2016-11-13T22:14:22-06:00 2015-12-31 510545975 PETER DECARLO CPA PLLC 112 WEST 34TH STREET 18TH FLOOR NEW YORK NY 10120 990 2015-01-01 160915820 UFCW LOCAL ONE HEALTH CARE FUND UFCW 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 3157979600 2016-11-13 1 PETER DECARLO CPA P00851470 2129464907 X 2015 2017-02-10 21:41:12Z FRANK C DERISO 5911 AIRPORT ROAD ORISKANY NY 13424 86983256 0 X WWW.UFCWONE.ORG X 1959 NY PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 10 0 27 0 0 0 0 0 68319842 71960326 1283891 704570 0 0 69603733 72664896 0 0 67907335 79933879 1289468 1360967 0 0 0 1443143 2272817 70639946 83567663 -1036213 -10902767 40945734 29604973 230394 232415 40715340 29372558 THE OBJECTIVE OF THE FUND IS TO PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS, WHO ARE MEMBERS OF UFCW DISTRICT UNION LOCAL ONE, AND THEIR COVERED DEPENDENTS. 0 0 THE PLAN PROVIDED CERTAIN HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 12,360 ELIGIBLE PARTICIPANTS AND THEIR COVERED DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 8 0 1 27 1 0 0 0 0 0 0 X 10 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 X MICHAEL CIANCAGLINI 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 1.00 52.00 X 0 253381 31681 ERIC A GLATHAR TRUSTEE 1.00 52.00 X 0 193996 28126 GREGORY P GOREA TRUSTEE 1.00 50.00 X 0 176114 27700 ROBERT CIANCAGLINI TRUSTEE 1.00 50.00 X 0 80974 22200 ROGER HEMMITT TRUSTEE 1.00 50.00 X 0 95219 22702 JOHN BARRETT TRUSTEE 1.00 2.00 X 0 0 0 I STEPHEN DAVIS TRUSTEE 1.00 0.00 X 0 0 0 JOSEPH SAHLEN TRUSTEE 1.00 1.00 X 0 0 0 RAYMOND WARDYNSKI TRUSTEE 1.00 1.00 X 0 0 0 KRISTINE WYDRO TRUSTEE 1.00 1.00 X 0 0 0 ED COLBURN TRUSTEE - PAST 1.00 0.00 X 0 0 0 ANDREA GOLDBERGER ADMINISTRATIVE DIRECTOR 22.00 18.00 X 144484 0 33755 MICHAEL CIANCAGLINI EMPLOYEE 40.00 0.00 X 117475 0 31628 261959 799684 197792 2 0 1 0 SLEVIN & HART PC 1625 MASSACHUSETTS AVENUE NW WASHINGTON DC 20036 LEGAL 129549 1 EMPLOYER CONTRIBUTIONS 525100 69171525 69171525 PARTICIPANT CONTRIBUTIONS 525100 2788801 2788801 71960326 865723 865723 14157207 14318360 -161153 -161153 -161153 72664896 71960326 0 704570 79933879 918954 168626 198797 74590 129780 71348 85659 154868 110158 413353 170727 34317 39584 31136 53603 AFFORDABLE CARE ACT TAX 894017 OPERATIONS EXPENSE 30709 LITIGATION EXPENSE 30000 PRINTING & PUBLICATIONS 21731 1827 83567663 10162 11251 5221015 3323976 6818660 7296908 271462 31458 2047013 2002389 75760 44624 27408069 17256150 1140606 1640606 40945734 29604973 154352 172766 76042 59649 230394 232415 X 0 0 0 0 40715340 29372558 40715340 29372558 40945734 29604973 -10902767 -440015 0 X X 0 1 X 1 0 28682 28682 0 676801 671512 5289 1341530 1302195 39335 44624 RESERVES HELD BY INSURANCE COMPANY 1640606 1640606 DUE TO BROKER FOR SECURITIES PURCHASED 20975 DUE TO UFCW DISTRICT UNION LOCAL ONE 38674 59649 72139222 -440015 -440015 72579237 85659 85659 72664896 83482004 0 83482004 85659 85659 83567663 X 0 0 0 FRANK C DERISO TRUSTEE 0 253381 0 0 0 0 0 10880 0 20801 0 285062 0 0 ERIC A GLATHAR TRUSTEE 0 193996 0 0 0 0 0 9264 0 18862 0 222122 0 0 GREGORY P GOREA TRUSTEE 0 176114 0 0 0 0 0 9071 0 18629 0 203814 0 0 ANDREA GOLDBERGER ADMINISTRATIVE DIRECTOR 144484 0 0 0 0 0 12695 0 21060 0 178239 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF TRUSTEES FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS CONDUCTED. FORM 990, PART VI, SECTION C, LINE 19 DISCLOSURES REQUIRED BY LAW ARE AVAILABLE TO THE PUBLIC AT THE FUND'S OFFICE, UPON REQUEST. FORM 990, PART XII, LINE 2C THE FUND'S BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE DURING THE TAX YEAR IN EITHER THE FUND'S OVERSIGHT OR SELECTION PROCESS. UFCW DISTRICT UNION LOCAL ONE 5911 AIRPORT ROAD ORISKANY NY 13424 150559586 LABOR UNION NY 501(C)(5) 0 UFCW LOCAL ONE PENSION FUND 5911 AIRPORT ROAD ORISKANY NY 13424 166144007 PENSION PLAN NY 501(A) 0 UFCW LOCAL ONE 401(K) SAVINGS PLAN 5911 AIRPORT ROAD ORISKANY NY 13424 166184130 PENSION PLAN NY 501(A) 0 LUTHERAN HOMES ADIRONDACK MEDICAL CENTER ST ELIZABETH MEDICAL CENTER EVERGREEN VALLEY NURSING HOME NIAGRA GERIATRIC CENTER STAMFORD HEALTH CARE HERITAGE HEALTH CARE CENTER TOPS MARKETS INC EMPIRE MERCHANTS NORTH ALBANY KRAFT FOODS INC GREAT AMERICAN STORES SILGAN CONTAINERS MANUFACTURING CORP SAHLEN PACKING CORP G&L DAVIS MEAT CO HOMETOWN MARKETS LLC THORNES OF WARREN SPECIALTY STEAK EMPIRE MERCHANTS NORTH BUFFALO SHOP RITE SUPERMARKETS INC CHANATRY'S FRENCH ROAD MARKET ZWEIGLES INC GIANT EAGLE INC SODEXO INC WELCH FOODS INC CARRIER COACH BREENS FAMILY INC FORT'S GROCERY INC SMITH PACKING COMPANY WALTON'S BIG M HOFMANN SAUSAGE CO INC OLD WORLD PROVISION CO INC LR BRASS INC COUDERSPORT JUBILEE SMYD CORP DIVERSE FOOD PRODUCTS LLC VANCHLOR CO FRANK WARDYNSKI & SONS INC TN HARVEY INC PAWLAKS FOOD CENTER FILLMORE JUBILEE GALETON IGA FIBERCELL PACKAGING LLC BIG V CORP MILWARD ALLOYS INC THE WINE GROUPMOGEN DAVID GATES BIG M CAPITAL DISTRICT AREA LABOR FEDERATION CAMELLIA GENERAL PROVISION CO CENTRAL NEW YORK LABOR AGENCY INDELICATO'S MARKET MUGG PHOTOGRAPHY PARKVIEW SUPERMARKET PENNSYLVANIA AFL-CIO P&C FOOD MARKETS INC 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 UFCW DISTRICT UNION LOCAL ONE P 212982 ALLOCATION UFCW LOCAL ONE PENSION FUND Q 892532 ALLOCATION UFCW LOCAL ONE 401(K) SAVINGS PLAN Q 203191 ALLOCATION UFCW DISTRICT UNION LOCAL ONE S 501512 CONTRACT LUTHERAN HOMES S 1919586 CONTRACT ADIRONDACK MEDICAL CENTER S 1210538 CONTRACT ST ELIZABETH MEDICAL CENTER S 1071917 CONTRACT EVERGREEN VALLEY NURSING HOME S 199541 CONTRACT NIAGRA GERIATRIC CENTER S 122550 CONTRACT STAMFORD HEALTH CARE S 541250 CONTRACT HERITAGE HEALTH CARE CENTER S 994904 CONTRACT TOPS MARKETS INC S 50531533 CONTRACT EMPIRE MERCHANTS NORTH ALBANY S 1797513 CONTRACT KRAFT FOODS INC S 1525066 CONTRACT GREAT AMERICAN STORES S 576113 CONTRACT SILGAN CONTAINERS MANUFACTURING CORP S 858133 CONTRACT SAHLEN PACKING CORP S 689440 CONTRACT G&L DAVIS MEAT CO S 709738 CONTRACT HOMETOWN MARKETS LLC S 464493 CONTRACT THORNES OF WARREN S 522954 CONTRACT SPECIALTY STEAK S 451441 CONTRACT EMPIRE MERCHANTS NORTH BUFFALO S 513912 CONTRACT SHOP RITE SUPERMARKETS INC S 630962 CONTRACT CHANATRY'S FRENCH ROAD MARKET S 361893 CONTRACT ZWEIGLES INC S 238355 CONTRACT GIANT EAGLE INC S 249047 CONTRACT SODEXO INC S 204074 CONTRACT WELCH FOODS INC S 246320 CONTRACT CARRIER COACH S 163274 CONTRACT BREENS FAMILY INC S 196996 CONTRACT FORT'S GROCERY INC S 208096 CONTRACT SMITH PACKING COMPANY S 176176 CONTRACT WALTON'S BIG M S 174180 CONTRACT HOFMANN SAUSAGE CO INC S 242013 CONTRACT OLD WORLD PROVISION CO INC S 197284 CONTRACT LR BRASS INC S 122180 CONTRACT COUDERSPORT JUBILEE S 166362 CONTRACT SMYD CORP S 146142 CONTRACT DIVERSE FOOD PRODUCTS LLC S 106400 CONTRACT VANCHLOR CO S 174331 CONTRACT FRANK WARDYNSKI & SONS INC S 83416 CONTRACT TN HARVEY INC S 68072 CONTRACT PAWLAKS FOOD CENTER S 53680 CONTRACT FILLMORE JUBILEE S 64197 CONTRACT GALETON IGA S 65106 CONTRACT FIBERCELL PACKAGING LLC S 302307 CONTRACT BIG V CORP S 171253 CONTRACT MILWARD ALLOYS INC S 188785 CONTRACT THE WINE GROUPMOGEN DAVID S 74160 CONTRACT