UFCW TRI STATE HEALTH & WELFARE FUND: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- UFCW TRI STATE HEALTH & WELFARE FUND (EIN 23-6449794)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201233209349310053
- Schema version
- 2011v1.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T15:21:05-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SHULMAN KURTZ TURER & TOPAZ LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 N LAKEVIEW DRIVE | AddressLine1 |
| City | GIBBSBORO | City |
| State | NJ | State |
| ZIP Code | 080261046 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 236449794 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UFCW UNION & PARTICIPATING FOOD IND | BusinessNameLine1 |
| Business Name Line2 | EMPLOYERS TRI-STATE HEALTH-WELFARE | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | UFCW | NameControl |
| Phone | 8567932500 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 ROLAND AVENUE | AddressLine1 |
| City | MT LAUREL | City |
| State | NJ | State |
| ZIP Code | 08054 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRIAN STRING | Name |
| Title | TRUSTEE | Title |
| Phone | 8567932500 | Phone |
| Date Signed | 2012-11-14 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | RICHARD L BAITZEL CPA | Name |
| Phone | 8566277444 | Phone |
| Date Prepared | 2012-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | FRANK VACCARO | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 ROLAND AVE | AddressLine1 |
| City | MT LAUREL | City |
| State | NJ | State |
| ZIP Code | 08054 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 30318756 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Type Of Organization Other | X | TypeOfOrganizationOther |
| Type Of Org Other Description | HEALTH FUND | TypeOfOrgOtherDescription |
| Year Formation | 1967 | YearFormation |
| State Legal Domicile | NJ | StateLegalDomicile |
| Activity Or Mission Description | TO 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 Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 31909774 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 30056587 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 228737 | InvestmentIncomePriorYear |
| Investment Income Current Year | 192144 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 70025 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 32138511 | TotalRevenuePriorYear |
| Total Revenue Current Year | 30318756 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 27970324 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 28803614 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2574252 | OtherExpensePriorYear |
| Other Expenses Current Year | 2401038 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 30544576 | TotalExpensesPriorYear |
| Total Expenses Current Year | 31204652 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1593935 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -885896 | RevenuesLessExpensesCY |
| Total Assets BOY | 11242024 | TotalAssetsBOY |
| Total Assets EOY | 9841046 | TotalAssetsEOY |
| Total Liabilities BOY | 6306552 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5781632 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4935472 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4059414 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO 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 Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Description | PROVIDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | TO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Described In501 C3 | false | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | false | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 309 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | false | ConflictOfInterestPolicy |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | FUND ADMINISTRATOR | NamePerson |
| Telephone Number | 8567932500 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 ROLAND AVENUE | AddressLine1 |
| City | MT LAUREL | City |
| State | NJ | State |
| ZIP Code | 08054 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (7 entries)
| Business Name Line2NameBusiness/BusinessNameLine2 | TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| DANIEL DOSENBACH | ||||||
| DANIEL DOSENBACH | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| JEFF CHAMPION | ||||||
| JEFF CHAMPION | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| GREGORY QUAGLIATO | ||||||
| GREGORY QUAGLIATO | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| DANIEL KONCZYK | ||||||
| DANIEL KONCZYK | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| BRIAN STRING | ||||||
| BRIAN STRING | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| TIM TERIFAY | ||||||
| TIM TERIFAY | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| MITCHELL SCHAFER | ||||||
| MITCHELL SCHAFER | TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRI-STATE ADMINISTRATORS | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 27 ROLAND AVE | AddressLine1 |
| City | MT LAUREL | City |
| State | NJ | State |
| ZIP Code | 08054 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | ADMINISTRATION | DescriptionOfServices |
| Compensation | 2009343 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| EMPLOYER CONTRIBUTIONS | 29808789 | 29808789 |
| EMPLOYEE CONTRIBUTIONS | 247798 | 247798 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 30056587 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 192144 | TotalRevenueColumn |
| Exclusion | $192,144 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Total Revenue Column | 70025 | TotalRevenueColumn |
| Related Or Exempt Function Income | 70025 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 70025 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 30318756 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30126612 | RelatedOrExemptFunctionIncome |
| Exclusion | $192,144 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28803614 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118184 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20000 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37230 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2957 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17913 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37912 | Total |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal |
|---|---|
| ADMINISTRATOR FEES | 1955866 |
| DATA PROCESSING | 82149 |
| SPECIAL PROJECT FEES | 59934 |
| ACTUARY | 39833 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29060 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31204652 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2346662 | BOY |
| EOY | 1789216 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1013563 | BOY |
| EOY | 501196 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2229425 | BOY |
| EOY | 1721707 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62365 | BOY |
| EOY | 56616 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1190091 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 978561 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 229111 | BOY |
| EOY | 211530 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4094052 | BOY |
| EOY | 4293935 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1266846 | BOY |
| EOY | 1266846 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11242024 | BOY |
| EOY | 9841046 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59564 | BOY |
| EOY | 81564 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6246988 | BOY |
| EOY | 5700068 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6306552 | BOY |
| EOY | 5781632 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4935472 | BOY |
| EOY | 4059414 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4935472 | BOY |
| EOY | 4059414 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11242024 | BOY |
| EOY | 9841046 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -885896 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 9838 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1190091 | OtherCostOrOtherBasis |
| Depreciation | 978561 | Depreciation |
| Book Value | 211530 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 211530 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | BLUE CROSS DEPOSIT | Description |
| Book Value | 1266846 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1266846 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ACCRUED BENEFIT LIABILITIES | Description |
| Amount | $5,700,068 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 5700068 | TotalOfAmounts |
| Total Revenue | 30318756 | TotalRevenue |
| Total Expenses | 31204652 | TotalExpenses |
| Excess Or Deficit For Year | -885896 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 9837 | NetUnrealizedGLOnInvestments |
| Other | -$546,919 | OtherAmount |
| Total Adjustments | -537082 | TotalAdjustments |
| Excess Or Deficit Per FS | -1422978 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 30320593 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 9837 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 9837 | RevenueNotRptdF990 |
| Revenue Subtotal | 30310756 | RevenueSubtotal |
| Investment Expenses Not Included | 8000 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 8000 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 30318756 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 31743571 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 31743571 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 8000 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | -546919 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | -538919 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 31204652 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RECONCILIATION OF CHANGES - OTHER | SCHEDULE D, PAGE 4, PART XI, LINE 8 | BENEFITS PAYABLE (SOP) ADJUSTMENT -546,919 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 4B | BENEFITS PAYABLE (SOP) ADJUSTMENT -546,919 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ALL OTHER ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | TO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS. |
| MANAGEMENT DELEGATED | FORM 990, PAGE 6, PART VI, LINE 3 | THE TRUSTEES HAVE DELEGATED MANAGEMENT AUTHORITY OVER DAY-TO-DAY OPERATIONS TO A THIRD-PARTY ADMINISTRATOR. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 WAS REVIEWED WITH THE FUND'S BOOKKEEPER, BEFORE BEING SENT TO THE TRUSTEES FOR FINAL REVIEW AND SIGNATURE. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNMENT 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/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| TRI-STATE LEGAL SERVICES FUND | |||||||||
| 27 ROLAND AVE | MT LAUREL | NJ | 08054 | 232073663 | LEGAL SVCS | NJ | 501C9 | N/A | false |
| WEPCO FEDERAL CREDIT UNION | |||||||||
| PO BOX 157 | BLOOMINGTON | MD | 21523 | 520627367 | FINL SVCS | MD | 501C1 | N/A | false |
| FIRST PEOPLES COMMUNITY FCU | |||||||||
| 153 BALTIMORE ST | CUMBERLAND | MD | 21502 | 520905189 | FINL SVCS | MD | 501C1 | N/A | false |
| CHESSIE FCU | |||||||||
| PO BOX 689 | CUMBERLAND | MD | 215010689 | 520580973 | FINL SVCS | MD | 501C1 | N/A | false |
| HUMAN RESOURCERS DEVELOPMENT COMM | |||||||||
| 125 VIRGINIA AVE | CUMBERLAND | MD | 21502 | 526065754 | CHARITY | MD | 501C3 | N/A | false |
| THE LIONS CENTER FOR REHABILITATION | |||||||||
| 901 SETON DR | CUMBERLAND | MD | 21502 | 520812302 | NURSINGSVC | MD | 115 | N/A | false |
| TOWNSHIP OF WATERFORD | |||||||||
| 2131 AUBURN AVE | ATCO | NJ | 08004 | 216001341 | GOVT AGENC | NJ | 170C1 | N/A | false |
| CAMDEN COUNTY MUA | |||||||||
| 1645 FERRY AVE | CAMDEN | NJ | 08104 | 222003702 | WATERTREAT | NJ | 115 | N/A | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| ACME MARKETS INC | |||||||||
| 11840 VALLEY VIEW RD | EDEN PRAIRIE | MN | 55344 | 870440072 | FOOD STORE | MN | SUPERVALUE | C CORP | |
| INCOLLINGO'S EGG HARBOR CITY MARKET | |||||||||
| 810 WHITE HORSE PK | EGG HARBOR CITY | NJ | 08215 | 205776050 | FOOD STORE | NJ | S CORP | N/A | |
| STATESMAN HEALTH & REHAB CTR | |||||||||
| 2629 TRENTON RD | LEVITTOWN | PA | 190561428 | 391406172 | REHAB CTR | PA | C CORP | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| TRI-STATE LEGAL SERVICES FUND | ||
| P | 12965 | AS AGREED PER CONTRACT |
| TRI-STATE LEGAL SERVICES FUND | ||
| R | 15096 | PER CAPITA AGREEMENT |
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