2012-11-15T15:21:05-06:00 2011-12-31 SHULMAN KURTZ TURER & TOPAZ LLC 101 N LAKEVIEW DRIVE GIBBSBORO NJ 080261046 990 2011-01-01 236449794 UFCW UNION & PARTICIPATING FOOD IND EMPLOYERS TRI-STATE HEALTH-WELFARE UFCW 8567932500 27 ROLAND AVENUE MT LAUREL NJ 08054 BRIAN STRING 8567932500 2012-11-14 true RICHARD L BAITZEL CPA 8566277444 2012-11-14 2011 2016-02-24 21:20:13Z FRANK VACCARO 27 ROLAND AVE MT LAUREL NJ 08054 30318756 false X X HEALTH FUND 1967 NJ 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. 8 8 0 0 0 31909774 30056587 228737 192144 70025 32138511 30318756 0 27970324 28803614 0 0 0 2574252 2401038 30544576 31204652 1593935 -885896 11242024 9841046 6306552 5781632 4935472 4059414 X 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. false false PROVIDED HEALTH BENEFITS TO ELIGIBLE PARTICIPANTS. TO PROVIDE HEALTH AND RELATED BENEFITS FOR ELIGIBLE PARTICIPANTS. false false false false false false false false false true false false true true false true false false false false false false false false false false false false false false false false false false false false false false false false true false false false true 309 0 true 0 false false false false false false X 8 8 false true false false false false false true true false false false false true true false false false X FUND ADMINISTRATOR 8567932500 27 ROLAND AVENUE MT LAUREL NJ 08054 X DANIEL DOSENBACH DANIEL DOSENBACH 1.00 X 0 0 0 JEFF CHAMPION JEFF CHAMPION 1.00 X 0 0 0 GREGORY QUAGLIATO GREGORY QUAGLIATO 1.00 X 0 0 0 DANIEL KONCZYK DANIEL KONCZYK 1.00 X 0 0 0 BRIAN STRING BRIAN STRING 1.00 X 0 0 0 TIM TERIFAY TIM TERIFAY 1.00 X 0 0 0 MITCHELL SCHAFER MITCHELL SCHAFER 1.00 X 0 0 0 false false false TRI-STATE ADMINISTRATORS 27 ROLAND AVE MT LAUREL NJ 08054 ADMINISTRATION 2009343 1 EMPLOYER CONTRIBUTIONS 29808789 29808789 EMPLOYEE CONTRIBUTIONS 247798 247798 30056587 192144 192144 OTHER REVENUE 70025 70025 70025 30318756 30126612 192144 28803614 118184 20000 37230 2957 17913 37912 ADMINISTRATOR FEES 1955866 DATA PROCESSING 82149 SPECIAL PROJECT FEES 59934 ACTUARY 39833 29060 31204652 0 0 0 2346662 1789216 1013563 501196 2229425 1721707 62365 56616 1190091 978561 229111 211530 4094052 4293935 1266846 1266846 11242024 9841046 59564 81564 6246988 5700068 6306552 5781632 X 4935472 4059414 4935472 4059414 11242024 9841046 -885896 9838 X false true true X false false false false false false false false false false 1190091 978561 211530 211530 BLUE CROSS DEPOSIT 1266846 1266846 ACCRUED BENEFIT LIABILITIES 5700068 5700068 30318756 31204652 -885896 9837 -546919 -537082 -1422978 30320593 9837 9837 30310756 8000 8000 30318756 31743571 31743571 8000 -546919 -538919 31204652 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 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. 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 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 N/A S CORP STATESMAN HEALTH & REHAB CTR 2629 TRENTON RD LEVITTOWN PA 190561428 391406172 REHAB CTR PA N/A C CORP false false false false false false false false false false false false false false true false true false TRI-STATE LEGAL SERVICES FUND P 12965 AS AGREED PER CONTRACT TRI-STATE LEGAL SERVICES FUND R 15096 PER CAPITA AGREEMENT