2013-09-04T10:42:04-05:00 2012-12-31 208078757 SALTER & COMPANY LLC 4600 EAST WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2012-01-01 530215881 NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND NATI 3015771700 8000 CORPORATE DRIVE LANDOVER MD 20785 MICHAEL W JACOBSON 3015771700 2013-09-03 1 CHARLES L UNDERWOOD JR P01259271 3018307400 2013-08-28 X 2012 2016-02-24 21:20:13Z MICHAEL W JACOBSON 8000 CORPORATE DRIVE LANDOVER MD 20785 3847757417 0 X WWW.NASIFUND.ORG X 1957 MD TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER A CBA & PARTICIPATION AGRMNTS. 10 10 52 0 0 0 0 0 155455485 167449798 21278813 18539090 0 0 176734298 185988888 0 0 150888797 155453568 3592081 3570719 0 0 0 3649377 3766429 158130255 162790716 18604043 23198172 374763140 461722644 19548161 72019446 355214979 389703198 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 1 23930 0 1 52 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 14.00 X 67735 127782 87836 JOHN EGER 13.00 X 58446 116543 72762 DAN CURRY 25.00 X 71373 42351 47395 WILLIAM SAPP 14.00 X 35492 67413 44770 LINDA DAVIS 7.00 X 16766 83630 44161 249812 437719 296924 0 0 1 0 BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO IL 606015099 CLAIMS PROCESSING 5838069 E-PLAN 22601 N 19TH AVE SUITE 22 PHOENIX AZ 85027 CLAIMS PROCESSING 1081366 AMERICAN HEALTH HOLDING INC 100 W OLD WILSON BRIDGE ROAD WORTHINGTON OH 43085 MEDICAL CLAIMS REVIEW 649716 DELTA DENTAL ONE DELTA DRIVE MECHANICSBURG PA 17055 DENTAL CLAIMS PROCESSING 481153 SMITH GRAHAM & CO INVESTMENT ADVISORS 140 BROADWAY 45TH FLOOR NEW YORK NY 10005 INVESTMENT ADVISORY 380980 5 UNDER UNION AGREEMENT 900099 150586515 150586515 PARTICIPANTS' CONTR. 900099 16716310 16716310 LIQUIDATED DAMAGES 900099 146953 146953 20 20 167449798 11814329 11814329 3668493290 3661768529 6724761 6724761 6724761 185988888 174174539 0 11814349 155453568 249812 1926474 739030 484647 170756 350077 166451 895272 206955 99890 32447 CLAIMS COST MANAGEMENT 781806 INSURANCE CONSULTATION 325618 DATA PROCESSING EXPENSE 203818 POSTAGE & SHIPPING 197928 506167 162790716 15471324 14444292 17033636 31038670 71336 81290 1862311 1739082 84616 123229 329465590 393020508 12636638 23014655 374763140 461722644 18294281 70463673 1253880 1555773 19548161 72019446 X 355214979 389703198 0 0 0 0 355214979 389703198 374763140 461722644 X 23198172 11290047 X X 0 1 X 1 0 1862311 1739082 123229 123229 FUNDS HELD IN ESCROW 1010307 OUTSTANDING HEALTH & WELFARE CLAIM CHECKS 545466 1555773 199329134 11290047 2945471 14235518 185093616 895272 895272 185988888 161895444 0 161895444 895272 895272 162790716 PART XI, LINE 2D - OTHER ADJUSTMENTS: RETIRED EMPLOYEE SUBSIDY ACCOUNT CONTRIBUTIONS (RESA) RETIRED EMPLOYEE SUBSIDY ACCOUNT HEALTH PREMIUM PAID X 0 1 0 MICHAEL W JACOBSON 62205 117350 0 0 5530 10432 7225 21898 20340 38373 95300 188053 0 0 JOHN EGER 53079 105841 0 0 5367 10702 4180 8405 20099 40078 82725 165026 0 0 DAN CURRY 71373 42351 0 0 0 0 0 0 29745 17650 101118 60001 0 0 PART I, LINE 4B MICHAEL W. JACOBSON PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $171,769. JOHN EGER PARTICIPATES IN A NONQUALIFED DEFERRED COMP PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $34,914. 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 2013 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 9: UNREALIZED APPRECIATION (DEPRECIATION) ON INVESTMENTS 11,290,047. 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 SUPPLEMENTAL PENSION FUND 8000 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PIPEFITTERS L 565 W & P 600 CHARLES ST WELLSBURG WV 26070 999999999 WV C 0 PIPEFITTERS LOCAL 007 308 WOLF RD LATHAM NY 12110 999999999 NY C 0 PIPEFITTERS LOCAL 026 201 QUEEN ANNE AVE N STE SEATTLE WA 98109 999999999 WA C 0 PIPEFITTERS LOCAL 030 PO BOX 5434 SPOKANE WA 99205 999999999 WA C 0 PIPEFITTERS LOCAL 047 1700 3 GATEWAY CTR PITTSBURGH PA 15222 999999999 PA C 0 PIPEFITTERS LOCAL 050 7570 CAPLE BLVD STE B NORTHWOOD OH 43619 999999999 OH C 0 PIPEFITTERS LOCAL 098 700 TOWER DR TROY MI 48098 999999999 MI C 0 PIPEFITTERS LOCAL 102 PO BOX 27126 KNOXVILLE TN 37927 999999999 TN C 0 PIPEFITTERS LOCAL 120 6305 HALLE DR CLEVELAND OH 44125 999999999 OH C 0 PIPEFITTERS LOCAL 136 PO BOX 3040 TERRE HAUTE IN 47803 999999999 IN C 0 PIPEFITTERS LOCAL 140 PO BOX 30604 SALT LAKE CTY UT 84130 999999999 UT C 0 PIPEFITTERS LOCAL 157 8801 E MILNER AVE TERRE HAUTE IN 47803 999999999 IN C 0 PIPEFITTERS LOCAL 211 PO BOX 721708 HOUSTON TX 77272 999999999 TX C 0 PIPEFITTERS LOCAL 290 1305 SW 12TH AVE PORTLAND OR 97201 999999999 OR C 0 PIPEFITTERS LOCAL 354 WILKINSON RD YOUNGWOOD PA 15697 999999999 PA C 0 PIPEFITTERS LOCAL 367 610 W 54TH AVE ANCHORAGE AK 99518 999999999 AK C 0 PIPEFITTERS LOCAL 396 PO BOX 230 NILES OH 44446 999999999 OH C 0 PIPEFITTERS LOCAL 412 4901 CHAPPELL DR NE ALBUQUERQUE NM 87107 999999999 NM C 0 PIPEFITTERS LOCAL 434 11270 W PARK PL STE 950 MILWAUKEE WI 53224 999999999 WI C 0 PIPEFITTERS LOCAL 495 5 HOT METAL ST PITTSBURGH PA 15203 999999999 PA C 0 PIPEFITTERS LOCAL 520 PO BOX 6480 HARRISBURG PA 17112 999999999 PA C 0 PIPEFITTERS LOCAL 538 5950 FAIRVIEW RD CHARLOTTE NC 28210 999999999 NC C 0 PIPEFITTERS LOCAL 553 995 E AIRLINE DR EAST ALTON IL 62024 999999999 IL C 0 PIPEFITTERS LOCAL 572 PO BOX 78245 NASHVILLE TN 37207 999999999 TN C 0 PIPEFITTERS LOCAL 597 45 N OGDEN AVE CHICAGO IL 60607 999999999 IL C 0 PIPEFITTERS LOCAL 619 PO BOX 261 VICKSBURG MS 39181 999999999 MS C 0 PIPEFITTERS LOCAL 630 1910 N FLORIDA MANGO RD WEST PALM BEACH FL 33409 999999999 FL C 0 PIPEFITTERS LOCAL 633 333 W VINE ST STE 500 LEXINGTON KY 40507 999999999 KY C 0 PIPEFITTERS LOCAL 636 700 TOWER DR STE 300 TROY MI 48098 999999999 MI C 0 PIPEFITTERS LOCAL 671 309 DETROIT ST MONROE MI 48161 999999999 MI C 0 PIPEFITTERS LOCAL 716 50 ELM ST MANCHESTER NH 03101 999999999 NH C 0 PIPEFITTERS LOCAL 760 PO BOX 2567 MUSCLE SHOALS AL 35662 999999999 AL C 0 PIPEFITTERS LOCAL 761 501 SHATTO PL 5TH FLOOR LOS ANGELES CA 90020 999999999 CA C 0 PLBRS & STEAMFITTERS L131 60 N MAIN ST WALLINGFORD CT 06492 999999999 CT C 0 PLUMBERS LOCAL 022 3900 PACKARD RD NIAGARA FALLS NY 14303 999999999 NY C 0 PLUMBERS LOCAL 025 1228 3RD AVE ROCK ISLAND IL 61201 999999999 IL C 0 PLUMBERS LOCAL 060 3515 I-10 SERVICE RD METAIRIE LA 70002 999999999 LA C 0 PLUMBERS LOCAL 083 600 CHARLES ST STE 2 WELLSBURG WV 26070 999999999 WV C 0 PLUMBERS LOCAL 104 PO BOX 268 CHICOPEE MA 01014 999999999 MA C 0 PLUMBERS LOCAL 146 1300 S UNIVERSITY DR STE FORT WORTH TX 76107 999999999 TX C 0 PLUMBERS LOCAL 150 907 TWO 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183 W175N5700 TECHNOLOGY DR MENOMONEE FLS WI 53051 391147455 WI C 0 SPRINKLER FITTERS LU 268 1544 S 3RD ST SAINT LOUIS MO 63104 999999999 MO C 0 SPRINKLER FITTERS LU 699 2800 1ST AVE STE 111 SEATTLE WA 98121 910636728 WA C 0 SPRINKLER FITTERS LU 709 12140 RIVERA RD WHITTIER CA 90606 951588769 CA C 0 SPRINKLERFITTERS LU 417 PO BOX 220 MINNEAPOLIS MN 55440 999999999 MN C 0 SPRINKLERFITTERS LU 821 106 PONCE DE LEON ST B RYL PALM BCH FL 33411 590936961 FL C 0 STEAMFITTERS LOCAL 072 3835 PRESIDENTIAL PKWY ATLANTA GA 30340 999999999 GA C 0 STEAMFITTERS LOCAL 449 1517 WOODRUFF ST PITTSBURGH PA 15220 999999999 PA C 0 STEAMFITTERS LOCAL 464 1941 S 42ND ST STE 129 OMAHA NE 68105 999999999 NE C 0 STEAMFITTERS LOCAL 475 PO BOX 4187 WARREN NJ 07059 999999999 NJ C 0 STEAMFITTERS LOCAL 638 5 PENN PLAZA NEW YORK NY 10001 999999999 NY C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0