USW RETIREES OF THE DANA CORPORATION HEALTH CARE TR: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
USW RETIREES OF THE DANA CORPORATION HEALTH CARE TR (EIN 26-1860594)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-08
IRS object ID
201203139349302290
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-08T17:35:41-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN208078757EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1SALTER & COMPANY LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14600 EAST-WEST HIGHWAY SUITE 300AddressLine1
CityBETHESDACity
StateMDState
ZIP Code208143415ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN261860594EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1USW RETIREES OF THE DANA CORPORATIONBusinessNameLine1
Business Name Line2HEALTH CARE TRUSTBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlUSWRNameControl
Phone4122102233Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line160 BLVD OF THE ALLIES 5TH FLOORAddressLine1
CityPITTSBURGHCity
StatePAState
ZIP Code15222ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameHARVEY NATHANName
TitleCOMMITTEE MEMBERTitle
Phone4122102233Phone
Date Signed2012-11-08DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameJOSEPH M HERISHEN CPAName
PTINP00361968PTIN
Phone3018307400Phone
Date Prepared2012-11-08DatePrepared
Self EmployedXSelfEmployed
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonHARVEY NATHANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line15 GATEWAY CENTERAddressLine1
CityPITTSBURGHCity
StatePAState
ZIP Code15222ZIPCode
FieldValueIRS element (for citing)
Gross Receipts14651085GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation2008YearFormation
State Legal DomicilePAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH AND OTHER WELFARE BENEFITS.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6384320ProgramServiceRevenuePriorYear
Program Service Revenue CY6214016ProgramServiceRevenueCY
Investment Income Prior Year6629201InvestmentIncomePriorYear
Investment Income Current Year6569083InvestmentIncomeCurrentYear
Other Revenue Prior Year706571OtherRevenuePriorYear
Other Revenue Current Year1867986OtherRevenueCurrentYear
Total Revenue Prior Year13720092TotalRevenuePriorYear
Total Revenue Current Year14651085TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year23693017BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY22710480BenefitsPaidToMembersCY
Salaries Etc Prior Year128032SalariesEtcPriorYear
Salaries Etc Current Year129320SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year691147OtherExpensePriorYear
Other Expenses Current Year711285OtherExpensesCurrentYear
Total Expenses Prior Year24512196TotalExpensesPriorYear
Total Expenses Current Year23551085TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-10792104RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-8900000RevenuesLessExpensesCY
Total Assets BOY251995108TotalAssetsBOY
Total Assets EOY243729868TotalAssetsEOY
Total Liabilities BOY828426TotalLiabilitiesBOY
Total Liabilities EOY1000622TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY251166682NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY242729246NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTHE TRUST PROVIDED HEALTH AND OTHER WELFARE BENEFITS THROUGH THE USW RETIREES OF THE DANA CORPORATION PLAN TO 5,585 PARTICIPANTS AND SURVIVING SPOUSES.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109643NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CDS ADMINISTRATORSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4122012242TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line15 GATEWAY CENTER SUITE 620AddressLine1
CityPITTSBURGHCity
StatePAState
ZIP Code15222ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
HARVEY NATHAN
COMMITTEE MEMBER2.00XX2586000
CHARLES PIPER
COMMITTEE MEMBER2.00X2069200
JAMES DWORKIN
COMMITTEE MEMBER2.00X2069200
JAMES COLE
COMMITTEE MEMBER2.00X2069200
THOMAS HAYHURST
COMMITTEE MEMBER2.00X2069200
THOMAS BRAUN
COMMITTEE MEMBER2.00X2069200
MIKE O'BRIEN
COMMITTEE MEMBER1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org129320TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HIGHMARK
120 5TH AVE 2015PITTSBURGHPA15222CLAIMS ADMINISTRATION & ACCESS FEE305339
CDS ADMINISTRATORS
5 GATEWAY CENTER STE 620 60 BLVDPITTSBURGHPA152221219THIRD PARTY ADMINISTRATOR158098
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPARTICIPANT CONTRIBUTIDescription
Business Code525100BusinessCode
Total Revenue Column6214016TotalRevenueColumn
Related Or Exempt Function Income6214016RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue6214016TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column6569083TotalRevenueColumn
Exclusion$6,569,083ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ERRP INCOME52510017850481785048
MEDICARE PART D SUBSID5251008284482844
PRESCRIPTION REBATES5251009494
FieldValueIRS element (for citing)
Total Other Revenue1867986TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column14651085TotalRevenueColumn
Related Or Exempt Function Income8082002RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$6,569,083ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total22710480Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total129320Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total171478Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total24047Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total24878Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total268574Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total427Total

Travel Travel

FieldValueIRS element (for citing)
Total23801Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total4750Total

Insurance Insurance

FieldValueIRS element (for citing)
Total59775Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotal
INVESTMENT CONSULTING89052
ACTUARY & CONSULTING39296
POSTAGE & MAILING4410
DEATH AUDITS797

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23551085Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY848820BOY
EOY925251EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY14871137BOY
EOY14674241EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY27246BOY
EOY22240EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY234971690BOY
EOY224942065EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1276215BOY
EOY3166071EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY251995108BOY
EOY243729868EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY828426BOY
EOY1000622EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY828426BOY
EOY1000622EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY251166682BOY
EOY242729246EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY251166682BOY
EOY242729246EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY251995108BOY
EOY243729868EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-8900000ReconcilationRevenueExpenses
Reconcilation Other Changes462564ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue14651085TotalRevenue
Total Expenses23551085TotalExpenses
Excess Or Deficit For Year-8900000ExcessOrDeficitForYear
Net Unrealized GL On Investments462564NetUnrealizedGLOnInvestments
Total Adjustments462564TotalAdjustments
Excess Or Deficit Per FS-8437436ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt14845075TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments462564NetUnrealizedGainsInvestments
Revenue Not Rptd F990462564RevenueNotRptdF990
Revenue Subtotal14382511RevenueSubtotal
Investment Expenses Not Included268574InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt268574RevenueNotRptdOnFinStmt
Total Revenue Per Form99014651085TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt23282511TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal23282511ExpensesSubtotal
Investment Expenses Not Included2268574InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt268574ExpensesNotRptdOnFinStmt
Total Expenses Per Form99023551085TotalExpensesPerForm990

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CCOMMIITTEE MEMBERS MONITOR THE CONFLICT OF INTEREST POLICY ANNUALLY FOR ANY POTENTIAL CONFLICTS.
FORM 990, PART VI, SECTION C, LINE 19ANY 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.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 462,564.CHANGES IN NET ASSETS OR FUND BALANCES:
PART XII - LINE 2 (C)NO CHANGE HAS BEEN MADE BY THE THE COMMITTEE MEMBERS TO THIS OVERSIGHT PROCESS FROM THE PRIOR YEAR.

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