2014-04-04T13:06:53-05:00 2013-06-30 MILLER KAPLAN ARASE LLP 4123 LANKERSHIM BLVD NORTH HOLLYWOOD CA 916022828 990 2013-01-01 936042567 Portland Area UFCW Local 555- Employers Health Plan % PATI PIRO-BOSLEY PORT 8006544411 7600 SW MOHAWK ST Suite TUALATIN OR 97062 pati piro-bosley Administrative manager 8006544411 2014-04-03 true miller kaplan arase llp 8187692010 2013 2015-11-30 17:44:51Z X SCOTT POWERS 7600 SW MOHAWK ST TUALATIN OR 97062 46035901 false X N/A X 1957 OR SEE SCHEDULE O X 10 0 1 0 0 0 0 0 84358207 43175714 95464 37328 0 0 84453671 43213042 0 0 73874396 34288834 0 0 0 0 0 1086145 755299 74960541 35044133 9493130 8168909 29285046 0 18434886 0 10850160 0 X SEE SCHEDULE O false false SEE SCHEDULE O false false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false true true false true false false true 576 0 true 1 true false false false false false false X 10 0 false true false false false false false true true false false true true true true true true false X PATI PIRO-BOSLEY 8006544411 7600 SW MOHAWK ST TUALATIN OR 97062 X X Jeff Anderson TRUSTEE 1.0 X 0 0 0 dAn clay TRUSTEE 1.0 X 0 0 0 matt smith TRUSTEE 1.0 X 0 0 0 lisa dupell TRUSTEE 1.0 X 0 0 0 BRENT BOHN Trustee 1.0 X 0 0 0 FRANK JORGENSEN TRUSTEE 1.0 X 0 0 0 KEVIN BILLMAN TRUSTEE 1.0 X 0 0 0 scott powers TRUSTEE 1.0 X 0 0 0 cindy thornton TRUSTEE 1.0 X 0 0 0 lynda hart TRUSTEE 1.0 X 0 0 0 0 0 0 0 false false false REGENCE BLUECROSS BLUESHIELD of ore PO BOX 1271 M/S ELLA PORTLAND OR 97207 PPO PROVIDER ADMIN. 2167195 EXPRESS SCRIPTS PO BOX 390873 BLOOMINGTON MN 55439 CLAIMS COST CONTROL 196608 segal company 100 montgomery st ste 500 SAN FRANCISCO CA 94104 actuarial services 115818 3 0 EMPLOYER CONTRIBUTIONS 900099 40511515 40511515 PARTICIPANT CONTRIBUTIONS 900099 2664199 2664199 43175714 48836 48836 0 0 0 0 0 2811351 2822859 -11508 -11508 -11508 0 0 0 0 43213042 43175714 37328 0 0 0 34288834 0 0 0 0 0 0 320975 18491 44901 0 0 10397 181242 0 146754 0 0 0 0 0 11802 0 0 0 20737 35044133 16449271 0 0 0 0 0 7800222 0 0 0 0 0 0 0 0 0 34010 0 0 5001543 0 0 0 0 0 0 0 0 0 29285046 0 111487 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 18323399 0 18434886 0 X 0 0 0 0 10850160 0 10850160 0 29285046 0 X 8168909 -3324 -19015745 X false true X true 0 0 X 43209718 -3324 -3324 43213042 43213042 35044133 35044133 35044133 The Plan has adopted guidance on accounting for uncertainty in income taxes issued by the Financial Accounting Standards Board. The Plan administrator believes that the Plan has taken no uncertain tax positions that require adjustment to the financial statements to comply with the provisions of this guidance. Certain Information returns are subject to examination by authorities. cash 2013-06-01 19015745 cash paid 237017278 joint labor mgmt retail TF 7600 sw mohawk st tualatin OR 97062 501(c)(9) true false false false true false true false cash 2013-06-01 19015745 cash paid 237017278 joint labor mgmt retail tf 7600 sw mohawk st tualatin OR 97062 501(c)(9) true false false false a number of trustees already serve as trustees on the joint labor management retail trust ("jlmrt" - the surviving trust). the following trustees will serve on the jlmrt effective july 1, 2013: bob mclauchlin (alternate) lynda hart (alternate) lisa dupell (alternate) attached is a copy of the signed merger agreement. TO PROVIDE MEDICAL, VISION, DENTAL, PRESCRIPTION, SUPPLEMENTAL INCOME, LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO PARTICIPANTS ON WHOSE BEHALF EMPLOYERS CONTRIBUTE TO THE PLAN IN ACCORDANCE WITH THEIR COLLECTIVE BARGAINING AGREEMENT. PART VI, LINE 11b: FORM 990 WAS REVIEWED BY THE ADMINISTRATIVE OFFICE PRIOR TO FILING. ANY UNUSUAL ITEMS WERE BROUGHT TO THE TRUSTEES ATTENTION. PART VI, LINE 12C: TRUSTEES ARE REQUIRED TO NOTIFY THE TRUST OF ANY CHANGES IN THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS. PART VI, LINE 19: THE TRUST DOCUMENT, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MAINTAINED IN THE TRUSTS' OFFICE AND ARE AVAILABLE UPON REQUEST. PART VII, SECTION A: TRUSTEES COMPENSATION AND BENEFITS FROM RELATED TAX-EXEMPT ORGANIZATIONS IS PROPERLY REPORTED AND AVAILABLE ON THOSE ORGANIZATIONS' tax filings. part xi, line 9: plan merger, net of transfer of benefit obligations. see part vii see part vii false false false false false false false false false false false false false false false false false false false THIS INFORMATION IS NOT MAINTAINED BY THE ADMINISTRATIVE OFFICE. IF SPECIFIC INFORMATION IS NEEDED, PLEASE CONTACT THE ADMINISTRATIVE OFFICE.