2015-04-08T18:42:14-05:00 2014-05-31 131578842 BUCHBINDER TUNICK & COMPANY ONE PENNSYLVANIA PLAZA SUITE 5335 NEW YORK NY 10119 990 2013-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 TIMOTHY SYLVESTER TRUSTEE 7187865410 2015-04-03 1 GREG AUTERI P01366109 2126955003 2013 2016-02-25 16:41:14Z TIMOTHY SYLVESTER 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 91289916 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 4 29 0 0 0 0 0 68031870 71287601 512605 186014 214822 92037 68759297 71565652 0 0 52223722 57681762 2025085 2157939 0 0 0 1507182 1437740 55755989 61277441 13003308 10288211 41200227 53910115 1016572 1573204 40183655 52336911 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 4532. 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 1 617 0 1 29 1 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 TIMOTHY SYLVESTER UNION TRUSTEE 0.60 40.00 X 0 126980 39547 JAMES REYNOLDS UNION TRUSTEE 0.60 40.00 X 0 126740 39547 PETE MASTRANDREA UNION TRUSTEE 0.60 40.00 X 0 125960 39547 CHRIS LANGAN EMPLOYER TRUSTEE 0.60 X 0 0 0 BJ DORFMAN EMPLOYER TRUSTEE - RESIGNED 0.00 X 0 0 0 STEVE BRENNAN EMPLOYER TRUSTEE - RESIGNED 0.20 X 0 0 0 BRIAN MCCABE EMPLOYER TRUSTEE 0.60 X 0 0 0 DAVE FENNELL UNION TRUSTEE 0.50 40.00 X 0 128164 39547 JIM MCGRATH EMPLOYER TRUSTEE 0.30 X 0 0 0 MATT HOFFMAN EMPLOYER TRUSTEE 0.30 X 0 0 0 THOMAS LAMONTANARO FUND OFFICE MANAGER 28.30 5.00 X 89514 0 40189 MARC PANTELEONE BENEFIT CLAIMS ASSISTANT 64.00 X 130809 0 22449 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 61.00 X 121219 0 22476 MAGGIE WU BOOKKEEPER 30.00 9.30 X 104517 0 22556 446059 507844 265858 3 0 1 0 EMPIRE HEALTHCHOICE ASSURANCE INC 3350 PEACHTREE ROAD ATLANTA GA 30326 BENEFIT ADMINISTRATIVE SERVICE 1756250 NEW YORK MEDICAL MANAGEMENT ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT CONSULTING SERVICES 345961 HEALTH PLAN SYSTEM ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT INFORMATION TECHNOLOGY 206400 COHEN WEISS AND SIMON LLP 330 WEST 42ND STREET NEW YORK NY 10036 LEGAL SERVICES 156007 THE SEGAL GROUP 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL SERVICES 139941 5 CONTRIBUTIONS - EMPLOYERS 900099 68573994 68573994 CONTRIBUTIONS - RETIRED PARTICIPA 900099 2488346 2488346 CONTRIBUTIONS - COBRA PARTICIPANT 900099 225261 225261 71287601 635513 635513 19274765 19724264 -449499 -449499 -449499 MISCELLANEOUS INCOME 900099 92037 92037 92037 71565652 71379638 0 186014 57681762 131193 1379598 125747 398896 122505 242276 39000 127690 139941 208283 514621 89452 18643 214496 20346 DUES AND SUBSCRIPTIONS 1982 MISC 50 ADM.EXPENSES REIMBURSED -179040 61277441 995096 599660 8584830 5601639 7098827 7100652 44155 72805 2817455 2335615 471013 481840 24006306 40053519 41200227 53910115 462860 1054667 390335 363804 163377 154733 1016572 1573204 X 0 0 0 0 40183655 52336911 40183655 52336911 41200227 53910115 10288211 1865045 0 X X 0 1 X 1 0 326292 317663 8629 563015 461261 101754 1928148 1556691 371457 481840 EST'D FUTURE RETIREMENT BENEFIT 154733 154733 X 73303007 1865045 1865045 71437962 127690 127690 71565652 61149751 0 61149751 127690 127690 61277441 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, 2014, 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, 2011. 0 0 0 TIMOTHY SYLVESTER UNION TRUSTEE 0 126980 0 0 0 0 0 23161 0 16386 0 166527 0 0 JAMES REYNOLDS UNION TRUSTEE 0 126740 0 0 0 0 0 23161 0 16386 0 166287 0 0 PETE MASTRANDREA UNION TRUSTEE 0 125960 0 0 0 0 0 23161 0 16386 0 165507 0 0 DAVE FENNELL UNION TRUSTEE 0 128164 0 0 0 0 0 23161 0 16386 0 167711 0 0 MARC PANTELEONE BENEFIT CLAIMS ASSISTANT 130809 0 0 0 0 0 4995 0 17454 0 153258 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 11 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 XII, LINE 2C: THE FUND'S PROCESS FOR OVERSEEING THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM PRIOR YEAR. 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 UNITED PARCEL SERVICE CONTRIBUTING EMPLOYER 0 EPPENDORF INC CONTRIBUTING EMPLOYER 0 OCS AMERICA INC CONTRIBUTING EMPLOYER 0 TRUMP VILLAGE INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 LOCAL 804 ANNUITY FUND N 53840 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND O 67876 SHARED ADM. COST AGREEMENT