2018-03-09T14:34:32-06:00 2017-04-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2016-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 800022815 STEVE DICROCE TRUSTEE 3034301118 2018-03-09 1 BRUCE PAVLIK P00748405 3123680500 12.197.118.215 2018-03-09 14:33:36 CS P D56625F7C0621E1EB8BA8C5A7372C18F0F4BC985 C3168D624729577079CA47B99B0ED2C5793BD89E 2016 2021-01-29 14:40:06Z STEVE DICROCE 5511 W 56TH AVE NO 250 ARVADA CO 800022815 121768020 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 6 3 0 0 0 0 0 0 119216193 121140907 20078 24474 117263 101689 119353534 121267070 0 0 107993683 111406082 0 0 0 0 0 8887423 9248353 116881106 120654435 2472428 612635 46848945 47684591 391010 967876 46457935 46716715 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 1 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 X 6 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 STEVE DICROCE TRUSTEE 1.00 X 0 0 0 BRYAN SMITH TRUSTEE 1.00 X 0 0 0 DANNY MA TRUSTEE 1.00 X 0 0 0 KIM CORDOVA TRUSTEE 1.00 45.00 X 0 186492 12600 KEVIN SCHNEIDER TRUSTEE 1.00 45.00 X 0 162408 12600 NATHANIEL BERNSTEIN TRUSTEE 1.00 45.00 X 0 158204 12600 0 507104 37800 0 0 1 0 CIGNA 900 COTTAGE GROVE ROAD HARTFORD CT 06152 PPO ACCESS AND ADMIN FEES 4871304 ZENITH AMERICAN SOLUTIONS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 2304262 DELTA DENTAL 4582 S ULSTER STREET STE 800 DENVER CO 80237 DENTAL BENEFIT ADMIN FEES 311216 REINHART BOERNER VAN DEURAN SC 1000 N WATER ST STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 197354 MINES & ASSOCIATES 10367 CENTENNIAL RD 100 LITTLETON CO 80127 MENTAL HEALTH ADMIN FEES 185605 8 EMPLOYER CONTRIBUTIONS 900099 105541721 105541721 PARTICIPANT CONTRIBUTIONS 900099 12141621 12141621 PRESCRIPTION REBATES 900099 2891147 2891147 MEDICARE PT. D RETIREE DRUG SUBSI 900099 506866 506866 BENEFITS CLAIMS REFUND 900099 59552 59552 121140907 25424 25424 500000 500950 -950 -950 -950 COMMISSION CREDITS 900099 52855 52855 MISCELLANEOUS INCOME 900099 48834 48834 101689 121267070 121140907 0 126163 111406082 1992576 343974 79512 6057252 335175 23761 50778 FEES MANDATED BY ACA 365325 120654435 3744585 4238465 31593021 33113517 11010389 10283497 49112 500950 0 46848945 47684591 288860 213628 102150 449495 0 304753 391010 967876 X 0 0 0 0 46457935 46716715 46457935 46716715 46848945 47684591 X 612635 -353855 0 X X 0 1 X 1 0 0 EMPLOYER REFUND PAYABLE 302197 DUE TO RELATED ORGANIZATIONS 2556 304753 X 111670681 0 111670681 9596389 9596389 121267070 111176732 0 111176732 9477703 9477703 120654435 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 LIKLEY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISIDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN - EMPLOYER CONTRIBUTIONS 2,771,504. RETIREE PLAN - INVESTMENT INTEREST 4,155. RETIREE PLAN - RETIREE CONTRIBUTIONS 5,452,605. RETIREE PLAN - PRESCRIPTION REBATES 789,487. RETIREE PLAN - MEDICARE PT. D RETIREE DRUG SUBSIDIES 506,866. RETIREE PLAN - REALIZED LOSS ON INVESTMENT SOLD -950. RETIREE PLAN - BENEFIT CLAIMS REFUND 19,867. RETIREE PLAN - COMMISSION CREDITS 52,855. PART XII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN - MEDICAL BENEFITS 2,431,497. RETIREE PLAN - PRESCRIPTION BENEFITS 4,356,377. RETIREE PLAN - MEDICAL PREMIUMS 2,016,129. RETIREE PLAN - HMO PREMIUMS 115,943. RETIREE PLAN - PPO FEES & PROVIDER FEES 251,346. RETIREE PLAN - ADMINISTRATIVE EXPENSES 291,818. RETIREE PLAN - FEES MANDATED BY ACA 14,593. RETIREE PLAN - INVESTMENT FEES 0 0 0 KIM CORDOVA TRUSTEE 0 184553 0 0 0 1939 0 2694 0 9906 0 199092 0 0 KEVIN SCHNEIDER TRUSTEE 0 162027 0 0 0 381 0 2694 0 9906 0 175008 0 0 NATHANIEL BERNSTEIN TRUSTEE 0 157222 0 0 0 982 0 2694 0 9906 0 170804 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS DELEGATED THE RECORD KEEPING AND DAY TO DAY ADMINISRATION 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 BOARDS REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANY NONADHERANCE 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. FORM 990, PART XI, LINE 8: ADJUSTMENT OF <353,855> DUE TO AN OVERSTATEMENT IN PARTICIPANT CONTRIBUTIONS IN THE PRIOR YEAR. ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS 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 DENVER AREA MEAT CUTTERS AND EMPLOYERS PENSION PLAN 5511 W 56TH AVE SUITE 250 ARVADA CO 80002 846097461 PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS AND BENEFICIARIES CO 401(A) N/A 0 UNITED FOOD AND COMMERICAL WORKERS INTERNATIONAL UNION 7R LOCAL CONTRIBUTING EMPLOYER 0 ALBERTSONS SAFEWAY CONTRIBUTING EMPLOYER 0 ALMAGNO FREELANCE CONTRIBUTING EMPLOYER 0 DARLING INTERNATIONAL CONTRIBUTING EMPLOYER 0 DEBONAIRE HAIR CONTRIBUTING EMPLOYER 0 DENVER PROCESSING (KS - MEAT PLANT) CONTRIBUTING EMPLOYER 0 IMAGES - A LIZZI CONTRIBUTING EMPLOYER 0 KING SOOPERSCITY MARKET CONTRIBUTING EMPLOYER 0 THE PERFECT TOUCH 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 PENSION PLAN S 3985690 COST DENVER AREA MEAT CUTTERS & EMPLOYERS PENSION PLAN S 191970 COST