MOINES IA 50266 ADMINISTRATOR 548332 10 EMPLOYER CONTRIBUTIONS 900099 160585641 160585641 EMPLOYEE CONTRIBUTIONS 900099 52110622 52110622 212696263 553168 553168 213249431 212696263 0 553168 205517301 11924918 317947 INCOME TAXES 41667 MISCELLANEOUS EXPENSES 2634 217804467 138022 23743000 14141000 7674157 12058746 772211 840994 32189368 27178762 2162777 1707207 22180370 25881085 24343147 27588292 X 7846221 -409530 0 0 0 0 7846221 -409530 32189368 27178762 X -4555036 -3700715 X 0 1 X 0 0 0 BENEFIT OBLIGATIONS 25881085 25881085 X 213249431 0 213249431 0 213249431 217804467 0 217804467 0 217804467 PART X, LINE 2: THE TRUST ESTABLISHED UNDER THE PLAN TO HOLD THE PLAN'S NET ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE SPONSOR HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER DATED MAY 18, 1982 FROM THE INTERNAL REVENUE SERVICE AND THE SPONSOR BELIEVES THAT THE TRUST, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE AS DESIGNED. MANAGEMENT HAS EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAS MAINTAINED ITS TAX EXEMPT STATUS AND HAS TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE FINANCIAL STATEMENTS. HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME, THE TRUST MAY BE SUBJECT TO INCOME TAXES ON UNRELATED BUSINESS INCOME. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2024 OR 2023. GENERALLY, THE STATUTE OF LIMITATIONS FOR EXAMINATION OF U.S. FEDERAL OR STATE TAX RETURNS IS THREE YEARS AND IS CONSIDERED CLOSED UPON REVIEW BY THE TAXING JURISDICTION. FORM 990, PART VI, SECTION A, LINE 2 THE TRUSTEES HAVE A BUSINESS RELATIONSHIP AS THEY ARE EMPLOYED BY THE SAME COMPANY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FINAL FORM 990, AS FILED WITH THE IRS, IS PROVIDED TO THE TRUSTEES PRIOR TO FILING THE FORM. THE TRUSTEES ARE AVAILABLE FOR REVIEW PRIOR TO FILING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C HY-VEE AND AFFILIATES' BENEFIT PLAN AND TRUST HAS A CONFLICT OF INTEREST POLICY. TRUSTEES ANNUALLY COMPLETE AND SIGN A CONFLICT OF INTEREST STATEMENT. TO THE EXTENT A TRUSTEE HAS A CONFLICT OF INTEREST, THEY LEAVE THE ROOM AND ABSTAIN FROM VOTING ON SUCH MATTER. IDENTIFIED CONFLICT OF INTEREST SITUATIONS AND DELIBERATIONS ARE CONTEMPORANEOUSLY DOCUMENTED IN THE MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FOR VIEWING IN THE OFFICE OF THE PLAN ADMINISTRATOR. THE FORM 990 IS AVAILABLE ON GUIDESTAR.ORG. FORM 990, PART VII, SECTION A, LINE 1A(B): THE TRUSTEES ARE EMPLOYEES OF THE RELATED ORGANIZATION AND SERVE AS VOLUNTEER TRUSTEES FOR THE ORGANIZATION. FORM 990, PART XI, LINE 9: ADJUSTMENT TO BENEFIT OBLIGATIONS -3,700,715. HY-VEE INC 5820 WESTOWN PARKWAY WEST DES MOINES IA 50266 420325638 RETAIL SALES IA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1