TRUSTEE

2013-07-08T10:54:05-05:00 2012-12-31 311307159 SCHOONOVER BOYER ASSOCIATES 383 NORTH FRONT STREET COLUMBUS OH 43215 990 2012-01-01 311040732 BURGESS & NIPLE EMPLOYEE BENEFIT TRUST BURG 6144597272 5085 REED ROAD COLUMBUS OH 432202513 PEGGY GARRISON TRUSTEE 6144597272 2013-07-08 JOHN E BOYER P00218741 6148888000 2012 2016-03-07 17:11:31Z PEGGY GARRISON 5085 REED ROAD COLUMBUS OH 432202513 3228551 0 X WWW.BURGESSNIPLE.COM X 1982 OH TO PROVIDE MEDICAL, DENTAL, PRESCRIPTION DRUGS, DISABILITY AND LIFE INSURANCE TO EMPLOYEES OF BURGESS & NIPLE. 8 0 0 0 0 0 0 0 3640863 3226839 1754 1712 0 0 3642617 3228551 0 0 3792219 3306915 0 0 0 0 0 8340 8202 3800559 3315117 -157942 -86566 1083734 997168 0 0 1083734 997168 TO PROVIDE MEDICAL, DENTAL, PRESCRIPTION DRUGS, DISABILITY AND LIFE INSURANCE TO EMPLOYEES OF BURGESS & NIPLE, INC. 0 0 TO PROVIDE MEDICAL, DENTAL, PRESCRIPTION DRUGS, DISABILITY AND LIFE INSURANCE TO PARTICIPATING EMPLOYEES AND DEPENDENTS, SERVING APPROXIMATELY 400 INDIVIDUALS AND FAMILIES. 0 0 0 0 0 0 0 0 0 0 0 0 1 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 8 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 X PEGGY GARRISON 6144597272 5085 REED ROAD COLUMBUS OH 432202513 X BARRY DIXON DIRECTOR 0.00 X 0 0 0 JIM GARRISON DIRECTOR 0.00 X 0 0 0 BOB DRAPER DIRECTOR 0.00 X 0 0 0 ED MUCCILLO DIRECTOR 0.00 X 0 0 0 BRUCE MANSFIELD DIRECTOR 0.00 X 0 0 0 RONALD SCHULTZ DIRECTOR 0.00 X 0 0 0 CHUCK ZIBBEL DIRECTOR 0.00 X 0 0 0 0 0 0 0 0 0 0 AETNA LIFE INSURANCE CO 7400 WEST CAMPUS ROAD NEW ALBANY OH 43054 THIRD PARTY ADMINISTRATION 203000 1 EMPLOYER CONTRIBUTIONS 525100 2161262 2161262 EMPLOYEE CONTRIBUTIONS 525100 1065577 1065577 3226839 1712 1712 3228551 3228551 0 0 3306915 6800 BANK FEES 1402 3315117 160512 172234 855192 756904 68030 68030 1083734 997168 0 0 X 1083734 997168 0 0 0 0 1083734 997168 1083734 997168 -86566 0 X 0 1 X 1 0 0 DEPOSIT 68030 68030 3228551 0 3228551 0 3228551 3315117 0 3315117 0 3315117 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED USING INFORMATION FROM THE AUDITED FINANCIAL STATEMENTS. THE PREPARED 990 IS REVIEWED BY THE SENIOR BENEFITS ADMINISTRATOR AT BURGESS & NIPLE, INC. AFTER THE REVIEW, THE 990 IS FORWARDED TO THE CONTROLLER OF BURGESS & NIPLE, INC. FOR REVIEW AND SIGNATURE. FORM 990, PART VI, SECTION C, LINE 18 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 NO DOCUMENTS AVAILABLE TO THE PUBLIC. PARTICIPANTS OF THE PLAN MAY REQUEST DOCUMENTS FROM THE SENIOR BENEFITS ADMINISTRATOR.