2013-03-14T15:05:01-05:00 2012-04-30 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE SUITE 4000 CHICAGO IL 60606 990 2011-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 800022815 STEVE DICROCE 3034301118 2013-03-14 1 BRUCE A PAVLIK P00748405 3123680500 2011 2016-02-25 16:41:14Z STEVE DICROCE 5511 W 56TH AVE NO 250 ARVADA CO 800022815 130316654 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 6 6 0 0 0 0 0 0 74317857 107382714 1182657 140074 0 0 75500514 107522788 0 0 107770238 106777417 0 0 0 0 0 7433375 7957791 115203613 114735208 -39703099 -7212420 38237248 30934447 1022624 990853 37214624 29943594 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 1 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 0 1 0 0 1 0 0 0 0 0 0 0 0 0 X 6 6 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 JAMES V MORGAN 1.00 X 0 0 0 DANNY MA 1.00 X 0 0 0 KIM CORDOVA 1.00 X 0 155864 9681 KEVIN SCHNEIDER 1.00 X 0 128496 9681 STEVE PARDEE 1.00 X 0 0 0 NATE BERNSTEIN 1.00 X 0 132582 9681 0 416942 29043 3 0 1 0 CIGNA 900 COTTAGE GROVE ROAD HARTFORD CT 06152 PPO ACCESS AND ADMIN FEES 3950662 ZENITH AMERICAN SOLUTIONS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 1374812 THE SEGAL COMPANY 101 N WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARIAL SERVICES 546681 DELTA DENTAL 4582 S ULSTER STREET STE 800 DENVER CO 80237 BENEFIT ADMIN FEES 355384 REINHART BOERNER VAN DEURAN SC 1000 WATER STREET STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 350636 10 EMPLOYER CONTRIBUTIONS 900099 92423941 92423941 RETIREE CONTRIBUTIONS 900099 6955260 6955260 PARTICIPANT CONTRIBUTI 900099 5448768 5448768 PRESCRIPTION REBATES 900099 1591730 1591730 MEDICARE RETIREE DRUG 900099 813296 813296 149719 149719 107382714 244928 244928 22689012 22793866 -104854 -104854 -104854 107522788 107382714 0 140074 106777417 4009167 644986 76753 19651 2886914 246522 30866 42177 MEMBERSHIP DUES 755 114735208 3670327 6150896 1315545 1433250 7876644 18505763 17122 57973 25357610 4786565 38237248 30934447 272624 653148 750000 337705 1022624 990853 X 0 0 0 0 37214624 29943594 37214624 29943594 38237248 30934447 X -7212420 -58610 X X 0 1 1 X 0 0 ESTIMATED EMPLOYER CONTRIBUTION CREDIT 337705 337705 107522788 114735208 -7212420 -58610 -58610 -7271030 96108126 0 96108126 11011 11403651 11414662 107522788 102079768 0 102079768 11011 12644429 12655440 114735208 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 XII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN EMPLOYER CONTRIBUTIONS 2,960,226. RETIREE PLAN INVESTMENT INTEREST 112,433. RETIREE PLAN RETIREE CONTRIBUTIONS 6,955,260. RETIREE PLAN PRESCRIPTION REBATES 503,147. RETIREE PLAN ERRP SUBSIDY 80,346. RETIREE PLAN MEDICARE RETIREE DRUG SUBSIDY 813,296. RETIREE PLAN REALIZED LOSS ON INVESTMENT SOLD -21,057. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RETIREE PLAN MEDICAL AND LOST TIME 3,958,830. RETIREE PLAN PRESCRIPTION 5,386,062. RETIREE PLAN PREMIUMS 2,696,775. RETIREE PLAN PPO FEES & PROVIDER FEES 136,548. ADMINISTRATIVE EXPENSES 457,574. RETIREE PLAN INVESTMENT FEES 8,640. 0 0 0 KIM CORDOVA 0 155864 0 0 0 0 0 2995 0 6686 0 165545 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -58,610. FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2D: EFFECTIVE MAY 1, 2011, THE TRUSTEES APPROVED A RESOLUTION TO ESTABLISH A SEPARATE PLAN FOR RETIRED PARTICIPANTS. THE ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS HEALTH BENEFIT FUND - ACTIVES AND ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS HEALTH BENEFIT FUND - RETIREE OPERATES UNDER ONE TRUST AGREEMENT AND EACH PLAN ISSUES SEPARATE AUDITED FINANCIAL STATEMENTS. BOTH PLANS ARE REPORTED ON THIS FORM 990 ON A CONSOLIDATED BASIS. 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 7760 W 38TH AVE WHEAT RIDGE CO 80033 CONTRIBUTING EMPLOYER CO 501(C)(5) N/A 0 ALBERTSONS 400 S 99TH AVE 200 TELLSON AZ 85353 CONTRIBUTING EMPLOYER AZ N/A ALMAGNO FREELANCE 10447 E DORADO PL ENGLEWOOD CO 80111 CONTRIBUTING EMPLOYER CO N/A DARLING INTERNATIONAL PO BOX 16372 DENVER CO 80216 CONTRIBUTING EMPLOYER CO N/A D'CARLO HAIR SALON 4783 SOUTH NEWTON LITTLETON CO 80123 CONTRIBUTING EMPLOYER CO N/A DEBONAIRE HAIR 11004 MANET WAY NORTHGLENN CO 80234 CONTRIBUTING EMPLOYER CO N/A GARRISON STREET STYLISTS 1990 S GARRISON LAKEWOOD CO 80227 CONTRIBUTING EMPLOYER CO N/A GARY & CORI LEETE 9546 BROOK HILL DRIVE LONE TREE CO 80124 CONTRIBUTING EMPLOYER CO N/A GARY MONTANA SALON INC 8101 E BELLEVIEW AVEUNIT 1 DENVER CO 80237 CONTRIBUTING EMPLOYER CO N/A IMAGES - A LIZZI 13851 PINE VALLEY ROAD PINE CO 80470 CONTRIBUTING EMPLOYER CO N/A KING SOOPERS 65 TEJON STREET DENVER CO 80223 CONTRIBUTING EMPLOYER CO N/A MOSHO'S BARBER SERVICE 1155 S HAVANA UNIT 33 AURORA CO 80012 CONTRIBUTING EMPLOYER CO N/A THE PERFECT TOUCH 832 FRANCES STREET LONGMONT CO 80501 CONTRIBUTING EMPLOYER CO N/A ROYBAL'S BARBER SHOP 6443 EAST 72ND PLACE COMMERCE CITY CO 80022 CONTRIBUTING EMPLOYER CO N/A SAFEWAY 6900 S YOSEMITE STREET CENTENNIAL CO 801121412 CONTRIBUTING EMPLOYER CO N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS PENSION PLAN R 3883555 COST DENVER AREA MEAT CUTTERS AND EMPLOYERS PENSION PLAN R 1501875 COST FORM 990, SCHEDULE R, PART IV, SECTION A: CERTAIN INFORMATION REQUIRED ON SCHEDULE R, PART IV IS NOT MAINTAINED BY THE FUND OFFICE. THE PLAN HAS ENDEAVORED TO OBTAIN ALL REQUIRED INFORMATION RELATED TO ITS CONTRIBUTING EMPLOYERS. AT THIS FILIING DATE HOWEVER, NOT ALL INFORMATION HAS BEEN RECEIVED. WHAT IS AVAILABLE HAS BEEN INCLUDED IN THIS FILING. IT IS THE INTENT OF THE BOARD OF TRUSTEES TO FULLY COMPLY WITH THE INSTRUCTIONS TO THIS FORM WHICH MAY REQUIRE AMENDING THIS FILING UPON RECEIPT OF SUCH INFORMATION AS CONSIDERED NECESSARY. THE EMPLOYER IDENTIFICATION NUMBERS OF THE CONTRIBUTING EMPLOYERS, WHEN AVAILABLE, WHICH ARE REQUIRED TO BE REPORTED IN PARTS IV HAVE NOT BEEN INCLUDED IN THIS FILING DUE TO THE SENSITIVE NATURE OF THE INFORMATION. THE INFORMATION MAY BE AVAILABLE AT THE PLAN OFFICE.