2012-11-05T16:53:22-06:00 2011-12-31 522385296 LINDQUIST LLP 600 CITY PARKWAY WEST SUITE 300 ORANGE CA 92868 990 2011-01-01 366090694 BOILERMAKERS NATIONAL HEALTH & WELFARE FUND BOIL 9133426555 754 MINNESOTA AVENUE KANSAS CITY KS 66101 RONNIE L TRAXLER 9133426555 2012-11-05 1 RICHARD G THIERMANN P00974294 7142570100 2011 2016-02-25 16:41:14Z RONNIE L TRAXLER 754 MINNESOTA AVENUE KANSAS CITY KS 66101 1455745883 0 X WWW.BNF-KC.COM X 1954 KS TO PROVIDE HEALTH AND WELFARE BENEFITS. 15 1 0 0 0 0 0 0 295917540 291503477 33979470 63822104 242103 365398 330139113 355690979 0 0 251645412 240143096 8221071 6381258 0 0 0 7313731 15314268 267180214 261838622 62958899 93852357 728543148 771953750 280092067 269973160 448451081 501980590 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 0 1 11102 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 GLENN MILLS CUSTODIAN OF RECORDS 9139067480 754 MINNESOTA AVE KANSAS CITY KS 661012766 RONNIE L TRAXLER 2.40 X X 0 0 0 JOHN T FULTZ 2.10 X X 0 0 0 KENNETH E WASILEWSKI 1.20 X 0 0 0 STEVEN R HARBISON 0.00 X 0 0 0 MIKE DOLAN 0.80 X 0 0 0 RANDY B ROBBINS 0.90 X 0 0 0 VAN G STEPHENS 0.20 X 0 0 0 JOHN CAMMUSO 0.80 X 0 0 0 JOSEPH P REYNOLDS 1.20 X 0 0 0 JAMES W BANFORD JR 0.80 X 0 0 0 MARK VANDIVER 0.80 X 0 0 0 J MICHAEL CARROLL 0.80 X 0 0 0 ANTHONY N JACOBS 1.00 X 0 0 0 JIMMY L NELSON 0.80 X 0 0 0 RANDALL W CRUSE 0.80 X 0 0 0 CLAY HERFORD 0.00 X 0 0 0 TYLER BROWN 0.00 X 0 0 0 PATRICK GALLAGHER 2.40 X 0 0 0 LORI JASPERSON 40.00 X 148404 0 42746 148404 0 42746 1 0 1 1 CGLIC-CHATTANOOCG EASC (CIGNA) 900 COTTAGE GROVE ROAD HARTFORD CT 06152 ADMINISTRATIVE SERVICES 9447927 CIGNA BEHAVIORAL HEALTH 11095 VIKING DRIVE SUITE 3505 EDEN PRAIRIE MN 55344 CLAIMS ADMINISTRATION 992227 BLAKE & UHLIG PA 753 STATE AVENUE SUITE 475 KANSAS CITY KS 66101 LEGAL 764885 BRANDYWINE 2929 ARCH STREET 8TH FLOOR PHILADELPHIA PA 19104 INVESTMENT MANAGER 524087 BATTERYMARCH 200 CALRENDON STREET 49TH FLOOR BOSTON MA 02116 INVESTMENT MANAGER 446254 19 EMPLOYER CONTRIBUTIONS 900099 238118257 238118257 MEMBER & RETIREE CONTR 900099 42321225 42321225 MEDICARE PART D SUBSID 900099 4398997 4398997 PRESCRIPTION REBATE 900099 4029618 4029618 EARLY RETIREE SUBSIDY 900099 1553249 1553249 1082131 1082131 291503477 17874613 17874613 1146002395 1100054904 45947491 45947491 45947491 OTHER INCOME 900099 211648 211648 DELINQ ER CONT INTERES 900099 153750 153750 365398 355690979 291868875 0 63822104 240143096 4503477 804864 692558 380359 839720 142429 2302611 10258659 708020 500076 319995 87323 51027 60 104348 261838622 68006544 77108315 26756185 20814762 92814 12825 1008770 1008770 0 0 489689252 507278659 143998353 166739189 728543148 771953750 1237011 1533353 3189744 4284086 275665312 264155721 280092067 269973160 X 0 0 0 0 448451081 501980590 448451081 501980590 728543148 771953750 X 93852357 -40322848 X X 0 1 1 X 0 50111 50111 0 6547 6547 0 952112 952112 0 0 COMMON COLLECTIVE TRUSTS 3271576 F POOLED REAL ESTATE FUND 34622180 F 103-12 INVESTMENT ENTITY 128845433 F 166739189 BENEFIT OBLIGATIONS 184753400 CASH OVERDRAFT 2076093 LIABILITY TO RETURN COLLATERAL FOR SECURITIES ON LOAN 77326228 264155721 355690979 261838622 93852357 -40322848 -20396500 -60719348 33133009 313065520 -40322848 -40322848 353388368 2302611 2302611 355690979 279932511 0 279932511 2302611 -20396500 -18093889 261838622 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2011, 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, 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATIONS PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGES IN BENEFIT OBLIGATIONS 0 0 0 LORI JASPERSON 146904 0 0 0 1500 0 33436 0 9310 0 191150 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 $148,404, DEFERRED COMPENSATION OF $33,436 AND NON-TAXABLE BENEFITS OF $9,310. 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 ON JUNE 14, 2011. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -40,322,848. 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. SEE EXPLANATION AT PART VII VARIOUS KS 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, 2011 THERE ARE APPROXIMATELY 527 EMPLOYERS THAT CONTRIBUTE TO THE TRUST AND APPROXIMATELY 101 SPONSORING EMPLOYEE ORGANIZATIONS. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS AND SPONSORING EMPLOYEE ORGANIZATIONS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER IDENTIFICATION NUMBERS AND LEGAL STRUCTURE (CORPORATION, PARTNERSHIP, ETC.) FOR EACH CONTRIBUTING EMPLOYER AND SPONSORING EMPLOYEE ORGANIZATIONS IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE CONTRIBUTING EMPLOYERS AND SPONSORING EMPLOYEE ORGANIZATIONS HAVE NOT BEEN INCLUDED ON SCHEDULE R.