RETAIL STORE EMPLOYEES HEALTH AND: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RETAIL STORE EMPLOYEES HEALTH AND (EIN 82-0289815)
- Tax period
- 2011-11-01 to 2012-10-31
- Filed
- 2013-06-24
- IRS object ID
- 201301759349301005
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-06-24T16:59:12-05:00 | Timestamp |
| Tax Period End Date | 2012-10-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 542189926 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Henningfield & Associates Inc | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27913 Smyth Drive | AddressLine1 |
| City | Valencia | City |
| State | CA | State |
| ZIP Code | 91355 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-11-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 820289815 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RETAIL STORE EMPLOYEES HEALTH AND WELFARE TRUST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RETA | NameControl |
| Phone | 8012663271 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4885 SOUTH 900 EAST No 202 | AddressLine1 |
| City | SALT LAKE CITY | City |
| State | UT | State |
| ZIP Code | 84117 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACKI FAERBER | Name |
| Title | TRUSTEE | Title |
| Phone | 8004534584 | Phone |
| Date Signed | 2013-06-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RANDY D HENNINGFIELD | Name |
| PTIN | P01364367 | PTIN |
| Phone | 6612953363 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JACKI FAERBER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4885 SOUTH 900 EAST | AddressLine1 |
| City | SALT LAKE CITY | City |
| State | UT | State |
| ZIP Code | 84117 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 4732815 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 1968 | YearFormation |
| State Legal Domicile | UT | StateLegalDomicile |
| Activity Or Mission Description | HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 4 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 4074874 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 4101718 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 106778 | InvestmentIncomePriorYear |
| Investment Income Current Year | 59749 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 12451 | OtherRevenuePriorYear |
| Other Revenue Current Year | 11348 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4194103 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4172815 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 5001087 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 3334430 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 405322 | OtherExpensePriorYear |
| Other Expenses Current Year | 392258 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 5406409 | TotalExpensesPriorYear |
| Total Expenses Current Year | 3726688 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -1212306 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 446127 | RevenuesLessExpensesCY |
| Total Assets BOY | 3020975 | TotalAssetsBOY |
| Total Assets EOY | 2961680 | TotalAssetsEOY |
| Total Liabilities BOY | 1749093 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1250066 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1271882 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1711614 | NetAssetsOrFundBalancesEOY |
| Mission Description | HEALTH AND WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3334430 | Expense |
| Description | HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. | Description |
| Total Program Service Expense | 3334430 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 468 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 4 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicy |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JAS INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8012663271 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4885 SOUTH 900 EAST SUITE 202 | AddressLine1 |
| City | SALT LAKE CITY | City |
| State | UT | State |
| ZIP Code | 84117 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (4 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|
| BRENT BOHN | |||||
| TRUSTEE | 10.00 | X | 0 | 0 | 0 |
| JACKI FAERBER | |||||
| TRUSTEE | 10.00 | X | 0 | 0 | 0 |
| LITA BANGEOCHEA | |||||
| TRUSTEE | 10.00 | X | 0 | 0 | 0 |
| STEPHANIE GUSHA | |||||
| TRUSTEE | 10.00 | X | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIGNA | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 20643 | AddressLine1 |
| City | LEHIGH VALLEY | City |
| State | PA | State |
| ZIP Code | 18002 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | PPO NETWORK | DescriptionOfServices |
| Compensation | 167745 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| EMPLOYER CONTRIBUTIONS | 445100 | 3499208 | 3499208 |
| PARTICIPANT CONTRIBUTI | 445110 | 602510 | 602510 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 4101718 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 59199 | TotalRevenueColumn |
| Exclusion | $59,199 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 560550 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 560000 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 550 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 550 | TotalRevenueColumn |
| Exclusion | $550 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PRESCRIPTION REBATES | Description |
| Business Code | 445100 | BusinessCode |
| Total Revenue Column | 11348 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11348 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 11348 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4172815 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4113066 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $59,749 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3334430 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94676 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3953 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13281 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15734 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4232 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8801 | Total |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal |
|---|---|
| COST CONTAINMENT FEES | 127608 |
| CONSULTING FEES | 60875 |
| ADMINISTRATION - CIGNA | 46341 |
| BANK ANALYSIS FEES AND | 8303 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8454 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3726688 | Total |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 149827 | BOY |
| EOY | 134525 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2509651 | BOY |
| EOY | 2482894 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 358183 | BOY |
| EOY | 337865 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3314 | BOY |
| EOY | 6396 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3020975 | BOY |
| EOY | 2961680 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17693 | BOY |
| EOY | 23766 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1731400 | BOY |
| EOY | 1226300 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1749093 | BOY |
| EOY | 1250066 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1271882 | BOY |
| EOY | 1711614 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1271882 | BOY |
| EOY | 1711614 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3020975 | BOY |
| EOY | 2961680 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 446127 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -6395 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| IBNR PAYABLE | $577,100 |
| ACCUMULATED ELIG CREDITS PAYABLE | $649,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1226300 | TotalOfAmounts |
| Total Revenue | 4172815 | TotalRevenue |
| Total Expenses | 3726688 | TotalExpenses |
| Excess Or Deficit For Year | 446127 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -6395 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -6395 | TotalAdjustments |
| Excess Or Deficit Per FS | 439732 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 4166420 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -6395 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -6395 | RevenueNotRptdF990 |
| Revenue Subtotal | 4172815 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 4172815 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 4231788 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 4231788 | ExpensesSubtotal |
| Other Expenses Not Included | -505100 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | -505100 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 3726688 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part XIII, Line 4b - Other Adjustments: | Identifier |
| Explanation | CHANGE IN IBNR AND EXTENDED ELIBIGILITY -505,100. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 | BRENT BOHN - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. JACKI FAERBER - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. LITA BANGEOCHEA - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. STEPHANIE GUSHA - 4885 SO 900 EAST, SALT LAKE CITY, UT 84117. | Contact Addresses for Officers, Directors, Etc |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -6,395. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|
| SUPERVALU | |||||||
| 1421 S MANHATTAN AVE | FULLERTON | CA | 92831 | 204057706 | RETAIL GROCERS | CA | C |
| SMITH'S | |||||||
| 4885 S 900 EAST | SALT LAKE CITY | UT | 84117 | 870258768 | RETAIL GROCERS | UT | C |
| UFCW 368 | |||||||
| 222 BROADWAY AVE | BOISE | ID | 83706 | 820180912 | LABOR UNION | ID | T |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |