2019-03-15T12:02:22-05:00 2018-04-30 350921680 CROWE LLP 175 POWDER FOREST DR SIMSBURY CT 06089 990 2017-05-01 042433313 UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH & WELFARE FUND UNIT 4014354700 40 COMMERCIAL WAY EAST PROVIDENCE RI 02914 RICHARD CHARETTE CHAIRMAN 4014354700 2019-03-14 1 KRISTIN ANDERSON P01231300 8606789200 108.209.250.21 2019-03-14 17:40:17 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FAAA596840D4CBEF9F157A88F2FFA508ED035AC3 2017 2019-02-21 02:37:17Z 40 COMMERCIAL WAY EAST PROVIDENCE RI 02914 77239311 0 X N/A X 1967 RI TO PROVIDE MEDICAL, DENTAL, LIFE, ACCIDENT AND SICK BENEFITS TO ELIGIBLE PARTCIPANTS. 6 1 0 0 0 0 0 0 58578337 69924175 338095 441396 0 0 58916432 70365571 0 0 59781290 60661284 0 0 0 0 0 5738470 5303605 65519760 65964889 -6603328 4400682 38168953 42419320 5978822 5947992 32190131 36471328 TO PROVIDE MEDICAL, DENTAL, LIFE, ACCIDENT AND SICK BENEFITS TO ELIGIBLE PARTCIPANTS. 0 0 65617795 0 69924175 TO OBTAIN AND ADMINISTER THE HEALTH AND WELFARE PROGRAM FOR ALL ELIGIBLE PARTICIPANTS. 65617795 0 0 0 0 0 0 0 0 0 0 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 2 0 0 0 0 0 0 0 0 0 0 0 0 X 6 1 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X SARA COTE CO LONDON HEALTH ADMINISTRATORS 4014354700 40 COMMERCIAL WAY EAST PROVIDENCE RI 02914 CHRISTINE NICKERSON ALTERNATE TRUSTEE 2.00 X 0 0 0 CYNDIE ESTEVAO ALTERNATE TRUSTEE 2.00 X 0 0 0 DOMENIC PONTARELLI ALTERNATE TRUSTEE 2.00 X 0 0 0 GENE DEL ROSARIO ALTERNATE TRUSTEE 2.00 X 0 0 0 JAMES RONAYNE TRUSTEE 2.00 X 148400 0 13892 JASON PARADIS TRUSTEE 2.00 X 0 0 0 JEFF BOLLEN TRUSTEE 2.00 X 159000 0 13892 JOEL BOONE TRUSTEE 2.00 X 0 0 0 SUSAN SANVILLE TRUSTEE 2.00 X 0 0 0 TIMOTHY MELIA TRUSTEE 2.00 X 179814 0 28439 TOM BROWN ALTERNATE TRUSTEE 2.00 X 0 0 0 RICHARD CHARETTE CHAIRMAN/PROFESSIONAL TRUS 10.00 X 12000 0 0 499214 0 56223 3 0 1 0 LONDON HEALTH ADMINISTRATORS 40 COMMERCIAL WAY EAST PROVIDENCE RI 02914 CONTRACT ADMINISTRATOR 2025842 THE SEGAL COMPANY 30 WATERSIDE DRIVE SUITE 300 FARMINGTON CT 06032 ACTUARIAL CONSULTANTS 116184 2 EMPLOYER CONTRIBUTIONS 525100 64143823 64143823 EMPLOYEE CONTRIBUTIONS 525100 5780352 5780352 69924175 353040 353040 6962096 6873740 88356 88356 88356 70365571 69924175 0 441396 60661284 60661284 2025842 2025842 32579 32579 30650 30650 66758 66758 2907240 2907240 176665 176665 17687 17687 22755 22755 PCORI FEE 23429 23429 65964889 65617795 347094 0 14521809 19783459 6049031 6940810 1120253 739901 14692947 14002437 1784913 952713 38168953 42419320 248814 108683 5730008 5839309 5978822 5947992 X 0 0 0 0 32190131 36471328 32190131 36471328 38168953 42419320 4400682 -119485 0 X 0 1 X 1 0 0 CLAIMS PAYABLE AND CLAIMS INCURRED BUT NOT REPORTED 5572221 INSURANCE PREMIUMS PAYABLE 267088 5839309 X 70246086 -119485 -119485 70365571 0 70365571 65855588 0 65855588 109301 109301 65964889 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. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF APRIL 30, 2018 AND 2017, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE 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 INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2015. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN AMOUNT CURRENTLY PAYABLE FOR PARTICIPANTS, BENEFICIARIES, DEPENDEN 109,301. 0 0 0 JAMES RONAYNE TRUSTEE 145600 0 2800 0 0 0 2252 0 11640 0 162292 0 0 0 JEFF BOLLEN TRUSTEE 156000 0 3000 0 0 0 2252 0 11640 0 172892 0 0 0 TIMOTHY MELIA TRUSTEE 167512 0 0 0 12302 0 16252 0 12187 0 208253 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 DAY-TO-DAY MANAGEMENT OF THE FUND IS CONTRACTED TO LONDON HEALTH ADMINISTRATORS, A THIRD PARTY CONTRACT ADMINISTRATOR. CONTRACTUAL TERMS AND CONDITIONS ARE EVALUATED AND NEGOTIATED BY THE BOARD ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION A, LINE 7A THE UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 328 AND LOCAL 1445, AS SPONSORING ORGANIZATIONS, HAVE THE AUTHORITY TO APPOINT THREE TRUSTEES AND ONE OR MORE ALTERNATE TRUSTEES TO THE ORGANIZATION'S BOARD. SIMILARLY, THE STOP & SHOP SUPERMARKET COMPANY, AS A SPONSORING ORGANIZATION AND A PARTICIPATING EMPLOYER, CAN, ON ITS BEHALF AND ON BEHALF OF OTHER CONTRIBUTING EMPLOYERS, APPOINT THREE TRUSTEES AND ONE OR MORE ALTERNATE TRUSTEES TO THE ORGANIZATION'S BOARD. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990 IS PROVIDED ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, TRUSTESS, FUND EMPLOYEES AND OTHER INTERESTED PERSONS MUST DISCLOSE THE EXISTENCE OF A FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OF TRUSTEES AND COMMITTEES WITH BOARD OF TRUSTEES' DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER SUCH DISCLOSURE, AND AFTER DISCUSSION WITH THE INTERESTED PERSON, THE BOARD OF TRUSTEES SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE CHAIRPERSON OF THE BOARD OF TRUSTEES SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. IF THE BOARD OF TRUSTEES HAS REASONABLE CAUSE TO BELIEVE A PERSON HAS FAILED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, IT SHALL AFFORD THE PERSON THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE, AND IF WARRANTED, TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. THE MINUTES OF THE BOARD OF TRUSTEES SHALL REFLECT ANY DISCLOSABLE OR DISCOVERED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST, AS WELL AS ACTIONS TAKEN REGARDING SUCH MATTERS. FORM 990, PART VI, SECTION C, LINE 19 THE FUND PROVIDES TO EACH OF ITS PARTICIPANTS ON AN ANNUAL BASIS, A SUMMARY OF THE FUND'S FINANCIAL STATUS, AND MAKES AVAILABLE, UPON REQUEST, ANY OTHER GOVERNING DOCUMENTS OR POLICIES AS REQUIRED BY ERISA AND THE INTERNAL REVENUE SERVICE. UFCW LOCAL UNION NO 1445 30 STERGIS WAY DEDHAM MA 02026 041768085 LABOR UNION MA 501(C)(5) NO 0 UFCW LOCAL UNION NO 328 278 SILVER SPRING STREET PROVIDENCE RI 02904 050227658 LABOR UNION RI 501(C)(5) NO 0 STOP AND SHOP COMPANIES INC WEETABIX GORTON'S SEAFOOD BAKER COMMODITIES INC TOPS MARKET BOSTON GARDEN ROBBINS BEEF COMPANY INC CITY PACKING 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0