2014-09-25T08:53:24-05:00 2013-12-31 208078757 SALTER & COMPANY LLC 4600 EAST WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2013-01-01 530215881 NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND NATI 3015771700 8000 CORPORATE DRIVE LANDOVER MD 20785 MICHAEL W JACOBSON ADMINISTRATOR 3015771700 2014-09-25 1 CHARLES L UNDERWOOD JR P01259271 3018307400 X 2013 2015-11-30 17:44:51Z MICHAEL W JACOBSON 8000 CORPORATE DRIVE LANDOVER MD 20785 6084827165 0 X WWW.NASIFUND.ORG X 1957 MD TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER A CBA & PARTICIPATION AGRMNTS. 10 5 59 0 0 0 0 0 167449798 175458255 18539090 18936195 0 0 185988888 194394450 0 0 155453568 169544074 3570719 3598378 0 0 0 3766429 4172026 162790716 177314478 23198172 17079972 461722644 497034024 72019446 88635092 389703198 408398932 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 20129 0 1 59 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 JOHN D BODINE SR TRUSTEE - RETIRED 7/15/13 1.00 39.00 X 0 99608 32451 FRED BARALL TRUSTEE 1.00 X 0 0 0 MICHAEL R MAHLER TRUSTEE 1.00 39.00 X 0 123569 73993 PETER GIBBONS TRUSTEE 1.00 39.00 X 0 180414 26726 SHAWN BROADRICK TRUSTEE 1.00 39.00 X 0 151131 43698 CORNELIUS J CAHILL TRUSTEE 1.00 X 0 0 0 JAMES E TUCKER TRUSTEE 1.00 39.00 X 0 148943 43698 RUSSELL P FLEMING TRUSTEE 1.00 X 0 0 0 JAMES F LYNCH TRUSTEE 1.00 X 0 0 0 CARLA GUNTHER TRUSTEE 1.00 X 0 0 0 BRIAN DUNN TRUSTEE 1.00 39.00 X 0 117139 42521 MICHAEL W JACOBSON ADMINISTRATOR 14.00 26.00 X 71162 136367 115329 JOHN EGER ASSISTANT ADMINISTRATOR 12.00 28.00 X 54182 132653 102339 DAN CURRY IT MANAGER 19.00 16.00 X 63842 56614 52159 WILLIAM SAPP COMPUTER PROGRAMMER 12.00 23.00 X 37058 71936 49041 REGINA DAVIS CHIEF ACCOUNTANT 15.00 20.00 X 74303 99708 66720 NIA PADMORE CLAIMS MANAGER 27.00 8.00 X 78921 22260 46916 379468 1340342 695591 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 CLAIMS PROCESSING 6168485 E-PLAN 22601 N 19TH AVE SUITE 22 PHOENIX AZ 85027 CLAIMS PROCESSING 1339298 EXPRESS SCIPTS 1 EXPRESS WAY ST LOUIS MO 63121 PROSCRIPTIONS PROCESSING 699089 AMERICAN HEALTH HOLDING INC 100 W OLD WILSON BRIDGE ROAD WORTHINGTON OH 43085 MEDICAL CLAIMS REVIEW 680544 DELTA DENTAL ONE DELTA DRIVE MECHANICSBURG PA 17055 DENTAL CLAIMS PROCESSING 483650 5 UNDER UNION AGREEMENT 900099 159109132 159109132 PARTICIPANTS' CONTR. 900099 16250334 16250334 LIQUIDATED DAMAGES 900099 94499 94499 4290 4290 175458255 11050253 11050253 5898318657 5890432147 568 7886510 -568 7885942 7885942 194394450 183339907 0 11054543 169544074 379468 1809472 758590 476652 174196 402358 169512 984884 203821 111330 43224 CLAIMS COST MANAGEMENT 794554 INSURANCE CONSULTATION 341834 PRINTING & PUBLICATIONS 207849 DATA PROCESSING EXPENSE 193193 719467 177314478 14444292 13082915 31038670 64733970 81290 74144 1923674 1779839 123229 143835 416035163 418999160 461722644 497034024 70463673 87299855 1555773 1335237 72019446 88635092 X 389703198 408398932 0 0 0 0 389703198 408398932 461722644 497034024 X 17079972 1615762 X X 0 1 X 1 0 1923674 1779839 143835 143835 FUNDS HELD IN ESCROW 529078 OUTSTANDING HEALTH & WELFARE CLAIM CHECKS 806159 1335237 196988359 1615762 1963031 3578793 193409566 984884 984884 194394450 176329594 0 176329594 984884 984884 177314478 PART XI, LINE 2D - OTHER ADJUSTMENTS: RETIRED EMPLOYEE SUBSIDY ACCOUNT CONTRIBUTIONS (RESA) RETIRED EMPLOYEE SUBSIDY ACCOUNT HEALTH PREMIUM PAID X 0 1 0 MICHAEL R MAHLER TRUSTEE 0 123569 0 0 0 0 0 57923 0 16070 0 197562 0 0 PETER GIBBONS TRUSTEE 0 172684 0 0 0 7730 0 10560 0 16166 0 207140 0 0 SHAWN BROADRICK TRUSTEE 0 151131 0 0 0 0 0 25248 0 18450 0 194829 0 0 JAMES E TUCKER TRUSTEE 0 148943 0 0 0 0 0 25248 0 18450 0 192641 0 0 BRIAN DUNN TRUSTEE 0 117139 0 0 0 0 0 24071 0 18450 0 159660 0 0 MICHAEL W JACOBSON ADMINISTRATOR 65833 126155 0 0 5329 10212 33377 66187 5406 10359 109945 212913 0 0 JOHN EGER ASSISTANT ADMINISTRATOR 49293 120684 0 0 4889 11969 22707 63867 4572 11193 81461 207713 0 0 DAN CURRY IT MANAGER 63842 56614 0 0 0 0 19288 17105 8356 7410 91486 81129 0 0 WILLIAM SAPP COMPUTER PROGRAMMER 37058 71936 0 0 0 0 11314 21962 5360 10405 53732 104303 0 0 REGINA DAVIS CHIEF ACCOUNTANT 74303 99708 0 0 0 0 21758 29197 6732 9033 102793 137938 0 0 PART I, LINE 4B MICHAEL W. JACOBSON PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $258,742. JOHN EGER PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $85,009. 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 JOHN D. BODINE, SR - 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. SHAWN BROADRICK - 7050 OAKLAND MILLS RD, COLUMBIA, MD 21046. CORNELIUS J. CAHILL - 40 JON BARRETT ROAD, PATTERSON, NY 12563. JAMES E. TUCKER - 7050 OAKLAND MILLS RD, COLUMBIA, MD 21046. RUSSELL P. FLEMING - 40 JON BARRETT ROAD, PATTERSON, NY 12563. JAMES F. LYNCH - 40 JON BARRETT ROAD, PATTERSON, NY 12563. CARLA GUNTHER - 40 JON BARRETT ROAD, PATTERSON, NY 12563. BRIAN DUNN - 7050 OAKLAND MILLS RD, COLUMBIA, MD 21046. FORM 990, PART XI, LINE 9: UNREALIZED APPRECIATION (DEPRECIATION) ON INVESTMENTS 1,615,762. 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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