2021-11-10T11:17:24-06:00 2020-12-31 450250958 EIDE BAILLY LLP 10681 FOOTHILL BLVD STE 300 RANCHO CUCAMONGA CA 917303831 990 2020-01-01 822616834 UFCW COMPREHENSIVE BENEFITS TRUST UFCW 9257467530 1000 BURNETT AVE SUITE 110 NO 20 CONCORD CA 945202000 JACQUES S LOVEALL CHAIRMAN 9257467530 2021-11-06 1 JACQUES LOVEALL 999009999 CATHERINE L GRAY P01294460 9094664410 2021-11-06 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z JACQUES S LOVEALL 1000 BURNETT AVE SUITE 110 NO 200 CONCORD CA 945202000 28936412 0 X N/A X 2017 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 5 5 468 5 24406 0 0 0 13610291 28912006 81263 24406 46174 0 13737728 28936412 0 0 12706667 24089190 0 0 0 0 0 1052996 1743030 13759663 25832220 -21935 3104192 6464686 11878341 3186628 5498391 3278058 6379950 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 1,300 ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION AND THE EMPLOYERS. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 220 0 1 468 1 1 1 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 X JESSE GLAVES 9257467530 1000 BURNETT AVE SUITE 110 NO 200 CONCORD CA 945202000 X X JACQUES S LOVEALL CHAIRMAN 5.00 X X 0 0 0 KEVIN SEARS SECRETARY 5.00 X X 0 0 0 DOREEN DORRAUGH TRUSTEE 5.00 X 0 0 0 KIRK L VOGT TRUSTEE 5.00 X 0 0 0 JOHN HEISE TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 UFCW GROUP ADMINISTRATION LLC 1000 BURNETT AVE 110 CONCORD CA 94520 CONTRACT ADMINISTRATOR 717444 BLUE SHIELD OF CALIFORNIA 3401 N CENTRE LAKE DR 400 ONTARIO CA 91761 HEALTHCARE ADMINISTRATION 365527 SEYFARTH & SHAW 601 SOUTH FIGUEROA STREET LOS ANGELES CA 90017 LEGAL SERVICES 114713 SEGAL COMPANY 10880 WILSHIRE BLVD LOS ANGELES CA 90024 HUMAN RESOURCES CONSULTING 108293 4 EMPLOYER CONTRIBUTIONS 900099 27463994 27463994 PARTICIPANT CONTRIBUTIONS 900099 1448012 1448012 28912006 24406 24406 28936412 28912006 24406 0 24089190 717444 159979 58370 4725 180524 78236 1489 11606 HEALTHCARE ADMINISTRATI 508915 COMMUNICATION SERVICES 21742 25832220 2726643 6941174 2022252 2032155 1449103 2334448 2056 152 264632 570412 6464686 11878341 330 26018 3186298 5472373 3186628 5498391 X 0 0 0 0 3278058 6379950 3278058 6379950 6464686 11878341 3104192 -2300 0 X X 0 1 X 1 0 0 GROUP INSURANCE PREMIUMS PAYABLE 1084440 SELF-FUNDED BENEFIT CLAIMS PAYABLE 2297989 CLAIMS INCURRED BUT NOT REPORTED 1482376 DUE TO OTHERS 331156 DUE TO LLC 38587 SICK LEAVE PAYABLE 237825 5472373 X 28929387 -2300 -2300 28931687 4725 4725 28936412 23911163 0 23911163 4725 1916332 1921057 25832220 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE TRUST ADMINISTRATOR BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. INFORMATIONAL TAX RETURNS, FOR TAX YEARS FOR WHICH THE APPLICABLE STATUTES OF LIMITATIONS HAVE NOT EXPIRED, ARE SUBJECT TO EXAMINATION BY AUTHORITIES. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN NET BENEFIT OBLIGATIONS 1,916,332. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CONTROL OF MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF THE OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO THE CONTRACT ADMINISTRATOR, UFCW GROUP ADMINISTRATION LLC. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD VOTES TO GIVE AUTHORITY TO CHAIR AND SECRETARY TO REVIEW INITIALLY TO SUBMISSION, WITH THE BOARD REVIEWING AFTERWARDS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, UPON REQUEST. FORM 990 PART VII SECTION A COLUMN E AND F TRUSTEES OF THE TRUST ARE EMPLOYEES OF CONTRIBUTING EMPLOYERS THAT ARE CONSIDERED RELATED ORGANIZATIONS UNDER THE DEFINITIONS IN SCHEDULE R. THE TRUST IS UNABLE TO REPORT COMPENSATION AND BENEFITS PAID TO THE TRUSTEES BY RELATED ORGANIZATIONS AS IT WAS UNABLE TO OBTAIN THE INFORMATION AFTER MAKING REASONABLE EFFORTS. THE TRUST REQUESTED THE COMPENSATION INFORMATION FROM THE TRUSTEE(S) BY PROVIDING A QUESTIONNAIRE REQUESTING THE REQUIRED INFORMATION ALONG WITH INSTRUCTIONS TO EXPLAIN THE INFORMATION NEEDED. THE QUESTIONNAIRES FOR THE TRUSTEES WERE NOT RECEIVED BACK PRIOR TO FILING THE TAX RETURN. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSEEING THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. UFCW COMPREHENSIVE BENEFITS TRUST 1000 BURNETT AVE SUITE 110 CONCORD CA 94520 822616834 CA 0 KROGER INC - UCBT SAVE MART SUPERMARKETS INC - UCBT 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 UFCW EMPLOYER BENEFIT TRUSTS OF NORTHERN CALIFORNIA GROUP ADMINISTRATION O 600777 ACTUAL PAID LOCAL UNIONS Q 9470 ACTUAL PAID UCBT RETIREE HEALTH PLAN B 816723 ACTUAL PAID PARTS II, III, AND IV - IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED A RELATED ORGANIZATION BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPATION AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.