2014-04-08T14:29:04-05:00 2013-05-31 131578842 BUCHBINDER TUNICK & COMPANY ONE PENNSYLVANIA PLAZA SUITE 5335 NEW YORK NY 10119 990 2012-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 TIMOTHY SYLVESTER 7187865410 2014-04-03 1 GREG AUTERI P01366109 2126955003 2012 2015-11-30 17:44:51Z TIMOTHY SYLVESTER 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 81040027 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 4 28 0 0 0 0 0 63993489 68031870 623659 512605 119888 214822 64737036 68759297 0 0 53796347 52223722 1878647 2025085 0 0 0 1263887 1507182 56938881 55755989 7798155 13003308 28564191 41200227 1406273 1016572 27157918 40183655 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 4547. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 1 613 0 1 28 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 0.60 40.00 X 0 116080 38334 JAMES REYNOLDS 0.60 40.00 X 0 115360 38334 PETE MASTRANDREA 0.60 40.00 X 0 115420 38334 CHRIS LANGAN 0.60 X 0 0 0 BJ DORFMAN 0.20 X 0 0 0 STEVE BRENNAN 0.60 X 0 0 0 BRIAN MCCABE 0.60 X 0 0 0 DAVE FENNELL 0.60 40.00 X 0 115360 38334 THOMAS LAMONTANARO 28.80 5.00 X 86840 0 39209 MARC PANTELEONE 59.40 X 115763 0 21236 JAMES PANTELEONE 65.30 X 124601 0 21190 MAGGIE WU 29.10 10.10 X 104546 0 21313 431750 462220 256284 3 0 1 0 EMPIRE HEALTHCHOICE ASSURANCE INC 3350 PEACHTREE ROAD ATLANTA GA 30326 BENEFIT ADMINISTRATIVE SERVICE 1525557 NEW YORK MEDICAL MANAGEMENT ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT CONSULTING SERVICES 309429 HEALTH PLAN SYSTEM ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT INFORMATION TECHNOLOGY 303551 COHEN WEISS AND SIMON LLP 330 WEST 42ND STREET NEW YORK NY 10036 LEGAL SERVICES 191710 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL SERVICES 134066 6 CONTRIBUTIONS - EMPLOYERS 900099 65213710 65213710 CONTRIBUTIONS - RETIRED PARTICIPA 900099 2626164 2626164 CONTRIBUTIONS - COBRA PARTICIPANT 900099 191996 191996 68031870 591846 591846 12201489 12280730 -79241 -79241 -79241 MISCELLANEOUS INCOME 900099 214822 214822 214822 68759297 68246692 0 512605 52223722 127234 1280208 127918 365224 124501 397110 49200 101207 193737 159148 471747 78990 1222 186479 19369 MISC 4250 DUES AND SUBSCRIPTIONS 2019 ADM.EXPENSES REIMBURSED -157296 55755989 911103 995096 2198036 8584830 5821531 7098827 41261 44155 2569048 2098035 642842 471013 18747305 24006306 202113 0 28564191 41200227 1036918 462860 203476 390335 165879 163377 1406273 1016572 X 0 0 0 0 27157918 40183655 27157918 40183655 28564191 41200227 13003308 22429 0 X X 0 1 X 1 0 316336 316336 0 197183 195866 1317 2055529 1585833 469696 471013 EST'D FUTURE RETIREMENT BENEFIT 163377 163377 68680519 22429 22429 68658090 101207 101207 68759297 55654782 0 55654782 101207 101207 55755989 0 0 0 TIMOTHY SYLVESTER 0 116080 0 0 0 0 0 22736 0 15598 0 154414 0 0 JAMES REYNOLDS 0 115360 0 0 0 0 0 22736 0 15598 0 153694 0 0 PETE MASTRANDREA 0 115420 0 0 0 0 0 22736 0 15598 0 153754 0 0 DAVE FENNELL 0 115360 0 0 0 0 0 22736 0 15598 0 153694 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. 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 0 1 0 0 LOCAL 804 ANNUITY FUND N 106836 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND O 68371 SHARED ADM. COST AGREEMENT