2024-11-12T08:11:18-06:00 2023-12-31 872525370 CITRIN COOPERMAN ADVISORS LLC 88 FROEHLICH FARM BLVD 3RD FLOOR WOODBURY NY 11797 990 2023-01-01 136179467 LOCAL 475 HEALTH PLAN LOCA 9147386555 629 FIFTH AVENUE PELHAM NY 10803 PETER VAUPEL FUND ADMINISTRATOR 9147386555 2024-11-08 1 1 JOHN ANTINORE P10557695 5163643390 2024-11-08 2023 2024-10-15 13:58:12Z 629 FIFTH AVENUE PELHAM NY 10803 8024438 0 X N/A X 1965 NY EMPLOYER CONTRIBUTIONS PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS IN THE PLAN. 3 1 5 0 0 0 0 0 6923174 7769175 270617 255263 0 0 7193791 8024438 0 0 3665982 5049643 188941 201274 0 0 0 778129 826118 4633052 6077035 2560739 1947403 14301318 17720882 601055 802478 13700263 16918404 EMPLOYER CONTRIBUTIONS PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS IN THE PLAN. 0 0 EMPLOYER CONTRIBUTIONS PROVIDE HEALTH & WELFARE BENEFITS TO PARTICIPANTS IN THE PLAN. 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 3 0 1 5 1 0 0 0 0 0 0 0 0 0 0 X 3 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LYNDA SCHULOK 9147386555 629 FIFTH AVE PELHAM NY 10803 PETER VAUPEL FUND ADMINISTRATOR 3.00 37.00 X 76884 76884 12432 RONALD KOWALSKI JR TRUSTEE 0.00 X 0 0 0 EDUARDO MELENDEZ TRUSTEE 6.00 34.00 X 39860 49133 12432 116744 126017 24864 0 0 1 0 ANTHEM INC PO BOX 951254 CLEVELAND OH 44193 ADMINISTRATIVE FEES 100114 1 EMPLOYER CONTRIBUTIONS 900099 7767294 7767294 COBRA CONTRIBUTIONS 900099 1881 1881 7769175 251538 251538 3725 0 3725 3725 3725 8024438 7769175 0 255263 5049643 116744 36508 16056 18477 13489 32168 25800 14277 13677 29046 7272 6994 STOP LOSS PREMIUMS 384438 CLAIMS PROCESSING FEES 292446 ACTUARIAL FEES 20000 6077035 1976920 5368038 10026 10471 1699540 178907 22437 22437 0 0 10585444 12109935 29388 53531 14301318 17720882 101055 87478 500000 715000 601055 802478 X 0 0 0 0 13700263 16918404 13700263 16918404 14301318 17720882 1947403 1270738 0 X 0 1 X 1 0 22437 22437 0 0 BENEFITS PAYABLE AND IBNR 715000 715000 X 9280899 1270738 1270738 8010161 14277 14277 8024438 5847758 0 5847758 14277 215000 229277 6077035 PART X, LINE 2: THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2023 AND 2022, THERE ARE 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 PROCESS. BASED ON THE NORMAL STATUTORY PERIOD FOR AUDITS, THE PLAN ADMINISTRATOR BELIEVES THAT THE TAX RETURNS OF THE PLAN FOR THE YEARS PRIOR TO THE YEAR ENDED DECEMBER 31, 2020 ARE NO LONGER OPEN TO EXAMINATION, NOTWITHSTANDING ANY INFORMATION NOT YET KNOWN WHICH COULD EXPAND THE OPEN PERIOD. PART XII, LINE 4B - OTHER ADJUSTMENTS: BENEFITS PAYABLE 215,000. 0 0 0 PETER VAUPEL FUND ADMINISTRATOR 76884 76884 0 0 0 0 0 0 5358 7074 82242 83958 0 0 FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WAS SENT TO THE TRUSTEES FOR REVIEW. UPON APPROVAL, A WAIVER IS SIGNED AUTHORIZING THE ELECTRONIC SUBMISSION OF THE FORM. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY AT THE BOARD OF TRUSTEE MEETINGS. FORM 990, PART VI, SECTION B, LINE 15 INCREASES IN COMPENSATION ARE APPROVED BY THE BOARD AND ARE COMPARED TO INDUSTRY STANDARDS. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC. LOCAL 475 PENSION PLAN 629 FIFTH AVENUE PELHAM NY 10803 132571151 TO PROVIDE PENSION BENEFITS TO MEMBERS NY 401(A) N/A 0 STAFF RETIREMENT PLAN OF LOCAL 475 629 FIFTH AVENUE PELHAM NY 10803 132996854 TO PROVIDE SUPPLEMENTAL RETIREMENT BENEFITS NY 401(A) N/A 0 IUEW LOCAL 475 629 FIFTH AVENUE PELHAM NY 10803 131654293 BETTERMENT OF WAGES AND WORKING CONDITIONS NY 501(C)(5) N/A 0 DELTA DENTAL OF NEW JERSEY 1639 ROUTE 10 PARSIPPANY NJ 07054 CONTRIBUTING EMPLOYER NJ N/A 0 CHROMALLOY NEW YORK 330 BLAISDELL ROAD ORANGEBURG NY 10962 CONTRIBUTING EMPLOYER NY N/A 0 C W BRABENDER INSTRUMENTS INC 50 E WESLEY STREET S HACKENSACK NJ 07604 CONTRIBUTING EMPLOYER NJ N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0