2017-10-13T11:31:45-05:00 2016-12-31 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2016-01-01 111896894 Amalgamated Meat Cutter & Retail Food AMAL 5167475980 166 E JERICHO TPKE MINEOLA NY 115012098 lisa O'leary union TRUSTEE 5167475980 2017-10-13 1 Louis Verzella CPA P00360279 6106689400 2017-10-10 162.211.205.39 2017-10-13 11:19:13 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 19998950A844A1ED5F18EB360E4E9E4F9906FFA9 2016 2021-01-29 14:40:06Z lisa o'leary 166 E JERICHO TPKE MINEOLA NY 115012098 19362476 0 X N/A X 1957 NY TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 4 2 56 0 0 0 0 0 25703133 19341668 20448 20381 280161 427 26003742 19362476 0 0 22146425 18223124 1208825 2020834 0 0 0 761643 1308692 24116893 21552650 1886849 -2190174 9931177 7607777 2519112 2385886 7412065 5221891 TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HEALTH BENEFITS FOR ELIGIBLE 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 1 790 0 56 1 0 0 0 0 0 0 X 4 2 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X FUND ADMINISTRATOR 5167475980 166 E JERICHO TURNPIKE MINEOLA NY 11501 DEANA TELMANY Alternate LABOR TRUSTEE 1.00 40.00 X 0 153345 17028 robert jandovitz EMPLOYER TRUSTEE 1.00 X 0 0 0 lisa o'leary labor Trustee 1.00 40.00 X 0 210792 17028 Michael Grosso eMPLOYER TRUSTEE 1.00 X 0 0 0 0 364137 34056 0 0 1 0 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL 346680 dickinson group llc 825 E Gate Blvd Ste 102 GARDEN CITY NY 11530 CLAIMS ADMINISTRATION/ACTUARIAL 229010 EMPIRE healthchoice assurance inc ONE LIBERTY PLAZA 165 BROADWAY NEW YORK NY 10006 CLAIMS ADMINISTRATION 106494 3 EMPLOYER CONTRIBUTIONS 525100 18877085 18877085 PRESCRIPTION REBATES 525100 223851 223851 COBRA CONTRIBUTIONS 525100 130214 130214 REFUND - CLAIMS 525100 61289 61289 REFUND - PREMIUMS 525100 49229 49229 19341668 20381 20381 MISCELLANEOUS INCOME 900099 427 427 427 19362476 19341668 0 20808 18223124 1526165 128375 231829 134465 366151 23602 32500 206259 49887 158899 101537 1413 463 80398 Emp. Benefits - W/d LIA 229645 Affordable Care Act Fe 57938 21552650 752424 1338251 6087061 5460662 2925517 581225 154523 154061 925 462 165250 227177 9931177 7607777 441907 636917 2077205 1748969 2519112 2385886 X 0 0 0 0 7412065 5221891 7412065 5221891 9931177 7607777 -2190174 0 X X 0 1 X 1 0 47393 47393 0 63157 62695 462 43973 43973 0 462 DUE TO related entities 104274 DEPOSIT PAYABLE 1593392 Fees mandated by ACA payable 51303 1748969 X 19362476 0 19362476 0 19362476 21552650 0 21552650 0 21552650 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 DEANA TELMANY Alternate LABOR TRUSTEE 0 153345 0 0 0 0 0 7935 0 9093 0 170373 0 0 lisa o'leary labor Trustee 0 210792 0 0 0 0 0 7935 0 9093 0 227820 0 0 Form 990, Part VI, Section B, line 11b AMCU LOCAL 342 WELFARE FUND'S FORM 990 IS PREPARED BY ITS INDEPENDENT PUBLIC ACCOUNTANT WHO THEN FORWARDS THE COMPLETED RETURN TO THE FUND'S ADMINISTRATOR FOR REVIEW. THE FUND ADMINISTRATOR THEN PRESENTS THE RETURN TO AT LEAST ONE MEMBER OF THE BOARD OF TRUSTEES FOR REVIEW AND SIGNATURE. Form 990, Part VI, Section C, line 19 AMCU LOCAL 342 WELFARE FUND MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE FOR INSPECTION BY PARTICIPANTS AND BENEFICIARIES AT THE FUND'S OFFICE. Form 990, Part VII Contact Addresses for Officers, Directors, Etc robert jandovitz - 8301 PROFESSIONAL PLACE, SUITE 110, LANDOVER, MD 20785. FORM 990, PART XII, LINE 2C: AMCU LOCAL 342 WELFARE FUND'S BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT THAT PERFORMS THE AUDIT. UFCW LOCAL 174 PENSION FUND 8751 18TH AVENUE BROOKLYN NY 11214 136219542 PENSION FUND NY 401 (A) 0 UFCW LOCAL 174 RETAIL PENSION FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 131845497 PENSION FUND NY 401 (A) 0 UFCW LOCAL 174 COMMERCIAL PENSION FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 133563111 PENSION FUND NY 401 (A) 0 FUR WORKERS LOCAL 3F PENSION FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 516099349 PENSION FUND NY 401 (A) 0 JT RETIREMENT FUND LEATHER GOODS PLASTICS HANDBAGS AND NOVELTY WORKERS 166 E JERICHO TURNPIKE MINEOLA NY 11501 112208237 PENSION FUND NY 401 (A) 0 AMCU LOCAL 342 A&P HEALTH AND WELFARE 166 E JERICHO TURNPIKE MINEOLA NY 11501 112208237 VEBA PLAN NY 501 (C)(9) 0 AMCU LOCAL 342 RFSEU GROUP LEGAL SERVICES FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 112547525 VEBA PLAN, LEGAL SERVICES NY 501 (C)(9) 0 AMCU LOCAL 342 PENSION FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 111896845 PENSION FUND NY 401 (A) 0 AMCU & RFSEU LOCAL 342 SAFETY EDUCATIONAL & CULTURAL FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 112447683 VEBA PLAN NY 501 (C)(9) 0 UFCW LOCAL 50 PENSION FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 136696824 PENSION FUND NY 401 (A) 0 UFCW LOCAL 342 HEALTH CARE FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 135626340 VEBA PLAN NY 501 (C)(9) 0 UFCW LOCAL 342 INDEPENDENT WELFARE FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 135328510 VEBA PLAN NY 501 (C)(9) 0 UFCW LOCAL 342 SAVINGS AND 401(K) PLAN 166 E JERICHO TURNPIKE MINEOLA NY 11501 562364474 PENSION FUND NY 401 (A) 0 UFCW LOCAL 50-627 SEVERANCE PAY FUND 166 E JERICHO TURNPIKE MINEOLA NY 11501 136415226 VEBA PLAN NY 501 (C)(9) 0 WALDBAUMS 2 PARAGON DRIVE MONTVALE NJ 07645 111448599 SUPERMARKET NJ C 0 PATHMARK STORES INC 2 PARAGON DRIVE MONTVALE NJ 07645 222879612 SUPERMARKET NJ C 0 THE STOP & SHOP SUPERMARKET 1385 HANCOCK ST QUINCY MA 02169 043061447 SUPERMARKET MA C 0 KING KULLEN GROCERY COMPANY INC 185 CENTRAL AVE BETHPAGE NY 11714 110954404 SUPERMARKET NY C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 AMCU LOCAL 342 RFSEU GROUP LEGAL SERVICES FUND P 1013932 UFCW UNION LOCAL 342 P 650000 AMCU LOCAL 342 RFSEU GROUP LEGAL SERVICES FUND O 165893 UFCW UNION LOCAL 342 O 870000 UFCW LOCAL 174 PENSION FUND O 56800 UFCW LOCAL 174 RETAIL PENSION FUND O 48179 UFCW LOCAL 174 COMMERCIAL PENSION FUND O 68000 JT RETIREMENT FUND LEATHER GOODS PLASTICS HANDBAGS AND NOVELTY WORKERS O 392800 AMCU LOCAL 342 HEALTHCARE FUND O 825000 AMCU LOCAL 342 PENSION FUND O 240000 amcu local 342 sec fund O 692854 ufcw local 342 savings and 401k fund O 114000