UFCW UNIONS & PARTCIPATING EMPLOYERS HEALTH AND WELFARE FUND: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- UFCW UNIONS & PARTCIPATING EMPLOYERS HEALTH AND WELFARE FUND (EIN 01-0749311)
- Tax period
- 2009-11-01 to 2010-10-31
- Filed
- 2011-09-15
- IRS object ID
- 201142589349300314
- Schema version
- 2009v1.7
- 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 | 2011-09-15T10:20:31-05:00 | Timestamp |
| Tax Period End Date | 2010-10-31 | 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 | 2009-11-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 010749311 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UFCW UNIONS & PARTICIPATING | BusinessNameLine1 |
| Business Name Line2 | EMPLOYERS HEALTH & WELFARE FUND | 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 | SAM FERRAINO | Name |
| Title | CHAIRMAN | Title |
| Phone | 8567932500 | Phone |
| Date Signed | 2011-09-08 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHARLES KURTZ CPA | Name |
| Phone | 8566277444 | Phone |
| Date Prepared | 2011-09-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | VINCE CARROLL | 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 | 33631336 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Type Of Organization Other | X | TypeOfOrganizationOther |
| Type Of Org Other Description | BENEFIT FUND | TypeOfOrgOtherDescription |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | NJ | StateLegalDomicile |
| Activity Or Mission Description | TO PAY HEALTH, LIFE AND LIMITED LEGAL BENEFITS FOR PARTICIPANTS. | 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 | 30609206 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 33567609 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 73238 | InvestmentIncomePriorYear |
| Investment Income Current Year | 40209 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 10212 | OtherRevenuePriorYear |
| Other Revenue Current Year | 23518 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 30692656 | TotalRevenuePriorYear |
| Total Revenue Current Year | 33631336 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 26886050 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 27907728 | 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 | 2944764 | OtherExpensePriorYear |
| Other Expenses Current Year | 3193410 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 29830814 | TotalExpensesPriorYear |
| Total Expenses Current Year | 31101138 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 861842 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2530198 | RevenuesLessExpensesCY |
| Total Assets BOY | 11055514 | TotalAssetsBOY |
| Total Assets EOY | 14364919 | TotalAssetsEOY |
| Total Liabilities BOY | 6649955 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 7429162 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4405559 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6935757 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PAY HEALTH, LIFE AND LIMITED LEGAL BENEFITS FOR PARTICIPANTS. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Description | TO PROVIDE HEALTH, LIFE, LEGAL, AND OTHER BENEFITS TO PARTICIPANTS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | TO PROVIDE HEALTH, LIFE, LEGAL, AND OTHER BENEFITS TO PARTICIPANTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Described In501 C3 | false | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| 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 | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 297 | 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 |
| 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 | ADMINISTRATIVE COMMITTEE | 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)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|
| DEWEY CANNELLA | |||||
| TRUSTEE/SECR | 1.00 | X | 0 | 0 | 0 |
| PATRICK J DURNING | |||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| PAUL TRUNCELLITO | |||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| DAVID B GILLIS | |||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| SAM FERRAINO | |||||
| CHAIR/TRUSTE | 1.00 | X | 0 | 0 | 0 |
| BRIAN STRING | |||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| DANIEL KONCZYK | |||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 |
| GREGORY QUAGLIATO | |||||
| 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 | 2945824 | 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 | 33386606 | 33386606 |
| EMPLOYEE CONTRIBUTIONS | 181003 | 181003 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 33567609 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 40209 | TotalRevenueColumn |
| Exclusion | $40,209 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER INCOME | Description |
| Total Revenue Column | 23518 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23518 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 23518 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33631336 | TotalRevenueColumn |
| Related Or Exempt Function Income | 33591127 | RelatedOrExemptFunctionIncome |
| Exclusion | $40,209 | ExclusionAmount |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27907728 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33726 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16500 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7917 | Total |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal |
|---|---|
| ADMINISTRATOR FEES | 2930831 |
| DATA PROCESSING | 77045 |
| OFFICE EXPENSES | 48858 |
| ACTUARY | 27000 |
| DEPENDENT AUDIT | 22914 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28619 | Total |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31101138 | 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 | 555664 | BOY |
| EOY | 2064820 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7041559 | BOY |
| EOY | 6927349 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2743208 | BOY |
| EOY | 3052705 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5084 | BOY |
| EOY | 5267 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 252456 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 25137 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 224910 | BOY |
| EOY | 227319 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 485089 | BOY |
| EOY | 2087459 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11055514 | BOY |
| EOY | 14364919 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6649955 | BOY |
| EOY | 7429162 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6649955 | BOY |
| EOY | 7429162 | 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 | 4405559 | BOY |
| EOY | 6935757 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4405559 | BOY |
| EOY | 6935757 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11055514 | BOY |
| EOY | 14364919 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 252456 | OtherCostOrOtherBasis |
| Depreciation | 25137 | Depreciation |
| Book Value | 227319 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 227319 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (2 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BLUE CROSS DEPOSIT/RESERVE | 1281175 |
| DEPOSITS & DRUG REBATE RECEIVABLE | 806284 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2087459 | TotalBookValueOtherAssets |
| Total Revenue | 33631336 | TotalRevenue |
| Total Expenses | 31101138 | TotalExpenses |
| Excess Or Deficit For Year | 2530198 | ExcessOrDeficitForYear |
| Other | $817,802 | OtherAmount |
| Total Adjustments | 817802 | TotalAdjustments |
| Excess Or Deficit Per FS | 3348000 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 33631336 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 33631336 | RevenueSubtotal |
| Total Revenue Per Form990 | 33631336 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 30283336 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 30283336 | ExpensesSubtotal |
| Other Expenses Not Included | 817802 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 817802 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 31101138 | 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 | BENEFIT PAYABLE ADJUSTMENT 817,802 |
| EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER | SCHEDULE D, PAGE 4, PART XIII, LINE 4B | BENEFIT PAYABLE ADJUSTMENT 817,802 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ALL OTHER ACHIEVEMENTS DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | TO PROVIDE HEALTH, LIFE, LEGAL, AND OTHER BENEFITS TO PARTICIPANTS. |
| MANAGEMENT DELEGATED | FORM 990, PAGE 6, PART VI, LINE 3 | DAILY OPERATIONS ARE PERFORMED BY A THIRD-PARTY ADMINISTRATOR (TRI-STATE ADMINISTRATORS). |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11 | THE FORM 990 WAS REVIEWED BY 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 TO THE ADMINISTRATIVE OFFICE AND REQUEST AN OPPORTUNITY TO REIVEW THE FORMS. |
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