2014-11-03T16:28:56-06:00 2013-12-31 208078757 SALTER & COMPANY LLC 4600 EAST-WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2013-01-01 261860594 USW RETIREES OF THE DANA CORPORATION HEALTH CARE TRUST USWR 4122102233 60 BLVD OF THE ALLIES 5TH FLOOR PITTSBURGH PA 15222 THOMAS BRAUN COMMITTEE MEMBER 4122102233 2014-10-31 1 JOSEPH M HERISHEN CPA P00361968 3018307400 2014-11-03 X 2013 2015-11-30 17:44:51Z THOMAS BRAUN 5 GATEWAY CENTER PITTSBURGH PA 15222 88882878 0 X N/A X 2008 PA TO PROVIDE HEALTH AND OTHER WELFARE BENEFITS. 7 6 0 0 0 0 0 0 5990301 5967083 9534598 11972574 19150 0 15544049 17939657 0 0 22441111 22032862 132294 168961 0 0 0 1086651 817075 23660056 23018898 -8116007 -5079241 248015302 245707605 540085 1103963 247475217 244603642 X THE USW RETIREES OF THE DANA CORPORATION HEALTH CARE TRUST IS ESTABLISHED FOR THE PURPOSE OF (I) PROVIDING HEALTH AND OTHER WELFARE BENEFITS TO PARTICIPANTS IN ACCORDANCE WITH THE USW RETIREES OF THE DANA CORPORATION HEALTH CARE PLAN AND AS ARE PERMISSIBLE UNDER SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE AS SET FORTH HEREIN; AND (II) TO PROVIDE HEALTH AND WELFARE BENEFITS TO THE RUN-OUT PARTICIPANTS IN ACCORDANCE WITH THE DANA CORPORATION'S ORIGINAL PLAN. 0 0 THE TRUST PROVIDED HEALTH AND OTHER WELFARE BENEFITS THROUGH THE USW RETIREES OF THE DANA CORPORATION PLAN TO 4,893 PARTICIPANTS AND SURVIVING SPOUSES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 53 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X CDS ADMINISTRATORS 4122012242 5 GATEWAY CENTER SUITE 620 PITTSBURGH PA 15222 HARVEY NATHAN COMMITTEE MEMBER 2.00 X 33146 0 0 CHARLES PIPER COMMITTEE MEMBER 2.00 X 27798 0 0 JAMES DWORKIN COMMITTEE MEMBER 2.00 X 27798 0 0 THOMAS BRAUN CHAIRMAN 2.00 X X 27798 0 0 THOMAS HAYHURST COMMITTEE MEMBER 2.00 X 27798 0 0 ANNE BLANTON COMMITTEE MEMBER 2.00 X 24623 0 0 MIKE O'BRIEN COMMITTEE MEMBER 1.00 X 0 0 0 168961 0 0 0 0 0 0 HIGHMARK 120 5TH AVE 2015 PITTSBURGH PA 15222 CLAIMS ADMINISTRATION & ACCESS FEE 214682 CDS ADMINISTRATORS 5 GATEWAY CENTER STE 620 60 BLVD PITTSBURGH PA 152221219 THIRD PARTY ADMINISTRATOR 171276 GALLAGHER FIDUCIARY ADVISORS 805 15TH ST NW WASHINGTON DC 20005 FIDUCIARY SERVICES 101279 3 PARTICIPANT CONTRIBUTIONS 525100 5967083 5967083 5967083 5149089 5149089 77766706 70943221 6823485 6823485 6823485 17939657 5967083 0 11972574 22032862 168961 385958 47667 32099 130713 720 10417 4667 44916 INVESTMENT CONSULTING 101279 ACTUARY & CONSULTING 46112 BANK FEES 10335 PCORI FEE 1170 1022 23018898 780232 2415336 8962750 10215248 19919 17855 103120431 100833850 133631970 132225316 1500000 0 248015302 245707605 540085 1103963 540085 1103963 X 0 0 0 0 247475217 244603642 247475217 244603642 248015302 245707605 -5079241 2207666 0 X X 0 1 X 1 0 0 LIMITED PARTNERSHIP 2567524 F COMMON COLLECTIVE TRUSTS 129657792 F 132225316 X 20015588 2207666 2207666 17807922 130713 1022 131735 17939657 22887163 0 22887163 130713 1022 131735 23018898 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION. THE PLAN IS NOT AWARE OF ANY UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS AS OF DECEMBER 31, 2013. PART XI, LINE 4B - OTHER ADJUSTMENTS: MED PART D REFUND PART XII, LINE 4B - OTHER ADJUSTMENTS: MED PART D REFUND FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PROVIDED TO THE TRUST'S ADMINISTRATOR TO BE DISTRIBUTED TO THE COMMITTEE MEMBERS FOR THEIR REVIEW PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C COMMIITTEE MEMBERS MONITOR THE CONFLICT OF INTEREST POLICY ANNUALLY FOR ANY POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION C, LINE 19 ANY DOCUMENTS THAT THE TRUST WOULD BE REQUIRED TO MAKE AVAILABLE TO THE PUBLIC WOULD BE AVAILABLE BY CONTACTING THE TRUST'S THIRD PARTY ADMINISTRATOR, CDS ADMINISTRATORS. PART XII - LINE 2(C) NO CHANGE HAS BEEN MADE BY THE COMMITTEE MEMBERS TO THE OVERSIGHT PROCESS FROM THE PRIOR YEAR.