2016-08-08T15:28:21-05:00 2015-09-30 464001827 SAXBST LLP 28 WEST 44TH STREET NEW YORK NY 10036 990 2014-10-01 463496310 UFCW LOCAL 1262 AND EMPLOYERS HEALTH FD UFCW 9737785800 1389 BROAD STREET CLIFTON NJ 07013 HARVEY WHILLE TRUSTEE 9737785800 2016-08-08 1 PATRICK C STINES P01592735 2126618640 2014 2016-12-15 16:53:06Z HARVEY WHILLE 1389 BROAD STREET CLIFTON NJ 07013 3514237 0 X X 2013 NJ TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE, AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 600 ELIGIBLE PARTICIPANTS. 4 0 0 0 0 0 0 0 3774091 3514214 6 23 0 0 3774097 3514237 0 0 3176974 2988843 65821 72385 0 0 0 124273 353324 3367068 3414552 407029 99685 3513375 3435584 106346 109870 3407029 3325714 TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE, AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 600 ELIGIBLE PARTICIPANTS. 0 0 TO PROVIDE MEDICAL, HOSPITALIZATION, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE, AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 600 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 1 0 0 0 0 0 0 0 0 0 X 4 0 0 1 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 TRUSTEE 1.00 40.00 X 0 346637 24267 MATTHEW MOLINARO TRUSTEE 1.00 40.00 X 0 305522 23557 LOUIS SCADUTO TRUSTEE 1.00 X 0 0 0 DAVID MANIACI TRUSTEE 1.00 X 0 0 0 0 652159 47824 0 0 1 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATOR 148105 BUCK CONSULTANTS 500 PLAZA DRIVE SECAUCUS NJ 07094 CONSULTANT 107119 2 EMPLOYERS' CONTRIBUTIO 900099 3334992 3334992 RETIREE CO-PAY 900099 114117 114117 PARTICIPANTS, COBRA 900099 65105 65105 3514214 23 23 3514237 3514214 0 23 2988843 54137 2826 10680 4742 144061 12000 8829 17007 2465 3805 148 2220 CONSULTING FEES 108244 THIRD PARTY ADMINISTRAT 47182 POSTAGE 4552 TELEPHONE 1899 912 3414552 2386 41206 297681 219749 201365 1259 1792 610 148 132 462 3251029 2931898 3513375 3435584 76798 89017 29548 20853 106346 109870 X 3407029 3325714 3407029 3325714 3513375 3435584 X 99685 -181000 X 0 1 X 0 0 610 148 462 462 PRESCRIPTION REBATES RECEIVABLE 54000 ASSET TRANSFER RECEIVABLE 2877898 2931898 DUE TO AFFILIATES 20853 20853 X 3514237 0 3514237 0 3514237 3414552 0 3414552 0 3414552 PART X, LINE 2: THE PLAN IS EXEMPT FROM FEDERAL INCOME TAX UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE, AND HAS OBTAINED A FAVORABLE DETERMINATION LETTER DATED JUNE 8, 2015 FROM THE INTERNAL REVENUE SERVICE (IRS). THE PLAN FILES AN ANNUAL FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, WITH THE IRS. 0 0 0 HARVEY WHILLE TRUSTEE 0 346637 0 0 0 0 0 9771 0 14496 0 370904 0 0 MATTHEW MOLINARO TRUSTEE 0 305522 0 0 0 0 0 9061 0 14496 0 329079 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENGAGES A MANAGEMENT COMPANY TO PERFORM ADMINISTRATIVE SERVICES INCLUDING OVERSIGHT OF CERTAIN PERSONNEL AND EXECUTING FINANCIAL OPERATIONS ON A LIMITED BASIS. THE SERVICES ARE PERFORMED UNDER THE TERMS OF A WRITTEN CONTRACT. 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 FUND'S 990 IS PREPARED BY ITS OUTSIDE AUDITOR AND IS SUBMITTED AND REVIEWED WITH THE ADMINISTRATOR. THE ADMINISTRATOR THEN REVIEWS IT WITH THE CHAIRPERSON OF THE BOARD OF TRUSTEES. A COPY OF THE RETURN 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 XI, LINE 9: EFFECTIVE OCTOBER 1, 2013, FOODTOWN, A CONTRIBUTING EMPLOYER IN THE UFCW LOCAL 1262 AND EMPLOYERS WELFARE FUND (WELFARE FUND) WITHDREW FROM THE WELFARE FUND. ACTIVE AND RETIRED FOODTOWN EMPLOYEES WERE SPUN OFF INTO THE PLAN. AS OF SEPTEMBER 30, 2015, THE ESTIMATED AMOUNT OF ASSETS TO BE TRANSFERRED FROM THE PLAN TO THE WELFARE FUND IS APPROXIMATELY $181,000 AND IS INCLUDED AS ASSET TRANSFER PAYABLE IN THE STATEMENT OF NET ASSETS AVAILABLE FOR BENEFITS. -181,000. FORM 990, PART XII, LINE 2C GENERALLY ACCEPTED ACCOUNTING PRINCIPLES ALLOW FOR PRESENTATION OF ESTIMATED CURRENT CLAIMS OBLIGATIONS ON A SEPARATE STATEMENT IN THE FUND'S AUDITED FINANCIAL STATEMENTS. FOR CONSISTENCY, THE BALANCE SHEET FOR FORM 990 WILL ALSO NOT INCLUDE LIABILITIES FOR ESTIMATED CURRENT CLAIMS OBLIGATIONS. NET ASSETS PER THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE ESTIMATED CURRENT CLAIMS OBLIGATIONS OF $2,963,979 AND ESTIMATED POST RETIREMENT OBLIGATIONS OF $2,560,699. UNITED FOOD AND COMMERICAL WORKERS LOCAL 1262 AND EMPLOYERS PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226074414 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UNITED FOOD AND COMMERICAL WORKERS LOCAL 1262 EMPLOYERS LEGAL SERVICES FUND 1389 BROAD STREET CLIFTON NJ 07013 222238707 TO PROVIDE LEGAL SERVICE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 1389 BROAD STREET CLIFTON NJ 07013 221339607 REPRESENTS MEMBERS IN COLLECTIVE BARGAINING MATTERS WITH EMPLOYERS NJ 501(C)(5) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 & EMPLOYERS NONFOOD PENSION F 1389 BROAD STREET CLIFTON NJ 07013 266181292 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 & EMPLOYERS PATHMARK HW FD 1389 BROAD STREET CLIFTON NJ 07013 371664252 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 & EMPLOYERS WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 226137317 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 & EMPLOYERS HLTH & WELFARE FD 1389 BROAD STREET CLIFTON NJ 07013 237042767 TO PROVIDE WELFARE BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 FOODTWON CORPORATION NJ 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 1 0 UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND O 72385 UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND P 103038 UFCW LOCAL 1262 AND EMPLOYERS WELFARE FUND R 181000