2025-08-15T08:48:37-05:00 2024-12-31 131577780 SCHULTHEIS & PANETTIERI LLP 450 WIRELESS BLVD HAUPPAUGE NY 11788 990 2024-01-01 132832806 UFCW LOCAL 2013 HEALTH AND WELFARE FUND UFCW 7187453487 9235 4TH AVENUE BROOKLYN NY 11209 LOUIS MARK CAROTENUTO PRESIDENT 7187453487 2025-08-15 1 1 CAROL WESTFALL P00539069 6312734778 2024 2025-03-06 01:10:19Z 9235 4TH AVENUE BROOKLYN NY 11209 51741435 0 X N/A X 1975 NY THE PURPOSE OF THE PLAN IS TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 2 2 0 0 0 0 0 0 38654193 48792256 1993567 2949179 0 0 40647760 51741435 0 0 26698046 46220716 0 0 0 0 0 2174429 2218906 28872475 48439622 11775285 3301813 74843760 80888877 3388641 6179088 71455119 74709789 THE PURPOSE OF THE PLAN IS TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 THE PURPOSE OF THE PLAN IS TO PROVIDE HEALTH AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 45 0 1 0 0 0 0 0 0 0 0 0 X 2 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X LOUIS M CAROTENUTO 7187453487 9235 4TH AVENUE BROOKLYN NY 11209 X LOUIS M CAROTENUTO UNION TRUSTEE 1.00 X 0 0 0 STANLEY FLEISHMAN EMPLOYER TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 EMPIRE HEALTHCHOICE ASSURANCE INC PO BOX 951254 CLEVELAND OH 44193 MEDICAL MGT & FEES 4440749 TRI-STATE ADMINISTRATORS INC 27 ROLAND AVESTE 200 MT LAUREL NJ 08054 THIRD PARTY ADMIN. 1166560 UHS PREMIUM BILLING PO BOX 94017 PALATINE IL 60094 DENTAL ADMIN. 402244 EXPRESS SCRIPTS 21653 NETWORK PLACE CHICAGO IL 606731216 PRESCRIPTION ADMIN. 179639 O'BRIENBELLANO & BUSHINSKY LLC 509 SLENOLA RD BLDG 6 MOORESTOWN NJ 08057 LEGAL FEES 123184 7 EMPLOYERS CONTRIBUTIONS 722300 47091006 47091006 PARTICIPANTS CONTRIBUTION 722300 1701250 1701250 48792256 2949179 2949179 51741435 48792256 0 2949179 46220716 148937 111475 20000 95589 348906 172314 206955 12765 THIRD PARTY ADMIN 1134056 NET REIMBURSED EXPENSES -32091 48439622 2847021 986848 50505643 54155189 6105340 9602656 182653 182653 0 0 15385756 16028184 116000 74843760 80888877 132641 95088 3256000 6084000 3388641 6179088 X 0 0 0 0 71455119 74709789 71455119 74709789 74843760 80888877 3301813 -47143 0 X 0 1 X 1 0 182653 182653 0 0 BENEFITS CURRENTLY PAYABLE 6084000 6084000 51674292 -47143 -47143 51721435 20000 20000 51741435 45591622 0 45591622 20000 2828000 2848000 48439622 PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFITS CURRENTLY PAYABLE 2,828,000. FORM 990, PART VI, SECTION A, LINE 3 THE UFCW LOCAL 2013 HEALTH AND WELFARE FUND RETAINS TRI-STATE ADMINISTRATORS, INC. TO ADMINISTER THE PLAN IN ACCORDANCE WITH THE GOVERNING PLAN DOCUMENTS, THE PROVISIONS OF ERISA, THE INTERNAL REVENUE CODE, AND OTHER APPLICABLE LAWS. SERVICES PERFORMED INCLUDE BUT ARE NOT LIMITED TO, ACCOUNTING AND FINANCIAL REPORTING, REQUIRED COMMUNICATIONS, CLAIMS PROCESSING AND RELATED SERVICES, VENDOR MANAGEMENT, AND TRUSTEE RELATED SERVICES. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED IN COORDINATION WITH THE FUND ADMINISTRATOR AND WAS REVIEWED WITH THE ORGANIZATION'S BOARD OF TRUSTEES PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE OR INTERESTED PERSON IS REQUIRED TO DISCLOSE ANNUALLY THEIR UNDERSTANDING AND COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT PAY COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO ALL PARTICIPANTS UPON REQUEST. NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. UFCW LOCAL 2013 PENSION FUND 9235 4TH AVENUE BROOKLYN NY 11209 131975910 PROVIDE RETIREMENT BENEFITS TO PARTICIPA NY 501(A) N/A N/A 0 UFCW LOCAL 2013 ANNUITY FUND 9235 4TH AVENUE BROOKLYN NY 11209 112457157 PROVIDE RETIREMENT BENEFITS TO PARTICIPA NY 501(A) N/A N/A 0 UFCW LCL 2013 REALTY HOLDING CORP 9235 4TH AVENUE BROOKLYN NY 11209 010784004 TO HOLD TITLE TO REAL PROPERTY NY 501(C)2 N/A N/A 0 UFCW LOCAL 2013 9235 4TH AVENUE BROOKLYN NY 11209 131995772 LABOR UNION NY 501(C)5 N/A N/A 0 SEE SUPPLEMENTAL R INFORMATION 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 FORM 990, SCHEDULE R, PART II AND IV CERTAIN TRUSTEES LISTED ON PART VII, SECTION A, SERVE AS VOLUNTEERS AND DO NOT RECEIVE COMPENSATION FROM THIS ORGANIZATION OR ANY RELATED ORGANIZATION IN CAPACITY AS TRUSTEES OF THIS ORGANIZATION. CERTAIN TRUSTEES LISTED ON PART VII, SECTION A, DO NOT RECEIVE COMPENSATION FROM THIS ORGANIZATION, BUT DO RECEIVE COMPENSATION FROM RELATED ORGANIZATIONS IN THEIR CAPACITY AS EMPLOYEES/OFFICERS OF THOSE ORGANIZATIONS. ACCORDINGLY, THEIR COMPENSATION IS REPORTED ON THE FORM 990 OF THOSE RELATED ORGANIZATIONS. THE INFORMATION DISCLOSED IN THE ATTACHED SCHEDULES OF RELATED PARTIES IS THAT WHICH WAS AVAILABLE TO THIS ORGANIZATION AT THE TIME OF THIS FILING. FORM 990, SCHEDULE R, PART IV IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A CORPORATION OR TRUST EMPLOYER NAME 108TH ST. OWNERS CORP. 1200 FULLER ROAD WAREHOUSE 134-54 MAPLE AVENUE 37-20 87TH STREET 41-21 CONDOMINIUM 617 APARTMENT CORP 9501 COMPANY LLC ALL AREA 41-15 44 ALLENDALE ASSOCIATION ALLIANCE BLVD ALLIED EXTRUDERS AMBER COURT ASSISTED LIVING AMERICARE, INC. ASHLEY MARKETPLACE BALTER SALES CO. BAYBERRY CARE BELLE HARBOR MANOR BLOSSOM GARDENS BOULEVARD ALP ASSOCIATION BRISAR INDUSTRIES BROADWAY FAMOUS PARTY RENTALS BROOKHAVEN CARE BROOKLYN BLVD ALPS CARE ONE AT THE HILL CARMIL INC. CHELSEA WINDOW CORTLAND TRUCKING COUNTY AGENCY/J&JCREAM CRESTVIEW MANOR HOME CRYSTORAMA, INC. CUMBERLAND PACKING DANA POLY INC. DO & CO NY CATERING FORHILLS OWNERS CO FRESH DIRECT G.S.N. TRUCKING GARDEN HEIGHTS P.M GRAND MANOR HARBOR VIEW ASSISTED LIVING HEDGEWOOD HOME FOR ADULTS INNOVANT INC. JAC TOWERS APTS., JFC INTERNATIONAL JORDACHE ENT., INC KATZ'S DELICATESSE KENT-VICTORIA ASSOCIATION KING STREET NURSIN KLM INSULATION INC KNF FLEX PAK LAZ PARKING LIGHTSPEED TELECOM LOVETT MANAGEMENT M. TUCKER CO., INC MADISON YORK ASSISTED LIVING MASPETH 5718 ASSOCIATION MASTERTECH FLOORS MAXIMUM QUALITY FOODS MERMAID MANOR HOME MILMAR FOOD GROUP MIVILA FOODS MOUNTAINVIEW HOME MZL HOME CARE NEW HAVEN MANOR HOME NORCOR OCEANVIEW MANOR ORLANDI, INC. OXFORD 41-41 OWNERS CORP. PACOA PARK IT- ABLE FIRE PARKVIEW HOME FOR ADULTS PARLUX HOLDINGS, INC PENZIM PRODUCE PFEIL & HOLING, INC PINNACLE DIETARY PLASTIFORM PACKAGING PLEXI CRAFT QUALITY PRITCHARD INDUSTRIES QACC ALP HOMECARE QUALITY KING QUEENS ADULT CARE RAYLEIGH HOUSE INC. RESTAURANT DEPOT RICK'S TRAILER REPAIR SABRE DIE CUTTING SAM TELL AND SON SANFORD HOME FOR ADULTS SAUNDERS APT. INC. SEA JET TRUCKING SEAVIEW MANOR HFA SERVCO INDUSTRIES SODEXO, INC. SP PLUS CORP. STAFF PRO/ GUMA CO STANDARD FIRE SUPP SURFSIDE MANOR HOME T & E STORES THE BOULEVARD TOWERS THE ELLIOT PEARL HOME THE PALM BEACH HEA THE REGENCY AT GLEN COVE THE W ASSISTED LIVING THE W GROUP AT NEW TMI PLASTICS TRI-B INDUSTRIES UNITED WINDOW & CO VALERIE ARMS APTS. WATERFORD ON THE BAY WELCOME PARK WELL LUCK COMPANY WINDSOR COURT ASSOCIATION YESHIVA DARCHEI TORAH