2011-10-17T13:31:21-05:00 2010-11-30 BST ADVISORS LLC 28 WEST 44TH STREET NEW YORK NY 10036 990 2009-12-01 237042767 UNITED FOOD AND COMMERCIAL WORKERS UNION LOCAL 1262 & EMPLOYERS HEALTH & WELFARE UNIT 9737785800 1389 BROAD ST CLIFTON NJ 07013 MATTHEW MOLINARO 9737785800 2011-10-14 1 DAVID C LEE 2126618640 2009 2016-03-07 17:11:31Z MATTHEW MOLINARO 1389 BROAD ST CLIFTON NJ 07013 25475581 0 X www.ufcw1262.org X 1968 NJ TO PROVIDE HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 6 6 0 0 0 0 0 18964234 21339170 578270 592638 971882 473193 20514386 22405001 0 19003546 20957412 372949 457788 0 0 766546 544000 20143041 21959200 371345 445801 12549454 13709298 566027 706616 11983427 13002682 TO PROVIDE HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 0 0 21959200 TO PROVIDE HOSPITAL, SURGICAL, MAJOR MEDICAL, DENTAL, PRESCRIPTION DRUG, VISION, LIFE INSURANCE AND OTHER MEDICAL BENEFITS TO APPROXIMATELY 4,600 ELIGIBLE MEMBERS AND THEIR DEPENDENTS. 21959200 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 6 0 1 0 0 0 0 0 0 0 0 6 6 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X The Organization 9737785800 1389 BROAD ST CLIFTON NJ 07013 X GAIL JORDAN 0.50 X 0 0 0 JASON PARADIS 0.50 X 0 0 0 HARVEY WHILLE 0.50 X 0 0 0 WILLIAM ROVENSKY 0.50 X 0 0 0 MATTHEW MOLINARO 0.50 X 0 0 0 KATHY RUSSELLO 0.50 X 0 0 0 DAVID GILLIS 0.50 X 0 0 0 0 0 0 0 0 0 0 HORIZON BCBS OF NJ 3 PONY LANE FLEMINGTON NJ 08822 CLAIMS ADMINISTRATOR 1032072 PROSKAUER ROSE LLP 1585 BROADWAY NEW YORK NY 10036 LEGAL SERVICES 151379 2 EMPLOYER CONTRIBUTIONS 900099 20462603 20462603 RETIREE CO-PAY CONTRIB 900099 721254 721254 COBRA CONTRIBUTIONS 900099 155313 155313 21339170 476725 476725 3186493 3070580 115913 115913 115913 MEDICAL REBATES 900099 473193 473193 473193 22405001 21812363 0 592638 20957412 20957412 359498 359498 15517 15517 50546 50546 32227 32227 151379 151379 56422 56422 30938 30938 4273 4273 26915 26915 2903 2903 3042 3042 6095 6095 THIRD PARTY ADMINISTRAT 98909 98909 ACTUARY & CONSULTING 52856 52856 MISCELLANEOUS 49715 49715 COMPUTER SERVICES 43032 43032 COMMUNICATION TO PARTIC 17521 17521 21959200 21959200 0 0 91171 112146 1010959 1889928 1116183 1419860 2820 1645 52597 51511 3220 1086 10035856 10256312 289245 28321 12549454 13709298 179226 153130 386801 553486 566027 706616 X 0 0 0 0 11983427 13002682 11983427 13002682 12549454 13709298 X 0 1 1 X 0 2528 1820 708 50069 49691 378 1086 CORPORATE BONDS -VAR 4137825 F STATE & LOCAL OBLIGATIONS 572169 F MORTGAGE-BACKED SECURITIES 2558429 F U.S. TREASURIES 2987889 F 10256312 STOP-LOSS INSURANCE RESERVE 349751 SERP LIABILITY 37050 DUE TO RELATED PARTIES 166685 553486 22405001 21959200 445801 29938 543516 573454 1019255 21930808 29938 29938 21900870 30938 473193 504131 22405001 20911553 0 20911553 30938 1016709 1047647 21959200 Part X: Description of Uncertain Tax Positions Under FIN 48: On December 1, 2009, the Plan adopted ASC 740-10-25, Accounting for Uncertainty in Income Taxes. This standard prescribes a recognition threshold and measurement attribute for financial statement recognition and measurement of an income tax position taken or expected to be taken on an income tax return. The benefit of an uncertain tax position may be recognized in the financial statements only if it is more likely than not that the tax position will be sustained, based on its technical merits, upon examination, including the resolution of appeals or litigation processes, if any. The Plan's tax years subject to review were 2006 through 2009, as of November 30, 2010. The adoption of this standard resulted in no material uncertain tax benefits or provisions identified and recorded as a liability or asset. Part XI, Line 8 - Other Adjustments: CHANGE IN BENEFIT OBLIGATION: 543516. Part XII, Line 4b - Other Adjustments: MEDICAL REBATES: 473193. Part XIII, Line 4b - Other Adjustments: MEDICAL REBATES: 473193. CHANGE IN BENEFIT OBLIGATIONS: 543516. Form 990, Part VI, Section B, line 11 THE FUND'S 990 IS PREPARED BY ITS OUTSIDE AUDITOR AND IS SUBMITTED AND REVIEWED WITH THE ADMINISTRATOR, WHO THEN REVIEWS IT WITH THE CHAIRPERSON OF THE BOARD OF TRUSTEES. Form 990, Part VI, Section C, line 19 THE FUND'S GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AND MAY BE VIEWED AT THE FUND OFFICE. FORM 990, PART XI, LINE 2C THE PROCESS FOR OVERSEEING THE AUDIT AND FOR SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED SINCE THE PRIOR YEAR. UFCW LOCAL 1262 & EMPLOYERS PENSION FUND 1389 BROAD STREET CLIFTON NJ 07013 226074414 TO PROVIDE PENSION BENEFITS TO ELIGIBLE MEMBERS AND THEIR BENEFICIARIES NJ 501(A) UFCW LOCAL 1262 & EMPLOYERS LEGAL SERVICES FUND 1389 BROAD STREET CLIFTON NJ 07013 222238707 TO PROVIDE LEGAL BENEFITS TO ELIGIBLE MEMBERS NJ 501(C)(9) UFCW LOCAL 1262 & EMPLOYERS WELFARE FUND 1389 BROAD STREET CLIFTON NJ 07013 226137317 TO PROVIDE HEALTH, MEDICAL & OTHER BENEFITS TO ELIGIBLE MEMBERS NJ 501(c)(9) 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 UFCW LOCAL 1262 & EMPLOYERS WELFARE FUND - Due to E 63536 UFCW LOCAL 1262 & EMPLOYERS LEGAL SVCS FUND-DUE TO E 9349 UFCW LOCAL 1262 & EMPLOYERS PENSION FUND O 590712