2024-11-06T12:34:14-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-01-01 926003453 ALASKA UFCW HEALTH & WELFARE TRUST ALAS 5034862045 12205 SW TUALATIN RD 200 TUALATIN OR 97062 BRENT BOHN SECRETARY 5034862045 2024-11-06 1 0 MICHAEL T MEAD CPA P01893207 4252506100 2024-11-06 2023 2024-10-15 13:58:12Z X BRENT BOHN 12205 SW TUALATIN RD 200 TUALATIN OR 97062 24382782 0 X WWW.AKUFCWTRUST.COM X 1965 AK TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 5 2 0 9 0 0 0 0 23772328 22813527 299949 280404 212342 14191 24284619 23108122 0 0 24116510 20041136 0 0 0 0 0 1841167 665834 25957677 20706970 -1673058 2401152 22138794 21621155 9044469 5236173 13094325 16384982 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 DISBURSEMENTS NEEDED TO PROVIDE HEALTH & WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AS SPECIFIED IN THE PLAN. 0 0 0 0 0 0 0 0 0 0 1 0 0 1 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 1 211 0 1 0 0 0 0 0 0 0 0 0 X 5 2 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X PATI PIRO-BOSLEY 5034862045 12205 SW TUALATIN ROAD SUITE 200 TUALATIN OR 97062 X X SILVANA TIRBAN CHAIRMAN 1.00 X X 0 0 0 BRENT BOHN SECRETARY - STARTED 6/2023 1.00 X X 0 0 0 DAN CLAY TRUSTEE 1.00 X 0 0 0 FRANK MUTCHIE TRUSTEE 1.00 X 0 0 0 SCOTT KLITZKE POWERS TRUSTEE - STARTED 6/2023 1.00 X 0 0 0 SEAN HAMMOND TRUSTEE - START 6/23; END 12/23 1.00 X 0 0 0 HL BUZZ RAVENSCRAFT TRUSTEE - ENDED 6/2023 1.00 X 0 0 0 ROBERT MCLAUCHLIN SECRETARY - ENDED 6/2023 1.00 X 0 0 0 0 0 0 0 0 0 0 LABOR TRUST SERVICES INC 375 W 36TH AVE 200 ANCHORAGE AK 99503 THIRD PARTY ADMINISTRATOR 725153 AETNA INC 151 FARMINGTON AVE HARTFORD CT 06156 PPO NETWORK 273329 BEACON OHSS INC 701 E TUDOR RD ANCHORAGE AK 99503 LABORATORY SERVICES 227200 RAEL & LETSON 601 UNION ST STE 2415 SEATTLE WA 98101 CONSULTING SERVICES 178741 4 EMPLOYER CONTRIBUTIONS 900099 21464797 21464797 PARTICIPANT CONTRIBUTIONS 900099 1348730 1348730 22813527 355064 355064 1200000 1274660 -74660 -74660 -74660 OTHER INCOME 900099 14191 14191 14191 23108122 22827718 0 280404 20041136 305602 38933 54885 22203 178741 32736 9425 2615 14970 PCORI TAX 5724 20706970 143330 422524 3176890 1207257 3075781 4294384 10039 0 13942178 13667019 1790576 2029971 22138794 21621155 360156 14950 8684313 5221223 9044469 5236173 X 0 0 0 0 13094325 16384982 13094325 16384982 22138794 21621155 2401152 889505 0 X X 0 1 X 1 0 0 103-12 INVESTMENT ENTITY - GOLDENTREE MULTI-SECTOR FUND OFFSHORE 2029971 F 2029971 CLAIMS PAYABLE 349223 CLAIMS INCURRED BUT NOT REPORTED 2754000 ACCUMULATED ELIGIBILITY CREDITS 2118000 5221223 23975424 889505 889505 23085919 22203 22203 23108122 24147857 0 24147857 22203 -3463090 -3440887 20706970 PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGAITONS -3,463,090. 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 THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. FORM 990, PART VI, SECTION A, LINE 3 THE PLAN CONTRACTS ZENITH AMERICAN SOLUTIONS AS THE THIRD-PARTY ADMINISTRATOR OF THE PLAN, WHO OVERSEES ALL DAY TO DAY OPERATIONS. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES, BY E-MAIL, FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST THEY ARE AWARE OF AS THEY BECOME AWARE OF IT. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN DOCUMENT, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PARTICIPANTS AND PUBLIC UPON REQUEST FORM 990, PART VII, SECTION A, LINE 6: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED TAX-EXEMPT ORGANIZATIONS IS REPORTED ON FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE PLAN ADMINISTRATOR. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES OVERSIGHT RESPONSIBILITY FOR THE ANNUAL INDEPENDENT AUDIT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UFCW LOCAL 1496 ALASKA UNITED FOOD AND COMMERCIALS WORKERS PENSION PLAN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTI-EMPLOYER TRUST THAT PROVIDES HEALTH BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF DECEMBER 31, 2023, THERE ARE APPROXIMATELY 15 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES, AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATION OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. ALASKA STATE AFL-CIO BEHRENDS MECHANICAL FAIRBANKS DISTRIBUTO GAVORA INC HAMMER & WIKAN INC IRONWORKERS LOCAL 75 LABOR TRUST SERVICES LOCAL 1496 UFCW MARKET BASKET INC PLUMBERS & STEAM SAFEWAY STORES INC SHEET METAL WORKERS TATSUDA'S SUPERMARKE THE TRADING UNION, I TONGASS TRADING CO