2025-02-03T16:05:34-06:00 2024-04-30 320043599 LEGACY PROFESSIONALS LLP 4 WESTBROOK CORPORATE CTR STE 700 WESTCHESTER IL 60154 990 2023-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE 250 ARVADA CO 800022815 MARTIN GARCIA TRUSTEE 3034301118 2025-02-03 1 0 ADAM SIMAGA P01649025 3123680500 2025-02-03 2023 2025-03-06 01:10:19Z MARTIN GARCIA 5511 W 56TH AVE 250 ARVADA CO 800022815 260207094 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 7 3 0 0 0 0 0 0 130926089 136754570 309528 1255517 114054 53914 131349671 138064001 0 0 123407842 119059122 0 0 0 0 0 6516504 7836577 129924346 126895699 1425325 11168302 41712920 52559351 616797 476203 41096123 52083148 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 7 3 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 LEROY WESTMORELAND TRUSTEE 1.00 X 0 0 0 SEAN HAMMOND TRUSTEE 1.00 X 0 0 0 ANDY LUKES TRUSTEE - PAST 1.00 X 0 0 0 BRENT BOHN TRUSTEE - NEW 1.00 X 0 0 0 KIM CORDOVA TRUSTEE 1.00 45.00 X 0 222852 14079 MARTIN GARCIA TRUSTEE 1.00 45.00 X 0 168874 12265 ADRIANA ESCOBAR TRUSTEE 1.00 45.00 X 0 187680 12265 CHRISTINE ARELLANO TRUSTEE 1.00 45.00 X 0 180287 12265 0 759693 50874 0 0 1 0 UMR INC 11 SCOTT STREET WAUSAU WI 54403 MEDICAL BENEFIT ADMINISTRATOR 2266362 ZENITH AMERICAN SOLUTIONS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 2095535 SPENCER FANE LLP 1700 LINCOLN ST STE 2000 DENVER CO 80203 LEGAL SERVICES 353303 REINHART BOERNER VAN DEUREN SC 1000 N WATER ST STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 313654 DELTA DENTAL 6465 GREENWOOD PLAZA BLVD STE 900 CENTENNIAL CO 80111 DENTAL BENEFIT ADMINISTRATOR 278223 8 EMPLOYER CONTRIBUTIONS 900099 121004026 121004026 PARTICIPANT CONTRIBUTIONS 900099 10003024 10003024 PRESCRIPTION DRUG REBATES 900099 5747520 5747520 136754570 1229057 1229057 122169553 122143093 26460 26460 26460 COMMISSION CREDITS 900099 53914 53914 53914 138064001 136754570 0 1309431 119059122 1831680 698590 84852 24152 4688644 356709 52334 70511 FEES MANDATED BY THE AC 29105 126895699 5857525 15391318 11597991 4260912 13028560 12617026 53234 49460 11175610 20240635 41712920 52559351 262592 134568 354205 341635 616797 476203 X 0 0 0 0 41096123 52083148 41096123 52083148 41712920 52559351 11168302 -181277 0 X X 0 1 X 1 0 0 X 130408162 -85008 -85008 130493170 20122 7550709 7570831 138064001 121229019 0 121229019 20122 5646558 5666680 126895699 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 4,203,793. RETIREE PLAN - EMPLOYER CONTRIBUTIONS 2,632,714. RETIREE PLAN - INVESTMENT INTEREST 461,864. RETIREE PLAN - PRESCRIPTION REBATES 209,535. RETIREE PLAN - COMMISSION CREDITS 53,914. RETIREE PLAN - REALIZED GAIN (LOSS) ON INVESTMENTS SOLD -11,111. PART XII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN - MEDICAL PREMIUMS 2,171,523. RETIREE PLAN - MEDICAL BENEFITS 1,766,537. RETIREE PLAN - PRESCRIPTION BENEFITS 946,867. RETIREE PLAN - HMO PREMIUMS 382,616. RETIREE PLAN - ADMINISTRATIVE EXPENSES 313,255. RETIREE PLAN - PPO FEES & PROVIDER FEES 61,065. RETIREE PLAN - INVESTMENT FEES 4,030. RETIREE PLAN - FEES MANDATED BY ACA 665. 0 0 0 KIM CORDOVA TRUSTEE 0 208311 0 0 0 14541 0 1024 0 13055 0 236931 0 0 ADRIANA ESCOBAR TRUSTEE 0 173139 0 0 0 14541 0 1024 0 11241 0 199945 0 0 CHRISTINE ARELLANO TRUSTEE 0 165746 0 0 0 14541 0 1024 0 11241 0 192552 0 0 MARTIN GARCIA TRUSTEE 0 168874 0 0 0 0 0 1024 0 11241 0 181139 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. 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 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 3145355 COST