2017-11-01T14:58:10-05:00 2016-12-31 510545975 PETER DECARLO CPA PLLC 112 WEST 34TH STREET 18TH FLOOR NEW YORK NY 10120 990 2016-01-01 160915820 UFCW LOCAL ONE HEALTH CARE FUND UFCW 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 3157979600 2017-11-01 1 PETER DECARLO CPA P00851470 2129464907 X 24.103.29.42 2017-11-01 15:52:23 ED P 2A7B8503737EFCA5C3BAB3589E044EABD2BAC681 2A7B8503737EFCA5C3BAB3589E044EABD2BAC681 2016 2021-01-29 14:40:06Z FRANK C DERISO 5911 AIRPORT ROAD ORISKANY NY 13424 92867924 0 X WWW.UFCWONE.ORG X 1959 NY PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 10 0 26 0 0 0 0 0 71960326 71217799 704570 150275 0 1144189 72664896 72512263 0 0 79933879 78533549 1360967 1262235 0 0 0 2272817 1783952 83567663 81579736 -10902767 -9067473 29604973 20701792 232415 140853 29372558 20560939 THE OBJECTIVE OF THE FUND IS TO PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, WHO ARE MEMBERS OF UFCW DISTRICT UNION LOCAL ONE, AND THEIR COVERED DEPENDENTS. 0 0 THE PLAN PROVIDED CERTAIN HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 12,110 ELIGIBLE PARTICIPANTS AND THEIR COVERED DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 1 26 1 0 0 0 0 0 0 X 10 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 X MICHAEL CIANCAGLINI 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 1.00 49.00 X 0 293783 35748 ERIC A GLATHAR TRUSTEE 1.00 49.00 X 0 191159 29699 GREGORY P GOREA TRUSTEE 1.00 49.00 X 0 176140 29367 ROBERT CIANCAGLINI TRUSTEE 1.00 49.00 X 0 80937 23506 ROGER HEMMITT TRUSTEE 1.00 49.00 X 0 106012 24950 JOHN BARRETT TRUSTEE 1.00 2.00 X 0 0 0 I STEPHEN DAVIS TRUSTEE 1.00 0.00 X 0 0 0 JOSEPH SAHLEN TRUSTEE 1.00 1.00 X 0 0 0 RAYMOND WARDYNSKI TRUSTEE 1.00 0.00 X 0 0 0 KRISTINE WYDRO TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL CIANCAGLINI ADMINISTRATIVE DIRECTOR 22.00 18.00 X 119872 0 33972 ANDREA GOLDBERGER ADMINISTRATIVE DIRECTOR - PAST 22.00 18.00 X 111988 0 28122 231860 848031 205364 2 0 1 0 SLEVIN & HART PC 1625 MASSACHUSETTS AVENUE NW WASHINGTON DC 20036 LEGAL 184739 THE SEGAL COMPANY 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 BENEFITS CONSULTING AND ACTUARIAL 146248 2 EMPLOYER CONTRIBUTIONS 525100 68267622 68267622 PARTICIPANT CONTRIBUTIONS 525100 2950177 2950177 71217799 502672 502672 20003264 20355661 -352397 -352397 -352397 PRESCRIPTION DRUG REBATES 525100 1096133 1096133 PRESCRIPTION DRUG PERFORMANCE CRE 525100 29032 29032 LIQUIDATED DAMAGES 525100 19024 19024 1144189 72512263 72361988 0 150275 78533549 825463 153474 214312 68986 185003 60000 59664 147048 87735 235276 161742 24538 58365 28404 56927 AFFORDABLE CARE ACT TAX 623542 PRINTING & PUBLICATIONS 30106 OPERATIONS EXPENSE 24048 FIELD AUDITS 1554 81579736 11251 731496 3323976 5200597 7296908 7297485 31458 32580 2094970 2030793 44624 64177 17256150 5288057 1640606 2087400 29604973 20701792 172766 140147 59649 706 232415 140853 X 0 0 0 0 29372558 20560939 29372558 20560939 29604973 20701792 -9067473 255854 0 X X 0 1 X 1 0 75381 33352 42029 678059 673334 4725 1341530 1324107 17423 64177 RESERVES HELD BY INSURANCE COMPANY 2087400 2087400 DUE TO BROKER FOR SECURITIES PURCHASED 706 706 72708453 255854 255854 72452599 59664 59664 72512263 81520072 0 81520072 59664 59664 81579736 X 0 0 0 FRANK C DERISO TRUSTEE 0 293783 0 0 0 0 0 12691 0 23057 0 329531 0 0 ERIC A GLATHAR TRUSTEE 0 191159 0 0 0 0 0 9989 0 19710 0 220858 0 0 GREGORY P GOREA TRUSTEE 0 176140 0 0 0 0 0 9870 0 19497 0 205507 0 0 MICHAEL CIANCAGLINI ADMINISTRATIVE DIRECTOR 119872 0 0 0 0 0 12149 0 21823 0 153844 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS CONDUCTED. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURES REQUIRED BY LAW ARE AVAILABLE TO THE PUBLIC AT THE FUND'S OFFICE, UPON REQUEST. FORM 990, PART XII, LINE 2C THE FUND'S BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE DURING THE TAX YEAR IN EITHER THE FUND'S OVERSIGHT OR SELECTION PROCESS. UFCW DISTRICT UNION LOCAL ONE 5911 AIRPORT ROAD ORISKANY NY 13424 150559586 LABOR UNION NY 501(C)(5) 0 UFCW LOCAL ONE PENSION FUND 5911 AIRPORT ROAD ORISKANY NY 13424 166144007 PENSION PLAN NY 501(A) 0 UFCW LOCAL ONE 401(K) SAVINGS PLAN 5911 AIRPORT ROAD ORISKANY NY 13424 166184130 PENSION PLAN NY 501(A) 0 THE LUTHERAN HOMES ADIRONDACK MEDICAL CENTER ST ELIZABETH MEDICAL CENTER EVERGREEN VALLEY NURSING HOME NIAGRA GERIATRIC CENTER STAMFORD HEALTH CARE HERITAGE HEALTH CARE CENTER TOPS MARKETS INC EMPIRE MERCHANTS NORTH ALBANY KRAFT INC DAIRY GROUP GREAT AMERICAN STORES SILGAN CONTAINERS MANUFACTURING CORP SAHLEN PACKING CORP G&L DAVIS MEAT CO HOMETOWN MARKETS LLC THORNES OF WARREN SPECIALTY STEAK EMPIRE MERCHANTS NORTH BUFFALO SHOP RITE CAPITAL DISTRICT CHANATRY'S FRENCH ROAD MARKET ZWEIGLES INC RETAIL MARKETSGIANT EAGLE INC SODEXO INCPAUL SMITH COLLEGE WELCH FOODS INC CARRIER COACH BREEN FAMILY INC FORT'S GROCERY INC SMITH PACKING COMPANY WALTON'S BIG M HOFMANN SAUSAGE CO INC OLD WORLD PROVISION CO INC LR BRASS INC COUDERSPORT JUBILEE SMYD CORP DIVERSE FOOD PRODUCTS LLC VANCHLOR CO FRANK WARDYNSKI & SONS INC TN HARVEY INC PAWLAKS FOOD CENTER FILLMORE JUBILEE GALETON IGA FIBERCELL PACKAGING LLC BIG V CORPSHOP RITE MILWARD ALLOYS INC THE WINE GROUPMOGEN DAVID ELDERWOOD AT LAKE PLACID GATES BIG M CAPITAL DISTRICT AREA LABOR FEDERATION CAMELLIA GENERAL PROVISION CO CENTRAL NEW YORK LABOR AGENCY INDELICATO'S MARKET MUGG PHOTOGRAPHY PENNSYLVANIA AFL-CIO TOWN OF WHITESTOWN 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 UFCW DISTRICT UNION LOCAL ONE P 345868 ALLOCATION UFCW LOCAL ONE PENSION FUND Q 855556 ALLOCATION UFCW LOCAL ONE 401(K) SAVINGS PLAN Q 229317 ALLOCATION UFCW DISTRICT UNION LOCAL ONE S 540205 CONTRACT THE LUTHERAN HOMES S 2093516 CONTRACT ADIRONDACK MEDICAL CENTER S 1210590 CONTRACT ST ELIZABETH MEDICAL CENTER S 1019974 CONTRACT EVERGREEN VALLEY NURSING HOME S 79142 CONTRACT NIAGRA GERIATRIC CENTER S 190363 CONTRACT STAMFORD HEALTH CARE S 591363 CONTRACT HERITAGE HEALTH CARE CENTER S 1040030 CONTRACT TOPS MARKETS INC S 48110198 CONTRACT EMPIRE MERCHANTS NORTH ALBANY S 1904262 CONTRACT KRAFT INC DAIRY GROUP S 1368134 CONTRACT GREAT AMERICAN STORES S 653726 CONTRACT SILGAN CONTAINERS MANUFACTURING CORP S 852957 CONTRACT SAHLEN PACKING CORP S 571778 CONTRACT G&L DAVIS MEAT CO S 943995 CONTRACT HOMETOWN MARKETS LLC S 511306 CONTRACT SPECIALTY STEAK S 417727 CONTRACT EMPIRE MERCHANTS NORTH BUFFALO S 544368 CONTRACT SHOP RITE CAPITAL DISTRICT S 650306 CONTRACT CHANATRY'S FRENCH ROAD MARKET S 287672 CONTRACT ZWEIGLES INC S 226780 CONTRACT RETAIL MARKETSGIANT EAGLE INC S 240974 CONTRACT SODEXOPAUL SMITH COLLEGE S 198776 CONTRACT WELCH FOODS INC S 250234 CONTRACT CARRIER COACH S 208397 CONTRACT BREEN FAMILY INC S 201487 CONTRACT FORT'S GROCERY INC S 218800 CONTRACT SMITH PACKING COMPANY S 188350 CONTRACT WALTON'S BIG M S 156994 CONTRACT HOFMANN SAUSAGE CO INC S 373086 CONTRACT OLD WORLD PROVISION CO INC S 193901 CONTRACT LR BRASS INC S 119116 CONTRACT COUDERSPORT JUBILEE S 168905 CONTRACT SMYD CORP S 150531 CONTRACT DIVERSE FOOD PRODUCTS LLC S 155641 CONTRACT VANCHLOR CO S 182274 CONTRACT FRANK WARDYNSKI & SONS INC S 84015 CONTRACT TN HARVEY INC S 68760 CONTRACT FILLMORE JUBILEE S 68779 CONTRACT GALETON IGA S 62598 CONTRACT FIBERCELL PACKAGING LLC S 312621 CONTRACT BIG V CORPSHOP RITE S 207194 CONTRACT MILWARD ALLOYS INC S 139061 CONTRACT THE WINE GROUPMOGEN DAVID S 318753 CONTRACT ELDERWOOD AT LAKE PLACID S 70222 CONTRACT