2017-06-08T07:50:44-05:00 2016-09-30 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2015-10-01 221458594 UFCW NATIONAL HEALTH AND WELFARE FUND UFCW 2015698801 66 GRAND AVENUE ENGLEWOOD NJ 07631 GEORGE J ORLANDO TRUSTEE 2015698801 2017-06-08 1 Louis Verzella CPA P00360279 6106689400 2017-05-18 2015 2021-01-29 14:40:06Z GEORGE J ORLANDO 66 GRAND AVENUE ENGLEWOOD NJ 07631 118298012 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 30 0 0 0 0 0 103057390 104374859 647373 972116 0 0 103704763 105346975 0 0 93099527 94689950 2597607 2758928 0 0 0 1837429 1840052 97534563 99288930 6170200 6058045 67331890 74239882 0 0 67331890 74239882 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 0 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 7 0 30 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 188630 0 26320 188630 0 26320 1 0 1 0 HORIZON BLUE CROSS BLUE SHIELD 3 Penn Plaza East PP-04K NEWARK NJ 07105 CLAIMS ADMINISTRATION 2023576 CONIFER VALUE BASED CARE LLC 15821 VENTURA BLVD STE 600 ENCINO CA 91436 COST CONTAINMENT 382835 THE SEGAL COMPANY 333 West 34th Street NEW YORK NY 10001 CONSULTING/ACTUARIAL FEES 305700 Express Scripts N19 W24130 Riverwood Drive Waukesha WI 53188 CLAIMS ADMINISTRATION 251769 HEALTHSMART CARE MGMT SOLUTION 222 WEST LAS COLINAS BOULEVARD STE IRVING TX 75039 HEALTH CARE MANAGEMENT 195129 8 EMPLOYER CONTRIBUTIONS 525100 103800986 103800986 PARTICIPANT AND RETIREE CONTRIBUT 525100 440054 440054 MEDICARE PART D REIMB. 525100 133819 133819 104374859 902364 902364 13020789 12951037 69752 69752 69752 105346975 104374859 0 972116 94689950 222197 1302580 630864 479393 123894 159448 97472 200802 458769 407558 153369 221928 62636 4996 40224 tEMPORARY STAFF AGENCY 32850 99288930 755243 1721382 22606731 28200582 866856 830935 8960 35921 43110955 42985163 850001 1296834 67331890 74239882 0 0 X 0 0 0 0 67331890 74239882 67331890 74239882 67331890 74239882 X 6058045 849947 X X 0 1 X 1 0 866856 830935 35921 35921 X 107786107 3024233 3024233 104761874 239189 345912 585101 105346975 98458213 -591528 -591528 99049741 239189 239189 99288930 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 4b - Other Adjustments: CHANGE IN RECEIVABLES 345,912. Part XII, Line 2d - Other Adjustments: CHANGE IN PAYABLES -591,528. X 0 0 0 MAURICE HODOS ADMINISTRATOR 188630 0 0 0 0 0 10519 0 15801 0 214950 0 0 0 Form 990, Part VI, Section B, line 11 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 VII GEORGE J. ORLANDO - 219 PATERSON AVENUE, LITTLE FALLS, NJ 07424. GERALDINE SENACK - 556 BOCA CIEGA POINT BLVD. SOUTH, MADEIRA BEACH, FL 33708. MICHELLE LEWIS - E & J GALLO WINERY, P.O. BOX 1130, MODESTO, CA 95353. JOHN PEPE - 520 DIVISION ST, GALLO WINE SALES OF NJ, ELIZABETH, NJ 07201. BRIAN FITZSIMMONS - P.O. BOX 600, SHAW'S SUPERMARKETS INC, e BRIDGEWATER, MA 02333. Form 990, Part XI, line 9: adjustment of cost basis of investments 849,947. FORM 990, PART XIi, LINE 1: UFCW NATIONAL HEALTH AND WELFARE FUND'S FORM 990 IS PREPARED USING THE MODIFIED CASH BASIS OF ACCOUNTING. 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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