2011-04-11T14:24:01-05:00 2010-05-31 Buchbinder Tunick & Co LLP One Penn Plaza New York NY 101190219 990 2009-06-01 111637886 Welfare Trust Fund Local 804 WELF 7187865410 34-21 Review Avenue Long Island City NY 111013241 Timothy Sylvester 7187865410 2011-04-06 1 2126955003 2009 2016-02-24 21:20:13Z TIMOTHY SYLVESTER 34-21 Review Avenue Long Island City NY 111013241 66454729 0 X http://www.local804fund.com X 1950 NY To provide health care benefits 8 8 32 0 0 0 0 52175771 55952902 777957 579157 28320 128546 52982048 56660605 0 54727471 55275191 1501018 1632076 0 0 896597 1076507 57125086 57983774 -4143038 -1323169 17925068 15880862 2135413 1155110 15789655 14725752 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 4925. 0 0 0 0 0 0 0 0 1 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 1 4652 0 1 32 1 0 0 0 0 0 8 8 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 1 1 0 X Thomas Lamontanaro Fund Manager 7187865410 34-21 Review Avenue Long Island City NY 11101 Timothy Sylvester 0.30 X 0 0 0 Tim Reynolds 0.30 X 0 0 0 Pete Mastrandrea 0.30 X 0 0 0 Larry McIver 0.30 X 0 0 0 Chris Langan 0.80 X 0 0 0 Michael Rosentrater 0.80 X 0 0 0 BJ Dorfman 0.80 X 0 0 0 Jack Dempsey 0.80 X 0 0 0 Howard Redmond 0.30 X 0 0 0 Anthony MaGrene 0.50 X 0 0 0 William Buhlert 0.50 X 0 0 0 Anthony Donato 0.20 X 0 0 0 Thomas Lamontanaro 30.50 X 81885 0 32168 81885 0 32168 0 0 0 0 Empire HealthChoice Assurance Inc 11 West 42nd Street New York NY 10036 Benefit Administrative Service 1197693 MagnacareManaged Health 825 East Gate Boulevard Garden City NY 11530 Benefit Consulting Services 283774 Proskauer Rose LLP Eleven Times Square New York NY 10036 Legal Services 221223 Health Plan System One Woodbridge Center Woodbridge NJ 07095 Benefit Information Technology 164220 New York Medical Management One Woodbridge Center Woodbridge NJ 07095 Benefit Consulting Services 141600 8 Contributions - Employ 900099 53926275 53926275 COntributions - retire 900099 1651596 1651596 Contributions - COBRA 900099 375031 375031 55952902 380108 380108 9993173 9794124 199049 199049 199049 Miscellaneous Income 900099 128546 128546 128546 56660605 56081448 0 579157 55275191 114053 1027981 104862 293583 91597 341019 39000 55326 100992 201368 164220 69375 925 175265 12320 dues and subscriptions 1935 Amortization of softwar 1012 Temporary Help 690 Adm.Expenses Reimbursed -86940 57983774 635092 3058 4454915 4991947 33896 41935 1965164 1556458 377543 408706 10840311 7880017 1583311 2555199 17925068 15880862 1589813 541071 145539 220416 400061 393623 2135413 1155110 X 0 0 0 0 15789655 14725752 15789655 14725752 17925068 15880862 X 0 1 1 X 0 316336 312782 3554 196950 190829 6121 1451878 1052847 399031 408706 Deposit with Empire blue cross and blue shield 2554700 Computer Software Costs 499 2555199 Severance pay 204868 Estimated future retirement benefit 167799 Due to Local 804 Pension Fund 20956 393623 56660605 57983774 -1323169 259266 259266 -1063903 56864545 259266 259266 56605279 55326 55326 56660605 57928448 0 57928448 55326 55326 57983774 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. 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 1 1 0 1 0 0 Local 804 Annuity Fund M 12330 Local 804 Annuity Fund N 43410 Local 804 Annuity Fund P 12580