2012-08-13T15:40:44-05:00 2011-12-31 208078757 SALTER & COMPANY LLC 4600 EAST WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2011-01-01 530215881 NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND NATI 3015771700 8000 CORPORATE DRIVE LANDOVER MD 20785 MICHAEL W JACOBSON 3015771700 2012-08-13 1 CHARLES L UNDERWOOD JR P01259271 3018307400 X 2011 2016-02-24 21:20:13Z MICHAEL W JACOBSON 8000 CORPORATE DRIVE LANDOVER MD 20785 1826774056 0 X WWW.NASIFUND.ORG X 1957 MD TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER A CBA & PARTICIPATION AGRMNTS. 10 10 66 0 0 0 0 0 147733081 155455485 23084645 21278813 0 0 170817726 176734298 0 0 161536978 150888797 3529148 3592081 0 0 0 3879127 3649377 168945253 158130255 1872473 18604043 383052707 374763140 42958914 19548161 340093793 355214979 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 0 1 9796 0 1 66 1 0 0 0 0 0 0 0 0 X 10 10 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 1.00 X 0 0 0 FRED BARALL 1.00 X 0 0 0 MICHAEL R MAHLER 1.00 X 0 0 0 PETER GIBBONS 1.00 X 0 0 0 SHAWN BROADRICK 1.00 X 0 0 0 CORNELIUS J CAHILL 1.00 X 0 0 0 JAMES E TUCKER 1.00 X 0 0 0 RUSSELL P FLEMING 1.00 X 0 0 0 JAMES F LYNCH 1.00 X 0 0 0 MICHAEL W JACOBSON 10.00 X 45718 138558 84506 JOHN EGER 13.00 X 55857 112303 67352 DAN CURRY 21.00 X 59102 51852 47288 WILLIAM SAPP 17.00 X 43030 57367 44725 203707 360080 243871 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 CLAIMS PROCESSING 6253146 E-PLAN 22601 N 19TH AVE SUITE 22 PHOENIX AZ 85027 CLAIMS PROCESSING 931097 AMERICAN HEALTH HOLDING INC 100 W OLD WILSON BRIDGE ROAD WORTHINGTON OH 43085 MEDICAL CLAIMS REVIEW 616434 SMITH GRAHAM & CO INVESTMENT ADVISORS 140 BROADWAY 45TH FLOOR NEW YORK NY 10005 INVESTMENT ADVISORY 365093 THE SEGAL COMPANY 1920 N STREET NW SUITE 400 WASHINGTON DC 200361659 ACTUARIAL & CONSULTING 329283 5 UNDER UNION AGREEMENT 900099 138473290 138473290 PARTICIPANTS' CONTR. 900099 16940945 16940945 LIQUIDATED DAMAGES 900099 41250 41250 155455485 16575734 16575734 1654742837 1650039758 4703079 4703079 4703079 176734298 160158564 0 16575734 150888797 203707 1972899 742006 496746 176723 267063 152903 841584 209753 94014 32092 CLAIMS COST MANAGEMENT 727621 INSURANCE CONSULTATION 286082 POSTAGE & SHIPPING 251720 PRINTING & PUBLICATIONS 176643 609902 158130255 6563265 15471324 39379871 17033636 57060 71336 1791251 1706635 94272 84616 328460568 329465590 8497671 12636638 383052707 374763140 41321672 18294281 1637242 1253880 42958914 19548161 X 340093793 355214979 0 0 0 0 340093793 355214979 383052707 374763140 X 18604043 -3482857 X X 0 1 1 X 0 1791251 1706635 84616 84616 FUNDS HELD IN ESCROW 476697 OUTSTANDING HEALTH & WELFARE CLAIM CHECKS 777183 1253880 176734298 158130255 18604043 -3482857 -3482857 15121186 174515214 -3482857 2105357 -1377500 175892714 841584 841584 176734298 157288671 0 157288671 841584 841584 158130255 PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED APPRECIATION (DEPRECIATION) ON INVESTMENTS -3,482,857. PART XII, LINE 2D - OTHER ADJUSTMENTS: RETIRED EMPLOYEE SUBSIDY ACCOUNT CONTRIBUTIONS (RESA) RETIRED EMPLOYEE SUBSIDY ACCOUNT HEALTH PREMIUM PAID PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING X 0 1 0 MICHAEL W JACOBSON 41734 126484 0 0 3984 12074 2458 19050 15629 47369 63805 204977 0 0 JOHN EGER 50496 101524 0 0 5361 10779 2784 5501 19620 39447 78261 157251 0 0 DAN CURRY 59102 51852 0 0 0 0 0 0 25189 22099 84291 73951 0 0 PART I, LINE 4B MICHAEL W. JACOBSON PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $142,646. JOHN EGER PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $22,329. 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 2012 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. CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED APPRECIATION (DEPRECIATION) ON INVESTMENTS -3,482,857. TOTAL TO FORM 990, PART XI, LINE 5: -3,482,857. 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 SUPPLEMETAL PENSION FUND 8000 CORPORATE DRIVE LANDOVER MD 20785 141595069 DEFINED CONTRIBUTION PENSION PLAN MD SECTION 401(A)(4) 0 UA INTERNATIONAL TRAINING FUND 901 MASS AVE NW WASHINGTON DC 20001 530238416 EDUCATION FUND DC SECTION 501(C)(5) 0 NATIONAL AUTOMATIC SPRINKLER INDUSTRY FUND OFFICE EMPLOYEE PENSION PLAN 8000 CORPORATE DRIVE LANDOVER MD 20785 530215881 DEFINED BENEFIT PENSION PLAN MD SECTION 401(A)(4) 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0