2012-08-14T13:07:44-05:00 2011-10-31 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2010-11-01 820289815 RETAIL STORE EMPLOYEES HEALTH AND WELFARE TRUST RETA 8012663271 4885 SOUTH 900 EAST No 202 SALT LAKE CITY UT 841175746 JACKI FAERBER 8004534584 2012-08-02 1 RANDY D HENNINGFIELD 6612953363 2010 2016-02-24 21:20:13Z JACKI FAERBER 4885 SOUTH 900 EAST SALT LAKE CITY UT 84117 6410103 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 3106008 4074874 148029 106778 10660 12451 3264697 4194103 0 0 4802185 5001087 0 0 0 0 0 357275 405322 5159460 5406409 -1894763 -1212306 3699166 3020975 1189604 1749093 2509562 1271882 HEALTH AND WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 0 0 5001087 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 5001087 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 0 0 0 0 1 471 0 1 0 0 0 0 0 0 0 X 3 3 0 0 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 BRENT BOHN 10.00 X 0 0 0 JACKI FAERBER 10.00 X 0 0 0 LITA BANGEOCHEA 10.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA PO BOX 20643 LEHIGH VALLEY PA 18002 PPO NETWORK 169536 JAS INC 4885 SO 900 EAST SALT LAKE CITY UT 84117 CONTRACT ADMINISTRATION 100684 2 EMPLOYER CONTRIBUTIONS 445100 3515870 3515870 PARTICIPANT CONTRIBUTI 445110 559004 559004 4074874 94955 94955 2227823 2216000 11823 11823 11823 PRESCRIPTION REBATES 445100 12451 12451 12451 4194103 4087325 0 106778 5001087 100684 7020 12342 18499 8573 7178 COST CONTAINMENT FEES 148678 CONSULTING FEES 41662 ADMINISTRATION - CIGNA 41202 BANK ANALYSIS FEES AND 10439 ADMINISTRATION - RX 6105 2940 5406409 9177 149827 3439049 2509651 247378 358183 3562 3314 3699166 3020975 22204 17693 1167400 1731400 1189604 1749093 X 0 0 0 0 2509562 1271882 2509562 1271882 3699166 3020975 X -1212306 -25374 X 0 1 1 X 0 0 IBNR PAYABLE 928900 ACCUMULATED ELIG CREDITS PAYABLE 802500 1731400 4194103 5406409 -1212306 -25374 -25374 -1237680 4168729 -25374 -25374 4194103 0 4194103 4842409 0 4842409 564000 564000 5406409 Part XIII, Line 4b - Other Adjustments: CHANGE IN IBNR AND EXTENDED ELIBIGILITY 564,000. 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 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -25,374.