2021-11-14T12:30:20-06:00 2020-12-31 510545975 PETER DECARLO CPA PLLC 68 3RD STREET ROOM 107 BROOKLYN NY 11231 990 2020-01-01 160915820 UFCW LOCAL ONE HEALTH CARE FUND UFCW 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 3157979600 2021-11-14 1 FRANK DERISO 999009999 PETER DECARLO CPA P00851470 7182382161 X 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z FRANK C DERISO 5911 AIRPORT ROAD ORISKANY NY 13424 79316464 0 X WWW.UFCWONE.ORG X 1959 NY PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 7 0 16 0 0 0 0 0 75273985 75336100 80657 123942 137308 3856422 75491950 79316464 0 0 72361596 62655235 973799 1200822 0 0 0 1070524 1065836 74405919 64921893 1086031 14394571 19984782 35895460 259642 1116521 19725140 34778939 THE OBJECTIVE OF THE FUND IS TO PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, WHO ARE MEMBERS OF UFCW DISTRICT UNION LOCAL ONE, AND THEIR COVERED DEPENDENTS. 0 0 THE PLAN PROVIDED CERTAIN HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 10,160 ELIGIBLE PARTICIPANTS AND THEIR COVERED DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 7 0 1 16 0 0 0 0 0 0 0 0 0 X 7 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 X MICHAEL CIANCAGLINI 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 1.00 49.00 X 0 313746 45132 GREGORY P GOREA TRUSTEE 1.00 49.00 X 0 238837 40765 ROBERT CIANCAGLINI TRUSTEE 1.00 49.00 X 0 166547 35418 ROGER HEMMITT TRUSTEE 1.00 49.00 X 0 114314 32189 I STEPHEN DAVIS TRUSTEE 1.00 X 0 0 0 JOSEPH SAHLEN TRUSTEE 1.00 1.00 X 0 0 0 RAYMOND WARDYNSKI TRUSTEE 1.00 X 0 0 0 MICHAEL CIANCAGLINI ADMINISTRATIVE DIRECTOR 21.00 19.00 X 147940 0 42640 ZACHARY GEHAN EMPLOYEE 0.00 40.00 X 0 102102 37699 DAVID PARDI TRUSTEE - PAST 1.00 49.00 X 0 182781 34761 147940 1118327 268604 1 0 1 0 SLEVIN & HART PC 1625 MASSACHUSETTS AVENUE NW WASHINGTON DC 20036 LEGAL 174360 THE SEGAL COMPANY 101 NORTH WACKER DRIVE SUITE 500 CHICAGO IL 60606 BENEFITS CONSULTING AND ACTUARIAL 127886 2 EMPLOYER CONTRIBUTIONS 525100 74931549 74931549 PARTICIPANT CONTRIBUTIONS 525100 404551 404551 75336100 66268 66268 27799 29875 0 0 27799 29875 57674 57674 PRESCRIPTION DRUG REBATES 525100 3847156 3847156 INTEREST & LIQUIDATED DAMAGES 525100 5338 5338 BENEFIT CLAIM REFUNDS 525100 3100 3100 828 828 3856422 79316464 79192522 0 123942 62655235 595471 395104 162956 47291 187955 81807 15000 204521 47261 148026 112980 3640 405 47324 68745 OPERATIONS EXPENSE 59151 PRINTING & PUBLICATIONS 53239 AFFORDABLE CARE ACT TAX 35778 FIELD AUDITS 4 64921893 696127 2939066 10806731 19662708 6317807 8978079 99459 106714 395011 308355 62358 86656 2119937 2002300 2002300 19984782 35895460 259642 774795 0 341726 259642 1116521 X 0 0 0 0 19725140 34778939 19725140 34778939 19984782 35895460 14394571 -26791 686019 0 X X 0 1 X 1 0 75381 70711 4670 27650 21227 6423 291980 216417 75563 86656 RESERVES HELD BY INSURANCE COMPANY 2002300 2002300 PAYCHECK PROTECTION PROGRAM LOAN 341726 341726 79274673 -26791 -26791 79301464 15000 15000 79316464 64906893 0 64906893 15000 15000 64921893 X 0 0 0 FRANK C DERISO TRUSTEE 0 313746 0 0 0 0 0 18172 0 26960 0 358878 0 0 GREGORY P GOREA TRUSTEE 0 238837 0 0 0 0 0 15760 0 25005 0 279602 0 0 ROBERT CIANCAGLINI TRUSTEE 0 166547 0 0 0 0 0 13115 0 22303 0 201965 0 0 MICHAEL CIANCAGLINI ADMINISTRATIVE DIRECTOR 147940 0 0 0 0 0 21563 0 21077 0 190580 0 0 0 DAVID PARDI TRUSTEE - PAST 0 182781 0 0 0 0 0 12792 0 21969 0 217542 0 0 FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B NO REVIEW WAS CONDUCTED. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURES REQUIRED BY LAW ARE AVAILABLE TO THE PUBLIC AT THE FUND'S OFFICE, UPON REQUEST. FORM 990, PART XII, LINE 2C THE FUND'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE DURING THE TAX YEAR IN EITHER THE FUND'S OVERSIGHT OR SELECTION PROCESS. UFCW DISTRICT UNION LOCAL ONE 5911 AIRPORT ROAD ORISKANY NY 13424 150559586 LABOR UNION NY 501(C)(5) 0 UFCW LOCAL ONE PENSION FUND 5911 AIRPORT ROAD ORISKANY NY 13424 166144007 PENSION PLAN NY 501(A) 0 UFCW LOCAL ONE 401(K) SAVINGS PLAN 5911 AIRPORT ROAD ORISKANY NY 13424 166184130 PENSION PLAN NY 501(A) 0 THE LUTHERAN HOMES ST ELIZABETH MEDICAL CENTER EVERGREEN VALLEY NURSING HOME NIAGRA GERIATRIC CENTER STAMFORD HEALTH CARE HERITAGE HEALTH CARE CENTER PRESBYTERIAN HOME ELDERWOOD AT LAKE PLACID CAPITAL DISTRICT AREA LABOR FEDERATION CENTRAL NEW YORK LABOR AGENCY PENNSYLVANIA AFL-CIO TOWN OF WHITESTOWN TOPS MARKETS INC EMPIRE MERCHANTS NORTH ALBANY KRAFT INC DAIRY GROUP GREAT AMERICAN STORES SILGAN CONTAINERS MANUFACTURING CORP SAHLEN PACKING CORP G&L DAVIS MEAT CO HOMETOWN MARKETS LLC EMPIRE MERCHANTS NORTH BUFFALO SHOP RITE CAPITAL DISTRICT CHANATRY'S FRENCH ROAD MARKET ZWEIGLES INC RETAIL MARKETSGIANT EAGLE INC SODEXO INCPAUL SMITH COLLEGE WELCH FOODS INC BREEN FAMILY INC FORT'S GROCERY INC SMITH PACKING COMPANY WALTON'S BIG M HOFMANN SAUSAGE CO INC OLD WORLD PROVISION CO INC LR BRASS INC COUDERSPORT JUBILEE SMYD CORP DIVERSE FOOD PRODUCTS LLC VANCHLOR CO FRANK WARDYNSKI & SONS INC TN HARVEY INC FILLMORE JUBILEE GALETON IGA FIBERCELL PACKAGING LLC BIG V CORPSHOP RITE THE WINE GROUPMOGEN DAVID GATES BIG M INDELICATO'S MARKET MILWARD ALLOYS INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 UFCW DISTRICT UNION LOCAL ONE P 141165 ALLOCATION UFCW LOCAL ONE PENSION FUND Q 851104 ALLOCATION UFCW LOCAL ONE 401(K) SAVINGS PLAN Q 523076 ALLOCATION UFCW DISTRICT UNION LOCAL ONE S 454251 CONTRACT THE LUTHERAN HOMES S 2149273 CONTRACT NIAGRA GERIATRIC CENTER S 176099 CONTRACT STAMFORD HEALTH CARE S 627370 CONTRACT HERITAGE HEALTH CARE CENTER S 688515 CONTRACT TOPS MARKETS INC S 54850233 CONTRACT EMPIRE MERCHANTS NORTH A R S S 2002325 CONTRACT KRAFT INC DAIRY GROUP S 1401930 CONTRACT GREAT AMERICAN STORES S 532492 CONTRACT SILGAN CONTAINERS MANUFACTURING CORP S 819608 CONTRACT SAHLEN PACKING CORP S 754054 CONTRACT G&L DAVIS MEAT CO S 940121 CONTRACT HOMETOWN MARKETS LLC S 603616 CONTRACT EMPIRE MERCHANTS NORTH BUFFALO S 592163 CONTRACT SHOP RITE CAPITAL DISTRICT S 1379320 CONTRACT CHANATRY'S FRENCH ROAD MARKET S 194904 CONTRACT ZWEIGLES INC S 528978 CONTRACT RETAIL MARKETSGIANT EAGLE INC S 180225 CONTRACT SODEXOPAUL SMITH COLLEGE S 177490 CONTRACT WELCH FOODS INC S 310585 CONTRACT BREEN FAMILY INC S 139073 CONTRACT FORT'S GROCERY INC S 219017 CONTRACT SMITH PACKING COMPANY S 243027 CONTRACT WALTON'S BIG M S 201845 CONTRACT HOFMANN SAUSAGE CO INC S 307622 CONTRACT OLD WORLD PROVISION CO INC S 189100 CONTRACT LR BRASS INC S 156968 CONTRACT COUDERSPORT JUBILEE S 203054 CONTRACT DIVERSE FOOD PRODUCTS LLC S 138994 CONTRACT VANCHLOR CO S 261993 CONTRACT FRANK WARDYNSKI & SONS INC S 121864 CONTRACT TN HARVEY INC S 68882 CONTRACT FILLMORE JUBILEE S 65898 CONTRACT GALETON IGA S 75259 CONTRACT FIBERCELL PACKAGING LLC S 482967 CONTRACT BIG V CORPSHOP RITE S 227861 CONTRACT THE WINE GROUPMOGEN DAVID S 428370 CONTRACT ELDERWOOD AT LAKE PLACID S 590385 CONTRACT MILWARD ALLOYS INC S 150935 CONTRACT PRESBYTERIAN HOME S 611705 CONTRACT