2012-10-10T13:22:28-05:00 2011-12-31 542189926 Henningfield & Associates Inc 27913 Smyth Drive Valencia CA 91355 990 2011-01-01 237100610 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 711 FOOD EMPLOYERS BENEFIT FUND UNIT 8004534584 4885 SOUTH 900 EAST No 202 SALT LAKE CITY UT 84117 TERRY RACHIELE 8004534584 2012-10-03 1 RANDY D HENNINGFIELD P01364367 6612953363 2011 2016-02-24 21:20:13Z TERRY RACHIELE 4885 SOUTH 900 EAST SALT LAKE CITY UT 84117 33618712 0 X N/A X 1970 CA HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 7 7 0 0 0 0 0 0 33877744 33606200 20633 12512 0 0 33898377 33618712 0 0 34830734 35531769 0 0 0 0 0 2955867 3028820 37786601 38560589 -3888224 -4941877 20080450 14515943 12434917 11812287 7645533 2703656 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS 0 0 35531769 HEALTH & WELFARE BENEFITS PROVIDED TO MEMBERS WHO ARE COVERED BY COLLECTIVE BARGAINING AGREEMENTS BETWEEN UNION AND EMPLOYERS. 35531769 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 1658 0 1 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 X X JAS INC 8004534584 4885 SOUTH 900 EAST 202 SALT LAKE CITY UT 84117 X DAVID GOODALL 10.00 X 0 0 0 ROBERTA WEST 10.00 X 0 0 0 DEANNA LEIVAS 10.00 X 0 0 0 PETER BARTH 10.00 X 0 0 0 BRENT BOHN 10.00 X 0 0 0 TERRY RACHIELE 10.00 X 0 0 0 MICHAEL GITTINGS 10.00 X 0 0 0 0 0 0 0 0 0 0 JAS INC 4885 SOUTH 900 EAST SUITE 202 SALT LAKE CITY UT 84117 CONTRACT ADMINISTRATION 899473 BEECH STREET 115 FIFTH AVE 7TH FL NEW YORK NY 10003 NETWORK ACCESS FEES 673898 SHPS 9200 SHELBYVILLE ROAD 440 LOUISVILLE KY 40222 CASE MANAGEMENT AND UTILIZATION REVIEW 207626 MINES & ASSOCIATES 4885 SOUTH 900 EAST SUITE 202 SALT LAKE CITY UT 84117 EAP SERVICES 161035 AVIA PARTNERS 20427 NORTH 27 AVE PHOENIX AZ 84117 RX BENEFIT ADMINISTRATOR 101475 5 EMPLOYER CONTRIBUTIONS 445100 32894405 32894405 PARTICIPANT CONTRIBUTI 445100 589135 589135 FEDERAL ERRP REIMBURSE 445100 118651 118651 FEDERAL COBRA SUBSIDY 445100 4009 4009 33606200 12512 12512 33618712 33606200 0 12512 35531769 899474 127795 31188 176499 18598 29033 MEDICAL COST CONTAINMEN 1300910 CONSULTING 137826 ADMIN.-LAS VEGAS OFFICE 102470 ADMINISTRATION - RX 101475 103552 38560589 17174824 11672727 2895935 2833525 9691 9691 20080450 14515943 118917 180287 12316000 11632000 12434917 11812287 X 0 0 0 0 7645533 2703656 7645533 2703656 20080450 14515943 -4941877 0 X 0 1 1 X 0 0 IBNR PAYABLE 5222000 ACCUM ELIG CREDITS PAYABLE 6410000 11632000 33618712 38560589 -4941877 -4941877 33618712 0 33618712 0 33618712 39244589 0 39244589 -684000 -684000 38560589 Part XIII, Line 4b - Other Adjustments: CHANGE IN IBNR & EXTENDED ELIGIBILITY -684,000. Form 990, Part VI, Section A, line 3 The trustees have contracted with a third party administrator to perform the everyday administration of the fund. Form 990, Part VI, Section B, line 11 A copy of Form 990 was presented to the trustees for review and signatures. Form 990, Part VI, Section C, line 19 Summary Annual Reports are provided to all participants annually. SPDs and audited financial statements are available from the administrator upon request, as well as the DOL website. Contact Addresses for Officers, Directors, Etc Form 990, Part VII DAVID GOODALL - 618 Michillinda Ave.,, ARCADIA, CA 91007. ROBERTA WEST - 1201 N. DECATUR,, LAS VEGAS, NV 89108. DEANNA LEIVAS - 1201 N. DECATUR,, LAS VEGAS, NV 89108. PETER BARTH - 4885 So 900 East,, SALT LAKE CITY, UT 84117. BRENT BOHN - 1421 S. Manhattan Ave.,, FULLERTON, CA 92831. TERRY RACHIELE - 1201 N. DECATUR,, LAS VEGAS, NV 89108. MICHAEL GITTINGS - 1201 N. DECATUR,, LAS VEGAS, NV 89108. ALBERTSON'S 1421 S MANHATTAN AVE FULLERTON CA 92831 204057706 RETAIL GROCERS CA C SMITH' FOOD 4 LESS 4885 S 900 EAST SALT LAKE CITY UT 84117 870258768 RETAIL GROCERS CA C VONS SAFEWAY 618 MICHILLINDA AVE ARCADIA CA 91007 381623900 RETAIL GROCERS CA C UFCW LOCAL 711 1201 NORTH DECATUR LAS VEGAS NV 89108 880057132 LABOR UNION NV C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0