2011-11-10T11:49:29-06:00 2010-12-31 BST ADVISORS LLC 28 WEST 44TH STREET NEW YORK NY 10036 990 2010-01-01 136162404 LOCAL 812 HEALTH FUND LOCA 5163031455 445 NORTHERN BLVD GREAT NECK NY 11021 JOSEPH VITTA 5163031455 2011-11-08 1 DAVID C LEE 2126618640 2010 2016-02-24 21:20:13Z JOSEPH VITTA 445 NORTHERN BLVD GREAT NECK NY 11021 51071280 0 X N/A X 1945 NY TO PROVIDE HOSPITALIZATION, DRUG, DENTAL, LIFE, VISION, DISABILITY AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS AND COVERED DEPENDENTS. 6 0 3619 0 0 0 0 0 37437648 38831854 233971 568152 467783 0 38139402 39400006 0 0 31880343 35206168 216358 224637 0 0 0 453605 509557 32550306 35940362 5589096 3459644 13452809 20067656 5879099 7953897 7573710 12113759 TO PROVIDE HOSPITALIZATION, DRUG, DENTAL, LIFE, VISION, DISABILITY AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS AND COVERED DEPENDENTS. 0 0 TO PROVIDE HOSPITALIZATION, DRUG, DENTAL, LIFE, VISION, DISABILITY AND OTHER BENEFITS TO ELIGIBLE PARTICIPANTS AND COVERED DEPENDENTS. 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 0 1 X 9 0 3619 1 0 0 0 0 0 0 X 6 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 X BOARD OF TRUSTEES LOCAL 812 HEALTH FUND 5163031455 445 NORTHERN BOULEVARD GREAT NECK NY 11021 JOSEPH WOJCIECHOWSKI 5.00 X 0 192146 16807 THOMAS ROSANO 5.00 X 0 152950 16807 WARREN MARSH 5.00 X 0 152268 16807 JOHN COTOGGIO 5.00 X 0 149967 16807 JOSEPH VITTA 5.00 X 0 152423 16807 EDWARD WEBER 5.00 X 0 127690 16779 JAMES SCARPATI 20.00 X 68946 68891 16807 68946 996335 117621 0 0 1 0 CROSSROADS HEALTHCARE MGT LLC 2556 ARTHUR KILL ROAD STATEN ISLAND NY 10309 CONTRACT ADMIN 3404764 PROSCRIPT PHARMACY MGT LLC 2556 ARTHUR KILL ROAD STATEN ISLAND NY 10309 RX ADMIN 476739 MULTIPLAN INC 115 FIFTH AVENUE NEW YORK NY 10003 PROVIDER NETWORK ADMIN 244803 3 EMPLOYER'S CONTRIBUTIO 900099 38200024 38200024 PRESCRIPTION SUBSIDY 900099 465953 465953 COBRA CONTRIBUTIONS 900099 165877 165877 38831854 360854 360854 11878572 11671274 207298 207298 207298 39400006 38831854 0 568152 35206168 161888 10093 36203 16453 158161 118999 18658 45000 44096 1856 24860 43077 11442 12463 BANK FEES 30945 35940362 2313313 1871068 114983 430470 153547 82842 73556 70705 10130038 16768235 820919 927178 13452809 20067656 515305 685844 5363794 7268053 5879099 7953897 X 0 0 0 0 7573710 12113759 7573710 12113759 13452809 20067656 3459644 1080405 X X 0 1 1 X 0 98115 35142 62973 55432 47700 7732 70705 BENEFITS PAYABLE 2935191 CLAIMS INCURRED BUT NOT REPORTED 4332862 7268053 39400006 35940362 3459644 1080405 1904259 2984664 6444308 40461753 1080405 1080405 39381348 18658 18658 39400006 34017445 0 34017445 1922917 1922917 35940362 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFITS PAYABLE AND CLAIMS IBNR 1,904,259. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES 18,658. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFITS PAYABLE AND CLAIMS IBNR 1,904,259. INVESTMENT EXPENSES 18,658. 0 0 0 JOSEPH WOJCIECHOWSKI 0 156923 0 1000 0 34223 0 0 0 16807 0 208953 0 0 THOMAS ROSANO 0 118742 0 1000 0 33208 0 0 0 16807 0 169757 0 0 WARREN MARSH 0 118742 0 1000 0 32526 0 0 0 16807 0 169075 0 0 JOHN COTOGGIO 0 117692 0 1000 0 31275 0 0 0 16807 0 166774 0 0 JOSEPH VITTA 0 123000 0 1000 0 28423 0 0 0 16807 0 169230 0 0 JAMES SCARPATI 68946 61282 0 3750 0 3859 0 0 8403 8404 77349 77295 0 0 W-2 ISSUANCE FORM 990, PART V, LINE 2A THIS LINE INCLUDES 2 PAID EMPLOYEES AND 3,617 PARTICIPANTS THAT RECEIVED A TAXABLE LIFE INSURANCE BENEFIT. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FUND'S INDEPENDENT ACCOUNTANT PREPARES THE FORM 990. THE 990 IS GIVEN TO THE BOARD OF TRUSTEES, WHO REVIEW IT WITH THE CONTROLLER, THE FUND'S ACCOUNTANT AND COMPLIANCE COUNSEL. FORM 990, PART VI, SECTION C, LINE 19 THE FUND'S DOCUMENTS,POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AND MAY BE EXAMINED AT THE FUND'S OFFICE. FORM 990, PART XI, LINE 2C THE FUND'S BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. SDBWU LOCAL 812 RETIREMENT PLAN 445 NORTHERN BLVD GREAT NECK NY 11021 135660090 PROVIDES RETIREMENT BENEFITS TO ITS MEMBERS NY 501(A) N/A N/A 0 SDBWU LOCAL 812 IBT 445 NORTHERN BLVD GREAT NECK NY 11021 135045803 LABOR ORGANIZATION NY 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 SOFT DRINKS BWERY WRKERS & DELIVERY EMPL IND'L EMPL WRHMEN HLRP & MISC M 43668 ACCRUAL BASIS SOFT DRINKS BWERY WRKERS & DELIVERY EMPL IND'L EMPL WRHMEN HLRP & MISC O 43668 ACCRUAL BASIS