2012-04-11T18:08:58-05:00 2011-05-31 BUCHBINDER TUNICK & CO LLP ONE PENN PLAZA NEW YORK NY 101190219 990 2010-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 TIMOTHY SYLVESTER 7187865410 2012-04-05 1 2126955003 2010 2016-02-24 21:20:13Z TIMOTHY SYLVESTER 34-21 REVIEW AVENUE LONG ISLAND CITY NY 111013241 65693384 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 8 26 0 0 0 0 0 55952902 60577047 579157 360567 128546 387886 56660605 61325500 0 0 55275191 53947934 1632076 1544519 0 0 0 1076507 1855673 57983774 57348126 -1323169 3977374 15880862 20389286 1155110 1349058 14725752 19040228 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 4813. 0 0 0 0 0 0 0 0 1 0 0 1 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 4396 0 1 26 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 0.50 X 0 0 0 CHRIS LANGAN 0.60 X 0 0 0 MICHAEL ROSENTRATER 0.20 X 0 0 0 BJ DORFMAN 0.60 X 0 0 0 JACK DEMPSEY 0.00 X 0 0 0 STEVE BRENNAN 0.20 X 0 0 0 BRIAN MCCABE 0.60 X 0 0 0 THOMAS LAMONTANARO 30.00 X 80340 0 33951 80340 0 33951 0 0 0 0 EMPIRE HEALTHCHOICE ASSURANCE INC ONE LIBERTY PLAZA 14TH FL NEW YORK NY 10006 BENEFIT ADMINISTRATIVE SERVICE 1476366 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL SERVICES 495170 COHEN WEISS AND SIMON LLP 330 WEST 42ND STREET NEW YORK NY 10036 LEGAL SERVICES 386002 NEW YORK MEDICAL MANAGEMENT ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT CONSULTING SERVICES 236928 HEALTH PLAN SYSTEM ONE WOODBRIDGE CENTER WOODBRIDGE NJ 07095 BENEFIT INFORMATION TECHNOLOGY 208520 8 CONTRIBUTIONS - EMPLOY 900099 57462342 57462342 CONTRIBUTIONS - RETIRE 900099 2667672 2667672 CONTRIBUTIONS - COBRA 900099 447033 447033 60577047 260684 260684 4467767 4367884 99883 99883 99883 MISCELLANEOUS INCOME 900099 387886 387886 387886 61325500 60964933 0 360567 53947934 116291 1109334 111026 111179 96689 931172 39000 41452 204178 230295 208520 71508 1550 161839 11878 ARBITRATION 36699 DUES AND SUBSCRIPTIONS 2715 AMORTIZATION OF SOFTWAR 333 MISC 130 ADM.EXPENSES REIMBURSED -85596 57348126 0 862697 3058 1143197 4991947 6034861 41935 38449 2361081 1718297 408706 642784 7880017 9112432 2555199 2554866 15880862 20389286 541071 977058 220416 187699 393623 184301 1155110 1349058 X 0 0 0 0 14725752 19040228 14725752 19040228 15880862 20389286 X 3977374 337102 X X 0 1 1 X 0 316336 316336 0 197183 192860 4323 1847562 1209101 638461 642784 DEPOSIT WITH EMPIRE BLUE CROSS AND BLUE SHIELD 2554700 COMPUTER SOFTWARE COSTS 166 2554866 EST'D FUTURE RETIREMENT BENEFIT 164344 DUE TO LOCAL 804 PENSION FUND 19957 184301 61325500 57348126 3977374 337102 337102 4314476 61621150 337102 337102 61284048 41452 41452 61325500 57306674 0 57306674 41452 41452 57348126 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: 337,102. FORM 990, PART XI, 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 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 4608 LOCAL 804 ANNUITY FUND N 54112 LOCAL 804 ANNUITY FUND P 14973