2017-06-06T14:21:53-05:00 2016-10-31 350921680 CROWE HORWATH LLP 175 POWDER FOREST DR SIMSBURY CT 06089 990 2015-11-01 222507311 UFCW LOCAL 1459 & CONTRIBUTING EMPLOYERS HEALTH & WELFARE FUND UNIT 4137331197 33 EASTLAND STREET SPRINGFIELD MA 011092348 DANIEL P CLIFFORD TRUSTEE 4137331197 2017-06-06 1 Richard Buggy P00512316 8606789200 2015 2021-01-29 14:40:06Z DANIEL P CLIFFORD 33 EASTLAND STREET SPRINGFIELD MA 011092348 11861662 0 X N/A X 1983 MA PROVIDING ELIGIBLE PARTICIPANTS WITH VARIOUS HEALTH AND WELFARE BENEFITS. 4 4 0 0 0 0 0 0 4978752 4612159 138256 72567 0 0 5117008 4684726 0 0 4652866 5573878 0 0 0 0 0 966776 875739 5619642 6449617 -502634 -1764891 7163805 5677753 940284 1131539 6223521 4546214 PROVIDING ELIGIBLE PARTICIPANTS WITH VARIOUS EMPLOYEE WELFARE BENEFITS, INCLUDING HEALTH, HOSPITALIZATION, PRESCRIPTION, DISABILITY AND LIFE. 0 0 6269993 4612159 TO OBTAIN AND ADMINISTER THE HEALTH AND WELFARE PROGRAM FOR ALL ELIGIBLE PARTICIPANTS. 6269993 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 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 0 0 0 0 0 0 0 0 0 X 4 4 1 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X ZENITH AMERICAN SOLUTIONS 4137331197 33 EASTLAND STREET SPRINGFIELD MA 01109 X JOEL A BOONE SECRETARY/TRUSTEE 2.00 X X 0 0 0 DANIEL P CLIFFORD CHAIRMAN/TRUSTEE 2.00 X X 0 0 0 SUSAN SANVILLE TRUSTEE 2.00 X 0 0 0 TYRONE HOUSEY TRUSTEE 2.00 X 0 0 0 GENEROSO DEL ROSARIO ALTERNATE TRUSTEE 2.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 33 EASTLAND STREET SPRINGFIELD CT 01109 THIRD PARTY CONTRACT ADMINISTRATOR 425302 CONNECTICUT GENERAL LIFE INSURANCE COTTAGE GROVE ROAD BLOOMFIELD CT 06002 ASO CONTRACT ADMINISTRATOR 165957 2 EMPLOYER CONTRIBUTIONS 525100 4438783 4438783 EMPLOYEE CONTRIBUTIONS 525100 173376 173376 4612159 110728 110728 7138775 7176936 -38161 -38161 -38161 4684726 4612159 0 72567 5573878 5573878 50428 50428 14250 14250 26762 26762 233957 165957 68000 -20096 -20096 5000 5000 9619 9619 16315 16315 CONTRACT ADMINISTRATOR 425302 425302 MASS. UNCOMPENSATED CAR 46682 46682 WELLNESS PROGRAM 32443 32443 TRANSITIONAL REINSURANC 25731 25731 9346 9346 6449617 6269993 179624 0 508475 630536 19051 5444 23338 39070 6612941 4863191 0 139512 7163805 5677753 156994 152373 783290 979166 940284 1131539 X 6223521 4546214 0 0 0 0 6223521 4546214 7163805 5677753 -1764891 87584 0 X X 0 1 X 1 0 0 Common Stock 828184 F MUTUAL FUNDS 1140002 F FOREIGN AND CORPORATE BONDS 127224 F U.S. GOVERNMENT SECURITIES 2767781 F 4863191 HEALTH CLAIMS PAYABLE 65266 ESTIMATED CLAIMS INCURRED BUT NOT REPORTED 913900 979166 X 4772310 87584 87584 4684726 0 4684726 6449617 0 6449617 0 6449617 Part X, Line 2: GAAP requires management to evaluate uncertain tax positions taken by the Plan. The financial statement effects of a tax position are recognized when the position is more likely than not, based on the technical merits, to be sustained upon examination by the IRS. The plan administrator has analyzed the tax positions taken by the Plan and has concluded that as of October 31, 2016 and 2015, there are no uncertain positions taken or expected to be taken. The Plan has recognized no interest or penalties related to uncertain tax positions. 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 tax examinations for years prior to 2013. Form 990, Part VI, Section A, line 2 DANIEL CLIFFORD AND TYRONE HOUSEY ARE OFFICERS OF THE UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1459, WHICH IS A SPONSORING ORGANIZATION FOR THE UFCW UNION LOCAL 1459 & CONTRIBUTING EMPLOYERS' HEALTH & WELFARE FUND. Form 990, Part VI, Section A, line 3 THE ORGANIZATION CONTRACTS WITH ZENITH AMERICAN SOLUTIONS, AN INDEPENDENT THIRD PARTY ADMINISTRATOR, TO CONDUCT THE DAY-TO-DAY OPERATIONS OF THE FUND. ZENITH AMERICAN SOLUTIONS IS ENGAGED BY AND REPORTS DIRECTLY TO THE BOARD OF TRUSTEES. Form 990, Part VI, Section A, line 7a AS A SPONSORING ORGANIZATION, THE UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1459 HAS THE AUTHORITY TO APPOINT TWO TRUSTEES AND ONE OR MORE ALTERNATE TRUSTEES TO THE ORGANIZATION'S BOARD. SIMILARLY, AS A SPONSORING ORGANIZATION AND A PARTICIPATING EMPLOYER, THE STOP & SHOP SUPERMARKET COMPANY HAS THE AUTHORITY TO APPOINT TWO TRUSTEES AND ONE OR MORE ALTERNATE TRUSTEES TO THE ORGANIZATION'S BOARD. Form 990, Part VI, Section B, line 11 FORM 990 IS REVIEWED BY THE BOARD AND APPROVED AND ACCEPTED AT THE FIRST BOARD MEETING SUBSEQUENT TO THE PREPARATION AND FILING OF THE RETURN. Form 990, Part VI, Section B, line 12c THE BOARD REQUIRES ALL TRUSTEES TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY. ANY POTENTIAL CONFLICTS OF INTEREST ARE BROUGHT TO THE BOARD FOR DISCUSSION AND RESOLUTION. Form 990, Part VI, Section B, line 15 DAY-TO-DAY MANAGEMENT OF THE FUND IS CONTRACTED TO ZENITH AMERICAN SOLUTIONS, 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 C, line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, TAX RETURNS AND AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE BENEFITS OFFICE. FORM 990, PART XII, LINE 2C: THE BOARD OF TRUSTEES IS RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT AND IS RESPONSIBLE FOR THE OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT PROCESS. THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR IN HOW THESE RESPONSIBILITIES ARE ADMINISTERED. UFCW LOCAL 1459 AND CONTRIBUTING EMPLOYERS LEGAL BENEFIT FUND 33 EASTLAND STREET SPRINGFIELD MA 01109 222507618 MULTIEMPLOYER LEGAL BENEFIT FUND MA 501(c)(9) N/A 0 UFCW LOCAL 1459 EDUCATION SAFETY & INDUSTRY TRUST FUND 33 EASTLAND STREET SPRINGFIELD MA 01109 522331090 MULTIEMPLOYER EDUCATION & SAFETY FUND MA 501(c)(9) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 UFCW UNION 1459 EDUCATION SAFETY AND INDUSTRY TRUST FUND N COST UFCW UNION 1459 & CONTRIBUTING EMPLOYERS LEGAL BENEFIT FUND N COST (SEE PART VII FOR ADDITIONAL DISCLOSURE) FORM 990, SCHEDULE R, PART V THE ORGANIZATION SHARES OFFICE SPACE WITH TWO RELATED BUT INDEPENDENT MULTIEMPLOYER BENEFIT FUNDS, AND UTILIZES THE SAME THIRD PARTY ADMINISTRATOR. EACH ORGANIZATION IS CHARGED FOR AND PAYS ALL OF ITS OWN COSTS.