RETAIL STORE EMPLOYEES HEALTH AND: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- RETAIL STORE EMPLOYEES HEALTH AND (EIN 82-0289815)
- Tax period
- 2014-11-01 to 2015-10-31
- Filed
- 2016-04-04
- IRS object ID
- 201630959349300913
- Schema version
- 2014v6.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-04-04T16:27:48-05:00 | ReturnTs |
| Tax Period End | 2015-10-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 542189926 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Henningfield & Associates Inc | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27913 Smyth Drive | AddressLine1Txt |
| City | Valencia | CityNm |
| State Abbreviation | CA | StateAbbreviationCd |
| ZIP | 91355 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-11-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 820289815 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RETAIL STORE EMPLOYEES HEALTH AND WELFARE TRUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | RETA | BusinessNameControlTxt |
| Phone | 8012663271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4885 SOUTH 900 EAST No 202 | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84117 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JACKI FAERBER | PersonNm |
| Person Title | TRUSTEE | PersonTitleTxt |
| Phone | 8004534584 | PhoneNum |
| Signature | 2016-03-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RANDY D HENNINGFIELD | PreparerPersonNm |
| PTIN | P01364367 | PTIN |
| Phone | 6612953363 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JACKI FAERBER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4885 SOUTH 900 EAST | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84117 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $6,474,522 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Trust | Yes (X) | TypeOfOrganizationTrustInd |
| Formation | 1968 | FormationYr |
| Legal Domicile State | UT | LegalDomicileStateCd |
| Activity Or Mission | HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,176,693 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,038,570 | CYProgramServiceRevenueAmt |
| PY Investment Income | $39,461 | PYInvestmentIncomeAmt |
| CY Investment Income | $22,605 | CYInvestmentIncomeAmt |
| PY Other Revenue | $78,916 | PYOtherRevenueAmt |
| CY Other Revenue | $45,347 | CYOtherRevenueAmt |
| PY Total Revenue | $4,295,070 | PYTotalRevenueAmt |
| CY Total Revenue | $5,106,522 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $4,506,629 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $5,657,419 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $454,778 | PYOtherExpensesAmt |
| CY Other Expenses | $596,814 | CYOtherExpensesAmt |
| PY Total Expenses | $4,961,407 | PYTotalExpensesAmt |
| CY Total Expenses | $6,254,233 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$666,337 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,147,711 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,721,908 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,814,760 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,781,532 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,022,098 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $940,376 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$207,338 | NetAssetsOrFundBalancesEOYAmt |
| Mission | HEALTH AND WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,254,233 | ExpenseAmt |
| Desc | HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. | Desc |
| Total Program Service Expenses | $6,254,233 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 416 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8012663271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4885 SOUTH 900 EAST SUITE 202 | AddressLine1Txt |
| City | SALT LAKE CITY | CityNm |
| State Abbreviation | UT | StateAbbreviationCd |
| ZIP | 84117 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|
| DANNY MA | |||||
| TRUSTEE | 10.00 | Yes (X) | $0 | $0 | $0 |
| JACKI FAERBER | |||||
| TRUSTEE | 10.00 | Yes (X) | $0 | $0 | $0 |
| STEPHANIE GUSHA | |||||
| TRUSTEE | 10.00 | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CIGNA | |||||
| PO BOX 20643 | LEHIGH VALLEY | PA | 18002 | PPO NETWORK | $214,557 |
| JAS INC | |||||
| 4885 SOUTH 900 EAST STE 202 | SALT LAKE CITY | UT | 84117 | CONTRACT ADMINISTRATOR | $108,652 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| EMPLOYER CONTRIBUTIONS | 445100 | $4,437,025 | $4,437,025 |
| PARTICIPANT CONTRIBUTIONS | 445110 | $601,545 | $601,545 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,038,570 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,177 | TotalRevenueColumnAmt |
| Exclusion | $21,177 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,369,428 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,368,000 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,428 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,428 | TotalRevenueColumnAmt |
| Exclusion | $1,428 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| STOP LOSS RECOVERIES | 445100 | $23,327 | $23,327 |
| SUBROGATIONS | 445100 | $14,139 | $14,139 |
| PRESCRIPTION REBATES | 445100 | $7,881 | $7,881 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $45,347 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,106,522 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,083,917 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $22,605 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,657,419 | TotalAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,652 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,603 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,714 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,579 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,310 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,726 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt |
|---|---|
| COST CONTAINMENT FEES | $222,430 |
| REINSURANCE FEES | $64,786 |
| ADMINISTRATION - CIGNA | $56,546 |
| CONSULTING FEES | $51,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,468 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,254,233 | TotalAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $577,448 | BOYAmt |
| EOY | $984,636 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,749,874 | BOYAmt |
| EOY | $377,404 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $388,817 | BOYAmt |
| EOY | $446,289 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,769 | BOYAmt |
| EOY | $6,431 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,721,908 | BOYAmt |
| EOY | $1,814,760 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,232 | BOYAmt |
| EOY | $38,250 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,750,300 | BOYAmt |
| EOY | $1,983,848 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,781,532 | BOYAmt |
| EOY | $2,022,098 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $940,376 | BOYAmt |
| EOY | -$207,338 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $940,376 | BOYAmt |
| EOY | -$207,338 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,721,908 | BOYAmt |
| EOY | $1,814,760 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,147,711 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$3 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| IBNR PAYABLE | $960,000 |
| ACCUMULATED ELIG CREDITS PAYABLE | $1,023,848 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,983,848 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $5,106,519 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$3 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$3 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,106,522 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,106,522 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $6,020,685 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $6,020,685 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $233,548 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $233,548 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $6,254,233 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part XII, Line 4b - Other Adjustments: | FormAndLineReferenceDesc |
| Explanation | CHANGE IN IBNR AND EXTENDED ELIBIGILITY 233,548. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 11 | 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 and SPDs are available from the administrator upon request. Audited financial statements are available to the public by request of the DOL or the administrator. |
| Form 990, Part VII | DANNY MA - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. JACKI FAERBER - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. STEPHANIE GUSHA - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|
| SUPERVALU | ||||||||
| 1421 S MANHATTAN AVE | FULLERTON | CA | 92831 | 204057706 | RETAIL GROCERS | CA | C | 0 |
| SMITH'S | ||||||||
| 4885 S 900 EAST | SALT LAKE CITY | UT | 84117 | 870258768 | RETAIL GROCERS | UT | C | 0 |
| UFCW 368 | ||||||||
| 222 BROADWAY AVE | BOISE | ID | 83706 | 820180912 | LABOR UNION | ID | T | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |