2025-04-11T12:23:21-05:00 2024-05-31 750786316 WEAVER AND TIDWELL LLP ONE PENNSYLVANIA PLAZA SUITE 3200 NEW YORK NY 10119 990 2023-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 44 S BAYLES AVENUE STE 302 PORT WASHINGTON NY 110503765 VINCENT PERRONE TRUSTEE 7187865410 2025-04-11 1 0 MATTHEW SIMON P01306208 2126955003 2023 2025-03-06 01:10:19Z VINCENT PERRONE 44 S BAYLES AVENUE STE 302 PORT WASHINGTON NY 110503765 175315741 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 4 23 0 0 0 0 0 134663676 136278845 1660691 2155422 256517 414785 136580884 138849052 0 0 123379853 138272460 2638936 3026412 0 0 0 2298293 1985654 128317082 143284526 8263802 -4435474 154905188 152158930 1775280 1563323 153129908 150595607 X THE LOCAL 804 WELFARE TRUST FUND WAS CREATED IN 1950, UNDER AN AGREEMENT AND DECLARATION OF TRUST, AS AMENDED, BETWEEN DELIVERY AND WAREHOUSE EMPLOYEES UNION, LOCAL 804 IBT (THE UNION") AND VARIOUS EMPLOYERS. THE UNION AND THE EMPLOYERS HAVE ENTERED INTO COLLECTIVE BARGAINING AGREEMENTS REQUIRING PAYMENTS BY THE EMPLOYERS FOR THE PURPOSE OF ESTABLISHING A WELFARE PROGRAM FOR THE EMPLOYERS TO PROVIDE WELFARE BENEFITS FOR THEIR EMPLOYEES AND THE EMPLOYEES OF THE UNION, AND THE EMPLOYEES OF THE LOCAL 804 WELFARE TRUST FUND. 0 0 PROVIDED HEALTH CARE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. ESTIMATED NUMBER OF PARTICIPANTS BENEFITED DURING THE PAST YEAR WAS 5724. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 992 0 1 23 1 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 X MARC PANTELEONE FUND MANAGER 7187865410 44 S BAYLES AVENUE SUITE 302 PORT WASHINGTON NY 110503765 CHRIS LANGAN EMPLOYER TRUSTEE 1.00 X 0 0 0 MARK MCELREATH EMPLOYER TRUSTEE 1.00 X 0 0 0 MATTHEW LOUGHLIN EMPLOYER TRUSTEE 1.00 X 0 0 0 MICHAEL CLAYTON EMPLOYER TRUSTEE 1.00 X 0 0 0 VINCENT PERRONE UNION TRUSTEE 1.00 40.00 X 0 155794 114463 ANTONINO ROSCIGLIONE UNION TRUSTEE 1.00 40.00 X 0 149774 114463 CHRISTOPHER WILLIAMSON UNION TRUSTEE 1.00 40.00 X 0 157444 114463 MARK COHEN UNION TRUSTEE 1.00 40.00 X 0 156507 114463 ANTHONY CERULLI FORMER UNION TRUSTEE 1.00 40.00 X 0 148084 56803 MARC PANTELEONE FUND MANAGER 18.00 17.00 X 228556 0 60052 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 58.00 1.00 X 144543 0 33885 MAGGIE WU ACCOUNTANT 38.00 18.00 X 211823 0 34137 CELIA LIAW BENEFIT CLAIMS ASSISTANT 49.00 1.00 X 123359 0 33911 CHRISTINE NICOLETTI OFFICE MANAGER 18.00 17.00 X 130333 0 60052 ANNA BYCHOWSKI ASST TO FUND ADMINISTRATOR 35.00 1.00 X 114462 0 71623 953076 767603 808315 6 0 1 0 EMPIRE HEALTHCHOICE ASSURANCE INC 165 BROADWAY NEW YORK NY 10006 BENEFIT ADMINISTRATIVE SERVICE 2247605 THE SEGAL COMPANY (EASTERN STATES) INC 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL AND CONSULTING SERVICES 548698 NEW YORK MEDICAL MANAGEMENT 2025 LINCOLN HIGHWAY ROUTE 21 EDISON NJ 08817 BENEFIT CONSULTING SERVICES 445885 HEALTH PLAN SYSTEM 2025 LINCOLN HIGHWAY ROUTE 21 EDISON NJ 08817 BENEFIT INFORMATION TECHNOLOGY 421405 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL SERVICES 195706 5 CONTRIBUTIONS - EMPLOYERS 900099 133085582 133085582 CONTRIBUTIONS - RETIRED PARTICIPA 900099 2898104 2898104 CONTRIBUTIONS - COBRA PARTICIPANT 900099 295159 295159 136278845 5182146 5182146 33439965 36466689 -3026724 -3026724 -3026724 MISCELLANEOUS INCOME 900099 414785 414785 414785 138849052 136693630 0 2155422 138272460 296546 1876803 197735 491465 163863 312069 49000 213984 497720 352672 618512 119029 52681 99657 95757 ADM.EXPENSES REIMBURSED -425427 143284526 947100 1033826 10937378 3766261 13187867 15527859 106058 63468 3853558 3598008 329804 255550 96842674 86353451 31577067 44266810 977240 891705 154905188 152158930 25864 326038 331824 328441 1417592 908844 1775280 1563323 X 0 0 0 0 153129908 150595607 153129908 150595607 154905188 152158930 -4435474 1901173 0 X X 0 1 X 1 0 343540 338356 5184 1102121 881128 220993 2407897 2378524 29373 255550 COMMON COLLECTIVE TRUST 15305074 F LIMITED PARTNERSHIP 13934888 F ETF 15026848 F 44266810 LEASE LIABILITY - OPERATING LEASE 908844 908844 X 140536241 1901173 1901173 138635068 213984 213984 138849052 143070542 0 143070542 213984 213984 143284526 PART X, LINE 2: THE VEBA TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED MARCH 12, 1987, STATING THAT THE TRUST IS TAX EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE IRC. HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2024 OR 2023 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND RELATED TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. PLAN MANAGEMENT BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. US GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 MARC PANTELEONE FUND MANAGER 228556 0 0 0 0 0 34147 0 25905 0 288608 0 0 0 CHRISTOPHER WILLIAMSON UNION TRUSTEE 0 132724 0 0 0 24720 31755 31331 25905 25472 57660 214247 0 0 MARK COHEN UNION TRUSTEE 0 132724 0 0 0 23783 31755 31331 25905 25472 57660 213310 0 0 VINCENT PERRONE UNION TRUSTEE 0 132724 0 0 0 23070 31755 31331 25905 25472 57660 212597 0 0 ANTONINO ROSCIGLIONE UNION TRUSTEE 0 132724 0 0 0 17050 31755 31331 25905 25472 57660 206577 0 0 MAGGIE WU ACCOUNTANT 211823 0 0 0 0 0 7401 0 26736 0 245960 0 0 0 ANTHONY CERULLI FORMER UNION TRUSTEE 0 132724 0 0 0 15360 0 31331 0 25472 0 204887 0 0 CHRISTINE NICOLETTI OFFICE MANAGER 130333 0 0 0 0 0 34147 0 25905 0 190385 0 0 0 ANNA BYCHOWSKI ASST TO FUND ADMINISTRATOR 114462 0 0 0 0 0 45718 0 25905 0 186085 0 0 0 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 144543 0 0 0 0 0 7401 0 26484 0 178428 0 0 0 CELIA LIAW BENEFIT CLAIMS ASSISTANT 123359 0 0 0 0 0 7401 0 26510 0 157270 0 0 0 FORM 990, PART VI, SECTION A, LINE 8B THE FUND DOES NOT HAVE ANY COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FUND'S BOARD OF TRUSTEES REVIEWS THE FORM 990 PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 15 THE FUND'S BOARD OF TRUSTEES REVIEWS AND AUTHORIZES COMPENSATION FOR ALL EMPLOYEES, INCLUDING FOR THE TOP MANAGEMENT OFFICIAL. THE REVIEW PROCESS IS CONDUCTED AT THE BOARD MEETING AND DOCUMENTED ACCORDINGLY. FORM 990, PART VI, SECTION C, LINE 19 THE FUND MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON RECEIPT OF A PARTICIPANT'S WRITTEN REQUEST. FORM 990, PART VXII, LINE 2C: THE ORGANIZATION'S PROCESS FOR OVERSEEING THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. LOCAL 804 ANNUITY FUND 44 S BAYLES AVE PORT WASHINGTON NY 110503765 112506358 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 0 LOCAL 804 IBT 44 S BAYLES AVE PORT WASHINGTON NY 110503765 111603598 CONTRIBUTING EMPLOYER & RENTAL EXPENSE NY 501(C)(5) 0 LOCAL 804 PENSION FUND 44 S BAYLES AVE PORT WASHINGTON NY 110503765 116077200 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 0 LOCAL 804 FEDERAL CREDIT UNION 44 S BAYLES AVE PORT WASHINGTON NY 110503765 112491081 RELATED TO LOCAL 804 IBT, THE UNION NY 501(C)(1) 0 UNITED PARCEL SERVICE CONTRIBUTING EMPLOYER 0 TRUMP VILLAGE INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 LOCAL 804 ANNUITY FUND O 309687 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND N 57278 SHARED ADM. COST AGREEMENT LOCAL 804 IBT K 118513 OFFICE RENTAL EXPENSE LOCAL 804 PENSION FUND O 50133 SHARED ADM. COST AGREEMENT LOCAL 804 PENSION FUND N 8329 SHARED ADM. COST AGREEMENT LOCAL 804 PENSION FUND Q 42918 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND Q 285925 SHARED ADM. COST AGREEMENT BOYD WATTERSON STATE GOVERNMENT FUND LP ONE NORTH WACKER DRIVE SUITE 4025 CHICAGO IL 60606 320538379 INVESTMENT IL 561552 0 13893557 0 0 0.00640