2014-02-20T10:03:41-06:00 2013-04-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 800022815 KEVIN SCHNEIDER 3034301118 2014-02-20 1 TIMOTHY CIBULKA P00841100 3123680500 2012 2015-11-30 17:44:51Z KEVIN SCHNEIDER 5511 W 56TH AVE NO 250 ARVADA CO 800022815 125240447 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 6 3 0 0 0 0 0 0 107382714 122193821 140074 29911 0 0 107522788 122223732 0 0 106777417 113897145 0 0 0 0 0 7957791 7754594 114735208 121651739 -7212420 571993 30934447 30871530 990853 359830 29943594 30511700 TO PROVIDE HEALTH BENEFITS TO THE ELIGIBLE PARTICIPANTS AND DEPENDENTS OF ROCKY MOUNTAIN UFCW & EMPLOYERS HEALTH BENEFIT PLAN. 0 0 TO PROVIDE HEALTH, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DENTAL, VISION, PRESCRIPTION AND TEMPORARY DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 80002 STEVE DICROCE 1.00 X 0 0 0 BRYAN SMITH - NEW 1.00 X 0 0 0 DANNY MA 1.00 X 0 0 0 KIM CORDOVA 1.00 45.00 X 0 164059 12844 KEVIN SCHNEIDER 1.00 45.00 X 0 132238 12844 NATHAN BERNSTEIN 1.00 45.00 X 0 136172 12844 JAMES MORGAN 1.00 X 0 0 0 0 432469 38532 3 0 1 0 CIGNA 900 COTTAGE GROVE ROAD HARTFORD CT 06152 PPO ACCESS AND ADMIN FEES 4162533 ZENITH AMERICAN SOLUTIONS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 1421253 THE SEGAL COMPANY 101 N WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARIAL SERVICES 453090 REINHART BOERNER VAN DEURAN SC 1000 WATER STREET STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 324726 DELTA DENTAL 4582 S ULSTER STREET STE 800 DENVER CO 80237 BENEFIT ADMIN FEES 272887 9 EMPLOYER CONTRIBUTIONS 900099 108016351 108016351 RETIREE CONTRIBUTIONS 900099 6657937 6657937 PARTICIPANT CONTRIBUTIONS 900099 6114259 6114259 MEDICARE RETIREE DRUG SUBSIDY 900099 747693 747693 PRESCRIPTION REBATES 900099 641748 641748 15833 15833 122193821 46626 46626 3000000 3016715 -16715 -16715 -16715 122223732 122193821 0 29911 113897145 1358013 597048 78701 19437 5424096 194722 33511 46833 MEMBERSHIP DUES 2233 121651739 6150896 11545509 1433250 5512743 18505763 10004872 57973 41848 4786565 3766558 30934447 30871530 653148 235470 124360 337705 0 990853 359830 X 0 0 0 0 29943594 30511700 29943594 30511700 30934447 30871530 571993 -3887 0 X X 0 1 X 1 0 0 X 111506658 0 111506658 2696 10714378 10717074 122223732 108905698 0 108905698 2696 12743345 12746041 121651739 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. PART XI, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN EMPLOYER CONTRIBUTIONS 2,977,412. RETIREE PLAN INVESTMENT INTEREST 46,432. RETIREE PLAN RETIREE CONTRIBUTIONS 6,657,937. RETIREE PLAN PRESCRIPTION REBATES 301,619. RETIREE PLAN MEDICARE RETIREE DRUG SUBSIDY 747,693. RETIREE PLAN REALIZED LOSS ON INVESTMENT SOLD -16,715. PART XII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN MEDICAL 4,758,448. RETIREE PLAN PRESCRIPTION 4,632,346. RETIREE PLAN MEDICAL PREMIUMS 2,757,598. RETIREE PLAN PPO FEES & PROVIDER FEES 241,483. ADMINISTRATIVE EXPENSES 336,729. RETIREE PLAN INVESTMENT FEES 16,741. 0 0 0 KIM CORDOVA 0 164059 0 0 0 0 0 2938 0 9906 0 176903 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF TRUSTEES HAS DELEGATED THE RECORD KEEPING AND DAY TO DAY ADMINISRATION OF THE PLAN TO ZENITH AMERICAN SOLUTIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARDS REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANY NONADHERANCE TO THE ADOPTED POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE PLAN OFFICE. ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS PENSION PLAN 5511 W 56TH AVE SUITE 250 ARVADA CO 80002 846045986 PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS AND BENEFICIARIES CO 401(A) N/A 0 DENVER AREA MEAT CUTTERS AND EMPLOYERS PENSION PLAN 5511 W 56TH AVE SUITE 250 ARVADA CO 80002 846097461 PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS AND BENEFICIARIES CO 401(A) N/A 0 UNITED FOOD AND COMMERICAL WORKERS INTERNATIONAL UNION 7R LOCAL CONTRIBUTING EMPLOYER 0 ALBERTSONS CONTRIBUTING EMPLOYER 0 ALMAGNO FREELANCE CONTRIBUTING EMPLOYER 0 DARLING INTERNATIONAL CONTRIBUTING EMPLOYER 0 D'CARLO HAIR SALON CONTRIBUTING EMPLOYER 0 DEBONAIRE HAIR CONTRIBUTING EMPLOYER 0 GARRISON STREET STYLISTS CONTRIBUTING EMPLOYER 0 GARY & CORI LEETE CONTRIBUTING EMPLOYER 0 GARY MONTANA SALON INC CONTRIBUTING EMPLOYER 0 IMAGES - A LIZZI CONTRIBUTING EMPLOYER 0 KING SOOPERS CONTRIBUTING EMPLOYER 0 MOSHO'S BARBER SERVICE CONTRIBUTING EMPLOYER 0 THE PERFECT TOUCH CONTRIBUTING EMPLOYER 0 ROYBAL'S BARBER SHOP CONTRIBUTING EMPLOYER 0 SAFEWAY CONTRIBUTING EMPLOYER 0 ZENITH AMERICAN SOLUTIONS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS PENSION PLAN S 3638165 COST DENVER AREA MEAT CUTTERS & EMPLOYERS PENSION PLAN S 1430695 COST