2018-08-14T16:16:35-05:00 2017-09-30 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2016-10-01 226137317 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1262 EMPLOYERS WELFARE FUND UNIT 9737785800 1389 BROAD ST CLIFTON NJ 07013 Harvey whille TRUSTEE 9737785800 2018-08-14 1 Louis Verzella CPA P00360279 6106689400 2018-08-09 2016 2022-09-23 18:48:47Z Harvey whille 1389 BROAD ST CLIFTON NJ 07013 296618155 0 X N/A X 1969 NJ TO PROVIDE HOSPITAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 6 3 0 0 0 0 0 0 76317981 72605683 1426872 917632 0 0 77744853 73523315 0 0 71196204 75368095 864409 910782 0 0 0 1482336 989469 73542949 77268346 4201904 -3745031 32815458 29422305 2181463 1769836 30633995 27652469 TO PROVIDE HOSPITAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HOSPITAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTSAND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 1 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 5 0 0 0 0 0 0 0 0 0 0 X 6 3 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X MATTHEW MOLINARO 9737785800 1389 BROAD STREET CLIFTON NJ 07013 PATRICK DURNING EMPLOYER TRUSTEE 5.00 X 0 0 0 DEWEY CANELLA EMPLOYER TRUSTEE 5.00 X 0 0 0 MICHAEL DEMARTINO UNION TRUSTEE 5.00 40.00 X 0 205274 20183 MATTHEW MOLINARO P UNION TRUSTEE 5.00 40.00 X 0 304989 20183 HARVEY WHILLE CHAIRMAN, UNION TRUSTEE 5.00 40.00 X 0 357458 20183 Thomas Whille UnION TRUSTEE 5.00 40.00 X 0 142249 20183 Mark Iwankiw EmplOYER TRUSTEE 5.00 X 0 0 0 0 1009970 80732 0 0 1 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATOR 3099639 HORIZON HEALTHCARE DENTAL SERVICES PO BOX 1938 NEWARK NJ 07101 CLAIMS ADMINISTRATOR 291801 EXPRESS SCRIPTS 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 CLAIMS ADMINISTRATOR 289991 FRANK M VACCARO & ASSOCIATES INC 27 ROLAND AVE SUITE 200 MOUNT LAUREL NJ 08054 THIRD-PARTY ADMINISTRATOR 238046 SLEVIN & HART PC 1625 MASSACHUSETTS AVE NW SU WASHINGTON DC 20036 LEGAL COUNSEL 130044 5 EMPLOYER 900099 70581534 70581534 RETIREE 900099 821308 821308 LEGAL 900099 705659 705659 COBRA 900099 497182 497182 72605683 399384 399384 223613088 223094840 518248 518248 518248 73523315 72605683 0 917632 75368095 650031 42209 163291 55251 238046 130044 59901 6855 105987 157706 158017 46774 3789 1625 47329 FEES MANDATED BY THE AF 33396 77268346 20607 18221 1332424 1230170 4942683 5083338 41985 31328 180866 177664 4566 3202 18666896 18957841 7806297 4098205 32815458 29422305 1003415 1043202 1178048 726634 2181463 1769836 X 0 0 0 0 30633995 27652469 30633995 27652469 32815458 29422305 X -3745031 848584 -85079 X X 0 1 X 1 0 4867 4867 0 122482 119610 2872 53517 53187 330 3202 REBATES AND SETTLEMENTS 2860579 Deposits 1237626 4098205 DUE TO RELATED PARTIES 221878 SERP LIABILITY 59960 ASSETS TRANSFER PAYABLE 444796 726634 X 74365044 848584 848584 73516460 6855 6855 73523315 77261491 0 77261491 6855 6855 77268346 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. 0 0 0 MICHAEL DEMARTINO UNION TRUSTEE 0 205274 0 0 0 0 0 4151 0 16032 0 225457 0 0 MATTHEW MOLINARO P UNION TRUSTEE 0 304989 0 0 0 0 0 4151 0 16032 0 325172 0 0 HARVEY WHILLE CHAIRMAN, UNION TRUSTEE 0 357458 0 0 0 0 0 4151 0 16032 0 377641 0 0 Thomas Whille UnION TRUSTEE 0 142249 0 0 0 0 0 4151 0 16032 0 162432 0 0 Form 990, Part VI, Section A, line 2 Thomas Whille and Harvey Whille are related family. Form 990, Part VI, Section A, line 8b THE ORGANIZATION HAS NO SUBCOMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11b THE UFCW LOCAL 1262 AND EMPLOYERS WELFARE FUND FORM 990 IS PREPARED BY ITS INDEPENDENT ACCOUNTANT AND IS SUBMITTED AND REVIEWED WITH THE ADMINISTRATOR. THE ADMINISTRATOR THEN REVIEWS IT WITH THE CHAIRPERSON OF THE BOARD OF TRUSTEES FOR THEIR APPROVAL PRIOR TO FILING. A COPY OF THE FORM 990 IS AVAILABLE TO THE EXECUTIVE BOARD MEMBERS UPON REQUEST. Form 990, Part VI, Section C, line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AND MAY BE EXAMINED AT THE ORGANIZATION'S OFFICE. Form 990, Part XI, line 9: Transfer to ufcw Local 1262 and Employers Health Fund -243,611. Transfer from ufcw Local 1262 and Employers Legal Services Fund 158,532. Form 990, Part XII, Line 2c: THE UFCW LOCAL 1262 EMPLOYERS WELFARE FUND'S GOVERNING BODY IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT. UFCW LOCAL 1262 & EMPLOYERS PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226074414 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UFCW LOCAL 1262 & EMPLOYERS LEGAL SERVICES FUND 1389 BROAD STREET CLIFTON NJ 07013 222238707 TO PROVIDE LEGAL BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UFCW LOCAL 1262 & EMPLOYERS HEALTH & WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 237042767 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UFCW LOCAL 1262 1389 BROAD STREET CLIFTON NJ 07013 221339607 REPRESENTS MEMBERS IN COLLECTIVE BARGAINING MATTERS WITH EMPLOYERS NJ 501(c)(5) 0 UFCW LOCAL 1262 & EMPLOYERS RETAIL NON-FOOD PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226181292 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UFCW LOCAL 1262 PATHMARK HEALTH & WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 371664252 TO PROVIDE HEALTH, MEDICAL & OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UFCW LOCAL 1262 & EMPLOYERS HEALTH FUND 1389 BROAD STREET CLIFTON NJ 07013 463496310 TO PROVIDE HEALTH, MEDICAL & OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 WAKEFERN CORPORATION 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 1 UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND P 481489 FMV UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND O 747491 FMV UFCW LOCAL 1262 K 46773 FMV UFCW LOCAL 1262 P 115697 FMV UFCW LOCAL 1262 AND EMPLOYERS HEALTH AND WELFARE FUND O 163259 FMV ufcw LOCAL 1262 and EMPLOYERS HEALTH FUND R 243611 fmv ufce local 1262 and employers legal services fund S 158532 fmv