2016-04-04T16:27:48-05:00 2015-10-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2014-11-01 820289815 RETAIL STORE EMPLOYEES HEALTH AND WELFARE TRUST RETA 8012663271 4885 SOUTH 900 EAST No 202 SALT LAKE CITY UT 84117 JACKI FAERBER TRUSTEE 8004534584 2016-03-17 1 RANDY D HENNINGFIELD P01364367 6612953363 2014 2016-08-17 19:52:53Z JACKI FAERBER 4885 SOUTH 900 EAST SALT LAKE CITY UT 84117 6474522 0 X N/A X 1968 UT HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 3 3 0 0 0 0 0 0 4176693 5038570 39461 22605 78916 45347 4295070 5106522 0 0 4506629 5657419 0 0 0 0 0 454778 596814 4961407 6254233 -666337 -1147711 2721908 1814760 1781532 2022098 940376 -207338 HEALTH AND WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 6254233 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 6254233 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 1 416 0 1 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 X JAS INC 8012663271 4885 SOUTH 900 EAST SUITE 202 SALT LAKE CITY UT 84117 X DANNY MA TRUSTEE 10.00 X 0 0 0 JACKI FAERBER TRUSTEE 10.00 X 0 0 0 STEPHANIE GUSHA TRUSTEE 10.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA PO BOX 20643 LEHIGH VALLEY PA 18002 PPO NETWORK 214557 JAS INC 4885 SOUTH 900 EAST STE 202 SALT LAKE CITY UT 84117 CONTRACT ADMINISTRATOR 108652 2 EMPLOYER CONTRIBUTIONS 445100 4437025 4437025 PARTICIPANT CONTRIBUTIONS 445110 601545 601545 5038570 21177 21177 1369428 1368000 1428 1428 1428 STOP LOSS RECOVERIES 445100 23327 23327 SUBROGATIONS 445100 14139 14139 PRESCRIPTION REBATES 445100 7881 7881 45347 5106522 5083917 0 22605 5657419 108652 23603 15714 17579 5310 10726 COST CONTAINMENT FEES 222430 REINSURANCE FEES 64786 ADMINISTRATION - CIGNA 56546 CONSULTING FEES 51000 20468 6254233 577448 984636 1749874 377404 388817 446289 5769 6431 2721908 1814760 31232 38250 1750300 1983848 1781532 2022098 X 0 0 0 0 940376 -207338 940376 -207338 2721908 1814760 -1147711 -3 0 X 0 1 X 1 0 0 IBNR PAYABLE 960000 ACCUMULATED ELIG CREDITS PAYABLE 1023848 1983848 5106519 -3 -3 5106522 0 5106522 6020685 0 6020685 233548 233548 6254233 Part XII, Line 4b - Other Adjustments: CHANGE IN IBNR AND EXTENDED ELIBIGILITY 233,548. 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. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0