2013-10-02T15:52:45-05:00 2012-12-31 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2012-01-01 135521921 LAUNDRY DRY CLEANING WORKERS & ALLIED INDUSTRIES HEALTH FUND WORKERS UNITED AMAL 9143675559 333 WESTCHESTER AVENUE WHITE PLAINS NY 106042910 MICHAEL POTACK 9143675559 2013-10-02 1 LOUIS VERZELLA CPA P00360279 6106689400 2013-10-02 2012 2016-02-25 16:41:14Z MICHAEL POTACK 275 7TH AVENUE NEW YORK NY 10001 48789925 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 17184996 18613550 197368 151469 0 167530 17382364 18932549 0 0 15709896 13149208 312114 250164 0 0 0 2502612 2580690 18524622 15980062 -1142258 2952487 9131200 12130473 648782 380420 8482418 11750053 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 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 1 688 0 4 1 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X FUND OFFICE 9143675559 333 WESTCHESTER AVENUE WHITE PLAINS NY 106042910 ALBERTO ARROYO 1.00 X 0 70664 0 MICHAEL POTACK 1.00 X 0 0 0 STANLEY ISRAEL ESQ 1.00 X 0 0 0 BRIAN SANTONNELLO 1.00 X 0 0 0 WILFREDO LARANCUENT 1.00 X 0 126987 0 CHRISTINE KERBER 1.00 X 0 160610 0 0 358261 0 0 0 1 0 ALICARE INC 333 WESTCHESTER AVENUE WHITE PLAINS NY 10604 ADMINISTRATIVE SERVICES 1939237 ANTHEM BLUE CROSS BLUE SHIELD ONE LIBERTY PLAZA NEW YORK NY 10006 CLAIM PROCESSING FEE 665858 SCHULTE ROTH & ZABEL LLP 919 THIRD AVENUE NEW YORK NY 10022 LEGAL 276488 DELTA DENTAL OF NY ONE DELTA DRIVE MECHANICSBURG PA 17055 CLAIM PROCESSING FEE 106444 4 EMPLOYER CONTRIBUTIONS 525100 18330015 18330015 MEMBER CONTRIBUTIONS 525100 258735 258735 SHARED EXPENSE REIMBURSEMENTS 525100 24800 24800 18613550 38838 38838 29970007 29857376 112631 112631 112631 ALICARE INC. - SETTLEMENT AGREEME 999999 167530 167530 167530 18932549 18613550 0 318999 13149208 157071 27972 48349 16772 288764 61030 24480 23899 49246 89707 8632 3376 21207 ADMINISTRATIVE FEES 1930237 ALLOCATED PAYROLL AND C 74800 PATIENT CENTERED OUTCOM 5312 15980062 250 250 660194 988498 2980907 2591184 2424 1222 16880 14076 6180 2804 1337875 2454883 3669677 4547996 473693 1543636 9131200 12130473 113400 169878 535382 210542 648782 380420 X 0 0 0 0 8482418 11750053 8482418 11750053 9131200 12130473 2952487 315148 0 X X 0 1 X 1 0 16880 14076 2804 2804 COMMINGLED FUND 1642508 F COMMON COLLECTIVE TRUST 2905488 F 4547996 DUE FROM RELATED ENTITIES 7133 INVESTMENT INCOME RECEIVABLE 10673 CASH HELD BY WORKERS' COMP BD - DEPOSITS 96000 DUE FROM ALICARE, INC.- SETTLEMENT 167530 DUE FROM BROKER 1262000 OTHER RECEIVABLES 300 1543636 DUE TO RELATED ENTITIES 74800 CASH OVERDRAFT 89955 DUE TO ALICO 616 OBLIGATION TO DISTRIBUTE CONTRIBUTIONS TO RELATED PARTIES 45087 DUE TO OTHER 84 210542 X 19198417 315148 315148 18883269 24480 24800 49280 18932549 15930782 0 15930782 24480 24800 49280 15980062 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MANAGEMENT EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAD MAINTAINED ITS TAX EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. AT THE PRESENT TIME, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XI, LINE 4B - OTHER ADJUSTMENTS: SHARED REIMBURSED EXPENSES 24,800. PART XII, LINE 4B - OTHER ADJUSTMENTS: SHARED REIMBURSED EXPENSES 24,800. 0 0 0 CHRISTINE KERBER 0 160610 0 0 0 0 0 0 0 0 0 160610 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. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII ALBERTO ARROYO - 275 7TH AVENUE, NEW YORK, NY 10001. MICHAEL POTACK - 401 SOUTH MACQUESTEN PARKWAY, MOUNT VERNON, NY 10550. STANLEY ISRAEL, ESQ - 50-35 56TH ROAD, MASPETH, NY 11378. BRIAN SANTONNELLO - 1100 6TH AVENUE, NEPTUNE, NJ 07753. WILFREDO LARANCUENT - 275 7TH AVENUE, NEW YORK, NY 10001. CHRISTINE KERBER - 18 WASHINGTON PLACE, 3RD FLR, NEWARK, NJ 07102. 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. 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