2013-11-06T13:38:44-06:00 2012-12-31 208078757 SALTER & COMPANY LLC 4600 EAST-WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2012-01-01 261860594 USW RETIREES OF THE DANA CORPORATION HEALTH CARE TRUST USWR 4122102233 60 BLVD OF THE ALLIES 5TH FLOOR PITTSBURGH PA 15222 HARVEY NATHAN 4122102233 2013-11-06 JOSEPH M HERISHEN CPA P00361968 3018307400 2013-11-06 X 2012 2016-03-07 17:11:31Z HARVEY NATHAN 5 GATEWAY CENTER PITTSBURGH PA 15222 55593866 0 X N/A X 2008 PA TO PROVIDE HEALTH AND OTHER WELFARE BENEFITS. 7 6 0 0 0 0 0 0 6214016 5990301 6569083 9534598 1867986 19150 14651085 15544049 0 0 22472004 22441111 129320 132294 0 0 0 1006826 1086651 23608150 23660056 -8957065 -8116007 243729868 248015302 383559 540085 243346309 247475217 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 5,083 PARTICIPANTS AND SURVIVING SPOUSES. 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 54 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 2.00 X X 28575 0 0 CHARLES PIPER 2.00 X 23284 0 0 JAMES DWORKIN 2.00 X 23284 0 0 JAMES COLE 2.00 X 6350 0 0 THOMAS HAYHURST 2.00 X 23284 0 0 THOMAS BRAUN 2.00 X 23284 0 0 ANNE BLANTON 2.00 X 4233 0 0 MIKE O'BRIEN 1.00 X 0 0 0 132294 0 0 0 0 0 0 HIGHMARK 120 5TH AVE 2015 PITTSBURGH PA 15222 CLAIMS ADMINISTRATION & ACCESS FEE 274598 WELLINGTON TRUST COMPANY 280 CONGRESS ST BOSTON MA 02210 INVESTMENT MANAGEMENT 246743 CDS ADMINISTRATORS 5 GATEWAY CENTER STE 620 60 BLVD PITTSBURGH PA 152221219 THIRD PARTY ADMINISTRATOR 170292 GALLAGHER FIDUCIARY ADVISORS 805 15TH ST NW WASHINGTON DC 20005 FIDUCIARY SERVICES 100077 4 PARTICIPANT CONTRIBUTI 525100 5990301 5990301 5990301 6932735 6932735 42651680 40049817 2601863 2601863 2601863 MEDICARE PART D SUBSIDY 525100 19150 19150 19150 15544049 8611314 0 6932735 22441111 132294 434722 27410 31831 348469 219 16285 16977 50127 INVESTMENT CONSULTING 100077 ACTUARY & CONSULTING 44863 BANK FEES 11468 POSTAGE & MAILING 4203 23660056 925251 780232 14674241 8962750 22240 19919 224942065 233496522 3166071 3255879 0 1500000 243729868 248015302 383559 540085 383559 540085 X 0 0 0 0 243346309 247475217 243346309 247475217 243729868 248015302 -8116007 12244915 0 X X 0 1 X 1 0 0 27440495 12244915 12244915 15195580 348469 348469 15544049 23311587 0 23311587 348469 348469 23660056 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.