FURP.ORG / PUBLIC DATA EXPLORER

WELFARE TRUST FUND LOCAL 804: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
WELFARE TRUST FUND LOCAL 804 (EIN 11-1637886)
Tax period
2011-06-01 to 2012-05-31
Filed
2013-04-10
IRS object ID
201321009349300227
Schema version
2011v1.5
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

FieldValueIRS element (for citing)
Timestamp2013-04-10T16:44:46-05:00Timestamp
Tax Period End Date2012-05-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN131578842EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BUCHBINDER TUNICK & COMPANYBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE PENNSYLVANIA PLAZA SUITE 5335AddressLine1
CityNEW YORKCity
StateNYState
ZIP Code10119ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-06-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN111637886EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1LOCAL 804 WELFARE TRUST FUNDBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlLOCANameControl
Phone7187865410Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line134-21 REVIEW AVENUEAddressLine1
CityLONG ISLAND CITYCity
StateNYState
ZIP Code111013241ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTIMOTHY SYLVESTERName
TitleTRUSTEETitle
Phone7187865410Phone
Date Signed2013-04-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGREG AUTERIName
PTINP01366109PTIN
Phone2126955003Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTIMOTHY SYLVESTERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line134-21 REVIEW AVENUEAddressLine1
CityLONG ISLAND CITYCity
StateNYState
ZIP Code111013241ZIPCode
FieldValueIRS element (for citing)
Gross Receipts73157730GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteHTTP://WWW.LOCAL804FUND.COMWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1950YearFormation
State Legal DomicileNYStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH CARE BENEFITSActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees25TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year60577047ProgramServiceRevenuePriorYear
Program Service Revenue CY63993489ProgramServiceRevenueCY
Investment Income Prior Year360567InvestmentIncomePriorYear
Investment Income Current Year623659InvestmentIncomeCurrentYear
Other Revenue Prior Year387886OtherRevenuePriorYear
Other Revenue Current Year119888OtherRevenueCurrentYear
Total Revenue Prior Year61325500TotalRevenuePriorYear
Total Revenue Current Year64737036TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year53947934BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY53796347BenefitsPaidToMembersCY
Salaries Etc Prior Year1544519SalariesEtcPriorYear
Salaries Etc Current Year1878647SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1855673OtherExpensePriorYear
Other Expenses Current Year1263887OtherExpensesCurrentYear
Total Expenses Prior Year57348126TotalExpensesPriorYear
Total Expenses Current Year56938881TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3977374RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7798155RevenuesLessExpensesCY
Total Assets BOY20389286TotalAssetsBOY
Total Assets EOY28564191TotalAssetsEOY
Total Liabilities BOY1349058TotalLiabilitiesBOY
Total Liabilities EOY1406273TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY19040228NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY27157918NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionPROVIDED HEALTH CARE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. ESTIMATED NUMBER OF PARTICIPANTS BENEFITED DURING THE PAST YEAR WAS 4610.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961207NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees25NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1THOMAS LAMONTANARO FUND MANAGERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7187865410TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line134-21 REVIEW AVENUEAddressLine1
CityLONG ISLAND CITYCity
StateNYState
ZIP Code11101ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
TIMOTHY SYLVESTER
UNION TRUSTEE0.60X000
JAMES REYNOLDS
UNION TRUSTEE0.60X000
PETE MASTRANDREA
UNION TRUSTEE0.60X000
LARRY MCIVER
UNION TRUSTEE (RESIGNED NOV 20110.20X000
CHRIS LANGAN
EMPLOYER TRUSTEE0.60X000
BJ DORFMAN
EMPLOYER TRUSTEE0.60X000
STEVE BRENNAN
EMPLOYER TRUSTEE0.60X000
BRIAN MCCABE
EMPLOYER TRUSTEE0.60X000
DAVE FENNELL
UNION TRUSTEE0.30X000
THOMAS LAMONTANARO
FUND OFFICE MANAGER29.0080840037120X
MARC PANTELEONE
BENEFIT CLAIMS ASSISTANT54.60103671019679X
FieldValueIRS element (for citing)
Total Reportable Comp From Org184511TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation56799TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
EMPIRE HEALTHCHOICE ASSURANCE INC
3350 PEACHTREE ROADATLANTAGA30326BENEFIT ADMINISTRATIVE SERVICE1518182
PROSKAUER ROSE LLP
ELEVEN TIMES SQUARENEW YORKNY10036LEGAL SERVICES538092
COHEN WEISS AND SIMON LLP
330 WEST 42ND STREETNEW YORKNY10036LEGAL SERVICES413504
HEALTH PLAN SYSTEM
ONE WOODBRIDGE CENTERWOODBRIDGENJ07095BENEFIT INFORMATION TECHNOLOGY311748
NEW YORK MEDICAL MANAGEMENT
ONE WOODBRIDGE CENTERWOODBRIDGENJ07095BENEFIT CONSULTING SERVICES287057
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CONTRIBUTIONS - EMPLOY9000996120954561209545
CONTRIBUTIONS - RETIRE90009926070692607069
CONTRIBUTIONS - COBRA900099176875176875
FieldValueIRS element (for citing)
Total Program Service Revenue63993489TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column381634TotalRevenueColumn
Exclusion$381,634ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities8662719Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities8420694Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities242025Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column242025TotalRevenueColumn
Exclusion$242,025ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column119888TotalRevenueColumn
Related Or Exempt Function Income119888RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue119888TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column64737036TotalRevenueColumn
Related Or Exempt Function Income64113377RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$623,659ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total53796347Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total121921Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1192716Total

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total116677Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total343501Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total103832Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total360841Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total41000Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total63169Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total164909Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total186763Total

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total275751Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total70920Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total15226Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total193259Total

Insurance Insurance

FieldValueIRS element (for citing)
Total14436Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
ARBITRATION6000
DUES AND SUBSCRIPTIONS1813
AMORTIZATION OF SOFTWAR166
MISC50

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total-130416Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total56938881Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY862697BOY
EOY911103EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1143197BOY
EOY2198036EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6034861BOY
EOY5821531EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY38449BOY
EOY41261EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2554398LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1911556LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY642784BOY
EOY642842EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY9112432BOY
EOY18747305EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2554866BOY
EOY202113EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20389286BOY
EOY28564191EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY977058BOY
EOY1036918EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY187699BOY
EOY203476EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY184301BOY
EOY165879EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1349058BOY
EOY1406273EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY19040228BOY
EOY27157918EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY19040228BOY
EOY27157918EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20389286BOY
EOY28564191EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7798155ReconcilationRevenueExpenses
Reconcilation Other Changes319535ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis316336OtherCostOrOtherBasis
Depreciation316336Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis197183OtherCostOrOtherBasis
Depreciation194716Depreciation
Book Value2467BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2040879OtherCostOrOtherBasis
Depreciation1400504Depreciation
Book Value640375BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings642842TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionEST'D FUTURE RETIREMENT BENEFITDescription
Amount$165,879Amount
FieldValueIRS element (for citing)
Total Of Amounts165879TotalOfAmounts
Total Revenue64737036TotalRevenue
Total Expenses56938881TotalExpenses
Excess Or Deficit For Year7798155ExcessOrDeficitForYear
Net Unrealized GL On Investments319535NetUnrealizedGLOnInvestments
Total Adjustments319535TotalAdjustments
Excess Or Deficit Per FS8117690ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt64993402TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments319535NetUnrealizedGainsInvestments
Revenue Not Rptd F990319535RevenueNotRptdF990
Revenue Subtotal64673867RevenueSubtotal
Investment Expenses Not Included63169InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt63169RevenueNotRptdOnFinStmt
Total Revenue Per Form99064737036TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt56875712TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal56875712ExpensesSubtotal
Investment Expenses Not Included263169InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt63169ExpensesNotRptdOnFinStmt
Total Expenses Per Form99056938881TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 8BTHE FUND DOES NOT HAVE ANY COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11THE FUND'S BOARD OF TRUSTEES REVIEWS THE FORM 990 PRIOR TO ITS FILING.
FORM 990, PART VI, SECTION B, LINE 15THE 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 19THE FUND MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON RECEIPT OF A PARTICIPANT'S WRITTEN REQUEST.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 319,535. TOTAL TO FORM 990, PART XI, LINE 5: 319,535.CHANGES IN NET ASSETS OR FUND BALANCES:
THE FUND'S PROCESS FOR OVERSEEING THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1LOCAL 804 ANNUITY FUNDBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line134-21 REVIEW AVENUEAddressLine1
CityLONG ISLAND CITYCity
StateNYState
ZIP Code111013241ZIPCode
FieldValueIRS element (for citing)
EIN112506358EIN
Primary ActivitiesSHARED ADMINISTRATIVE COSTPrimaryActivities
Legal Domicile StateNYLegalDomicileState
Exempt Code Section1.401-1(B)(3)ExemptCodeSection
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
LOCAL 804 ANNUITY FUND
M11948SHARED ADM. COST AGREEMENT
LOCAL 804 ANNUITY FUND
N79564SHARED ADM. COST AGREEMENT
LOCAL 804 ANNUITY FUND
P2404ACTUAL EXPENSES SHARED