2011-01-27T14:07:59-06:00 2010-03-31 Lindquist LLP 5000 Executive Pkwy Suite 400 San Ramon CA 945834210 990 2009-04-01 911950259 Retail Clerks Retiree Welfare Trust RETA 2062824100 201 Queen Anne Avenue North No 100 Seattle WA 98109 RANDY ZEILER 2062824100 2011-01-27 1 9252779100 2009 2016-02-24 21:20:13Z Randy Zeiler 201 Queen Anne Avenue North No 100 Seattle WA 98109 4978232 0 X N/A X 1998 WA TO PROVIDE HEALTH BENEFITS TO ELIGIBLE RETIREES AND THEIR DEPENDENTS 12 12 119 0 0 0 0 1416872 1505936 876664 531573 0 2293536 2037509 0 2841290 4068868 0 0 0 240948 334095 3082238 4402963 -788702 -2365454 16584190 18955809 410863 554209 16173327 18401600 To provide health and welfare benefits to qualified retirees and their dependents 0 0 Provided health and welfare benefits to eligbile retirees and their dependenTs. 0 0 0 0 0 0 0 0 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 1 0 0 1 119 1 0 0 0 0 0 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Zenith Administrators 2062824100 201 Queen Anne Ave North Seattle WA 981094896 X Randy Zeiler 1.20 X 0 0 0 Derrick Anderson 1.20 X 0 0 0 BRENT R BOHN 1.20 X 0 0 0 Frank Jorgensen 1.20 X 0 0 0 Scott Klitzke Powers 1.20 X 0 0 0 Carl Wojciechowski 1.20 X 0 0 0 David Blitzstein 1.20 X 0 0 0 Todd Crosby 1.20 X 0 0 0 David Schmitz 1.20 X 0 0 0 Mike williams 1.20 X 0 0 0 Brenda Willis 1.20 X 0 0 0 Diane Zahn 1.20 X 0 0 0 NATHAN HYDE 1.20 X 0 0 0 0 0 0 0 0 0 0 ZENITH ADMINISTRATORS INC 201 QUEEN ANNE AVENUE NORTH SEATTLE WA 981094896 ADMINISTRATION 110406 1 RETIREE SELF PAY CONTR 900099 1007415 1007415 EMPLOYER CONTRIBUTIONS 900099 498521 498521 1505936 472296 472296 3000000 2940723 59277 59277 59277 2037509 1505936 0 531573 4068868 100305 20944 23918 22777 136372 16819 728 7604 4628 4402963 957376 191319 32311 40841 8255 13169 10709728 9253049 4876520 9457431 16584190 18955809 9863 6279 97930 401000 450000 410863 554209 X 0 0 0 0 16173327 18401600 16173327 18401600 16584190 18955809 X 0 1 1 X 0 0 Limited partnership 9457431 F 9457431 CLAIMS PAYABLE AND incurred but not reported 450000 450000 2037509 4402963 -2365454 4593727 49000 4642727 2277273 6608459 4593727 4593727 2014732 22777 22777 2037509 4331186 0 4331186 22777 49000 71777 4402963 Part XI, Line 8 - Other Adjustments: CHANGE IN BENEFIT OBLIGATIONS Part XIII, Line 4b - Other Adjustments: CHANGE IN BENEFIT OBLIGATIONS Form 990, Part VI, Section A, line 3 The plan has contracted with Zenith Administrators, Inc. to provide administrative services for the organization. Form 990, Part VI, Section B, line 11 A trustEE reviewED the form 990 prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy pertains to all Trustees and service Providers who can influence the actions of the Trust. A conflict of interest includes an interest, direct or indirect, of a Trustee or service provider to a Trust, which may result in the Trustee or service provider benefiting financially from decision made in relation to his or her capacity as a Trustee of or service provider to the Trusts. Disclosure of possible conflicts of interest are made to either the Secretary or the Chair of the Trust. The Trustees determine if a conflict of interest exists. The decision of the Trustees, in relation to a conflict of interest, is binding and final. Form 990, Part VI, Section C, line 19 upon request, the organization makes its governing documents, CONFLICT-OF-INTERST POLICY and financial statemeNTs available to the public. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. Form 990, Part V, Line 2a: The plan pays "Incentive Payments" to participants for accomplishing certain outlined objectives, such as, Tobacco cessation and answering surveys. These payments are taxable benefits and the Trust reports the benefits on Forms W-2. Form 990, Part V, Line 1a: The Trust does not issue Forms 1099 directly to reportable service providers. Rather, the contract administrator uses their employer identification number for the Forms 1099 that they issue on behalf of the Trust. Retail clerks welfare trust 201 queen anne ave n ste 100 seattle WA 981094824 916058475 active employees welfare benefits WA 501(c) 9 na N/A Retail clerks pension trust 201 queen anne ave n ste 100 seattle WA 981094824 916069306 retirement benefits WA 501(a) na N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0