2016-08-01T15:13:17-05:00 2015-09-30 464001827 SAXBST LLP 28 WEST 44TH STREET NEW YORK NY 10036 990 2014-10-01 226137317 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1262 EMPLOYERS WELFARE FUND UNIT 9737785800 1389 BROAD STREET CLIFTON NJ 07013 HARVEY WHILLE TRUSTEE 9737785800 2016-08-01 1 DAVID LEE P00178190 2126618640 2014 2016-12-15 16:53:06Z HARVEY WHILLE 1389 BROAD STREET CLIFTON NJ 07013 76334584 0 X N/A X 1969 NJ TO PROVIDE HOSPITAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 14,000 ELIGIBLE PARTICIPANTS. 5 0 0 0 0 0 0 0 74389388 75530241 496640 804338 29 5 74886057 76334584 0 0 72661032 73633189 710930 803739 0 0 0 905165 938064 74277127 75374992 608930 959592 30792790 30659963 4818921 4407984 25973869 26251979 TO PROVIDE HOSPITAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE HOSPITAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 14,000 ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 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 5 0 1 0 0 0 0 0 0 0 0 0 X 5 0 0 1 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X ROBERT GEREMINO CONTROLLER 9737785800 1389 BROAD STREET CLIFTON NJ 07013 PATRICK DURNING TRUSTEE 5.00 X 0 0 0 DEWEY CANELLA TRUSTEE 5.00 X 0 0 0 MICHAEL DEMARTINO TRUSTEE 5.00 40.00 X 0 155185 20873 MATTHEW MOLINARO TRUSTEE 5.00 40.00 X 0 305522 23409 HARVEY WHILLE TRUSTEE 5.00 40.00 X 0 346637 23409 FRANK VACCARO OFFICER 5.00 X 244338 275889 0 244338 1083233 67691 1 0 1 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATION 3163524 HORIZON HEALTHCARE DENTAL SERVICES PO BOX 1938 NEWARK NJ 07101 CLAIMS ADMINISTRATION 279392 FRANK M VACCARO & ASSOCIATES INC 27 ROLAND AVE SUITE 200 MOUNT LAUREL NJ 08054 THIRD-PARTY ADMINISTRATOR 215495 EXPRESS SCRIPTS 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 CLAIMS ADMINISTRATION 127659 SLEVIN & HART 100 PARSONS POND DR FRANKLIN LAKES NJ 07417 CLAIMS ADMINISTRATION 124551 6 EMPLOYER'S CONTRIBUTIONS 900099 73549476 73549476 RETIREE CO-PAY CONTRIBUTIONS 900099 820287 820287 LEGAL CONTRIBUTIONS 900099 675603 675603 COBRA CONTRIBUTIONS 900099 484875 484875 75530241 804338 804338 INTEREST ON DELINQUENT CONTRIBUTI 900099 5 5 5 76334584 75530246 0 804338 73633189 586230 166206 51303 185214 55500 6078 12231 37854 3248 1306 16846 THIRD-PARTY ADMINISTRAT 215495 COMPUTER SERVICES 124822 COMMUNICATION TO PARTIC 97924 ACTUARIAL AND OTHER CON 84715 96831 75374992 X 217468 384868 2577704 1196264 4320734 5842795 12169 15389 179715 173799 1334 5916 22634644 22576105 1028737 638626 30792790 30659963 115351 166663 4703570 4241321 4818921 4407984 X 0 0 0 0 25973869 26251979 25973869 26251979 30792790 30659963 X 959592 -862482 181000 X 0 1 X 0 0 4867 4867 0 169643 163727 5916 5205 5205 0 5916 DUE TO AFFILIATES 233428 SERP LIABILITY 59960 OTHER PAYABLES 770035 ASSET TRANSFER PAYABLE 3177898 4241321 X 75466024 -862482 -862482 76328506 6078 6078 76334584 75368914 0 75368914 6078 6078 75374992 PART X, LINE 2: THE PLAN IS EXEMPT FROM FEDERAL INCOME TAX UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, AND HAS OBTAINED A FAVORABLE DETERMINATION LETTER DATED NOVEMBER 16, 1970, FROM THE INTERNAL REVENUE SERVICE (IRS). THE PLAN HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE PLAN S TRUSTEES AND THE PLAN S COUNSEL BELIEVE THAT THE PLAN IS CURRENTLY DESIGNED AND BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE INTERNAL REVENUE CODE. THE PLAN FILES AN ANNUAL FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, WITH THE IRS. 0 0 0 MICHAEL DEMARTINO TRUSTEE 0 155185 0 0 0 0 0 6229 0 14644 0 176058 0 0 MATTHEW MOLINARO TRUSTEE 0 305522 0 0 0 0 0 8765 0 14644 0 328931 0 0 HARVEY WHILLE TRUSTEE 0 346637 0 0 0 0 0 8765 0 14644 0 370046 0 0 FRANK VACCARO OFFICER 244338 275889 0 0 0 0 0 0 0 0 244338 275889 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENGAGES A MANAGEMENT COMPANY TO PERFORM ADMINISTRATIVE SERVICES INCLUDING OVERSIGHT OF CERTAIN PERSONNEL AND EXECUTING FINANCIAL OPERATIONS ON A LIMITED BASIS. THE SERVICES ARE PERFORMED UNDER THE TERMS OF A WRITTEN CONTRACT. 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 11 THE FUND'S 990 IS PREPARED BY ITS OUTSIDE AUDITOR AND IS SUBMITTED AND REVIEWED WITH THE ADMINISTRATOR. THE ADMINISTRATOR THEN REVIEWS IT WITH THE CHAIRPERSON OF THE BOARD OF TRUSTEES. A COPY OF THE RETURN 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 X, LINE 33: GENERALLY ACCEPTED ACCOUNTING PRINCIPLES ALLOW FOR PRESENTATION OF ESTIMATED CURRENT CLAIMS OBLIGATIONS ON A SEPARATE STATEMENT IN THE FUND'S AUDITED FINANCIAL STATEMENTS. FOR CONSISTENCY, THE BALANCE SHEET FOR FORM 990 WILL ALSO NOT INCLUDE LIABILITIES FOR ESTIMATED CURRENT CLAIMS OBLIGATIONS. NET ASSETS PER THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE ESTIMATED CURRENT CLAIMS OBLIGATIONS OF $13,064,369 AND ESTIMATED POST RETIREMENT OBLIGATIONS OF $16,131,999. FORM 990, PART XI, LINE 9: TRANSFER FROM OTHER PLAN 181,000. UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 AND EMPLOYERS PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226074414 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES. NJ 501(A) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 AND EMPLOYERS LEGAL FUND 1389 BROAD STREET CLIFTON NJ 07013 222238707 TO PROVIDE LEGAL BENEFITS TO ELIGIBLE MEMBERS. NJ 501(C)9 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 1389 BROAD STREET CLIFTON NJ 07013 221339607 TO REPRESENT UNION MEMBERS IN COLLECTIVE BARGAINING MATTERS WITH EMPLOYERS NJ 501(C)5 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 PATHMARK HEALTH AND WELFARE F 1389 BROAD STREET CLIFTON NJ 07013 371664252 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)9 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 AND EMPLOYERS HEALTH FUND 1389 BROAD STREET CLIFTON NJ 07013 463496310 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)9 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 & EMPLOYERS HEALTH & WELFARE 1389 BROAD STREET CLIFTON NJ 07013 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)9 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 & EMPLOYERS NONFOOD PENSION F 1389 BROAD STREET CLIFTON NJ 07013 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES. NJ 501(A) 0 WAKEFERN CORPORATION NJ FOODTOWN SUPERMARKETS NJ A&P PATHMARK NJ 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 UFCW LOCAL 1262 AND EMPLOYERS' PENSION FUND P 1004239 CASH UFCW LOCAL 1262 AND EMPLOYERS' PENSION FUND N 200500 CASH UFCW LOCAL 1262 AND EMPLOYERS' PENSION FUND O 803739 CASH UFCW LOCAL 1262 J 30014 CASH UFCW LOCAL 1262 O 129138 CASH UFCW LOCAL 1262 P 159836 CASH UFCW LOCAL 1262 AND EMPLOYERS HEALTH FUND R 2819000 ACCRUAL