2016-10-14T08:37:48-05:00 2015-12-31 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2015-01-01 135521921 LAUNDRY DRY CLEANING WORKERS & ALIIED INDUSTRIES HEALTH FUND workers united AMAL 9143675000 333 westchester avenue white plains NY 106042910 michael potack TRUSTEE 9143675000 2016-10-14 1 Louis Verzella CPA P00360279 6106689400 2016-10-04 2015 2017-02-10 21:41:12Z michael potack 275 7TH AVENUE NEW YORK NY 10001 66514144 0 X N/A X 1946 NY VEBA HEALTH FUND PROVIDING HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 6 3 4 0 0 0 0 0 16846493 16507483 50828 59803 0 0 16897321 16567286 0 0 12243128 13175365 224795 221030 0 0 0 2587729 2282318 15055652 15678713 1841669 888573 15955656 16460027 534732 416810 15420924 16043217 TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, VISION AND PRESCRITION BENEFITS PAID TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 MEDICAL, HOSPITALIZATION, DENTAL, VISION AND PRESCRITION BENEFITS PAID TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 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 27 0 4 1 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 0 0 0 X FUND OFFICE 9143675000 333 westchester avenue white plains NY 106042910 ALBERTO ARROYO TRUSTEE 1.00 40.00 X 0 103478 36854 MICHAEL POTACK TRUSTEE 1.00 X 0 0 0 STANLEY ISRAEL ESQ TRUSTEE 1.00 X 0 0 0 BRIAN SANTONELLO TRUSTEE 1.00 X 0 0 0 WILFREDO LARANCUENT TRUSTEE 1.00 40.00 X 0 141469 46356 CHRISTINE KERBER TRUSTEE (P) 1.00 40.00 X 0 116827 0 MEGHAN CHAMBERS TRUSTEE 1.00 40.00 X 0 93133 0 0 454907 83210 0 0 1 0 Alicare INC 333 WESTCHESTER AVENUE WHITE PLAINS NY 10604 ADMINISTRATIVE & INVESTMENT SERVICES 1661441 EMPIRE HEALTHCHOICE ASSURANCE INC ONE LIBERTY PLAZA NEW York NY 10006 Claim processing fee 585466 SCHULTE ROTH & ZABEL LLP 919 Third Avenue New York NY 10022 LEGAL 147925 DELTA DENTAL OF NEW YORK 575 MADISON AVE 1006 NEW York NY 10022 112412 112412 4 EMPLOYER CONTRIBUTIONS 525100 16455856 16455856 SHARED EXPENSE REIMBURSEMENTS 525100 23700 23700 MEMBER CONTRIBUTIONS 525100 21486 21486 COBRA CONTRIBUTIONS 525100 6441 6441 16507483 77192 77192 49929469 49946858 -17389 -17389 -17389 16567286 16507483 0 59803 X 13175365 127667 18239 58937 16187 148904 35404 112297 1653825 43368 62827 5676 1616 22174 Fees mandated by the Af 164227 ALLOCATED PAYROLL AND C 32000 15678713 250 250 1342282 788366 1563396 1493640 20925 20925 16880 16880 0 0 3802588 4367713 8934585 9483133 291630 306000 15955656 16460027 133322 60551 401410 356259 534732 416810 X 0 0 0 0 15420924 16043217 15420924 16043217 15955656 16460027 888573 -266280 0 X X 0 1 X 1 0 16880 16880 0 0 Hedge fund of funds - diversified 4262899 F COMMON COLLECTIVE TRUST 5220234 F 9483133 DUE TO RELATED ENTITIES 32000 CASH OVERDRAFT 116228 dUE TO alico 173 OBLIGATION TO DISTRIBUTE CONTRIBUTIONS TO RELATED PARTIES 43631 Fees mandated by the Affordable Care Act 164227 356259 X 16165009 -266280 -266280 16431289 112297 23700 135997 16567286 15542716 0 15542716 112297 23700 135997 15678713 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: SHARED REIMBURSED EXPENSES 23,700. Part XII, Line 4b - Other Adjustments: SHARED REIMBURSED EXPENSES 23,700. 0 0 0 WILFREDO LARANCUENT TRUSTEE 0 141469 0 0 0 0 0 0 0 46356 0 187825 0 0 Form 990, Part VI, Section B, line 11 LAUNDRY, DRY CLEANING WORKERS & ALLIED INDUSTRIES HEALTH FUND, WORKERS UNITED'S FORM 990 IS PREPARED BY ITS INDEPENDENT PUBLIC ACCOUNTANT WHO THEN FORWARDS THE COMPLETED RETURN TO THE BOARD OF TRUSTEES FOR REVIEW AND SIGNATURE. Form 990, Part VI, Section B, line 12c LAUNDRY, DRY CLEANING WORKERS & ALLIED INDUSTRIES HEALTH FUND, workers united MONITORS ITS CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. Form 990, Part VI, Section C, line 19 LAUNDRY, DRY CLEANING WORKERS & ALLIED INDUSTRIES HEALTH FUND, WORKERS UNITED'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part VII ALBERTO ARROYO - 18 WASHINGTON PLACE, 3RD FLR, NEWARK, NJ 07102. MICHAEL POTACK - 401 SOUTH MACQUESTEN PARKWAY, MOUNT VERNON, NY 10550. STANLEY ISRAEL, ESQ - 50-35 56TH ROAD, MASPETH, NY 11378. BRIAN SANTONELLO - 1100 6TH AVENUE, NEPTUNE, NJ 07753. WILFREDO LARANCUENT - 18 WASHINGTON PLACE, 3RD FLR, NEWARK, NJ 07102. CHRISTINE KERBER - 18 WASHINGTON PLACE, 3RD FLR, NEWARK, NJ 07102. Form 990, Part IX, line 11g ACTUARY 55,408. ADMINISTRATIVE FEES 1,571,441. CONSULTING 26,976. FORM 990, PART XII, LINE 2C: LAUNDRY, DRY CLEANING WORKERS & ALLIED INDUSTRIES HEALTH FUND,WORKERS UNITED BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT WHO PERFORMED THE AUDIT. LAUNDRY DRY CLEANING WORKERS & ALLIED IND RETIREMENT FUNDWORKERS UNITED 333 westchester avenue WHITE PLAINS NY 10604 135521921 PENSION FUND NY 401(A)/501(A) 0 LAUNDRY DRY CLEANING WORKERS EDUCATION & LEGAL ASSISTANCE FUND WORKERS UNI 333 westchester avenue WHITE PLAINS NY 10604 201072118 EDUCATION AND LEGAL ASSISTANCE FUND NY 501(C)(9) 0 LAUNDRY DISTRIBUTION AND FOOD SERVICE JOINT BOARDWORKERS UNITED 18 WASHINGTON PLACE 2ND FLR NEWARK NJ 07102 135197381 LABOR UNION NJ 501(C)(5) 0 ACLS New England Inc Allen Linen Supply American Drive In Cleaners of Hewlett Amertex Services Apparel Plus Textile Rental LLC Aramark Uniform Services Newark NJ Arrow Linen Supply Co Best Metropolitan Elite Airline Linen of New York Inc Ernest Winzer Cleaners LLC FDR Services Corp of New Jersey HCSC Laundry Asbury Park NJ Highland Light Steam Laundry Inc Keum Limited MSJ Inc FKA Auburn Towel Marval Industries Inc Med Apparel Services Meritex LLC Merlin Industries Oceanside Institutional Industries Paul Dyeing Co Quality Linen Supply Service Riddell Inc All American Sports Corp Sanitary Coat Appron & Towel Supply Co Inc Shared Textiles - MiddleTown Stain-Less Inc Star Cleaners - Rockville UNITEX Textile Rental Inc WH Linen Supply NEW ENGLAND LINEN NORTH EAST LINEN WH Christian & Sons (Vision & Retirement Only) 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 LAUNDRY DRY CLEANING WORKERS & ALLIED IND RETIREMENT FUNDWORKERS UNITED Q 20700 FMV LAUNDRY DRY CLEANING WORKERS & UNITE EDUCATION & LEGAL ASSISTANCE FUND Q 3000 FMV LAUNDRY DISTRIBUTION AND FOOD SERVICE JOINT BOARDWORKERS UNITED O 32000 fMV LAUNDRY DISTRIBUTION AND FOOD SERVICE JOINT BOARDWORKERS UNITED K 53400 fMV