2012-03-03T11:40:02-06:00 2011-04-30 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE SUITE 4000 CHICAGO IL 60606 990 2010-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 800022815 STEVE DICROCE 3034301118 2012-03-03 1 LEGACY PROFESSIONALS LLP 3123680500 2010 2016-02-24 21:20:13Z STEVE DICROCE 5511 W 56TH AVE NO 250 ARVADA CO 800022815 122943326 0 X N/A X 1965 CO PROVIDE HEALTH BENEFITS 6 6 0 0 0 0 0 0 68925774 74317857 2315806 1182657 1195 0 71242775 75500514 0 0 101396890 107770238 0 0 0 0 0 6965385 7433375 108362275 115203613 -37119500 -39703099 83430284 38237248 6059164 1022624 77371120 37214624 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 1 1 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 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 ADMINISTRATORS 3034301118 5511 W 56TH AVE NO 250 ARVADA CO 80002 X 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 0 0 KEVIN SCHNEIDER 1.00 X 0 0 0 STEVE PARDEE 1.00 X 0 0 0 0 0 0 0 0 0 0 CIGNA 900 COTTAGE GROVE ROAD HARTFORD CT 06152 PPO ACCESS AND ADMIN FEES 3986429 ZENITH ADMINISTRATORS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 1198450 THE SEGAL COMPANY 101 N WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARIAL SERVICES 451991 DELTA DENTAL 4582 S ULSTER STREET STE 800 DENVER CO 80237 BENEFIT ADMIN FEES 337026 REINHART BOERNER VAN DEURAN SC 1000 WATER STREET STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 302446 8 EMPLOYER CONTRIBUTIONS 900099 58337844 58337844 RETIREE CONTRIBUTIONS 900099 6424608 6424608 PARTICIPANT CONTRIBUTI 900099 5902338 5902338 PRESCRIPTION REBATES 900099 1475641 1475641 ERRP SUBSIDY 900099 1303938 1303938 873488 873488 74317857 1297293 1297293 47328176 47442812 -114636 -114636 -114636 75500514 74317857 0 1182657 107770238 3847345 479925 64817 20000 2679439 290871 23668 26570 MEMBERSHIP DUES 740 115203613 3213673 3670327 2964888 1315545 3958561 7876644 39342 17122 73253820 25357610 83430284 38237248 121553 272624 387611 5550000 750000 6059164 1022624 X 0 0 0 0 77371120 37214624 77371120 37214624 83430284 38237248 X -39703099 -453397 X 0 1 1 X 0 0 ESTIMATED EMPLOYER CONTRIBUTION CREDIT 750000 750000 75500514 115203613 -39703099 -453397 -453397 -40156496 75027117 -453397 -453397 75480514 20000 20000 75500514 115183613 0 115183613 20000 20000 115203613 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. 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 ADMINISTRATORS. 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 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: -453,397. 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 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 3488069 COST DENVER AREA MEAT CUTTERS AND EMPLOYERS PENSION PLAN R 1342678 COST