2022-11-15T16:12:18-06:00 2021-12-31 135565207 KPMG LLP 345 PARK AVENUE NEW YORK NY 10154 990 2021-01-01 134129368 1199SEIU NBF FOR HOME CARE EMPLOYEES 1199 6464736336 PO BOX 842 NEW YORK NY 10108 MERCEDES MAMBRU CFO 6464736336 2022-11-15 1 MERCEDES MAMBRU 999009999 OMO-OSE JOSEPH-ERAMEH P02534927 2127589700 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MERCEDES MAMBRU PO BOX 842 NEW YORK NY 10108 165227602 0 X HTTP://1199SEIUBENEFITS.ORG X 1949 NY TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. SEE SCHEDULE O.TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENT AND TRUST DOCUMENT. 13 13 0 15 0 0 0 0 176098701 155449625 14248800 9754406 40745 23571 190388246 165227602 0 0 210978318 193095910 8107322 8139198 0 0 0 6369482 5666378 225455122 206901486 -35066876 -41673884 201357253 153233170 30095501 32742186 171261752 120490984 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENT AND TRUST DOCUMENT. 0 0 0 0 0 THOUGH THE FUND DOES NOT UNDERTAKE PROGRAM SERVICES AND DOES NOT REPORT ANY EXPENSES ON FORM 990, PART IX, COL (B), THE FUND PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENT AND TRUST DOCUMENT. IN 2021 21,576 MEMBERS/PARTICIPANTS RECEIVED HEALTH AND WELFARE BENEFITS. 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 X 5037 0 1 0 0 0 0 0 0 0 0 0 0 0 X 13 13 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MERCEDES MAMBRU 6464736336 PO BOX 842 NEW YORK NY 10108 X JAMES CAREY EMPLOYER TRUSTEE (END 2/21) 1.00 0.00 X 0 0 0 GLADYS CONFIDENT EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 ADRIA POWELL EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 JESSICA CUMMINGS EMPLOYER TRUSTEE (END 1/21) 1.00 0.00 X 0 0 0 LING MA EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 MARC KRAMER EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 ANDREA THOMAS-RANDALL EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 JAMES ROLLA EMPLOYER TRUSTEE (BEG. 2/21) 1.00 0.00 X 0 0 0 GUADALUPE ASTACIO UNION TRUSTEE 1.00 0.00 X 0 0 0 VLADIMIR FORTUNNY UNION TRUSTEE 1.00 0.00 X 0 0 0 KWAIDAVIDHO UNION TRUSTEE 1.00 0.00 X 0 0 0 KEITH JOSEPH UNION TRUSTEE 1.00 0.00 X 0 0 0 RONA SHAPIRO UNION TRUSTEE 1.00 0.00 X 0 0 0 YVONNE ARMSTRONG UNION TRUSTEE 1.00 0.00 X 0 0 0 HAROLD FONG-SAM UNION TRUSTEE 1.00 0.00 X 0 0 0 LORRAINE MONCHAK CHIEF INVESTMENTS OFFICER 2.00 0.00 X 54098 0 25922 MITRA BEHROOZI EXECUTIVE OFFICER 2.00 0.00 X 33045 0 15063 DONNA S REY EXECUTIVE OFFICER 2.00 0.00 X 34910 0 16027 VAN H DUNN CHIEF MEDICAL OFFICER 2.00 0.00 X 23136 0 10869 MERCEDES MAMBRU CHIEF FINANCIAL OFFICER 2.00 0.00 X 13075 0 6140 158264 0 74021 0 0 0 0 MEDCO HEALTH SOLUTIONS INC (ADMIN) 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 CLAIMS PROCESSING 788541 EVERNORTH BEHAVIORAL HEALTH INC (PRE-C 5144 COLLECTION CTR DR CHICAGO IL 60693 CONSULTING (GENERAL) 571061 CHANGE HEALTHCARE SOLUTION LLC 3055 LEBANON PIKE 1000 NASHVILLE TN 37214 CLAIMS PROCESSING 394793 MILLIMAN INC 1 PENN PLAZA NEW YORK NY 10019 ACTUARIAL 192519 CHANGE HEALTHCARE LLC PO BOX 98347 CHICAGO IL 60693 CLAIMS PROCESSING 134281 8 EMPLOYERS CONTRIBUTION 900099 149172935 149172935 MEMBER PREMIUMS 900099 6061881 6061881 INTEREST & CHARGES 900099 111655 111655 COBRA PAYMENTS 900099 103154 103154 155449625 125121 125121 9629285 0 9629285 9629285 9629285 BANK EARNING CREDITS 900099 23571 23571 23571 165227602 155449625 0 9777977 193095910 232286 5120458 597037 1783776 405641 169472 138416 101199 371478 868852 234591 2258411 122775 3RD PARTY ADMIN CHARGES 788541 MANAGED CARE PRECERT. 612643 206901486 109157701 11094603 29790355 27981831 31596 42423163 81778242 19986034 32346898 201357253 153233170 1233321 1842389 28862180 30899797 30095501 32742186 X 171261752 120490984 171261752 120490984 201357253 153233170 X -41673884 -7972883 -1124001 X 0 1 X 1 0 0 GOVERNMENT AGENCY SECURITIES 36765389 F GOVERNMENT BONDS 45012853 F 81778242 PREMIUMS 946502 DUE FROM PHARMACY BENEFIT MANAGER AND OTHERS 23255469 DUES FROM RELATED ENTITIES 216551 3BF, NET 7869270 ACCRUED INVESTMENT INCOME 59106 32346898 CURRENT BENEFIT OBLIGATIONS 29348754 DUE TO RELATED ENTITIES 1551043 30899797 X 157153520 -7972883 -7972883 165126403 101199 101199 165227602 206800287 0 206800287 101199 101199 206901486 PART X, LINE 2: U.S. GAAP REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF LIABILITY (OR ASSET) OR DISCLOSURE IN FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO FEDERAL INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2018. FORM 990, PART V, LINE 3B UNRELATED BUSINESS INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 419A(F)(5)(A), COLLECTIVE BARGAINING AGREEMENTS ARE EXEMPT FROM ACCOUNT LIMIT REQUIREMENTS SET UNDER IRC SECTION 419A(C), AND ARE THEREFORE NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX UNDER IRC SECTION 512(A)(3). FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIP ALL OF THE UNION TRUSTEES ARE ALSO EMPLOYEES OF 1199SEIU (THE UNION) AND THEREFORE HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT THE UNION TRUSTEES ARE APPOINTED BY 1199SEIU UNITED HEALTHCARE WORKERS EAST, AND THE EMPLOYER TRUSTEES ARE APPOINTED BY THE CONTRIBUTING EMPLOYERS. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 THE CHIEF FINANCIAL OFFICER AND FINANCE TEAM REVIEW THE DRAFT FORM 990 AND CONFER WITH THE ACCOUNTANTS AND LEGAL COUNSEL TO ENSURE THE ACCURACY OF THE RETURN. ANY CONCERNS ARE NOTED AND ADDRESSED AND MANAGEMENT ENSURES THAT THE CHANGES ARE INCORPORATED IN THE FORM 990. THE COMPLETED FORM 990 IS THEN SIGNED BY AN OFFICER BEFORE BEING SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY TRUSTEES AND EMPLOYEES ARE REQUIRED TO ANNUALLY DISCLOSE OR UPDATE TO THE EXECUTIVE DIRECTOR, OR DESIGNEE, THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTERESTS. FOR EACH INTEREST DISCLOSED BY A TRUSTEE, THE EXECUTIVE DIRECTOR OR DESIGNEE WILL DETERMINE WHETHER TO (A) TAKE NO ACTION (B) ASSURE FULL DISCLOSURE TO THE TRUSTEES (C) ASK THE TRUSTEE TO BE RECUSED FROM PARTICIPATION IN RELATED DISCUSSIONS OR DECISIONS; AND/OR (D) ASK THE TRUSTEE TO RESIGN. REGARDING EMPLOYEES, COMPLETED CONFLICTS OF INTEREST DISCLOSURE FORMS WILL BE REVIEWED BY THE HUMAN RESOURCES DEPARTMENT AND DISCLOSED CONFLICTS WILL BE REVIEWED BY HUMAN RESOURCES MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW COMPENSATION FOR ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE FUND IS DETERMINED BY THE CROSS FUNDS COMPENSATION COMMITTEE (THE "COMMITTEE"), COMPRISED OF INDEPENDENT MEMBERS. THE COMMITTEE UTILIZES APPROPRIATE DATA AS TO COMPARABILITY IN ITS DETERMINATIONS, INCLUDING INFORMATION PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS. THE COMMITTEE DOCUMENTS THE BASIS FOR ANY COMPENSATION DETERMINATIONS CONTEMPORANEOUSLY IN THE MINUTES OF THE COMMITTEE. THE COMMITTEE DETERMINES COMPENSATION PERIODICALLY AS IT DEEMS APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DISCLOSURE SUMMARY PLAN DESCRIPTIONS AND FINANCIAL REPORTS ARE MADE PUBLIC PURSUANT TO IRS REQUIREMENTS. WRITTEN REQUESTS FOR OTHER INFORMATION WILL BE FORWARDED TO GENERAL COUNSEL'S OFFICE FOR CONSIDERATION. FORM 990, PART VII, SECTION A, LINE 1 THE EMPLOYER TRUSTEES REPORTED ON PART VII MAY HAVE RECEIVED COMPENSATION FROM A RELATED TAX-EXEMPT ORGANIZATION REPORTED IN SCHEDULE R, PART II. WITH VERY LIMITED EXCEPTION, NO ONE RESPONDED TO THE REQUEST MADE FOR COMPENSATION INFORMATION. FORM 990, PART XI, LINE 9: CHANGE IN BENEFIT OBLIGATION -1,124,001. ALLIANCE FOR HEALTH INC N/A ALLIANCE HOME SERVICES INC N/A AREBA CASRIEL INC N/A AZOR HOME CARE INC BEST CHOICE HOME CARE INC N/A BHRAGS HOME CARE CORP N/A BRONX JEWISH COMMUNITY COUNCIL N/A BUSHWICK STUYVESANT HEIGHTS N/A CABS HOME ATTENDANT SERVICES INC N/A CARE AT HOME DIOCESE OF BROOKLYN INC N/A CHINESE-AMERICAN PLANNING-880 N/A CIDNY - INDEPENDENT LIVING SERVICES INC N/A ELDERSERVE - LICENSED HOME CARE SERVICES N/A FAMILY HOME CARE SVCS OF BROOKLYN & QUEE N/A FEDCAP REHABILITATION SERVICES INC FEGS HOME ATTENDANT SERVICES INC N/A HOME ATTENDANT SERVICES OF HYDE PARK N/A HOME CARE SERVICES FOR INDEPENDENT LIVIN N/A HOME HEALTH MANAGEMENT SERVICE N/A HUDSON RIVER HEALTHCARE-SUFFOLK N/A INSTITUTE FOR FAMILY HEALTH N/A NEIGHBORS HOME CARE SERVICE N/A NY FOUNDATION FOR SR CITIZENS HM ATT SVS N/A PARTNERS IN CARE INC N/A PREMIER HOME HEALTHCARE SERVICES INC N/A PSC COMMUNITY SERVICES INC N/A RAIN HOME ATTENDANT SERVICES INC N/A RICHMOND HOME NEEDS SERVICES INC N/A RISEBORO HOMECARE N/A ROCKAWAY HOME ATTENDANT SERVICES INC N/A SCHOOL SETTLEMENT HOME ATT SERVICE CORP N/A SAINT NICHOLAS HUMAN SUPPORT N/A START RECOVERY AND TREATMENT CENTERS N/A STELLA ORTON HOME CARE AGENCY INC N/A SUNNYSIDE HOME CARE PROJECT INC N/A THE FIRST CHINESE PRESBYTERIAN COMMUNITY AFFAIRS HOME ATTENDANT CORPORATION N/A UNITED JEWISH COUNCIL N/A UPPER MANHATTAN MENTAL HEALTH N/A ABC HEALTH REGISTRY INC N/A ALL METRO HEALTH CARE N/A BEST CARE INC DBA ALL CITY CARE N/A BEST SERVICE HOME CARE N/A BESTCARE INC N/A COOPERATIVE HOME CARE N/A NO PLACE LIKE HOME CARE SERVICES N/A PEOPLE CARE INCORPORATED N/A PERSONAL TOUCH HOME CARE OF NY INC N/A REGION CARE NURSING N/A RELIANCE HOME SENIOR SERVICES N/A SPECIAL TOUCH HOME CARE SERVICES INC N/A UNLIMITED CARE INC N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1