2023-06-05T09:59:45-05:00 2022-09-30 611436956 NOVAK FRANCELLA LLC 40 MONUMENT RD 5TH FLR BALA CYNWYD PA 19004 990 2021-10-01 221458594 UFCW NATIONAL HEALTH AND WELFARE FUND UFCW 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 GEORGE J ORLANDO TRUSTEE 2015698801 2023-06-05 1 GEORGE ORLANDO 999009999 LOUIS VERZELLA CPA P00360279 6106689400 2023-06-05 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z GEORGE J ORLANDO 66 GRAND AVENUE ENGLEWOOD NJ 07631 159328022 0 X N/A X 1947 NJ THE PLAN PROVIDES HOSPITAL, MAJOR MEDICAL, SURGICAL, DISABILITY, PRESCRIPTION DRUG, DEATH AND VISION BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. ALL HEALTH, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFITS ARE SELF-FUNDED. 7 6 33 0 0 0 0 0 152986993 148407271 3265534 2710548 0 0 156252527 151117819 0 0 145729604 142242080 3205352 3109276 0 0 0 2190099 2221108 151125055 147572464 5127472 3545355 122447009 113084722 4614972 3030512 117832037 110054210 THE PLAN PROVIDES HOSPITAL, MAJOR MEDICAL, SURGICAL, DISABILITY, PRESCRIPTION DRUG, DEATH AND VISION BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. ALL HEALTH, DISABILITY, PRESCRIPTION DRUG AND DEATH BENEFITS ARE SELF-FUNDED. 0 0 THE FUND PROVIDES MEDICAL, HOSPITAL, PRESCRIPTION DRUGS, DEATH AND VISION BENEFITS FOR MEMBERS AND THEIR DEPENDENTS. 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 13 0 33 1 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BOARD OF TRUSTEES 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 FRANK J RUNEY TRUSTEE 2.00 X 0 0 0 GEORGE J ORLANDO TRUSTEE-CHAIRMAN 5.00 X 0 0 0 GERALDINE SENACK TRUSTEE/INTERIM FD ADMIN 5.00 X 66000 0 17850 JAMES BLAU TRUSTEE 2.00 X 0 0 0 JOHN PEPE TRUSTEE 2.00 X 0 0 0 MICHELLE LEWIS TRUSTEE 2.00 X 0 0 0 TOM R BALLARD TRUSTEE (P) 2.00 X 0 0 0 VIOLETA AGUILAR-WYRICK TRUSTEE (P) 2.00 X 0 0 0 BOB BLAIR TRUSTEE 2.00 X 0 0 0 MAURICE HODOS ADMINISTRATOR (P) 40.00 X 146775 0 26589 BRENDA GARMA MANAGER 40.00 X 115046 0 38375 327821 0 82814 2 0 1 0 HORIZON BLUE CROSS BLUE SHIELD 3 PENN PLAZA EAST PP-04K NEWARK NJ 07105 CLAIMS ADMINISTRATION 3058785 EMPIRX HEALTH LLC 155 CHESTNUT RIDGE RD SUITE 103 MONTVALE NJ 07645 CLAIMS ADMINISTRATION 3005672 THE SEGAL COMPANY 333 WEST 34TH STREET NEW YORK NY 10001 CONSULTING/ACTUARIAL FEES 416679 CONIFER VALUE BASED CARE LLC 15821 VENTURA BLVD STE 600 ENCINO CA 91436 COST CONTAINMENT 316204 HEALTHSMART CARE MGMT SOLUTION 222 WEST LAS COLINAS BOULEVARD STE IRVING TX 75039 HEALTH CARE MANAGEMENT 255589 12 EMPLOYER CONTRIBUTIONS 525100 146802340 146802340 PARTICIPANT AND RETIREE CONTRIBUT 525100 1448566 1448566 MEDICARE PART D REIMB. 525100 156365 156365 148407271 3288192 3288192 7632559 8210203 -577644 -577644 -577644 151117819 148407271 0 2710548 142242080 43235 1890530 290365 758698 126448 248335 177338 206173 735824 322952 206101 211704 28367 30086 54228 147572464 702000 2952175 23826024 24102495 3372492 940594 27227 53940 537919 274411 53105 263508 92169608 81116133 2296553 3655877 122447009 113084722 624536 682083 2740813 2317551 1249623 30878 4614972 3030512 X 0 0 0 0 117832037 110054210 117832037 110054210 122447009 113084722 X 3545355 -13464740 2141558 X X 0 1 X 1 0 244067 15396 228671 293852 259015 34837 263508 DUE TO BROKER 30878 30878 X 137446906 -13464740 -13464740 150911646 206173 206173 151117819 147366291 0 147366291 206173 206173 147572464 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT, MORE LIKELY THAN NOT, WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE U.S. FEDERAL, STATE, OR LOCAL TAXING AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. TYPICALLY, PLAN TAX YEARS WILL REMAIN OPEN FOR THREE YEARS; HOWEVER, THIS MAY DIFFER DEPENDING UPON THE CIRCUMSTANCES OF THE PLAN. X 0 0 0 MAURICE HODOS ADMINISTRATOR (P) 146775 0 0 0 0 0 13347 0 13242 0 173364 0 0 0 BRENDA GARMA MANAGER 115046 0 0 0 0 0 20525 0 17850 0 153421 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B UFCW NATIONAL HEALTH AND WELFARE FUND'S FORM 990 IS PREPARED BY ITS INDEPENDENT ACCOUNTANT. THE RETURN IS THEN FORWARDED TO THE FUND ADMINISTRATOR FOR INITIAL REVIEW BEFORE BEING PRESENTED TO THE TRUSTEES FOR REVIEW AND SIGNATURE. FORM 990, PART VI, SECTION B, LINE 12C UFCW NATIONAL HEALTH & WELFARE FUND MONITORS ITS CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF PLAN SERVICE PROVIDERS IS SUBJECT TO APPROVAL OF THE BOARD OF TRUSTEES UNDER THE PLAN'S TRUST AGREEMENTS. PERSONS WITH A CONLFICT OF INTEREST WITH RESPECT TO A COMPENSATION ARRANGEMENT WILL NOT BE INVOLVED. DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS IS USED. CONTEMPORANEOUS DOCUMENTATION AND REORDS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT ARE MADE AND KEPT. FORM 990, PART VI, SECTION C, LINE 19 UFCW NATIONAL HEALTH AND WELFARE FUND MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: COMPENSATION - RETIREMENT BENEFITS ADJUSTMENT 2,141,558. FORM 990, PART XII, LINE 2C: UFCW NATIONAL HEALTH AND WELFARE FUND'S BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT THAT PERFORMS THE AUDIT. 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