2014-10-10T12:36:55-05:00 2013-12-31 611436956 NOVAK FRANCELLA LLC ONE PRESIDENTIAL BLVD SUITE 330 BALA CYNWYD PA 19004 990 2013-01-01 456218538 PARTICIPATING UNION GM BANKRUPTCY CLAIM HEALTH CARE REIMBURSEMENT TRUST PART 4122012242 60 BLVD OF THE ALLIES 5TH FLR PITTSBURGH PA 15222 RACHAEL DAVIS COMMITTEE MEMBER 4122012242 2014-10-09 1 LOUIS VERZELLA CPA P00360279 6106689400 2014-10-03 2013 2015-11-30 17:44:51Z RACHAEL DAVIS 60 BLVD OF THE ALLIES 5TH FLR PITTSBURGH PA 15222 123054093 0 X N/A X 2011 PA THE PARTICIPATING UNION GM BANKRUPTCY CLAIM HEALTH CARE REIMBURSEMENT TRUST WAS ESTABLISHED ON APRIL 11, 2011 AND HAS BEEN CREATED TO FUND BENEFITS FOR CERTAIN RETIRED BARGAINING UNIT MEMBERS WHO LOST THEIR GM POST-RETIREMENT HEALTH BENEFITS IN THE GM BANKRUPTCY, AND FOR CERTAIN SPOUSES AND ELIGIBLE DEPENDENTS OF THOSE RETIREES. 5 5 0 0 0 0 0 0 2497455 0 -2757249 4186977 0 0 -259794 4186977 0 0 5766972 5048528 0 0 0 0 0 349628 346666 6116600 5395194 -6376394 -1208217 39819656 40007950 1116952 1185188 38702704 38822762 TO PROVIDE POST-RETIREMENT HEALTH BENEFITS FOR CERTAIN RETIRED BARGAINING UNIT MEMBERS WHO LOST THEIR HEALTH BENEFITS IN THE GM BANKRUPTCY. 0 0 TO PROVIDE POST-RETIREMENT HEALTH BENEFITS FOR CERTAIN RETIRED BARGAINING UNIT MEMBERS WHO LOST THEIR HEALTH BENEFITS IN THE GM BANKRUPTCY. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 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 1 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X CDS ADMINISTRATORS INC 4122012242 60 BLVD OF THE ALLIES 5TH FLR PITTSBURGH PA 15222 X DARRELL COLLINS COMMITTEE MEMBER 1.00 X 0 0 0 STEVEN ELLICOTT COMMITTEE MEMBER 1.00 X 0 0 0 KARL HEIM COMMITTEE MEMBER 1.00 X 0 0 0 DAVID MCLEAN COMMITTEE MEMBER 1.00 X 0 0 0 RACHAEL DAVIS COMMITTEE MEMBER 1.00 X 0 0 0 0 0 0 0 0 0 0 CENTRAL DATA SERVICES INC 60 BLVD OF THE ALIES PITTSBURGH PA 15222 DATA PROCESSING 122315 1 671956 671956 122382137 118867116 3515021 3515021 3515021 4186977 3515021 0 671956 5048528 21441 10500 134049 13426 24746 ADMINISTRATIVE SERVICES 122315 ACTUARIAL 15778 PCORI FEE 4411 5395194 622283 520796 15023 13612 38999944 39316224 182406 157318 39819656 40007950 56471 48766 1060481 1136422 1116952 1185188 X 0 0 0 0 38702704 38822762 38702704 38822762 39819656 40007950 X -1208217 687406 640869 X X 0 1 X 1 0 0 DUE TO BROKER - INVESTMENTS PURCHASED 1136422 1136422 X 4740334 687406 687406 4052928 134049 134049 4186977 5261145 0 5261145 134049 134049 5395194 PART X, LINE 2: MANAGEMENT EVALUATED THE PLAN'S TAX POSITIONS AND CONCLUDED THAT THE PLAN HAD MAINTAINED ITS TAX EXEMPT STATUS AND HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. FORM 990, PART VI, SECTION A, LINE 8B THE COMMITTEE HAS NOT AUTHORIZED ANY SUBCOMMITTEE TO ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11 THE PARTICIPATING UNION GM BANKRUPTCY CLAIM HEALTH CARE REIMBURSEMENT TRUST FORM 990 IS REVIEWED BY THE COMMITTEE BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE PARTICIPATING UNION GM BANKRUPTCY CLAIM HEALTH CARE REIMBURSEMENT TRUST COMMITTEE MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER OF ASSETS FROM INTERNATIONAL BROTHERHOOD OF TEAMSTERS LOCAL #743 640,869. FORM 990, PART XII, LINE 2C: THE PARTICIPATING UNION GM BANKRUPTCY CLAIM HEALTH CARE REIMBURSEMENT TRUST COMMITTEE IS RESPONSIBLE FOR OVERSEEING THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT THAT PERFORMS THE AUDIT. FORM 990, PART VI, SECTION B, LINE 15: PART VI, SECTION B, LINE 15: ORGANIZATION DOES NOT HAVE ANY EMPLOYEES AND DOES NOT PAY ANY COMPENSATION.