Form990
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 05-01-2011 and ending 04-30-2012
BCheck if applicable:
CName of organization
LOCAL 212 IBEW HEALTH & WELFARE TRUST FUND
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
212 CROWNE POINT PLACE
 
Room/suite
City or town, state or country, and ZIP + 4
CINCINNATI, OH45241
D Employer identification number

31-0782819
E Telephone number

G Gross receipts $ 12,926,621
F Name and address of principal officer:
RITA MCLUCAS
212 CROWNE POINT PLACE SUITE 102
CINCINNATI,OH45241
I
Tax-exempt status: ( 9 ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
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: 1973
M State of legal domicile: OH
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE MISSION IS TO PROVIDE BENEFITS TO ELIGIBLE PARTICIPANTS OF LOCAL 212, IBEW HEALTH AND WELFARE TRUST FUND.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 6
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 6
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 28
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
9 Program service revenue (Part VIII, line 2g) ......... 10,982,453 11,893,132
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 961,356 691,428
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 792,187 342,061
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 12,735,996 12,926,621
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...   0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 8,294,404 10,351,900
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 2,570 1,852
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 1,447,313 1,522,915
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 9,744,287 11,876,667
19 Revenue less expenses. Subtract line 18 from line 12....... 2,991,709 1,049,954
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 22,838,442 24,517,080
21 Total liabilities (Part X, line 26)............. 3,897,784 4,526,468
22 Net assets or fund balances. Subtract line 21 from line 20..... 18,940,658 19,990,612
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: THE MISSION IS TO PROVIDE BENEFITS TO ELIGIBLE PARTICIPANTS
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 $   )
THE ORGANIZATION PROVIDED MEDICAL, PRESCRIPTION DRUG AND DISABILITY BENEFITS TO ELIGIBLE PARTICIPANTS OF LOCAL UNION 212 IBEW.
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
 
No
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 I....................
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 II...
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 ....................
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 IV...................
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 V
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.
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.
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.
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.
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.
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
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
 
No
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
 
No
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........
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...
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 VI
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
28
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
 
No
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
 
No
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
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
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
6
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
6
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
 
No
b
Other officers or key employees of the organization ................
15b
 
No
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
RITA MCLUCAS CEBS
212 CROWNE POINT PLACE SUITE 102
CINCINNATI,OH45241
(513) 861-4800
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) HOWARD MAYERS
TRUSTEE
 1.00 X           0 0 0
(2) LYNAN SMITH
TRUSTEE
 1.00 X           0 0 0
(3) KEVIN BROXTERMAN
TRUSTEE
 1.00 X           0 0 0
(4) KURT KUBE
TRUSTEE
 1.00 X           0 0 0
(5) CHRIS GUTERMUTH
TRUSTEE
 1.00 X           0 0 0
(6) RICHARD MCDONALD
TRUSTEE
 1.00 X           1,852 0 0






















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 1,852    
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet  
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
HUMANA HEALTH PLAN INC
PO BOX 528
CAROL STREAM,IL60132 		BENEFIT ADMINISTRATION 607,701
HUMANA HEALTH PLAN INC
PO BOX 528
CAROL STREAM,IL60132 		STOP LOSS INSURANCE 422,717
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet2
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet  
Program Service Revenue Business Code
2a CONTRACTOR CONTRIBUTIONS 900,099 9,669,085      
b SELF PAYMENTS 900,099 2,224,047      
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 11,893,132
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 691,428     691,428
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(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    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
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      
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        
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        
Miscellaneous Revenue Business Code
11a SUBROGATION CLAIMS 900,099        
b UNREALIZED APPRECIATION 900,099 275,558 275,558    
c STOP LOSS PROCEEDS 900,099 55,002 55,002    
d All other revenue .... 11,501 11,501    
e Total. Add lines 11a–11d ......MediumBullet 342,061
12 Total revenue. See Instructions....MediumBullet 12,926,621 12,235,193   691,428
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    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members 10,351,900 10,351,900
5 Compensation of current officers, directors, trustees, and key employees .... 1,852 1,852 0 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages        
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits .......        
10 Payroll taxes ...........        
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other ..........        
12 Advertising and promotion ....        
13 Office expenses .......        
14 Information technology ......        
15 Royalties ..        
16 Occupancy ...........        
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .....        
23 Insurance ..............        
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 PPO ADMINSTRATIVE FEES 607,701 607,701 0 0
b ADMINISTRATIVE EXPENSES 427,296 427,296 0 0
c INSURANCE-STOP LOSS 422,717 422,717 0 0
d CLAIMS REVIEW EXPENSES 46,558 46,558 0 0
e
f All other expenses 18,643 18,643 0 0
25 Total functional expenses. Add lines 1 through 24f 11,876,667 11,876,667 0 0
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 .......... 1,290,989 1 678,949
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 831,917 4 975,653
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
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 ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ............   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation. ..... 10b     10c  
11 Investments—publicly traded securities .......... 18,998,609 11 22,594,782
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 1,716,927 15 267,696
16 Total assets. Add lines 1 through 15 (must equal line 34)... 22,838,442 16 24,517,080
Liabilities 17 Accounts payable and accrued expenses . 3,897,784 17 4,526,468
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
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.....   25  
26 Total liabilities. Add lines 17 through 25..... 3,897,784 26 4,526,468
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 ..... 18,940,658 27 19,990,612
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 .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 18,940,658 33 19,990,612
34 Total liabilities and net assets/fund balances ..... 22,838,442 34 24,517,080
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
12,926,621
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
11,876,667
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
1,049,954
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
18,940,658
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
 
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
19,990,612
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: 11000175
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
LOCAL 212 IBEW HEALTH & WELFARE TRUST FUND
 
Employer identification number

31-0782819
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  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
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 12,926,621
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 11,876,667
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 1,049,954
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 575,684
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 575,684
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 1,625,638
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 12,982,894
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d 56,273
e Add lines 2a through 2d ..................... 2e 56,273
3 Subtract line 2e from line 1..................... 3 12,926,621
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  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 12,926,621
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 11,357,256
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 56,273
e Add lines 2a through 2d...................... 2e 56,273
3 Subtract line 2e from line 1..................... 3 11,300,983
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 575,684
c Add lines 4a and 4b....................... 4c 575,684
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 11,876,667
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
Pt X   ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES
    OF AMERICA REQUIRE MANAGEMENT OF AN ORGANIZATION TO EVALUATE TAX POSITIONS TAKEN BY THE ORGANIZATION AND RECOGNIZE A TAX LIABILITY IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. PLAN MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF APRIL 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. THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PLAN MANAGEMENT BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEAR PRIOR TO 2009.
Pt XII Line 2d   RECIPROCITY PAYMENTS
Pt XIII Line 2d   RECIPROCITY PAYMENTS
Pt XI Line 8   CHANGE IN CLAIMS PAYABLE: CLAIMS PAYABLE AT 4/30/11 $(2,980,966) CLAIMS PAYABLE AT 4/30/12 3,556,650 INCREASE IN BENEFITS EXPENSE 575,684
Pt XIII Line 4b   CLAIMS PAYABLE AT 4/30/11 $(2,980,966) CLAIMS PAYABLE AT 4/30/12 3,556,650 INCREASE IN BENEFITS EXPENSE 575,684
Schedule D (Form 990) 2011

Additional Data


Software ID: 11000175
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
LOCAL 212 IBEW HEALTH & WELFARE TRUST FUND
 
Employer identification number

31-0782819
Identifier Return Reference Explanation
Pt VI, Line 7a   THE UNION MEMBERS ELECT THREE OF THE GOVERNING BODY MEMBERS,
    AND THE OTHER THREE GOVERNING BODY MEMBERS ARE APPOINTED
    BY THE LOCAL CHAPTER OF NECA.
Pt VI, Line 11a   FORM 990 WAS MAILED TO THE ORGANIZATION'S TRUSTEE GOVERNING
    BODY FOR REVIEW AND COMMENT PRIOR TO SUBMITTING THE RETURN
    TO THE INTERNAL REVENUE SERVICE. A REVIEW OF FORM 990 WAS
    CONDUCTED BY JOHN C. LAYNE, CPA (PREPARER OF THE RETURN)
    WITH THE PLAN ADMINISTRATOR.
Pt VI, Line 12c   THE ORGANIZATION INFORMALLY MONITORS ITS CONFLICTS OF INTEREST
    POLICY UNDER DIRECTION OF THE GOVERNING BOARD AND THE PLAN
    ADMINISTRATOR.
Pt VI, Line 15   NO COMPENSATION IS PAID DIRECTLY BY THE PLAN. ALL COMPENSATION
    IS PAID THROUGH THE LOCAL UNION NO. 212 BENEFIT OFFICE
    (TIN 23-7345993). THE HEALTH & WELFARE TRUST FUND IS ALLOCATED
    ITS RESPECTIVE SHARE OF COMPENSATION AND ADMINISTRATIVE
    EXPENSES. ALL COMPENSATION IS REPORTED ON W-2 FORMS ISSUED BY
    THE BENEFIT OFFICE. THE BENEFIT OFFICE IS NOT CONSIDERED A
    RELATED ORGANIZATION UNDER THE INSTRUCTIONS TO FORM 990.
Pt VI, Line 19   THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS,
    CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS
    AVAILABLE TO THE PUBLIC.
Form 990, Part IX, Line 24f   MISCELLANEOUS 12125. 12125. 0. 0. FED TAX ON DISABILITY 6518. 6518. 0. 0.
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: 11000175
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
LOCAL 212 IBEW HEALTH & WELFARE TRUST FUND
 
Employer identification number

31-0782819
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) LOCAL UNION 212 PENSION TRUST FUND

212 CROWNE POINT PLACE SUITE 102

CINCINNATI,OH45241
31-6127280 		PENSION BENEFITS OH 401   NA
 
 
No
(2) LOCAL UNION 212 IBEW SUPPLEMENTAL UNEMPLOYMENT TRUST FUND

212 CROWNE POINT PLACE SUITE 102

CINCINNATI,OH45241
23-7278092 		SUPPLEMENTAL UNEMPLOYMENT OH 501 C (9)   NA
 
 
No
(3) LOCAL UNION NO 212 IBEW BENEFIT OFFICE

212 CROWNE POINT PLACE

CINCINNATI,OH45241
23-7345993 		ADMINISTRATION OH 501 C (5)   NA
 
 
No
(4) CINCINNATI OHIO AREA ELECTRICAL JOINT APPRENTICESHIP AND TRAINING

5455 GLENWAY AVE

CINCINNATI,OH45238
31-6065915 		SCHOOL OH 501 C (3)   NA
 
 
No
(5) NATIONAL ELECTRICAL CONTRACTORS ASSOCIATION CINCINNATI CHAPTER

7815 COOPER RD B

CINCINNNATI,OH45242
31-0272168 		CONTRACTOR ASSOCIATION OH 501 C (6)   NA
 
 
No
(6) LOCAL 212 IBEW UNION HALL

212 CROWNE POINT PLACE SUITE 102

CINCINNATI,OH45241
31-0329978 		UNION OH 501 C (5)   NA
 
 
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
(1) ZENITH SYSTEMS LLC

5069 CORBIN DR
BEDFORD HEIGHTS,OH44128
26-3799494 		ELECTRICAL CONTRACTOR OH NA
  		RELATED             No 0 %
(2) POWER SERVICES LLC

PO BOX 750066
CENTERVILLE,OH45475
31-1686185 		ELECTRICAL CONTRACTOR OH NA
  		RELATED 26,845           No 0 %
(3) PAFF ELECTRIC LLC

5115 CROOKSHANK ROAD
CINCINNATI,OH45238
03-0497807 		ELECTRICAL CONTRACTOR OH NA
  		RELATED 20,914           No 0 %
(4) HOLLSTEGGE ELECTRIC LLC

PO BOX 18232
CINCINNATI,OH45218
26-0786922 		ELECTRICAL CONTRACTOR OH NA
  		RELATED 21,437           No 0 %
(5) CHAPEL ROMANOFF TECHNOLOGIES

1985 FOUNDERS DR
DAYTON,OH45420
20-1876357 		ELECTRICAL CONTRACTOR OH NA
  		RELATED             No 0 %
(6) CHAPEL ELECTRIC CO INC

1985 FOUNDERS DRIVE
DAYTON,OH45420
74-3062585 		ELECTRICAL CONTRACTOR OH NA
  		RELATED 44,091           No 0 %
(7) HENDERSON SERVICES LLC

4502 POPLAR LEVEL RD
LOUISVILLE,KY40213
61-1400434 		ELECTRICAL CONTRACTOR KY NA
  		RELATED 946           No 0 %
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) ACPI SYSTEMS INC
PO BOX 368
ROSS,OH45061
31-1682216 		ELECTRICAL CONTRACTORS OH  
  135,710    
(2) ALTERNATIVE ELECTRICAL SOLUTIONS LLC
2604 CRANBROOK DR
CINCINNATI,OH45231
27-1847134 		ELECTRICAL CONTRACTOR OH  
  2,922    
(3) A & M SERVICE
2422 CENTRAL PARKWAY
CINCINNATI,OH45214
31-1579607 		ELECTRICAL CONTRACTOR OH  
  23,826    
(4) ARCHIABLE ELECTRIC COMPANY
3803 FORD CIRCLE
CINCINNNATI,OH45227
31-0202890 		ELECTRICAL CONTRACTOR OH  
  495,479    
(5) ATLAS ELECTRIC CO OF CINCINNATI LLC
4187 CLEARPOINT
CINCINNATI,OH45247
32-0115868 		ELECTRICAL CONTRACTOR OH  
  9,766    
(6) BANTA ELECTRICAL CONTRACTORS INC
5701 ST ROUTE 128
CLEVES,OH45002
35-1630902 		ELECTRICAL CONTRACTOR OH  
  753,901    
(7) BJ ELECTRICAL COMPANY INC
6316 WIELTE ROAD
CINCINNATI,OH45237
31-0851702 		ELECTRICAL CONTRACTOR OH  
  333,878    
(8) BROADWAY ELECTRIC SERVICE CORP
1800 N CENTRAL ST
KNOXVILLE,TN37917
62-0609618 		ELECTRICAL CONTRACTOR TN  
  1,456    
(9) CAPITAL ELECTRIC LINE BUILDERS
4400 NW MATTOX ROAD
RIVERSIDE,MO64150
48-0771042 		ELECTRICAL CONTRACTOR MO  
  10,408    
(10) CINCY ELECTRICAL SOLUTIONS LLC
3695 GARDNER AVE
CINCINNATI,OH45236
26-4006721 		ELECTRICAL CONTRACTOR OH  
  9,844    
(11) DEBRA-KUEMPEL INC
3976 SOUTHERN AVE
CINCINNATI,OH45227
31-1615931 		ELECTRICAL CONTRACTOR OH  
  320,624    
(12) DELTA ELECTRICAL CONTRACTORS LTD
4890 GRAY ROAD
CINCINNATI,OH45232
31-1604562 		ELECTRICAL CONTRACTOR OH  
  269,485    
(13) DELTA SERVICES LLC
4676 JENNINGS LANE
LOUISVILLE,KY40218
20-1972910 		ELECTRICAL CONTRACTOR KY  
  203    
(14) DIXON ELECTRICAL SYSTEMS & CONTRACTING INC
3352 NORWOOD RD
HUNTINGTON,WV25705
55-0760019 		ELECTRICAL CONTRACTOR WV  
       
(15) ELECTRICAL CERTIFICATION INC
6086 STATE ROUTE 128
MIAMITOWN,OH45041
43-1988273 		ELECTRICAL CONTRACTOR OH  
  51,405    
(16) ELEX INC
11000 WINTON RD
CINCINNATI,OH45218
31-1134144 		ELECTRICAL CONTRACTOR OH  
  21,856    
(17) GINTER ELECTRICAL CONTRACTORS LLC
3930 COLERAIN AVE
CINCINNATI,OH45223
61-1333255 		ELECTRICAL CONTRACTOR OH  
  115,378    
(18) GLENWOOD ELECTRIC INC
12250 CHANDLER DR
WALTON,KY41094
31-0913270 		ELECTRICAL CONTRACTOR KY  
  575,696    
(19) HIGH VOLTAGE MAINTENANCE
5100 ENERGY DR
DAYTON,OH45414
31-0725252 		ELECTRICAL CONTRACTOR OH  
  6,635    
(20) HILVERT & POPE ELECTRIC INC
11070 SOUTHLAND ROAD
CINCINNATI,OH45240
31-1610103 		ELECTRICAL CONTRACTOR OH  
  237,840    
(21) INDROLECT COMPANY
630 WEST WYOMING AVE
CINCINNATI,OH45215
31-0825005 		ELECTRICAL CONTRACTOR OH  
  143,055    
(22) INSPECTION BUREAU INC
250 W COURT STREET SUITE 125W
CINCINNATI,OH45202
31-0520480 		ELECTRICAL CONTRACTOR OH  
  138,086    
(23) KALLMEYER ELECTRIC INC
9672 DALY ROAD
CINCINNATI,OH45231
31-1439852 		ELECTRICAL CONTRACTOR OH  
  6,032    
(24) KATHMAN ELECTRIC CO INC
8969 HARRISON AVE
CLEVES,OH45002
31-1192679 		ELECTRICAL CONTRACTOR OH  
  353,814    
(25) M-PACT CORPORATION
5005 WINTON ROAD
CINCINNATI,OH45232
20-3764298 		ELECTRICAL CONTRACTOR OH  
  100,230    
(26) MAYERS ELECTRIC CO INC
4004 ERIE COURT
CINCINNATI,OH45227
31-0740553 		ELECTRICAL CONTRACTOR OH  
  1,014,257    
(27) MJ ADAMS ELECTRICAL CONTRACTORS INC
3898 RIDGEDALE DR
CINCINNATI,OH45247
31-1321604 		ELECTRICAL CONTRACTOR OH  
  141,276    
(28) MORSE ELECTRIC INC
500 W SOUTH ST
FREEPORT,IL61032
36-2428820 		ELECTRICAL CONTRACTOR IL  
       
(29) MUTUAL ELECTRIC COMPANY
3660 DAYTON PANIC DRIVE
DAYTON,OH45414
31-0630361 		ELECTRICAL CONTRACTOR OH  
       
(30) OREGON ELECTRIC CONSTRUCTION INC
1709 SE 3RD AVE
PORTLAND,OR97214
93-0473216 		ELECTRICAL CONTRACTOR OR  
  13,096    
(31) PHASOR ELECTRICAL SERVICES INC
555 N WAYNE AVE
CINCINNATI,OH45215
31-1788756 		ELECTRICAL CONTRACTOR OH  
  135,135    
(32) PRITCHARD ELECTRIC CO INC
PO BOX 2503
HUNTINGTON,WV25725
55-0459967 		ELECTRICAL CONTRACTOR WV  
       
(33) RIVERSIDE ELECTRICAL INC
680 REDNA TERRACE
WOODLAWN,OH45215
31-0708396 		ELECTRICAL CONTRACTOR OH  
  87,634    
(34) SECO ELECTRIC CO INC
350 PIKE STREET
COVINGTON,KY41011
61-1150383 		ELECTRICAL CONTRACTOR KY  
  246,319    
(35) SIDEWINDER ELECTRIC CO INC
3267 STATE ROUTE 133
CLARKSVILLE,OH45113
31-1513410 		ELECTRICAL CONTRACTOR OH  
  18,950    
(36) STORMS MCMULLEN ELECTRIC INC
4007 GUION LANE
INDIANAPOLIS,IN46268
35-1153847 		ELECTRICAL CONTRACTOR IN  
  4,930    
(37) STRUCTURED CABLING SYSTEMS INC
2640 CRESCENT SPRINGS RD
CRESCENT SPRINGS,KY41017
68-0591531 		ELECTRICAL CONTRACTOR KY  
       
(38) TPL TECHNICAL SERVICES CORP
7526 PICKWAY DR
CINCINNATI,OH45233
31-1397401 		ELECTRICAL CONTRACTOR OH  
  51,028    
(39) TROY ELECTRIC INC
3530 CHAPEL RD
HAMILTON,OH45013
31-1410475 		ELECTRICAL CONTRACTOR OH  
  61,897    
(40) UNITED ELECTRIC CO INC
4333 ROBARDS LANE
LOUISVILLE,KY40218
61-0526410 		ELECTRICAL CONTRACTOR KY  
  935,492    
(41) WESTFIELD ELECTRIC INC
PO BOX 93
GIBONSBURG,OH43431
34-1901159 		ELECTRICAL CONTRACTOR OH  
       
(42) WISE SERVICE INC
PO BOX 159
DAYTON,OH45427
31-1384068 		ELECTRICAL CONTRACTOR OH  
  14,209    
(43) 3-PHASE ELECTRIC CO INC
20741 N MANCEHSTER RD
SUNMAN,IN47041
20-4301145 		ELECTRICAL CONTRACTOR    
  26,770    
(44) ALLENMAYERS ELECTRIC LTD
830 MELBOURNE AVE
CINCINNATI,OH45229
20-5319637 		ELECTRICAL CONTRACTOR    
  2,943    
(45) BOGGESS ELECTRIC IN
6665 FAIRPARK AVE
CINCINNATI,OH45216
31-1485949 		ELECTRICAL CONTRACTOR    
  5,470    
(46) CE POWER
4500 W MITCHELL AVE
CINCINNATI,OH45232
31-1732597 		ELECTRICAL CONTRACTOR    
  98,826    
(47) CRYSTAL ELECTRICAL CONTRACTOR
42 SHELBY STREET
FLORENCE,KY41042
20-2840560 		ELECTRICAL CONTRACTOR    
  6,750    
(48) ESI INC
4696 DEVITT DR
CINCINNATI,OH45246
34-1002467 		ELECTRICAL CONTRACTOR    
  648,479    
(49) FIVE STAR
2134 CHAPPELLE LN
CINCINATI,OH45240
32-0004697 		ELECTRICAL CONTRACTOR    
  4,576    
(50) GERKE ELECTRIC INC
618 E ROSS AVE
CINCINNATI,OH45217
31-1764163 		ELECTRICAL CONTRACTOR    
  19,755    
(51) J & L ELECTIC INC
4002 N 800 EAST
MILAN,IN47031
35-1857158 		ELECTRICAL CONTRACTOR    
  12,184    
(52) LAKE ERIE ELECTIC INC
PO BOX 450859
WESTLAKE,OH44145
34-1536829 		ELECTRICAL CONTRACTOR    
  66,446    
(53) LUCE ELECTRIC CO INC
237 WEST MAIN STREET
WILLIAMSBURG,OH45176
31-1305323 		ELECTRICAL CONTRACTOR    
  6,656    
(54) TJ WILLIAMS ELECTRIC CO
PO BOX 586
MIAMITOWN,OH45041
31-1107248 		ELECTRICAL CONTRACTOR    
  454,206    
(55) THE FOWLER COMPANY
7777 FIRST PLACE
OAKWOOD VILLAGE,OH44146
34-0925491 		ELECTRICAL CONTRACTOR    
  2,200    
(56) UNITED CONSTRUCTION CO
PO BOX 4859
PARKERSBURG,WV26104
55-0676159 		ELECTRICAL CONTRACTOR    
  38,347    
(57) USI
532 GARDEN WAY
EDGEWOOD,KY41017
20-0615516 		ELECTRICAL CONTRACTOR    
  10,525    
(58) VOLKER & ASSOCIATES
10175 HARRISON AVE SUITE D
HARRISON,OH45030
01-0616991 		ELECTRICAL CONTRACTOR    
  65,749    
(59) WAGNER INDUSTRIAL
PO BOX 55
DAYTON,OH45401
06-1771253 		ELECTRICAL CONTRACTOR    
  14,404    
(60) WESTERN INDUSTRIAL CONTRACTORS
1480 E MONCRIEFF PL
AURORA,CO80011
84-0888336 		ELECTRICAL CONTRACTOR    
  7,358    
(61) WHALEN ELECTRIC
4485 ST RT 132
MORROW,OH45152
20-2215699 		ELECTRICAL CONTRACTOR    
  22,402    
(62) YORK ELECTRIC
530 E SECOND STREET
DAYTON,OH45401
31-0558219 		ELECTRICAL CONTRACTOR    
  4,217    
(63) CINCINNATI OHIO AREA ELECTRICAL JOINT APPRENTICESHIP
5455 GLENWAY AVE
CINCINNATI,OH45248
31-6065915 		SCHOOL OH  
  28,418    
(64) NATIONAL ELECTRICAL CONTRACTORS ASSOCIATION CINCINNATI CHAPTER
7815 COOPER RD B
CINCINNATI,OH45242
31-0272168 		CONTRACTOR ASSOCIATION OH NA
  		C 22,048   0 %
(65) LOCAL 212 BENEFIT OFFICE
212 CROWNE POINT PLACE SUITE 102
CINCINNATI,OH45241
23-7345993 		BENEFIT OFFICE OH  
  42,875    
(66) LOCAL 212 IBEW UNION HALL
212 CROWNE POINT PLACE SUITE 102
CINCINNATI,OH45241
31-0329978 		UNION OH NA
  		C 92,654   0 %
(67) LOCAL UNION 212 PENSION TRUST
212 CROWNE POINT PLACE SUITE 102
CINCINNATI,OH45241
31-6127280 		PENSION BENFITS OH  
       
(68) LOCAL UNION 212 IBEW SUPPLEMENTAL UNEMPLOYMENT BENEFITS
212 CROWNE POINTE PLACE SUITE 102
CINCINNATI,OH45241
23-7278092 		SUPPLEMENTAL UNEMPLOYMENT BENEFITS OH  
       
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
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
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
 
No
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) LOCAL UNION NO 212 IBEW BENEFIT OFFICE

 o   ACCRUAL
(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
Additional Data


Software ID: 11000175
Software Version: