2018-02-12T11:09:56-06:00 2017-03-31 952648289 VAVRINEK TRINE DAY & CO LLP 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2016-04-01 952301788 UNITED FOOD & COMMERCIAL WORKERS UNIONS & FOOD EMPLOYERS BENEFIT FUND UNIT 7142202297 6425 KATELLA AVE CYPRESS CA 90630 TRUSTEE TRUSTEE ADMINISTRATOR 7142202297 2018-02-12 1 P00739466 4158364000 65.60.100.226 2018-02-12 09:06:37 PS P 6DDAC0003BCC8996D20B35C2703FD2556DD28933 95CE0C244788E45AB842836579C43CA2C7AAE6CD 2016 2021-01-29 14:40:06Z 6425 KATELLA AVE CYPRESS CA 90630 1346856166 0 X N/A X 1964 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 10 10 0 0 0 0 0 0 596158638 581927775 1567887 2323240 4009044 9010847 601735569 593261862 0 0 560250512 559438557 0 0 0 0 0 32054187 30823893 592304699 590262450 9430870 2999412 342420138 332444032 142686786 128188408 199733352 204255624 NONE 0 0 THE PLAN IS A MULTI-EMPLOYER WELFARE BENEFIT PLAN PROVIDING HOSPITAL, MEDICAL, PSYCHIATRIC, PREVENTIVE MEDICINE, DENTAL ORTHODONTIA, PRESCRIPTION DRUG, DEATH, INDUSTRY VACATION AND VISION CARE BENEFITS 0 0 0 0 0 0 0 0 0 0 1 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 8585 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X RON SCHOEN 7142202297 6425 KATELLA AVENUE CYPRESS CA 90630 X GREG CONGER TRUSTEE 5.00 X 0 0 0 RICARDO ICAZA TRUSTEE 5.00 X 0 0 0 RICK BRUER TRUSTEE 5.00 X 0 0 0 MARK RAMOS TRUSTEE 5.00 X 0 0 0 MICHAEL KASPARIAN TRUSTEE 5.00 X 0 0 0 MICHAEL STRAETER TRUSTEE 5.00 X 0 0 0 KATHLEEN A FINAZZO TRUSTEE 5.00 X 0 0 0 FRANK JORGENSEN TRUSTEE 5.00 X 0 0 0 BRENT BOHN TRUSTEE 5.00 X 0 0 0 LEROY WESTMORELAND TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 SC UFCW ADMINISTRATION LLC 6425 KATELLA AVE CYPRESS CA 90630 CONTRACT ADMINISTRATOR 18380441 BLUE CROSS OF CALIFORNIA DEPT 5812 LOS ANGELES CA 90074 CONSULTANT 4481811 HEALTH MANAGEMENT CONCEPTS 181 COMMODORE DR JUPITER FL 33477 CONSULTANT 2009286 SAFEWAY HEALTH INC PO BOX 742820 LOS ANGELES CA 90074 CONSULTANT 802403 SEYFARTHSHAW 2029 CENTURY PARK EAST LOS ANGELES CA 90067 ATTORNEY 508961 13 EMPLOYER CONTRIBUTIONS 900099 525647080 525647080 PARTICIPANT CONT. 900099 56280695 56280695 581927775 3188194 3188194 752729350 753594304 -864954 -864954 -864954 LEGAL SETTLEMENT INCOME 900099 4725077 4725077 MEDICARE PART D SUBSIDY 900099 4073013 4073013 OTHER INCOME 900099 212757 212757 9010847 593261862 590073668 0 3188194 559438557 18380441 941730 66480 374716 51183 212282 COST CONTAINMENT FEES 6460795 BENEFIT CONSULTING 1068321 ACTUARIAL CONSULTANTS 827878 MARKET PRICE DRUG PROGR 802403 1637664 590262450 60344080 51574168 42960908 41745130 195757 207455 156327721 152043214 80904551 84728080 1687121 2145985 342420138 332444032 581814 392953 142104972 127795455 142686786 128188408 X 0 0 0 0 199733352 204255624 199733352 204255624 342420138 332444032 2999412 1522860 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 84728080 F 84728080 GROUP INSURANCE PREMIUMS AND CLAIMS PAYABLE 84676304 CLAIMS INCURRED BUT NOT REPORTED 26508000 ANCILLARY AWARDS AND GRANTS NOT USED 352000 CASH - OPERATING ACCOUNTS (OVERDRAFT) 837106 LIABILITY TO RETURN COLLATERAL FOR SECURITY ON LOAN 7849573 DUE TO OTHER TRUST FUNDS AND LLC 7572472 127795455 X 594784722 1522860 1522860 593261862 0 593261862 590262450 0 590262450 0 590262450 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE ENTITY BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. THE ENTITY BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS PRIOR TO MARCH 31, 2014. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. SO CA UFCW UNIONS & FOOD EMPLOYERS JOINT PENSION TRUST FUND 6425 KATELLA AVENUE CYPRESS CA 90630 951939092 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A 0 SO CA UNITED FOOD & COMM WORKERS UNIONS & FOOD EMPOYERS INDIV ACCT 6425 KATELLA AVENUE CYPRESS CA 90630 330548757 TO PROVIDE ANNUITY PENSION BENEFITS TO ELIGBLE PARTICIPANTS CA 401A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART IV, LINE 34 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ENTITY IS A 501(C)(9) VEBA WHO MUST LIST CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE ADMINISTRATIVE OFFICE MAINTAINS A LIST OF CONTRIBUTIONS EMPLOYERS, HOWEVER, THAT LIST DOES NOT INCLUDE FEDERAL TAX CLASSIFICATION. THEREFORE, THE LIST OF CONTRIBUTING EMPLOYERS IS REPORTED ON PART VII, SUPPLEMENTAL INFORMATION. ALBERTSONS & HAGGEN 2501-1 W. GRANDVIEW ROAD PHOENIX, AZ 85023 BLEIWEISS COMMUNICATIONS BRIDGFORD FOODS DIAMOND BAKERY GELSONS MARKET J J GRACE INC. KEILS FOOD STORES MONTECITO VILLAGE GROCERS PADA SUSHI RALPHS GROCERY CO. RALPH MODUGNO RANCHO FEDERAL CREDIT UNION NAGATANIEN RS FOODS LLC DBA RED SHELL FOODS RICE GARDEN SAVEMART SUPERMARKETS SMITH'S BAKERIES STATER BROS MARKETS SUPER A FOODS UFCW TRUST FUND UFCW LOCAL 135 UFCW LOCAL 324 UFCW LOCAL 770 UFCW LOCAL 8 - GOLDEN STATE UFCW REGION 8 STATES COUNCIL UFCW LOCAL 1167 UFCW LOCAL 1428 UFCW LOCAL 1442 VICENTE FOODS VONS GROCERY CO.