2013-04-10T16:44:46-05:00 2012-05-31 131578842 BUCHBINDER TUNICK & COMPANY ONE PENNSYLVANIA PLAZA SUITE 5335 NEW YORK NY 10119 990 2011-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 TIMOTHY SYLVESTER 7187865410 2013-04-09 1 GREG AUTERI P01366109 2126955003 2011 2016-03-07 17:11:31Z TIMOTHY SYLVESTER 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 73157730 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 8 25 0 0 0 0 0 60577047 63993489 360567 623659 387886 119888 61325500 64737036 0 0 53947934 53796347 1544519 1878647 0 0 0 1855673 1263887 57348126 56938881 3977374 7798155 20389286 28564191 1349058 1406273 19040228 27157918 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 4610. 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1207 0 1 25 1 0 0 0 0 0 0 X 8 8 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 X 0 0 0 JAMES REYNOLDS 0.60 X 0 0 0 PETE MASTRANDREA 0.60 X 0 0 0 LARRY MCIVER 0.20 X 0 0 0 CHRIS LANGAN 0.60 X 0 0 0 BJ DORFMAN 0.60 X 0 0 0 STEVE BRENNAN 0.60 X 0 0 0 BRIAN MCCABE 0.60 X 0 0 0 DAVE FENNELL 0.30 X 0 0 0 THOMAS LAMONTANARO 29.00 X 80840 0 37120 MARC PANTELEONE 54.60 X 103671 0 19679 184511 0 56799 1 0 0 0 EMPIRE HEALTHCHOICE ASSURANCE INC 3350 PEACHTREE ROAD ATLANTA GA 30326 BENEFIT ADMINISTRATIVE SERVICE 1518182 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL SERVICES 538092 COHEN WEISS AND SIMON LLP 330 WEST 42ND STREET NEW YORK NY 10036 LEGAL SERVICES 413504 HEALTH PLAN SYSTEM ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT INFORMATION TECHNOLOGY 311748 NEW YORK MEDICAL MANAGEMENT ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT CONSULTING SERVICES 287057 6 CONTRIBUTIONS - EMPLOY 900099 61209545 61209545 CONTRIBUTIONS - RETIRE 900099 2607069 2607069 CONTRIBUTIONS - COBRA 900099 176875 176875 63993489 381634 381634 8662719 8420694 242025 242025 242025 MISCELLANEOUS INCOME 900099 119888 119888 119888 64737036 64113377 0 623659 53796347 121921 1192716 116677 343501 103832 360841 41000 63169 164909 186763 275751 70920 15226 193259 14436 ARBITRATION 6000 DUES AND SUBSCRIPTIONS 1813 AMORTIZATION OF SOFTWAR 166 MISC 50 -130416 56938881 862697 911103 1143197 2198036 6034861 5821531 38449 41261 2554398 1911556 642784 642842 9112432 18747305 2554866 202113 20389286 28564191 977058 1036918 187699 203476 184301 165879 1349058 1406273 X 0 0 0 0 19040228 27157918 19040228 27157918 20389286 28564191 X 7798155 319535 X X 0 1 1 X 0 316336 316336 0 197183 194716 2467 2040879 1400504 640375 642842 EST'D FUTURE RETIREMENT BENEFIT 165879 165879 64737036 56938881 7798155 319535 319535 8117690 64993402 319535 319535 64673867 63169 63169 64737036 56875712 0 56875712 63169 63169 56938881 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 319,535. TOTAL TO FORM 990, PART XI, LINE 5: 319,535. 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. LOCAL 804 ANNUITY FUND 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 112506358 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 LOCAL 804 ANNUITY FUND M 11948 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND N 79564 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND P 2404 ACTUAL EXPENSES SHARED