2022-04-25T15:04:38-05:00 2021-09-30 611436956 NOVAK FRANCELLA LLC 40 MONUMENT RD 5TH FLR BALA CYNWYD PA 19004 990 2020-10-01 221458594 UFCW NATIONAL HEALTH AND WELFARE FUND UFCW 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 GEORGE J ORLANDO TRUSTEE 2015698801 2022-04-25 1 GEORGE ORLANDO 999009999 LOUIS VERZELLA CPA P00360279 6106689400 2022-04-25 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z GEORGE J ORLANDO 66 GRAND AVENUE ENGLEWOOD NJ 07631 182430715 0 X N/A X 1947 NJ THE PLAN PROVIDES HOSPITAL, MAJOR MEDICAL, SURGICAL, DISABILITY, PRESCRIPTION DRUG, DEATH AND VISION BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. ALL HEALTH, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFITS ARE SELF-FUNDED. 8 8 37 0 0 0 0 0 146270599 152986993 960558 3265534 0 0 147231157 156252527 0 0 137093573 145729604 3157496 3205352 0 0 0 2024782 2190099 142275851 151125055 4955306 5127472 108924045 122447009 7080191 4614972 101843854 117832037 THE PLAN PROVIDES HOSPITAL, MAJOR MEDICAL, SURGICAL, DISABILITY, PRESCRIPTION DRUG, DEATH AND VISION BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. ALL HEALTH, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFITS ARE SELF-FUNDED. 0 0 THE FUND PROVIDES MEDICAL, HOSPITAL, PRESCRIPTION DRUGS, DEATH AND VISION BENEFITS FOR MEMBERS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 9 0 37 1 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BOARD OF TRUSTEES 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 X GEORGE J ORLANDO TRUSTEE-CHAIRMAN 5.00 X 0 0 0 TOM R BALLARD TRUSTEE 2.00 X 0 0 0 FRANK J RUNEY TRUSTEE 2.00 X 0 0 0 GERALDINE SENACK TRUSTEE 5.00 X 0 0 0 MICHELLE LEWIS TRUSTEE 2.00 X 0 0 0 JOHN PEPE TRUSTEE 2.00 X 0 0 0 JAMES BLAU TRUSTEE 2.00 X 0 0 0 DANNY MA TRUSTEE (P) 2.00 X 0 0 0 VIOLETA AGUILAR-WYRICK TRUSTEE 2.00 X 0 0 0 MAURICE HODOS ADMINISTRATOR 40.00 X 237118 0 39884 BRENDA GARMA MANAGER 40.00 X 101709 0 36389 338827 0 76273 2 0 1 0 HORIZON BLUE CROSS BLUE SHIELD 3 PENN PLAZA EAST PP-04K NEWARK NJ 07105 CLAIMS ADMINISTRATION 3154313 EMPIRX HEALTH LLC 155 CHESTNUT RIDGE RD SUITE 103 MONTVALE NJ 07645 CLAIMS ADMINISTRATION 699540 CONIFER VALUE BASED CARE LLC 15821 VENTURA BLVD STE 600 ENCINO CA 91436 COST CONTAINMENT 399535 THE SEGAL COMPANY 333 WEST 34TH STREET NEW YORK NY 10001 CONSULTING/ACTUARIAL FEES 368325 HEALTHSMART CARE MGMT SOLUTION 222 WEST LAS COLINAS BOULEVARD STE IRVING TX 75039 HEALTH CARE MANAGEMENT 246599 9 EMPLOYER CONTRIBUTIONS 525100 150967393 150967393 PARTICIPANT AND RETIREE CONTRIBUT 525100 1685174 1685174 MEDICARE PART D REIMB. 525100 334426 334426 152986993 1474376 1474376 27969346 26178188 1791158 1791158 1791158 156252527 152986993 0 3265534 145729604 1725087 628583 712659 139023 316623 147343 156216 591474 438875 202204 210262 21278 24671 16552 57441 TEMPORARY STAFF AGENCY 7160 151125055 3288651 702000 33289597 23826024 2973450 3372492 32414 27227 297432 244327 64496 53105 67127637 92169608 2147800 2296553 108924045 122447009 667530 624536 2813972 2740813 3598689 1249623 7080191 4614972 X 0 0 0 0 101843854 117832037 101843854 117832037 108924045 122447009 X 5127472 8343566 2517145 X X 0 1 X 1 0 3578 269 3309 293854 244058 49796 53105 ACCRUED PENSION COST 1216986 DUE TO BROKER 32637 1249623 X 164439877 8343566 8343566 156096311 156216 156216 156252527 150968839 0 150968839 156216 156216 151125055 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT, MORE LIKELY THAN NOT, WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE U.S. FEDERAL, STATE, OR LOCAL TAXING AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. TYPICALLY, PLAN TAX YEARS WILL REMAIN OPEN FOR THREE YEARS; HOWEVER, THIS MAY DIFFER DEPENDING UPON THE CIRCUMSTANCES OF THE PLAN. PART XII, LINE 4B - OTHER ADJUSTMENTS: COMPENSATION - RETIREMENT BENEFITS ADJUSTMENT X 0 0 0 MAURICE HODOS ADMINISTRATOR 237118 0 0 0 0 0 20021 0 19863 0 277002 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B UFCW NATIONAL HEALTH AND WELFARE FUND'S FORM 990 IS PREPARED BY ITS INDEPENDENT ACCOUNTANT. THE RETURN IS THEN FORWARDED TO THE FUND ADMINISTRATOR FOR INITIAL REVIEW BEFORE BEING PRESENTED TO THE TRUSTEES FOR REVIEW AND SIGNATURE. FORM 990, PART VI, SECTION B, LINE 12C UFCW NATIONAL HEALTH & WELFARE FUND MONITORS ITS CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF PLAN SERVICE PROVIDERS IS SUBJECT TO APPROVAL OF THE BOARD OF TRUSTEES UNDER THE PLAN'S TRUST AGREEMENTS. PERSONS WITH A CONLFICT OF INTEREST WITH RESPECT TO A COMPENSATION ARRANGEMENT WILL NOT BE INVOLVED. DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS IS USED. CONTEMPORANEOUS DOCUMENTATION AND REORDS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT ARE MADE AND KEPT. FORM 990, PART VI, SECTION C, LINE 19 UFCW NATIONAL HEALTH AND WELFARE FUND MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: COMPENSATION RETIREMENT BENEFIT ADJUSTMENT 2,517,145. FORM 990, PART XII, LINE 2C: UFCW NATIONAL HEALTH AND WELFARE FUND'S BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT THAT PERFORMS THE AUDIT. RETIREMENT PLAN OF THE UFCW NATIONAL HEALTH AND WELFARE FUND 66 GRAND AVENUE ENGLEWOOD NJ 07631 221458594 PENSION FUND NJ 401(A)/501(A) 0 HARRIS COUNTY AFL CIO 2506 SUTHERLAND ST HOUSTON TX 77023 741356044 LABOR UNION TX 501(C)(5) 0 UFCW LOCAL UNION 540 11041 GARLAND RD DALLAS TX 75218 750953266 LABOR UNION TX 501(C)(5) 0 UFCW LOCAL UNION 791 55 NORFOLK AVE SOUTH EASTON MA 02375 237281421 LABOR UNION MA 501(C)(5) 0 METROPOLITAN BALTIMORE COUNCIL 2701 W PATAPSCO AVE 110 BALTIMORE MD 21230 526068046 LABOR UNION MD 501(C)(5) 0 UFCW LOCAL UNION 18 3163 EAST TREMONT AVE BRONX NY 10461 130664176 LABOR UNION NY 501(C)(5) 0 UFCW LOCAL UNION 22D 8402 18TH AVENUE BROOKLYN NY 11214 131471825 LABOR UNION MO 501(C)(5) 0 UFCW LOCAL UNION 186186D 329 DOWNEY MODESTO CA 95354 941549203 LABOR UNION CA 501(C)(5) 0 UFCW LOCAL 496 2901 RIDGELAKE DR STE 202 METAIRIE LA 70002 720225967 LABOR UNION LA 501(C)(5) 0 UFCW LOCAL 368A 456 N ARTHUR POCATELLO ID 83204 820187215 LABOR UNION 501(C)(5) 0 SHEET METAL AIR RAIL & TRANSPORTATION WORKERS LOCAL 103 5250 N MONTANA AVE HELENA MT 59602 810378730 LABOR UNION MT 501(C)(5) 0 TEAMSTERS LOCAL 570 6910 EASTERN AVE BALTIMORE MD 21224 520521895 LABOR UNION MD 501(C)(5) 0 AKZO NOBEL ALBERTSONS COMPANIES LLC ALMADEN WINE CELLARS (THE WINE GROUP) ALSCOAMERICAN LINEN AMRI RENNSELAER INC AOC RESINS ARAMARK UNIFORM & APPAREL LLC ARDAGH METAL PACKAGING ARISTECH SURFACES BIONETICS CORPORATION BUFFALO TRACE DISTILLERY CANTU SERVICES INC CATALYST EAST SIDE CENTRAL CO-OP CHARLES KRUG COMMUNITY FEDERAL CREDIT UNION COMPASSIONATE CARE CONNECTED BELLFLOWER CONNECTED BELMONT CONNECTED CHERRY CONNECTED SANTA ANA CONSTELLATION WINES USA CSL BEHRING DELANO GROWERS COOPERATIVE WINERY DIAGEO PLC E&J GALLO WINERY FOOD FRONT COOPERTIVE GROCERY FRANKLIN LABS LLC FRANZIA (THE WINE GROUP) G-3 ENTERPRISES-CLOSURE DIVISION GALLO WINE SALES OF NJ INC GARDEN STATE DISPENSARY GARY & LEO'S FRESH FOODS GIBSON WINE CO GLEASON INDUSTIRAL PRODUCTS INC GLENDIVE BN FED CREDIT UNION GLENMORE DISTILLERIESSAZERAC COMPANY GOLDEN STATE VINTERS INC (THE WINE GROUP) HAVE A HEART CC HERITAGE THERMAL SERVICE HUHTAMAKI INC JACOB STERN JEFFERSON COMMUNITY JIM BEAM BRANDS COMPANY JUSTIN TANKS LEAF AND LION MARYLAND MEDICAL SOLUTIONS METROPOLITAN BALTIMORE COUNCIL MINNESOTA FREEZER WAREHOUSE CO MOUNTANEER PARK INC MR NICE GUY MUSHROOM FARMS INC NATURAL RX PATRICK METALS PENNSYLVANIA DISPENSARIES PENNSYLVANIA MEDICAL PERNOD RICARD PROFUSION INDUSTRIES RED WING SHOE COMPANY RICH'S FOOD TOWN INC RIEDELL SHOES RODGERS CORPORATION ROSCOMMON COUNTY TRANSIT AUTHORITY ROYAL WINE CORP RYDER INTEGRATED LOGISTICS SB FOOT TANNING COMPANY SEBASTIANI VINEYARDSFOLEY FAMILY VINEYARDS SERVICE LINEN SUPPLY SHAWS SHERRY LEHMAN SILGAN CAN COMPANY SKYY SPIRITS DBA CAMPARI AMERICA SMITH'S FOOD & DRUG CENTER SOUTH COAST SAFE ACCESS SOUTH CORD HOLDINGS SOUTHERN WINE & SPIRITS STARFIRE LIGHTING INC SUNMAID GROWERS OF CALIFORNIA SUPERIOR LINEN SERVICE INC THE JOINT THE STATION THE SUN PRODUCTS CORPORATION TOMLINSON LINEN UNION CLUB BAR INC VENTURA FOODS INC VIE-DEL CO VISCOFAN USA INC VIVENDI WH BAGSHAW COMPANY INC WAVESEER OF LAS VEGAS NV LLC 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1