2012-12-12T10:57:45-06:00 2011-12-31 113266576 GRASSI & CO CPA'S PC 50 JERICHO QUADRANGLE JERICHO NY 11753 990 2011-01-01 116036373 LOCAL 365 UAW WELFARE FUND LOCA 2019478000 140 SYLVAN AVENUE SUITE 303 ENGLEWOOD CLIFFS NJ 07652 PETER FULLERTON 2019478000 2012-11-29 1 STEVEN GOLDSTEIN P00011393 5162563500 2011 2016-02-24 21:20:13Z PETER FULLERTON 140 SYLVAN AVENUE SUITE 303 ENGLEWOOD CLIFFS NJ 07652 6961931 0 X N/A X 1949 NY TO PROVIDE HEALTH BENEFITS TO MEMBERS 3 3 0 0 0 0 0 0 3834425 2951110 325532 288147 55614 83871 4215571 3323128 0 0 4169979 3805231 4 0 0 0 0 201180 291033 4371163 4096264 -155592 -773136 6542018 5691808 376661 427650 6165357 5264158 TO PROVIDE ACCIDENT AND SICKNESS, DENTAL, OPTICAL AND MEDICAL BENEFITS TO MEMBERS EMPLOYED BY CONTRIBUTING EMPLOYERS 0 0 TO PROVIDE ACCIDENT AND SICKNESS, DENTAL, OPTICAL AND MEDICAL BENEFITS TO MEMBERS EMPLOYED BY CONTRIBUTING EMPLOYERS 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 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 0 1 6 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X LOCAL 365 UAW WELFARE FUND 2019478000 140 SYLVAN AVENUE SUITE 303 ENGLEWOOD CLIFFS NJ 07652 X PETER FULLERTON 1.00 X 0 0 0 ALFRED SCHNEIDER 1.00 X 0 0 0 JEFFREY ISAACS 1.00 X 0 0 0 0 0 0 0 0 0 0 EXPRESS SCRIPTS INC 21653 NETWORK PLACE CHICAGO IL 60673 PROVIDE PRESCRIPTION DRUG BENEFITS FOR M 575524 1 EMPLOYERS CONTRIBUTION 900099 2103987 2103987 EMPLOYEES COBRA CONTRI 900099 847123 847123 2951110 219993 219993 3706957 3638803 68154 68154 68154 MISCELLANEOUS REVENUE 900099 83871 83871 83871 3323128 3034981 0 288147 3805231 96700 34647 9500 43356 1540 8795 4047 WITHDRAWAL LIABILITY EX 92448 4096264 551846 230132 139716 159975 277 276 0 0 0 0 5824908 5275440 25271 25985 6542018 5691808 376661 427650 376661 427650 X 6165357 5264158 6165357 5264158 6542018 5691808 X -773136 -128063 X X 0 1 1 X 0 0 CLAIMS PAYABLE 335202 EMPLOYER WITHDRAWAL LIABILITY 92448 427650 3323128 4096264 -773136 -128063 -34117 -162180 -935316 3195065 -128063 -128063 3323128 0 3323128 4087025 0 4087025 43356 -34117 9239 4096264 PART XIII, LINE 4B - OTHER ADJUSTMENTS: CLAIMS PAYABLE -34,117. CLAIMS PAYABLE IS THE DIFFERENCE IN THE CHANGE IN PLANS TOTAL BENEFIT OBLIGATION AT THE END OF THE YEAR. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES TO THIRD PARTY ADMINISTRATOR - BENEFIT SERVICES,INC. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS 3 VOTING MEMBERS OF THE GOVERNING BOARD AND THE MEMBERS ARE INDEPENDENT. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS MEMBERS WHO MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD HAS THE RIGHT TO MAKE DECISIONS ON BEHALF OF THE MEMBERS WITHOUT APPROVAL. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION REVIEWS THE 990 AT BOARD MEETINGS BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THIS POLICY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AT THE FUND OFFICE ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -128,063. FORM 990, PART XII, LINE 2C ( PAGE 12 ) THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. LOCAL 365 UAW PENSION FUND 140 SYLVAN AVENUE SUITE 303 ENGLEWOOD CLIFFS NJ 07652 116045281 TO PROVIDE PENSION BENEFITS TO PARTICIPANTS NY 401(A) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0