2018-06-07T14:49:02-05:00 2017-09-30 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2016-10-01 221458594 UFCW NATIONAL HEALTH AND WELFARE FUND UFCW 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 GEORGE J ORLANDO TRUSTEE 2015698801 2018-06-07 1 Louis Verzella CPA P00360279 6106689400 2018-05-22 2016 2022-09-23 18:48:47Z GEORGE J ORLANDO 66 GRAND AVENUE ENGLEWOOD NJ 07631 141899357 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 27 0 0 0 0 0 104374859 115522572 972116 2011158 0 0 105346975 117533730 0 0 94689950 106684136 2758928 2925387 0 0 0 1840052 1814895 99288930 111424418 6058045 6109312 74239882 80644923 0 15388 74239882 80629535 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 0 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 7 0 27 1 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 BRIAN FITZSIMMONS TRUSTEE 2.00 X 0 0 0 CHARLES RADER TRUSTEE 2.00 X 0 0 0 MAURICE HODOS ADMINISTRATOR 40.00 X 196452 0 28713 196452 0 28713 1 0 1 0 HORIZON BLUE CROSS BLUE SHIELD 3 Penn Plaza East PP-04K NEWARK NJ 07105 CLAIMS ADMINISTRATION 2347540 CONIFER VALUE BASED CARE LLC 15821 VENTURA BLVD STE 600 ENCINO CA 91436 COST CONTAINMENT 457262 THE SEGAL COMPANY 333 West 34th Street NEW YORK NY 10001 CONSULTING/ACTUARIAL FEES 291940 Express Scripts N19 W24130 Riverwood Drive Waukesha WI 53188 CLAIMS ADMINISTRATION 242845 HEALTHSMART CARE MGMT SOLUTION 222 WEST LAS COLINAS BOULEVARD STE IRVING TX 75039 HEALTH CARE MANAGEMENT 199946 9 EMPLOYER CONTRIBUTIONS 525100 114948812 114948812 PARTICIPANT AND RETIREE CONTRIBUT 525100 424417 424417 MEDICARE PART D REIMB. 525100 149343 149343 115522572 1097384 1097384 25279401 24365627 913774 913774 913774 117533730 115522572 0 2011158 106684136 1574829 692016 527838 130704 152399 102555 256591 445118 361015 140337 223208 65235 7411 41492 tEMPORARY STAFF AGENCY 19534 111424418 1721382 24309302 28200582 3025816 906625 837648 35921 68977 42985163 51809009 1296834 1431819 74239882 80644923 15388 0 15388 X 0 0 0 0 74239882 80629535 74239882 80629535 74239882 80644923 X 6109312 3518997 -3238656 X X 0 1 X 1 0 906625 837648 68977 68977 X 120039713 3518997 3518997 116520716 260992 752022 1013014 117533730 110685249 -478177 -478177 111163426 260992 260992 111424418 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 XI, Line 4b - Other Adjustments: CHANGE IN RECEIVABLES 752,022. Part XII, Line 2d - Other Adjustments: CHANGE IN PAYABLES -478,177. X 0 0 0 MAURICE HODOS ADMINISTRATOR 196452 0 0 0 0 0 13340 0 15373 0 225165 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 VII Contact Addresses for Officers, Directors, Etc GEORGE J. ORLANDO - 219 PATERSON AVENUE, LITTLE FALLS, NJ 07424. Tom R. Ballard - 206 EDGEWOOD DRIVE, BARDSTOWN, KY 40004. FRANK J. RUNEY - 55 NORFOLK AVE., S. EASTON, MA 02375. GERALDINE SENACK - 556 BOCA CIEGA POINT BLVD. SOUTH, MADEIRA BEACH, FL 33708. MICHELLE LEWIS - E & J GALLO WINERY, P.O. BOX 1130, MODESTO, CA 95353. JOHN PEPE - 28 DANIEL ROAD, MASSAPEQUA, NY 11758. BRIAN FITZSIMMONS - P.O. BOX 600, SHAW'S SUPERMARKETS INC, e BRIDGEWATER, MA 02333. CHARLES RADER - 1775 K STREET N.W., WASHINGTON, DC 20006. Form 990, Part XI, line 9: adjustment of cost basis of investments -3,238,656. FORM 990, PART XIi, LINE 1: UFCW NATIONAL HEALTH AND WELFARE FUND'S FORM 990 IS PREPARED USING THE MODIFIED CASH BASIS OF ACCOUNTING. 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 2D 8402 18TH AVENUE BROOKLYN NY 11214 131471825 LABOR UNION MO 501(c)(5) 0 UFCW LOCAL UNION 186 329 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 Ardagh Metal Packaging Aristech Surfaces Atlantic CoffeeMaximus Coffee Group Black Prince Distillery Inc Bronco Winery Buffalo Trace Distillery Canandaigua Wine CompanyAlmaden Charles Krug CSL Behring CWC Contracting Corporation Delano Growers Cooperative Winery Diageo PLC E&J Gallo Winery Evant Inc Fountain Industries Company Franzia Brothers Winery Franzia Sanger Winery G-3 Enterprises-Closure Division GAC Chemical Corporation Gallo Wine Sales of NJ Inc Gibson Wine Company Giumarra Vineyards Corp Gleason Industiral Products Inc Glendive Bn Fed Credit Union Glenmore DistilleriesSazerac Company Golden State Vinters Inc Heritage Thermal Service Huhtamaki Inc Jacob Stern Jim Beam Brands Company John Jones Services LLC Cantu Services Inc Justin Tanks Mountaneer Park Inc Natural RX UFCW Local 99 Patrick Metals Pernod Ricard Priority One Services Rich's Food Town Inc Riedell Shoes Roscommon County Transit Authority SB Foot Tanning Company Sebastiani VineyardsFoley Family Vineyards Shaws Silgan Can Company SKYY Spirits dba Campari America Smith's Food & Drug Center South Coast Safe Access Southern Wine & Spirits Sunmaid Growers of California Texas Gulf Coast Area Labor The Sun Products Corporation Treasury Wine Estates Union Club Bar Inc United Distribution Products Inc Ventura Foods Inc Vie-Del Co Viscofan USA Inc Vivendi WH Bagshaw Company Inc 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1