2014-02-15T15:49:27-06:00 2013-03-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PKWY SUITE 400 SAN RAMON CA 945834210 990 2012-04-01 911950259 RETAIL CLERKS RETIREE WELFARE TRUST RETA 2062824100 201 QUEEN ANNE AVENUE NORTH NO 100 SEATTLE WA 98109 RANDY ZEILER 2062824100 2014-02-18 1 KATHLEEN D HAAB P01068129 9252779100 2012 2015-11-30 17:44:51Z RANDY ZEILER 201 QUEEN ANNE AVENUE NORTH NO 100 SEATTLE WA 98109 5856698 0 X WWW.SOUNDHEALTHWELLNESS.COM X 1998 WA TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS 12 1 0 0 2853 2853 0 0 1999736 2245067 654670 934102 432579 0 3086985 3179169 0 0 3464459 4377729 0 0 0 0 0 373943 371652 3838402 4749381 -751417 -1570212 17019554 16039762 570517 793284 16449037 15246478 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS. 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 0 0 0 1 1 0 0 0 0 0 X 12 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X ZENITH AMERICAN SOLUTIONS INC 2062824100 201 QUEEN ANNE AVE NORTH SEATTLE WA 981094896 X RANDY ZEILER 1.20 X 0 0 0 DERRICK ANDERSON 1.20 X 0 0 0 BRENT R BOHN 1.20 X 0 0 0 FRANK JORGENSEN 1.20 X 0 0 0 SCOTT KLITZKE POWERS 1.20 X 0 0 0 CARL WOJCIECHOWSKI 1.20 X 0 0 0 DAVID BLITZSTEIN 1.20 X 0 0 0 TODD CROSBY 1.20 X 0 102754 13388 DAVID SCHMITZ 1.20 X 0 138885 13370 MIKE WILLIAMS 1.20 X 0 62740 13388 BRENDA WILLIS 1.20 X 0 92142 13388 DIANE ZAHN 1.20 X 0 138897 13388 FAYE GUENTHER 1.20 X 0 94696 13388 RUTH DICK 1.20 X 0 89435 13388 0 719549 93698 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 981094896 ADMINISTRATION 159786 1 RETIREE SELF PAY CONTRIBUTIONS 900099 1758470 1758470 EMPLOYER CONTRIBUTIONS 900099 486597 486597 2245067 611631 2853 608778 3000000 2677529 322471 322471 322471 3179169 2245067 2853 931249 4377729 110940 13673 10194 22246 186882 9508 6607 11602 4749381 399503 1119436 34480 34377 15310 14730 12889862 11648744 3680399 3222475 17019554 16039762 4593 18239 140780 156080 425144 618965 570517 793284 X 0 0 0 0 16449037 15246478 16449037 15246478 17019554 16039762 -1570212 367653 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 3222475 F 3222475 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 476000 CHECKS IN EXCESS OF DEPOSITS 142965 618965 X 3524576 367653 367653 3156923 22246 22246 3179169 4577135 0 4577135 22246 150000 172246 4749381 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND TO RECOGNIZE A TAX ASSET OR LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2010. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE PLAN HAS CONTRACTED WITH ZENITH AMERICAN SOLUTIONS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 IN ADDITION TO PROVIDING A COMPLETE COPY OF THIS FORM 990 TO ALL OF THE TRUSTEES OF THE TRUST, THE FORM 990 IS REVIEWED BY THE EXECUTIVE COMMITTEE PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT-OF-INTEREST POLICY PERTAINS TO ALL TRUSTEES AND SERVICE PROVIDERS WHO CAN INFLUENCE THE ACTIONS OF THE TRUST. A CONFLICT OF INTEREST INCLUDES AN INTEREST, DIRECT OR INDIRECT, OF A TRUSTEE OR SERVICE PROVIDER TO A TRUST, WHICH MAY RESULT IN THE TRUSTEE OR SERVICE PROVIDER BENEFITING FINANCIALLY FROM DECISIONS MADE IN RELATION TO HIS OR HER CAPACITY AS A TRUSTEE OF OR SERVICE PROVIDER TO THE TRUST. DISCLOSURE OF POSSIBLE CONFLICTS OF INTEREST ARE MADE TO EITHER THE SECRETARY OR THE CHAIR OF THE TRUST. THE TRUSTEES DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE DECISION OF THE TRUSTEES, IN RELATION TO A CONFLICT OF INTEREST, IS BINDING AND FINAL. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTERST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII, SECTION A, LINE 1A: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION REPORTED ON PART VII, SECTION A REPRESENTS COMPENSATION PAID TO THOSE TRUSTEES EMPLOYED BY A LABOR UNION, A RELATED TAX-EXEMPT ORGANIZATION. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE RELATED TAX-EXEMPT ORGANIZATION'S FORM 990, FILED WITH THE INTERNAL REVENUE SERVICE. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE TRUST'S THIRD-PARTY ADMINISTRATOR, ZENITH AMERICAN SOLUTIONS, INC. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. FORM 990, PART V, LINE 1A: THE TRUST DOES NOT ISSUE FORMS 1099 DIRECTLY TO REPORTABLE SERVICE PROVIDERS. RATHER, THE CONTRACT ADMINISTRATOR USES THEIR EMPLOYER IDENTIFICATION NUMBER FOR THE FORMS 1099 ISSUED ON BEHALF OF THE TRUST. RETAIL CLERKS WELFARE TRUST 201 QUEEN ANNE AVE N STE 100 SEATTLE WA 981094824 916058475 ACTIVE EMPLOYEES WELFARE BENEFITS WA 501(C) 9 N/A N/A 0 RETAIL CLERKS PENSION TRUST 201 QUEEN ANNE AVE N STE 100 SEATTLE WA 981094824 916069306 RETIREMENT BENEFITS WA 501(A) N/A N/A 0 UFCW LOCAL UNION 367 6403 LAKEWOOD DRIVE TACOMA WA 984673331 910383680 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 UFCW LOCAL UNION 1439 1719 NORTH ATLANTIC STREET SPOKANE WA 992050298 910487097 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 UFCW LOCAL UNION 21 5030 FIRST AVENUE SOUTHSTE 200 SEATTLE WA 98134 203286319 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 GENERAL TEAMSTERS LOCAL UNION 38 2601 EVERETT AVENUE EVERETT WA 98201 910267959 SPONSORING LOCAL WA 501(C) 5 N/A N/A 0 ALLIED EMPLOYERS INC 4030 LAKE WASHINGTON BLVD NE STE 20 KIRKLAND WA 98033 910698183 SPONSORING ASSOCIATION WA 501(C) 6 N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF MARCH 31, 2013, THERE ARE APPROXIMATELY 100 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS I THROUGH IV BY FEDERAL TAX CLASSIFICATION. A & J MEATS ABERDEEN HEALTH MART ABERDEEN OFFICE EQUIPMENT ACE ELECTRIC AFFORDABLE DENTAL GROUP AHMR, INC ALBERTSONS INC ALL SMILEZ DENTISTRY ALLEN CREEK IGA ALLIED EMPLOYERS, INC. AVENUE DENTAL CARE BAVARIAN MEAT PRODUCTS BERTS RED APPLE MARKET BIMBO BAKERIES USA BLUHER'S DBA FARMHOUSE MKT BORNSTEIN SEAFOOD INC BOTTMAN'S SUPERMARKETS, INC BRIDLE TRAILS RED APPLE MKT BYRNIE UTZ MEN'S HAT STORE CAMANO PLAZA MARKET CAP FOODS DBA WEST SEA THFTWY CENTRAL CO-OP/MADISON MARKET CITY CENTER DRUG CLAUS MEAT MARKET CROWN DRUG COMPANY DBA MARTIN'S SOUTHGATE DRUG DMG DENTAL DESIGN DON & JOES MEATS EVERYBODY'S FORKS OUTFITTERS FRANCO THE TAILOR, INC FRANZ & GAIS BAKERIES GARGUILES RED APPLE GOLDEN STEER CHOICE MEATS GORDONS GROCERY HAGGEN INC HARBOR DRUG INC HARRISON MEDICAL CENTER HERBIG JEWELERS HOSTESS BRANDS ILWU LOCAL #23 ISLAND MKT CO DBA VASHON THRW J SPRINGER LLC JEFFERSON COUNTY JEFFERSON HEALTHCARE KAUFMAN SCROGGS FURNITURE KC FOODS KIRBY CO/SHELTON RED APPLE KROGER DBA FRED MEYER KROGER DBA QFC LABORER'S INTERNATIONAL #252 MATTHEWS AT LAKEMONT LLC METROPOLITAN MARKETS MOUNT VERNON RED APPLE MARKET N MASON SCHOOL DIST #403 PATEL DENTAL CARE PAYLESS FOODS PENHOLLOW MKTS LLC PICK-RITE INC PIERCE CTY CENTRAL LABOR COUN PIONEER SELECT MARKET POULSBO RED APPLE PRAIRIE CENTER RED APPLE MKT PUGET SOUND LABOR AGENCY RALPH'S RED APPLE RANDYS LOAN & COIN RAYMOND DRUG ROGER'S MARKETPLACE ROSE & ASSOCIATES, LLC SAAR'S INC SAFEWAY STORES INC SAGEN'S PHARMACY SEQUIM SCHOOL DIST #323 SHOP-N-KART SOINES DBA RED WING SHOE STOR SOUTH BEND PHARMACY SPANAWAY WATER CO. INC STADIUM THRIFTWAY STERLING DENTAL CARE STOLZ VASHON MARKET STORMAN'S SUMMIT TRADING COMPANY SUNRISE DENTAL SPECIALISTS SWAIN'S INC SWANSONS FOOD INC TACOMA LONGSHOREMEN CR UNION THE DENNIS CO THE MARKETS LLC THE VALU DRUG CO TM MEATS LLC TOWN & COUNTRY TUKWILA TRADING CO UFCW LOCAL #21 UFCW LOCAL 367 UNIFIED GROCERS INC UNITED WAY OF SKAGIT CO UWAJIMAYA INC VASHON MARKET FRESH IGA WIITAMAKI JEWELERS ZENITH AMERICAN SOLUTIONS