2015-11-14T10:10:14-06:00 2014-12-31 510545975 PETER DECARLO CPA PLLC 112 WEST 34TH STREET 18TH FLOOR NEW YORK NY 10120 990 2014-01-01 160915820 UFCW LOCAL ONE HEALTH CARE FUND UFCW 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 3157979600 2015-11-14 1 PETER DECARLO CPA P00851470 2129464907 X 2014 2016-04-25 22:37:26Z FRANK C DERISO 5911 AIRPORT ROAD ORISKANY NY 13424 81954549 0 X WWW.UFCWONE.ORG X 1959 NY PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 8 0 28 0 0 0 0 0 69843646 68319842 1308445 1283891 0 0 71152091 69603733 0 0 72838627 67907335 1227207 1289468 0 0 0 1435142 1443143 75500976 70639946 -4348885 -1036213 42490118 40945734 374610 230394 42115508 40715340 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 12,700 ELIGIBLE PARTICIPANTS AND THEIR COVERED DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 0 0 0 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 11 0 1 28 1 0 0 0 0 0 0 X 8 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 X ANDREA GOLDBERGER 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO TRUSTEE 1.00 X 0 246641 30447 ERIC A GLATHAR TRUSTEE 1.00 X 0 191175 27169 GREGORY P GOREA TRUSTEE 1.00 X 0 174969 26735 JOHN BARRETT TRUSTEE 1.00 X 0 0 0 ED COLBURN TRUSTEE 1.00 X 0 0 0 I STEPHEN DAVIS TRUSTEE 1.00 X 0 0 0 RAYMOND WARDYNSKI TRUSTEE 1.00 X 0 0 0 KRISTINE WYDRO TRUSTEE 1.00 X 0 0 0 DONALD ELIASON TRUSTEE - PAST 1.00 X 0 193502 27450 ANDREA GOLDBERGER ADMINISTRATIVE DIRECTOR 22.00 X 144528 0 32189 MICHAEL CIANCAGLINI EMPLOYEE 40.00 X 115521 0 29822 260049 806287 173812 2 0 1 0 SLEVIN & HART PC 1625 MASSACHUSETTS AVENUE NW WASHINGTON DC 20036 LEGAL 181011 1 EMPLOYER CONTRIBUTIONS 525100 66075418 66075418 PARTICIPANT CONTRIBUTIONS 525100 2243536 2243536 LIQUIDATED DAMAGES 525100 888 888 68319842 1263585 1263585 12352122 19000 12350816 0 1306 19000 20306 20306 69603733 68319842 0 1283891 67907335 891483 127402 198645 71938 183756 56015 111519 156598 109528 399699 160228 25966 37109 26109 54796 OPERATIONS EXPENSE 42339 PRINTING & PUBLICATIONS 39603 AFFORDABLE CARE ACT TAX 36244 FIELD AUDITS 3634 70639946 7605 10162 3364887 5221015 8043519 6818660 295372 271462 2047013 1971253 44208 75760 29583921 27408069 1150606 1140606 42490118 40945734 210584 154352 164026 76042 374610 230394 X 0 0 0 0 42115508 40715340 42115508 40715340 42490118 40945734 -1036213 -363955 0 X X 0 1 X 1 0 28682 28682 0 676801 669584 7217 1341530 1272987 68543 75760 DUE TO BROKER FOR SECURITIES PURCHASED 35976 DUE TO UFCW DISTRICT UNION LOCAL ONE 40066 76042 69128259 -363955 -363955 69492214 111519 111519 69603733 70528427 0 70528427 111519 111519 70639946 X 0 0 0 FRANK C DERISO TRUSTEE 0 246641 0 0 0 0 0 10102 0 20345 0 277088 0 0 ERIC A GLATHAR TRUSTEE 0 191175 0 0 0 0 0 8612 0 18557 0 218344 0 0 GREGORY P GOREA TRUSTEE 0 174969 0 0 0 0 0 8415 0 18320 0 201704 0 0 DONALD ELIASON TRUSTEE - PAST 0 193502 0 0 0 0 0 8879 0 18571 0 220952 0 0 ANDREA GOLDBERGER ADMINISTRATIVE DIRECTOR 144528 0 0 0 0 0 11990 0 20199 0 176717 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 TOPS MARKETS INC EMPIRE MERCHANTS NORTH ALBANY KRAFT FOODS INC GREAT AMERICAN STORES HERITAGE HEALTH CARE CENTER 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 PROVIDENTIAL FOODS CORP VANCHLOR CO FRANK WARDYNSKI & SONS INC PARKVIEW SUPERMARKET TN HARVEY INC PAWLAKS FOOD CENTER FILLMORE JUBILEE GALETON IGA INDELICATO'S MARKET FIBERCELL PACKAGING LLC BIG V CORP MILWARD ALLOYS 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 308999 ALLOCATION UFCW LOCAL ONE PENSION FUND Q 884568 ALLOCATION UFCW LOCAL ONE 401(K) SAVINGS PLAN Q 212862 ALLOCATION LUTHERAN HOMES S 1670001 CONTRACT ADIRONDACK MEDICAL CENTER S 1121525 CONTRACT ST ELIZABETH MEDICAL CENTER S 1033328 CONTRACT UFCW DISTRICT UNION LOCAL ONE S 489024 CONTRACT TOPS MARKETS INC S 49121833 CONTRACT EMPIRE MERCHANTS NORTH ALBANY S 1664400 CONTRACT KRAFT FOODS INC S 1553270 CONTRACT GREAT AMERICAN STORES S 697765 CONTRACT HERITAGE HEALTH CARE CENTER S 1120616 CONTRACT SILGAN CONTAINERS MANUFACTURING CORP S 782952 CONTRACT SAHLEN PACKING CORP S 612912 CONTRACT G&L DAVIS MEAT CO S 723624 CONTRACT HOMETOWN MARKETS LLC S 478788 CONTRACT THORNES OF WARREN S 558805 CONTRACT SPECIALTY STEAK S 434656 CONTRACT EMPIRE MERCHANTS NORTH BUFFALO S 461700 CONTRACT SHOP RITE SUPERMARKETS INC S 615192 CONTRACT CHANATRY'S FRENCH ROAD MARKET S 341420 CONTRACT ZWEIGLES INC S 227298 CONTRACT GIANT EAGLE INC S 246934 CONTRACT SODEXO INC S 221734 CONTRACT WELCH FOODS INC S 243122 CONTRACT CARRIER COACH S 273000 CONTRACT BREENS FAMILY INC S 160753 CONTRACT FORT'S GROCERY INC S 203926 CONTRACT SMITH PACKING COMPANY S 173316 CONTRACT WALTON'S BIG M S 167812 CONTRACT HOFMANN SAUSAGE CO INC S 264026 CONTRACT OLD WORLD PROVISION CO INC S 221426 CONTRACT LR BRASS INC S 130748 CONTRACT COUDERSPORT JUBILEE S 150533 CONTRACT SMYD CORP S 154245 CONTRACT DIVERSE FOOD PRODUCTS LLC S 121998 CONTRACT VANCHLOR CO S 193781 CONTRACT FRANK WARDYNSKI & SONS INC S 93728 CONTRACT PARKVIEW SUPERMARKET S 146867 CONTRACT TN HARVEY INC S 57644 CONTRACT PAWLAKS FOOD CENTER S 58176 CONTRACT FILLMORE JUBILEE S 59416 CONTRACT GALETON IGA S 51488 CONTRACT FIBERCELL PACKAGING LLC S 307662 CONTRACT BIG V CORP S 161419 CONTRACT MILWARD ALLOYS INC S 206477 CONTRACT