2013-10-11T14:21:13-05:00 2012-12-31 522385296 LINDQUIST LLP 600 CITY PARKWAY WEST SUITE 300 ORANGE CA 92868 990 2012-01-01 366090694 BOILERMAKERS NATIONAL HEALTH & WELFARE FUND BOIL 9133426555 754 MINNESOTA AVENUE KANSAS CITY KS 66101 RONNIE L TRAXLER 9133426555 2013-10-11 1 RICHARD G THIERMANN P00974294 7142570100 2012 2016-02-25 16:41:14Z RONNIE L TRAXLER 754 MINNESOTA AVENUE KANSAS CITY KS 66101 1312900169 0 X WWW.BNF-KC.COM X 1954 KS TO PROVIDE HEALTH AND WELFARE BENEFITS. 15 1 0 0 0 0 0 0 291503477 246710260 63822104 19930972 365398 95534 355690979 266736766 0 0 240143096 206783266 6381258 2369122 0 0 0 15314268 21956146 261838622 231108534 93852357 35628232 771953750 805024745 269973160 228367499 501980590 576657246 TO PROVIDE HEALTH AND WELFARE BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS FOR PARTICIPANTS AND THEIR DEPENDENTS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 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 1 587 0 1 0 0 0 0 0 0 0 X 15 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 X TONYA PAVELAC-WALKER 9139067497 753 STATE AVENUE SUITE 106 KANSAS CITY KS 66101 RONNIE L TRAXLER 2.10 X X 0 0 0 JOHN T FULTZ 2.10 X X 0 0 0 KENNETH E WASILEWSKI 2.20 X X 0 0 0 NELSON JORDAN 0.60 X 0 0 0 MIKE DOLAN 0.60 X 0 0 0 RANDY B ROBBINS 0.70 X 0 0 0 VAN G STEPHENS 0.80 X 0 0 0 JOHN CAMMUSO 0.90 X 0 0 0 JOSEPH P REYNOLDS 1.00 X 0 0 0 JAMES W BANFORD JR 0.60 X 0 0 0 MARK VANDIVER 0.90 X 0 0 0 J MICHAEL CARROLL 0.90 X 0 0 0 CLAY HERFORD 0.60 X 0 0 0 TYLER BROWN 0.30 X 0 0 0 PATRICK GALLAGHER 2.00 X X 0 0 0 LORI JASPERSON 40.00 X 149942 0 48623 149942 0 48623 1 0 1 0 CGLIC-CHATTANOOCG EASC (CIGNA) 900 COTTAGE GROVE ROAD HARTFORD CT 06152 ADMINISTRATIVE SERVICES 11192857 CIGNA BEHAVIORAL HEALTH 11095 VIKING DRIVE SUITE 3505 EDEN PRAIRIE MN 55344 CLAIMS ADMINISTRATION 930030 WILSON MCSHANE 3001 METRO DR STE 500 BLOOMINTON MN 55425 RECORD KEEPING 853274 BLAKE & UHLIG PA 753 STATE AVENUE SUITE 475 KANSAS CITY KS 66101 LEGAL 802725 BRANDYWINE 2929 ARCH STREET 8TH FLOOR PHILADELPHIA PA 19104 INVESTMENT MANAGER 570117 18 EMPLOYER CONTRIBUTIONS 900099 197086545 197086545 MEMBER & RETIREE CONTRIBUTIONS 900099 46463394 46463394 PRESCRIPTION REBATE 900099 2768530 2768530 COBRA SUBSIDY 900099 316829 316829 MEDICARE PART D SUBSIDY 900099 74962 74962 246710260 19493913 19493913 1046600462 1046163403 437059 437059 437059 DELINQ ER CONT INTEREST 900099 91473 91473 OTHER INCOME 900099 4061 4061 95534 266736766 246805794 0 19930972 206783266 1563622 371721 303044 130735 1480295 832977 278969 2739703 13208946 395825 135872 112232 70390 36365 490 110335 LOSS ON DISPOSAL OF FIX 2553747 231108534 54830 77108315 62987034 20814762 15822212 12825 70774 854278 854278 0 0 507278659 432327943 166739189 293761952 771953750 805024745 1533353 5565083 4284086 4429044 264155721 218373372 269973160 228367499 X 0 0 0 0 501980590 576657246 501980590 576657246 771953750 805024745 35628232 39048424 0 X X 0 1 X 1 0 854278 854278 0 0 LIMITED PARTNERSHIP/LIMITED LIABILITY COM 144483301 F 103-12 INVESTMENT ENTITY 149278651 F 293761952 BENEFIT OBLIGATIONS 152922000 CASH OVERDRAFT 2331787 LIABILITY TO RETURN COLLATERAL FOR SECURITIES ON LOAN 63119585 218373372 X 303045487 39048424 39048424 263997063 2739703 2739703 266736766 260200231 0 260200231 2739703 -31831400 -29091697 231108534 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE THE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO DECEMBER 31, 2009. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATIONS 0 0 0 LORI JASPERSON 149942 0 0 0 0 0 39708 0 8915 0 198565 0 0 0 SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, LINE 5: THE BOILERMAKER-BLACKSMITH NATIONAL PENSION TRUST (AN UNRELATED ORGANIZATION) PAID LORI JASPERSON BASE COMPENSATION OF $149,942, DEFERRED COMPENSATION OF $39,708 AND NON-TAXABLE BENEFITS OF $8,915. FORM 990, PART VI, SECTION B, LINE 11 COPIES OF FORM 990 WERE PROVIDED TO THE GOVERNING BODY MEMBERS BY EMAIL PRIOR TO THE FORM 990 BEING FILED. NO REVIEW WAS OR WILL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION DOES NOT REQUIRE ANNUAL DISCLOSURES FOR POTENTIAL CONFLICTS OF INTEREST. HOWEVER, THE ORGANIZATION'S TRUSTEES AND EMPLOYEES HAVE A DUTY TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND THE AFFECTED TRUSTEE OR EMPLOYEE MUST CEASE PARTICIPATION IN THE DECISION OR TRANSACTION UNTIL IT IS DETERMINED THAT THE AFFECTED TRUSTEE OR EMPLOYEE MAY CONTINUE TO PARTICIPATE IN THE DECISION OR TRANSACTION. POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ALSO REVIEWED FOR COMPLIANCE WITH ERISA REQUIREMENTS. THE ORGANIZATION DOES REQUIRE FULL DISCLOSURE FOR POTENTIAL CONFLICTS OF INTEREST WHEN CONDUCTING SEARCHES FOR NEW VENDORS AND SERVICE PROVIDERS. THE ORGANIZATION DOES NOT COMPENSATE TOP MANAGEMENT OFFICIALS OR KEY EMPLOYEES. THE BOILERMAKER-BLACKSMITH NATIONAL PENSION TRUST (PENSION TRUST), PAYS ALL SALARIES AND OTHER COMPENSATION FOR THE EMPLOYEES OF THE PENSION TRUST, THE BOILERMAKERS NATIONAL ANNUITY TRUST (ANNUITY), AND THE BOILERMAKERS NATIONAL HEALTH AND WELFARE FUND (THE WELFARE FUND). THE PENSION TRUST AND THE ANNUITY TRUSTS ARE UNRELATED TO THE WELFARE FUND. A JOINT BOARD OF TRUSTEES HAS REVIEWED AND APPROVED AN ALLOCATION METHOD TO SHARE THE COMPENSATION RELATED EXPENSES. THE WELFARE FUND REIMBURSES THE UNRELATED PENSION TRUST FOR ITS SHARE OF REPORTABLE SALARIES AND OTHER COMPENSATION. THIS PROCESS WAS LAST USED IN JANUARY 2012. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE FULL BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT, AND FOR THE SELECTION OF THEIR INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. FORM 990, PART V, LINE 2A: THE BOILERMAKER-BLACKSMITH NATIONAL PENSION TRUST (PENSION TRUST), PAYS ALL SALARIES AND OTHER COMPENSATION FOR THE EMPLOYEES OF THE PENSION TRUST, BOILERMAKERS NATIONAL ANNUITY TRUST (ANNUITY), AND THE BOILERMAKERS NATIONAL HEALTH AND WELFARE FUND (THE WELFARE FUND). THE PENSION TRUST AND THE ANNUITY TRUST ARE UNRELATED TO THE WELFARE FUND. A JOINT BOARD OF TRUSTEES HAVE REVIEWED AND APPROVED AN ALLOCATION METHOD TO SHARE THE COMPENSATION RELATED EXPENSES. THE WELFARE FUND REIMBURSES THE UNRELATED PENSION TRUST FOR ITS SHARE OF REPORTABLE SALARIES AND OTHER COMPENSATION. INTERNATIONAL BROTHERHOOD OF BOILERMAKERS IRON SHIP BUILDERS 753 STATE AVE NO 565 KANSAS CITY KS 66101 486031851 INTERNATIONAL LABOR ORGANIATION KS 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF DECEMBER 31, 2012, THERE ARE APPROXIMATELY 476 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. 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