2012-11-08T17:35:41-06:00 2011-12-31 208078757 SALTER & COMPANY LLC 4600 EAST-WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2011-01-01 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 2012-11-08 JOSEPH M HERISHEN CPA P00361968 3018307400 2012-11-08 X 2011 2016-02-24 21:20:13Z HARVEY NATHAN 5 GATEWAY CENTER PITTSBURGH PA 15222 14651085 0 X N/A X 2008 PA TO PROVIDE HEALTH AND OTHER WELFARE BENEFITS. 7 6 0 0 0 0 0 0 6384320 6214016 6629201 6569083 706571 1867986 13720092 14651085 0 0 23693017 22710480 128032 129320 0 0 0 691147 711285 24512196 23551085 -10792104 -8900000 251995108 243729868 828426 1000622 251166682 242729246 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 5,585 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 0 1 43 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 25860 0 0 CHARLES PIPER 2.00 X 20692 0 0 JAMES DWORKIN 2.00 X 20692 0 0 JAMES COLE 2.00 X 20692 0 0 THOMAS HAYHURST 2.00 X 20692 0 0 THOMAS BRAUN 2.00 X 20692 0 0 MIKE O'BRIEN 1.00 X 0 0 0 129320 0 0 0 0 0 0 HIGHMARK 120 5TH AVE 2015 PITTSBURGH PA 15222 CLAIMS ADMINISTRATION & ACCESS FEE 305339 CDS ADMINISTRATORS 5 GATEWAY CENTER STE 620 60 BLVD PITTSBURGH PA 152221219 THIRD PARTY ADMINISTRATOR 158098 2 PARTICIPANT CONTRIBUTI 525100 6214016 6214016 6214016 6569083 6569083 ERRP INCOME 525100 1785048 1785048 MEDICARE PART D SUBSID 525100 82844 82844 PRESCRIPTION REBATES 525100 94 94 1867986 14651085 8082002 0 6569083 22710480 129320 171478 24047 24878 268574 427 23801 4750 59775 INVESTMENT CONSULTING 89052 ACTUARY & CONSULTING 39296 POSTAGE & MAILING 4410 DEATH AUDITS 797 23551085 848820 925251 14871137 14674241 27246 22240 234971690 224942065 1276215 3166071 251995108 243729868 828426 1000622 828426 1000622 X 0 0 0 0 251166682 242729246 251166682 242729246 251995108 243729868 X -8900000 462564 X X 0 1 1 X 0 0 14651085 23551085 -8900000 462564 462564 -8437436 14845075 462564 462564 14382511 268574 268574 14651085 23282511 0 23282511 268574 268574 23551085 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 462,564. PART XII - LINE 2 (C) NO CHANGE HAS BEEN MADE BY THE THE COMMITTEE MEMBERS TO THIS OVERSIGHT PROCESS FROM THE PRIOR YEAR.