2019-03-08T13:27:35-06:00 2018-09-30 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2017-10-01 221458594 UFCW NATIONAL HEALTH AND WELFARE FUND UFCW 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 GEORGE J ORLANDO TRUSTEE 2015698801 2019-03-08 1 LOUIS VERZELLA CPA P00360279 6106689400 2019-02-25 162.211.205.39 2019-03-08 10:19:58 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 19998950A844A1ED5F18EB360E4E9E4F9906FFA9 2017 2019-02-21 02:37:17Z GEORGE J ORLANDO 66 GRAND AVENUE ENGLEWOOD NJ 07631 149307559 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. 8 8 27 0 0 0 0 0 115522572 122237940 2011158 2217669 0 0 117533730 124455609 0 0 106684136 118970540 2925387 4635496 0 0 0 1814895 2018411 111424418 125624447 6109312 -1168838 80644923 95055948 15388 5118751 80629535 89937197 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 6 0 27 1 0 0 0 0 0 0 X 8 8 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 X GEORGE J ORLANDO TRUSTEE-CHAIRMAN 5.00 X 0 0 0 TOM R BALLARD TRUSTEE 2.00 X 0 0 0 FRANK J RUNEY TRUSTEE 2.00 X 0 0 0 GERALDINE SENACK TRUSTEE 5.00 X 0 0 0 MICHELLE LEWIS TRUSTEE 2.00 X 0 0 0 JOHN PEPE TRUSTEE 2.00 X 0 0 0 BRIAN FITZSIMMONS TRUSTEE 2.00 X 0 0 0 CHARLES RADER TRUSTEE 2.00 X 0 0 0 MAURICE HODOS ADMINISTRATOR 40.00 X 208295 0 35166 208295 0 35166 1 0 1 0 HORIZON BLUE CROSS BLUE SHIELD 3 PENN PLAZA EAST PP-04K NEWARK NJ 07105 CLAIMS ADMINISTRATION 2629099 CONIFER VALUE BASED CARE LLC 15821 VENTURA BLVD STE 600 ENCINO CA 91436 COST CONTAINMENT 436141 EMPIRX HEALTH LLC 155 CHESTNUT RIDGE RD SUITE 103 MONTVALE NJ 07645 CLAIMS ADMINISTRATION 360997 THE SEGAL COMPANY 333 WEST 34TH STREET NEW YORK NY 10001 CONSULTING/ACTUARIAL FEES 309350 HEALTHSMART CARE MGMT SOLUTION 222 WEST LAS COLINAS BOULEVARD STE IRVING TX 75039 HEALTH CARE MANAGEMENT 249119 10 EMPLOYER CONTRIBUTIONS 525100 121101288 121101288 PARTICIPANT AND RETIREE CONTRIBUT 525100 938276 938276 MEDICARE PART D REIMB. 525100 198376 198376 122237940 1667287 1667287 25402332 24851950 550382 550382 550382 124455609 122237940 0 2217669 118970540 1633164 2300533 570043 131756 138344 167706 305839 492988 386041 159736 214143 60162 30210 11402 18632 TEMPORARY STAFF AGENCY 33208 125624447 24309302 3694178 3025816 32084729 1029081 31502 908109 847187 68977 60922 51809009 56723717 1431819 1431819 80644923 95055948 15388 354905 2761467 0 2002379 15388 5118751 X 0 0 0 0 80629535 89937197 80629535 89937197 80644923 95055948 X -1168838 2161233 8315267 X X 0 1 X 1 0 908109 847187 60922 60922 ACCRUED PENSION COST 2002379 2002379 X 128551924 2161233 2967453 5128686 123423238 253283 779088 1032371 124455609 124713392 1455737 1455737 123257655 253283 2113509 2366792 125624447 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: PRIOR YEAR DEFERRED EMPLOYER CONTRIBUTIONS - CASH TO ACCRUAL 2,944,438. PRIOR YEAR DEFERRED PARTICIPANT CONTRIBUTIONS - CASH TO ACCRUAL 23,015. PART XI, LINE 4B - OTHER ADJUSTMENTS: PRIOR YEAR EMPLOYER RECEIVABLES - CASH TO ACCRUAL 750,311. PRIOR YEAR MEDICARE PART D RECEIVABLES - CASH TO ACCRUAL 28,777. PART XII, LINE 2D - OTHER ADJUSTMENTS: PRIOR YEAR PREPAID EXPENSES - CASH TO ACCRUAL 30,751. PRIOR YEAR PRESCRIPTION REBATES RECEIVABLE - CASH TO ACCRUAL 1,424,986. PART XII, LINE 4B - OTHER ADJUSTMENTS: PRIOR YEAR ACCRUED INVESTMENT EXPENSES - CASH TO ACCRUAL 52,556. PRIOR YEAR ACCRUED PENSION COST - CASH TO ACCRUAL & RETIRMENT BENEFITS ADJ 1,718,715. PRIOR YEAR DUE TO RETIREMENT FUND FOR ADMIN FEES - CASH TO ACCRUAL 17,952. PRIOR YEAR ACCRUED OTHER PROFESSIONAL FEES - CASH TO ACCRUAL 1,219. PRIOR YEAR ACCRUED ACCOUNTING FEES - CASH TO ACCRUAL 39,039. PRIOR YEAR ACCRUED LEGAL FEES - CASH TO ACCRUAL 2,575. PRIOR YEAR ACCRUED OFFICE EXPENSES - CASH TO ACCRUAL 7,562. PRIOR YEAR ACCRUED ACCRUED CONTAINMENT FEES - CASH TO ACCRUAL 273,891. X 0 0 0 MAURICE HODOS ADMINISTRATOR 208295 0 0 0 0 0 18121 0 17045 0 243461 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: PRIOR YEAR COST BASIS TO FMV OF INVESTMENTS - CASH TO ACCRUAL 8,315,267. FORM 990, PART XII, LINE 1: THE UFCW NATIONAL HEALTH AND WELFARE FUND'S FORM 990 PREPARATION CHANGED FROM MODIFIED CASH BASIS TO ACCRUAL (GAAP) BASIS. THIS CHANGE WAS MADE DUE TO THE ORGANIZATIONS FINANCIAL STATMENTS BEING PREPARED USING THE ACCRUAL METHOD. 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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