401k Plan data: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST plan

UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 401k Plan overview

Plan Name	UFCW LOCAL 555-EMPLOYERS HEALTH TRUST
Plan identification number	501

UFCW LOCAL 555-EMPLOYERS HEALTH TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

BOARD OF TRUSTEES, UFCW LOCAL 555-EMPLOYERS HEALTH has sponsored the creation of one or more 401k plans.

Company Name: BOARD OF TRUSTEES, UFCW LOCAL 555-EMPLOYERS HEALTH

Employer identification number (EIN): 237017278

NAIC Classification: 445110
NAIC Description: Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01
501 2021-07-01
501 2020-07-01
501 2019-07-01
501 2018-07-01
501 2017-07-01
501 2016-07-01 MILLER KAPLAN ARASE LLP
501 2015-07-01 MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP 2017-03-24
501 2014-07-01 MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP 2016-04-15
501 2013-07-01 SANDY S. GARCIA SANDY S. GARCIA 2015-04-08
501 2012-07-01 SANDY S. GARCIA SANDY S. GARCIA 2014-04-09
501 2011-07-01 PATI PIRO-BOSLEY
501 2009-07-01 PATI PIRO-BOSLEY

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2022-07-01
501	2021-07-01
501	2020-07-01
501	2019-07-01
501	2018-07-01
501	2017-07-01
501	2016-07-01	MILLER KAPLAN ARASE LLP
501	2015-07-01	MILLER KAPLAN ARASE LLP	MILLER KAPLAN ARASE LLP	2017-03-24
501	2014-07-01	MILLER KAPLAN ARASE LLP	MILLER KAPLAN ARASE LLP	2016-04-15
501	2013-07-01	SANDY S. GARCIA	SANDY S. GARCIA	2015-04-08
501	2012-07-01	SANDY S. GARCIA	SANDY S. GARCIA	2014-04-09
501	2011-07-01	PATI PIRO-BOSLEY
501	2009-07-01	PATI PIRO-BOSLEY

Plan Statistics for UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

401k plan membership statisitcs for UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

Measure Date Value
2022: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2022 401k membership
Total participants, beginning-of-year 2022-07-01 10,483
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 11,497
Number of retired or separated participants receiving benefits 2022-07-01 413
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 11,910
Total participants 2022-07-01 11,910
Number of employers contributing to the scheme 2022-07-01 42
2021: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 401k membership
Total participants, beginning-of-year 2021-07-01 11,312
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 10,057
Number of retired or separated participants receiving benefits 2021-07-01 426
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 10,483
Total participants 2021-07-01 10,483
Number of employers contributing to the scheme 2021-07-01 44
2020: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 401k membership
Total participants, beginning-of-year 2020-07-01 11,155
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 10,904
Number of retired or separated participants receiving benefits 2020-07-01 408
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 11,312
Total participants 2020-07-01 11,312
Number of employers contributing to the scheme 2020-07-01 44
2019: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 401k membership
Total participants, beginning-of-year 2019-07-01 11,365
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 10,756
Number of retired or separated participants receiving benefits 2019-07-01 399
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 11,155
Total participants 2019-07-01 11,155
Number of employers contributing to the scheme 2019-07-01 48
2018: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 401k membership
Total participants, beginning-of-year 2018-07-01 11,937
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 10,974
Number of retired or separated participants receiving benefits 2018-07-01 391
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 11,365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-07-01 0
Total participants 2018-07-01 11,365
Number of participants with account balances 2018-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 0
Number of employers contributing to the scheme 2018-07-01 48
2017: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 401k membership
Total participants, beginning-of-year 2017-07-01 11,503
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 11,344
Number of retired or separated participants receiving benefits 2017-07-01 593
Number of other retired or separated participants entitled to future benefits 2017-07-01 0
Total of all active and inactive participants 2017-07-01 11,937
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 11,937
Number of participants with account balances 2017-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 0
Number of employers contributing to the scheme 2017-07-01 48
2016: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 401k membership
Total participants, beginning-of-year 2016-07-01 10,847
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 11,048
Number of retired or separated participants receiving benefits 2016-07-01 455
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 11,503
Total participants 2016-07-01 11,503
Number of employers contributing to the scheme 2016-07-01 48
2015: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 401k membership
Total participants, beginning-of-year 2015-07-01 11,130
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 10,448
Number of retired or separated participants receiving benefits 2015-07-01 399
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 10,847
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 10,847
Number of participants with account balances 2015-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
Number of employers contributing to the scheme 2015-07-01 52
2014: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 401k membership
Total participants, beginning-of-year 2014-07-01 11,881
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 10,687
Number of retired or separated participants receiving benefits 2014-07-01 443
Total of all active and inactive participants 2014-07-01 11,130
Total participants 2014-07-01 11,130
Number of employers contributing to the scheme 2014-07-01 61
2013: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 401k membership
Total participants, beginning-of-year 2013-07-01 12,446
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 11,499
Number of retired or separated participants receiving benefits 2013-07-01 382
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 11,881
Total participants 2013-07-01 11,881
Number of employers contributing to the scheme 2013-07-01 59
2012: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 401k membership
Total participants, beginning-of-year 2012-07-01 4,129
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 3,845
Number of retired or separated participants receiving benefits 2012-07-01 276
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 4,121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 4,121
Number of participants with account balances 2012-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
Number of employers contributing to the scheme 2012-07-01 26
2011: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 401k membership
Total participants, beginning-of-year 2011-07-01 5,165
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 3,966
Number of retired or separated participants receiving benefits 2011-07-01 163
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 4,129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 4,129
Number of participants with account balances 2011-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
Number of employers contributing to the scheme 2011-07-01 32
2009: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2009 401k membership
Total participants, beginning-of-year 2009-07-01 6,323
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 5,039
Number of retired or separated participants receiving benefits 2009-07-01 141
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 5,180
Total participants 2009-07-01 5,180
Number of employers contributing to the scheme 2009-07-01 33

Measure	Date	Value
2022: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2022 401k membership
Total participants, beginning-of-year	2022-07-01	10,483
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	11,497
Number of retired or separated participants receiving benefits	2022-07-01	413
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	11,910
Total participants	2022-07-01	11,910
Number of employers contributing to the scheme	2022-07-01	42
2021: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 401k membership
Total participants, beginning-of-year	2021-07-01	11,312
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	10,057
Number of retired or separated participants receiving benefits	2021-07-01	426
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	10,483
Total participants	2021-07-01	10,483
Number of employers contributing to the scheme	2021-07-01	44
2020: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 401k membership
Total participants, beginning-of-year	2020-07-01	11,155
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	10,904
Number of retired or separated participants receiving benefits	2020-07-01	408
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	11,312
Total participants	2020-07-01	11,312
Number of employers contributing to the scheme	2020-07-01	44
2019: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 401k membership
Total participants, beginning-of-year	2019-07-01	11,365
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	10,756
Number of retired or separated participants receiving benefits	2019-07-01	399
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	11,155
Total participants	2019-07-01	11,155
Number of employers contributing to the scheme	2019-07-01	48
2018: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 401k membership
Total participants, beginning-of-year	2018-07-01	11,937
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	10,974
Number of retired or separated participants receiving benefits	2018-07-01	391
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	11,365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-07-01	0
Total participants	2018-07-01	11,365
Number of participants with account balances	2018-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	0
Number of employers contributing to the scheme	2018-07-01	48
2017: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 401k membership
Total participants, beginning-of-year	2017-07-01	11,503
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	11,344
Number of retired or separated participants receiving benefits	2017-07-01	593
Number of other retired or separated participants entitled to future benefits	2017-07-01	0
Total of all active and inactive participants	2017-07-01	11,937
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	11,937
Number of participants with account balances	2017-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	0
Number of employers contributing to the scheme	2017-07-01	48
2016: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 401k membership
Total participants, beginning-of-year	2016-07-01	10,847
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	11,048
Number of retired or separated participants receiving benefits	2016-07-01	455
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	11,503
Total participants	2016-07-01	11,503
Number of employers contributing to the scheme	2016-07-01	48
2015: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 401k membership
Total participants, beginning-of-year	2015-07-01	11,130
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	10,448
Number of retired or separated participants receiving benefits	2015-07-01	399
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	10,847
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	10,847
Number of participants with account balances	2015-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
Number of employers contributing to the scheme	2015-07-01	52
2014: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 401k membership
Total participants, beginning-of-year	2014-07-01	11,881
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	10,687
Number of retired or separated participants receiving benefits	2014-07-01	443
Total of all active and inactive participants	2014-07-01	11,130
Total participants	2014-07-01	11,130
Number of employers contributing to the scheme	2014-07-01	61
2013: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 401k membership
Total participants, beginning-of-year	2013-07-01	12,446
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	11,499
Number of retired or separated participants receiving benefits	2013-07-01	382
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	11,881
Total participants	2013-07-01	11,881
Number of employers contributing to the scheme	2013-07-01	59
2012: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 401k membership
Total participants, beginning-of-year	2012-07-01	4,129
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	3,845
Number of retired or separated participants receiving benefits	2012-07-01	276
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	4,121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	4,121
Number of participants with account balances	2012-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
Number of employers contributing to the scheme	2012-07-01	26
2011: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 401k membership
Total participants, beginning-of-year	2011-07-01	5,165
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	3,966
Number of retired or separated participants receiving benefits	2011-07-01	163
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	4,129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	4,129
Number of participants with account balances	2011-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
Number of employers contributing to the scheme	2011-07-01	32
2009: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2009 401k membership
Total participants, beginning-of-year	2009-07-01	6,323
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	5,039
Number of retired or separated participants receiving benefits	2009-07-01	141
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	5,180
Total participants	2009-07-01	5,180
Number of employers contributing to the scheme	2009-07-01	33

Financial Data on UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

Measure	Date	Value
2023 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2023-06-30	$-118,766
Total unrealized appreciation/depreciation of assets	2023-06-30	$-118,766
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-06-30	$40,006,994
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-06-30	$36,660,329
Total income from all sources (including contributions)	2023-06-30	$157,798,486
Total loss/gain on sale of assets	2023-06-30	$-379,835
Total of all expenses incurred	2023-06-30	$152,946,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-06-30	$149,860,971
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-06-30	$155,134,210
Value of total assets at end of year	2023-06-30	$156,665,753
Value of total assets at beginning of year	2023-06-30	$148,467,269
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-06-30	$3,085,696
Total interest from all sources	2023-06-30	$481,968
Total dividends received (eg from common stock, registered investment company shares)	2023-06-30	$191,318
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2023-06-30	$191,318
Administrative expenses professional fees incurred	2023-06-30	$590,359
Was this plan covered by a fidelity bond	2023-06-30	Yes
Value of fidelity bond cover	2023-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2023-06-30	No
Contributions received from participants	2023-06-30	$8,002,814
Participant contributions at end of year	2023-06-30	$1,623,779
Participant contributions at beginning of year	2023-06-30	$1,457,278
Value of other receiveables (less allowance for doubtful accounts) at end of year	2023-06-30	$1,688,881
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2023-06-30	$2,696,308
Administrative expenses (other) incurred	2023-06-30	$877,544
Liabilities. Value of operating payables at end of year	2023-06-30	$112,805
Liabilities. Value of operating payables at beginning of year	2023-06-30	$185,185
Total non interest bearing cash at end of year	2023-06-30	$42,075,200
Total non interest bearing cash at beginning of year	2023-06-30	$36,743,744
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-06-30	No
Value of net income/loss	2023-06-30	$4,851,819
Value of net assets at end of year (total assets less liabilities)	2023-06-30	$116,658,759
Value of net assets at beginning of year (total assets less liabilities)	2023-06-30	$111,806,940
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-06-30	No
Were any leases to which the plan was party in default or uncollectible	2023-06-30	No
Investment advisory and management fees	2023-06-30	$255,560
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-06-30	$8,847,313
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-06-30	$10,683,951
Income. Interest from US Government securities	2023-06-30	$192,225
Income. Interest from corporate debt instruments	2023-06-30	$267,277
Value of interest in common/collective trusts at end of year	2023-06-30	$74,224,259
Value of interest in common/collective trusts at beginning of year	2023-06-30	$72,431,723
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2023-06-30	$545,783
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2023-06-30	$954,085
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2023-06-30	$954,085
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2023-06-30	$22,466
Expenses. Payments to insurance carriers foe the provision of benefits	2023-06-30	$26,224,872
Asset value of US Government securities at end of year	2023-06-30	$7,565,618
Asset value of US Government securities at beginning of year	2023-06-30	$7,208,109
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-06-30	$697,055
Net investment gain or loss from common/collective trusts	2023-06-30	$1,792,536
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-06-30	No
Was there a failure to transmit to the plan any participant contributions	2023-06-30	No
Has the plan failed to provide any benefit when due under the plan	2023-06-30	No
Contributions received in cash from employer	2023-06-30	$147,131,396
Employer contributions (assets) at end of year	2023-06-30	$12,454,115
Employer contributions (assets) at beginning of year	2023-06-30	$11,340,471
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-06-30	$123,636,099
Asset. Corporate debt instrument preferred debt at end of year	2023-06-30	$4,613,071
Asset. Corporate debt instrument preferred debt at beginning of year	2023-06-30	$2,929,295
Asset. Corporate debt instrument debt (other) at end of year	2023-06-30	$3,027,734
Asset. Corporate debt instrument debt (other) at beginning of year	2023-06-30	$2,022,305
Contract administrator fees	2023-06-30	$1,362,233
Liabilities. Value of benefit claims payable at end of year	2023-06-30	$39,894,189
Liabilities. Value of benefit claims payable at beginning of year	2023-06-30	$36,475,144
Did the plan have assets held for investment	2023-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-06-30	No
Aggregate proceeds on sale of assets	2023-06-30	$12,321,816
Aggregate carrying amount (costs) on sale of assets	2023-06-30	$12,701,651
Opinion of an independent qualified public accountant for this plan	2023-06-30	Unqualified
Accountancy firm name	2023-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2023-06-30	952036255
2022 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2022-06-30	$-1,446,273
Total unrealized appreciation/depreciation of assets	2022-06-30	$-1,446,273
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$36,660,329
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$33,883,235
Total income from all sources (including contributions)	2022-06-30	$133,691,664
Total loss/gain on sale of assets	2022-06-30	$6,869
Total of all expenses incurred	2022-06-30	$139,795,441
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-06-30	$137,134,521
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-06-30	$138,692,794
Value of total assets at end of year	2022-06-30	$148,467,269
Value of total assets at beginning of year	2022-06-30	$151,793,952
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-06-30	$2,660,920
Total interest from all sources	2022-06-30	$325,783
Total dividends received (eg from common stock, registered investment company shares)	2022-06-30	$228,569
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-06-30	$228,569
Administrative expenses professional fees incurred	2022-06-30	$468,912
Was this plan covered by a fidelity bond	2022-06-30	Yes
Value of fidelity bond cover	2022-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2022-06-30	No
Contributions received from participants	2022-06-30	$7,367,615
Participant contributions at end of year	2022-06-30	$1,457,278
Participant contributions at beginning of year	2022-06-30	$1,678,504
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-06-30	$2,696,308
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-06-30	$1,660,833
Administrative expenses (other) incurred	2022-06-30	$710,459
Liabilities. Value of operating payables at end of year	2022-06-30	$185,185
Liabilities. Value of operating payables at beginning of year	2022-06-30	$178,386
Total non interest bearing cash at end of year	2022-06-30	$36,743,744
Total non interest bearing cash at beginning of year	2022-06-30	$35,729,921
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Value of net income/loss	2022-06-30	$-6,103,777
Value of net assets at end of year (total assets less liabilities)	2022-06-30	$111,806,940
Value of net assets at beginning of year (total assets less liabilities)	2022-06-30	$117,910,717
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-06-30	No
Were any leases to which the plan was party in default or uncollectible	2022-06-30	No
Investment advisory and management fees	2022-06-30	$255,858
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-06-30	$10,683,951
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-06-30	$11,643,159
Income. Interest from US Government securities	2022-06-30	$160,324
Income. Interest from corporate debt instruments	2022-06-30	$164,472
Value of interest in common/collective trusts at end of year	2022-06-30	$72,431,723
Value of interest in common/collective trusts at beginning of year	2022-06-30	$75,485,673
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-06-30	$954,085
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-06-30	$1,273,580
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-06-30	$1,273,580
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-06-30	$987
Expenses. Payments to insurance carriers foe the provision of benefits	2022-06-30	$26,345,348
Asset value of US Government securities at end of year	2022-06-30	$7,208,109
Asset value of US Government securities at beginning of year	2022-06-30	$7,645,088
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-06-30	$-1,062,128
Net investment gain or loss from common/collective trusts	2022-06-30	$-3,053,950
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-06-30	No
Was there a failure to transmit to the plan any participant contributions	2022-06-30	No
Has the plan failed to provide any benefit when due under the plan	2022-06-30	No
Contributions received in cash from employer	2022-06-30	$131,325,179
Employer contributions (assets) at end of year	2022-06-30	$11,340,471
Employer contributions (assets) at beginning of year	2022-06-30	$11,492,272
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-06-30	$110,789,173
Asset. Corporate debt instrument preferred debt at end of year	2022-06-30	$2,929,295
Asset. Corporate debt instrument preferred debt at beginning of year	2022-06-30	$2,838,763
Asset. Corporate debt instrument debt (other) at end of year	2022-06-30	$2,022,305
Asset. Corporate debt instrument debt (other) at beginning of year	2022-06-30	$2,346,159
Contract administrator fees	2022-06-30	$1,225,691
Liabilities. Value of benefit claims payable at end of year	2022-06-30	$36,475,144
Liabilities. Value of benefit claims payable at beginning of year	2022-06-30	$33,704,849
Did the plan have assets held for investment	2022-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-06-30	No
Aggregate proceeds on sale of assets	2022-06-30	$3,779,612
Aggregate carrying amount (costs) on sale of assets	2022-06-30	$3,772,743
Opinion of an independent qualified public accountant for this plan	2022-06-30	Unqualified
Accountancy firm name	2022-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2022-06-30	952036255
2021 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2021-06-30	$-1,882,602
Total unrealized appreciation/depreciation of assets	2021-06-30	$-1,882,602
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$33,883,235
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$31,480,456
Total income from all sources (including contributions)	2021-06-30	$129,432,805
Total loss/gain on sale of assets	2021-06-30	$2,040,367
Total of all expenses incurred	2021-06-30	$140,692,450
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$137,824,449
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$124,624,469
Value of total assets at end of year	2021-06-30	$151,793,952
Value of total assets at beginning of year	2021-06-30	$160,650,818
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$2,868,001
Total interest from all sources	2021-06-30	$405,755
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$317,941
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-06-30	$256,205
Administrative expenses professional fees incurred	2021-06-30	$556,256
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$8,172,836
Participant contributions at end of year	2021-06-30	$1,678,504
Participant contributions at beginning of year	2021-06-30	$1,715,217
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-06-30	$1,660,833
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-06-30	$154,820
Administrative expenses (other) incurred	2021-06-30	$792,107
Liabilities. Value of operating payables at end of year	2021-06-30	$178,386
Liabilities. Value of operating payables at beginning of year	2021-06-30	$115,655
Total non interest bearing cash at end of year	2021-06-30	$35,729,921
Total non interest bearing cash at beginning of year	2021-06-30	$12,176,587
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Value of net income/loss	2021-06-30	$-11,259,645
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$117,910,717
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$129,170,362
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Investment advisory and management fees	2021-06-30	$276,124
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-06-30	$11,643,159
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-06-30	$16,661,699
Income. Interest from US Government securities	2021-06-30	$195,304
Income. Interest from corporate debt instruments	2021-06-30	$210,375
Value of interest in common/collective trusts at end of year	2021-06-30	$75,485,673
Value of interest in common/collective trusts at beginning of year	2021-06-30	$98,669,071
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-06-30	$1,273,580
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-06-30	$1,780,043
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-06-30	$1,780,043
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-06-30	$76
Expenses. Payments to insurance carriers foe the provision of benefits	2021-06-30	$27,072,764
Asset value of US Government securities at end of year	2021-06-30	$7,645,088
Asset value of US Government securities at beginning of year	2021-06-30	$14,450,104
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-06-30	$2,110,273
Net investment gain or loss from common/collective trusts	2021-06-30	$1,816,602
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2021-06-30	No
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Contributions received in cash from employer	2021-06-30	$116,451,633
Employer contributions (assets) at end of year	2021-06-30	$11,492,272
Employer contributions (assets) at beginning of year	2021-06-30	$257,957
Income. Dividends from common stock	2021-06-30	$61,736
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-06-30	$110,751,685
Asset. Corporate debt instrument preferred debt at end of year	2021-06-30	$2,838,763
Asset. Corporate debt instrument preferred debt at beginning of year	2021-06-30	$7,345,988
Asset. Corporate debt instrument debt (other) at end of year	2021-06-30	$2,346,159
Asset. Corporate debt instrument debt (other) at beginning of year	2021-06-30	$2,980,428
Contract administrator fees	2021-06-30	$1,243,514
Assets. Corporate common stocks other than exployer securities at end of year	2021-06-30	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2021-06-30	$4,458,904
Liabilities. Value of benefit claims payable at end of year	2021-06-30	$33,704,849
Liabilities. Value of benefit claims payable at beginning of year	2021-06-30	$31,364,801
Did the plan have assets held for investment	2021-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Aggregate proceeds on sale of assets	2021-06-30	$53,863,759
Aggregate carrying amount (costs) on sale of assets	2021-06-30	$51,823,392
Opinion of an independent qualified public accountant for this plan	2021-06-30	Unqualified
Accountancy firm name	2021-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2021-06-30	952036255
2020 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-06-30	$1,459,992
Total unrealized appreciation/depreciation of assets	2020-06-30	$1,459,992
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$31,480,456
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$33,975,639
Total income from all sources (including contributions)	2020-06-30	$58,099,403
Total loss/gain on sale of assets	2020-06-30	$405,999
Total of all expenses incurred	2020-06-30	$133,423,403
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$130,875,498
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$48,680,019
Value of total assets at end of year	2020-06-30	$160,650,818
Value of total assets at beginning of year	2020-06-30	$238,470,001
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$2,547,905
Total interest from all sources	2020-06-30	$662,445
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$493,998
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-06-30	$385,248
Administrative expenses professional fees incurred	2020-06-30	$451,781
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$8,249,333
Participant contributions at end of year	2020-06-30	$1,715,217
Participant contributions at beginning of year	2020-06-30	$1,914,613
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-06-30	$154,820
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-06-30	$457,725
Administrative expenses (other) incurred	2020-06-30	$488,261
Liabilities. Value of operating payables at end of year	2020-06-30	$115,655
Liabilities. Value of operating payables at beginning of year	2020-06-30	$357,090
Total non interest bearing cash at end of year	2020-06-30	$12,176,587
Total non interest bearing cash at beginning of year	2020-06-30	$50,891,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-75,324,000
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$129,170,362
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$204,494,362
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Investment advisory and management fees	2020-06-30	$376,506
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$16,661,699
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$11,598,085
Income. Interest from US Government securities	2020-06-30	$357,912
Income. Interest from corporate debt instruments	2020-06-30	$290,394
Value of interest in common/collective trusts at end of year	2020-06-30	$98,669,071
Value of interest in common/collective trusts at beginning of year	2020-06-30	$128,201,968
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-06-30	$1,780,043
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-06-30	$1,643,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-06-30	$1,643,130
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-06-30	$14,139
Expenses. Payments to insurance carriers foe the provision of benefits	2020-06-30	$26,370,199
Asset value of US Government securities at end of year	2020-06-30	$14,450,104
Asset value of US Government securities at beginning of year	2020-06-30	$14,194,492
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$-70,154
Net investment gain or loss from common/collective trusts	2020-06-30	$6,467,104
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$40,430,686
Employer contributions (assets) at end of year	2020-06-30	$257,957
Employer contributions (assets) at beginning of year	2020-06-30	$12,253,483
Income. Dividends from common stock	2020-06-30	$108,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$104,505,299
Asset. Corporate debt instrument preferred debt at end of year	2020-06-30	$7,345,988
Asset. Corporate debt instrument preferred debt at beginning of year	2020-06-30	$8,942,721
Asset. Corporate debt instrument debt (other) at end of year	2020-06-30	$2,980,428
Asset. Corporate debt instrument debt (other) at beginning of year	2020-06-30	$4,026,966
Contract administrator fees	2020-06-30	$1,231,357
Assets. Corporate common stocks other than exployer securities at end of year	2020-06-30	$4,458,904
Assets. Corporate common stocks other than exployer securities at beginning of year	2020-06-30	$4,279,631
Liabilities. Value of benefit claims payable at end of year	2020-06-30	$31,364,801
Liabilities. Value of benefit claims payable at beginning of year	2020-06-30	$33,618,549
Assets. Value of buildings and other operty used in plan operation at end of year	2020-06-30	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2020-06-30	$65,566
Did the plan have assets held for investment	2020-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Aggregate proceeds on sale of assets	2020-06-30	$18,201,256
Aggregate carrying amount (costs) on sale of assets	2020-06-30	$17,795,257
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	No
Opinion of an independent qualified public accountant for this plan	2020-06-30	Unqualified
Accountancy firm name	2020-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2020-06-30	952036255
2019 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2019-06-30	$2,062,763
Total unrealized appreciation/depreciation of assets	2019-06-30	$2,062,763
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$33,975,639
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$31,282,504
Total income from all sources (including contributions)	2019-06-30	$163,427,424
Total loss/gain on sale of assets	2019-06-30	$-197,561
Total of all expenses incurred	2019-06-30	$137,110,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$134,083,266
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$154,175,535
Value of total assets at end of year	2019-06-30	$238,470,001
Value of total assets at beginning of year	2019-06-30	$209,460,031
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$3,027,323
Total interest from all sources	2019-06-30	$677,795
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$421,013
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-06-30	$305,924
Administrative expenses professional fees incurred	2019-06-30	$680,899
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$8,744,163
Participant contributions at end of year	2019-06-30	$1,914,613
Participant contributions at beginning of year	2019-06-30	$2,047,500
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-06-30	$457,725
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-06-30	$161,997
Administrative expenses (other) incurred	2019-06-30	$753,975
Liabilities. Value of operating payables at end of year	2019-06-30	$357,090
Liabilities. Value of operating payables at beginning of year	2019-06-30	$304,230
Total non interest bearing cash at end of year	2019-06-30	$50,891,621
Total non interest bearing cash at beginning of year	2019-06-30	$61,054,899
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$26,316,835
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$204,494,362
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$178,177,527
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Investment advisory and management fees	2019-06-30	$353,178
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-06-30	$11,598,085
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-06-30	$5,984,299
Income. Interest from US Government securities	2019-06-30	$285,713
Income. Interest from corporate debt instruments	2019-06-30	$362,539
Value of interest in common/collective trusts at end of year	2019-06-30	$128,201,968
Value of interest in common/collective trusts at beginning of year	2019-06-30	$98,267,171
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-06-30	$1,643,130
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-06-30	$1,743,594
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-06-30	$1,743,594
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-06-30	$29,543
Expenses. Payments to insurance carriers foe the provision of benefits	2019-06-30	$25,253,587
Asset value of US Government securities at end of year	2019-06-30	$14,194,492
Asset value of US Government securities at beginning of year	2019-06-30	$14,204,893
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-06-30	$353,082
Net investment gain or loss from common/collective trusts	2019-06-30	$5,934,797
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$145,431,372
Employer contributions (assets) at end of year	2019-06-30	$12,253,483
Employer contributions (assets) at beginning of year	2019-06-30	$12,458,803
Income. Dividends from common stock	2019-06-30	$115,089
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$108,829,679
Asset. Corporate debt instrument preferred debt at end of year	2019-06-30	$8,942,721
Asset. Corporate debt instrument preferred debt at beginning of year	2019-06-30	$6,114,996
Asset. Corporate debt instrument debt (other) at end of year	2019-06-30	$4,026,966
Asset. Corporate debt instrument debt (other) at beginning of year	2019-06-30	$3,213,411
Contract administrator fees	2019-06-30	$1,239,271
Assets. Corporate common stocks other than exployer securities at end of year	2019-06-30	$4,279,631
Assets. Corporate common stocks other than exployer securities at beginning of year	2019-06-30	$4,139,422
Liabilities. Value of benefit claims payable at end of year	2019-06-30	$33,618,549
Liabilities. Value of benefit claims payable at beginning of year	2019-06-30	$30,978,274
Assets. Value of buildings and other operty used in plan operation at end of year	2019-06-30	$65,566
Assets. Value of buildings and other operty used in plan operation at beginning of year	2019-06-30	$69,046
Did the plan have assets held for investment	2019-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Aggregate proceeds on sale of assets	2019-06-30	$7,173,004
Aggregate carrying amount (costs) on sale of assets	2019-06-30	$7,370,565
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	No
Opinion of an independent qualified public accountant for this plan	2019-06-30	Unqualified
Accountancy firm name	2019-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2019-06-30	952036255
2018 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2018-06-30	$-839,053
Total unrealized appreciation/depreciation of assets	2018-06-30	$-839,053
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$31,282,504
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$28,034,482
Total income from all sources (including contributions)	2018-06-30	$162,179,736
Total loss/gain on sale of assets	2018-06-30	$-82,517,242
Total of all expenses incurred	2018-06-30	$129,692,407
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$127,122,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$161,399,344
Value of total assets at end of year	2018-06-30	$209,460,031
Value of total assets at beginning of year	2018-06-30	$173,724,680
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$2,569,712
Total interest from all sources	2018-06-30	$601,842
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$261,220
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-06-30	$171,454
Administrative expenses professional fees incurred	2018-06-30	$530,795
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$9,311,050
Participant contributions at end of year	2018-06-30	$2,047,500
Participant contributions at beginning of year	2018-06-30	$2,185,393
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-06-30	$161,997
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-06-30	$365,717
Administrative expenses (other) incurred	2018-06-30	$400,298
Liabilities. Value of operating payables at end of year	2018-06-30	$304,230
Liabilities. Value of operating payables at beginning of year	2018-06-30	$207,240
Total non interest bearing cash at end of year	2018-06-30	$61,054,899
Total non interest bearing cash at beginning of year	2018-06-30	$45,994,984
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$32,487,329
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$178,177,527
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$145,690,198
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Investment advisory and management fees	2018-06-30	$291,019
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-06-30	$5,984,299
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-06-30	$2,468,380
Income. Interest from US Government securities	2018-06-30	$280,361
Income. Interest from corporate debt instruments	2018-06-30	$308,496
Value of interest in common/collective trusts at end of year	2018-06-30	$98,267,171
Value of interest in common/collective trusts at beginning of year	2018-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-06-30	$1,743,594
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-06-30	$200,905
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-06-30	$200,905
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-06-30	$12,985
Expenses. Payments to insurance carriers foe the provision of benefits	2018-06-30	$24,980,773
Asset value of US Government securities at end of year	2018-06-30	$14,204,893
Asset value of US Government securities at beginning of year	2018-06-30	$45,403,715
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-06-30	$243,719
Net investment gain or loss from common/collective trusts	2018-06-30	$83,029,906
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$152,088,294
Employer contributions (assets) at end of year	2018-06-30	$12,458,803
Employer contributions (assets) at beginning of year	2018-06-30	$12,415,784
Income. Dividends from common stock	2018-06-30	$89,766
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$102,141,922
Asset. Corporate debt instrument preferred debt at end of year	2018-06-30	$6,114,996
Asset. Corporate debt instrument preferred debt at beginning of year	2018-06-30	$52,971,012
Asset. Corporate debt instrument debt (other) at end of year	2018-06-30	$3,213,411
Asset. Corporate debt instrument debt (other) at beginning of year	2018-06-30	$11,639,894
Contract administrator fees	2018-06-30	$1,347,600
Assets. Corporate common stocks other than exployer securities at end of year	2018-06-30	$4,139,422
Assets. Corporate common stocks other than exployer securities at beginning of year	2018-06-30	$0
Liabilities. Value of benefit claims payable at end of year	2018-06-30	$30,978,274
Liabilities. Value of benefit claims payable at beginning of year	2018-06-30	$27,827,242
Assets. Value of buildings and other operty used in plan operation at end of year	2018-06-30	$69,046
Assets. Value of buildings and other operty used in plan operation at beginning of year	2018-06-30	$78,896
Did the plan have assets held for investment	2018-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Aggregate proceeds on sale of assets	2018-06-30	$42,945,987
Aggregate carrying amount (costs) on sale of assets	2018-06-30	$125,463,229
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	No
Opinion of an independent qualified public accountant for this plan	2018-06-30	Unqualified
Accountancy firm name	2018-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2018-06-30	952036255
2017 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-06-30	$-522,132
Total unrealized appreciation/depreciation of assets	2017-06-30	$-522,132
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$28,034,482
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$27,469,123
Total income from all sources (including contributions)	2017-06-30	$155,694,842
Total loss/gain on sale of assets	2017-06-30	$30,092
Total of all expenses incurred	2017-06-30	$119,755,925
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$116,927,826
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$154,178,153
Value of total assets at end of year	2017-06-30	$173,724,680
Value of total assets at beginning of year	2017-06-30	$137,220,404
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$2,828,099
Total interest from all sources	2017-06-30	$1,636,785
Total dividends received (eg from common stock, registered investment company shares)	2017-06-30	$43,910
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-06-30	$43,910
Administrative expenses professional fees incurred	2017-06-30	$412,872
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$10,612,630
Participant contributions at end of year	2017-06-30	$2,185,393
Participant contributions at beginning of year	2017-06-30	$1,754,622
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-06-30	$365,717
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-06-30	$246,601
Administrative expenses (other) incurred	2017-06-30	$968,559
Liabilities. Value of operating payables at end of year	2017-06-30	$207,240
Liabilities. Value of operating payables at beginning of year	2017-06-30	$139,142
Total non interest bearing cash at end of year	2017-06-30	$45,994,984
Total non interest bearing cash at beginning of year	2017-06-30	$29,306,987
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$35,938,917
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$145,690,198
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$109,751,281
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Investment advisory and management fees	2017-06-30	$253,448
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-06-30	$2,468,380
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-06-30	$2,096,435
Interest earned on other investments	2017-06-30	$11,016
Income. Interest from US Government securities	2017-06-30	$609,759
Income. Interest from corporate debt instruments	2017-06-30	$1,012,900
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-06-30	$200,905
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-06-30	$4,140,544
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-06-30	$4,140,544
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-06-30	$3,110
Expenses. Payments to insurance carriers foe the provision of benefits	2017-06-30	$21,152,236
Asset value of US Government securities at end of year	2017-06-30	$45,403,715
Asset value of US Government securities at beginning of year	2017-06-30	$53,784,930
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-06-30	$328,034
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Contributions received in cash from employer	2017-06-30	$143,565,523
Employer contributions (assets) at end of year	2017-06-30	$12,415,784
Employer contributions (assets) at beginning of year	2017-06-30	$11,604,275
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$95,775,590
Asset. Corporate debt instrument preferred debt at end of year	2017-06-30	$52,971,012
Asset. Corporate debt instrument preferred debt at beginning of year	2017-06-30	$26,186,514
Asset. Corporate debt instrument debt (other) at end of year	2017-06-30	$11,639,894
Asset. Corporate debt instrument debt (other) at beginning of year	2017-06-30	$8,088,660
Contract administrator fees	2017-06-30	$1,193,220
Liabilities. Value of benefit claims payable at end of year	2017-06-30	$27,827,242
Liabilities. Value of benefit claims payable at beginning of year	2017-06-30	$27,329,981
Assets. Value of buildings and other operty used in plan operation at end of year	2017-06-30	$78,896
Assets. Value of buildings and other operty used in plan operation at beginning of year	2017-06-30	$10,836
Did the plan have assets held for investment	2017-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Aggregate proceeds on sale of assets	2017-06-30	$174,337,678
Aggregate carrying amount (costs) on sale of assets	2017-06-30	$174,307,586
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	No
Opinion of an independent qualified public accountant for this plan	2017-06-30	Unqualified
Accountancy firm name	2017-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2017-06-30	952036255
2016 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-06-30	$411,725
Total unrealized appreciation/depreciation of assets	2016-06-30	$411,725
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$27,469,123
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$26,119,370
Total income from all sources (including contributions)	2016-06-30	$147,311,838
Total loss/gain on sale of assets	2016-06-30	$-43,519
Total of all expenses incurred	2016-06-30	$122,681,124
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$119,413,265
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$146,083,995
Value of total assets at end of year	2016-06-30	$137,220,404
Value of total assets at beginning of year	2016-06-30	$111,239,937
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$3,267,859
Total interest from all sources	2016-06-30	$782,104
Total dividends received (eg from common stock, registered investment company shares)	2016-06-30	$40,863
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-06-30	$40,863
Administrative expenses professional fees incurred	2016-06-30	$542,659
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$7,527,195
Participant contributions at end of year	2016-06-30	$1,754,622
Participant contributions at beginning of year	2016-06-30	$1,759,130
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-06-30	$246,601
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-06-30	$106,241
Administrative expenses (other) incurred	2016-06-30	$1,318,050
Liabilities. Value of operating payables at end of year	2016-06-30	$139,142
Liabilities. Value of operating payables at beginning of year	2016-06-30	$78,190
Total non interest bearing cash at end of year	2016-06-30	$29,306,987
Total non interest bearing cash at beginning of year	2016-06-30	$57,513,348
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$24,630,714
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$109,751,281
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$85,120,567
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Investment advisory and management fees	2016-06-30	$142,701
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-06-30	$2,096,435
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-06-30	$2,018,901
Income. Interest from US Government securities	2016-06-30	$289,551
Income. Interest from corporate debt instruments	2016-06-30	$490,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-06-30	$4,140,544
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-06-30	$983,242
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-06-30	$983,242
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-06-30	$1,874
Expenses. Payments to insurance carriers foe the provision of benefits	2016-06-30	$18,583,446
Asset value of US Government securities at end of year	2016-06-30	$53,784,930
Asset value of US Government securities at beginning of year	2016-06-30	$15,017,890
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-06-30	$36,670
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$138,556,800
Employer contributions (assets) at end of year	2016-06-30	$11,604,275
Employer contributions (assets) at beginning of year	2016-06-30	$11,596,824
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-06-30	$100,829,819
Asset. Corporate debt instrument preferred debt at end of year	2016-06-30	$26,186,514
Asset. Corporate debt instrument preferred debt at beginning of year	2016-06-30	$18,842,360
Asset. Corporate debt instrument debt (other) at end of year	2016-06-30	$8,088,660
Asset. Corporate debt instrument debt (other) at beginning of year	2016-06-30	$3,347,206
Contract administrator fees	2016-06-30	$1,264,449
Liabilities. Value of benefit claims payable at end of year	2016-06-30	$27,329,981
Liabilities. Value of benefit claims payable at beginning of year	2016-06-30	$26,041,180
Assets. Value of buildings and other operty used in plan operation at end of year	2016-06-30	$10,836
Assets. Value of buildings and other operty used in plan operation at beginning of year	2016-06-30	$54,795
Did the plan have assets held for investment	2016-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Aggregate proceeds on sale of assets	2016-06-30	$46,945,961
Aggregate carrying amount (costs) on sale of assets	2016-06-30	$46,989,480
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	No
Opinion of an independent qualified public accountant for this plan	2016-06-30	Unqualified
Accountancy firm name	2016-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2016-06-30	952036255
2015 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-06-30	$-147,770
Total unrealized appreciation/depreciation of assets	2015-06-30	$-147,770
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$26,119,370
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$27,642,296
Total income from all sources (including contributions)	2015-06-30	$141,619,480
Total loss/gain on sale of assets	2015-06-30	$17,055
Total of all expenses incurred	2015-06-30	$117,635,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$114,599,722
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$141,079,091
Value of total assets at end of year	2015-06-30	$111,239,937
Value of total assets at beginning of year	2015-06-30	$88,778,953
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$3,035,848
Total interest from all sources	2015-06-30	$534,081
Total dividends received (eg from common stock, registered investment company shares)	2015-06-30	$37,746
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-06-30	$37,746
Administrative expenses professional fees incurred	2015-06-30	$467,592
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$9,339,604
Participant contributions at end of year	2015-06-30	$1,759,130
Participant contributions at beginning of year	2015-06-30	$1,852,500
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-06-30	$106,241
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-06-30	$753,515
Administrative expenses (other) incurred	2015-06-30	$1,431,268
Liabilities. Value of operating payables at end of year	2015-06-30	$78,190
Liabilities. Value of operating payables at beginning of year	2015-06-30	$185,004
Total non interest bearing cash at end of year	2015-06-30	$57,513,348
Total non interest bearing cash at beginning of year	2015-06-30	$46,051,633
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$23,983,910
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$85,120,567
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$61,136,657
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Investment advisory and management fees	2015-06-30	$93,207
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-06-30	$2,018,901
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-06-30	$1,881,878
Interest earned on other investments	2015-06-30	$610
Income. Interest from US Government securities	2015-06-30	$174,356
Income. Interest from corporate debt instruments	2015-06-30	$358,996
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-06-30	$983,242
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-06-30	$115,603
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-06-30	$115,603
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-06-30	$119
Expenses. Payments to insurance carriers foe the provision of benefits	2015-06-30	$19,176,666
Asset value of US Government securities at end of year	2015-06-30	$15,017,890
Asset value of US Government securities at beginning of year	2015-06-30	$11,484,902
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-06-30	$99,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$131,739,487
Employer contributions (assets) at end of year	2015-06-30	$11,596,824
Employer contributions (assets) at beginning of year	2015-06-30	$10,426,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$95,423,056
Asset. Corporate debt instrument preferred debt at end of year	2015-06-30	$18,842,360
Asset. Corporate debt instrument preferred debt at beginning of year	2015-06-30	$14,330,391
Asset. Corporate debt instrument debt (other) at end of year	2015-06-30	$3,347,206
Asset. Corporate debt instrument debt (other) at beginning of year	2015-06-30	$1,879,278
Contract administrator fees	2015-06-30	$1,043,781
Liabilities. Value of benefit claims payable at end of year	2015-06-30	$26,041,180
Liabilities. Value of benefit claims payable at beginning of year	2015-06-30	$27,457,292
Assets. Value of buildings and other operty used in plan operation at end of year	2015-06-30	$54,795
Assets. Value of buildings and other operty used in plan operation at beginning of year	2015-06-30	$3,117
Did the plan have assets held for investment	2015-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Aggregate proceeds on sale of assets	2015-06-30	$21,464,325
Aggregate carrying amount (costs) on sale of assets	2015-06-30	$21,447,270
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	No
Opinion of an independent qualified public accountant for this plan	2015-06-30	Unqualified
Accountancy firm name	2015-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2015-06-30	952036255
2014 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-06-30	$160,699
Total unrealized appreciation/depreciation of assets	2014-06-30	$160,699
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$27,642,296
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$25,737,932
Total income from all sources (including contributions)	2014-06-30	$133,887,077
Total loss/gain on sale of assets	2014-06-30	$-195,753
Total of all expenses incurred	2014-06-30	$116,316,858
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$113,925,427
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$133,030,246
Value of total assets at end of year	2014-06-30	$88,778,953
Value of total assets at beginning of year	2014-06-30	$69,304,370
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$2,391,431
Total interest from all sources	2014-06-30	$522,856
Total dividends received (eg from common stock, registered investment company shares)	2014-06-30	$32,025
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-06-30	$32,025
Administrative expenses professional fees incurred	2014-06-30	$581,009
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$10,010,180
Participant contributions at end of year	2014-06-30	$1,852,500
Participant contributions at beginning of year	2014-06-30	$1,892,014
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-06-30	$753,515
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-06-30	$1,493,352
Administrative expenses (other) incurred	2014-06-30	$569,985
Liabilities. Value of operating payables at end of year	2014-06-30	$185,004
Liabilities. Value of operating payables at beginning of year	2014-06-30	$99,851
Total non interest bearing cash at end of year	2014-06-30	$46,051,633
Total non interest bearing cash at beginning of year	2014-06-30	$27,066,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$17,570,219
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$61,136,657
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$43,566,438
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Investment advisory and management fees	2014-06-30	$85,121
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-06-30	$1,881,878
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-06-30	$1,512,849
Income. Interest from US Government securities	2014-06-30	$259,078
Income. Interest from corporate debt instruments	2014-06-30	$263,684
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-06-30	$115,603
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-06-30	$729,953
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-06-30	$729,953
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-06-30	$94
Expenses. Payments to insurance carriers foe the provision of benefits	2014-06-30	$12,033,441
Asset value of US Government securities at end of year	2014-06-30	$11,484,902
Asset value of US Government securities at beginning of year	2014-06-30	$15,074,258
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-06-30	$337,004
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$123,020,066
Employer contributions (assets) at end of year	2014-06-30	$10,426,136
Employer contributions (assets) at beginning of year	2014-06-30	$10,038,047
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$101,891,986
Asset. Corporate debt instrument preferred debt at end of year	2014-06-30	$14,330,391
Asset. Corporate debt instrument preferred debt at beginning of year	2014-06-30	$9,601,974
Asset. Corporate debt instrument debt (other) at end of year	2014-06-30	$1,879,278
Asset. Corporate debt instrument debt (other) at beginning of year	2014-06-30	$1,867,740
Contract administrator fees	2014-06-30	$1,155,316
Liabilities. Value of benefit claims payable at end of year	2014-06-30	$27,457,292
Liabilities. Value of benefit claims payable at beginning of year	2014-06-30	$25,638,081
Assets. Value of buildings and other operty used in plan operation at end of year	2014-06-30	$3,117
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-06-30	$27,383
Did the plan have assets held for investment	2014-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Aggregate proceeds on sale of assets	2014-06-30	$21,507,467
Aggregate carrying amount (costs) on sale of assets	2014-06-30	$21,703,220
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	No
Opinion of an independent qualified public accountant for this plan	2014-06-30	Unqualified
Accountancy firm name	2014-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2014-06-30	952036255
2013 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-06-30	$-206,039
Total unrealized appreciation/depreciation of assets	2013-06-30	$-206,039
Total transfer of assets to this plan	2013-06-30	$19,015,745
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$25,737,932
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$8,813,812
Total income from all sources (including contributions)	2013-06-30	$39,118,142
Total loss/gain on sale of assets	2013-06-30	$-32,292
Total of all expenses incurred	2013-06-30	$35,335,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$34,356,322
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$38,683,279
Value of total assets at end of year	2013-06-30	$69,304,370
Value of total assets at beginning of year	2013-06-30	$29,582,281
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$979,596
Total interest from all sources	2013-06-30	$477,708
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$22,203
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-06-30	$22,203
Administrative expenses professional fees incurred	2013-06-30	$342,656
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$3,063,870
Participant contributions at end of year	2013-06-30	$1,892,014
Participant contributions at beginning of year	2013-06-30	$650,861
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-06-30	$1,493,352
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-06-30	$281,736
Administrative expenses (other) incurred	2013-06-30	$148,010
Liabilities. Value of operating payables at end of year	2013-06-30	$99,851
Liabilities. Value of operating payables at beginning of year	2013-06-30	$27,205
Total non interest bearing cash at end of year	2013-06-30	$27,066,800
Total non interest bearing cash at beginning of year	2013-06-30	$5,215,847
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$3,782,224
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$43,566,438
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$20,768,469
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Investment advisory and management fees	2013-06-30	$101,814
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-06-30	$1,512,849
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$957,546
Interest earned on other investments	2013-06-30	$10,855
Income. Interest from US Government securities	2013-06-30	$265,022
Income. Interest from corporate debt instruments	2013-06-30	$201,827
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$729,953
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$414,767
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$414,767
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-06-30	$4
Expenses. Payments to insurance carriers foe the provision of benefits	2013-06-30	$3,038,329
Asset value of US Government securities at end of year	2013-06-30	$15,074,258
Asset value of US Government securities at beginning of year	2013-06-30	$11,535,921
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-06-30	$173,283
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$35,619,409
Employer contributions (assets) at end of year	2013-06-30	$10,038,047
Employer contributions (assets) at beginning of year	2013-06-30	$2,975,009
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$31,317,993
Asset. Corporate debt instrument preferred debt at end of year	2013-06-30	$9,601,974
Asset. Corporate debt instrument preferred debt at beginning of year	2013-06-30	$6,489,485
Asset. Corporate debt instrument debt (other) at end of year	2013-06-30	$1,867,740
Asset. Corporate debt instrument debt (other) at beginning of year	2013-06-30	$1,051,680
Contract administrator fees	2013-06-30	$387,116
Liabilities. Value of benefit claims payable at end of year	2013-06-30	$25,638,081
Liabilities. Value of benefit claims payable at beginning of year	2013-06-30	$8,786,607
Assets. Value of buildings and other operty used in plan operation at end of year	2013-06-30	$27,383
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-06-30	$9,429
Did the plan have assets held for investment	2013-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Aggregate proceeds on sale of assets	2013-06-30	$22,614,161
Aggregate carrying amount (costs) on sale of assets	2013-06-30	$22,646,453
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	No
Opinion of an independent qualified public accountant for this plan	2013-06-30	Unqualified
Accountancy firm name	2013-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2013-06-30	952036255
2012 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-06-30	$-41,771
Total unrealized appreciation/depreciation of assets	2012-06-30	$-41,771
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$8,813,812
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$9,265,160
Total income from all sources (including contributions)	2012-06-30	$38,836,565
Total loss/gain on sale of assets	2012-06-30	$82,367
Total of all expenses incurred	2012-06-30	$36,012,962
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$35,234,653
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$38,345,636
Value of total assets at end of year	2012-06-30	$29,582,281
Value of total assets at beginning of year	2012-06-30	$27,210,026
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$778,309
Total interest from all sources	2012-06-30	$402,200
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$17,692
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-06-30	$17,692
Administrative expenses professional fees incurred	2012-06-30	$226,522
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$3,010,142
Participant contributions at end of year	2012-06-30	$650,861
Participant contributions at beginning of year	2012-06-30	$673,559
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-06-30	$281,736
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-06-30	$278,409
Administrative expenses (other) incurred	2012-06-30	$93,872
Liabilities. Value of operating payables at end of year	2012-06-30	$27,205
Liabilities. Value of operating payables at beginning of year	2012-06-30	$40,356
Total non interest bearing cash at end of year	2012-06-30	$5,215,847
Total non interest bearing cash at beginning of year	2012-06-30	$5,832,121
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$2,823,603
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$20,768,469
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$17,944,866
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Investment advisory and management fees	2012-06-30	$84,818
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-06-30	$957,546
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-06-30	$909,413
Interest earned on other investments	2012-06-30	$9,457
Income. Interest from US Government securities	2012-06-30	$194,204
Income. Interest from corporate debt instruments	2012-06-30	$198,539
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$414,767
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$274,945
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$274,945
Expenses. Payments to insurance carriers foe the provision of benefits	2012-06-30	$3,155,650
Asset value of US Government securities at end of year	2012-06-30	$11,535,921
Asset value of US Government securities at beginning of year	2012-06-30	$9,743,314
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$30,441
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$35,335,494
Employer contributions (assets) at end of year	2012-06-30	$2,975,009
Employer contributions (assets) at beginning of year	2012-06-30	$2,954,395
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$32,079,003
Asset. Corporate debt instrument preferred debt at end of year	2012-06-30	$6,489,485
Asset. Corporate debt instrument preferred debt at beginning of year	2012-06-30	$5,792,242
Asset. Corporate debt instrument debt (other) at end of year	2012-06-30	$1,051,680
Asset. Corporate debt instrument debt (other) at beginning of year	2012-06-30	$743,831
Contract administrator fees	2012-06-30	$373,097
Liabilities. Value of benefit claims payable at end of year	2012-06-30	$8,786,607
Liabilities. Value of benefit claims payable at beginning of year	2012-06-30	$9,224,804
Assets. Value of buildings and other operty used in plan operation at end of year	2012-06-30	$9,429
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-06-30	$7,797
Did the plan have assets held for investment	2012-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Aggregate proceeds on sale of assets	2012-06-30	$16,129,846
Aggregate carrying amount (costs) on sale of assets	2012-06-30	$16,047,479
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	No
Opinion of an independent qualified public accountant for this plan	2012-06-30	Unqualified
Accountancy firm name	2012-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2012-06-30	952036255
2011 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-06-30	$-35,710
Total unrealized appreciation/depreciation of assets	2011-06-30	$-35,710
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$9,265,160
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$8,285,100
Total income from all sources (including contributions)	2011-06-30	$40,258,430
Total loss/gain on sale of assets	2011-06-30	$64,432
Total of all expenses incurred	2011-06-30	$33,883,399
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$33,038,692
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$39,717,533
Value of total assets at end of year	2011-06-30	$27,210,026
Value of total assets at beginning of year	2011-06-30	$19,854,935
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$844,707
Total interest from all sources	2011-06-30	$299,577
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$15,261
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-06-30	$15,261
Administrative expenses professional fees incurred	2011-06-30	$260,769
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$3,733,979
Participant contributions at end of year	2011-06-30	$673,559
Participant contributions at beginning of year	2011-06-30	$529,284
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-06-30	$278,409
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-06-30	$259,152
Administrative expenses (other) incurred	2011-06-30	$166,210
Liabilities. Value of operating payables at end of year	2011-06-30	$40,356
Liabilities. Value of operating payables at beginning of year	2011-06-30	$28,653
Total non interest bearing cash at end of year	2011-06-30	$5,832,121
Total non interest bearing cash at beginning of year	2011-06-30	$6,567,976
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$6,375,031
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$17,944,866
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$11,569,835
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Investment advisory and management fees	2011-06-30	$71,610
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-06-30	$909,413
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-06-30	$696,815
Income. Interest from US Government securities	2011-06-30	$147,647
Income. Interest from corporate debt instruments	2011-06-30	$150,987
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$274,945
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-06-30	$1,170,122
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-06-30	$1,170,122
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$943
Expenses. Payments to insurance carriers foe the provision of benefits	2011-06-30	$3,390,647
Asset value of US Government securities at end of year	2011-06-30	$9,743,314
Asset value of US Government securities at beginning of year	2011-06-30	$5,063,151
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-06-30	$197,337
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$35,983,554
Employer contributions (assets) at end of year	2011-06-30	$2,954,395
Employer contributions (assets) at beginning of year	2011-06-30	$3,016,698
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$29,648,045
Asset. Corporate debt instrument preferred debt at end of year	2011-06-30	$5,792,242
Asset. Corporate debt instrument preferred debt at beginning of year	2011-06-30	$2,010,262
Asset. Corporate debt instrument debt (other) at end of year	2011-06-30	$743,831
Asset. Corporate debt instrument debt (other) at beginning of year	2011-06-30	$530,743
Contract administrator fees	2011-06-30	$346,118
Liabilities. Value of benefit claims payable at end of year	2011-06-30	$9,224,804
Liabilities. Value of benefit claims payable at beginning of year	2011-06-30	$8,256,447
Assets. Value of buildings and other operty used in plan operation at end of year	2011-06-30	$7,797
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-06-30	$10,732
Did the plan have assets held for investment	2011-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Aggregate proceeds on sale of assets	2011-06-30	$14,893,110
Aggregate carrying amount (costs) on sale of assets	2011-06-30	$14,828,678
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	No
Opinion of an independent qualified public accountant for this plan	2011-06-30	Unqualified
Accountancy firm name	2011-06-30	MILLER, KAPLAN, ARASE & CO., LLP
Accountancy firm EIN	2011-06-30	952036255

Form 5500 Responses for UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

2022: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2022 form 5500 responses
2022-07-01	Type of plan entity	Multi-employer plan
2022-07-01	Plan is a collectively bargained plan	Yes
2022-07-01	Plan funding arrangement – Trust	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement - Trust	Yes
2021: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 form 5500 responses
2021-07-01	Type of plan entity	Multi-employer plan
2021-07-01	Plan is a collectively bargained plan	Yes
2021-07-01	Plan funding arrangement – Trust	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement - Trust	Yes
2020: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 form 5500 responses
2020-07-01	Type of plan entity	Multi-employer plan
2020-07-01	Plan is a collectively bargained plan	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement - Trust	Yes
2019: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 form 5500 responses
2019-07-01	Type of plan entity	Multi-employer plan
2019-07-01	Plan is a collectively bargained plan	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 form 5500 responses
2018-07-01	Type of plan entity	Multi-employer plan
2018-07-01	Plan is a collectively bargained plan	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement - Trust	Yes
2017: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 form 5500 responses
2017-07-01	Type of plan entity	Multi-employer plan
2017-07-01	Plan is a collectively bargained plan	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement - Trust	Yes
2016: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 form 5500 responses
2016-07-01	Type of plan entity	Multi-employer plan
2016-07-01	Plan is a collectively bargained plan	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes
2015: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 form 5500 responses
2015-07-01	Type of plan entity	Multi-employer plan
2015-07-01	Plan is a collectively bargained plan	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 form 5500 responses
2014-07-01	Type of plan entity	Multi-employer plan
2014-07-01	Plan is a collectively bargained plan	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 form 5500 responses
2013-07-01	Type of plan entity	Multi-employer plan
2013-07-01	Plan is a collectively bargained plan	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 form 5500 responses
2012-07-01	Type of plan entity	Multi-employer plan
2012-07-01	Plan is a collectively bargained plan	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 form 5500 responses
2011-07-01	Type of plan entity	Multi-employer plan
2011-07-01	Plan is a collectively bargained plan	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2009: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2009 form 5500 responses
2009-07-01	Type of plan entity	Multi-employer plan
2009-07-01	Plan is a collectively bargained plan	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	8635
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	86
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $420,898
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	21
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $99,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	9401
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000521

Policy instance

Insurance contract or identification number	40000521
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	PDP PLAN
Welfare Benefit Premiums Paid to Carrier	USD $1,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	2446
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2390
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,037,886
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Number of Individuals Covered	421
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDIGAP
Welfare Benefit Premiums Paid to Carrier	USD $556,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	9
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	9
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $49,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	7823
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	94
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $474,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	26
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	7102
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,336,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2574
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,806,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Number of Individuals Covered	188
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDIGAP
Welfare Benefit Premiums Paid to Carrier	USD $274,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	2
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	PDP PLAN
Welfare Benefit Premiums Paid to Carrier	USD $1,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	103
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $522,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	7487
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	3
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	2396
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,451,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2731
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,685,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Number of Individuals Covered	362
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Other welfare benefits provided	MEDIGAP
Welfare Benefit Premiums Paid to Carrier	USD $515,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	11
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	1
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	8033
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	30
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	103
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $468,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	7691
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	2
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	12
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $85,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	42
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $181,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	0
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	4
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	2369
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,342,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2712
Insurance policy start date	2019-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,671,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Number of Individuals Covered	330
Insurance policy start date	2019-01-01
Insurance policy end date	2020-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $489,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	111
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $501,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	2
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	16
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	42
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $186,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	7313
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	2374
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,238,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	7
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2590
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,017,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	7791
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $65,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	8
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	2431
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,922,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2470
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,122,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Number of Individuals Covered	299
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $448,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	46
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $220,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	123
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $507,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	7740
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	3
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	20
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000521

Policy instance

Insurance contract or identification number	40000521
Number of Individuals Covered	7
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	2080
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,210,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	5215073
Number of Individuals Covered	142
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,379
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D, DEPENDENT LIFE
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $26,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,379
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000509

Policy instance

Insurance contract or identification number	40000509
Number of Individuals Covered	3
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	7946
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	54
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $196,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	159
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $684,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	7500
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	4
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	23
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $127,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 1

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 1
Number of Individuals Covered	113
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $148,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE 2

Policy instance

Insurance contract or identification number	SEE FOOTNOTE 2
Number of Individuals Covered	172
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $214,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	29
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	4
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	126
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $171,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000521

Policy instance

Insurance contract or identification number	40000521
Number of Individuals Covered	7
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

19678

Policy instance

Insurance contract or identification number	19678
Number of Individuals Covered	1806
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,776,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	1763
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,851,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000509

Policy instance

Insurance contract or identification number	40000509
Number of Individuals Covered	6
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	9578
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

111276

Policy instance

Insurance contract or identification number	111276
Number of Individuals Covered	55
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $183,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	182
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $808,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	8492
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

40000021

Policy instance

Insurance contract or identification number	40000021
Number of Individuals Covered	163
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $184,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )

Policy contract number

034562

Policy instance

Insurance contract or identification number	034562
Number of Individuals Covered	4
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )

Policy contract number

0R093772

Policy instance

Insurance contract or identification number	0R093772
Number of Individuals Covered	222
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,791,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000509

Policy instance

Insurance contract or identification number	40000509
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100544

Policy instance

Insurance contract or identification number	100544
Number of Individuals Covered	44
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $149,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

800000017

Policy instance

Insurance contract or identification number	800000017
Number of Individuals Covered	21146
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $323,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

1024

Policy instance

Insurance contract or identification number	1024
Number of Individuals Covered	171
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $725,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	9575
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12227540

Policy instance

Insurance contract or identification number	12227540
Number of Individuals Covered	8792
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )

Policy contract number

034513

Policy instance

Insurance contract or identification number	034513
Number of Individuals Covered	29
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $145,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	3153
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

9661

Policy instance

Insurance contract or identification number	9661
Number of Individuals Covered	29
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $120,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	133
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100536

Policy instance

Insurance contract or identification number	100536
Number of Individuals Covered	21
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $71,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03305998

Policy instance

Insurance contract or identification number	03305998
Number of Individuals Covered	2901
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000509

Policy instance

Insurance contract or identification number	40000509
Number of Individuals Covered	6
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,440

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

SEE FOOTNOTE

Policy instance

Insurance contract or identification number	SEE FOOTNOTE
Number of Individuals Covered	115
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $153,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

9661

Policy instance

Insurance contract or identification number	9661
Number of Individuals Covered	29
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100536

Policy instance

Insurance contract or identification number	100536
Number of Individuals Covered	21
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03305998

Policy instance

Insurance contract or identification number	03305998
Number of Individuals Covered	3105
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )

Policy contract number

40000509

Policy instance

Insurance contract or identification number	40000509
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	3242
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )

Policy contract number

100536

Policy instance

Insurance contract or identification number	100536
Number of Individuals Covered	30
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $96,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03305998

Policy instance

Insurance contract or identification number	03305998
Number of Individuals Covered	3391
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

612432

Policy instance

Insurance contract or identification number	612432
Number of Individuals Covered	3671
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )

Policy contract number

9661

Policy instance

Insurance contract or identification number	9661
Number of Individuals Covered	35
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $142,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )

Policy contract number

813949

Policy instance

Insurance contract or identification number	813949
Number of Individuals Covered	109
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $225,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BOARD OF TRUSTEES, UFCW LOCAL 555-EMPLOYERS HEALTH
Employer identification number (EIN):	237017278
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores