2013-10-31T11:54:26-05:00 2012-12-31 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2012-01-01 136178513 LOCAL 580 INSURANCE FUND LOCA 2126955206 501 WEST 42ND STREET NEW YORK NY 100366205 JAMES MAHONEY 2126955206 2013-10-22 1 LOUIS VERZELLA CPA P00360279 6106689400 2013-10-22 2012 2016-03-07 17:11:31Z JAMES MAHONEY 501 WEST 42ND STREET NEW YORK NY 10036 141380082 0 X N/A X 1946 NY LIFE INSURANCE, MEDICAL, HOSPITALIZATION, DENTAL, DISABILITY, OPTICAL, HEARING AIDS, DEATH BENEFITS, ETC. 501 (C)(9) ORGANIZATION. 9 9 0 0 0 0 0 0 29236270 34892046 7099212 5531671 12970 15259 36348452 40438976 0 0 23630102 24011794 565357 581785 0 0 0 871631 943034 25067090 25536613 11281362 14902363 141330767 154148733 11809239 6145512 129521528 148003221 TO PROVIDE LIFE INSURANCE, MEDICAL, HOSPITALIZATION, DENTAL, DISABILITY, HEARING AIDS, DEATH BENEFITS, ETC. FOR MEMBER OF IRON WORKERS UNION LOCAL 580. 0 0 TO PROVIDE LIFE INSURANCE, MEDICAL, HOSPITALIZATION, DENTAL, DISABILITY, HEARING AIDS, DEATH BENEFITS, ETC. FOR MEMBER OF IRON WORKERS UNION LOCAL 580. 0 0 0 0 0 0 0 0 0 1 0 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 2 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X FUND OFFICE 2126955206 501 WEST 42ND STREET NEW YORK NY 100366205 HERBERT KOENIG 2.00 X 0 0 0 RANDALL RIFELLI 2.00 X 0 0 0 RANDALL MENT 2.00 X 0 0 0 PETER CARRIERO 2.00 X 0 0 0 ROBERT BENESH 2.00 45.00 X 0 128304 110695 KENNETH CODY 2.00 X 0 0 0 JAMES MAHONEY 2.00 45.00 X 0 131704 110695 PETER MYERS 2.00 45.00 X 0 128904 110695 JOHN BUSCH 2.00 5.00 X 0 17722 10256 MARK NARDELLA 25.00 25.00 X 54153 94905 85935 PATRICK DOHERTY 25.00 25.00 X 55683 97586 82550 ROBERT MAGUIRE 25.00 25.00 X 50751 88943 82550 DENNIS LUSARDI 25.00 25.00 X 51792 90768 82550 212379 778836 675926 0 0 1 0 EMPIRE BLUE CROSS AND BLUE SHIELD ONE LIBERTY PLAZA NEW YORK NY 10006 ADMINISTRATIVE FEES 1182669 MDSASS ASSOCIATES INC 1185 AVENUE OF THE AMERICAS NEW YORK NY 10036 INVESTMENT FEES 128861 BUCKHEAD CAPITAL MANAGEMENT LLC 3339 CUMBERLAND BLVD STE 650 ATLANTA GA 30339 INVESTMENT FEES 125223 JOSEPH M STERN CPA 89 JOSEPH AVENUE STATEN ISLAND NY 10314 PAYROLL AUDIT FEES 103904 4 EMPLOYER CONTRIBUTIONS 525100 34589780 34589780 COBRA CONTRIBUTIONS 525100 171919 171919 PAYROLL AUDIT REIMBURSEMENTS 525100 129802 129802 COBRA PREMIUM ASSISTANCE PAYMENTS 525100 545 545 34892046 4551120 4551120 101921657 100941106 980551 980551 980551 ADMINISTRATIVE FEES 900099 15259 15259 15259 40438976 34892046 0 5546930 24011794 375539 104245 74387 27614 134890 150689 376836 66415 53744 37362 67138 11706 2965 7128 34161 25536613 9251360 10762231 923211 6975738 2940710 3952654 110112 2689 201655 194208 14575 7447 128028969 132361941 61830 86033 141330767 154148733 185595 195272 11623644 5950240 11809239 6145512 X 0 0 0 0 129521528 148003221 129521528 148003221 141330767 154148733 14902363 3579330 0 X X 0 1 X 1 0 201655 194208 7447 7447 DUE TO BROKER 595080 DUE TO RELATED PARTY 5353262 PAYROLL TAXES 1898 5950240 X 43511668 3579330 3579330 39932338 376836 129802 506638 40438976 25029975 0 25029975 376836 129802 506638 25536613 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MANAGEMENT EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAD MAINTAINED ITS TAX EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. AT THE PRESENT TIME, THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATION BY THE U.S. FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XI, LINE 4B - OTHER ADJUSTMENTS: PAYROLL AUDIT REIMBURSEMENTS PART XII, LINE 4B - OTHER ADJUSTMENTS: PAYROLL AUDIT REIMBURSEMENTS X 0 0 0 ROBERT BENESH 0 123954 0 0 0 4350 0 81661 0 29034 0 238999 0 0 JAMES MAHONEY 0 123954 0 0 0 7750 0 81661 0 29034 0 242399 0 0 PETER MYERS 0 123954 0 0 0 4950 0 81661 0 29034 0 239599 0 0 MARK NARDELLA 54153 94905 0 0 0 0 19296 33817 11924 20898 85373 149620 0 0 PATRICK DOHERTY 55683 97586 0 0 0 0 18537 32488 11453 20072 85673 150146 0 0 ROBERT MAGUIRE 50751 88943 0 0 0 0 18537 32488 11453 20072 80741 141503 0 0 DENNIS LUSARDI 51792 90768 0 0 0 0 18537 32488 11453 20072 81782 143328 0 0 FORM 990, PART VI, SECTION B, LINE 11 LOCAL 580 INSURANCE FUND'S FORM 990 IS PREPARED BY ITS INDEPENDENT ACCOUNTANT WHO THEN FORWARDS THE COMPLETED RETURN TO THE FUND'S ADMINISTRATOR FOR REVIEW. THE FUND ADMINISTRATOR THEN PRESENTS THE FORM 990 TO THE GOVERNING BODY FOR REVIEW AND SIGNATURE. FORM 990, PART VI, SECTION B, LINE 12C LOCAL 580 INSURANCE FUND MONITORS ITS CONFLICT OF INTERST POLICY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 LOCAL 580 INSURANCE FUND'S GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII HERBERT KOENIG - ALLIED BRONZE CORP, 25-11 HUNTERS POINT AVE., LIC, NY 11101-4429. RANDALL RIFELLI - UNITED IRON WORKS, 6 ROSLYN PLACE, MT VERNON, NY 10550. RANDALL MENT - MENT BROS IRON WORKS, 11 BROADWAY, SUITE 1131, NEW YORK, NY 10004. PETER CARRIERO - POST ROAD IRON WORKS, 345 W. PUTNAM AVE., GREENWICH, CT 06830. FORM 990, PART XII, LINE 2C: LOCAL 580 INSURANCE FUND'S BOARD OF TRUSTEES IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDPENDENT ACCOUNTANT THAT PERFORMS THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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