2011-01-27T15:09:57-06:00 2010-03-31 lindquist llp 5000 executive parkway suite 400 san ramon CA 94583 990 2009-04-01 916058475 RETAIL CLERKS WELFARE TRUST RETA 2062824100 201 queen anne ave north No 100 seattle WA 981094824 RANDY ZEILER 2062824100 2011-01-27 1 9252779100 2009 2016-02-24 21:20:13Z randy zeiler 201 queen anne ave north No 100 seattle WA 981094824 283938187 0 X n/a X 1957 WA To PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 12 12 4478 0 0 0 0 168280313 225874924 7882373 2961312 0 176162686 228836236 0 212230593 220112093 0 0 0 18706491 19988849 230937084 240100942 -54774398 -11264706 127256166 139837672 67008663 77590870 60247503 62246802 TO Provide health and welfare benefits to eligible participants and their dependents. 0 0 ProvideD health and welfare benefits to eligible participants and their dependents. 0 0 0 0 0 0 0 0 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 0 0 1 4478 1 0 0 0 0 0 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X zenith administrators inc 2062824100 201 queen anne avenue north seattle WA 98109 X Derrick Anderson 1.00 X 0 0 0 Brent R Bohn 1.00 X 0 0 0 frank jorgensen 1.00 X 0 0 0 scott k powers 1.00 X 0 0 0 carl wojciechowski 1.00 X 0 0 0 randy zeiler 1.00 X 0 0 0 david blitzstein 1.00 X 0 0 0 Todd Crosby 1.00 X 0 0 0 david schmitz 1.00 X 0 0 0 mike williams 1.00 X 0 0 0 brenda willis 1.00 X 0 0 0 diane zahn 1.00 X 0 0 0 MIKE HATFIELD 1.00 X 0 0 0 NATHAN HYDE 1.00 X 0 0 0 0 0 0 0 0 0 0 zenith administrators inc 201 queen anne avenue north seattle WA 981094896 administration 7031832 group health cooperative 320 westlake avenue north suite 10 seattle WA 981095233 HMO Administration 5378561 stay well health management 3000 ames crossing road suite 100 st paul MN 55121 personal health assessment administratio 1673794 bank of america 201 north tryon street charlotte NC 28202 HRA Administration & bank service fees 1284734 MERCER HUMAN RESOURCE CONSULTING 1301 Fifth Avenue Suite 1900 seattle WA 98101 CONSULTING SERVICES 1004112 16 Employer Contributions 900099 206687877 206687877 Participant Contributi 900099 18027230 18027230 PRESCRIPTION REBATES 900099 1159817 1159817 225874924 3658233 3658233 54405030 55101951 -696921 -696921 -696921 228836236 225874924 0 2961312 220112093 6511834 128267 161955 114076 11902577 995170 8944 20856 30946 NEWSLETTER EXPENSE 114224 240100942 21183441 14338544 19567504 495272 469715 104873088 85933527 7549262 12683485 127256166 139837672 760736 562015 66247927 77028855 67008663 77590870 X 0 0 0 0 60247503 62246802 60247503 62246802 127256166 139837672 X 0 1 1 X 0 0 limited partnership 12683485 F 12683485 IBNR and Estimated Claims Payable 34000000 cash overdrafts 5436855 ACCUMULATED ELIGIBILITY CREDITS 37592000 77028855 228836236 240100942 -11264706 13264005 10156000 23420005 12155299 241986165 13264005 13264005 228722160 114076 114076 228836236 229830866 0 229830866 114076 10156000 10270076 240100942 Part XI, Line 8 - Other Adjustments: Increase in Benefit ObligationS Part XIII, Line 4b - Other Adjustments: Increase in Benefit Obligations Form 990, Part VI, Section A, line 3 THE ORGANIZATION HAS CONTRACTED WITH Zenith Administrators, INC. TO PROVIDE DAY TO DAY ADMINISTRATIVE SERVICES TO THE ORGANIZATION. Form 990, Part VI, Section B, line 11 A TRUSTEE REVIEWED FORM 990 PRIOR TO FILING with the IRS. Form 990, Part VI, Section B, line 12c The Conflict of Interest Policy pertains to all Trustees and service Providers who can influence the actions of the Trust. A conflict of interest includes an interest, direct or indirect, of a Trustee or service provider to a Trust, which may result in the Trustee or service provider benefiting financially from decision made in relation to his or her capacity as a Trustee of or service provider to the Trust. Disclosure of possible conflicts of interest are made to either the Secretary or the Chair of the Trust. The Trustees determine if a conflict of interest exists. The decision of the Trustees, in relation to a conflict of interest, is binding and final. Form 990, Part VI, Section C, line 19 UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF INTERST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 2C: The board of trustees assumes responsibilty for oversight of the audit of its financial statements and selection of independent auditors. Form 990, Part V, Line 2a: The plan pays "Incentive Payments" to participants for accomplishing certain outlined objectives, such as, Tobacco cessation and answering surveys. These payments are taxable benefits and are reported on Forms W-2. Form 990, Part V, Line 1a: The Trust does not issue Forms 1099 directly to reportable service providers. Rather, the contract administrator uses their employer identification number for the Forms 1099 that they issue on behalf of the Trust. retail clerks pension trust 201 queen anne avenue north seattle WA 98109 916069306 to provide pension benefits WA 501(a) N/A N/A retail clerks retiree welfare trust 201 queen anne avenue north seattle WA 98109 911950259 to provide RETIREE health and welfare benefits WA 501(c) 9 N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0