2011-11-14T15:22:54-06:00 2010-12-31 SALTER & COMPANY LLC 4600 EAST-WEST HIGHWAY SUITE 300 BETHESDA MD 208143415 990 2010-01-01 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 2011-11-14 JOSEPH M HERISHEN CPA 3018307400 2011-11-14 X 2010 2016-03-07 17:11:31Z HARVEY NATHAN 5 GATEWAY CENTER PITTSBURGH PA 15222 13720092 0 X N/A X 2008 PA TO PROVIDE HEALTH AND OTHER WELFARE BENEFITS. 7 6 0 0 0 0 0 0 6368234 6384320 7067776 6629201 1174277 706571 14610287 13720092 0 0 21526740 23693017 152900 128032 0 0 0 1361098 691147 23040738 24512196 -8430451 -10792104 251752861 251995108 538764 828426 251214097 251166682 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 6,182 PARTICIPANTS AND SURVIVING SPOUSES. 0 0 0 0 0 0 0 0 0 1 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 6 0 76 1 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 25632 0 0 CHARLES PIPER 2.00 X 20480 0 0 JAMES DWORKIN 2.00 X 20480 0 0 JAMES COLE 2.00 X 20480 0 0 THOMAS HAYHURST 2.00 X 20480 0 0 THOMAS BRAUN 2.00 X 20480 0 0 MIKE O'BRIEN 1.00 X 0 0 0 128032 0 0 0 0 0 0 HIGHMARK 120 5TH AVE 2015 PITTSBURGH PA 15222 CLAIMS ADMINISTRATION 346368 CDS ADMINISTRATORS 5 GATEWAY CENTER STE 620 60 BLVD PITTSBURGH PA 152221219 THIRD PARTY ADMINISTRATOR 164315 2 PARTICIPANT CONTRIBUTI 525100 6384320 6384320 6384320 6629201 6629201 MEDICARE PART D SUBSID 525100 626465 626465 PRESCRIPTION REBATES 525100 80106 80106 706571 13720092 6384320 0 7335772 23693017 128032 179420 62571 23090 169815 17668 13926 377 84819 INVESTMENT CONSULTING 86036 ACTUARY AND CONSULTING 47867 PRINTING 5528 MED BEN ADMIN - PROCLAI 30 24512196 987773 848820 24605807 14871137 3971 30328 27246 226124982 234971690 1276215 251752861 251995108 538764 828426 538764 828426 X 0 0 0 0 251214097 251166682 251214097 251166682 251752861 251995108 X -10792104 10744689 X X 0 1 1 X 0 0 13720092 24512196 -10792104 10744689 10744689 -47415 24294966 10744689 10744689 13550277 169815 169815 13720092 24342381 0 24342381 169815 169815 24512196 TOTAL NUMBER OF EMPLOYEES (PART V, LINE 2 A) PART I LINE 5 & PART V LINE 2 (A) THE TRUST DOES NOT HAVE ANY EMPLOYEES. HOWEVER, FOR YEAR END 2010, THE VEBA ISSUED 76 - W-2'S FOR PARTICIPANTS RECEIVING LONG TERM DISABILITY. 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: 10,744,689. WHETHER THE ORGANIZATION CHANGED ITS OVERSIGHT OR SELECTION PROCESS. PART XII - LINE 2 (C)COMMITTEE OVERSIGHT OF THE AUDIT AND SELECTION OF AN I THE COMMITTEE MEMBERS PROCESS DID NOT CHANGE FROM THE PRIOR YEAR.