2020-04-15T12:52:29-05:00 2019-05-31 131578842 BUCHBINDER TUNICK & COMPANY LLP ONE PENNSYLVANIA PLAZA SUITE 3500 NEW YORK NY 10119 990 2018-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 VINCENT PERRONE TRUSTEE 7187865410 2020-04-15 1 GREG AUTERI P01366109 2126955003 207.99.80.132 2020-04-15 10:33:11 ED P 7EA41B086A7FFB4185721C7DC6DC2EBE07C6BE5E CB8B4554FF2B0E55EAF1BAEF1CDA56A6BA42187A 2018 2020-11-19 02:30:22Z VINCENT PERRONE 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 133717953 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 4 31 0 0 0 0 0 90437439 99796314 8044046 2018471 471208 55718 98952693 101870503 0 0 79171730 87241764 2679026 2738416 0 0 0 1483622 1796980 83334378 91777160 15618315 10093343 91399660 104966889 674816 787754 90724844 104179135 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 5048. 0 0 0 0 0 0 0 0 0 1 0 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 0 1 590 0 1 31 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 THOMAS LAMONTANARO FUND MANAGER 7187865410 34-21 REVIEW AVENUE LONG ISLAND CITY NY 11101 CHRIS LANGAN EMPLOYER TRUSTEE 1.00 X 0 0 0 RYAN THIBODEAU EMPLOYER TRUSTEE 1.00 X 0 0 0 MATTHEW LOUGHLIN EMPLOYER TRUSTEE (EFF 5/29 1.00 X 0 0 0 MATT HOFFMAN EMPLOYER TRUSTEE 1.00 X 0 0 0 VINCENT PERRONE UNION TRUSTEE 1.00 40.00 X 0 0 48684 ANTONINO ROSCIGLIONE UNION TRUSTEE 1.00 40.00 X 0 0 48684 CHRISTOPHER WILLIAMSON UNION TRUSTEE 1.00 40.00 X 0 0 48684 ANTHONY CERULLI UNION TRUSTEE 1.00 40.00 X 0 0 48684 DENNIE GANDEE EMPLOYER TRUSTEE (RESIGNED) 1.00 X 0 0 0 EDWEEN VILLALTA UNION TRUSTEE (RESIGNED 5/30/19 1.00 40.00 X 0 0 0 JOHN PICCINICH UNION TRUSTEE (RESIGNED) 1.00 40.00 X 0 125900 0 DANIEL MONTALVO UNION TRUSTEE (RESIGNED) 1.00 40.00 X 0 129600 0 DANIEL BETANCOURT UNION TRUSTEE (RESIGNED) 1.00 40.00 X 0 126100 0 THOMAS LAMONTANARO FUND OFFICE MANAGER 34.00 6.00 X 108159 0 48684 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 64.00 X 143622 0 34739 MARC PANTELEONE BENEFIT CLAIMS ASSISTANT 65.00 X 176927 0 34847 MAGGIE WU ACCOUNTANT 31.00 19.00 X 157247 0 34952 585955 381600 347958 4 0 1 0 EMPIRE HEALTHCHOICE ASSURANCE INC 165 BROADWAY NEW YORK NY 10006 BENEFIT ADMINISTRATIVE SERVICE 1854659 HEALTH PLAN SYSTEM 2025 LINCOLN HIGHWAY ROUTE 21 EDISON NJ 08817 BENEFIT INFORMATION TECHNOLOGY 499282 NEW YORK MEDICAL MANAGEMENT 2025 LINCOLN HIGHWAY ROUTE 21 EDISON NJ 08817 BENEFIT CONSULTING SERVICES 355599 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL SERVICES 230253 THE SEGAL COMPANY (EASTERN STATES) INC 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL AND CONSULTING SERVICES 185200 8 CONTRIBUTIONS - EMPLOYERS 900099 97111084 97111084 CONTRIBUTIONS - RETIRED PARTICIPA 900099 2549124 2549124 CONTRIBUTIONS - COBRA PARTICIPANT 900099 136106 136106 99796314 2596243 2596243 31269678 31847450 -577772 -577772 -577772 MISCELLANEOUS INCOME 900099 55718 55718 55718 101870503 99852032 0 2018471 87241764 158923 1705171 288414 444455 141453 379358 49000 261068 231074 241811 577490 95560 1222 100569 36958 MEDICAL CLAIMS AUDIT FE 62681 TEMPORARY HELP 18000 MISCELLANEOUS 5521 ADM.EXPENSES REIMBURSED -263784 452 91777160 709713 688337 12675556 3935077 9594183 15049934 105195 91835 3248660 3164946 166197 83714 68148816 78147113 6970879 91399660 104966889 343763 409403 159587 235140 171466 143211 674816 787754 X 0 0 0 0 90724844 104179135 90724844 104179135 91399660 104966889 10093343 3360948 0 X 0 1 X 0 0 335226 335226 0 764286 724772 39514 2149148 2104948 44200 83714 COMMON COLLECTIVE TRUST 6970879 F 6970879 EST'D FUTURE RETIREMENT BENEFIT 128617 DUE TO LOCAL 804 PENSION FUND 9957 DUE TO LOCAL 804 ANNUITY FUND 4637 143211 X 104970383 3360948 3360948 101609435 261068 261068 101870503 91516092 0 91516092 261068 261068 91777160 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE 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 INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF MAY 31, 2018, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. EMPLOYEE BENEFIT PLANS ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS FOR THE PLAN. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO MAY 31, 2016. 0 0 0 THOMAS LAMONTANARO FUND OFFICE MANAGER 108159 0 0 0 0 0 27233 0 21451 0 156843 0 0 0 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 143622 0 0 0 0 0 12793 0 21946 0 178361 0 0 0 MARC PANTELEONE BENEFIT CLAIMS ASSISTANT 176927 0 0 0 0 0 12793 0 22054 0 211774 0 0 0 MAGGIE WU ACCOUNTANT 157247 0 0 0 0 0 12793 0 22159 0 192199 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. LOCAL 804 ANNUITY FUND 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 112506358 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 0 LOCAL 804 IBT 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 111603598 CONTRIBUTING EMPLOYER & RENTAL EXPENSE NY 501(C)(5) 0 LOCAL 804 FEDERAL CREDIT UNION 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 112491081 CONTRIBUTING EMPLOYER NY 501(C)(1) 0 LOCAL 804 PENSION FUND 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 116077200 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 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 76081 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND N 108295 SHARED ADM. COST AGREEMENT LOCAL 804 IBT K 61560 OFFICE RENTAL EXPENSE LOCAL 804 PENSION FUND O 29677 SHARED ADM. COST AGREEMENT LOCAL 804 PENSION FUND N 49731 SHARED ADM. COST AGREEMENT LOCAL 804 PENSION FUND Q 65797 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND Q 153146 SHARED ADM. COST AGREEMENT