TRUSTEE

2012-07-16T10:03:12-05:00 2011-12-31 311307159 SCHOONOVER BOYER ASSOCIATES 383 NORTH FRONT STREET COLUMBUS OH 43215 990 2011-01-01 311040732 BURGESS & NIPLE EMPLOYEE BENEFIT TRUST BURG 6144597272 5085 REED ROAD COLUMBUS OH 432202513 PEGGY GARRISON TRUSTEE 6144597272 2012-07-17 JOHN E BOYER P00218741 6148888000 2011 2016-02-24 21:20:13Z PEGGY GARRISON 5085 REED ROAD COLUMBUS OH 432202513 3642617 0 X WWW.BURGESSNIPLE.COM X 1982 OH TO PROVIDE MEDICAL, DENTAL, PRESCRIPTION DRUGS, DISABILITY AND LIFE INSURANCE TO EMPLOYEES OF BURGESS & NIPLE. 7 0 0 0 0 0 0 0 5464130 3640863 1845 1754 0 0 5465975 3642617 0 0 4876566 3792219 0 0 0 0 0 13927 8340 4890493 3800559 575482 -157942 1241676 1083734 0 0 1241676 1083734 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 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 0 1 0 0 0 0 0 0 0 0 0 0 0 X 7 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 X 0 0 0 JIM GARRISON DIRECTOR X 0 0 0 BOB DRAPER DIRECTOR X 0 0 0 ED MUCCILLO DIRECTOR X 0 0 0 BRUCE MANSFIELD DIRECTOR X 0 0 0 RONALD SCHULTZ DIRECTOR X 0 0 0 CHUCK ZIBBEL DIRECTOR 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 234961 1 EMPLOYER CONTRIBUTIONS 525100 2390853 2390853 EMPLOYEE CONTRIBUTIONS 525100 1224458 1224458 ARRA TAX CREDIT FOR CO 525100 25552 25552 3640863 1754 1754 3642617 3642617 0 0 3792219 6800 BANK FEES 1540 3800559 270208 160512 903438 855192 68030 68030 1241676 1083734 0 0 X 1241676 1083734 0 0 0 0 1241676 1083734 1241676 1083734 -157942 0 X 0 1 1 X 0 0 DEPOSIT 68030 68030 3642617 3800559 -157942 -157942 3642617 0 3642617 0 3642617 3800559 0 3800559 0 3800559 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.