2026-04-10T07:49:35-05:00 2025-05-31 750786316 WEAVER AND TIDWELL LLP ONE PENNSYLVANIA PLAZA STE 2800 NEW YORK NY 10119 990 2024-06-01 111637886 LOCAL 804 WELFARE TRUST FUND LOCA 7187865410 44 S BAYLES AVENUE STE 302 PORT WASHINGTON NY 110503765 MARC PANTELEONE FUND ADMINISRATOR 7187865410 2026-04-06 1 1 MATTHEW SIMON P01306208 2126955003 2024 2025-03-06 01:10:19Z MARC PANTELEONE 44 S BAYLES AVENUE STE 302 PORT WASHINGTON NY 110503765 207423277 0 X HTTP://WWW.LOCAL804FUND.COM X 1950 NY TO PROVIDE HEALTH CARE BENEFITS 8 4 22 0 0 0 0 0 136278845 138178907 2155422 1372829 414785 658104 138849052 140209840 0 0 138272460 143724283 3026412 2953295 0 0 0 1985654 2167716 143284526 148845294 -4435474 -8635454 152158930 151269833 1563323 3063060 150595607 148206773 X 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 5,700. 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 1 1 976 0 1 22 1 0 0 0 0 0 0 0 0 X 8 4 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 1 1 0 X MARC PANTELEONE FUND MANAGER 7187865410 44 S BAYLES AVENUE SUITE 302 PORT WASHINGTON NY 110503765 CHRIS LANGAN EMPLOYER TRUSTEE 1.00 X 0 0 0 MARK MCELREATH EMPLOYER TRUSTEE 1.00 X 0 0 0 MATTHEW LOUGHLIN FORMER EMPLOYER TRUSTEE 1.00 X 0 0 0 MICHAEL CLAYTON EMPLOYER TRUSTEE 1.00 X 0 0 0 VINCENT PERRONE UNION TRUSTEE 1.00 40.00 X 0 158909 58700 ANTONINO ROSCIGLIONE UNION TRUSTEE 1.00 40.00 X 0 157739 58700 CHRISTOPHER WILLIAMSON UNION TRUSTEE 1.00 40.00 X 0 160079 58700 MARK COHEN UNION TRUSTEE 1.00 40.00 X 0 157089 58700 NICOLE PEITRANGELI EMPLOYER TRUSTEE 1.00 X 0 0 0 MARC PANTELEONE FUND MANAGER 26.00 9.00 X 242903 0 61078 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 61.00 1.00 X 176243 0 35807 MAGGIE WU ACCOUNTANT 39.00 19.00 X 230234 0 36067 CELIA LIAW BENEFIT CLAIMS ASSISTANT 46.00 1.00 X 127164 0 35834 CHRISTINE NICOLETTI OFFICE MANAGER 26.00 9.00 X 143396 0 61078 ANWAR ZAIDI MEDICAL CLERK 45.00 X 104431 0 35749 1024371 633816 500413 8 0 1 0 EMPIRE HEALTHCHOICE ASSURANCE INC 165 BROADWAY NEW YORK NY 10006 BENEFIT ADMINISTRATIVE SERVICE 2278644 THE SEGAL COMPANY (EASTERN STATES) INC 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL AND CONSULTING SERVICES 469980 NEW YORK MEDICAL MANAGEMENT 2025 LINCOLN HIGHWAY ROUTE 21 EDISON NJ 08817 BENEFIT CONSULTING SERVICES 442204 HEALTH PLAN SYSTEM 2025 LINCOLN HIGHWAY ROUTE 21 EDISON NJ 08817 BENEFIT INFORMATION TECHNOLOGY 393094 PROSKAUER ROSE LLP ELEVEN TIMES SQUARE NEW YORK NY 10036 LEGAL SERVICES 240715 5 CONTRIBUTIONS - EMPLOYERS 900099 135271112 135271112 CONTRIBUTIONS - RETIRED PARTICIPA 900099 2625562 2625562 CONTRIBUTIONS - COBRA PARTICIPANT 900099 282233 282233 138178907 5058890 5058890 63527376 67213437 -3686061 -3686061 -3686061 MISCELLANEOUS INCOME 900099 658104 658104 658104 140209840 138837011 0 1372829 143724283 307037 1818813 174359 495318 157768 431674 104876 196042 582675 372974 510846 120166 12086 66502 85587 ADM.EXPENSES REIMBURSED -315712 148845294 1033826 1045820 3766261 15687399 15527859 20262371 63468 118559 924467 437018 255550 487449 86353451 66205254 44266810 46659368 891705 803613 152158930 151269833 326038 504420 328441 330502 908844 2228138 1563323 3063060 X 0 0 0 0 150595607 148206773 150595607 148206773 152158930 151269833 -8635454 6246620 0 X X 0 1 X 1 0 8314 4369 3945 675574 358132 317442 240579 74517 166062 487449 COMMON COLLECTIVE TRUST 17303207 F LIMITED PARTNERSHIP 13741287 F ETF 15614874 F 46659368 LEASE LIABILITY - OPERATING LEASE 832252 DUE TO BROKER FOR SECURITIES PURCHASED 1395886 2228138 X 146260418 6246620 6246620 140013798 196042 196042 140209840 148649252 0 148649252 196042 196042 148845294 PART X, LINE 2: THE VEBA TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED MARCH 12, 1987, STATING THAT THE TRUST IS TAX EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE IRC. HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2025 OR 2024 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND RELATED TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. PLAN MANAGEMENT BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. US GAAP REQUIRES PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 MARC PANTELEONE FUND MANAGER 242903 0 0 0 0 0 34133 0 26945 0 303981 0 0 0 MAGGIE WU ACCOUNTANT 230234 0 0 0 0 0 8262 0 27805 0 266301 0 0 0 CHRISTOPHER WILLIAMSON UNION TRUSTEE 0 140819 0 0 0 19260 0 31755 0 26945 0 218779 0 0 VINCENT PERRONE UNION TRUSTEE 0 140819 0 0 0 18090 0 31755 0 26945 0 217609 0 0 ANTONINO ROSCIGLIONE UNION TRUSTEE 0 140819 0 0 0 16920 0 31755 0 26945 0 216439 0 0 MARK COHEN UNION TRUSTEE 0 140819 0 0 0 16270 0 31755 0 26945 0 215789 0 0 JAMES PANTELEONE IT AND BENEFIT CLAIMS ASSI 176243 0 0 0 0 0 8262 0 27545 0 212050 0 0 0 CHRISTINE NICOLETTI OFFICE MANAGER 143396 0 0 0 0 0 34133 0 26945 0 204474 0 0 0 CELIA LIAW BENEFIT CLAIMS ASSISTANT 127164 0 0 0 0 0 8262 0 27572 0 162998 0 0 0 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 11B 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 XII, LINE 2C: THE ORGANIZATION'S PROCESS FOR OVERSEEING THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. LOCAL 804 ANNUITY FUND 44 S BAYLES AVE PORT WASHINGTON NY 110503765 112506358 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 0 LOCAL 804 IBT 44 S BAYLES AVE PORT WASHINGTON NY 110503765 111603598 CONTRIBUTING EMPLOYER & RENTAL EXPENSE NY 501(C)(5) 0 LOCAL 804 PENSION FUND 44 S BAYLES AVE PORT WASHINGTON NY 110503765 116077200 SHARED ADMINISTRATIVE COST NY 1.401-1(B)(3) 0 LOCAL 804 FEDERAL CREDIT UNION 44 S BAYLES AVE PORT WASHINGTON NY 110503765 112491081 RELATED TO LOCAL 804 IBT, THE UNION NY 501(C)(1) 0 UNITED PARCEL SERVICE CONTRIBUTING EMPLOYER 0 TRUMP VILLAGE INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 LOCAL 804 ANNUITY FUND O 213802 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND N 41402 SHARED ADM. COST AGREEMENT LOCAL 804 IBT K 118510 OFFICE RENTAL EXPENSE LOCAL 804 PENSION FUND O 52556 SHARED ADM. COST AGREEMENT LOCAL 804 PENSION FUND N 7950 SHARED ADM. COST AGREEMENT LOCAL 804 PENSION FUND Q 63071 SHARED ADM. COST AGREEMENT LOCAL 804 ANNUITY FUND Q 428606 SHARED ADM. COST AGREEMENT BOYD WATTERSON STATE GOVERNMENT FUND LP ONE NORTH WACKER DRIVE SUITE 4025 CHICAGO IL 60606 320538379 INVESTMENT IL 569703 0 14288268 0 0 0.00650