2019-02-15T11:46:40-06:00 2018-03-31 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2017-04-01 952301788 UNITED FOOD & COMMERCIAL WORKERS UNIONS & FOOD EMPLOYERS BENEFIT FUND UNIT 7142202297 6425 KATELLA AVE CYPRESS CA 90630 TRUSTEE TRUSTEE ADMINISTRATOR 7142202297 2019-02-15 1 TROY ATKINSON P00739466 4158364000 69.170.7.86 2019-02-15 11:46:06 PS P 6A119F164E6EB55EF1F9B46B97FA75FDA10D5472 79ACAE867A9DB9871DCF109F9EDC9C017100E02E 2017 2019-02-21 02:37:17Z 6425 KATELLA AVE CYPRESS CA 90630 1298762284 0 X N/A X 1964 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 10 10 0 0 0 0 0 0 581927775 574875827 2323240 2579961 9010847 3942532 593261862 581398320 0 0 559438557 563671308 0 0 0 0 0 30823893 31310190 590262450 594981498 2999412 -13583178 332444032 325674998 128188408 132706061 204255624 192968937 NONE 0 0 THE PLAN IS A MULTI-EMPLOYER WELFARE BENEFIT PLAN PROVIDING HOSPITAL, MEDICAL, PSYCHIATRIC, PREVENTIVE MEDICINE, DENTAL ORTHODONTIA, PRESCRIPTION DRUG, DEATH, INDUSTRY VACATION AND VISION CARE BENEFITS 0 0 0 0 0 0 0 0 0 0 1 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 8458 25 1 0 1 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X RON SCHOEN 7142202297 6425 KATELLA AVENUE CYPRESS CA 90630 X GREG CONGER TRUSTEE 5.00 X 0 0 0 JOE DUFFLE TRUSTEE 5.00 X 0 0 0 DUANE SNIDER TRUSTEE 5.00 X 0 0 0 MARK RAMOS TRUSTEE 5.00 X 0 0 0 MICHAEL KASPARIAN TRUSTEE 5.00 X 0 0 0 MICHAEL STRAETER TRUSTEE 5.00 X 0 0 0 KATHY FINN TRUSTEE 5.00 X 0 0 0 FRANK JORGENSEN TRUSTEE 5.00 X 0 0 0 BRENT BOHN TRUSTEE 5.00 X 0 0 0 LEROY WESTMORELAND TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 SC UFCW ADMINISTRATION LLC 6425 KATELLA AVE CYPRESS CA 90630 CONTRACT ADMINISTRATOR 18713705 BLUE CROSS OF CALIFORNIA DEPT 5812 LOS ANGELES CA 90074 CONSULTANT 4588535 HEALTH MANAGEMENT CONCEPTS 181 COMMODORE DR JUPITER FL 33477 CONSULTANT 1920036 SAFEWAY HEALTH INC PO BOX 742820 LOS ANGELES CA 90074 CONSULTANT 792584 SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 CONSULTANT 540347 13 EMPLOYER CONTRIBUTIONS 900099 517512027 517512027 PARTICIPANT CONT. 900099 57363800 57363800 574875827 3491011 3491011 716452914 717363964 -911050 -911050 -911050 MEDICARE PART D SUBSIDY 900099 3942296 3942296 LEGAL SETTLEMENT INCOME 900099 236 236 3942532 581398320 581398320 0 0 563671308 18713705 951768 67437 385801 83339 223980 COST CONTAINMENT FEES 6483579 BENEFIT CONSULTING 1055718 ACTUARIAL CONSULTANTS 910432 MARKET PRICE DRUG PROGR 792584 1641847 594981498 51574168 45554576 41745130 41762280 207455 207455 152043214 148410811 84728080 88190813 2145985 1549063 332444032 325674998 392953 542390 127795455 132163671 128188408 132706061 X 0 0 0 0 204255624 192968937 204255624 192968937 332444032 325674998 -13583178 2296491 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 88190813 F 88190813 GROUP INSURANCE PREMIUMS AND CLAIMS PAYABLE 88933106 CLAIMS INCURRED BUT NOT REPORTED 28183400 ANCILLARY AWARDS AND GRANTS NOT USED 289000 CASH - OPERATING ACCOUNTS (OVERDRAFT) 6041860 LIABILITY TO RETURN COLLATERAL FOR SECURITY ON LOAN 7801004 DUE TO OTHER TRUST FUNDS AND LLC 915301 132163671 X 583694811 2296491 2296491 581398320 0 581398320 594981498 0 594981498 0 594981498 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. THE ENTITY BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES DESIGNATE THE ADMINISTRATOR TO REVIEW THE FORM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND FOR SELECTING THE INDEPENDENT AUDITOR. SO CA UFCW UNIONS & FOOD EMPLOYERS JOINT PENSION TRUST FUND 6425 KATELLA AVENUE CYPRESS CA 90630 951939092 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PARTS II, III, AND IV- IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED A RELATED ORGANIZATIONS BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPANTS AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SEPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.