2013-02-01T12:43:06-06:00 2011-12-31 510545975 PETER DECARLO CPA PLLC ELEVEN PENNSYLVANIA PLAZA NEW YORK NY 10001 990 2011-01-01 160915820 UFCW LOCAL ONE HEALTH CARE FUND UFCW 3157979600 5911 AIRPORT ROAD ORISKANY NY 13424 FRANK C DERISO 3157979600 2013-02-01 1 PETER DECARLO CPA P00851470 2129464907 X 2011 2016-02-25 16:41:14Z FRANK C DERISO 5911 AIRPORT ROAD ORISKANY NY 13424 72956405 0 X WWW.UFCWONE.ORG X 1959 NY PROVIDE CERTAIN HEALTH AND WELFARE BENEFITS TO PLAN PARTICIPANTS. 8 0 27 0 0 0 0 0 64924744 64871237 1026358 1074821 0 0 65951102 65946058 0 0 67282567 60231122 1309303 1198764 0 0 0 1304957 1248559 69896827 62678445 -3945725 3267613 33826509 35061180 2719666 292138 31106843 34769042 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 13,200 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 0 1 180 0 1 27 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 1.00 X 0 245812 20511 ERIC A GLATHAR 1.00 X 0 181056 18783 GREGORY P GOREA 1.00 X 0 175824 18835 DONALD ELIASON 1.00 X 0 128336 17244 JOHN BARRETT 1.00 X 0 0 0 RAYMOND WARDYNSKI 1.00 X 0 0 0 I STEPHEN DAVIS 1.00 X 0 0 0 KRISTINE WYDRO 1.00 X 0 0 0 CHRISTINE MCMAHON 1.00 X 0 0 0 ANDREA GOLDBERGER 22.00 X 127995 0 28824 MICHAEL CIANCAGLINI 40.00 X 103085 0 25824 231080 731028 130021 2 0 1 0 SLEVIN & HART PC 1625 MASSACHUSETTS AVENUE NW WASHINGTON DC 20036 LEGAL 131419 1 EMPLOYER CONTRIBUTIONS 525100 62796273 62796273 PARTICIPANT CONTRIBUTI 525100 2047812 2047812 LIQUIDATED DAMAGES 525100 27152 27152 64871237 951937 951937 7123231 10000 7010347 0 112884 10000 122884 122884 65946058 64871237 0 1074821 60231122 173482 661166 115820 180434 67862 141472 56000 74906 174284 98928 159952 21036 21706 51681 53868 COMPUTER EXPENSE 304164 OPERATIONS EXPENSE 49003 PRINTING & PUBLICATIONS 24826 MAINTENANCE 15111 1622 62678445 12880 18170 1350451 4860949 5961281 4839650 41164 25675 2027163 2001367 77477 25796 22906316 24140334 3476940 1150606 33826509 35061180 151354 203586 2568312 88552 2719666 292138 X 0 0 0 0 31106843 34769042 31106843 34769042 33826509 35061180 X 3267613 394586 X X 0 1 1 X 0 28682 28682 0 668316 653479 14837 1330165 1319206 10959 25796 DUE TO BROKER FOR SECURITIES PURCHASED 38306 DUE TO UFCW LOCAL ONE PENSION FUND 49505 DUE TO UFCW DISTRICT UNION LOCAL ONE 741 88552 65946058 62678445 3267613 394586 394586 3662199 66265738 394586 394586 65871152 74906 74906 65946058 62603539 0 62603539 74906 74906 62678445 X 0 0 0 FRANK C DERISO 0 224113 0 0 0 21699 0 9037 0 11474 0 266323 0 0 ERIC A GLATHAR 0 166987 0 0 0 14069 0 7309 0 11474 0 199839 0 0 GREGORY P GOREA 0 158488 0 0 0 17336 0 7378 0 11457 0 194659 0 0 ANDREA GOLDBERGER 127995 0 0 0 0 0 10016 0 18808 0 156819 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 394,586. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 UFCW DISTRICT UNION LOCAL ONE O 353167 ALLOCATION UFCW LOCAL ONE PENSION FUND P 889625 ALLOCATION UFCW LOCAL ONE 401(K) SAVINGS PLAN P 97646 ALLOCATION