UFCW TRI STATE HEALTH & WELFARE FUND: Form 990, tax year 2023
View the entire original 990 at ProPublica ↗
- Organization
- UFCW TRI STATE HEALTH & WELFARE FUND (EIN 23-6449794)
- Tax period
- 2023-01-01 to 2023-12-31
- Filed
- 2024-10-15
- IRS object ID
- 202432899349300413
- Schema version
- 2023v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-10-15T08:39:49-04:00 | ReturnTs |
| Tax Period End | 2023-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 222212404 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BARATZ & ASSOCIATES PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4B EVES DR STE 100 | AddressLine1Txt |
| City | MARLTON | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 08053 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2023-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 236449794 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UFCW UNION & PARTICIPATING FOOD IND | BusinessNameLine1Txt |
| Business Name Line2 | EMPLOYERS TRI-STATE HEALTH-WELFARE | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UFCW | BusinessNameControlTxt |
| Phone | 8567932500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 ROLAND AVENUE | AddressLine1Txt |
| City | MT LAUREL | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 08054 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL DOSENBACH | PersonNm |
| Person Title | TRUSTEE | PersonTitleTxt |
| Phone | 8567932500 | PhoneNum |
| Signature | 2024-10-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | false | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | JOHN FEKETE CPA | PreparerPersonNm |
| PTIN | P00956964 | PTIN |
| Phone | 8569855688 | PhoneNum |
| Preparation | 2024-10-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2023 | TaxYr |
| Build TS | 2024-10-15 13:58:12Z | BuildTS |
Form 990 IRS990
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRIAN STRING | BusinessNameLine1Txt |
| Business Name Line2 | BRIAN STRING | BusinessNameLine2Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3120 FIRE RD STE 201 | AddressLine1Txt |
| City | EGG HARBOR TOWNSHIP | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 08234 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,864,886 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Other | Yes (X) | TypeOfOrganizationOtherInd |
| Other Organization Dsc | HEALTH FUND | OtherOrganizationDsc |
| Formation | 1967 | FormationYr |
| Legal Domicile State | NJ | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS WHOSE EMPLOYERS HAVE ENTERED INTO COLLECTIVE BARGAINING AGREEMENTS WITH VARIOUS LOCAL AFFILIATES OF THE UNITED FOOD AND COMMERCIAL WORKERS UNION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,077,841 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $39,649,726 | CYProgramServiceRevenueAmt |
| PY Investment Income | $73,684 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,215,160 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $38,151,525 | PYTotalRevenueAmt |
| CY Total Revenue | $40,864,886 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $26,700,830 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $29,601,128 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,569,899 | PYOtherExpensesAmt |
| CY Other Expenses | $2,715,058 | CYOtherExpensesAmt |
| PY Total Expenses | $29,270,729 | PYTotalExpensesAmt |
| CY Total Expenses | $32,316,186 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $8,880,796 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $8,548,700 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,323,133 | TotalAssetsBOYAmt |
| Total Assets EOY | $51,119,661 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,529,463 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,946,397 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $36,793,670 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $46,173,264 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE HEALTH BENEFITS TO PARTICIPANTS WHOSE EMPLOYERS HAVE ENTERED INTO COLLECTIVE BARGAINING AGREEMENTS WITH VARIOUS LOCAL AFFILIATES OF THE UNITED FOOD AND COMMERCIAL WORKERS UNION. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Desc | PROVIDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | TO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Described In Section501c3 | false | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 110 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicyInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | FUND ADMINISTRATOR | PersonNm |
| Phone | 8567932500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 ROLAND AVENUE | AddressLine1Txt |
| City | MT LAUREL | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 08054 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| Business Name Line2BusinessName/BusinessNameLine2Txt | TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| BRIAN STRING | ||||||
| BRIAN STRING | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| DANIEL DOSENBACH | ||||||
| DANIEL DOSENBACH | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| DANIEL KONCZYK | ||||||
| DANIEL KONCZYK | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| LISSA WOLCOTT | ||||||
| LISSA WOLCOTT | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| MITCHELL SCHAFER | ||||||
| MITCHELL SCHAFER | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| SAM FERRAINO JR | ||||||
| SAM FERRAINO JR | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| TIM TERIFAY | ||||||
| TIM TERIFAY | TRUSTEE | 1.00 | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | Address Line2ContractorAddress/USAddress/AddressLine2Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|---|
| TRI-STATE ADMINISTRATORS INC | ||||||
| 27 ROLAND AVE | 27 ROLAND AVE | MT LAUREL | NJ | 08054 | ADMINISTRATIVE | $2,325,381 |
| O'BRIEN BELLAND & BUSHINSKY LLC | ||||||
| 1526 BERLIN RD | 1526 BERLIN RD | CHERRY HILL | NJ | 08003 | LEGAL | $190,248 |
| SPEAR WILDERMAN PC | ||||||
| 230 S BROAD ST | 230 S BROAD ST | PHILADELPHIA | PA | 19102 | LEGAL | $181,288 |
| HEALTH PLAN SYSTEMS | ||||||
| 2025 LINCOLN HWY STATE ROUTE 27 | 2025 LINCOLN HWY STATE ROUTE 27 | EDISON | NJ | 08817 | CPU PROGRAMMING | $101,487 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|
| EMPLOYER CONTRIBUTIONS | $39,538,966 | $39,538,966 |
| EMPLOYEE CONTRIBUTIONS | $110,760 | $110,760 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $39,649,726 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,215,160 | TotalRevenueColumnAmt |
| Exclusion | $1,215,160 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,864,886 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $39,649,726 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $1,215,160 | ExclusionAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,601,128 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,662 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,750 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,750 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,234 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,099 | TotalAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt |
|---|---|
| ADMINISTRATOR FEES | $2,295,740 |
| DATA PROCESSING | $109,087 |
| OFFICE | $30,616 |
| SPECIAL PROJECT FEES | $29,641 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,479 | TotalAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,316,186 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $0 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,886,331 | BOYAmt |
| EOY | $7,967,460 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,659,157 | BOYAmt |
| EOY | $2,677,491 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,697 | BOYAmt |
| EOY | $50,704 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $277,544 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $277,544 | LandBldgEquipAccumDeprecAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,843,948 | BOYAmt |
| EOY | $39,558,006 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $866,000 | BOYAmt |
| EOY | $866,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,323,133 | BOYAmt |
| EOY | $51,119,661 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $111,198 | BOYAmt |
| EOY | $83,082 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,418,265 | BOYAmt |
| EOY | $4,863,315 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,529,463 | BOYAmt |
| EOY | $4,946,397 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,793,670 | BOYAmt |
| EOY | $46,173,264 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,793,670 | BOYAmt |
| EOY | $46,173,264 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,323,133 | BOYAmt |
| EOY | $51,119,661 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $8,548,700 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $830,894 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $277,544 | OtherCostOrOtherBasisAmt |
| Depreciation | $277,544 | DepreciationAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED BENEFIT LIABILITIES | Desc |
| Amt | $4,863,315 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,863,315 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $41,683,610 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $830,894 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $830,894 | RevenueNotReportedAmt |
| Revenue Subtotal | $40,852,716 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $12,170 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $12,170 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $40,864,886 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,858,966 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $31,858,966 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $12,170 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $445,050 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $457,220 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $32,316,186 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PAGE 3, PART X | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX PROVISIONS TAKEN BY THE PLAN. MANAGEMENT EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAD MAINTAINED ITS TAX-EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OF LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. WITH FEW EXCEPTIONS, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2021. |
| SCHEDULE D, PAGE 4, PART XII, LINE 4B | BENEFITS PAYABLE ADJUSTMENT 445,050 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4D | TO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS. |
| FORM 990, PAGE 6, PART VI, LINE 3 | THE TRUSTEES HAVE DELEGATED MANAGEMENT AUTHORITY OVER DAY-TO-DAY OPERATIONS TO A THIRD-PARTY ADMINISTRATOR. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 WAS REVIEWED WITH THE FUND'S BOOKKEEPER, BEFORE BEING SENT TO THE TRUSTEES FOR FINAL REVIEW AND SIGNATURE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNMENT FORMS ARE AVAILABLE FOR REVIEW UPON REQUEST. PARTICIPANTS ARE ABLE TO COME INTO THE ADMINISTRATIVE OFFICE AND REQUEST AN OPPORTUNITY TO REVIEW THE FORMS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| TOWNSHIP OF WATERFORD | |||||||||
| 2131 AUBURN AVE | ATCO | NJ | 08004 | 216001341 | GOVT AGENC | NJ | 170C1 | N/A | false |
| CAMDEN COUNTY MUA | |||||||||
| 1645 FERRY AVE | CAMDEN | NJ | 08104 | 222003702 | WATERTREAT | NJ | 115 | N/A | false |
| TOWNSHIP OF MONROE | |||||||||
| 125 VIRGINIA DR | WILLIAMSTOWN | NJ | 08094 | 216000892 | MUNICIPAL | NJ | 115 | N/A | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVISTA HEALTHCARE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3025 CHAPEL AVE WEST | AddressLine1Txt |
| City | CHERRY HILL | CityNm |
| State Abbreviation | NJ | StateAbbreviationCd |
| ZIP | 08002 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205274922 | EIN |
| Legal Domicile State | NJ | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | false | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line2RelatedOrganizationName/BusinessNameLine2Txt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ACME MARKETS INC | |||||||||||
| 20427 N 27TH AVE | PHOENIX | AZ | 85027 | 870440072 | FOOD STORE | AZ | ALBERTSONS | C CORP | false | ||
| AVON FOODS INC | |||||||||||
| 1275 HORNBERGER AVE | ROEBLING | NJ | 08554 | 562628476 | GROCERY ST | NJ | S CORP | false | ROEBLING TOWN MARKET | N/A | |
| CAPE REGIONAL MEDICAL CENTER | |||||||||||
| 2 STONE HARBOR BLVD | CAPE MAY CO COURTHOUSE | NJ | 08210 | 210662542 | HEALTHCARE | NJ | C CORP | false | N/A | ||
| CROTHALL HEALTHCARE | |||||||||||
| 1550 LIBERTY RIDGE DR STE 110 | WAYNE | PA | 19087 | 510386133 | HEALTHCARE | PA | C CORP | false | N/A | ||
| STATESMAN HEALTH AND REHABILITATION | |||||||||||
| 2629 TRENTON RD | LEVITTOWN | PA | 19056 | 391406172 | HEALTHCARE | PA | C CORP | false | STATESMAN HEALTH & REHABILITATION C | N/A | |
| MARYLAND JOCKEY CLUB | |||||||||||
| PIMLICO RACE COURSE | BALTIMORE | MD | 21215 | 521550164 | RACING | MD | false | N/A | |||
| FINE FARE SUPERMARKETS | |||||||||||
| 320 THIRD AVE | LONG BEACH | NJ | 07740 | 222134741 | FOOD STORE | NJ | C CORP | false | N/A | ||
| ARAMARK CORRECTIONAL SVCS | |||||||||||
| 2400 MARKET ST | PHILADELPHIA | PA | 19103 | 232778485 | FOOD SERV | NJ | C CORP | false | N/A | ||
| KINGS MARKET (ACME) | |||||||||||
| 700 LANIDEX PLACE | PARSIPPANY | NJ | 07054 | 221686769 | FOOD STORE | NJ | C CORP | false | N/A | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (8 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| UFCW HEALTH & WELFARE FUND | ||
| Q | $7,876 | ALLOCATED BASED ON USAGE |
| UFCW LOC 152 HEALTH & WELFARE FUND | ||
| Q | $2,672 | ALLOCATED BASED ON USAGE |
| UFCW LOCAL 360 | ||
| Q | $4,805 | REIMBURSEMENT OF LEGAL EX |
| UFCW RETIREMENT AND SAVINGS | ||
| Q | $621 | ALLOCATED BASED ON USAGE |
| UFCW RETAIL MEATS | ||
| Q | $741 | ALLOCATED BASED ON USAGE |
| UFCW 152 SAVINGS | ||
| Q | $741 | ALLOCATED BASED ON USAGE |
| UFCW REGIONAL PENSION FUND | ||
| Q | $1,126 | ALLOCATED BASED ON USAGE |
| UFCW LOCAL 152 | ||
| P | $310 | ALLOCATED BASED ON USAGE |
Comments