2011-02-04T10:02:49-06:00 2010-04-30 Legacy Professionals LLP 311 S Wacker Drive Suite 4000 Chicago IL 60606 990 2009-05-01 846044454 ROCKY MOUNTAIN UFCW UNIONS & EMPLOYERS HEALTH BENEFIT FUND ROCK 3034301118 5511 W 56th Ave No 250 Arvada CO 800022815 STEVE DICROCE 3034301118 2011-02-04 1 3123680500 2009 2016-02-24 21:20:13Z X STEVE DICROCE 5511 W 56th Ave No 250 Arvada CO 800022815 117749261 0 X n/a X 1965 CO PROVIDE HEALTH BENEFITS 6 6 0 0 0 0 0 118303266 68925774 3421331 2315806 3512 1195 121728109 71242775 0 99804786 101396890 0 0 0 7232068 6965385 107036854 108362275 14691255 -37119500 115732017 83430284 460708 6059164 115271309 77371120 TO PROVIDE HEALTH BENEFITS TO THE ELIGIBLE PARTICIPANTS AND DEPENDENTS OF ROCKY MOUNTAIN UFCW & EMPLOYERS HEALTH BENEFIT PLAN. 0 0 TO PROVIDE HEALTH, LIFE, ACCIDENTAL DEATH AND DISMEMBERMENT, DENTAL, VISION, PRESCRIPTION AND TEMPORARY DISABILITY 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 0 0 0 0 0 0 0 0 6 6 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Zenith Administrators 3034301118 5511 W 56th Ave No 250 arvada CO 80002 X STEVE dicroce 1.00 X X 0 0 0 JAMES v morgan 1.00 X X 0 0 0 DANNY ma 1.00 X X 0 0 0 KIM CORDOVA 1.00 X X 0 0 0 KEVIN SCHNEIDER 1.00 X X 0 0 0 STEVE PARDEE 1.00 X X 0 0 0 CRISanta duran 1.00 X X 0 0 0 ERNEST DURAN JR 1.00 X X 0 0 0 ERNEST DURAN III 1.00 X X 0 0 0 0 0 0 0 0 0 0 CIGNA 900 COTTAGE GROVE ROAD HARTFORD CT 06152 PPO ACCESS AND ADMIN FEES 4239185 ZENITH ADMINISTRATORS 5511 W 56TH AVE STE 250 ARVADA CO 80002 THIRD PARTY ADMINISTRATOR 1579298 DELTA DENTAL 4582 S ULSTER STREET STE 800 DENVER CO 80237 BENEFIT ADMIN FEES 333242 THE SEGAL COMPANY 101 N WACKER DRIVE STE 500 CHICAGO IL 60606 ACTUARIAL SERVICES 300687 REINHART BOERNER VAN DEURAN SC 1000 WATER STREET STE 1700 MILWAUKEE WI 53202 LEGAL SERVICES 281582 8 EMPLOYER CONTRIBUTIONS 900099 52658523 52658523 RETIREE CONTRIBUTIONS 900099 6881164 6881164 parTICIPANT CONTRIBUTI 900099 5859488 5859488 PRESCRIPTION REBATES 900099 1502234 1502234 MEDICARE RETIREE DRUG 900099 1272415 1272415 751950 751950 68925774 2984739 2984739 45837553 46506486 -668933 -668933 -668933 MISCELLANEOUS REVENUE 900099 1195 1195 1195 71242775 68173824 0 3068951 101396890 3959479 253145 50102 20000 2374772 277830 3263 25146 membership dues 1648 108362275 2442998 3213673 14586855 2964888 10850111 3958561 18300 39342 87833753 73253820 115732017 83430284 145606 121553 387611 315102 5550000 460708 6059164 X 0 0 0 0 115271309 77371120 115271309 77371120 115732017 83430284 X 0 1 1 X 0 0 estimated EMPLOYER CONTRIBUTION credit 5550000 5550000 71242775 108362275 -37119500 -780689 -780689 -37900189 70442086 -780689 -780689 71222775 20000 20000 71242775 108342275 0 108342275 20000 20000 108362275 Part X: Description of Uncertain Tax Positions Under FIN 48: the plan files form 990, return of organization exempt from income taxes, and form 5500, annual return/report of employee benefit plan. the plan's returns are subject to examination by the internal revenue service until the applicable statute of limitation expires. Form 990, Part VI, Section A, line 2 A FAMILY RELATIONSHIP EXISTS BETWEEN ERNEST DURAN, JR., ERNEST DURAN, III AND CRISANTA DURAN. Form 990, Part VI, Section A, line 3 THE BOARD OF TRUSTEES has delegated the recORD KEEPING and day to day ADMINISRATION of the plan TO ZENITH ADMINISTRATORS. Form 990, Part VI, Section B, line 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARDS REVIEW, THE FORM IS APPROVED AND FILED. Form 990, Part VI, Section B, line 12c THE BOARD OF TRUSTEES ARE REQUIRED TO DISCLOSE ANY NONADHERANCE TO THE ADOPTED POLICY. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE PLAN OFFICE. ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS PENSION PLAN 8700 TURNPIKE DRIVE STE 200 WESTMINSTER CO 80031 846045986 PENSION BENEFIT FUND CO 401(a) N/A DENVER AREA MEAT CUTTERS AND EMPLOYERS PENSION PLAN 8700 TURNPIKE DRIVE STE 200 WESTMINSTER CO 80031 846097461 PENSION BENEFIT FUND CO 401(a) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 ROCKY MOUNTAIN UFCW UNIONS AND EMPLOYERS PENSION PLAN R 3172170 DENVER AREA MEAT CUTTERS AND EMPLOYERS PENSION PLAN R 1280570