UFCW TRI STATE HEALTH & WELFARE FUND: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
UFCW TRI STATE HEALTH & WELFARE FUND (EIN 23-6449794)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201343199349304299
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-15T10:39:37-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SHULMAN KURTZ TURER & TOPAZ LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1101 N LAKEVIEW DRIVEAddressLine1
CityGIBBSBOROCity
StateNJState
ZIP Code080261046ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN236449794EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1UFCW UNION & PARTICIPATING FOOD INDBusinessNameLine1
Business Name Line2EMPLOYERS TRI-STATE HEALTH-WELFAREBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUFCWNameControl
Phone8567932500Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line127 ROLAND AVENUEAddressLine1
CityMT LAURELCity
StateNJState
ZIP Code08054ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRIAN STRINGName
TitleTRUSTEETitle
Phone8567932500Phone
Date Signed2013-11-11DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRICHARD L BAITZEL CPAName
Phone8566277444Phone
Date Prepared2013-11-11DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonFRANK VACCARONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line127 ROLAND AVEAddressLine1
CityMT LAURELCity
StateNJState
ZIP Code08054ZIPCode
FieldValueIRS element (for citing)
Gross Receipts36149345GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Type Of Organization OtherXTypeOfOrganizationOther
Type Of Org Other DescriptionHEALTH FUNDTypeOfOrgOtherDescription
Year Formation1967YearFormation
State Legal DomicileNJStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH BENEFITS TO PARTICIPANTS WHOSE EMPLOYERS HAVE ENTERED INTO COLLECTIVE BARGAINING AGREEMENTS WITH VARIOUS LOCAL AFFILIATES OF THE UNITED FOOD AND COMMERCIAL WORKERS UNION.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year30056587ProgramServiceRevenuePriorYear
Program Service Revenue CY35929687ProgramServiceRevenueCY
Investment Income Prior Year192144InvestmentIncomePriorYear
Investment Income Current Year215210InvestmentIncomeCurrentYear
Other Revenue Prior Year70025OtherRevenuePriorYear
Other Revenue Current Year4448OtherRevenueCurrentYear
Total Revenue Prior Year30318756TotalRevenuePriorYear
Total Revenue Current Year36149345TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year28803614BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY33851467BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2401038OtherExpensePriorYear
Other Expenses Current Year2464178OtherExpensesCurrentYear
Total Expenses Prior Year31204652TotalExpensesPriorYear
Total Expenses Current Year36315645TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-885896RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-166300RevenuesLessExpensesCY
Total Assets BOY9841046TotalAssetsBOY
Total Assets EOY12339299TotalAssetsEOY
Total Liabilities BOY5781632TotalLiabilitiesBOY
Total Liabilities EOY8160708TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4059414NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4178591NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE HEALTH BENEFITS TO PARTICIPANTS WHOSE EMPLOYERS HAVE ENTERED INTO COLLECTIVE BARGAINING AGREEMENTS WITH VARIOUS LOCAL AFFILIATES OF THE UNITED FOOD AND COMMERCIAL WORKERS UNION.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionPROVIDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
DescriptionTO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS.Description
FieldValueIRS element (for citing)
Described In501 C3falseDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredfalseScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096417NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicyfalseConflictOfInterestPolicy
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonFUND ADMINISTRATORNamePerson
Telephone Number8567932500TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line127 ROLAND AVENUEAddressLine1
CityMT LAURELCity
StateNJState
ZIP Code08054ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

Business Name Line2NameBusiness/BusinessNameLine2TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DANIEL DOSENBACH
DANIEL DOSENBACHTRUSTEE1.00X000
GREGORY QUAGLIATO
GREGORY QUAGLIATOTRUSTEE1.00X000
DANIEL KONCZYK
DANIEL KONCZYKTRUSTEE1.00X000
BRIAN STRING
BRIAN STRINGTRUSTEE1.00X000
TIM TERIFAY
TIM TERIFAYTRUSTEE1.00X000
MITCHELL SCHAFER
MITCHELL SCHAFERTRUSTEE1.00X000
FieldValueIRS element (for citing)
Formers ListedfalseFormersListed
Total Comp GT150 KfalseTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1Address Line2AddressOfContractor/AddressUS/AddressLine2CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
TRI-STATE ADMINISTRATORS INC
27 ROLAND AVE27 ROLAND AVEMT LAURELNJ08054ADMINISTRATIVE2166100
SPEAR WILDERMAN PC
230 S BROAD ST230 S BROAD STPHILADELPHIAPA19102LEGAL116513
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS3564627735646277
EMPLOYEE CONTRIBUTIONS283410283410
FieldValueIRS element (for citing)
Total Program Service Revenue35929687TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column215210TotalRevenueColumn
Exclusion$215,210ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Total Revenue Column4448TotalRevenueColumn
Related Or Exempt Function Income4448RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue4448TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column36149345TotalRevenueColumn
Related Or Exempt Function Income35934135RelatedOrExemptFunctionIncome
Exclusion$215,210ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total33851467Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total54780Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20500Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5083Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7387Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total52503Total

Insurance Insurance

FieldValueIRS element (for citing)
Total39036Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
ADMINISTRATOR FEES2137764
DATA PROCESSING83461
SPECIAL PROJECT FEES28336
NEWSLETTER16028

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total19300Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total36315645Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1789216BOY
EOY3848324EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY501196BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1721707BOY
EOY2185586EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY56616BOY
EOY56559EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis277543LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec73517LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY211530BOY
EOY204026EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4293935BOY
EOY4777958EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1266846BOY
EOY1266846EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9841046BOY
EOY12339299EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY81564BOY
EOY152711EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5700068BOY
EOY8007997EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5781632BOY
EOY8160708EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY4059414BOY
EOY4178591EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4059414BOY
EOY4178591EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9841046BOY
EOY12339299EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-166300ReconcilationRevenueExpenses
Reconciliation Unrealized Invest269485ReconciliationUnrealizedInvest
Reconcilation Other Changes15992ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis277543OtherCostOrOtherBasis
Depreciation73517Depreciation
Book Value204026BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings204026TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionBLUE CROSS DEPOSITDescription
Book Value1266846BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets1266846TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionACCRUED BENEFIT LIABILITIESDescription
Amount$8,007,997Amount
FieldValueIRS element (for citing)
Total Of Amounts8007997TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt36410830TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments269485NetUnrealizedGainsInvestments
Revenue Not Rptd F990269485RevenueNotRptdF990
Revenue Subtotal36141345RevenueSubtotal
Investment Expenses Not Included8000InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt8000RevenueNotRptdOnFinStmt
Total Revenue Per Form99036149345TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt33999717TotExpensesEtcAuditedFinclStmt
Expenses Subtotal33999717ExpensesSubtotal
Investment Expenses Not Included28000InvestmentExpensesNotIncluded2
Other Expenses Not Included2307928OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt2315928ExpensesNotRptdOnFinStmt
Total Expenses Per Form99036315645TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierEXPENSE AMOUNTS INCLUDED ON RETURN - OTHERIdentifier
Return ReferenceSCHEDULE D, PAGE 4, PART XII, LINE 4BReturnReference
ExplanationBENEFITS PAYABLE (SOP) ADJUSTMENT 2,307,928Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ALL OTHER ACCOMPLISHMENT DESCRIPTIONFORM 990, PAGE 2, PART III, LINE 4DTO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS.
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3THE TRUSTEES HAVE DELEGATED MANAGEMENT AUTHORITY OVER DAY-TO-DAY OPERATIONS TO A THIRD-PARTY ADMINISTRATOR.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 WAS REVIEWED WITH THE FUND'S BOOKKEEPER, BEFORE BEING SENT TO THE TRUSTEES FOR FINAL REVIEW AND SIGNATURE.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19GOVERNMENT FORMS ARE AVAILABLE FOR REVIEW UPON REQUEST. PARTICIPANTS ARE ABLE TO COME INTO THE ADMINISTRATIVE OFFICE AND REQUEST AN OPPORTUNITY TO REVIEW THE FORMS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
TRI-STATE LEGAL SERVICES FUND
27 ROLAND AVEMT LAURELNJ08054232073663LEGAL SVCSNJ501C9N/Afalse
WEPCO FEDERAL CREDIT UNION
PO BOX 157BLOOMINGTONMD21523520627367FINL SVCSMD501C1N/Afalse
FIRST PEOPLES COMMUNITY FCU
153 BALTIMORE STCUMBERLANDMD21502520905189FINL SVCSMD501C1N/Afalse
CHESSIE FCU
PO BOX 689CUMBERLANDMD215010689520580973FINL SVCSMD501C1N/Afalse
HUMAN RESOURCERS DEVELOPMENT COMM
125 VIRGINIA AVECUMBERLANDMD21502526065754CHARITYMD501C3N/Afalse
THE LIONS CENTER FOR REHABILITATION
901 SETON DRCUMBERLANDMD21502520812302NURSINGSVCMD115N/Afalse
TOWNSHIP OF WATERFORD
2131 AUBURN AVEATCONJ08004216001341GOVT AGENCNJ170C1N/Afalse
CAMDEN COUNTY MUA
1645 FERRY AVECAMDENNJ08104222003702WATERTREATNJ115N/Afalse

Form990 Schedule R Part III Form990ScheduleRPartIII (15 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNADisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
FROSTBURG FACILITY OPERATIONS LLC
ONE KAYLOR CIRCLEFROSTBURGMD21532205111843MDN/Afalsefalse
ASSISTED LIVING AT FROSTBURG VILLAG
100 VILLAGE PARKWAYFROSTBURGMD21532205103941MDN/Afalsefalse
AVISTA HEALTHCARE LLC
3025 CHAPEL AVE WESTCHERRY HILLNJ08002205274922NJN/Afalsefalse
FROSTBURG FACILITY OPERATIONS LLC
ONE KAYLOR CIRCLEFROSTBURGMD21532205111843MDN/Afalsefalse
ASSISTED LIVING AT FROSTBURG VILLAG
100 VILLAGE PARKWAYFROSTBURGMD21532205103941MDN/Afalsefalse
AVISTA HEALTHCARE LLC
3025 CHAPEL AVE WESTCHERRY HILLNJ08002205274922NJN/Afalsefalse
FROSTBURG FACILITY OPERATIONS LLC
ONE KAYLOR CIRCLEFROSTBURGMD21532205111843MDN/Afalsefalse
ASSISTED LIVING AT FROSTBURG VILLAG
100 VILLAGE PARKWAYFROSTBURGMD21532205103941MDN/Afalsefalse
AVISTA HEALTHCARE LLC
3025 CHAPEL AVE WESTCHERRY HILLNJ08002205274922NJN/Afalsefalse
FROSTBURG FACILITY OPERATIONS LLC
ONE KAYLOR CIRCLEFROSTBURGMD21532205111843MDN/Afalsefalse
ASSISTED LIVING AT FROSTBURG VILLAG
100 VILLAGE PARKWAYFROSTBURGMD21532205103941MDN/Afalsefalse
AVISTA HEALTHCARE LLC
3025 CHAPEL AVE WESTCHERRY HILLNJ08002205274922NJN/Afalsefalse
FROSTBURG FACILITY OPERATIONS LLC
ONE KAYLOR CIRCLEFROSTBURGMD21532205111843MDN/Afalsefalse
ASSISTED LIVING AT FROSTBURG VILLAG
100 VILLAGE PARKWAYFROSTBURGMD21532205103941MDN/Afalsefalse
AVISTA HEALTHCARE LLC
3025 CHAPEL AVE WESTCHERRY HILLNJ08002205274922NJN/Afalsefalse

Form990 Schedule R Part IV Form990ScheduleRPartIV (95 entries)

Business Name Line2NameOfRelatedOrg/BusinessNameLine2Address Line1AddressUS/AddressLine1Address Line2AddressUS/AddressLine2CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Business Name Line2DirectControllingEntityName/BusinessNameLine2
WILLSE & ASSOCIATES INC
WILLSE & ASSOCIATES INC1501 S CLINTON ST7TH FLOORBALTIMOREMD21224521187907GROCERY STMDN/AC CORPfalse
VIW-IWCO ENT INC
VIW-IWCO ENT INC1 N VIRGINIA AVEPENNSGROVENJ08069222478138NJN/AS CORPfalse
STATESMAN HEALTH & REHAB CTR
2629 TRENTON RDLEVITTOWNPA190561428391406172REHAB CTRPAN/AC CORPfalse
PATHMARK STORES INC
2 PARAGON DRMONTVALENJ07645222879612NJN/AC CORPfalse
NURSING HOME BOARD OF ALLEGHANEY
NURSING HOME BOARD OF ALLEGHANEY901 SETON DRCUMBERLANDMD21502520812302HELATHCAREN/AC CORPfalse
INCOLLINGO'S HOLDING CO
INCOLLINGO'S HOLDING CO457 CAST BROADWAYSALEMNJ08079223813956NJN/AS CORPfalse
INCOLLINGO'S EGG HARBOR CITY MARKET
810 WHITE HORSE PKEGG HARBOR CITYNJ08215205776050FOOD STORENJN/AS CORPfalse
HEALTHCARE SERVICES GROUP INC
3220 TILLMAN DRSUITE 300BENSALEMPA19020232018365PAN/AC CORPfalse
HEALTH FACILITIES INC
HEALTH FACILITIES INC2629 TRENTON RDLEVITTOWNPA19056391406172PAN/AC CORPfalse
GREAT ATLANTIC & PACIFIC TEA COMPAN
2 PARAGON DRMONTVALENJ07645131890974NJN/AC CORPfalse
AVON FOODS INC
AVON FOODS INC1275 HORNBERGER AVEROEBLINGNJ08554562628476GROCERY STNJN/AS CORPfalse
ALLEGHANEY COUNTY HUMAN RESOURCES
ALLEGHANEY COUNTY HUMAN RESOURCES125 VIRGINIA AVECUMBERLANDMD21502526065754MDN/AC CORPfalse
ACME MARKETS INC
11840 VALLEY VIEW RDEDEN PRAIRIEMN55344870440072FOOD STOREMNC CORPfalseSUPERVALUE
ACME MARKETS
PO BOX 958844ST LOUISMO63195870440072MON/AC CORPfalse
ARAMARK CORRECTIONAL SERVICES
PO BOX 34TITUSVILLENJ08560232778485FOOD SERVNJN/AC CORPfalse
CROTHALL HEALTHCARE
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210510386133HEALTHCARENJN/AC CORPfalse
CAPE REGIONAL MEDICAL CENTER
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210210662542HEALTHCARENJN/AC CORPfalse
GENESIS HEALTHCARE
515 FAIRMONT AVETOWSONMD21286HEALTHCARENJN/AC CORPfalse
PATHMARK
2 PARAGON DRMONTVALENJ07645222879612GROCERY STNJC CORPfalseGREATATLANTIC & PACIFIC TEA COMPANY
WILLSE & ASSOCIATES INC
WILLSE & ASSOCIATES INC1501 S CLINTON ST7TH FLOORBALTIMOREMD21224521187907GROCERY STMDN/AC CORPfalse
VIW-IWCO ENT INC
VIW-IWCO ENT INC1 N VIRGINIA AVEPENNSGROVENJ08069222478138NJN/AS CORPfalse
STATESMAN HEALTH & REHAB CTR
2629 TRENTON RDLEVITTOWNPA190561428391406172REHAB CTRPAN/AC CORPfalse
PATHMARK STORES INC
2 PARAGON DRMONTVALENJ07645222879612NJN/AC CORPfalse
NURSING HOME BOARD OF ALLEGHANEY
NURSING HOME BOARD OF ALLEGHANEY901 SETON DRCUMBERLANDMD21502520812302HELATHCAREN/AC CORPfalse
INCOLLINGO'S HOLDING CO
INCOLLINGO'S HOLDING CO457 CAST BROADWAYSALEMNJ08079223813956NJN/AS CORPfalse
INCOLLINGO'S EGG HARBOR CITY MARKET
810 WHITE HORSE PKEGG HARBOR CITYNJ08215205776050FOOD STORENJN/AS CORPfalse
HEALTHCARE SERVICES GROUP INC
3220 TILLMAN DRSUITE 300BENSALEMPA19020232018365PAN/AC CORPfalse
HEALTH FACILITIES INC
HEALTH FACILITIES INC2629 TRENTON RDLEVITTOWNPA19056391406172PAN/AC CORPfalse
GREAT ATLANTIC & PACIFIC TEA COMPAN
2 PARAGON DRMONTVALENJ07645131890974NJN/AC CORPfalse
AVON FOODS INC
AVON FOODS INC1275 HORNBERGER AVEROEBLINGNJ08554562628476GROCERY STNJN/AS CORPfalse
ALLEGHANEY COUNTY HUMAN RESOURCES
ALLEGHANEY COUNTY HUMAN RESOURCES125 VIRGINIA AVECUMBERLANDMD21502526065754MDN/AC CORPfalse
ACME MARKETS INC
11840 VALLEY VIEW RDEDEN PRAIRIEMN55344870440072FOOD STOREMNC CORPfalseSUPERVALUE
ACME MARKETS
PO BOX 958844ST LOUISMO63195870440072MON/AC CORPfalse
ARAMARK CORRECTIONAL SERVICES
PO BOX 34TITUSVILLENJ08560232778485FOOD SERVNJN/AC CORPfalse
CROTHALL HEALTHCARE
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210510386133HEALTHCARENJN/AC CORPfalse
CAPE REGIONAL MEDICAL CENTER
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210210662542HEALTHCARENJN/AC CORPfalse
GENESIS HEALTHCARE
515 FAIRMONT AVETOWSONMD21286HEALTHCARENJN/AC CORPfalse
PATHMARK
2 PARAGON DRMONTVALENJ07645222879612GROCERY STNJC CORPfalseGREATATLANTIC & PACIFIC TEA COMPANY
WILLSE & ASSOCIATES INC
WILLSE & ASSOCIATES INC1501 S CLINTON ST7TH FLOORBALTIMOREMD21224521187907GROCERY STMDN/AC CORPfalse
VIW-IWCO ENT INC
VIW-IWCO ENT INC1 N VIRGINIA AVEPENNSGROVENJ08069222478138NJN/AS CORPfalse
STATESMAN HEALTH & REHAB CTR
2629 TRENTON RDLEVITTOWNPA190561428391406172REHAB CTRPAN/AC CORPfalse
PATHMARK STORES INC
2 PARAGON DRMONTVALENJ07645222879612NJN/AC CORPfalse
NURSING HOME BOARD OF ALLEGHANEY
NURSING HOME BOARD OF ALLEGHANEY901 SETON DRCUMBERLANDMD21502520812302HELATHCAREN/AC CORPfalse
INCOLLINGO'S HOLDING CO
INCOLLINGO'S HOLDING CO457 CAST BROADWAYSALEMNJ08079223813956NJN/AS CORPfalse
INCOLLINGO'S EGG HARBOR CITY MARKET
810 WHITE HORSE PKEGG HARBOR CITYNJ08215205776050FOOD STORENJN/AS CORPfalse
HEALTHCARE SERVICES GROUP INC
3220 TILLMAN DRSUITE 300BENSALEMPA19020232018365PAN/AC CORPfalse
HEALTH FACILITIES INC
HEALTH FACILITIES INC2629 TRENTON RDLEVITTOWNPA19056391406172PAN/AC CORPfalse
GREAT ATLANTIC & PACIFIC TEA COMPAN
2 PARAGON DRMONTVALENJ07645131890974NJN/AC CORPfalse
AVON FOODS INC
AVON FOODS INC1275 HORNBERGER AVEROEBLINGNJ08554562628476GROCERY STNJN/AS CORPfalse
ALLEGHANEY COUNTY HUMAN RESOURCES
ALLEGHANEY COUNTY HUMAN RESOURCES125 VIRGINIA AVECUMBERLANDMD21502526065754MDN/AC CORPfalse
ACME MARKETS INC
11840 VALLEY VIEW RDEDEN PRAIRIEMN55344870440072FOOD STOREMNC CORPfalseSUPERVALUE
ACME MARKETS
PO BOX 958844ST LOUISMO63195870440072MON/AC CORPfalse
ARAMARK CORRECTIONAL SERVICES
PO BOX 34TITUSVILLENJ08560232778485FOOD SERVNJN/AC CORPfalse
CROTHALL HEALTHCARE
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210510386133HEALTHCARENJN/AC CORPfalse
CAPE REGIONAL MEDICAL CENTER
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210210662542HEALTHCARENJN/AC CORPfalse
GENESIS HEALTHCARE
515 FAIRMONT AVETOWSONMD21286HEALTHCARENJN/AC CORPfalse
PATHMARK
2 PARAGON DRMONTVALENJ07645222879612GROCERY STNJC CORPfalseGREATATLANTIC & PACIFIC TEA COMPANY
WILLSE & ASSOCIATES INC
WILLSE & ASSOCIATES INC1501 S CLINTON ST7TH FLOORBALTIMOREMD21224521187907GROCERY STMDN/AC CORPfalse
VIW-IWCO ENT INC
VIW-IWCO ENT INC1 N VIRGINIA AVEPENNSGROVENJ08069222478138NJN/AS CORPfalse
STATESMAN HEALTH & REHAB CTR
2629 TRENTON RDLEVITTOWNPA190561428391406172REHAB CTRPAN/AC CORPfalse
PATHMARK STORES INC
2 PARAGON DRMONTVALENJ07645222879612NJN/AC CORPfalse
NURSING HOME BOARD OF ALLEGHANEY
NURSING HOME BOARD OF ALLEGHANEY901 SETON DRCUMBERLANDMD21502520812302HELATHCAREN/AC CORPfalse
INCOLLINGO'S HOLDING CO
INCOLLINGO'S HOLDING CO457 CAST BROADWAYSALEMNJ08079223813956NJN/AS CORPfalse
INCOLLINGO'S EGG HARBOR CITY MARKET
810 WHITE HORSE PKEGG HARBOR CITYNJ08215205776050FOOD STORENJN/AS CORPfalse
HEALTHCARE SERVICES GROUP INC
3220 TILLMAN DRSUITE 300BENSALEMPA19020232018365PAN/AC CORPfalse
HEALTH FACILITIES INC
HEALTH FACILITIES INC2629 TRENTON RDLEVITTOWNPA19056391406172PAN/AC CORPfalse
GREAT ATLANTIC & PACIFIC TEA COMPAN
2 PARAGON DRMONTVALENJ07645131890974NJN/AC CORPfalse
AVON FOODS INC
AVON FOODS INC1275 HORNBERGER AVEROEBLINGNJ08554562628476GROCERY STNJN/AS CORPfalse
ALLEGHANEY COUNTY HUMAN RESOURCES
ALLEGHANEY COUNTY HUMAN RESOURCES125 VIRGINIA AVECUMBERLANDMD21502526065754MDN/AC CORPfalse
ACME MARKETS INC
11840 VALLEY VIEW RDEDEN PRAIRIEMN55344870440072FOOD STOREMNC CORPfalseSUPERVALUE
ACME MARKETS
PO BOX 958844ST LOUISMO63195870440072MON/AC CORPfalse
ARAMARK CORRECTIONAL SERVICES
PO BOX 34TITUSVILLENJ08560232778485FOOD SERVNJN/AC CORPfalse
CROTHALL HEALTHCARE
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210510386133HEALTHCARENJN/AC CORPfalse
CAPE REGIONAL MEDICAL CENTER
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210210662542HEALTHCARENJN/AC CORPfalse
GENESIS HEALTHCARE
515 FAIRMONT AVETOWSONMD21286HEALTHCARENJN/AC CORPfalse
PATHMARK
2 PARAGON DRMONTVALENJ07645222879612GROCERY STNJC CORPfalseGREATATLANTIC & PACIFIC TEA COMPANY
WILLSE & ASSOCIATES INC
WILLSE & ASSOCIATES INC1501 S CLINTON ST7TH FLOORBALTIMOREMD21224521187907GROCERY STMDN/AC CORPfalse
VIW-IWCO ENT INC
VIW-IWCO ENT INC1 N VIRGINIA AVEPENNSGROVENJ08069222478138NJN/AS CORPfalse
STATESMAN HEALTH & REHAB CTR
2629 TRENTON RDLEVITTOWNPA190561428391406172REHAB CTRPAN/AC CORPfalse
PATHMARK STORES INC
2 PARAGON DRMONTVALENJ07645222879612NJN/AC CORPfalse
NURSING HOME BOARD OF ALLEGHANEY
NURSING HOME BOARD OF ALLEGHANEY901 SETON DRCUMBERLANDMD21502520812302HELATHCAREN/AC CORPfalse
INCOLLINGO'S HOLDING CO
INCOLLINGO'S HOLDING CO457 CAST BROADWAYSALEMNJ08079223813956NJN/AS CORPfalse
INCOLLINGO'S EGG HARBOR CITY MARKET
810 WHITE HORSE PKEGG HARBOR CITYNJ08215205776050FOOD STORENJN/AS CORPfalse
HEALTHCARE SERVICES GROUP INC
3220 TILLMAN DRSUITE 300BENSALEMPA19020232018365PAN/AC CORPfalse
HEALTH FACILITIES INC
HEALTH FACILITIES INC2629 TRENTON RDLEVITTOWNPA19056391406172PAN/AC CORPfalse
GREAT ATLANTIC & PACIFIC TEA COMPAN
2 PARAGON DRMONTVALENJ07645131890974NJN/AC CORPfalse
AVON FOODS INC
AVON FOODS INC1275 HORNBERGER AVEROEBLINGNJ08554562628476GROCERY STNJN/AS CORPfalse
ALLEGHANEY COUNTY HUMAN RESOURCES
ALLEGHANEY COUNTY HUMAN RESOURCES125 VIRGINIA AVECUMBERLANDMD21502526065754MDN/AC CORPfalse
ACME MARKETS INC
11840 VALLEY VIEW RDEDEN PRAIRIEMN55344870440072FOOD STOREMNC CORPfalseSUPERVALUE
ACME MARKETS
PO BOX 958844ST LOUISMO63195870440072MON/AC CORPfalse
ARAMARK CORRECTIONAL SERVICES
PO BOX 34TITUSVILLENJ08560232778485FOOD SERVNJN/AC CORPfalse
CROTHALL HEALTHCARE
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210510386133HEALTHCARENJN/AC CORPfalse
CAPE REGIONAL MEDICAL CENTER
2 STONE HARBOR BLVDCAPE MAY CO COURTHOUSENJ08210210662542HEALTHCARENJN/AC CORPfalse
GENESIS HEALTHCARE
515 FAIRMONT AVETOWSONMD21286HEALTHCARENJN/AC CORPfalse
PATHMARK
2 PARAGON DRMONTVALENJ07645222879612GROCERY STNJC CORPfalseGREATATLANTIC & PACIFIC TEA COMPANY
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Dividends Related OrganizationfalseDividendsRelatedOrganization
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
TRI-STATE LEGAL SERVICES FUND
Q7578AS AGREED PER CONTRACT
TRI-STATE LEGAL SERVICES FUND
R8606PER CAPITA AGREEMENT
TRI-STATE LEGAL SERVICES FUND
S9659NET REALIZABLE VALUE

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