2014-01-31T17:42:41-06:00 2013-03-31 300702322 HEMMING MORSE CPA'S AND CONSULTANTS 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2012-04-01 952301788 UNITED FOOD & COMMERCIAL WORKERS UNIONS & FOOD EMPLOYERS BEN FUND UNIT 7142202297 6425 KATELLA AVE CYPRESS CA 90630 ADMINISTRATOR 7142202297 2014-01-31 1 4158364000 2012 2015-11-30 17:44:51Z 6425 KATELLA AVE CYPRESS CA 90630 1594885049 0 X N/A X 1964 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 10 10 0 0 0 0 0 0 504022683 570471719 1021427 1109998 7765094 3786832 512809204 575368549 0 0 519221569 496157005 0 0 0 0 0 28511301 29927817 547732870 526084822 -34923666 49283727 251998301 250732778 171844688 124743046 80153613 125989732 NONE 0 0 THE PLAN IS A MULTI-EMPLOYER WELFARE BENEFIT PLAN PROVIDING HOSPITAL, MEDICAL, PSYCHIATRIC, PREVENTIVE MEDICINE, DENTAL ORTHODONTIA, PRESCRIPTION DRUG, DEATH, INDUSTRY VACATION AND VISION CARE BENEFITS 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 17145 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X BILL SMITH 7142202297 6425 KATELLA AVENUE CYPRESS CA 90630 X GREG CONGER 5.00 X 0 0 0 RICARDO ICAZA 5.00 X 0 0 0 BILL LATHROP 5.00 X 0 0 0 CONNIE LEYVA 5.00 X 0 0 0 MICHAEL KASPARIAN 5.00 X 0 0 0 MICHAEL STRAETER 5.00 X 0 0 0 KATHLEEN A FINAZZO 5.00 X 0 0 0 FRANK JORGENSEN 5.00 X 0 0 0 BRENT BOHN 5.00 X 0 0 0 LEROY WESTMORELAND 5.00 X 0 0 0 0 0 0 0 0 0 0 SC UFCW ADMINISTRATION LLC 6425 KATELLA AVE CYPRESS CA 90630 CONTRACT ADMINISTRATOR 18023120 HEALTH MANAGEMENT CONCEPTS 181 COMMODORE DR JUPITER FL 33477 CONSULTANT 1062920 SAFEWAY HEALTH INC 5918 STONERIDGE MALL ROAD PLEASANTON CA 94588 CONSULTANT 576059 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARY/CONSULTANT 509272 SEYFARTH SHAW LLP ONE CENTURY PLAZA SUITE 3500 LOS ANGELES CA 900673021 LEGAL COUNSEL 503998 8 EMPLOYER CONTRIBUTIONS 900099 515289622 515289622 PARTICIPANT CONT. 900099 55182097 55182097 570471719 1923365 1923365 1018703133 1019516500 -813367 -813367 -813367 MEDICARE PART D SUBSIDY 900099 3725621 3725621 OTHER INCOME 900099 61211 61211 3786832 575368549 574258551 0 1109998 496157005 18023120 838302 57881 75351 48996 398 243604 COST CONTAINMENT FEES 5986319 ACTUARIAL CONSULTANTS 2074632 POSTAGE 854459 PRINTING 762583 962172 526084822 46272492 8368924 43368843 49963331 222356 235653 152748943 188417856 9385667 3747014 251998301 250732778 608924 307033 171235764 124436013 171844688 124743046 X 0 0 0 0 80153613 125989732 80153613 125989732 251998301 250732778 49283727 -3447608 0 X X 0 1 X 1 0 0 GROUP INSURANCE PREMIUMS AND CLAIMS PAYABLE 69500638 CLAIMS INCURRED BUT NOT REPORTED 31457000 ANCILLARY AWARDS AND GRANTS NOT USED 245000 CASH - OPERATING ACCOUNTS (OVERDRAFT) 6520529 LIABILITY TO RETURN COLLATERAL FOR SECURITY ON LOAN 13554436 DUE TO OTHER TRUST FUNDS AND LLC 3158410 124436013 571920941 -3447608 -3447608 575368549 0 575368549 526084822 0 526084822 0 526084822 FORM 990, PART IV, LINE 34 THE TRUST FUND HAS A SPECIFIC PROCEDURE IN PLACE FOR THIS NEW DISCLOSURE REQUIREMENT ON THE SCHEDULE R. THE ADMINISTRATOR HAS SENT OUT A QUESTIONNAIRE TO OBTAIN THE REQUIRED INFORMATION FROM THE CONTRIBUTING EMPLOYERS. THE ENCLOSED INFORMATION REPRESENTS WHAT THE TRUST FUND HAS RECEIVED TO DATE. FORM 990, PART VI, SECTION B, LINE 11 THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. 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