2020-08-10T17:29:35-05:00 2019-09-30 208149084 ANASTASI MOORE & MARTIN PLLC 9 S WASHINGTON ST STE 600 SPOKANE WA 99201 990 2018-10-01 810305103 MONTANA RETAIL STORE EMPLOYEES HEALTH & HEALTH & WELFARE TRUST MONT 2062824100 11724 NE 195TH STREET NO 300 BOTHELL WA 980118242 DANNY MA CHAIRMAN 2062824100 2020-08-06 1 PAUL ANASTASI P00395796 5093230272 2020-08-06 209.210.95.36 2020-08-06 15:32:09 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 46CAEAA8ACE1A846D2D686457D1D3826578CD455 2018 2020-09-23 17:36:50Z DANNY MA 11724 NE 195TH STREET NO 300 BOTHELL WA 980118242 11528402 0 X N/A X 1968 MT TO PROVIDE HEALTH AND WELFARE BENEFITS FOR COVERED EMPLOYEES IN ACCORDANCE WITH THE PLAN. 6 6 0 6 0 0 0 0 10618493 11161304 114002 170061 0 197037 10732495 11528402 0 0 8934669 10098243 0 0 0 0 0 1143224 1048452 10077893 11146695 654602 381707 13198685 13937047 3909650 4214050 9289035 9722997 TO PROVIDE HEALTH AND WELFARE BENEFITS FOR COVERED EMPLOYEES IN ACCORDANCE WITH THE PLAN. 0 0 11146695 TO PROVIDE HEALTH AND WELFARE BENEFITS FOR COVERED EMPLOYEES IN ACCORDANCE WITH THE PLAN. 11146695 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 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 0 0 0 WA X ZENITH AMERICAN SOLUTIONS 2062824100 11724 NE 195TH STREET BOTHELL WA 980118242 X KATINA WOOD TRUSTEE 1.00 0.00 X 0 0 0 STEFANIE GUSHA TRUSTEE 1.00 0.00 X 0 0 0 SARA THODY TRUSTEE 1.00 0.00 X 0 0 0 TERRIE TRETTENBACH TRUSTEE 1.00 0.00 X 0 0 0 DANNY MA CHAIRMAN 1.00 0.00 X X 0 0 0 NICOLAI COCERGINE SECRETARY 1.00 0.00 X X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 11724 NE 195TH STREET SUITE 300 BOTHELL WA 980118242 CONTRACT ADMINSTRATION 330738 MEDICAL REHABILITATION CONSULTANTS INC 111 WEST CATALDO AVENUE SUITE 200 SPOKANE WA 99201 HEALTH CARE MANAGEMENT 243154 2 EMPLOYER CONTRIBUTIONS 445100 10437296 10437296 EMPLOYEE CONTRIBUTIONS 445100 724008 724008 11161304 170061 170061 PRESCRIPTION REBATES 445100 158215 158215 LIQUIDATED DAMAGES 445100 38822 38822 197037 11528402 11358341 0 170061 10098243 10098243 314921 314921 70468 70468 17582 17582 2071 2071 560121 560121 17482 17482 22471 22471 6415 6415 PRINTING EXPENSES 19783 19783 BANK SERVICE FEES 12593 12593 MISCELLANEOUS 4545 4545 11146695 11146695 0 0 7356770 7845860 980725 1043120 0 5127 5127 4856063 5042940 13198685 13937047 625824 40898 3283826 4173152 3909650 4214050 X 0 0 0 0 9289035 9722997 9289035 9722997 13198685 13937047 381707 52255 0 X 0 1 X 0 0 0 CHECKS ISSUED IN EXCESS OF DEPOSITS 267278 AMOUNTS CURRENTLY PAYABLE TO/FOR PARTICIPANTS, BENEFICIARIES, AND DEPENDENTS 356774 OTHER OBLIGATIONS FOR CURRENT BENEFIT COVERAGE, AT PV OF ESTIMATED AMOUNTS 3549100 4173152 X 11578586 52255 52255 11526331 2071 2071 11528402 10522576 0 10522576 2071 622048 624119 11146695 PART X, LINE 2: THE UNITED STATES TREASURY DEPARTMENT ADVISED IN A LETTER DATED APRIL 27, 1971, THAT THE PLAN IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. THE BOARD OF TRUSTEES BELIEVES THE PLAN, AS AMENDED, CONTINUES TO QUALIFY AND TO OPERATE IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE IRC. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS). THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2019, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF THE LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS AND THE PLAN COULD BE SUBJECT TO INCOME TAX IF CERTAIN ISSUES WERE FOUND BY THE IRS THAT COULD RESULT IN THE DISQUALIFICATION OF THE PLAN'S TAX-EXEMPT STATUS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN AMOUNTS DUE TO INSURANCE COMPANY 198,948. CHANGE IN CLAIMS INCURRED BUT NOT REPORTED 290,000. CHANGE IN LIABILITY FOR FUTURE BENEFITS 133,100. FORM 990, PART VI, SECTION A, LINE 3 THE PLAN CONTRACTS WITH A THIRD-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. TO CARRY OUT THE DAY TO DAY ADMINISTRATION OF THE PLAN. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS PROVIDED TO THE BOARD AND REVIEWED BY THE BOARD BEFORE ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL LETTERS ARE MAILED AND COLLECTED FROM EACH TRUSTEE. TRUST COUNSEL ASKS FOR ANY KNOWN ISSUES AT EACH TRUSTEE MEETING. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND OTHER DOCUMENTS ARE AVAILABLE UPON REQUEST THROUGH THE PLAN'S ADMINISTRATOR. ALBERTSONS LLC 250 PARKCENTER BOULEVARD BOISE ID 83706 ID SAFEWAY INC 5918 STONERIDGE MALL ROAD PLEASANTON CA 94588 CA ROSAUERS SUPERMARKETS INC 1815 WEST GARLAND AVENUE SPOKANE WA 99205 WA VAN'S THRIFTWAY 306 EUCLID AVENUE HELENA MT 59601 MT GARY & LEO'S FRESH FOODS IGA 730 1ST STREET HAVRE MT 59501 MT BOB WARD & SONS INC 3015 PAXSON STREET MISSOULA MT 59801 MT WESTERN MEAT & SAUSAGE BLOCK 820 DEWEY BOULEVARD BUTTE MT 59701 MT 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 TRANSACTIONS WITH RELATED PARTNERSHIPS S 5888475 CASH TRANSACTIONS WITH RELATED CORPORATIONS S 4850205 CASH