UFCW TRI STATE HEALTH & WELFARE FUND: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: UFCW TRI STATE HEALTH & WELFARE FUND (EIN 23-6449794)
Tax period: 2010-01-01 to 2010-12-31
Filed: 2011-11-14
IRS object ID: 201133189349306003
Schema version: 2010v3.4
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
Form 990
Schedule D
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-11-14T14:40:48-06:00	Timestamp
Tax Period End Date	2010-12-31	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	2010-01-01	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	2011-11-10	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	CHARLES KURTZ CPA	Name
Phone	8566277444	Phone
Date Prepared	2011-11-10	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2010	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	32138511	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	36948682	ProgramServiceRevenuePriorYear
Program Service Revenue CY	31909774	ProgramServiceRevenueCY
Investment Income Prior Year	188745	InvestmentIncomePriorYear
Investment Income Current Year	228737	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	37137427	TotalRevenuePriorYear
Total Revenue Current Year	32138511	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	33869545	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	27970324	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	2897545	OtherExpensePriorYear
Other Expenses Current Year	2574252	OtherExpensesCurrentYear
Total Expenses Prior Year	36767090	TotalExpensesPriorYear
Total Expenses Current Year	30544576	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	370337	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	1593935	RevenuesLessExpensesCY
Total Assets BOY	11346722	TotalAssetsBOY
Total Assets EOY	11242024	TotalAssetsEOY
Total Liabilities BOY	8240133	TotalLiabilitiesBOY
Total Liabilities EOY	6306552	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	3106589	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	4935472	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	329	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 (8 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 DOSENBACK	TRUSTEE	1.00	X	0	0	0
H P BAKER
H P BAKER	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
EDWARD TRAVERS
EDWARD TRAVERS	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 (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
TRI-STATE ADMINISTRATORS
27 ROLAND AVE	MT LAUREL	NJ	08054	ADMINISTRATION	2129447
STEVENS & LEE
620 FREEDOM BUSINESS CENTER STE 200	KING OF PRUSSIA	PA	19406	LEGAL	107170

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	2	NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIBUTIONS	31665567	31665567
EMPLOYEE CONTRIBUTIONS	244207	244207

Field	Value	IRS element (for citing)
Total Program Service Revenue	31909774	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	228737	TotalRevenueColumn
Exclusion	$228,737	ExclusionAmount

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	32138511	TotalRevenueColumn
Related Or Exempt Function Income	31909774	RelatedOrExemptFunctionIncome
Exclusion	$228,737	ExclusionAmount

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	27970324	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	184950	Total

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	15500	Total

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	15431	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	9688	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	25093	Total

Insurance Insurance

Field	Value	IRS element (for citing)
Total	38681	Total

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal
ADMINISTRATOR FEES	2125407
DATA PROCESSING	76494
DEPENDENT AUDIT	40493
NEWSLETTER	22115
ACTUARY	12400

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	8000	Total

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	30544576	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	875525	BOY
EOY	2346662	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	3660739	BOY
EOY	1013563	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2872358	BOY
EOY	2229425	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	51764	BOY
EOY	62365	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	1275462	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	1046351	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	247231	BOY
EOY	229111	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	3639105	BOY
EOY	4094052	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
EOY	1266846	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	11346722	BOY
EOY	11242024	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	80679	BOY
EOY	59564	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	8159454	BOY
EOY	6246988	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	8240133	BOY
EOY	6306552	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	3106589	BOY
EOY	4935472	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3106589	BOY
EOY	4935472	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	11346722	BOY
EOY	11242024	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	1593935	ReconcilationRevenueExpenses
Reconcilation Other Changes	234948	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
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	1275462	OtherCostOrOtherBasis
Depreciation	1046351	Depreciation
Book Value	229111	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	229111	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	$6,246,988	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	6246988	TotalOfAmounts
Total Revenue	32138511	TotalRevenue
Total Expenses	30544576	TotalExpenses
Excess Or Deficit For Year	1593935	ExcessOrDeficitForYear
Net Unrealized GL On Investments	234948	NetUnrealizedGLOnInvestments
Other	-$1,912,466	OtherAmount
Total Adjustments	-1677518	TotalAdjustments
Excess Or Deficit Per FS	-83583	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	32365459	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	234948	NetUnrealizedGainsInvestments
Revenue Not Rptd F990	234948	RevenueNotRptdF990
Revenue Subtotal	32130511	RevenueSubtotal
Investment Expenses Not Included	8000	InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt	8000	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	32138511	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	32449042	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	32449042	ExpensesSubtotal
Investment Expenses Not Included2	8000	InvestmentExpensesNotIncluded2
Other Expenses Not Included	-1912466	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	-1904466	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	30544576	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 -1,912,466
EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER	SCHEDULE D, PAGE 4, PART XIII, LINE 4B	BENEFITS PAYABLE (SOP) ADJUSTMENT -1,912,466

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ALL OTHER ACHIEVEMENTS 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.
CHANGE IN FINANCIAL REVIEW PROCESS	FORM 990, PAGE 12, PART XII, LINE 2C	THE ORGANIZATION THROUGH ITS EXECUTIVE BOARD ASSUMES RESPONSIBILITY FOR THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	TRI-STATE LEGAL SERVICES FUND	BusinessNameLine1

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)
EIN	232073663	EIN
Primary Activities	LEGAL SVCS	PrimaryActivities
Legal Domicile State	NJ	LegalDomicileState
Exempt Code Section	501C9	ExemptCodeSection
Direct Controlling Entity NA	N/A	DirectControllingEntityNA
Controlled Org	false	ControlledOrg

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	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
TRI-STATE LEGAL SERVICES FUND
P	13208	AS AGREED PER CONTRACT
TRI-STATE LEGAL SERVICES FUND
P	1158	PER ALLOCATION
TRI-STATE LEGAL SERVICES FUND
R	16492	PER CAPITA PAYMENT

UFCW TRI STATE HEALTH & WELFARE FUND: Form 990, tax year 2010

Return header ReturnHeader

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Preparer Firm US Address PreparerFirmUSAddress

Filer Filer

Name Name

US Address USAddress

Officer Officer

Preparer Preparer

Form 990 IRS990

Address Principal Officer US AddressPrincipalOfficerUS

Activity Other ActivityOther

The Books Are In Care Of TheBooksAreInCareOf

Address US AddressUS

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

Contractor Compensation ContractorCompensation (2 entries)

Program Service Revenue ProgramServiceRevenue (2 entries)

Investment Income InvestmentIncome

Total Revenue TotalRevenue

Benefits To Members BenefitsToMembers

Fees For Services Legal FeesForServicesLegal

Fees For Services Accounting FeesForServicesAccounting

Office Expenses OfficeExpenses

Conferences Meetings ConferencesMeetings

Depreciation Depletion DepreciationDepletion

Insurance Insurance

Other Expenses OtherExpenses (5 entries)

All Other Expenses AllOtherExpenses

Total Functional Expenses TotalFunctionalExpenses

Cash Non Interest Bearing CashNonInterestBearing

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Accounts Receivable AccountsReceivable

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Other Assets Total OtherAssetsTotal

Total Assets TotalAssets

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Other Liabilities OtherLiabilities

Total Liabilities TotalLiabilities

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Schedule D IRS990ScheduleD

Other Land Buildings OtherLandBuildings

Other Assets OtherAssets

Other Liabilities OtherLiabilities

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

Address US AddressUS

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Comments