2017-07-14T09:43:59-05:00 2016-09-30 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2015-10-01 463496310 UFCW LOCAL 1262 AND EMPLOYERS HEALTH FUND UFCW 9737773700 1389 BROAD STREET CLIFTON NJ 07013 Harvey whille TRUSTEE 9737773700 2017-07-14 Louis Verzella CPA P00360279 6106689400 2017-07-10 2015 2021-01-29 14:40:06Z Harvey whille 1389 BROAD STREET CLIFTON NJ 07013 2914610 0 X N/A X 2013 NJ TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE, AND OTHER MEDICAL BENEFITS TO APPROXIMATELY XXX ELIGIBLE PARTICIPANTS. 4 2 0 0 0 0 0 0 3514214 2914264 23 346 0 0 3514237 2914610 0 0 2988843 5290739 72385 71382 0 0 0 353324 341018 3414552 5703139 99685 -2788529 3435584 615983 109870 78798 3325714 537185 TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE, AND OTHER MEDICAL BENEFITS TO APPROXIMATELY XXX ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE, AND OTHER MEDICAL BENEFITS TO APPROXIMATELY XXX ELIGIBLE PARTICIPANTS. 0 0 0 0 0 0 0 0 0 1 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 4 0 0 0 0 0 0 0 0 X 4 2 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X ROBERT GEREMINO CONTROLLER 9737785800 1389 BROAD STREET CLIFTON NJ 07013 HARVEY WHILLE UNION TRUSTEE 1.00 40.00 X 0 364950 23453 MATTHEW MOLINARO UNION tRUSTEE 1.00 40.00 X 0 322848 23453 LOUIS SCADUTO EMPLOYER TRUSTEE 1.00 X 0 0 0 DAVID MANIACI EMPLOYER TRUSTEE 1.00 X 0 0 0 0 687798 46906 0 0 1 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATOR 106502 1 EMPLOYER CONTRIBUTIONS 900099 2770079 2770079 RETIREE CONTRIBUTIONS 900099 133168 133168 COBRA CONTRIBUTIONS 900099 11017 11017 2914264 346 346 2914610 2914264 0 346 5290739 53342 2778 10795 4467 71096 145469 13941 60199 13981 15465 2658 317 213 3607 FEES MANDATED BY THE AF 14072 5703139 2386 11074 297681 666 201365 318000 1792 3400 802 361 462 441 2931898 282402 3435584 615983 89017 44486 20853 34312 109870 78798 X 3325714 537185 3325714 537185 3435584 615983 -2788529 0 X X 0 1 X 1 0 783 353 430 19 8 11 441 PRESCRIPTION REBATES RECEIVABLE 138412 ASSET TRANSFER RECEIVABLE 143990 282402 DUE TO RELATED PARTIES 14556 FEES MANDATED BY THE AFFORDABLE CARE ACT 14094 CASH OVERDRAFT 5662 34312 X 2914610 0 2914610 0 2914610 5703139 0 5703139 0 5703139 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. 0 0 0 HARVEY WHILLE UNION TRUSTEE 0 358604 0 6346 0 0 0 8957 0 14496 0 388403 0 0 MATTHEW MOLINARO UNION tRUSTEE 0 317240 0 5608 0 0 0 8957 0 14496 0 346301 0 0 Form 990, Part VI, Section A, line 8b THE ORGANIZATION HAS NO SUBCOMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. Form 990, Part VI, Section B, line 11 THE UFCW LOCAL 1262 AND EMPLOYERS HEALTH FUND'S FORM 990 IS PREPARED BY ITS INDEPENDENT ACCOUNTANT AND IS SUBMITTED AND REVIEWED WITH THE ADMINISTRATOR. THE ADMINISTRATOR THEN REVIEWS IT WITH THE CHAIRPERSON OF THE BOARD OF TRUSTEES FOR THEIR APPROVAL PRIOR TO FILING. A COPY OF THE FORM 990 IS AVAILABLE TO THE EXECUTIVE BOARD MEMBERS UPON REQUEST. Form 990, Part VI, Section C, line 19 THE FUND'S GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AND MAY BE VIEWED AT THE FUND OFFICE. Form 990, Part XII, Line 2c: THE ORGANIZATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. UFCW LOCAL 1262 & EMPLOYERS PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226074414 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UFCW LOCAL 1262 & EMPLOYERS LEGAL SERVICES FUND 1389 BROAD STREET CLIFTON NJ 07013 222238707 TO PROVIDE LEGAL BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UFCW LOCAL 1262 & EMPLOYERS WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 226137317 TO PROVIDE HEALTH, MEDICAL & OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UFCW LOCAL 1262 1389 BROAD STREET CLIFTON NJ 07013 221339607 REPRESENTS MEMBERS IN COLLECTIVE BARGAINING MATTERS WITH EMPLOYERS NJ 501(c)(5) 0 UFCW LOCAL 1262 & EMPLOYERS RETAIL NON-FOOD PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226181292 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UFCW LOCAL 1262 PATHMARK HEALTH & WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 371664252 TO PROVIDE HEALTH, MEDICAL & OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UFCW LOCAL 1262 & EMPLOYERS HEALTH & WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 237042767 TO PROVIDE HEALTH, MEDICAL & OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 FOODTOWN CORPORATION NJ 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 UFCW LOCAL 1262 & EMPLOYERS PENSION FUND O 164049 FMV UFCW LOCAL 1262 K 2658 FMV UFCW LOCAL 1262 P 10929 FMV UFCW LOCAL 1262 & EMPLOYERS HEALTH AND WELFARE O 10925 FMV