2020-10-30T10:12:06-05:00 2019-12-31 470900880 CALIBRE CPA GROUP PLLC 7501 WISCONSIN AVENUE BETHESDA MD 20814 990 2019-01-01 261860594 USW RETIREES OF THE DANA CORPORATION HEALTH CARE TRUST USWR 4122102233 60 BLVD OF THE ALLIES 5TH FLOOR PITTSBURGH PA 15222 THOMAS BRAUN COMMITTEE MEMBER 4122102233 2020-10-30 1 JOSEPH M HERISHEN CPA P00361968 2023319880 2020-10-30 X 38.100.43.98 2020-10-30 11:11:58 ED P A3C8B6A7531A613EF6C0C99A1A809E67D3FF72EF 1F0160B020F94BED843F50CF691077A649148339 2019 2021-04-22 16:20:28Z THOMAS BRAUN 5 GATEWAY CENTER PITTSBURGH PA 15222 54479355 0 X N/A X 2008 PA TO PROVIDE HEALTH AND OTHER WELFARE BENEFITS. 7 6 0 0 0 0 0 0 12716125 12252531 10860536 5688571 0 0 23576661 17941102 0 0 23065750 21862610 176294 169072 0 0 0 1103145 1088715 24345189 23120397 -768528 -5179295 204725692 220903007 254839 286733 204470853 220616274 X THE USW RETIREES OF THE DANA CORPORATION HEALTH CARE TRUST IS ESTABLISHED FOR THE PURPOSE OF (I) PROVIDING HEALTH AND OTHER WELFARE BENEFITS TO PARTICIPANTS IN ACCORDANCE WITH THE USW RETIREES OF THE DANA CORPORATION HEALTH CARE PLAN AND AS ARE PERMISSIBLE UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE AS SET FORTH HEREIN; AND (II) TO PROVIDE HEALTH AND WELFARE BENEFITS TO THE RUN-OUT PARTICIPANTS IN ACCORDANCE WITH THE DANA CORPORATION'S ORIGINAL PLAN. 0 0 THE TRUST PROVIDED HEALTH AND OTHER WELFARE BENEFITS THROUGH THE USW RETIREES OF THE DANA CORPORATION PLAN TO PARTICIPANTS AND SURVIVING SPOUSES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 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 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CDS ADMINISTRATORS 4122012242 60 BLVD OF THE ALLIES 5TH FLOOR PITTSBURGH PA 15222 MIKE MILSAP COMMITTEE MEMBER 2.00 X 0 0 0 CHARLES PIPER COMMITTEE MEMBER 2.00 X 22782 0 0 JAMES DWORKIN COMMITTEE MEMBER 2.00 X 22782 0 0 THOMAS BRAUN CHAIRMAN 2.00 X X 28478 0 0 THOMAS HAYHURST COMMITTEE MEMBER 2.00 X 22782 0 0 ANNE BLANTON COMMITTEE MEMBER 2.00 X 22782 0 0 HOWARD KLINE COMMITTEE MEMBER 2.00 X 22782 0 0 142388 0 0 0 0 0 0 EXPRESS SCRIPTS 100 PARSONS POND DRIVE FRANKLIN LAKES NJ 07417 CLAIMS ADMINISTCLAIM 376607 CDS ADMINISTRATORS 60 BLVD OF THE ALLIES 5TH FLOOR PITTSBURGH PA 15222 THIRD PARTY ADMINISTRATOR 170096 HIGHMARK 120 5TH AVE 2015 PITTSBURGH PA 15222 CLAIMS ADMINISTRATION & ACCESS FEE 142578 3 PARTICIPANT CONTRIBUTIONS 525100 4680649 4680649 7571882 7571882 12252531 6502162 6502162 35724662 36538253 -813591 -813591 -813591 17941102 4680649 0 13260453 21862610 169072 689281 44701 39730 31653 3954 5146 34733 INVESTMENT CONSULTING 95866 ACTUARY & CONSULTING 91554 BANK FEES 50855 PCORI FEE 1242 23120397 2019023 788912 3882255 8968151 2807565 2235995 14519 14807 128323383 131001688 67678947 77893454 204725692 220903007 254839 286733 254839 286733 X 0 0 0 0 204470853 220616274 204470853 220616274 204725692 220903007 -5179295 21324716 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 8870846 F COMMON COLLECTIVE TRUSTS 69022608 F 77893454 X 39186066 21324716 21324716 17861350 79752 79752 17941102 23040645 0 23040645 79752 79752 23120397 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION. THE PLAN IS NOT AWARE OF ANY UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2019. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO THE TRUST'S ADMINISTRATOR TO BE DISTRIBUTED TO THE COMMITTEE MEMBERS FOR THEIR REVIEW PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C COMMITTEE MEMBERS MONITOR THE CONFLICT OF INTEREST POLICY ANNUALLY FOR ANY POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION C, LINE 19 ANY DOCUMENTS THAT THE TRUST WOULD BE REQUIRED TO MAKE AVAILABLE TO THE PUBLIC WOULD BE AVAILABLE BY CONTACTING THE TRUST'S THIRD PARTY ADMINISTRATOR, CDS ADMINISTRATORS. PART XII - LINE 2 (C) THE COMMITTEE HAS NOT DELEGATED RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT, REVIEW, OR COMPILATION OF ITS FINANCIAL STATEMENTS OR THE SELECTION OF AN INDEPENDENT ACCOUNTANT TO A SUBCOMMITTEE.