401k Plan data: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN plan

PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 401k Plan overview

Plan Name	PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN
Plan identification number	501

PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 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, PORTLAND AREA UFCW LOCAL 555- has sponsored the creation of one or more 401k plans.

Company Name: BOARD OF TRUSTEES, PORTLAND AREA UFCW LOCAL 555-

Employer identification number (EIN): 936042567

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2013-01-01 SANDY S. GARCIA SANDY S. GARCIA 2014-04-09
501 2012-01-01 PATI PIRO-BOSLEY
501 2011-01-01 PATI PIRO-BOSLEY
501 2009-01-01 PATI PIRO-BOSLEY

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2013-01-01	SANDY S. GARCIA	SANDY S. GARCIA	2014-04-09
501	2012-01-01	PATI PIRO-BOSLEY
501	2011-01-01	PATI PIRO-BOSLEY
501	2009-01-01	PATI PIRO-BOSLEY

Plan Statistics for PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN

401k plan membership statisitcs for PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN

Measure Date Value
2013: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 8,328
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 7,958
Number of retired or separated participants receiving benefits 2013-01-01 367
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 8,325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 8,325
Number of participants with account balances 2013-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
Number of employers contributing to the scheme 2013-01-01 43
2012: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8,579
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 7,941
Number of retired or separated participants receiving benefits 2012-01-01 387
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 8,328
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 8,328
Number of participants with account balances 2012-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
Number of employers contributing to the scheme 2012-01-01 47
2011: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9,295
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 8,178
Number of retired or separated participants receiving benefits 2011-01-01 401
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 8,579
Total participants 2011-01-01 8,579
Number of employers contributing to the scheme 2011-01-01 45
2009: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8,810
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 9,283
Number of retired or separated participants receiving benefits 2009-01-01 479
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 9,762
Total participants 2009-01-01 9,762
Number of employers contributing to the scheme 2009-01-01 68

Measure	Date	Value
2013: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	8,328
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	7,958
Number of retired or separated participants receiving benefits	2013-01-01	367
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	8,325
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	8,325
Number of participants with account balances	2013-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
Number of employers contributing to the scheme	2013-01-01	43
2012: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8,579
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	7,941
Number of retired or separated participants receiving benefits	2012-01-01	387
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	8,328
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	8,328
Number of participants with account balances	2012-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
Number of employers contributing to the scheme	2012-01-01	47
2011: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9,295
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	8,178
Number of retired or separated participants receiving benefits	2011-01-01	401
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	8,579
Total participants	2011-01-01	8,579
Number of employers contributing to the scheme	2011-01-01	45
2009: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8,810
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	9,283
Number of retired or separated participants receiving benefits	2009-01-01	479
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	9,762
Total participants	2009-01-01	9,762
Number of employers contributing to the scheme	2009-01-01	68

Financial Data on PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN

Measure	Date	Value
2013 : PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-06-30	$-43,589
Total unrealized appreciation/depreciation of assets	2013-06-30	$-43,589
Total transfer of assets from 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$18,434,886
Total income from all sources (including contributions)	2013-06-30	$43,209,718
Total loss/gain on sale of assets	2013-06-30	$-11,508
Total of all expenses incurred	2013-06-30	$35,044,133
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$34,288,834
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$43,175,714
Value of total assets at end of year	2013-06-30	$0
Value of total assets at beginning of year	2013-06-30	$29,285,046
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$755,299
Total interest from all sources	2013-06-30	$45,621
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$3,215
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2013-06-30	$0
Total dividends received from registered investment company shares (eg mutual funds)	2013-06-30	$3,215
Administrative expenses professional fees incurred	2013-06-30	$244,634
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	$2,664,199
Participant contributions at end of year	2013-06-30	$0
Participant contributions at beginning of year	2013-06-30	$901,605
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-06-30	$210,329
Administrative expenses (other) incurred	2013-06-30	$179,293
Liabilities. Value of operating payables at end of year	2013-06-30	$0
Liabilities. Value of operating payables at beginning of year	2013-06-30	$111,487
Total non interest bearing cash at end of year	2013-06-30	$0
Total non interest bearing cash at beginning of year	2013-06-30	$16,449,271
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	$8,165,585
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$0
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$10,850,160
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	$10,397
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-06-30	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-06-30	$316,337
Income. Interest from US Government securities	2013-06-30	$25,772
Income. Interest from corporate debt instruments	2013-06-30	$19,836
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$212,921
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$212,921
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-06-30	$13
Expenses. Payments to insurance carriers foe the provision of benefits	2013-06-30	$3,057,021
Asset value of US Government securities at end of year	2013-06-30	$0
Asset value of US Government securities at beginning of year	2013-06-30	$3,002,985
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-06-30	$40,265
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	$40,511,515
Employer contributions (assets) at end of year	2013-06-30	$0
Employer contributions (assets) at beginning of year	2013-06-30	$6,688,288
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$31,231,813
Asset. Corporate debt instrument preferred debt at end of year	2013-06-30	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2013-06-30	$985,016
Asset. Corporate debt instrument debt (other) at end of year	2013-06-30	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2013-06-30	$484,284
Contract administrator fees	2013-06-30	$320,975
Liabilities. Value of benefit claims payable at end of year	2013-06-30	$0
Liabilities. Value of benefit claims payable at beginning of year	2013-06-30	$18,323,399
Assets. Value of buildings and other operty used in plan operation at end of year	2013-06-30	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-06-30	$34,010
Did the plan have assets held for investment	2013-06-30	No
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	Yes
Aggregate proceeds on sale of assets	2013-06-30	$2,811,351
Aggregate carrying amount (costs) on sale of assets	2013-06-30	$2,822,859
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 : PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$34,141
Total unrealized appreciation/depreciation of assets	2012-12-31	$34,141
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$18,434,886
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$19,060,172
Total income from all sources (including contributions)	2012-12-31	$84,524,616
Total loss/gain on sale of assets	2012-12-31	$-11,066
Total of all expenses incurred	2012-12-31	$74,960,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$73,874,396
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$84,358,207
Value of total assets at end of year	2012-12-31	$29,285,046
Value of total assets at beginning of year	2012-12-31	$20,346,257
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,086,145
Total interest from all sources	2012-12-31	$99,730
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$6,800
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$6,800
Administrative expenses professional fees incurred	2012-12-31	$278,181
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$5,417,005
Participant contributions at end of year	2012-12-31	$901,605
Participant contributions at beginning of year	2012-12-31	$950,437
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$210,329
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$255,412
Administrative expenses (other) incurred	2012-12-31	$136,734
Liabilities. Value of operating payables at end of year	2012-12-31	$111,487
Liabilities. Value of operating payables at beginning of year	2012-12-31	$64,983
Total non interest bearing cash at end of year	2012-12-31	$16,449,271
Total non interest bearing cash at beginning of year	2012-12-31	$7,614,702
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$9,564,075
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$10,850,160
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,286,085
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Investment advisory and management fees	2012-12-31	$20,969
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$316,337
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$273,117
Income. Interest from US Government securities	2012-12-31	$59,272
Income. Interest from corporate debt instruments	2012-12-31	$40,458
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$212,921
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$140,338
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$140,338
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$7,885,276
Asset value of US Government securities at end of year	2012-12-31	$3,002,985
Asset value of US Government securities at beginning of year	2012-12-31	$3,000,135
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$36,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$78,941,202
Employer contributions (assets) at end of year	2012-12-31	$6,688,288
Employer contributions (assets) at beginning of year	2012-12-31	$6,747,104
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$65,989,120
Asset. Corporate debt instrument preferred debt at end of year	2012-12-31	$985,016
Asset. Corporate debt instrument preferred debt at beginning of year	2012-12-31	$754,569
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$484,284
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$575,096
Contract administrator fees	2012-12-31	$650,261
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$18,323,399
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$18,995,189
Assets. Value of buildings and other operty used in plan operation at end of year	2012-12-31	$34,010
Assets. Value of buildings and other operty used in plan operation at beginning of year	2012-12-31	$35,347
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$2,946,058
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$2,957,124
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2012-12-31	952036255
2011 : PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$5,248
Total unrealized appreciation/depreciation of assets	2011-12-31	$5,248
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$19,060,172
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$18,414,923
Total income from all sources (including contributions)	2011-12-31	$81,244,685
Total loss/gain on sale of assets	2011-12-31	$4,153
Total of all expenses incurred	2011-12-31	$82,366,551
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$81,194,347
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$81,099,673
Value of total assets at end of year	2011-12-31	$20,346,257
Value of total assets at beginning of year	2011-12-31	$20,822,874
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,172,204
Total interest from all sources	2011-12-31	$64,882
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$2,819
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$2,819
Administrative expenses professional fees incurred	2011-12-31	$252,999
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$5,604,059
Participant contributions at end of year	2011-12-31	$950,437
Participant contributions at beginning of year	2011-12-31	$992,359
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$255,412
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$213,085
Other income not declared elsewhere	2011-12-31	$30,912
Administrative expenses (other) incurred	2011-12-31	$287,952
Liabilities. Value of operating payables at end of year	2011-12-31	$64,983
Liabilities. Value of operating payables at beginning of year	2011-12-31	$15,736
Total non interest bearing cash at end of year	2011-12-31	$7,614,702
Total non interest bearing cash at beginning of year	2011-12-31	$9,175,022
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-1,121,866
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,286,085
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$2,407,951
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Investment advisory and management fees	2011-12-31	$15,358
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$273,117
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$629,566
Income. Interest from US Government securities	2011-12-31	$34,783
Income. Interest from corporate debt instruments	2011-12-31	$30,086
Value of interest in common/collective trusts at end of year	2011-12-31	$0
Value of interest in common/collective trusts at beginning of year	2011-12-31	$3,018,465
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$140,338
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$29
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$29
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$13
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$8,504,308
Asset value of US Government securities at end of year	2011-12-31	$3,000,135
Asset value of US Government securities at beginning of year	2011-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$16,605
Net investment gain or loss from common/collective trusts	2011-12-31	$20,393
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$75,495,614
Employer contributions (assets) at end of year	2011-12-31	$6,747,104
Employer contributions (assets) at beginning of year	2011-12-31	$6,762,587
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$72,690,039
Asset. Corporate debt instrument preferred debt at end of year	2011-12-31	$754,569
Asset. Corporate debt instrument preferred debt at beginning of year	2011-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$575,096
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$0
Contract administrator fees	2011-12-31	$615,895
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$18,995,189
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$18,399,187
Assets. Value of buildings and other operty used in plan operation at end of year	2011-12-31	$35,347
Assets. Value of buildings and other operty used in plan operation at beginning of year	2011-12-31	$31,761
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$7,866,050
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$7,861,897
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	MILLER, KAPLAN, ARASE & CO., LLP
Accountancy firm EIN	2011-12-31	952036255
2010 : PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$18,414,923
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$12,500,674
Total income from all sources (including contributions)	2010-12-31	$79,339,437
Total of all expenses incurred	2010-12-31	$79,414,516
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$77,932,297
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$79,098,497
Value of total assets at end of year	2010-12-31	$20,822,874
Value of total assets at beginning of year	2010-12-31	$14,983,704
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,482,219
Total interest from all sources	2010-12-31	$8
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$8,848
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$8,848
Administrative expenses professional fees incurred	2010-12-31	$291,665
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$5,904,571
Participant contributions at end of year	2010-12-31	$992,359
Participant contributions at beginning of year	2010-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$213,085
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$410,083
Other income not declared elsewhere	2010-12-31	$7,300
Administrative expenses (other) incurred	2010-12-31	$346,388
Liabilities. Value of operating payables at end of year	2010-12-31	$15,736
Liabilities. Value of operating payables at beginning of year	2010-12-31	$531,488
Total non interest bearing cash at end of year	2010-12-31	$9,175,022
Total non interest bearing cash at beginning of year	2010-12-31	$4,053,033
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-75,079
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$2,407,951
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$2,483,030
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Investment advisory and management fees	2010-12-31	$17,062
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$629,566
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$856,538
Value of interest in common/collective trusts at end of year	2010-12-31	$3,018,465
Value of interest in common/collective trusts at beginning of year	2010-12-31	$4,557,862
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$29
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$28
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$28
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$8
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$9,258,001
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$61,539
Net investment gain or loss from common/collective trusts	2010-12-31	$163,245
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$73,193,926
Employer contributions (assets) at end of year	2010-12-31	$6,762,587
Employer contributions (assets) at beginning of year	2010-12-31	$5,075,493
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$68,674,296
Contract administrator fees	2010-12-31	$827,104
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$18,399,187
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$11,969,186
Assets. Value of buildings and other operty used in plan operation at end of year	2010-12-31	$31,761
Assets. Value of buildings and other operty used in plan operation at beginning of year	2010-12-31	$30,667
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	MILLER, KAPLAN, ARASE & CO., LLP
Accountancy firm EIN	2010-12-31	952036255

Form 5500 Responses for PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN

2013: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	This submission is the final filing	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PORTLAND AREA UFCW LOCAL 555-EMPLOYERS HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

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Company Name:	BOARD OF TRUSTEES, PORTLAND AREA UFCW LOCAL 555-
Employer identification number (EIN):	936042567
NAIC Classification:	445110
NAIC Description:	Supermarkets and Other Grocery (except Convenience) Stores