Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 10-01-2011 and ending 09-30-2012
BCheck if applicable:
CName of organization
UNITED MINE WORKERS OF AMERICA COMBINED
BENEFIT FUND
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2121 K STREET NW
 
Room/suite
City or town, state or country, and ZIP + 4
WASHINGTON, DC200371879
D Employer identification number

52-1805433
E Telephone number

G Gross receipts $ 217,389,545
F Name and address of principal officer:
MICHAEL H HOLLAND
2121 K STREET NW STE 350
WASHINGTON,DC20037
I
Tax-exempt status: ( 9 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.UMWAFUNDS.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1993
M State of legal domicile: DC
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: High quality delivery of contractually and statutorily mandated benefits to eligible beneficiaries in the most efficient and effective manner possible.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 7
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 2
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 7
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 0
9 Program service revenue (Part VIII, line 2g) ......... 237,262,630 215,207,593
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 177,112 143,270
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 56,731 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 237,496,473 215,350,863
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 220,446,640 193,917,619
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 626,381 661,418
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 22,056,482 25,588,157
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 243,129,503 220,167,194
19 Revenue less expenses. Subtract line 18 from line 12....... -5,633,030 -4,816,331
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 98,975,607 101,083,961
21 Total liabilities (Part X, line 26)............. 61,920,681 71,013,834
22 Net assets or fund balances. Subtract line 21 from line 20..... 37,054,926 30,070,127
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: High quality delivery of contractually and statutorily mandated benefits to eligible beneficiaries in the most efficient and effective manner possible.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
Served as a trust for a multiemployer welfare plan that provided medical, vision, and death benefits.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$  
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A.....................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................
23
 
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
 
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
 
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
7
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
 
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
7
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
2
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
DALE R STOVER
2121 K STREET NW STE 350
WASHINGTON,DC20037
(202) 521-2294
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Michael H Holland
TRUSTEE, CO-CHAIR
 8.0 X           40,000 0 9,458
(2) MichEAl W Buckner
Trustee (resigned)
 12.0 X           50,000 0 9,608
(3) Gail R Wilensky
TRUSTEE
 4.0 X           70,000 0 9,799
(4) William P Hobgood
Trustee
 4.0 X           70,000 0 9,137
(5) Daniel L Fassio
Trustee, Co-Chair
 8.0 X           70,000 30,000 10,037
(6) Carl E Van Horn
Trustee
 8.0 X           70,000 0 9,782
(7) Morris D Feibusch
Trustee (resigned)
 5.0 X           70,000 30,000 10,037
(8) MARTY D HUDSON
TRUSTEE
 12.0 X           0 0  
(9) KURT A SALVATORI
TRUSTEE
 5.0 X           0 0  
(10) Lorraine Lewis
Executive Director
 9.0     X       68,235 68,985 12,670
(11) Dale R Stover
DirECTOR, Finance
 13.0     X       63,439 41,023 8,791












Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 571,674 170,008 89,319
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
 
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
UNIVITA HEALTH INC
11000 LONG PRAIRIE LAKES DR
EDEN PRAIRIE,MN55344 		GERIATRIC CARE MGT 7,293,774
HEALTHSMART BENEFIT SOLUTIONS
222 W LAS COLINAS BLVD 40N
IRVING,TX75039 		CONTRACT ADMIN 5,516,379
BIG SANDY AREA DEVELOPMENT
110 RESOURCE CT
PRESTONSBURG,KY41653 		CONSULTING 154,661
BOND BEEBE
4600 EAST-WEST HWY STE 900
BETHESDA,MD20814 		ACCOUNTING 144,777
MERCER HUMAN RESOURCE
1166 AVENUE OF THE AMERICAS
NEW YORK,NY10036 		ACTUARIAL 137,809
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet6
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a LEGISLATED TRANSFER AML 900,099 91,551,994 91,551,994    
b MEDICARE REIMBURSEMENT 525,100 96,138,720 96,138,720    
c EMPLOYER PREMIUMS 525,100 26,890,914 26,890,914    
d DOL REIMBURSEMENT 525,100 570,000 570,000    
e COBRA PREMIUMS 525,100 55,965 55,965    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 215,207,593
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 185,157     185,157
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 1,996,795  
b Less: cost or other basis and sales expenses 2,038,682  
c Gain or (loss) -41,887  
d Net gain or (loss)..........MediumBullet -41,887     -41,887
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 215,350,863 215,207,593   143,270
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 193,917,619  
5 Compensation of current officers, directors, trustees, and key employees .... 591,994      
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 0      
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 0      
10 Payroll taxes ........... 69,424      
11 Fees for services (non-employees):        
a Management ...... 8,022,387      
b Legal ......... 192,490      
c Accounting ........... 125,897      
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 6,574,117      
12 Advertising and promotion .... 0      
13 Office expenses ....... 294,912      
14 Information technology ...... 216,770      
15 Royalties .. 0      
16 Occupancy ........... 765,100      
17 Travel ............ 224,042      
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 49,801      
20 Interest ........... 1,572      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 86,012      
23 Insurance .............. 116,353      
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a ALLOC SALARIES, TAXES, BENEFIT 8,884,461      
b ALL OTHER ADMIN EXPENSES 34,243      
c
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 220,167,194      
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... -2,165,380 1 -2,687,507
2 Savings and temporary cash investments ....... 73,342,057 2 95,265,977
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 25,111,830 4 18,800
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 0 9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation. ..... 10b   0 10c  
11 Investments—publicly traded securities .......... 1,998,909 11 8,095,265
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 688,191 15 391,426
16 Total assets. Add lines 1 through 15 (must equal line 34)... 98,975,607 16 101,083,961
Liabilities 17 Accounts payable and accrued expenses . 39,662,318 17 49,758,093
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 22,258,363 19 21,255,741
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 0 25 0
26 Total liabilities. Add lines 17 through 25..... 61,920,681 26 71,013,834
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .....   27  
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ..... 0 30 0
31 Paid-in or capital surplus, or land, building or equipment fund ..... 0 31 0
32 Retained earnings, endowment, accumulated income, or other funds 37,054,926 32 30,070,127
33 Total net assets or fund balances ..... 37,054,926 33 30,070,127
34 Total liabilities and net assets/fund balances ..... 98,975,607 34 101,083,961
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
215,350,863
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
220,167,194
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-4,816,331
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
37,054,926
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-2,168,468
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
30,070,127
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UNITED MINE WORKERS OF AMERICA COMBINED
BENEFIT FUND
Employer identification number

52-1805433
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet  
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 0
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 215,350,863
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 220,167,194
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 -4,816,331
4 Net unrealized gains (losses) on investments .......................... 4 55,244
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -2,223,712
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -2,168,468
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -6,984,799
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 118,697,000
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 55,244
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e 55,244
3 Subtract line 2e from line 1..................... 3 118,641,756
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b 96,709,107
c Add lines 4a and 4b....................... 4c 96,709,107
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 215,350,863
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 125,681,000
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d -94,486,194
e Add lines 2a through 2d...................... 2e -94,486,194
3 Subtract line 2e from line 1..................... 3 220,167,194
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 220,167,194
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
OTHER REVENUE INCLUDED ON FORM 990 BUT NOT INCLUDED ON AUDITED F/S PART XII, LINE 4B $96,708,720 REIMBURSEMENTS NETTED ON F/S IN DEDUCTIONS $ 387 AUDITED F/S ROUNDED TO NEAREST $1,000 ----------- $96,709,107 TOTAL OTHER ===========
OTHER EXPENSES AND LOSSES INCLUDED IN AUDITED F/S NOT INCLUDED ON FORM 990 PART XIII, LINE 2D $(96,708,720) REIMBURSEMENTS NETTED ON F/S IN DEDUCTIONS $( 1,186) AUDITED F/S ROUNDED TO NEAREST $1,000 $ 439,233 pension-related changes other than periodic pension cost $ 1,784,479 post-retirement changes other than periodic pension cost ------------- $(94,486,194) TOTAL OTHER =============
FIN 48 FOOTNOTE PART X, LINE 2 Accounting principles generally accepted in the United States of America require management to evaluate tax positions taken and recognize a tax liability if the organization has taken an uncertain position that more likely than not would not be sustained upon examination by the Internal Revenue Service. Management has analyzed the tax positions taken by the Combined Fund, and has concluded that as of September 30, 2012, 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 Combined Fund is subject to routine audits by taxing jurisdictions; however, there are currently no audits in progress for any tax periods. Management believes the Combined Fund is no longer subject to income tax examinations for years prior to the year ended September 30, 2009.
OTHER CHANGE IN NET ASSETS PART XI, LINE 8 $( 439,233) pension-related changes other than periodic pension cost $(1,784,479) post-retirement changes other than periodic pension cost ----------- $(2,223,712) TOTAL OTHER CHANGE IN NET ASSETS ===========
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
UNITED MINE WORKERS OF AMERICA COMBINED
BENEFIT FUND
Employer identification number

52-1805433
Identifier Return Reference Explanation
How Members of Shareholders Elect Governing Body PART VI, SECTION A, LINE 7A Pursuant to the United Mine Workers of America Combined Benefit Fund Agreement and Declaration of Trust, the Fund is administered by a Board of seven trustees, two of whom are appointed by the Bituminous Coal Operators' Association ("BCOA"), two of whom are appointed by the United Mine Workers of America ("UMWA"), and three of whom are appointed jointly by the BCOA and the UMWA. The UMWA may remove the Trustees appointed by it, at any time and for any reason, the BCOA may remove the Trustees appointed by it, at any time and for any reason, and the UMWA and the BCOA may remove the Trustees appointed by them jointly, at any time for any reason. In the event of resignation, death, removal, inability or unwillingness to serve of a Trustee, the party(s) who appointed that Trustee shall appoint a successor. The UMWA designates one Trustee to serve as Co-Chairman and the BCOA designates one Trustee to serve as Co-Chairman.
Form 990 Review Process PART VI, SECTION B, LINE 11B The Trustees, management staff, and legal counsel of the plan have extensively reviewed the prepared Form 990 prior to signing and filing the form with the Internal Revenue Service.
Explanation of Monitoring and Enforcement of Conflicts PART VI, SECTION B, LINE 12C The United Mine Workers of America Combined Benefit Fund requests staff, on an annual basis, to review the organization's conflict of interest policy, to provide a list of potential conflicts of interest to management and to declare that, to the best of their knowledge, they have no other potential conflicts of interest.
CompensatIOn Review & Approval Process for Officers & Key Employees PART VI, SECTION B, LINES 15A & 15B THE UMWA COMBINED BENEFIT FUND ("THE PLAN") RECEIVES ADMINISTRATIVE SERVICES JOINTLY WITH OTHER HEALTH AND PENSION PLANS SERVING RETIREES OF THE COAL MINING INDUSTRY. THESE PLANS ARE COLLECTIVELY REFERRED TO AS THE UMWA HEALTH & RETIREMENT FUNDS ("THE FUNDS"). PURSUANT TO ADMINISTRATIVE SERVICE AGREEMENTS, THE UMWA 1974 PENSION TRUST SERVES AS MASTER ADMINISTRATIVE ENTITY FOR THE OTHER PLANS AND EMPLOYS THE ADMINISTRATIVE STAFF OF THE FUNDS. COMPENSATION OF THE EXECUTIVE DIRECTOR AND OTHER KEY STAFF OFFICERS, INCLUDING HEADS OF ALL STAFF DEPARTMENTS, IS DETERMINED BY THE BOARD OF TRUSTEES OF THE 1974 PENSION TRUST AFTER CONSULTATION WITH THE BOARD OF TRUSTEES OF THE PLAN AND OTHER BOARDS OF TRUSTEES OF PLANS AMONG THE FUNDS. NEITHER THE EXECUTIVE DIRECTOR NOR ANY STAFF OFFICER SERVES ON THE PLAN'S OR ANY OF THE FUNDS' BOARDS OF TRUSTEES. COMPENSATION OF THE EXECUTIVE DIRECTOR AND ALL KEY STAFF OFFICERS (AS WELL AS ALL OTHER STAFF EMPLOYEES) IS DETERMINED BASED UPON RESULTS OF PERIODIC SURVEYS AND ANALYSIS CONDUCTED BY EXPERT OUTSIDE CONSULTANTS WHO GATHER AND REVIEW COMPENSATION DATA FROM COMPARABLE POSITIONS AT COMPARABLE ORGANIZATIONS. THE MOST RECENT SUCH SURVEY AND ANALYSIS WAS CONDUCTED BY BUCK CONSULTANTS IN 2011. THE REPORTS AND SUPPORTING DOCUMENTATION OF OUTSIDE COMPENSATION CONSULTANTS AND THE MEMORANDA AND MINUTES REFLECTING THE BOARD OF TRUSTEES' REVIEW OF THESE REPORTS AND THEIR ESTABLISHMENT OF COMPENSATION OF THE EXECUTIVE DIRECTOR AND OTHER KEY STAFF OFFICERS ALL CONSTITUTE THE CONTEMPORANEOUS DOCUMENTATION OF DECISIONS REGARIDNG THE COMPENSATION ARRANGEMENT, AND ALL ARE MAINTAINED AS PART OF THE RECORDS OF THE PLAN AND THE FUNDS.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES PART XI, LINE 5 $ 55,244 NET UNREALIZED GAINS ON INVESTMENTS $(1,784,479) post-retirement changes other than periodic pension cost $( 439,233) pension-related changes other than periodic pension cost ------------ $(2,168,468) TOTAL OTHER CHANGES IN NET ASSETS/FUND BALANCES ============
OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST, WHISTLE BLOWING AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY PROVIDING COPIES UPON REQUEST OR INSPECTION AT THE OFFICE OF THE ORGANIZATION.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael H Holland TITLE:TRUSTEE, CO-CHAIR HOURS:12
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MichEAl W Buckner TITLE:Trustee (resigned) HOURS:9
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Daniel L Fassio TITLE:Trustee, Co-Chair HOURS:12
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Morris D Feibusch TITLE:Trustee (resigned) HOURS:18
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lorraine Lewis TITLE:Executive Director HOURS:8
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Dale R Stover TITLE:DirECTOR, Finance HOURS:7
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
UNITED MINE WORKERS OF AMERICA COMBINED
BENEFIT FUND
Employer identification number

52-1805433
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) UMWA 1993 Benefit Plan

2121 K Street NW

Washington,DC20037
52-1888497 		health plan DC 501(c)(9)    
 
No
(2) UMWA 1992 Benefit Plan

2121 K Street NW

Washington,DC20037
52-1805437 		health plan DC 501(c)(9)    
 
No
(3) UMWA Prefunded Benefit Plan

2121 K Street NW

Washington,DC20037
26-1508254 		health plan DC 501(c)(9)    
 
No
(4) UNITED MINE WORKERS OF AMERICA

18354 QUANTICO GATEWAY STE 200

TRIANGLE,VA22172
53-0159200 		LABOR ORG VA 501(C)(5)    
 
No
(5) BITUMINOUS COAL OPERATORS ASSOCIATION

1176 I STREET NW STE 255

WASHINGTON,DC20006
52-0906130 		TRADE ASSOC DC 501(C)(6)    
 
No
(6) BOARD OF TRUSTEES UMWA COMBINED BENEFIT

2121 K STREET NW STE 350

WASHINGTON,DC20037
52-1805433 		MANAGEMENT DC      
 
No


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) A T MASSEY COAL CO
PO BOX 16429
BRISTOL,VA24202
54-0295165 		     
       
(2) ALABAMA ELECTRIC COOPERATIVE
P O BOX 550 HWY 29 N
ANDALUSIA,AL36420
62-0238274 		     
       
(3) ALABAMA LAND & MINERAL CORP
PO BOX 11080
CHARLESTON,WV25339
63-0733361 		     
       
(4) ALCO STANDARD CORPORATION
PO BOX 834
VALLEY FORGE,PA19482
23-0334400 		     
       
(5) ALLIED CHEMICAL CORP
101 COLUMBIA ROAD
MORRISTOWN,NJ07962
13-4918545 		     
       
(6) ALLIED SIGNAL INC
101 COLUMBIA ROAD
MORRISTOWN,NJ07962
22-2640650 		     
       
(7) ALOE COAL CO
200 NEVILLE ROAD
PITTSBURGH,PA15225
25-1069839 		     
       
(8) AMAX INC
PO BOX 16429
BRISTOL,VA24202
13-4923460 		     
       
(9) AMERICAN ELECTRIC POWER GROUP
1 RIVERSIDE PLAZA 24TH FLOOR
COLUMBUS,OH43215
13-4922640 		     
       
(10) AMHERST COAL CO
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
55-0219450 		     
       
(11) ANKER ENERGY CORPORATION
ONE CITYPLACE DR STE 300
ST LOUIS,MO63141
51-0217205 		     
       
(12) APPALACHIAN CONSTRUCTION INC
PO BOX 1787
CHARLESTON,WV25326
55-0488032 		     
       
(13) ARCH OF ALABAMA INC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
43-0962442 		     
       
(14) ARCH OF ILLINOIS INC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
35-0672865 		     
       
(15) ARCH OF WV INC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
43-0921172 		     
       
(16) ARCH ON THE GREEN INC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
59-0995531 		     
       
(17) ARMCO INC
9227 CENTRE POINTE DRIVE
WEST CHESTER,OH45069
31-0200500 		     
       
(18) ASARCO INC
5285 E WILLIAMS CIR
TUCSON,AZ85711
13-4924440 		     
       
(19) ATLAS RAILROAD CONSTRUCTION
RT 136 P O BOX 8
EIGHTY FOUR,PA15330
25-1011910 		     
       
(20) B & L EXCAVATION CO INC
BOX 467
LYNCO,WV24857
55-0458856 		     
       
(21) B H & H COAL CO INC
261 ISLE RD
BUTLER,PA16001
25-1208621 		     
       
(22) BEATRICE POCAHONTAS COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
54-0738412 		     
       
(23) BEILCHICK BROTHERS
BEILCHICK HOLLOW STRIP
HEILWOOD,PA15745
25-1022357 		     
       
(24) BELLAIRE CORPORATION
5340 LEGACY DRIVE
PLANO,TX75024
34-0431290 		     
       
(25) BENTLEY COAL COMPANY INC
P O BOX 338
BLAIRSVILLE,PA15717
25-1216174 		     
       
(26) BERRY TRUCKING CO INC
BOX 290
GLASGOW,WV25086
25-0860290 		     
       
(27) BERWIND CORPORATION
1500 MARKET ST 30TH FLOOR
PHILADELPHIA,PA19102
23-0406815 		     
       
(28) BIG BOTTOM COAL COMPANY
PO BOX 16429
BRISTOL,VA24202
54-1143359 		     
       
(29) BIG HORN COAL CO
1000 KIEWIT PLAZA
OMAHA,NE68131
47-0347087 		     
       
(30) BIRD COAL COMPANY INC
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
23-0411050 		     
       
(31) BISHOP COAL COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
54-0703223 		     
       
(32) BLUESTONE COAL CORPORATION
P O BOX 1085
BECKLEY,WV25802
55-0526141 		     
       
(33) BOICH MINING COMPANY
200 NEVILLE ROAD
PITTSBURGH,PA15225
34-1448657 		     
       
(34) BOLLMEIER CONSTRUCTION COMPANY
PO BOX 17
MARISSA,IL62257
37-0889156 		     
       
(35) BOLOGNA COAL COMPANY
BOX 271
BURGETTSTOWN,PA15021
25-1116315 		     
       
(36) BUFFALO MINING CO
PO BOX 1268
ABINGDON,VA24212
55-0477938 		     
       
(37) C & A COAL COMPANY INC
DRAWER 1030
BLUEFIELD,VA24605
55-0575959 		     
       
(38) CANNELTON INDUSTRIES INC
PO BOX 16429
BRISTOL,VA24202
55-0136145 		     
       
(39) CANTERBURY COAL COMPANY
153 HIGHWAY 7 SOUTH
POWHATAN POINT,OH43942
25-1127473 		     
       
(40) CARBON INDUSTRIES INC
503-A PENNSYLVANIA AVENUE
CHARLESTON,WV25302
55-0546672 		     
       
(41) CEDAR COAL COMPANY
1 RIVERSIDE PLAZA 24TH FL
COLUMBUS,OH43215
55-0514884 		     
       
(42) CENTRAL OHIO COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
31-4356096 		     
       
(43) CHARBON BRIDGE INC
475 WHITTINGTON DRIVE
MADISONVILLE,KY42431
61-0597159 		     
       
(44) CHARLES P M COAL CO
PO BOX 16429
BRISTOL,VA24202
55-0516543 		     
       
(45) CHEVRON MINING INC
116 INVERNESS DRIVE EAST 207
ENGLEWOOD,CO80112
44-0658937 		     
       
(46) CHICAGO BRIDGE & IRON COMPANY
1501 NORTH DIVISION STREET
PLAINFIELD,IL60544
36-2556816 		     
       
(47) CHISHOLM COAL COMPANY
600 GRANT ST RM 2643
PITTSBURGH,PA15219
34-0972540 		     
       
(48) CHRISTOPHER COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
55-0143318 		     
       
(49) CLEVELAND CLIFF COAL CO
1100 SUPERIOR AVE
CLEVELAND,OH44114
34-1682880 		     
       
(50) CLINCHFIELD COAL CO
PO BOX 1268
ABINGDON,VA24212
54-0740625 		     
       
(51) CLINCHFIELD COAL CO
PO BOX 1268
ABINGDON,VA24212
54-0172680 		     
       
(52) COAL STATE CONSTRUCTION COMPANY
1529 BLUE HORIZON RD
MORGANTOWN,WV26501
55-0525597 		     
       
(53) CODELL CONSTRUCTION CO
P O BOX 17
WINCHESTER,KY40392
61-0160150 		     
       
(54) COMMERCIAL LAND COMPANY INC
P O BOX 10246
BIRMINGHAM,AL35202
31-0928018 		     
       
(55) COMSTOCK (L K) & CO INC
5 PENN PLAZA 1701
NEW YORK,NY10001
13-0594190 		     
       
(56) CONSOLIDATION COAL COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
13-2566594 		     
       
(57) CONTINENTAL CONVEYOR & EQP CO
P O BOX 400
WINFIELD,AL35594
34-1606996 		     
       
(58) COWIN & COMPANY INC
301 INDUSTRIAL DRIVE
BIRMINGHAM,AL35219
63-0181840 		     
       
(59) DAL-TEX COAL CORP
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
55-0454630 		     
       
(60) DICK COAL CORPORATION
PO BOX 10896
PITTSBURGH,PA15236
25-0952038 		     
       
(61) DONALDSON MINE COMPANY
PO BOX 2463
HOUSTON,TX77252
34-1140564 		     
       
(62) DRUMMOND COAL SALES INC
P O BOX 10246
BIRMINGHAM,AL35202
63-0803854 		     
       
(63) DRUMMOND COMPANY INC
P O BOX 10246
BIRMINGHAM,AL35202
63-0653224 		     
       
(64) DUKE POWER COMPANY
400 SOUTH TRYON STREET
CHARLOTTE,NC28285
56-0205520 		     
       
(65) DUQUESNE LIGHT CO
411 SEVENTH AVENUE
PITTSBURGH,PA15219
25-0451600 		     
       
(66) EASTERN ASSOCIATED COAL LLC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
25-1125516 		     
       
(67) EASTERN COAL CORP
PO BOX 1268
ABINGDON,VA24212
55-0162070 		     
       
(68) EIDEMILLER ADAM INC
56 SHERATON DRIVE
GREENSBURG,PA15601
25-0932600 		     
       
(69) ELGIN NATIONAL INDUSTRIES INC
2001 BUTTERFIELD ROAD
DOWNERS GROVE,IL60515
36-1035880 		     
       
(70) ELKAY MINING CO
PO BOX 1268
ABINGDON,VA24212
55-0404636 		     
       
(71) ENOXY COAL CO INC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
61-0997729 		     
       
(72) EVANS COAL CO
9227 CENTRE POINTE DRIVE
WEST CHESTER,OH45069
73-0559253 		     
       
(73) F M C CORP
1735 MARKET STREET
PHILADELPHIA,PA19103
94-0479804 		     
       
(74) F M C CORPORATION M H S DIV
1735 MARKET STREET
PHILADELPHIA,PA19103
95-0479804 		     
       
(75) FERRELL MINE SERV INC
PO BOX 367
PECKS MILL,WV25547
55-0518909 		     
       
(76) FETTEROLF GROUP INC
227 NEW CENTERVILLE ROAD
SOMERSET,PA15501
25-1312447 		     
       
(77) FLORENCE MINING CO
PO BOX 51
NEW FLORENCE,PA15944
34-1002232 		     
       
(78) FORD COAL CO
P O BOX 175
HANSFORD,WV25103
55-0372966 		     
       
(79) FREEMAN UNITED COAL MINING COMPANY
2941 FAIRVIEW PARK DRIVE
FALLS CHURCH,VA22042
36-2117346 		     
       
(80) G M & W COAL CO INC
181 WEST MADISON STREET
CHICAGO,IL60602
23-1531781 		     
       
(81) GAL CONSTRUCTION CO INC
P O BOX 127
BELLE VERNON,PA15012
25-1115864 		     
       
(82) GATEWAY COAL COMPANY
1330 LAKE ROBBINS DR SUITE 400
THE WOODLANDS,TX77380
75-1751176 		     
       
(83) GENERAL COAL CO
9540 SOUTH MAROON CIRCLE
ENGLEWOOD,CO80112
23-1701997 		     
       
(84) GILBERT IMPORTED HARDWOODS INC
PO BOX 1210
GILBERT,WV25621
63-0511235 		     
       
(85) GREENWICH COLLIERIES
TWO N NINTH ST
ALLENTOWN,PA18101
23-1699492 		     
       
(86) HARMAN MINING CORP
4 PARKWAY NORTH
DEERFIELD,IL60015
13-3285586 		     
       
(87) HARMAN MINING CORPORATION
4 PARKWAY NORTH
DEERFIELD,IL60015
54-0576340 		     
       
(88) HAYS RUN COAL COMPANY
316 FIRST AVENUE
KITTANNING,PA16201
23-2319568 		     
       
(89) HELEN MINING CO THE
PO BOX 2463
HOUSTON,TX77252
34-1003450 		     
       
(90) HELVETIA COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
25-1180531 		     
       
(91) HERITAGE COAL COMPANY LLC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
13-2606920 		     
       
(92) HINKLE DAVE ELECTRIC INC
4563 PLUTO ROAD
SHADY SPRING,WV25918
55-0581213 		     
       
(93) HOBET MINING & CONSTR CO INC
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
31-4446083 		     
       
(94) IMPERIAL COLLIERY CO
BOX 638
LYNCHBURG,VA24505
54-0258040 		     
       
(95) INLAND STEEL COAL CO
3210 WATLING STREET
EAST CHICAGO,IN46312
36-1262880 		     
       
(96) INLAND STEEL INDUSTRIES
3210 WATLING STREET
EAST CHICAGO,IN46312
36-3425828 		     
       
(97) INSPIRATION COAL COMPANY
4 PARKWAY NORTH
DEERFIELD,IL60015
13-3332308 		     
       
(98) INSPIRATION COAL COMPANY
4 PARKWAY NORTH
DEERFIELD,IL60015
98-0045830 		     
       
(99) ISLAND CREEK COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
61-0998078 		     
       
(100) ISLAND CREEK COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
55-0421562 		     
       
(101) ISLAND CREEK COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
55-0479426 		     
       
(102) ISLAND CREEK COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
04-1474370 		     
       
(103) ITMANN COAL COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
54-0720291 		     
       
(104) JERICOL MINING INC
549 LONDONDERRY RD
CUMBERLAND GAP,TN37724
61-0844927 		     
       
(105) JEWELL RIDGE COAL CORPORATION
PO BOX 1268
ABINGDON,VA24212
54-0263144 		     
       
(106) JIM WALTER RESOURCES INC
PO BOX 133
BROOKWOOD,AL35444
59-2981186 		     
       
(107) KANAWHA COAL COMPANY
600 GRANT ST RM 2643
PITTSBURGH,PA15219
34-1059207 		     
       
(108) KENTLAND ELKHORN COAL CO
PO BOX 1268
ABINGDON,VA24212
54-1289913 		     
       
(109) KENTLAND-ELKHORN CORPORATION
PO BOX 1268
ABINGDON,VA24212
23-1582210 		     
       
(110) KENTUCKY CARBON CORP
503-A PENNSYLVANIA AVENUE
CHARLESTON,WV25302
55-0479569 		     
       
(111) KERR-MCGEE CORP
3301 NW 150TH STREET
OKLAHOMA CITY,OK73134
73-0311467 		     
       
(112) KEYSTONE COAL MINING CORP
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
25-1323822 		     
       
(113) KING KNOB COAL CO INC
ONE CITYPLACE DR STE 300
ST LOUIS,MO63141
55-0488823 		     
       
(114) KITT ENERGY CORPORATION
501 Westlake Pk Blvd
Houston,TX77079
34-1338073 		     
       
(115) L & D INC
RR 17 BOX 248
MADISON,WV25130
55-0536648 		     
       
(116) LANGLEY & MORGAN CORP
2001 BUTTERFIELD ROAD
DOWNERS GROVE,IL60515
61-0601219 		     
       
(117) LANZENDORFER TRUCKING INC
P O BOX 245
TWIN ROCKS,PA15960
25-1075108 		     
       
(118) LAUREL RUN MINING CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
54-0892422 		     
       
(119) LILLYBROOK COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
55-0218060 		     
       
(120) LONG BRANCH DEVELOPMENT COMPANY
PO BOX 776
DANVILLE,WV25053
36-3628831 		     
       
(121) LONG BRANCH ENERGY
P O BOX 776
DANVILLE,WV25053
55-0599661 		     
       
(122) LYNN LAND COMPANY
PO BOX 1210
GILBERT,WV25621
55-0482848 		     
       
(123) MAPLE MEADOW MINING COMPANY
PO BOX 16429
BRISTOL,VA24202
55-0529664 		     
       
(124) MARIGOLD COAL INC
P O BOX 10246
BIRMINGHAM,AL35202
63-0310726 		     
       
(125) MARMON COAL COMPANY
181 WEST MADISON STREET
CHICAGO,IL60602
25-1035001 		     
       
(126) MARMON HOLDINGS INC
181 WEST MADISON STREET
CHICAGO,IL60602
36-3104690 		     
       
(127) MASSEY COAL SERVICES INC
PO BOX 16429
BRISTOL,VA24202
54-1095096 		     
       
(128) MATHIES COAL COMPANY
1201 RICHMOND ROAD
LEXINGTON,KY40502
25-0983989 		     
       
(129) MAXUS ENERGY CORP & SUBSID
1330 LAKE ROBBINS DR SUITE 400
THE WOODLANDS,TX77380
75-1891531 		     
       
(130) MCWANE COMPANY INC
1143 VANDERBILT ROAD
BIRMINGHAM,AL35234
63-0139000 		     
       
(131) MEAD CORPORATION
501 SOUTH 5TH STREET
RICHMOND,VA23219
31-0535759 		     
       
(132) MEADOW RIVER COAL COMPANY
PO BOX 1268
ABINGDON,VA24212
54-1289902 		     
       
(133) MEADOWLARK INC
PO BOX 16429
BRISTOL,VA24202
35-0782260 		     
       
(134) MENALLEN COKE CO
PO BOX 226
BUFFALO,NY14226
25-1008220 		     
       
(135) MERLO CHARLES J INC
234 MERLO ROAD
MINERAL PT,PA15942
25-1068024 		     
       
(136) MIDWEST COAL COMPANY fka AMAX COAL COMPA
PO BOX 16429
BRISTOL,VA24202
35-6030195 		     
       
(137) MILBURN COLLIERY CO
PO BOX 638
LYNCHBURG,VA24505
54-0623673 		     
       
(138) MOUNTAIN STATES MACHINERY & SY
P O BOX 550
PRICE,UT84501
87-0305639 		     
       
(139) MUELLER INDUSTRIES INC
8285 TOUNAMENT DRIVE
MEMPHIS,TN38125
25-0790410 		     
       
(140) NACCO INDUSTRIES
5340 LEGACY DRIVE
PLANO,TX75024
34-1505819 		     
       
(141) NATIONAL BULK CARRIERS INC
1345 AV OF THE AMERICAS
NEW YORK,NY10105
13-1894988 		     
       
(142) NATIONAL MINES CORP
1201 RICHMOND ROAD
LEXINGTON,KY40502
55-0350627 		     
       
(143) NATIONAL STEEL CORP
1201 RICHMOND ROAD
LEXINGTON,KY40502
25-0687210 		     
       
(144) NATIONAL STEEL CORPORATION
1201 RICHMOND ROAD
LEXINGTON,KY40502
38-0624830 		     
       
(145) NELL-JEAN INDUSTRIES INC
PO BOX 1109
BECKLEY,WV25802
55-0392013 		     
       
(146) NORTH AMERICAN COAL CORP
5340 LEGACY DRIVE
PLANO,TX75024
34-1554846 		     
       
(147) NORTH AMERICAN REFRACTORIES
400 Fairway Drive
Moon Township,PA15108
31-0943770 		     
       
(148) NORTH BRANCH COAL COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
55-0400701 		     
       
(149) NORTH CAMBRIA FUEL CO
175 MCKNIGHT ROAD
BLAIRSVILLE,PA15717
25-1219503 		     
       
(150) NORTH CAMBRIA FUEL COMPANY INC
Four Gateway Ctr 400
Pittsburgh,PA15222
25-1336732 		     
       
(151) NORTON CO
11 STANWIX ST 21TH FLOOR
PITTSBURGH,PA15222
34-0432670 		     
       
(152) OAK GROVE COAL COMPANY INC
PO BOX 11080
CHARLESTON,WV25339
63-0753298 		     
       
(153) OGLEBAY NORTON CO
11 STANWIX ST 21TH FLOOR
PITTSBURGH,PA15222
34-0158970 		     
       
(154) OHIO AMCO INC
PO BOX 199
CONESVILLE,OH43811
31-0785183 		     
       
(155) OMAR MINING CO
PO BOX 16429
BRISTOL,VA24202
55-0385010 		     
       
(156) PALMER COKING COMPANY
PO BOX 10
BLACK DIAMOND,WA98010
91-0922729 		     
       
(157) PARDEE COAL COMPANY INC
P O BOX 668
NORTON,VA24273
54-1071337 		     
       
(158) PARIS ALEX E CONTRACT COMPANY
1595 Smith Twp State Road
Atlasburg,PA15004
25-0934300 		     
       
(159) PATTERSON EXCAVATING COMPANY
P O BOX 99
CORA,WV25614
55-0691972 		     
       
(160) PEERLESS EAGLE COALS INC
PO BOX 16429
BRISTOL,VA24202
55-0451306 		     
       
(161) PENN ALLEGH COAL CO INC
P O BOX 630
GIBSONIA,PA15044
25-1154735 		     
       
(162) PENN POCAHONTAS COAL COMPANY
181 WEST MADISON STREET
CHICAGO,IL60602
25-1209148 		     
       
(163) PERRY & HYLTON INC
PO BOX 1109
BECKLEY,WV25802
55-0399576 		     
       
(164) PICKANDS-MATHER & CO
1100 SUPERIOR AVE 1500
CLEVELAND,OH44114
34-1672204 		     
       
(165) PITTSBURGH COAL MINING
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
31-0927365 		     
       
(166) PITTSTON CO
PO BOX 1268
ABINGDON,VA24212
13-1776504 		     
       
(167) PITTSTON CO
PO BOX 1268
ABINGDON,VA24212
54-1317776 		     
       
(168) PITTSTON COAL GROUP INC
PO BOX 1268
ABINGDON,VA24212
54-1289905 		     
       
(169) PRINCESS DOROTHY COAL CO
9227 CENTRE POINTE DRIVE
WEST CHESTER,OH45069
55-0258400 		     
       
(170) PYRO ENERGY
PO BOX 11080
CHARLESTON,WV25339
95-2623858 		     
       
(171) QUAKER STATE CORP
PO BOX 2463
HOUSTON,TX77252
58-1198597 		     
       
(172) QUARTO MINING COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
34-1048622 		     
       
(173) RANGER FUEL CORP
PO BOX 1268
ABINGDON,VA24212
55-0454470 		     
       
(174) RED ASH SALES COMPANY INC
PO BOX 16429
BRISTOL,VA24202
55-0515479 		     
       
(175) REITZ COAL CO
509 15TH STREET
WINDBER,PA15963
25-1353738 		     
       
(176) REITZ COAL CO
509 15TH STREET
WINDBER,PA15963
25-0751690 		     
       
(177) RIDGELAND CO INC
640 CLOVER DEW DAIRY RD
PRINCETON,WV24740
55-6022565 		     
       
(178) RIVERTON COAL CO
PO BOX 16429
BRISTOL,VA24202
55-0266080 		     
       
(179) ROBERTS & SCHAEFER COMPANY
2001 BUTTERFIELD ROAD
DOWNERS GROVE,IL60515
36-2734867 		     
       
(180) ROCHESTER & PITTSBURGH COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
25-0761480 		     
       
(181) ROCKY HOLLOW COAL COMPANY
PO BOX 16429
BRISTOL,VA24202
55-0573663 		     
       
(182) RUSHTON MINING CO
TWO N NINTH ST
ALLENTOWN,PA18101
25-1123520 		     
       
(183) SAGINAW MINING COMPANY
11 STANWIX ST 21TH FLOOR
PITTSBURGH,PA15222
34-1148947 		     
       
(184) SEA B MINING COMPANY
PO BOX 1268
ABINGDON,VA24212
54-1289911 		     
       
(185) SEWELL COAL COMPANY INC
PO BOX 1268
ABINGDON,VA24212
55-0364537 		     
       
(186) SHARPLES COAL CORPORATION
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
55-0581089 		     
       
(187) SHAWMUT DEVELOPMENT CORPORATION
316 FIRST AVENUE
KITTANNING,PA16201
25-1521438 		     
       
(188) SHEESLEY FRANK M CO
P O BOX 339
JOHNSTOWN,PA15907
25-0950644 		     
       
(189) SHENANGO INC
200 NEVILLE ROAD
PITTSBURGH,PA15225
25-1104158 		     
       
(190) SNOW HILL COAL CORP
12312 OLIVE BLVD SUITE 400
ST LOUIS,MO63141
35-0667830 		     
       
(191) SODDER TRUCKING CO INC
P O BOX 237
ALLOY,WV25002
55-0604562 		     
       
(192) SOUTHERN OHIO COAL COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
55-0403282 		     
       
(193) SPROUSE CREEK PROCESSING CO
PO BOX 16429
BRISTOL,VA24202
54-1030694 		     
       
(194) STARVAGGI INDUSTRIES INC
401 PENNSYLVANIA AVE
WIERTON,WV26062
55-0490247 		     
       
(195) STELCO COAL CO
600 GRANT ST RM 2643
PITTSBURGH,PA15219
34-0754300 		     
       
(196) STELCO USA INC
600 GRANT ST RM 2643
PITTSBURGH,PA15219
38-2560774 		     
       
(197) SVEDALA INDUSTRIES INC
20965 CROSSROADS CIR
WAUKESHA,WI53186
39-1599801 		     
       
(198) TAFT A J COAL COMPANY INC
PO BOX 1608
JASPER,AL35502
63-0625213 		     
       
(199) TALL TIMBER COAL COMPANY
PO BOX 16429
BRISTOL,VA24202
54-1209674 		     
       
(200) TENNESSEE CONSOLIDATED COAL CO
PO BOX 16429
BRISTOL,VA24202
62-6029380 		     
       
(201) TRACE FORK COAL CO
PO BOX 16429
BRISTOL,VA24202
55-0699070 		     
       
(202) TRANSOCEAN HOLDING INC (READING & BATE
4 Greenway Plaza
Houston,TX77252
73-0642271 		     
       
(203) TRUAX TRAER COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
36-1882000 		     
       
(204) TUNNELTON MINING CO
TWO NORTH NINTH STREET
ALLENTOWN,PA18101
25-1114741 		     
       
(205) TURNER ELKHORN MINING CO
1100 SUPERIOR AVE 1500
CLEVELAND,OH44114
61-0868837 		     
       
(206) U S NATURAL RESOURCES INC
212 STATE STREET
BELLE VERNON,PA15012
94-2462111 		     
       
(207) U S STEEL MINING COMPANY LLC
600 GRANT ST RM 2643
PITTSBURGH,PA15219
25-1396523 		     
       
(208) UNION CARBIDE CHEMICALS AND PLASTICS
PO BOX 2169
MIDLAND,MI48640
13-1421730 		     
       
(209) UNION CARBIDE CORP
PO BOX 2169
MIDLAND,MI48640
55-0586010 		     
       
(210) UNION CARBIDE CORP
PO BOX 2169
MIDLAND,MI48640
06-1255728 		     
       
(211) UNITED STATES FUEL COMPANY
8285 TOURNAMENT DRIVE
MEMPHIS,TN38125
87-0186350 		     
       
(212) USIBELLI COAL MINE INC
PO BOX 1000
HEALY,AK99743
92-0014216 		     
       
(213) USX CORPORATION
600 GRANT ST RM 2643
PITTSBURGH,PA15219
25-0996816 		     
       
(214) VALLEY CAMP COAL COMPANY
PO BOX 2463
HOUSTON,TX77252
34-0592970 		     
       
(215) VECELLIO & GROGAN INC
PO BOX 2438
BECKLEY,WV25802
55-0345840 		     
       
(216) VP-5 MINING COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
54-1020843 		     
       
(217) WELDING INC
BOX 6007
CHARLESTON,WV25362
55-0335167 		     
       
(218) WEST KEN COAL CORP
PO BOX 910
EAST CARBON,UT84520
61-0402550 		     
       
(219) WEST KENTUCKY COAL CO
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
61-0378555 		     
       
(220) WEST VIRGINIA ELECTRIC CORP
P O BOX 1587
FAIRMONT,WV26555
55-0328559 		     
       
(221) WESTMORELAND COAL COMPANY
9540 SOUTH MAROON CIRCLE
ENGLEWOOD,CO80112
23-1128670 		     
       
(222) WESTMORELAND COAL COMPANY
9540 SOUTH MAROON CIRCLE
ENGLEWOOD,CO80112
23-1213590 		     
       
(223) WHEELING PITTSBURGH STEEL CORP
1134 MARKET ST
WHEELING,WV26003
55-0703273 		     
       
(224) WHEELING-PITTSBURGH STEEL CORP
1134 MARKET ST
WHEELING,WV26003
55-0309927 		     
       
(225) WHITACRE ENGINEERING CO
3833 PROGRESS ST NE
CANTON,OH44711
34-0616182 		     
       
(226) WINDING GULF COALS INC
9540 SOUTH MAROON CIRCLE
ENGLEWOOD,CO80112
55-0393870 		     
       
(227) WINDSOR COAL COMPANY
1000 CONSOL ENERGY DR
CANONSBURG,PA15317
13-5488703 		     
       
(228) W-P COAL COMPANY
1134 MARKET STREET
WHEELING,WV26003
55-0536600 		     
       
(229) ANDALEX RESOURCES
 
 
61-0931325 		     
       
(230) FIVE J ENERGY INC
 
 
55-0631943 		     
       
(231) MOUNTAINEER CONTRACTORS INC
 
 
55-0481221 		     
       
(232) PETITTO BROS INC
 
 
55-0477747 		     
       
(233) RUSH RUN COAL COMPANY INC
 
 
55-0614776 		     
       
(234) SARGENT ELECTRIC COMPANY
 
 
25-0935920 		     
       
(235) STEEL ERECTORS INC
 
 
55-0285760 		     
       
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
RELATED PARTY DATA PART III AND PART IV THE UNITED MINE WORKERS OF AMERICA COMBINED BENEFIT FUND MADE A REASONABLE EFFORT TO COLLECT DATA REGARDING THE CONTRIBUTING EMPLOYERS TO THE PLAN PRIOR TO THE FILING OF THE RETURN.
Additional Data


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