2021-11-15T18:37:47-06:00 2020-12-31 135565207 KPMG LLP 550 S HOPE STREET LOS ANGELES CA 90071 990 2020-01-01 134129368 1199SEIU NBF FOR HOME CARE EMPLOYEES 1199 6464736336 PO BOX 842 NEW YORK NY 10108 MERCEDES MAMBRU CFO 6464736336 2021-11-15 1 MERCEDES MAMBRU 999009999 DAVID M HIGHFILL P01517891 2139724000 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z MERCEDES MAMBRU PO BOX 842 NEW YORK NY 10108 190388246 0 X HTTP://1199SEIUBENEFITS.ORG 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. 14 14 0 14 0 0 0 0 199253566 176098701 4027862 14248800 36138 40745 203317566 190388246 0 0 224121245 210978318 8311277 8107322 0 0 0 6154382 6369482 238586904 225455122 -35269338 -35066876 241561521 201357253 27553650 30095501 214007871 171261752 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 2020, 24,544 MEMBERS/PARTICIPANTS RECEIVED HEALTH AND WELFARE BENEFITS. 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 5021 0 1 0 0 0 0 0 0 0 0 0 X 14 14 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 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 1.00 0.00 X 0 0 0 LING MA EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 ANDREA-THOMAS RANDALL EMPLOYER TRUSTEE 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 MARC KRAMER EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 LORRAINE MONCHAK CHIEF INVESTMENTS OFFICER 2.00 0.00 X 41961 0 18699 MITRA BEHROOZI EXECUTIVE OFFICER 2.00 0.00 X 32782 0 14399 DONNA S REY CHIEF OPERATING OFFICER 2.00 0.00 X 28598 0 12556 VAN H DUNN CHIEF MEDICAL OFFICER 2.00 0.00 X 23695 0 10553 MERCEDES MAMBRU CHIEF FINANCIAL OFFICER (BEG. 4/20) 2.00 0.00 X 11582 0 5056 138618 0 61263 0 0 0 0 MEDCO HEALTH(ADMIN FEE) 100 PARSONS POND DRIVE FRANKLIN LAKES NJ 07417 CONSULTING (GENERAL) 759463 CARE ALLIES (PRE-CERT) 5144 COLLECTION CENTER DRIVE CHICAGO IL 60693 CONSULTING (GENERAL) 697473 CHANGE HEALTHCARE SOLUTION LLC 3055 LEBANON PIKE 1000 NASHVILLE TN 37214 COPYING/DUPLICATING 291618 MILLIMAN INC 1 PENN PLAZA NEW YORK NY 10119 ACTUARIAL 202645 WESTERN ASSET MANAGEMENT COMPANY 620 8TH AVE 50 NEW YORK NY 10018 INVESTMENT MGMT 148720 7 EMPLOYER CONTRIBUTION 900099 166900039 166900039 MEMBER PREMIUMS 900099 8826545 8826545 INTEREST & CHARGES - EMPLOYER DEL 900099 216297 216297 COBRA PAYMENTS 900099 155820 155820 176098701 51348 51348 14197452 0 14197452 14197452 14197452 BANK EARNING CREDITS 900099 40745 40745 40745 190388246 176098701 0 14289545 210978318 199881 5123163 637512 1761092 385674 196942 135283 157577 264453 878517 225348 2979678 120446 3RD PARTY ADMIN CHARGES 720509 MANAGED CARE PRECERT. 690729 225455122 9979183 109157701 54700237 29790355 165885194 42423163 10996907 19986034 241561521 201357253 1173770 1233321 26379880 28862180 27553650 30095501 X 214007871 171261752 214007871 171261752 241561521 201357253 X -35066876 -5834370 -1844873 X 0 1 X 1 0 0 COMMON COLLECTIVE TRUSTS 42423163 F 42423163 PREMIUMS 1341919 DUE FROM PHARMACY BENEFIT MANAGER AND OTHERS 9466881 DUES FROM RELATED ENTITIES 834902 3BF, NET 8342332 19986034 CURRENT BENEFIT OBLIGATIONS 28224753 DUE TO RELATED ENTITIES 637427 28862180 X 184396299 -5834370 -5834370 190230669 157577 157577 190388246 225297545 0 225297545 157577 157577 225455122 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, 2020, 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 2017. 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 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 BENEFITS REPORTED & PAID -1,844,873. PREMIER CDPAP NYC NSW ALLIANCE HOME SERVICES INC N/A AZOR HOME CARE N/A BEST CHOICE HOME CARE INC 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 FAMILY HOME CARE SVCS OF BROOKLYN & QUEE N/A FEDCAP REHABILITATION SERVICES INC N/A FEGS HOME ATTENDANT SERVICES INC N/A FIRST CHINESE PRES CHURCH HOUSEKEEPER N/A HOME ATTENDANT SERVICES OF HYDE PARK N/A HOME CARE SERVICES FOR INDEPENDENT LIVIN N/A HOME HEALTH MANAGEMENT SERVICE N/A NY FOUNDATION FOR SR CITIZENS HM ATT SVS N/A PARTNERS IN CARE INC N/A PSC COMMUNITY SERVICES INC N/A RAIN HOME ATTENDANT SERVICES INC N/A RICHMOND HOME NEEDS SERVICES INC N/A RIDGEWOOD-BUSHWICK SENIOR CITIZENS N/A ROCKAWAY HOME ATTENDANT SERVICES INC N/A SCHOOL SETTLEMENT HOME ATT SERVICE CORP N/A SUNNYSIDE HOME CARE PROJECT INC N/A UNITED JEWISH COUNCIL N/A WART BURG RESIDENTIAL COMMUNITY INC N/A ST NICKS ALLIANCE HOME CARE N/A ELDERSERVE - LICENSED HOME CARE SERVICES N/A BRONX COMMUNITY HOME CARE INC N/A HUDSON RIVER HEALTHCARE-SUFFOLK N/A UPPER MANHATTAN MENTAL HEALTH N/A INSTITUTE FOR FAMILY HEALTH N/A START RECOVERY AND TREATMENT CENTERS N/A BHRAGS HOME CARE CORP N/A ABC HEALTH REGISTRY INC N/A BEST CARE INC DBA ALL CITY CARE N/A ALL METRO HEALTH CARE N/A BESTCARE INC N/A ALLIANCE FOR HEALTH INC N/A PERSONAL TOUCH HOME CARE OF NY INC N/A PEOPLE CARE INCORPORATED N/A PREMIER HOME HEALTHCARE SERVICES INC N/A SPECIAL TOUCH HOME CARE SERVICES INC N/A UNLIMITED CARE INC N/A BRONX COMM HCI N/A AREBA CASRIEL INC N/A STELLA ORTON HOME CARE AGENCY INC N/A RELIANCE HOME SENIOR SERVICES (NYC) N/A RELIANCE HOME SENIOR SERVICES (NASSAU) N/A PREMIER - PRIVATE PAY N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1