2014-04-24T10:31:35-05:00 2013-10-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2012-11-01 820289815 RETAIL STORE EMPLOYEES HEALTH AND WELFARE TRUST RETA 8012663271 4885 SOUTH 900 EAST No 202 SALT LAKE CITY UT 84117 JACKI FAERBER 8004534584 2014-03-28 1 RANDY D HENNINGFIELD P01364367 6612953363 2012 2015-11-30 17:44:51Z JACKI FAERBER 4885 SOUTH 900 EAST SALT LAKE CITY UT 84117 4638876 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 4101718 3965939 59749 47283 11348 47654 4172815 4060876 0 0 3334430 3726019 0 0 0 0 0 392258 427132 3726688 4153151 446127 -92275 2961680 3048088 1250066 1454039 1711614 1594049 HEALTH AND WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 3726019 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 3726019 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 1 468 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 10.00 X 0 0 0 JACKI FAERBER 10.00 X 0 0 0 STEPHANIE GUSHA 10.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA PO BOX 20643 LEHIGH VALLEY PA 18002 PPO NETWORK 166508 1 EMPLOYER CONTRIBUTIONS 445100 3422856 3422856 PARTICIPANT CONTRIBUTI 445110 543083 543083 3965939 45124 45124 580159 578000 2159 2159 2159 PRESCRIPTION REBATES 445100 47654 47654 47654 4060876 4015752 0 45124 3726019 90198 18883 17773 18154 10684 10663 COST CONTAINMENT FEES 126424 CONSULTING FEES 76308 ADMINISTRATION - CIGNA 42894 BANK ANALYSIS FEES AND 7483 7668 4153151 134525 88453 2482894 2554308 337865 399261 6396 6066 2961680 3048088 23766 47039 1226300 1407000 1250066 1454039 X 0 0 0 0 1711614 1594049 1711614 1594049 2961680 3048088 -92275 -25290 0 X 0 0 0 0 IBNR PAYABLE 647600 ACCUMULATED ELIG CREDITS PAYABLE 759400 1407000 4035586 -25290 -25290 4060876 0 4060876 3972451 0 3972451 180700 180700 4153151 Part XII, Line 4b - Other Adjustments: CHANGE IN IBNR AND EXTENDED ELIBIGILITY 180,700. 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. Contact Addresses for Officers, Directors, Etc 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