2022-11-11T06:46:47-06:00 2022-04-30 470900880 CALIBRE CPA GROUP PLLC 462 SEVENTH AVENUE 16TH FLOOR NEW YORK NY 10018 990 2021-05-01 136129427 HEALTH FUND 917 HEAL 5163263371 22 NORTH TYSON AVENUE 1 FL FLORAL PARK NY 11001 RALPH NATALE TRUSTEE 5163263371 2022-11-10 1 RALPH NATALE XXX-XX-XXXX JOSEPH MORELLO P02146706 2126951300 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z RAPLH NATALE 22 NORTH TYSON AVENUE 1 FL FLORAL PARK NY 11001 19959156 0 X N/A X 1950 NY TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 6 3 2 0 0 0 0 0 17086368 16907670 962622 1542953 0 0 18048990 18450623 0 0 17513157 17736636 219399 186602 0 0 0 316450 366663 18049006 18289901 -16 160722 46697658 42995154 3270006 2887398 43427652 40107756 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 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 1 268 0 1 2 0 0 0 0 0 0 0 0 0 0 0 X 6 3 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X BOARD OF TRUSTEES 5163263371 22 NORTH TYSON AVENUE FLORAL PARK NY 11001 DEMOS DEMOPOULOS TRUSTEE 2.00 0.00 X 0 0 0 RALPH NATALE TRUSTEE 2.00 40.00 X 0 134500 38932 ROY KOHN TRUSTEE 2.00 6.00 X 0 0 0 KIRK CONAWAY TRUSTEE 2.00 6.00 X 0 0 0 JEFFREY ISAACS TRUSTEE 2.00 0.00 X 0 0 0 DAVID PEREZ TRUSTEE 2.00 40.00 X 0 131900 38932 ANA TANG FUND ADMINISTRATOR 27.00 13.00 X 131331 0 40316 131331 266400 118180 1 0 1 0 EMPIRE BLUE CROSS AND BLUE SHIELD ONE LIBERTY PLAZA NEW YORK NY 10006 PPO ACCESS 407575 ZENITH AMERICAN SOLUTIONS 302 KNIGHTS RUN AVENUE TAMPA FL 33602 CLAIMS PROCESSING 286093 CALIBRE CPA GROUP 462 SEVENTH AVE NEW YORK NY 10018 AUDIT SERVICES 116361 3 EMPLOYER CONTRIBUTIONS 525100 16766514 16766514 COBRA CONTRIBUTIONS 525100 141156 141156 16907670 993344 993344 2058142 1508533 549609 549609 549609 18450623 17457279 0 993344 17736636 112925 37170 12848 14792 8867 35928 116361 28828 44000 32274 10152 65893 524 32703 18289901 562990 832087 419008 403470 13602 13582 88988 84533 3495 4455 29645426 28891241 16025362 12822544 27775 27775 46697658 42995154 43006 38398 3227000 2849000 3270006 2887398 X 0 0 0 0 43427652 40107756 43427652 40107756 46697658 42995154 160722 -3480618 0 X 0 1 X 0 0 88988 84533 4455 4455 COLLECTIVE TRUST FUND 12822544 F 12822544 POSTRETIREMENT BENEFIT OBLIGATIONS 1179000 CLAIMS INCURRED BUT NOT REPORTED 1670000 2849000 X 14941177 -3480618 -3480618 18421795 28828 28828 18450623 18639073 0 18639073 28828 -378000 -349172 18289901 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF APRIL 30, 2022 AND 2021, THERE WERE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: DECREASE IN BENEFIT OBLIGATIONS 0 0 0 RALPH NATALE TRUSTEE 0 122200 0 0 0 12300 0 19300 0 19632 0 173432 0 0 ANA TANG FUND ADMINISTRATOR 131331 0 0 0 0 0 19320 0 20996 0 171647 0 0 0 DAVID PEREZ TRUSTEE 0 119600 0 0 0 12300 0 19300 0 19632 0 170832 0 0 FORM 990, PART VI, SECTION B, LINE 11B LINE 11B EXPLANATION - THE RETURN PREPARER E-MAILS A COPY OF THE FINAL VERSION OF FORM 990 TO THE PLAN ADMINISTRATOR AND TRUSTEES FOR THEIR REVIEW AND APPROVAL. INQUIRIES ARE MADE TO THE PREPARER AS NEEDED. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH THE ORGANIZATION'S ANNUAL FORM 5500 FILING. NO OTHER DOCUMENTS ARE AVAILABLE TO THE PUBLIC. LOCAL UNION 917 IBT 24 N TYSON AVENUE FLORAL PARK NY 11001 135279293 LABOR UNION NY 501(C)(5) 0 LOCAL 917 PENSION FUND 22 NORTH TYSON AVENUE FLORAL PARK NY 11001 136086164 BENEFIT FUND NY 401(A) 0 LOCAL 868 I B OF T PENSION FUND 22 NORTH TYSON AVENUE FLORAL PARK NY 11001 132930439 BENEFIT FUND NY 401(A) 0 LOCAL 816 LABOR & MGMT PENSION TR FUND 22 NORTH TYSON AVENUE FLORAL PARK NY 11001 131869789 BENEFIT FUND NY 401(A) 0 19-20 INDUSTRY CITY AF SUPPLY ALLIED AVIATION AMBRO OPERATING CORP APPROVED OIL BAKERY DRIVERS LOCAL BARNEY'S SERVICE STATION BAYSIDE FUEL BLUE DIAMOND BORO FUEL BRONX AUTOMOTIVE BUCKEYE PIPELINE CARMEL GARAGE INC CENTURY MOTORS INC COHLER FUEL DEBRAGGA & SPITLER DORCHESTER HEATING EAST COAST MECHANICAL EAST COAST PETROLEUM FANCY FOODS INC FRED SCHILDWACHTER GROCERY HAULERS HEALTH FUND 917 HEMSTEAD LINCOLN MERCURY INTERSTATE FOODS INC JM HUNTINGTON MOTORS KARP VOLVO INC LAB CORP LAZ PARKING LOCAL 553 PENSION FUND LOCAL 917 IBT LOCAL UNION 553 MAJOR CHEVROLET INC MAJOR WORLD CDJR LLC MERRICK DODGE INC MISSION OF THE IMMAC MONTEBELLO COAL NEW UTRECHT PACIFIC PETROLEUM PETRO PLAZA OLDSMOBILE PLAZA TOYOTA PRIDE BUS CORP ROCKWAY FUEL RSTR MOTORS SJ FUEL SKAGGS & WALSH SPEEDWAY-NJ SPEEDWAY-NY STANDARD PARKING STATEWIDE OIL THE CAR PARK UNITED APOLLO PETROLEUM UNITED JEWISH APPEAL WELCOME PARKING 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 LOCAL 917 PENSION FUND Q 75872 TIME STUDY LOCAL 868 IBT PENSION FUND Q 50417 TIME STUDY LOCAL 816 LABOR & MGMT PENSION FUND Q 76890 TIME STUDY