2022-03-23T08:15:55-05:00 2021-08-31 131577780 SCHULTHEIS & PANETTIERI LLP 450 WIRELESS BLVD HAUPPAUGE NY 11788 990 2020-09-01 135548780 LOCAL 807 LABOR-MANAGEMENT HEALTH FUND LOCA 7187262525 32-43 49TH STREET LONG ISLAND CITY NY 11103 DEMOS P DEMOPOULOS UNION TRUSTEE 7187262525 2022-03-23 1 DEMOS DEMOPOULOS 999009999 CAROL WESTFALL P00539069 6312734778 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z TERESA CASANOVA 32-43 49TH STREET LONG ISLAND CITY NY 11103 48796228 0 X N/A X 1948 NY TO PROVIDE HEALTH & MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 6 6 14 0 0 0 0 0 10456077 9357588 1819816 3474925 165684 167186 12441577 12999699 0 0 10320396 10284160 1336420 1353254 0 0 0 141748 167191 11798564 11804605 643013 1195094 73465201 75545076 1973767 1442944 71491434 74102132 TO PROVIDE HEALTH & MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HEALTH & MEDICAL BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 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 1 585 0 1 14 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 X TERESA CASANOVA 7187262525 32-43 49TH STREET LONG ISLAND CITY NY 11103 ANTHONY STORZ UNION TRUSTEE 1.00 0.00 X 0 0 0 JOHN SULLIVAN - THRU 032021 UNION TRUSTEE 1.00 0.00 X 0 0 0 MARTY MEYERS - EFF 042021 UNION TRUSTEE 1.00 0.00 X 0 0 0 LUIS HERRERA UNION TRUSTEE 1.00 0.00 X 0 0 0 SCOTT LITTLE MGT TRUSTEE 1.00 0.00 X 0 0 0 JOHN ZAK MGT TRUSTEE 1.00 0.00 X 0 0 0 ROBERT HOLDEN MGT TRUSTEE 1.00 0.00 X 0 0 0 TERESA CASANOVA FUND ADMIN. 40.00 0.00 X 167954 0 44937 167954 0 44937 1 0 1 0 MAGNACARE ADMIN SERVICES ONE PENN PLAZA NEW YORK NY 10119 NETWORK ACCESS 237540 BLUE CROSS BLUE SHIELD 15 METROTECH CENTER BROOKLYN NY 11201 MED CLAIM ADMIN 232660 THE SEGAL COMPANY (EASTERN STATES) INC 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL CONSULTING 114799 3 EMPLOYER CONTRIBUTIONS 484110 8992631 8992631 PARTICIPANTS CONTRIBUTIONS 484110 364957 364957 9357588 1562677 1562677 167186 0 167186 167186 167186 37708777 35796529 1912248 1912248 1912248 12999699 9357588 0 3642111 10284160 220896 607398 263303 196041 65616 124414 96014 74788 136598 76771 34171 117376 721 3633 41886 REIMB PR, TAXES AND BEN -539181 11804605 766078 1124079 3085928 1100450 2041222 1564410 104602 87200 6591418 791418 5803633 5800000 55231037 56079558 6432701 9789379 73465201 75545076 275000 245344 1698767 1197600 1973767 1442944 X 0 0 0 0 71491434 74102132 71491434 74102132 73465201 75545076 1195094 1415604 0 X 0 1 X 1 0 5800000 5800000 173693 173693 0 617725 617725 0 5800000 SSGA S&P 500 NL QP CTF 1852597 F SSGA S&P 500 SL QP CTF 4679207 F BOYD WATTERSON STATE GOVT FUND LP 3257575 F 9789379 BENEFIT CLAIMS& PREM CURRENTLY PAY 1197600 1197600 14340515 1415604 1415604 12924911 74788 74788 12999699 11793417 0 11793417 74788 -63600 11188 11804605 PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFITS PAYABLE -63,600. X 0 0 0 TERESA CASANOVA FUND ADMIN. 167954 0 0 0 0 0 25782 0 19155 0 212891 0 0 0 SCHEDULE J PART II TERESA CASANOVA RECEIVED COMPENSATION AND BENEFITS IN HER CAPACITY AS FUND ADMINISTRATOR OF THIS ENTITY AND THE RELATED ANNUITY AND PENSION FUNDS. COMPENSATION AND BENEFITS ARE PAID BY THE HEALTH FUND WITH REIMBURSEMENTS MADE ACCORDINGLY. THE HEALTH FUND PORTION OF THESE EXPENSES IS 51% OF THE GROSS AMOUNT DETAILED ON THE FORM 990, PART VII, SECTION A. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED IN COORDINATION WITH MANAGEMENT OF THE ORGANIZATION AND WAS REVIEWED BY THE BOARD PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, POLICIES AND FINANCIAL STATEMENTS ARE AVAILABLE TO PARTICIPANTS UPON REQUEST. THE ORGANIZATION DOES NOT MAKE DOCUMENTS AVAILABLE TO THE PUBLIC. LOCAL 807 LABOR-MANAGEMENT PENSION FUND 32-43 49TH STREET LONG ISLAND CITY NY 11103 516099111 PROVIDE RET BENEFITS TO PARTICIPANTS NY 501(A) N/A N/A 0 LOCAL 807 PROFIT-SHARING PLAN 32-43 49TH STREET LONG ISLAND CITY NY 11103 112532544 PROVIDE RET BENEFITS TO PARTICIPANTS NY 501(A) N/A N/A 0 INTL BROTHERHOOD OF TEAMSTERS L807 32-43 49TH STREET LONG ISLAND CITY NY 11103 135157850 LABOR UNION NY 501(C)(5) N/A N/A 0 NYC TRUCKING AUTHORITY (NYCTA) 32-43 49TH STREET LONG ISLAND CITY NY 11103 135614411 LABOR UNION NY 501(C)(5) N/A N/A 0 SEE SCHEDULE R SUPPLEMENTAL INFORMATION 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 FORM 990, PART VII, SECTION A CERTAIN TRUSTEES LISTED ON FORM 990, PART VII, SECTION A, SERVE AS VOLUNTEERS AND DO NOT RECEIVE COMPENSATION FROM THIS ORGANIZATION OR ANY RELATED ORGANIZATION IN THEIR CAPACITY AS TRUSTEES OF THIS ORGANIZATION. THE FILING ORGANIZATION IS NOT REQUIRED TO LIST THE COMPENSATION FOR THESE TRUSTEES BECAUSE THE RELATED ORGANIZATION (I) WAS "FOR PROFIT", (II) WAS NOT OWNED OR CONTROLLED DIRECTLY OR INDIRECTLY BY THE FILING ORGANIZATION OR ONE OR MORE RELATED TAX EXEMPT ORGANIZATIONS, AND (III) DID NOT PROVIDE MANAGEMENT SERVICES FOR A FEE TO THE FILING ORGANIZATION. CERTAIN TRUSTEES LISTED ON FORM 990, PART VII, SECTION A, DO NOT RECEIVE COMPENSATION FROM THIS ORGANIZATION, BUT DO RECEIVE COMPENSATION FROM LOCAL 807 IN THEIR CAPACITY AS EMPLOYEES/OFFICERS OF THE UNION. THE INFORMATION DISCLOSED ON THE ATTACHED SCHEDULE OF RELATED PARTIES IS THAT WHICH WAS AVAILABLE TO THIS ORGANIZATION AT THE TIME OF THIS FILING. PART IV IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS CORP OR TRUST (A) NAME ABC SUPPLY CO INC ACCORD SUPPLY CO, INC. 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