Form 5500 · Employee benefit plan · PORT WASHINGTON, NY
BOARD OF TRUSTEES LOCAL 804 WELFARE TRUST FUND
The filing calls this plan LOCAL 804 WELFARE TRUST FUND.
BOARD OF TRUSTEES LOCAL 804 WELFARE TRUST FUND of PORT WASHINGTON, NY is a 5,724-participant transportation and logistics employer whose group benefits are disclosed in its annual Form 5500 filing. Coverage is written through AMALGAMATED LIFE INSURANCE COMPANY. The plan's most recent policy period ended in May.
Sourced from U.S. DOL EFAST2 Form 5500 · EIN 11-1637886 · plan 501 · plan year 2025, filed Mar 16, 2026
Get an email when this employer files a new Form 5500, and again about four months before its plan renews.
How this plan is funded
Self-funded as reported
The filing reports benefits paid from the plan's own money, and no medical insurance contract on Schedule A.
A stop-loss policy appears on a Form 5500 only when the plan itself is the beneficiary, or the premiums are paid from plan money. Many employers buy stop-loss and never report it here. So a plan with no stop-loss on its filing may still have it.
Benefits declared on this filing
Declared benefits are the plan’s own line 8b codes on Form 5500. “Not on Schedule A” means no insured contract for that line appears on this filing. That usually means the benefit is self-funded, or it sits under a different plan number.
Persons covered is the count the carrier filed for that policy at the end of its policy year, and it can include dependents. Participants is the plan's own count at the start of its plan year. The two count different people, so a covered figure can be larger.
Plan brief
Schedule A lists 2 insured contracts covering life and disability; the largest, with AMALGAMATED LIFE INSURANCE COMPANY, covers 4,993 people.
The filing declares life, disability, health, dental and vision. Health, dental and vision appear with no insured contract on Schedule A. That coverage may be self-funded, or placed with a carrier that is not on this filing.
Reported premium is $2,474,396; the filing discloses no broker commission on these contracts.
The most recent policy period ended in May, and the plan year ends May 31. Group contracts typically renew on that annual cycle.
No broker of record is named on the Schedule A. The contracts may be written directly with the carrier, or the broker fields were left blank on the filing.
Schedule A insurance contracts
| Carrier | Benefits | Covered | Renews | Premium | Commission |
|---|---|---|---|---|---|
| AMALGAMATED LIFE INSURANCE COMPANY | Disability | 4,993 | Jun 1, 2025 | $2,210,727 | $0 |
| AMALGAMATED LIFE INSURANCE COMPANY | Life | 11,318 | Jun 1, 2025 | $263,669 | $0 |
Covered = persons covered at policy year end, as filed on Schedule A for that policy — often certificates or one class, not the whole plan. Premium = the filing’s own premium/charges figure; “—” means not credibly reported.
Administrator and service providers
The plan administrator is from line 3a of the main form. The service providers are named on Schedule C of this filing. We publish company names only.
Money the plan held and paid out
Sourced from U.S. DOL EFAST2 Form 5500 · Schedule H
These are the plan's own figures from Schedule H, the financial statement it files. They are not the premium on Schedule A.
How this plan compares
Subscribers see how this compares with similar plans in New York. A subscription also adds this plan's filing history and the renewal calendar for its state. See plans and prices
Without an account you can open 10 employer, broker and carrier pages a day, including through an AI assistant, and 50 a day with a free account. Paid plans are what keep these records free to read.
More employer plans in New York — largest plans, brokers, carriers and renewal months.