2015-11-05T10:11:36-06:00 2014-12-31 464001827 SAXBST LLP 28 WEST 44TH STREET NEW YORK NY 10036 990 2014-01-01 371664252 UFCW LOCAL 1262 AND PATHMARK HEALTH & WELFARE FUND UFCW 9737785800 1389 BROAD STREET CLIFTON NJ 07013 MATTHEW MOLINARO TRUSTEE 9737785800 2015-11-05 1 PATRICK C STINES P01592735 2126618640 2014 2016-03-07 17:11:31Z MATTHEW MOLINARO 1389 BROAD STREET CLIFTON NJ 07013 15630305 0 X WWW.UFCW1262.ORG X 2012 NJ TO PROVIDE HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND MEDICAL BENEFITS TO APPROXIMATELY 2200 ELIGIBLE PARTICIPANTS. 4 0 0 0 0 0 0 0 14174989 15630120 25 49 63427 136 14238441 15630305 0 0 15185086 10451091 268550 277010 0 0 0 308979 287389 15762615 11015490 -1524174 4614815 280656 3777213 1856139 737881 -1575483 3039332 TO PROVIDE HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE 2200 MEMBERS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 2200 ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 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 THE ORGANIZATION 9737785800 1389 BROAD STREET CLIFTON NJ 07013 X HARVEY WHILLE PRESIDENT 1.00 40.00 X 0 346637 24267 MATTHEW MOLINARO SECRETARY-TREASURER 1.00 40.00 X 0 305522 23557 MICHAEL FREDERICKS TRUSTEE 1.00 40.00 X 0 0 0 DEREK KINNEY TRUSTEE 1.00 40.00 X 0 0 0 FRANK VACCARO ADMINISTRATOR 3.00 22.00 X 39554 454406 0 39554 1106565 47824 0 0 1 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATOR 593851 1 EMPLOYERS' CONTRIBUTIONS 900099 15151143 15151143 RETIREE CO-PAY 900099 333363 333363 PARTICIPANTS, COBRA 900099 145614 145614 15630120 49 49 OTHER INCOME 900099 136 136 136 15630305 15630256 0 49 10451091 198476 12197 48807 17530 96969 17250 1019 13051 3095 268 3854 THIRD PARTY ADMINISTRAT 39554 COMPUTER SERVICES 33039 ACTURIAL AND OTHER CONS 28353 BANK SERVICE CHARGES 13532 37405 11015490 X 13262 52573 115329 3487195 2236 1516 803 268 0 535 149829 235394 280656 3777213 1159837 332839 696302 405042 1856139 737881 X -1575483 3039332 -1575483 3039332 280656 3777213 4614815 0 X X 0 1 X 1 0 803 268 535 535 PRESCRIPTION REBATES 216771 OTHER RECEIVABLES 18623 235394 SERP LIABILITY 16041 PM-HORIZON SUBROGATION CREDIT 280590 DUE TO PENSION FUND 76585 DUE TO WELFARE 2000 DUE TO H&W FUND 3800 DUE TO LEGAL 26 DUE TO UNION 26000 405042 X 15630305 0 15630305 0 15630305 11015490 0 11015490 0 11015490 PART X, LINE 2: THE PLAN RECEIVED ITS LATEST DETERMINATION LETTER ON AUGUST 11, 2014, IN WHICH THE INTERNAL REVENUE SERVICE ADVISED THAT THE PLAN QUALIFIES UNDER SECTION 501(C)(9) AND IS, THEREFORE, EXEMPT FROM FEDERAL INCOME TAXES UNDER THE PROVISIONS OF SECTION 501(A). THE PLAN'S MANAGEMENT EVALUATES TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZES A TAX LIABILITY OR ASSET IF AN UNCERTAIN TAX POSITION WAS TAKEN AND IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAXING AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 HARVEY WHILLE PRESIDENT 0 346637 0 0 0 0 0 9771 0 14496 0 370904 0 0 MATTHEW MOLINARO SECRETARY-TREASURER 0 305522 0 0 0 0 0 9061 0 14496 0 329079 0 0 FRANK VACCARO ADMINISTRATOR 39554 454406 0 0 0 0 0 0 0 0 39554 454406 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. 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 VII, SECTION A FRANK VACCARO & ASSOCIATES IS A THIRD PARTY ADMINISTRATOR OF THE PLAN AND ITS OTHER RELATED PLANS. THE COMPANY IS ENGAGED PURSUANT TO A RETAINER AGREEMENT AND IS COMPENSATED FOR SERVICES AND FUNCTIONS NOT BASED ON TIME CHARGES. FORM 990, PART X, LINE 33 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 CLAIM OBLIGATIONS OF $10,601,171 AND ESTIMATED POST RETIREMENT OBLIGATION OF $425,000. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMED RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. UNITED FOOD AND COMMERCIAL 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 COMMERCIAL 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 AND EMPLOYERS WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 226137317 TO PROVIDE HEALTH, MEDICAL AND OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 UNITED FOOD AND COMMERCIAL WORKERS LOCAL 1262 AND EMPLOYERS RETAIL NON FOOD 1389 BROAD STREET CLIFTON NJ 07013 226181292 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) 0 UFCW LOCAL 1262 HEALTH & WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 237042767 TO PROVIDE MEDICAL AND BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) 0 PATHMARK NJ 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND N 55284 CASH UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND O 277010 CASH UFCW LOCAL 1262 AND EMPLOYERS PENSION FUND P 380930 CASH