2022-11-15T16:48:47-06:00 2021-12-31 135565207 KPMG LLP 345 PARK AVENUE NEW YORK NY 10154 990 2021-01-01 136125570 1199SEIU GREATER NEW YORK BENEFIT FUND 1199 6464736336 PO BOX 842 NEW YORK NY 10108 MERCEDES MAMBRU CFO 6464736336 2022-11-15 1 MERCEDES MAMBRU XXX-XX-XXXX OMO-OSE JOSEPH-ERAMEH P02534927 2127589700 2022-11-14 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MERCEDES MAMBRU PO BOX 842 NEW YORK NY 10108 198900852 0 X HTTP://1199SEIUBENEFITS.ORG X 1992 NY TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS. SEE SCHEDULE O.TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENT AND TRUST DOCUMENT. 12 12 0 12 0 0 0 0 203104832 198850155 12468429 21301 26838 29396 215600099 198900852 0 0 224261105 199860375 9459850 9482333 0 0 0 7900868 6923740 241621823 216266448 -26021724 -17365596 107225868 90660707 57130262 64448207 50095606 26212500 TO PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENT AND TRUST DOCUMENT; SEE SCHEDULE O. 0 0 0 0 0 THOUGH THE FUND DOES NOT UNDERTAKE PROGRAM SERVICES AND DOES NOT REPORT ANY EXPENSES ON FORM 990, PART IX, COL (B), THE FUND PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENT AND TRUST DOCUMENT. IN 2021 THE ORGANIZATION PROVIDED HEALTH AND WELFARE BENEFITS TO 19,890 MEMBERS. 0 0 0 0 0 0 0 0 0 0 0 0 1 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 X 5424 0 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X MERCEDES MAMBRU 6464736336 PO BOX 842 NEW YORK NY 10108 MICHAEL BALBONI EMPLOYER TRUSTEE 1.00 5.00 X 0 0 0 WILLIAM PASCOCELLO EMPLOYER TRUSTEE 1.00 5.00 X 0 0 0 ROBIN ROSEN EMPLOYER TRUSTEE 1.00 5.00 X 0 0 0 HOWARD SUKOFF EMPLOYER TRUSTEE 1.00 0.00 X 0 0 0 DOUG WISSMANN EMPLOYER TRUSTEE 1.00 4.00 X 0 0 0 YVONNE ARMSTRONG UNION TRUSTEE 1.00 5.00 X 0 0 0 MARIA CASTANEDA UNION TRUSTEE 1.00 1.00 X 0 0 0 ALLAN SHERMAN UNION TRUSTEE 1.00 5.00 X 0 0 0 MILLY SILVA UNION TRUSTEE 1.00 4.00 X 0 0 0 JULIO VIVES UNION TRUSTEE 1.00 1.00 X 0 0 0 NOREEN WRAY UNION TRUSTEE 1.00 1.00 X 0 0 0 RONALD MCCALLA UNION TRUSTEE 1.00 0.00 X 0 0 0 LORRAINE MONCHAK CHIEF INVESTMENT OFFICER 2.00 20.00 X 70929 45683 55875 MITRA BEHROOZI EXECUTIVE OFFICER 2.00 20.00 X 43326 27904 32471 DONNA S REY CHIEF OPERATING OFFICER 2.00 20.00 X 41399 27895 31813 VAN H DUNN CHIEF MEDICAL OFFICER 2.00 16.00 X 30334 19537 23431 MERCEDES MAMBRU CHIEF FINANCIAL OFFICER 2.00 20.00 X 15506 10448 12186 201494 131467 155776 0 0 1 0 MEDCO HEALTH SOLUTIONS INC PO BOX 945551 ATLANTA GA 30394 CLAIMS PROCESSING 783455 AETNA INC PO BOX 13049 NEWARK NJ 07188 CLAIMS PROCESSING 657257 CHANGE HEALTHCARE OPERATIONS LLC 3055 LEBANON PIKE NASHVILLE TN 37214 CLAIMS PROCESSING 363443 EVERNORTH BEHAVIORAL HEALTH INC 5144 COLLECTION CENTER DRIVE CHICAGO IL 60693 CLAIMS PROCESSING 347891 MILLIMAN INC 1 PENN PLAZA 38TH FLOOR NEW YORK NY 10119 ACTURIAL 317442 9 EMPLOYER CONTRIBUTION 900099 173613720 173613720 ADVANCE TRAINING INITI 900099 21426167 21426167 MEMBER SPOUSAL CONTRIB 900099 3258136 3258136 COBRA 900099 372173 372173 EMPLOYER DELINQUENCIES 900099 179959 179959 198850155 4058 4058 17243 0 17243 17243 17243 OTHER INCOME 900099 29396 29396 29396 198900852 198850155 0 50697 199860375 295769 5999183 691342 2064656 431383 166129 125470 27889 493446 679772 305027 2731364 160972 3RD PARTY ADMIN PRESCRI 1817992 MANAGED CARE PRECERT 415679 216266448 10890983 7159667 4990926 38685257 42585845 22614 162715 34841 0 28357158 0 29235015 35761554 107225868 90660707 5235871 5314514 51894391 59133693 57130262 64448207 X 50095606 26212500 50095606 26212500 107225868 90660707 X -17365596 -7566 -6509944 X 0 1 X 1 0 0 MEMBER SPOUSAL CONTRIBUTIONS 295250 DUE FROM PHARM. BENEFIT MGRS 12750836 DUE FROM RELATED ENTITIES 670927 DUE FROM BROKERS 13178763 ACCRUED INVESTMENT INCOME 61109 INVEST IN 3BF PTRS, LLC 8804669 35761554 DUE TO RELATED PARTIES 2322330 BENEFIT OBLIGATIONS 43182777 DUE TO BROKERS 13178763 DUE TO EMPLOYERS 449823 59133693 X 198865397 -7566 -7566 198872963 27889 27889 198900852 216238559 0 216238559 27889 27889 216266448 PART X, LINE 2: U.S. GAAP REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2021, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF LIABILITY (OR ASSET) OR DISCLOSURE IN FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO FEDERAL INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2018. X X X 0 1 0 LORRAINE MONCHAK CHIEF INVESTMENT OFFICER 69844 44984 0 0 1085 699 8577 5524 25409 16365 104915 67572 0 0 PART I, LINE 3 COMPENSATION ALLOCATION FORM 990, SCHEDULE J, PART II ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY THE 1199SEIU NATIONAL BENEFIT FUND FOR HEALTH AND HUMAN SERVICE EMPLOYEES (NBF) FOR THEIR SERVICES PERFORMED FOR ALL 1199SEIU FUNDS. THEIR SALARY IS THEN ALLOCATED TO EACH FUND BASED AN ALLOCATION STUDY AND IS REPORTED AS IF PAID BY THE FILING ORGANIZATION. THE AMOUNT REPORTED IN SCHEDULE J, PART II, LINE (I) REPRESENTS THE AMOUNT ALLOCATED TO NBF AND THE AMOUNTS REPORTED ON LINE (II) REPRESENT THE TOTAL SALARY AND BENEFITS RECEIVED FOR SERVICES PROVIDED TO ALL 1199SEIU FUNDS. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED DEFERRED CONTRIBUTIONS DURING 2021: LORRAINE MONCHAK $103,888 MITRA BEHROOZI $79,139 VAN H. DUNN $53,720 DONNA S. REY $71,715 MERCEDES MAMBRU $35,496 THE ABOVE AMOUNTS ARE INCLUDED ON SCHEDULE J, PART II, COL C. FORM 990, PART V, LINE 3B UNRELATED BUSINESS INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 419A(F)(5)(A), COLLECTIVE BARGAINING AGREEMENTS ARE EXEMPT FROM ACCOUNT LIMIT REQUIREMENTS SET UNDER IRC SECTION 419A(C), AND ARE THERFORE NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX UNDER IRC SECTION 512(A)(3). FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIP ALL OF THE UNION TRUSTEES ARE ALSO EMPLOYEES OF 1199SEIU (THE UNION) AND THEREFORE HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT THE UNION TRUSTEES ARE APPOINTED BY 1199SEIU UNITED HEALTHCARE WORKERS EAST, AND THE EMPLOYER TRUSTEES ARE APPOINTED BY THE GREATER NEW YORK HEALTH CARE FACILITIES ASSOCIATION, INC. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF FORM 990 THE CHIEF FINANCIAL OFFICER AND FINANCE TEAM REVIEW THE DRAFT FORM 990 AND CONFER WITH THE ACCOUNTANTS AND LEGAL COUNSEL TO ENSURE THE ACCURACY OF THE RETURN. ANY CONCERNS ARE NOTED AND ADDRESSED AND MANAGEMENT ENSURES THAT THE CHANGES ARE INCORPORATED IN THE FORM 990. THE COMPLETED FORM 990 IS THEN SIGNED BY THE CHIEF FINANCIAL OFFICER. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST POLICY TRUSTEES AND EMPLOYEES ARE REQUIRED TO ANNUALLY DISCLOSE OR UPDATE TO THE EXECUTIVE DIRECTOR, OR DESIGNEE, THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTERESTS. FOR EACH INTEREST DISCLOSED BY A TRUSTEE, THE EXECUTIVE DIRECTOR OR DESIGNEE WILL DETERMINE WHETHER TO (A) TAKE NO ACTION (B) ASSURE FULL DISCLOSURE TO THE TRUSTEES (C) ASK THE TRUSTEE TO BE RECUSED FROM PARTICIPATION IN RELATED DISCUSSIONS OR DECISIONS; AND/OR (D) ASK THE TRUSTEE TO RESIGN. REGARDING EMPLOYEES, COMPLETED CONFLICTS OF INTEREST DISCLOSURE FORMS WILL BE REVIEWED BY THE HUMAN RESOURCES DEPARTMENT AND DISCLOSED CONFLICTS WILL BE REVIEWED BY HUMAN RESOURCES MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION REVIEW COMPENSATION FOR ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE FUND IS DETERMINED BY THE CROSS FUNDS COMPENSATION COMMITTEE (THE "COMMITTEE"), COMPRISED OF INDEPENDENT MEMBERS. THE COMMITTEE UTILIZES APPROPRIATE DATA AS TO COMPARABILITY IN ITS DETERMINATIONS, INCLUDING INFORMATION PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS. THE COMMITTEE DOCUMENTS THE BASIS FOR ANY COMPENSATION DETERMINATIONS CONTEMPORANEOUSLY IN THE MINUTES OF THE COMMITTEE. THE COMMITTEE DETERMINES COMPENSATION PERIODICALLY AS IT DEEMS APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 PUBLIC DISCLOSURE SUMMARY PLAN DESCRIPTIONS AND FINANCIAL REPORTS ARE MADE PUBLIC PURSUANT TO IRS FILING REQUIREMENTS. WRITTEN REQUESTS FOR OTHER INFORMATION WILL BE FORWARDED TO GENERAL COUNSEL'S OFFICE FOR CONSIDERATION. FORM 990, PART XI, LINE 9: CHANGE IN BENEFIT OBLIGATION -6,509,944. 1199SEIU GREATER NY PENSION FUND 330 WEST 42ND STREET NEW YORK NY 10036 136601940 PENSION FUND NY 401(A) N/A 0 1199SEIU GREATER NEW YORK EDUCATION FUND 330 WEST 42ND STREET NEW YORK NY 10036 133753121 EDUC/TRAINING NY 501(C)(9) N/A 0 1199SEIU GREATER NEW YORK CHILDCARE FUND 330 WEST 42ND STREET NEW YORK NY 10036 753086330 CHILDCARE FND NY 501(C)(9) N/A 0 1199SEIU GREATER NY WORKER PARTICIPATION 330 WEST 42ND STREET NEW YORK NY 10036 134079917 LABOR MGMT NY 501(C)(5) N/A 0 1199SEIU GREATER NY JOB SECURITY 330 WEST 42ND STREET NEW YORK NY 10036 050557207 BENEFIT FUND NY 501(C)(9) N/A 0 1199SEIU HEALTH & HUMAN SVC UNION (GNY) N/A ACTOR'S FUND NURSING HOME N/A BEZALEL NURSING HOME N/A COBBLE HILL CARE CENTER N/A CONCORD NURSING HOME N/A METHODIST CHURCH HOME N/A NEW YORK CONGREGATIONAL N/A NORTHERN METROPOLITAN INC N/A NORTHERN RIVERVIEW HEALTH CARE CTR INC N/A NORWEGIAN CHRISTIAN HOME AND HEALTH CTR N/A SAN-SIMEON BY THE SOUND N/A TOLSTOY FOUNDATION N/A LIVINGSTON VENTURES LLC ARISTACARE CEDAR CARE CENTER ARISTACARE NORWOOD TERRACE ATLANTIS REHAB CENTER BEACON REHABILITATION & NURSING CENTER BEDFORD CTR FOR NURSING & REHABILITATION BRONX PARK REHAB AND NURSING CENTER CARING FAMILY NURSING AND REHAB CENTER CONFIDENCE MGMT SERVICES-CEDAR PARK CONFIDENCE MGMT SVCS - NORWOOD TERRACE CORAL HARBOR NURSING & REHAB CTR CROWN HEIGHTS CTR FOR NUR & REHAB CYPRESS CARE CENTER DELLRIDGE CARE CENTER FAIRVIEW NURSING HOME FAR ROCKAWAY NURSING HOME FIELDSTON LODGE CARE CENTER FORDHAM NURSING & REHAB CENTER FOREST HILLS CARE CENTER FOREST VIEW NURSING HOME FORT TRYON CENTER FOR REHAB & NURSING FOUR SEASONS REHABILITATION FRANKLIN CENTER REHAB AND NURSING FRIEDWALD HOUSE CTR FOR REHAB & NURSING FULTON COMMONS CARE CENTER GLENGARIFF CORPORATION GOLDCREST NURSING HOME GOLDEN GATE REHAB & HEALTH CARE CTR GRANDELL NURSING & REHAB CENTER ALARIS HEALTH AT HAMILTON PARK HAMPTON CENTER FOR REHAB & NURSING HEALTH CARE-BARNEGAT HEALTH CARE-CLARK HEALTH CARE-EDISON HEALTH CARE-GALLOWAY HEALTH CARE-KING MANOR HEALTH CARE-WANAQUE HEALTH CARE-WILLOW SPRINGS HEALTHCARE AT GREEN KNOLL HEALTHCARE SERVICES GRP AT WILLOW CREE HEALTHCARE SVCS GRP CONCORD HEALTHCARE HEALTHCARE SVCS GRP ATLANTIC COAST HEALTHCARE SVCS GRP OAKRIDGE WEDGEWOOD HEALTHCARE SVCS GRP INC BRONX PARK HEALTHCARE SVCS GRP INC BRONX PARK LA HIGHLAND VIEW CARE CENTER HILLSIDE MANOR HEALTH HOLLIS PARK MANOR HOPE CENTER FOR HIV AND NURSING CARE HUNTINGTON HILLS CTR FOR HEALTH & REHAB JFK HARTWYCK-CEDAR BROOK JFK HARTWYCK-EDISON ESTATES JOPAL ST JAMES LLC KING HARBOR MULTICARE CENTER KING MANOR CARE CENTER LACONIA NURSING HOME LAWRENCE NURSING HOME LEISURE CHATEAU CARE CENTER LITTLE NECK NURSING HOME LIVINGSTON VENTURES LLC LONG ISLAND CARE CENTER MANHATTANVIEW HEALTH CARE CTR MANHATTANVILLE HEALTH CARE MEADOW PARK REHABILITATION MEADOWBROOK CARE CENTER MEDCO ENTERPRISES AT WAYNE HEALTH RELAT MEDCO ENTERPRISES AT BAINBRIDGE NURSING MEDCO ENTERPRISES AT EASTHAVEN HEALTH MEDCO ENTERPRISES AT MOSHULA PARKWAY MEDFORD MULTI CARE CENTER MONTGOMERY NURSING HOME MORRIS PARK NURSING HOME NASSAU EXTENDED CARE CENTER NEW BRIDGEVIEW COMPANY LLC NEW GLEN OAKS NURSING HOME NEW MAYFAIR COMPANY INC NEW MIDWAY COMPANY LLC NEW VANDERBILT NURSING HOME NORTHERN MANHATTAN NORTHERN WESTCHESTER RESIDENTIAL NYACK RIDGE REHAB NUR CTR OCEAN GARDENS OCEANSIDE CARE CENTER OCEANVIEW NURSING HOME OXFORD NURSING HOME PALM GARDENS NURSING HOME PALM TREE CENTER FOR NURSING & REHAB PARK AVENUE EXTENDED CARE PARK GARDENS PARK HOUSE CARE CENTER PARK TERRACE CARE CENTER INC PARK VIEW NURSING HOME PELHAM PARKWAY NURSING HOME THE ENCLAVES PROMENADE REHABILITATION PUTNAM NURSING AND REHABILITAT QUEENS NASSAU (BC) QUEENS NASSAU (LPN) RARITAN HEALTH AND EXTENDED REGEIS CARE CENTER REGENCY EXTENDED CARE CENTER EXCELCARE AT WAYNE ANCHOR CARE REGO PARK NURSING HOME RESORT NURSING HOME RIVERDALE NURSING HOME ROCKAWAY CARE CENTER ROCKAWAY CARE CENTER HOUSEKEEPING ROCKAWAY CARE CENTER(BC) ROCKVILLE NURSING CENTER INC ROCKVILLE SKILLED NURSING SAINT JAMES HEALTHCARE CTR SANDS POINT NURSING HOME (BC) SAPPHIRE CENTER FOR REHAB & NURSING LLC SEACREST HEALTH CARE CENTER SHEEPSHEAD NURS & REHAB CTR SHOREVIEW NURSING HOME SILVER LAKE SPECIALIZED SKYVIEW HEALTHCARE CENTER SOUTH SHORE HEALTHCARE SPLIT ROCK REHABILITATION SPRAIN BROOK MANOR REHAB LLC SPRING CREEK NH WILLBOUGHBY REHABHCC STATEN ISLAND CARE CENTER - LAFAYETTE AV SUNHARBOR MANOR LLC SUTTON PARK CENTER FOR NURS & REHAB TARRYTOWN HALL CARE CENTER TEANECK NURSING CENTER THE GRAND REHAB & NURSING AT SOUTH POINT THE GRAND REHAB & NURSING AT RIVER VALLEY THE PINES AT POUGHKEEPSIE CENTER FOR NURSING AND REHAB THROGS NECK EXTENDED CARE TOWNHOUSE EXTENDED CARE CENTER UNION PLAZA NURSING HOME UNIVERSITY NURSING HOME UPPER EAST SIDE REHAB & NURSING CENTER VERRAZANO NURSING HOME THE ELANOR WATER'S EDGE PART JEFFERSON WATERVIEW NURSING HOME WEDGEWOOD HEALTHCARE CENTER WESTCHESTER CARE CENTER WESTCHESTER CARE CENTER (RN) WHITE PLAINS CENTER FOR CARE WILLIAMSBRIDGE MANOR WINDSOR PARK NURSING HOME WOODCLIFF LAKE CARE CENTER WOODCREST NURSING HOME WOODMERE REHAB & HEALTHCARE CTR WORKMENS CIRCLE HOME AFFINITY SKILLED LIVING AND NURSING HOME AMBOY CARE CENTER ARBOR GLEN CARE ARNOLD WALTER NURSING HOME ATLANTIC COAST REHABILITATION ATRIUM CENTER FOR REHABILITATION & NURSI BEACH TERRACE CENTER BERKSHIRE NURSING & REHAB CTR BRONX CENTER MANAGEMENT CORP BRONX HARBOR HEALTH CARE COMPL BROOKHAVEN BEACH HEALTH BROOKHAVEN HEALTH CARE BROOKLYN CTR FOR REHAB CENTER BROOKLYN-QUEENS NURSING HOME - 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