2015-08-17T12:37:49-05:00 2014-09-30 464001827 SAXBST LLP 28 WEST 44TH STREET NEW YORK NY 10036 990 2013-10-01 226137317 UNITED FOOD & COMMERCIAL WORKERS UNION LOCAL 1262 EMPLOYERS WELFARE FUND UNIT 9737785800 1389 BROAD ST CLIFTON NJ 07013 MATTHEW MOLINARO TRUSTEE 9737785800 2015-08-17 1 DAVID C LEE P00178190 2126618640 2013 2016-02-25 16:41:14Z MATTHEW MOLINARO 1389 BROAD STREET CLIFTON NJ 07013 74886057 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 76408910 74389388 974288 496640 32 29 77383230 74886057 0 0 73751918 72661032 760071 710930 0 0 0 856120 905165 75368109 74277127 2015121 608930 27614592 30792790 465214 4818921 27149378 25973869 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 9 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 MATTHEW MOLINARO TRUSTEE 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 149510 20771 MATTHEW MOLINARO TRUSTEE 5.00 40.00 X 0 299800 23307 HARVEY WHILLE TRUSTEE 5.00 40.00 X 0 334188 23307 FRANK VACCARO OFFICER 5.00 X 177635 232437 0 177635 1015935 67385 1 0 1 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATION 3241060 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 ATTORNEY 298108 HORIZON HEALTHCARE DENTAL SERVICES PO BOX 1938 NEWARK NJ 07101 CLAIMS ADMINISTRATION 271082 FRANK M VACCARO & ASSOCIATES INC 27 ROLAND AVE SUITE 200 MOUNT LAUREL NJ 08054 THIRD-PARTY ADMINISTRATOR 210858 VALUE OPTIONS THREE PENN PLAZA NEWARK NJ 07105 CLAIMS ADMINISTRATION 123841 5 EMPLOYER'S CONTRIBUTIONS 900099 72658939 72658939 RETIREE CO-PAY CONTRIBUTIONS 900099 894829 894829 COBRA CONTRIBUTIONS 900099 466692 466692 LEGAL CONTRIBUTIONS 900099 368928 368928 74389388 496640 496640 INTEREST ON DELINQUENT CONTRIBUTI 900099 29 29 29 74886057 74389417 0 496640 72661032 503114 164246 43570 304115 55000 8478 10958 36666 2610 1118 18573 THIRD-PARTY ADMINISTRAT 210858 COMPUTER SERVICES 86394 ACTUARIAL AND OTHER CON 63963 COMMUNICATION TO PARTIC 36685 69747 74277127 X 255709 217468 1247219 2577704 4608471 4320734 14217 12169 173827 172493 670 1334 20623048 22634644 865258 1028737 27614592 30792790 166519 115351 298695 4703570 465214 4818921 X 0 0 0 0 27149378 25973869 27149378 25973869 27614592 30792790 X 608930 1515561 -3300000 X 0 1 X 0 0 4867 4867 0 163755 162421 1334 5205 5205 0 1334 DUE TO AFFILIATES 244020 SERP LIABILITY 59960 OTHER PAYABLES 900207 ASSET TRANSFER PAYABLE 3499383 4703570 X 76393140 1515561 1515561 74877579 8478 8478 74886057 74268649 0 74268649 8478 8478 74277127 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 149510 0 0 0 0 0 6127 0 14644 0 170281 0 0 MATTHEW MOLINARO TRUSTEE 0 299800 0 0 0 0 0 8663 0 14644 0 323107 0 0 HARVEY WHILLE TRUSTEE 0 334188 0 0 0 0 0 8663 0 14644 0 357495 0 0 FRANK VACCARO OFFICER 177635 232437 0 0 0 0 0 0 0 0 177635 232437 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 $10,954,480 AND ESTIMATED POST RETIREMENT OBLIGATIONS OF $16,566,726. FORM 990, PART XI, LINE 9: TRANSFER TO SPUN-OFF PLAN -3,300,000. 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 824597 CASH UFCW LOCAL 1262 AND EMPLOYERS' PENSION FUND N 113667 CASH UFCW LOCAL 1262 AND EMPLOYERS' PENSION FUND O 710930 CASH UFCW LOCAL 1262 J 27912 CASH UFCW LOCAL 1262 O 85340 CASH UFCW LOCAL 1262 P 119306 CASH UFCW LOCAL 1262 N 6054 CASH UFCW LOCAL 1262 PATHMARK HEALTH AND WELFARE FUND R 300000 ACCRUAL UFCW LOCAL 1262 AND EMPLOYERS HEALTH FUND R 3000000 ACCRUAL