2013-02-06T15:07:15-06:00 2012-03-31 300702322 HEMMING MORSE CPA'S AND CONSULTANTS 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2011-04-01 952301788 UNITED FOOD & COMMERCIAL WORKERS UNIONS & FOOD EMPLOYERS BEN FUND UNIT 7142202297 6425 KATELLA AVE CYPRESS CA 90630 ADMINISTRATOR 7142202297 2013-02-06 1 4158364000 2011 2016-02-25 16:41:14Z 6425 KATELLA AVE CYPRESS CA 90630 1538078198 0 X N/A X 1964 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 10 10 0 0 0 0 0 0 454314794 504022683 1196824 1021427 4723529 7765094 460235147 512809204 0 0 507608563 519221569 0 0 0 0 0 27143710 28511301 534752273 547732870 -74517126 -34923666 337282112 251998301 221910180 171844688 115371932 80153613 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 0 0 0 1 0 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 17683 0 0 0 0 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 JOEL MELTZ 7142202297 6425 KATELLA AVENUE CYPRESS CA 90630 X GREG CONGER 5.00 X 0 0 0 RICARDO ICAZA 5.00 X 0 0 0 BILL LATHROP 5.00 X 0 0 0 CONNIE LEYVA 5.00 X 0 0 0 MICHAEL KASPARIAN 5.00 X 0 0 0 MICHAEL STRAETER 5.00 X 0 0 0 KATHLEEN A FINAZZO 5.00 X 0 0 0 FRANK JORGENSEN 5.00 X 0 0 0 BRENT BOHN 5.00 X 0 0 0 LEROY WESTMORELAND 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 17900125 HEALTH MANAGEMENT CONCEPTS 181 COMMODORE DR JUPITER FL 33477 CONSULTANT 909745 THE SEGAL COMPANY 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 ACTUARY/CONSULTANT 580151 SEYFARTH SHAW LLP ONE CENTURY PLAZA SUITE 3500 LOS ANGELES CA 900673021 LEGAL COUNSEL 559166 CREWS MACQUARRIE & ASSOCIATES 2855 MICHELLE DR SUITE 100 IRVINE CA 92606 ACTUARY/CONSULTANT 333488 6 EMPLOYER CONTRIBUTIONS 900099 470885137 470885137 PARTICIPANT CONT. 900099 32812157 32812157 COBRA SUBSIDY 900099 325389 325389 504022683 2204699 2204699 1024085722 1025268994 -1183272 -1183272 -1183272 MEDICARE PART D SUBSID 900099 4188121 4188121 MHNS SETTLEMENT 900099 3237919 3237919 OTHER INCOME 900099 339054 339054 7765094 512809204 511787777 0 1021427 519221569 17900125 871602 66284 60611 59038 350 253050 COST CONTAINMENT FEES 5856438 ACTUARIAL CONSULTANTS 1833490 PRINTING 611273 POSTAGE 554909 444131 547732870 69167819 46272492 36063689 43368843 213268 222356 229656627 152748943 2180709 9385667 337282112 251998301 376696 608924 221533484 171235764 221910180 171844688 X 0 0 0 0 115371932 80153613 115371932 80153613 337282112 251998301 X -34923666 -294653 X X 0 1 1 X 0 0 GROUP INSURANCE PREMIUMS AND CLAIMS PAYABLE 74216244 CLAIMS INCURRED BUT NOT REPORTED 35673000 ANCILLARY AWARDS AND GRANTS NOT USED 150000 CASH - OPERATING ACCOUNTS (OVERDRAFT) 9546129 LIABILITY TO RETURN COLLATERAL FOR SECURITY ON LOAN 51650391 171235764 512809204 547732870 -34923666 -294653 -294653 -35218319 512514551 -294653 -294653 512809204 0 512809204 547732870 0 547732870 0 547732870 FORM 990, PART IV, LINE 34 THE TRUST FUND HAS A SPECIFIC PROCEDURE IN PLACE FOR THIS NEW DISCLOSURE REQUIREMENT ON THE SCHEDULE R. THE ADMINISTRATOR HAS SENT OUT A QUESTIONNAIRE TO OBTAIN THE REQUIRED INFORMATION FROM THE CONTRIBUTING EMPLOYERS. THE ENCLOSED INFORMATION REPRESENTS WHAT THE TRUST FUND HAS RECEIVED TO DATE. FORM 990, PART VI, SECTION B, LINE 11 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -294,653. 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. 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