2015-10-29T14:00:27-05:00 2014-12-31 208078757 SALTER & COMPANY LLC 4600 EAST WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2014-01-01 530215881 NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND NATI 3015771700 8000 CORPORATE DRIVE LANDOVER MD 20785 MICHAEL W JACOBSON ADMINISTRATOR 3015771700 2015-10-28 1 CHARLES L UNDERWOOD JR P01259271 3018307400 X 2014 2016-02-25 16:41:14Z MICHAEL W JACOBSON 8000 CORPORATE DRIVE LANDOVER MD 20785 4894230118 0 X WWW.NASIFUND.ORG X 1957 MD TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER A CBA & PARTICIPATION AGRMNTS. 10 5 55 0 0 0 0 0 175458255 185964166 18936195 22665811 0 0 194394450 208629977 0 0 169544074 173747927 3598378 3509694 0 0 0 4172026 6814254 177314478 184071875 17079972 24558102 497034024 508121277 88635092 77547874 408398932 430573403 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER A COLLECTIVE BARGAINING AGREEMENT AND PARTICIPATION AGREEMENTS. 0 0 N/A 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 19306 0 1 55 1 0 0 0 0 0 0 0 0 X 10 5 1 0 0 0 0 1 0 1 1 1 0 1 0 0 0 1 0 0 X MICHAEL W JACOBSON ADMINISTRATOR 3015771700 8000 CORPORATE DRIVE LANDOVER MD 20785 SHAWN BROADRICK TRUSTEE, CHAIRMAN 1.00 39.00 X 0 160869 94063 FRED BARALL TRUSTEE, SECRETARY 1.00 X 0 0 0 MICHAEL R MAHLER TRUSTEE 1.00 39.00 X 0 124886 75641 PETER GIBBONS TRUSTEE 1.00 39.00 X 0 163254 99073 BRIAN DUNN TRUSTEE 1.00 39.00 X 0 157513 93056 JAMES E TUCKER TRUSTEE 1.00 39.00 X 0 156730 92821 JAMES F LYNCH TRUSTEE 1.00 X 0 0 0 CARLA GUNTHER TRUSTEE 1.00 X 0 0 0 GREGG HUENNEKENS TRUSTEE 1.00 X 0 0 0 JON ACKLEY TRUSTEE 1.00 X 0 0 0 CORNELIUS J CAHILL TRUSTEE - RESIGNED 3/18/14 1.00 X 0 0 0 RUSSELL P FLEMING TRUSTEE - RESIGNED 3/18/14 1.00 X 0 0 0 MICHAEL W JACOBSON ADMINISTRATOR 14.00 26.00 X 71316 136663 157563 JOHN EGER ASSISTANT ADMINISTRATOR 12.00 28.00 X 65121 125961 123685 DAN CURRY IT MANAGER 19.00 16.00 X 66612 51704 53747 WILLIAM SAPP COMPUTER PROGRAMMER 12.00 23.00 X 42759 64299 50480 NIA PADMORE CLAIMS MANAGER 27.00 8.00 X 88983 11859 48675 334791 1153738 888804 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 CLAIMS PROCESSING 5755837 E-PLAN 22601 N 19TH AVE SUITE 22 PHOENIX AZ 85027 CLAIMS PROCESSING 1659131 AMERICAN HEALTH HOLDING INC 100 W OLD WILSON BRIDGE ROAD WORTHINGTON OH 43085 MEDICAL CLAIMS REVIEW 707886 EXPRESS SCRIPTS 1 EXPRESS WAY ST LOUIS MO 63121 PROSCRIPTIONS PROCESSING 599304 SEGAL CONSULTING 1920 N STREET NW 400 WASHINGTON DC 20036 INSURANCE, ACTUARY 558896 5 UNDER UNION AGREEMENT 900099 170405706 170405706 PARTICIPANTS' CONTR. 900099 15436024 15436024 LIQUIDATED DAMAGES 900099 120100 120100 2336 2336 185964166 10808319 10808319 4697457633 4685600141 11857492 11857492 11857492 208629977 197819322 0 10810655 173747927 334791 1802147 739721 479184 153851 298675 168900 1070141 204370 137649 49833 AFFORDABLE CARE ACT FEE 2434425 CLAIMS COST MANAGEMENT 816463 INSURANCE CONSULTATION 558896 POSTAGE & SHIPPING 224731 850171 184071875 13082915 6672465 64733970 45069953 74144 64225 2025884 1829672 143835 196212 418999160 456118422 497034024 508121277 87299855 76245367 1335237 1302507 88635092 77547874 X 408398932 430573403 0 0 0 0 408398932 430573403 497034024 508121277 24558102 -2383631 0 X X 0 1 X 1 0 2025884 1829672 196212 196212 FUNDS HELD IN ESCROW 549311 OUTSTANDING HEALTH & WELFARE CLAIM CHECKS 753196 1302507 206003951 -2383631 827746 -1555885 207559836 1070141 1070141 208629977 183001734 0 183001734 1070141 1070141 184071875 PART XI, LINE 2D - OTHER ADJUSTMENTS: RETIRED EMPLOYEE SUBSIDY ACCOUNT CONTRIBUTIONS (RESA) RETIRED EMPLOYEE SUBSIDY ACCOUNT HEALTH PREMIUM PAID X 0 1 0 SHAWN BROADRICK TRUSTEE, CHAIRMAN 0 160869 0 0 0 0 0 75405 0 18658 0 254932 0 0 MICHAEL R MAHLER TRUSTEE 0 124886 0 0 0 0 0 59571 0 16070 0 200527 0 0 PETER GIBBONS TRUSTEE 0 163254 0 0 0 0 0 82907 0 16166 0 262327 0 0 BRIAN DUNN TRUSTEE 0 157513 0 0 0 0 0 74398 0 18658 0 250569 0 0 JAMES E TUCKER TRUSTEE 0 156730 0 0 0 0 0 74163 0 18658 0 249551 0 0 MICHAEL W JACOBSON ADMINISTRATOR 65929 126340 0 0 5387 10323 48622 93176 5406 10359 125344 240198 0 0 JOHN EGER ASSISTANT ADMINISTRATOR 59884 115832 0 0 5237 10129 41098 66822 5373 10392 111592 203175 0 0 DAN CURRY IT MANAGER 66612 51704 0 0 0 0 21384 16598 8876 6889 96872 75191 0 0 WILLIAM SAPP COMPUTER PROGRAMMER 42759 64299 0 0 0 0 13865 20849 6297 9469 62921 94617 0 0 PART I, LINE 4B MICHAEL W. JACOBSON PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $340,172. JOHN EGER PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $137,465. FORM 990, PART VI, SECTION A, LINE 2 THE LOCAL 669 OFFICERS ARE TRUSTEES FOR THE NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND. FORM 990, PART VI, SECTION A, LINE 7A THE NATIONAL FIRE SPRINKLER ASSOCIATION APPOINTS MGMT TRUSTEES, THE UNITED ASSOCIATION APPOINTS CERTAIN UNION TRUSTEES AND OFFICERS OF L.669, ELECTED BY ITS MEMBERS, WHO ARE PARTICIPANTS IN THIS PLAN, ARE APPOINTED TRUSTEES OF THE NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PRESENTED TO THE TRUSTEES AT THE AUGUST 2014 MEETING FOR REVIEW. FUND ADMINISTRATOR HAS BEEN DESIGNATED BY THE JOINT BOARD OF TRUSTEES TO REVIEW AND SIGN THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12 THE TRUST IS GOVERNED BY ERISA AND THE BOARD OF TRUSTEES COMPLY WITH THE CONFLICTS OF INTEREST REQUIREMENTS ESTABLISHED BY ERISA. FORM 990, PART VI, SECTION B, LINE 15A THE INDEPENDENT BOARD OF TRUSTEES REVIEWS AND APPROVES THE ADMINISTRATORS SALARY ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUEST AND THROUGH THE 5500 FILING WITH THE DEPARTMENT OF LABOR. FORM 990, PART VII SHAWN BROADRICK - 7050 OAKLAND MILLS RD, COLUMBIA, MD 21046. FRED BARALL - 40 JON BARRETT ROAD, PATTERSON, NY 12563. MICHAEL R. MAHLER - 1544 S. 3RD STREET, ST LOUIS, MO 63104. PETER GIBBONS - 46 ROCKLAND STREET, BOSTON, MA 02132. BRIAN DUNN - 7050 OAKLAND MILLS RD, COLUMBIA, MD 21046. JAMES E. TUCKER - 7050 OAKLAND MILLS RD, COLUMBIA, MD 21046. JAMES F. LYNCH - 40 JON BARRETT ROAD, PATTERSON, NY 12563. CARLA GUNTHER - 40 JON BARRETT ROAD, PATTERSON, NY 12563. GREGG HUENNEKENS - 40 JON BARRETT ROAD, PATTERSON, NY 12563. JON ACKLEY - 40 JON BARRETT ROAD, PATTERSON, NY 12563. CORNELIUS J. CAHILL - 40 JON BARRETT ROAD, PATTERSON, NY 12563. RUSSELL P. FLEMING - 40 JON BARRETT ROAD, PATTERSON, NY 12563. FORM 990, PART XII, LINE 2C: THE NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND HAS NOT CHANGED ITS RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AUDITED BY AN INDEPENDENT ACCOUNTANT NATIONAL AUTOMATIC SPRINKLER INDUSTRY PENSION FUND 8000 CORPORATE DRIVE LANDOVER MD 20785 526054620 DEFINED BENEFIT PENSION PLAN MD SECTION 401(A)(4) 0 NATIONAL AUTOMATIC SPRINKLER METAL TRADES WELFARE FUND 8000 CORPORATE DRIVE LANDOVER MD 20785 237351551 HEALTH & WELFARE FUND MD SECTION 501(C)(9) 0 NATIONAL AUTOMATIC SPRINKLER METAL TRADES PENSION FUND 8000 CORPORATE DRIVE LANDOVER MD 20785 526133856 DEFINED BENEFIT PENSION PLAN MD SECTION 401(A)(4) 0 NATIONAL AUTOMATIC SPRINKLER LOCAL 669 UA EDUCATION FUND 8000 CORPORATE DRIVE LANDOVER MD 20785 526035213 EDUCATION FUND MD SECTION 501(C)(5) 0 SPRINKLER FITTER LOCAL 696 UNEMPLOYMENT COBRA ASSISTANCE PLAN 41-43 E WILLOW STREET MILLBURN NJ 07041 223201568 HEALTH & WELFARE FUND NJ SECTION 501(C)(9) 0 SPRINKLER INDUSTRY 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