2024-11-08T16:21:56-06:00 2023-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2023-01-01 946078804 UFCW & EMPLOYERS BENEFIT TRUST UFCW 9257467530 1000 BURNETT AVENUE SUITE 110 CONCORD CA 94520 JACQUES S LOVEALL CHAIRMAN 9257467530 2024-11-08 1 1 KIM HUNWARDSEN CPA P00484560 6122536500 2024-11-08 2023 2024-10-15 13:58:12Z JACQUES S LOVEALL 1000 BURNETT AVENUE SUITE 110 CONCORD CA 94520 679456604 0 X N/A X 1962 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 10 0 8063 0 2673184 0 0 0 537798704 516173164 -6237926 2673184 21803691 10191202 553364469 529037550 0 0 511160318 485818471 0 0 0 0 0 35286270 33307853 546446588 519126324 6917881 9911226 526950081 565423054 116969779 117225377 409980302 448197677 PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 39,556 ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION AND THE EMPLOYERS. 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1801 0 1 8063 1 1 1 0 0 0 0 0 0 0 X 10 0 0 1 0 0 0 0 0 1 0 0 0 0 1 0 0 1 1 0 0 0 CA X JESSE GLAVES 9254901227 1000 BURNETT AVENUE SUITE 110 CONCORD CA 94520 JACQUES S LOVEALL CHAIR 5.00 35.00 X X 0 292687 40920 PENNY SCHUMACHER SECRETARY 5.00 35.00 X X 0 0 0 TARA LOCASO TRUSTEE 5.00 35.00 X 0 0 0 KEVIN SEARS TRUSTEE 5.00 35.00 X 0 0 0 JOSEPH AMBROSI TRUSTEE 5.00 0.00 X 0 0 0 JOHN FRAHM TRUSTEE 5.00 35.00 X 0 164676 15105 JOHN HEISE TRUSTEE 5.00 35.00 X 0 210362 23886 DANIEL LARSON TRUSTEE 5.00 35.00 X 0 124818 38601 KIRK L VOGT TRUSTEE 5.00 35.00 X 0 268205 23886 OSCAR OROZCO TRUSTEE (AS OF SEP '23) 5.00 35.00 X 0 132887 14978 JOHN A NUNES TRUSTEE (UNTIL SEP '23) 5.00 35.00 X 0 149894 14873 0 1343529 172249 0 0 1 0 UFCW GROUP ADMINISTRATION LLC 1000 BURNETT AVE 110 CONCORD CA 94520 CONTRACT ADMINISTRATOR 17080426 BLUE SHIELD OF CALIFORNIA 4207 TOWN CENTER BLVD EL DORADO HILLS CA 95762 HEALTHCARE ADMINISTRATION 3638090 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 94583 ACCOUNTING 1079658 DELTA DENTAL 560 MISSION ST 1300 SAN FRANCISCO CA 94105 HEALTHCARE ADMINISTRATION 833008 ABS GLOBAL INVESTMENTS 2187 ATLANTIC STREET SUITE 604 STAMFORD CT 06902 INVESTMENT MANAGEMENT 797228 5 EMPLOYER CONTRIBUTIONS 900099 474143887 474143887 PARTICIPANT CONTRIBUTIONS 900099 42029277 42029277 516173164 5439983 5439983 147652255 150419054 -2766799 -2766799 -2766799 MEDICARE PART D SUBSIDY 900099 7627861 7627861 SUTTER HOSPITAL SETTLEMENT 900099 2563341 2563341 10191202 529037550 526364366 2673184 0 485818471 17080426 556553 1079658 2096714 2575154 1267793 29900 131594 HEALTHCARE ADMINISTRATI 8114601 PATIENT CARE OUTCOME RE 202692 COMMUNICATION SERVICES 142041 STAFF RELATED EXPENSE 30585 142 519126324 58862793 71783374 44710227 44044515 26684 34507 181334519 125464005 234461896 263228155 7553962 60868498 526950081 565423054 305489 890863 116664290 116334514 116969779 117225377 X 0 0 0 0 409980302 448197677 409980302 448197677 526950081 565423054 9911226 28306149 0 X X 0 1 X 1 0 0 HEDGE FUNDS 58581205 F REAL ESTATE 10323489 F LIMITED PARTNERSHIP 45943693 F POOLED SEPARATE ACCOUNT 42263030 F OTHER- PRIVATE TRUST 43035213 F RCM CONSTRUCTION MBS OPPORTUNITIES 63081525 F 263228155 ACCRUED INTEREST 707028 REFUND, REBATES & SUBSIDIES 7332152 DUE FROM BROKER FOR SECURITIES SOLD 52829318 60868498 GROUP INSURANCE PREMIUMS PAYABLE 22707180 SELF-FUNDED BENEFIT CLAIMS PAYABLE 5726297 CLAIMS INCURRED BUT NOT REPORTED 83791134 DUE TO OTHER TRUST FUNDS 2173857 OTHER LIABILITIES 1936046 116334514 X 555246985 28306149 28306149 526940836 2096714 2096714 529037550 517926635 897025 897025 517029610 2096714 2096714 519126324 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN NET BENEFIT OBLIGATIONS 897,025. 0 0 0 JACQUES S LOVEALL CHAIR 0 257120 0 1500 0 34067 0 24224 0 16696 0 333607 0 0 KIRK L VOGT TRUSTEE 0 234173 0 1500 0 32532 0 7190 0 16696 0 292091 0 0 JOHN HEISE TRUSTEE 0 173690 0 26500 0 10172 0 7190 0 16696 0 234248 0 0 JOHN FRAHM TRUSTEE 0 164676 0 0 0 0 0 0 0 15105 0 179781 0 0 JOHN A NUNES TRUSTEE (UNTIL SEP '23) 0 149894 0 0 0 0 0 0 0 14873 0 164767 0 0 DANIEL LARSON TRUSTEE 0 124818 0 0 0 0 0 18571 0 20030 0 163419 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES CONTROL OF MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF THE OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO THE CONTRACT ADMINISTRATOR, UFCW GROUP ADMINISTRATION LLC. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE TRUSTEES FORM 990, PART VI, SECTION B, LINE 11B THE BOARD VOTES TO GIVE AUTHORITY TO THE CHAIR, CO-CHAIR AND SECRETARY TO REVIEW INITIALLY, PRIOR TO SUBMISSION, WITH THE BOARD REVIEWING AFTERWARDS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC, UPON REQUEST. FORM 990, PART VII, SECTION A TARA LOCASO, KEVIN SEARS AND PENNY SCHUMACHER ARE EMPLOYEES OF CONTRIBUTING EMPLOYER OR SPONSORING EMPLOYER ORGANIZATION THAT ARE CONSIDERED RELATED ORGANIZATIONS UNDER THE DEFINITIONS IN SCHEDULE R. THE RELATED ORGANIZATIONS ARE FOR-PROFIT ORGANIZATIONS, ARE NOT OWNED OR CONTROLLED, DIRECTLY OR INDIRECTLY, BY THE ORGANIZATION OR ONE OR MORE RELATED TAX-EXEMPT ORGANIZATION, AND DO NOT PROVIDE MANAGEMENT SERVICES FOR A FEE TO THE ORGANIZATION. AS SUCH, UNDER THE VOLUNTEER EXCEPTION COMPENSATION PAID BY THOSE RELATED ORGANIZATIONS IS OMITTED. THE REMAINING TRUSTEES ARE CURRENT OR FORMER EMPLOYEES OF THE SPONSORING UNIONS WHICH ARE CONSIDERED RELATED ORGANIZATIONS PER SCHEDULE R DEFINITION. CURRENT EMPLOYEE COMPENSATION PROVIDED BY THE SPONSORING UNION IS REPORTED IN PART VII. UFCW NORTHERN CALIFORNIA EMPLOYERS JOINT PENSION PLAN 1000 BURNETT AVENUE SUITE 110 CONCORD CA 94520 946313554 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A N/A 0 UFCW NORTHERN CALIFORNIA EMPLOYERS INDIVIDUAL ACCOUNT PLAN 1000 BURNETT AVENUE SUITE 110 CONCORD CA 94520 680161773 TO PROVIDE ANNUITY BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A N/A 0 UFCW LOCAL 5 UFCW LOCAL 5 SPUR UFCW 8 - GOLDEN STATE UFCW UNION LOCAL 648 UFCW UNION LOCAL 648 SPUR UFCW REGION 8 STATES COUNCIL UFCW 8 - GOLDEN STATE SPUR SWAN CO LLC DAVIS COWELL & BOWE LLP GROUP ADMINISTRATION LLC CONCORD GROUP ADMINISTRATION LLC ROSEVILLE 2040 FAIRFAX INC A R PAPE INC ALEX-KAY ENTERPRISES INC ALS FOOD MARKET BIANCHINIS MARKET BIMBO BAKERIES USA BRYANS QUALITY MEATS CALIFORNIA COMMUNITY CREDIT UNION CALIFORNIA SHELLFISH CO CAL-MART INC CASCADE PAINT SUPPLY CENTRAL DRUG COMPANY CORTI BROTHERS INC COST LESS FOOD COMPANY - OAKDALE #6 COST LESS FOOD COMPANY - CERES #7 COST LESS FOOD COMPANY - JACKSON #8 COST LESS FOOD COMPANY - MODESTO WEST #9 COST LESS FOOD COMPANY - MODESTO EAST #10 DEHOFF ENTERPRISES INC DELUXE FOODS DIABLO FOODS DMLS INC DRAEGER'S SUPERMARKET INC FOG CITY FOODS LLC FOODVILLE INC FRESH MARKET GROCERY INC FRESNO MADERA KINGS & TULARE COUNTIES BLDG CONST GROCERY OUTLET INC GROVE MARKET GUERRA QUALITY MEATS INC HARVEST MARKET INC ITALIAN AMERICAN PASTRY CO INC J & J CHECK CASHING JUG SHOP INC LIVINGSTON LIBERTY MARKET #3 DELHI LIBERTY MARKET #4 LUNARDI FOODS LUNARDI'S SUPERMARKET MALFRAN INC MAR-VAL FOOD STORES #4 MAR-VAL FOOD STORES #6 MAR-VAL FOOD STORES #7 MAR-VAL FOOD STORES #8 MAR-VAL FOOD STORES #9 DBA GENE'S FINE FOOD MCBRIDE & SHAW INC MILL VALLEY MARKET MODESTO FOODS DISTRIBUTORS INC MOLLIE STONES - SITE 1 MOLLIE STONES - SITE 2 MOLLIE STONES - SITE 3 MOLLIE STONES - SITE 4 MOLLIE STONES - SITE 5 MOLLIE STONES - SITE 6 MOLLIE STONES - SITE 7 MOLLIE STONES - SITE 8 MOLLIE STONES - SITE 9 MR LIQUOR NOVATO FOODS PEERLESS COFFEE & TEA JP FOODS INC PIAZZA'S FINE FOODS INC PIEDMONT GROCERY CO POR NIMA INC PURITY SUPERMARKET RALEY'S SUPERMARKET BEL AIR NOB HILL FOODS S P D MARKETS INC - NEVADA CITY S P D MARKETS INC - GRASS VALLEY SAFEAMERICA SAFEWAY NOR CAL SAFEWAY - VONS SAVE MART SCOTTYS MARKET SEE'S CANDIES SUNSHINE CENTER PHARMACY THE MEAT MARKET TORGSYN GIFTS & CIGAR TRI-WAY FREEZER MEATS UNITED LOCAL CREDIT UNION UNITED MARKETS UNITED MARKETS DELI VILLAGE MARKET 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1