2018-10-22T12:18:53-04:00 2017-12-31 222212404 BARATZ & ASSOCIATES PA 7 EVES DRIVE SUITE 100 MARLTON NJ 080533196 990 2017-01-01 236449794 UFCW UNION & PARTICIPATING FOOD IND EMPLOYERS TRI-STATE HEALTH-WELFARE UFCW 8567932500 27 ROLAND AVENUE MT LAUREL NJ 08054 BRIAN STRING TRUSTEE 8567932500 2018-10-15 true JOHN FEKETE CPA P00956964 8569855688 2018-10-22 71.245.123.86 2018-10-22 11:18:53 CD P A9A4BEAFAD9B34E2AB7ABC2F9099AF2C7B0A04C0 87D733E89D3F0882E3130F70511142B0764A40B8 2017 2018-06-14 16:35:46Z BRIAN STRING BRIAN STRING 701 ROUTE 50 MAYS LANDING NJ 08330 33229154 false X N/A X HEALTH FUND 1967 NJ 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. 7 7 0 0 0 33474609 33165124 75354 64030 0 33549963 33229154 0 29308267 28558661 0 0 0 2886266 2514510 32194533 31073171 1355430 2155983 7640147 9997796 5075863 5145046 2564284 4852750 X 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. false false PROVIDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. TO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS. false false false false false false false false false true false false true true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 396 0 true 0 false false false false false false X 7 7 false true false false false false false true true false false true false true true false false false X FUND ADMINISTRATOR 8567932500 27 ROLAND AVENUE MT LAUREL NJ 08054 X DANIEL DOSENBACH DANIEL DOSENBACH TRUSTEE 1.00 X 0 0 0 GREGORY QUAGLIATO GREGORY QUAGLIATO TRUSTEE 1.00 X 0 0 0 DANIEL KONCZYK DANIEL KONCZYK TRUSTEE 1.00 X 0 0 0 BRIAN STRING BRIAN STRING TRUSTEE 1.00 X 0 0 0 TIM TERIFAY TIM TERIFAY TRUSTEE 1.00 X 0 0 0 MITCHELL SCHAFER MITCHELL SCHAFER TRUSTEE 1.00 X 0 0 0 STEPHEN MOYER STEPHEN MOYER TRUSTEE 1.00 X 0 0 0 false false false TRI-STATE ADMINISTRATORS INC 27 ROLAND AVE 27 ROLAND AVE MT LAUREL NJ 08054 ADMINISTRATIVE 2131245 AMERIHEALTH ADMINISTRATORS 720 BLAIR MILL RD 720 BLAIR MILL RD HORSHAM PA 19044 HEALTH BENEFITS 268276 SPEAR WILDERMAN PC 230 S BROAD ST 230 S BROAD ST PHILADELPHIA PA 19102 LEGAL 191178 HEALTH MAP INC 1 CLEMENTS COURT 1 CLEMENTS COURT MT LAUREL NJ 08054 STAFFING CO 165444 HEALTH PLAN SYSTEMS INC 1 WOODBRIDGE CENTER STE220 1 WOODBRIDGE CENTER STE 220 WOODBRIDGE TWP NJ 07095 COMPUTER 148069 6 EMPLOYER CONTRIBUTIONS 33074677 33074677 EMPLOYEE CONTRIBUTIONS 90447 90447 33165124 64030 28 64002 33229154 33165152 64002 28558661 48932 26750 2824 318 38114 ADMINISTRATOR FEES 2040322 DATA PROCESSING 148069 SPECIAL PROJECT FEES 101923 OFFICE 66207 41051 31073171 0 0 0 3280060 5499340 1200112 1150603 35883 27594 277543 277543 318 2257774 2454259 866000 866000 7640147 9997796 362811 125896 4713052 5019150 5075863 5145046 X 2564284 4852750 2564284 4852750 7640147 9997796 2155983 132483 X false true X true false 277543 277543 BLUE CROSS DEPOSIT 866000 866000 ACCRUED BENEFIT LIABILITIES 5019150 5019150 X 33353637 132483 132483 33221154 8000 8000 33229154 30759072 -1 -1 30759073 8000 306098 314098 31073171 SCHEDULE D, PAGE 3, PART X THE FUND MEETS THE CRITERIA OF THE US FEDERAL TAX CODE SECTION 501(C)(9) FOR EXEMPTION FROM FEDERAL INCOME TAX. 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 2015. SCHEDULE D, PAGE 4, PART XII, LINE 2D ROUNDING -1 SCHEDULE D, PAGE 4, PART XII, LINE 4B BENEFITS PAYABLE ADJUSTMENT 306,098 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. WEPCO FEDERAL CREDIT UNION PO BOX 157 BLOOMINGTON MD 21523 520627367 FINL SVCS MD 501C1 N/A false FIRST PEOPLES COMMUNITY FCU 153 BALTIMORE ST CUMBERLAND MD 21502 520905189 FINL SVCS MD 501C1 N/A false CHESSIE FCU PO BOX 689 CUMBERLAND MD 215010689 520580973 FINL SVCS MD 501C1 N/A false THE LIONS CENTER FOR REHABILITATION 901 SETON DR CUMBERLAND MD 21502 520812302 NURSINGSVC MD 115 N/A false 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 UNION ORGANIZATION FOR SOCIAL SERV 4212 BEACON AVE PENNSAUKEN NJ 08019 210639887 SOCIAL SVC NJ 501C3 N/A false FROSTBURG FACILITY OPERATIONS LLC ONE KAYLOR CIRCLE FROSTBURG MD 21532 205111843 MD N/A false false ASSISTED LIVING AT FROSTBURG VILLAG 100 VILLAGE PARKWAY FROSTBURG MD 21532 205103941 MD N/A false false AVISTA HEALTHCARE LLC 3025 CHAPEL AVE WEST CHERRY HILL NJ 08002 205274922 NJ N/A false false ACME MARKETS INC 11840 VALLEY VIEW RD EDEN PRAIRIE MN 55344 870440072 FOOD STORE MN SUPERVALUE C CORP false ARAMARK CORRECTIONAL SERVICES PO BOX 34 TITUSVILLE NJ 08560 232778485 FOOD SERV NJ N/A C CORP false AVON FOODS INC ROEBLING TOWN MARKET 1275 HORNBERGER AVE ROEBLING NJ 08554 562628476 GROCERY ST NJ N/A S CORP false CAPE REGIONAL MEDICAL CENTER 2 STONE HARBOR BLVD CAPE MAY CO COURTHOUSE NJ 08210 210662542 HEALTHCARE NJ N/A C CORP false CROTHALL HEALTHCARE 2 STONE HARBOR BLVD CAPE MAY CO COURTHOUSE NJ 08210 510386133 HEALTHCARE NJ N/A C CORP false GENESIS HEALTHCARE 515 FAIRMONT AVE TOWSON MD 21286 HEALTHCARE NJ N/A C CORP false HEALTH FACILITIES INC STATESMAN HEALTH & REHABILITATION C 2629 TRENTON RD LEVITTOWN PA 19056 391406172 PA N/A C CORP false HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DR SUITE 300 BENSALEM PA 19020 232018365 PA N/A C CORP false MARYLAND JOCKEY CLUB OF BALTIMORE CITY INC PIMLICO RACE COURSE 5201 PARK HEIGHTS AVENUE BALTIMORE MD 21215 521550164 RACING MD N/A false NURSING HOME BOARD OF ALLEGHANEY COUNTY THE LIONS CENTER FOR REHAB 901 SETON DR CUMBERLAND MD 21502 520812302 HEALTHCARE N/A C CORP false PATHMARK 2 PARAGON DR MONTVALE NJ 07645 222879612 GROCERY ST NJ GREAT ATLANTIC & PACIFIC TEA COMPANY C CORP false STATESMAN HEALTH & REHAB CENTER 2629 TRENTON RD LEVITTOWN PA 19056 222879612 HEALTHCARE PA N/A false WILLSE & ASSOCIATES INC NATIONAL CAPITAL ADMIN SVCS (NCAS) 1501 S CLINTON ST 7TH FLOOR BALTIMORE MD 21224 521187907 GROCERY ST MD N/A C CORP false SUPER FRESH 2 PARAGON DR MONTVALE NJ 07645 222402491 GROCERY ST NJ GREAT ATLANTIC & PACIFIC TEA COMPANY false false false false false false false false false false false false false false false false true true false false UFCW HEALTH & WELFARE FUND P 3175 ALLOCATED BASED ON USAGE UFCW HEALTH & WELFARE FUND Q 7449 ALLOCATED BASED ON USAGE UFCW LOC 152 HEALTH & WELFARE FUND Q ALLOCATED BASED ON USAGE