2018-01-08T13:50:48-06:00 2017-04-30 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2016-05-01 870221322 INTERMOUNTAIN UNITED FOOD & COMMERCIAL WORKERS FOOD INDUSTRY INTE 8004534584 4885 SOUTH 900 EAST No 202 SALT LAKE CITY UT 841175746 MICHAEL GITTINGS TRUSTEE 8004534584 2018-01-04 1 RANDY D HENNINGFIELD P01364367 6612953363 108.89.97.154 2018-01-08 11:44:05 PS P 468F7E0B5429FFDB8E266DF0556E3F9FFE9372C5 B174AE6F88008EEA395284392A0091C0770EC910 2016 2021-01-29 14:40:06Z MICHAEL GITTINGS 1201 N DECATUR LAS VEGAS NV 89108 14247089 0 X N/A X 1953 UT HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 6 6 0 0 0 0 0 0 13210874 14206130 29705 40959 0 0 13240579 14247089 0 0 10573407 13227647 0 0 0 0 0 1225680 1149424 11799087 14377071 1441492 -129982 7185461 7926158 3533641 4405075 3651820 3521083 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 14377071 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 14377071 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 1164 0 1 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 X X SOUTHWEST SERVICE ADMINISTRATORSINC 8004534584 4885 SOUTH 900 EAST STE 202 SALT LAKE CITY UT 84117 X IAN ADAMS TRUSTEE 10.00 X 0 0 0 DANNY MA TRUSTEE 10.00 X 0 0 0 CAROL ANDERSON TRUSTEE 10.00 X 0 0 0 DEANNA LEIVAS TRUSTEE 10.00 X 0 0 0 MICHAEL GITTINGS TRUSTEE 10.00 X 0 0 0 RUBEN PEREZ TRUSTEE 10.00 X 0 0 0 0 0 0 0 0 0 0 SOUTHWEST SERVICE ADMINISTRATORS INC 4885 SOUTH 900 EAST SUITE 202 SALT LAKE CITY UT 84117 CONTRACT ADMINISTRATOR 339360 ANTHEM BLUE CROSS 25500 COMMERCENTRE DRIVE LAKE FORREST CA 92630 CLAIMS REPRICING 122850 SSA INC DATA ISIGHT 4885 SOUTH 900 EAST SUITE 202 SALT LAKE CITY UT 84117 CLAIMS REPRICING 121917 3 EMPLOYER CONTRIBUTIONS 445100 12162843 12162843 STOP LOSS RECOVERIES 445100 1190252 1190252 EMPLOYEE COPAY 445100 634033 634033 RETIREE CONTRIBUTIONS 445100 107202 107202 PRESCRIPTION REBATE 445100 102506 102506 9294 9294 14206130 40959 40959 14247089 14206130 0 40959 13227647 13227647 339360 339360 40130 40130 22639 22639 29497 29497 12267 12267 13183 13183 COST CONTAINMENT 452706 452706 CONSULTING 157743 157743 REINSURANCE FEES 54819 54819 BANK SERVICE CHARGE 11847 11847 15233 15233 14377071 14377071 0 0 5758561 5421402 1376087 2478820 50813 25936 7185461 7926158 97641 220075 3436000 4185000 3533641 4405075 X 0 0 0 0 3651820 3521083 3651820 3521083 7185461 7926158 -129982 -755 0 X 0 1 X 1 0 0 IBNR PAYABLE 2129000 ACCUM ELIG CREDITS PAYABLE 2056000 4185000 14244834 -755 -755 14245589 1500 1500 14247089 13626571 0 13626571 1500 749000 750500 14377071 Part XII, Line 4b - Other Adjustments: CHANGE IN IBNR & EXTENDED ELIGIBILITY 749,000. Form 990, Part VI, Section A, line 3 The Trustees have contracted with a third party administrator to perform the everyday administration of the fund. Form 990, Part VI, Section B, line 11b A copy of Form 990 was presented to the trustees for review and signatures. Form 990, Part VI, Section C, line 19 Summary Annual Reports are provided to all participants annually. SPDs and audited financial statements are available from the administrator upon request, as well as the DOL website. Form 990, Part VII Contact Addresses for Officers, Directors, Etc IAN ADAMS - 4885 SO. 900 EAST, SALT LAKE CITY, UT 84117. DANNY MA - 1421 S. MANHATTAN AVE.,, FULLERTON, CA 92831. CAROL ANDERSON - 1201 N. DECATUR, LAS VEGAS, NV 89108. DEANNA LEIVAS - 1201 N. DECATUR, LAS VEGAS, NV 89108. MICHAEL GITTINGS - 1201 N. DECATUR, LAS VEGAS, NV 89108. RUBEN PEREZ - 4885 SO. 900 EAST, SALT LAKE CITY, UT 84117. ALBERTSON'S 1421 S MANHATTA AVE FULLERTON CA 92831 204057706 RETAIL GROCERS CA C 0 SMITH'S FOOD 4 LESS 4885 S 900 EAST SALT LAKE CITY UT 84117 870258768 RETAIL GROCERS CA C 0 VONS SAFEWAY 618 MICHILLINDA AVE ARCADIA CA 91007 381623900 RETAIL GROCERS CA C 0 UFCW LOCAL 711 1201 NORTH DECATUR LAS VEGAS NV 89108 880057132 LABOR UNION NV C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0