TY 2019 Form 990

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NATIONAL AUTOMATIC SPRINKLER METAL
TRADES WELFARE FUND

Employer identification number

23-7351551

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII 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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on 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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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).)..		0

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	7,430,269
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	1,175,406
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	1,175,406
3	Subtract line 2e from line 1..................			3	6,254,863
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	20,860
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	20,860
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	6,275,723

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	5,360,699
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 XIII.) ............	2d
e	Add lines 2a through 2d....................			2e	0
3	Subtract line 2e from line 1...................			3	5,360,699
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	20,860
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	20,860
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	5,381,559

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.

Return Reference

Explanation

PART X, LINE 2:

ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.

Schedule D (Form 990) 2019

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NATIONAL AUTOMATIC SPRINKLER METAL
TRADES WELFARE FUND

Employer identification number

23-7351551

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1BRIAN DUNN TRUSTEE, CHAIRMAN	(i) (ii)	0 ------------- 173,258	0 ------------- 0	0 ------------- 0	0 ------------- 69,348	0 ------------- 20,780	0 ------------- 263,386	0 ------------- 0
2ROBERT J COOPER TRUSTEE	(i) (ii)	0 ------------- 170,262	0 ------------- 0	0 ------------- 0	0 ------------- 68,450	0 ------------- 20,780	0 ------------- 259,492	0 ------------- 0
3BRIAN E FISHER TRUSTEE	(i) (ii)	0 ------------- 169,264	0 ------------- 0	0 ------------- 0	0 ------------- 68,150	0 ------------- 20,780	0 ------------- 258,194	0 ------------- 0
4MICHAEL W JACOBSON ADMINISTRATOR	(i) (ii)	3,388 ------------- 233,775	0 ------------- 0	307 ------------- 21,176	1,557 ------------- 107,458	260 ------------- 17,925	5,512 ------------- 380,334	0 ------------- 0
5JOHN EGER ASSISTANT ADMINISTRATOR	(i) (ii)	3,096 ------------- 213,650	0 ------------- 0	271 ------------- 18,709	1,984 ------------- 136,864	260 ------------- 3,096	5,611 ------------- 372,319	0 ------------- 0
6DAN CURRY IT MANAGER	(i) (ii)	2,043 ------------- 130,775	0 ------------- 0	0 ------------- 0	280 ------------- 22,023	344 ------------- 17,905	2,667 ------------- 170,703	0 ------------- 0
7NIA PADMORE CLAIMS MANAGER	(i) (ii)	2,974 ------------- 118,676	0 ------------- 0	0 ------------- 0	509 ------------- 20,299	445 ------------- 17,740	3,928 ------------- 156,715	0 ------------- 0
8ROBERT KAUFMAN COMPUTER ANALYST	(i) (ii)	0 ------------- 116,700	0 ------------- 0	0 ------------- 0	0 ------------- 20,116	0 ------------- 18,184	0 ------------- 155,000	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 1A	ANY AMOUNT OF THE PRESENT VALUE ACCRUAL IN EXCESS OF THE IRC SECTION 457 DEFERRED COMPENSATION IS REQUIRED TO BE INCLUDED IN A PARTICIPANT'S W-2. THE DEFERRED COMPENSATION AGREEMENTS REQUIRE ANY SUCH AMOUNT INCLUDED IN THE W-2 TO BE GROSSED UP FOR FEDERAL, STATE AND LOCAL TAXES.
PART I, LINE 4B	MICHAEL JACOBSON PARTICIPATES IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $585,223. JOHN EGER PARTICIPATES IN A NONQUALIFIED DEFERRED COMPENSATION PLAN. BALANCE FOR ALL AFFILIATED FUNDS - $432,230.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

NATIONAL AUTOMATIC SPRINKLER METAL
TRADES WELFARE FUND

Employer identification number

23-7351551

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	LOCAL 669 OFFICERS ARE TRUSTEES FOR THE NATIONAL AUTOMATIC SPRINKLER METAL TRADES WELFARE FUND.
FORM 990, PART VI, SECTION A, LINE 7A	THE NATIONAL FIRE SPRINKLER ASSOCIATION APPOINTS MANAGEMENT TRUSTEES. OFFICERS OF LOCAL 669, ELECTED BY MEMBERS OF LOCAL 669, WHICH INCLUDE PARTICIPANTS IN THIS PLAN, ARE TRUSTEES OF THE NATIONAL AUTOMATIC SPRINKLER METAL TRADES WELFARE FUND.
FORM 990, PART VI, SECTION B, LINE 11B	JOINT BOARD OF TRUSTEES REVIEWS FILING THROUGH AN EMAILED DRAFT BEFORE SUBMITTING. FUND ADMINISTRATOR HAS BEEN DESIGNATED BY THE JOINT BOARD OF TRUSTEES TO REVIEW AND SIGN THE FORM 990 FILING.
FORM 990, PART VI, SECTION B, LINE 12	THE TRUST IS GOVERNED BY ERISA AND THE BOARD OF TRUSTEES COMPLY WITH THE CONFLICTS OF INTEREST REQUIREMENTS OF ERISA.
FORM 990, PART VI, SECTION B, LINE 15A	THE INDEPENDENT BOARD OF TRUSTEES REVIEWS AND APPROVES THE ADMINISTRATORS SALARY ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19	AVAILABLE UPON REQUEST AND THROUGH THE FORM 5500 FILING WITH THE DEPARTMENT OF LABOR.
FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC	BRIAN DUNN - 7050 OAKLAND MILLS ROAD STE. 200, COLUMBIA, MD 21046. FRED BARALL - 514 PROGRESS DRIVE SUITE A, LINTHICUM HEIGHTS, MD 21090. ROBERT J. COOPER - 7050 OAKLAND MILLS ROAD STE. 200, COLUMBIA, MD 21046. SHANE RAY - 514 PROGRESS DRIVE SUITE A, LINTHICUM HEIGHTS, MD 21090. THOMAS LYDON - 514 PROGRESS DRIVE SUITE A, LINTHICUM HEIGHTS, MD 21090. BRIAN E. FISHER - 7050 OAKLAND MILLS ROAD STE. 200, COLUMBIA, MD 21046.
PART XII, LINE 2C EXPLANATION	NO CHANGES

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

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Software Version:

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

NATIONAL AUTOMATIC SPRINKLER METAL
TRADES WELFARE FUND

Employer identification number

23-7351551

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) 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 entity?
(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	Yes	No
(1)NATIONAL AUTOMATIC SPRINKLER INDUSTRY WELFARE FUND 8000 CORPORATE DRIVE LANDOVER,MD20785 53-0215881	HEALTH AND WELFARE FUND	MD	SECTION 501(C)(9)				No
(2)NATIONAL AUTOMATIC SPRINKLER INDUSTRY PENSION FUND 8000 CORPORATE DRIVE LANDOVER,MD20785 52-6054620	DEFINED BENEFIT PENSION PLAN	MD	SECTION 401(A)(4)				No
(3)NATIONAL AUTOMATIC SPRINKLER INDUSTRY METAL TRADE PENSION FUND 8000 CORPORATE DRIVE LANDOVER,MD20785 52-6133856	DEFINED BENEFIT PENSION PLAN	MD	SECTION 401(A)(4)				No
(4)NATIONAL AUTOMATIC SPRINKLER LOCAL 669 UA EDUCATION FUND 8000 CORPORATE DRIVE LANDOVER,MD20785 52-6035213	EDUCATION FUND	MD	SECTION 501(C)(5)				No
(5)SPRINKLER FITTER LOCAL 696 UNEMPLOYMENT COBRA ASSISTANCE PLAN 41-43 E WILLOW ST MILLBURN,NJ07041 22-3201568	HEALTH AND WELFARE FUND	NJ	SECTION 501(C)(9)				No
(6)SPRINKLER INDUSTRY SUPPLEMENTAL PENSION FUND 8000 CORPORATE DRIVE LANDOVER,MD20785 14-1595069	DEFINED CONTRIBUTION PENSION PLAN	MD	SECTION 401(A)(4)				No
(7)UA INTERNATIONAL TRAINING FUND THREE PARK PLACE ANNAPOLIS,MD21401 53-0238416	EDUCATION FUND	DC	SECTION 501(C)(5)				No
(8)NATIONAL AUTOMATIC SPRINKLER IND FD OFFICE EMPLOYEE PENSION PLN 8000 CORP DR LANDOVER,MD20785 53-0215881	DEFINED BENEFIT PENSION PLAN	MD	SECTION 401(A)(4)				No
(9)NATIONAL AUTOMATIC SPRINKLER METAL TRADES WELFARE PLAN JOINT BOARD OF TRUST 8000 CORPORATE DRIVE LANDOVER,MD20785 23-7351551	HEALTH AND WELFARE FUND	MD	SECTION 501(C)(9)				No
(10)SPRINKLER FITTERS LOCAL UNION 483 2525 BARRINGTON CT HAYWARD,CA94545 94-1011692	LOCAL UNION	CA	SECTION 501(C)(5)				No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) 247 FIRE PROTECTION SERVICES INCORPORATED 12540 SLAUSON AVE STE C SANTA FE SPGS,CA90670 30-0125772	SPRINKLER INSTALLATION	CA		C				No
(2) A G OBRIEN PLUMBING AND HEATING 4907 LIGHTNING DR HERMANTOWN,MN55811 41-0852203	SPRINKLER INSTALLATION	MN		C				No
(3) ADVANCED SYSTEMS INC 1415 S 30TH AVE HOLLYWOOD,FL33020 59-1098273	SPRINKLER INSTALLATION	FL		C				No
(4) ALL SAFE FIRE SPRINKLER SYSTEMS INC 375 EXECUTIVE BLVD ELMSFORD,NY10523 47-3975166	SPRINKLER INSTALLATION	NY		C				No
(5) ALL STATE FIRE & SECURITY 400 MINERAL SPRINGS RD BUFFALO,NY14224 45-0558273	SPRINKLER INSTALLATION	NY		C				No
(6) ALLIED FIRE PROTECTION 555 HIGH ST OAKLAND,CA94601 94-1665896	SPRINKLER INSTALLATION	CA		C				No
(7) ALLIED FIRE PROTECTION SYSTEMS INC 1885 LYNDON BOULEVARD FALCONER,NY14733 16-1059681	SPRINKLER INSTALLATION	NY		C				No
(8) ALL-STATE FIRE PROT INC 107 CENTRAL AVE WIGGINS,CO80654 84-0958633	SPRINKLER INSTALLATION	CO		C				No
(9) ALPHA FIRE PROTECTION PO BOX 32106 EDMOND,OK73003 26-1720809	SPRINKLER INSTALLATION	OK		C				No
(10) AMERICAN FIRE SPRINKLER CORP PO BOX 958 SHAWNEE MSN,KS66201 43-0907831	SPRINKLER INSTALLATION	KS		C				No
(11) APEX FIRE PROTECTION LLC 500 S CTY RD I ELAND,WI54427 45-4391155	SPRINKLER INSTALLATION	WI		C				No
(12) ASSURANCE FIRE SYSTEMS 10864 W COCO PL LITTLETON,CO80127 04-3760291	SPRINKLER INSTALLATION	CO		C				No
(13) AUTOMATIC FIRE SPR LLC 1809 INDUSTRIAL PARK DR NORMAL,IL61761 20-0276964	SPRINKLER INSTALLATION	IL		C				No
(14) AZTEC FIRE PROTECTION 5121 W JEFFERSON BLVD LOS ANGELES,CA90016 95-4091439	SPRINKLER INSTALLATION	CA		C				No
(15) BAY AREA FIRE PROT LLC 1174 SAPPHIRE DR LIVERMORE,CA94550 46-5252461	SPRINKLER INSTALLATION	CA		C				No
(16) BFP FIRE PROTECTION INC 17 JANIS WAY SCOTTS VALLEY,CA95066 20-1548939	SPRINKLER INSTALLATION	CA		C				No
(17) BLACKSTONE FIRE PROTLLC 421 C ST UNIT 4A WASHOUGAL,WA98671 46-1574011	SPRINKLER INSTALLATION	WA		C				No
(18) BOSTON AUTOMATIC SPRINKLE FABRICATION INC 10 COMMERCE RD ROCKLAND,MA02370 01-0730691	SPRINKLER INSTALLATION	MA		C				No
(19) BROWN SPRINKLER CORP 4705 PINEWOOD RD LOUISVILLE,KY40218 61-0560682	SPRINKLER INSTALLATION	KY		C				No
(20) C W PIPING LLC 85 WOODMILL DR ROCHESTER,NY14626 47-4918436	SPRINKLER INSTALLATION	NY		C				No
(21) CALCULATED FIRE PROTECTION CO INC 2510 ROUTE 44 SALT POINT,NY12578 14-1785600	SPRINKLER INSTALLATION	NY		C				No
(22) CENTURY FIRE SPRINKLERS 27 CASSENS CT FENTON,MO63026 48-0925527	SPRINKLER INSTALLATION	MO		C				No
(23) COLUMBIA FIRE INC 111 S FINDLAY ST SEATTLE,WA98108 68-0610033	SPRINKLER INSTALLATION	WA		C				No
(24) CORE & MAIN 1830 CRAIG PARK CT SAINT LOUIS,MO63146 03-0550887	SPRINKLER INSTALLATION	MO		C				No
(25) COSCO FIRE PROT INC 29222 RANCHO VIEJO RD SAN JUAN CAPO,CA92675 95-4208955	SPRINKLER INSTALLATION	CA		C				No
(26) CROWN FIRE SYSTEMSINC 7402 SE JOHNSON CREEK BLV PORTLAND,OR97206 99-9999999	SPRINKLER INSTALLATION	OR		C				No
(27) DCL FABRICATION INC 13551 NW INDUSTRIAL DR BRIDGETON,MO63044 99-9999999	SPRINKLER INSTALLATION	MO		C				No
(28) DELTA FIRE SYSTEMS INC 7020 S TUCSON WAY CENTENNIA,CO80112 87-0276405	SPRINKLER INSTALLATION	CO		C				No
(29) ECO FIRE SPRINKLERS INC PO BOX 327 COPPEROPOLIS,CA95228 47-3268832	SPRINKLER INSTALLATION	CA		C				No
(30) EMERALD FIRE LLC 11021 CRAMER ROAD KPN GIG HARBOR,WA98329 91-2177798	SPRINKLER INSTALLATION	WA		C				No
(31) F E MORAN INC FIRE ATTN PAYROLL - FPS NORTHBROOK,IL60062 36-3083258	SPRINKLER INSTALLATION	IL		C				No
(32) F J MURPHY AND SON INC 1800 FACTORY ST SPRINGFIELD,IL62702 37-0905840	SPRINKLER INSTALLATION	IL		C				No
(33) FERGUSON FIRE AND FAB 55500 GRAND RIVER AVE NEW HUDSON,MI48165 95-2912930	SPRINKLER INSTALLATION	MI		C				No
(34) FIRE SPRINKLER INC 1524 45TH ST E STE 102 SUMNER,WA98390 90-0052043	SPRINKLER INSTALLATION	WA		C				No
(35) FOX FIRE PREVENTION INC PO BOX 594 PORT ORCHARD,WA98366 91-1411429	SPRINKLER INSTALLATION	WA		C				No
(36) FRONT RANGE FIRE PROT INC 246 BARBERRY PL LOVELAND,CO80537 84-0961750	SPRINKLER INSTALLATION	CO		C				No
(37) FRONTIER FIRE PROTECTION LLC 9430 E 40TH AVE DENVER,CO80238 84-0499748	SPRINKLER INSTALLATION	CO		C				No
(38) GEORGE M ROBINSON CO 1461 ATTEBERRY LN SAN JOSE,CA95131 94-1643953	SPRINKLER INSTALLATION	CA		C				No
(39) GEYER FIRE PROTECTIONLLC 700 N HIGH SCHOOL RD INDIANAPOLIS,IN46214 27-5539175	SPRINKLER INSTALLATION	IN		C				No
(40) GLACIER FIRE PROTECTION PO BOX 7980 BONNEY LAKE,WA98391 82-1872126	SPRINKLER INSTALLATION	WA		C				No
(41) GRUNAU COMPANY INC 2400 LAKE ORANGE DR ORLANDO,FL32837 99-9999999	SPRINKLER INSTALLATION	FL		C				No
(42) H G FIRE SYSTEMS INC 15102 SOMMERMEYER ST HOUSTON,TX77041 20-2487081	SPRINKLER INSTALLATION	TX		C				No
(43) HYDRO FIRE PROT INC PO BOX 8141 S LAKE TAHOE,CA96158 26-2128970	SPRINKLER INSTALLATION	CA		C				No
(44) INDY FIRE PROTECTION PO BOX 353 NORTH SALEM,IN46165 20-8170920	SPRINKLER INSTALLATION	IN		C				No
(45) INTEGRITY FIRE PROTECTION 11722 ALLISONVILLE RD FISHERS,IN46038 47-3710174	SPRINKLER INSTALLATION	IN		C				No
(46) INTERNATIONAL FIRE PROTECTION INC 243 ROYAL DR MADISON,AL35758 63-1027070	SPRINKLER INSTALLATION	AL		C				No
(47) J & S FIRE PROTECTIONINC 1204 ANDERSON AVE DREXEL HILL,PA19026 47-4099279	SPRINKLER INSTALLATION	PA		C				No
(48) J F AHERN 855 MORRIS ST FOND DU LAC,WI54935 39-0123200	SPRINKLER INSTALLATION	WI		C				No
(49) L AND K FIRE PROTECTION INC 1501 E MAIN ST MARION,IL62959 36-4121556	SPRINKLER INSTALLATION	IL		C				No
(50) LONG ISLAND PIPE SUPPLY OF MA 1830 CRAIG PARK CT ST LOUIS,MO63146 99-9999999	SPRINKLER INSTALLATION	MO		C				No
(51) LPG FIRE PROTECTION INC 1742 SEVILLE WAY SAN JOSE,CA95131 99-9999999	SPRINKLER INSTALLATION	CA		C				No
(52) LSE FIRE PROTECTION INC 28568 LANTERN PARK LN MENIFEE,CA92584 45-1615529	SPRINKLER INSTALLATION	CA		C				No
(53) M AND S FIRE PROTECTION LLC 3466 HILL CREST LN CANASTOTA,NY13032 47-5655147	SPRINKLER INSTALLATION	NY		C				No
(54) OKLAHOMA VISTA FIRE SPRINKLERS INC PO BOX 5564 NORMAN,OK73070 73-1377465	SPRINKLER INSTALLATION	OK		C				No
(55) OLYMPIC WEST FIRE PROT CORPORATION 128 S RIVER DR TEMPE,AZ85281 86-0601516	SPRINKLER INSTALLATION	AZ		C				No
(56) PATRIOT FIRE PROTECTION INC 2707 70TH AVE E TACOMA,WA98424 91-1492898	SPRINKLER INSTALLATION	WA		C				No
(57) PRIME FABRICATION &SUPPLY 3130 WESTWOOD DR A LAS VEGAS,NV89109 88-0283693	SPRINKLER INSTALLATION	NV		C				No
(58) PRYOR AUTOMATIC FIRE SPRINKLER PO BOX 1243 GREAT BEND,KS67530 20-1681535	SPRINKLER INSTALLATION	KS		C				No
(59) QUICK RESPONSE FIRE PROTECTION INC 566 HALLS MILL RD FREEHOLD,NJ07728 22-3635518	SPRINKLER INSTALLATION	NJ		C				No
(60) R & F FIRE PROTECTION 723 SONORA AVE GLENDALE,CA91201 99-9999999	SPRINKLER INSTALLATION	CA		C				No
(61) R E GRIESEMER INC 51 W RAYMOND ST INDIANAPOLIS,IN46225 35-1332487	SPRINKLER INSTALLATION	IN		C				No
(62) R W J CORPORATION PO BOX 277 SEBRING,OH44672 34-1058388	SPRINKLER INSTALLATION	OH		C				No
(63) RBM-GUARDIAN FIRE PROTECTION INC 8 ENTERPRISE DR ALBANY,NY12204 14-1598090	SPRINKLER INSTALLATION	NY		C				No
(64) RCM FIRE PROTECTION 350 ENTERPRISE PL TRACY,CA95304 01-0566019	SPRINKLER INSTALLATION	CA		C				No
(65) RED HAWK FIRE PROTECTION 801 VALLEY AVE NW STE D PUYALLUP,WA98371 27-3826115	SPRINKLER INSTALLATION	WA		C				No
(66) RELIABLE FIRE SYSTEMS INC 6636 S HIGHWAY 97 SAPULPA,OK74066 73-1340457	SPRINKLER INSTALLATION	OK		C				No
(67) RELIANCE FIRE PROTECTION 60 PAGE PARK DRIVE SUITE 1 POUGHKEEPSIE,NY12601 47-2341496	SPRINKLER INSTALLATION	NY		C				No
(68) RISER FIRE PROTECTION PO BOX 2319 BATTLE GROUND,WA98604 32-0059069	SPRINKLER INSTALLATION	WA		C				No
(69) RLH FIRE PROTECTION 4300 STINE RD STE 800 BAKERSFIELD,CA93313 77-0535230	SPRINKLER INSTALLATION	CA		C				No
(70) RYAN FIRE PROTECTION INC 9740 E 148TH ST NOBLESVILLE,IN46060 35-1788848	SPRINKLER INSTALLATION	IN		C				No
(71) S A COMUNALE CO INC 2900 NEWPARK DR BARBERTON,OH44203 34-1122758	SPRINKLER INSTALLATION	OH		C				No
(72) SALAMANDER FIRE PROTECTION 6103 TYRONE STREET VAN NUYS,CA91401 95-4709879	SPRINKLER INSTALLATION	CA		C				No
(73) SECURITY FIRE PROTECTION CO 4495 S MENDENHALL RD MEMPHIS,TN38141 62-0762619	SPRINKLER INSTALLATION	TN		C				No
(74) SHAMBAUGH & SON LP 7614 OPPORTUNITY DR FORT WAYNE,IN46825 35-0965412	SPRINKLER INSTALLATION	IN		C				No
(75) SIMPLEXGRINNELL LP 50 TECHNOLOGY DRIVE WESTMINSTER,MA01441 58-2608861	SPRINKLER INSTALLATION	MA		C				No
(76) SMITH FIRE SYSTEMS INC 1106 54TH AVENUE EAST TACOMA,WA98424 91-1386377	SPRINKLER INSTALLATION	WA		C				No
(77) SOUTHLAND INDUSTRIES 12131 WESTERN AVE GARDEN GROVE,CA92841 95-1596533	SPRINKLER INSTALLATION	CA		C				No
(78) SPS COMPANIES INC 6363 HIGHWAY 7 ST LOUIS PARK,MN55416 41-0719467	SPRINKLER INSTALLATION	MN		C				No
(79) SPS COMPANIES INC SPS COMPANY-ECHO 6363 HIGHWAY 7 ST LOUIS PARK,MN55416 41-0719467	SPRINKLER INSTALLATION	MN		C				No
(80) SRI FIRE SPRINKLERLLC 1060 CENTRAL AVE ALBANY,NY12205 26-3567501	SPRINKLER INSTALLATION	NY		C				No
(81) STREB FIRE PROTECTION 1305 WEST ENOS AVENUE SPRINGFIELD,IL62702 81-4453944	SPRINKLER INSTALLATION	IL		C				No
(82) SUMMIT FIRE PROTECTION 520 TEXAS ST REDLANDS,CA92374 33-0824386	SPRINKLER INSTALLATION	CA		C				No
(83) THE PIPCO COMPANIES LTD 1409 W ALTORFER DR PEORIA,IL61615 37-0800205	SPRINKLER INSTALLATION	IL		C				No
(84) TOMLINSON FIRE PROTECTION SERVICES LLC 16282 SE 150 AVE NORWICH,KS67118 81-3207590	SPRINKLER INSTALLATION	KS		C				No
(85) VOGT SPRINKLER SERVICES INC 363 DELAWARE RD KENMORE,NY14217 99-9999999	SPRINKLER INSTALLATION	NY		C				No
(86) WESTERN STATES FIRE PROTECTION COMPANY 7020 S TUCSON WAY CENTENNIAL,CO80112 84-0973303	SPRINKLER INSTALLATION	CO		C				No
(87) WILSON FIRE SPRINKLER CO PO BOX 188 SELMA,CA93662 51-0607615	SPRINKLER INSTALLATION	CA		C				No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2019

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER COLLECTIVE BARGAINED AGREEMENTS AND PARTICIPATION AGREEMENTS.
2	Check this box
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	3
5	Total number of individuals employed in calendar year 2019 (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 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	5,278,353	5,909,255
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	306,862	366,468
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	5,585,215	6,275,723
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).....	3,887,266	4,998,003
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	126,098	108,721
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	269,840	274,835
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	4,283,204	5,381,559
19	Revenue less expenses. Subtract line 18 from line 12.......	1,302,011	894,164
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	12,945,940	14,934,831
21	Total liabilities (Part X, line 26).............	249,045	168,366
22	Net assets or fund balances. Subtract line 21 from line 20.....	12,696,895	14,766,465

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	PROVIDING HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES UNDER COLLECTIVE BARGAINED AGREEMENTS AND PARTICIPATION AGREEMENT.

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 expenses

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(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
(A) Name and title
(1) BRIAN DUNN...................................................................... TRUSTEE, CHAIRMAN	1.00 ................. 39.00	X			0	173,258	90,128
(2) FRED BARALL...................................................................... TRUSTEE, SECRETARY	1.00 ................. 39.00	X			0	0	0
(3) ROBERT J COOPER...................................................................... TRUSTEE	1.00 ................. 39.00	X			0	170,262	89,230
(4) SHANE RAY...................................................................... TRUSTEE	1.00 ................. 39.00	X			0	0	0
(5) THOMAS LYDON...................................................................... TRUSTEE	1.00 ................. 39.00	X			0	0	0
(6) BRIAN E FISHER...................................................................... TRUSTEE	1.00 ................. 39.00	X			0	169,264	88,930
(7) MICHAEL W JACOBSON...................................................................... ADMINISTRATOR	1.00 ................. 39.00		X		3,695	254,951	127,200
(8) JOHN EGER...................................................................... ASSISTANT ADMINISTRATOR	1.00 ................. 39.00		X		3,367	232,359	142,204
(9) DAN CURRY...................................................................... IT MANAGER	1.00 ................. 34.00			X	2,043	130,775	40,552
(10) NIA PADMORE...................................................................... CLAIMS MANAGER	1.00 ................. 34.00			X	2,974	118,676	38,993
(11) ROBERT KAUFMAN...................................................................... COMPUTER ANALYST	0.00 ................. 35.00			X	0	116,700	38,300

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	12,079	1,366,245	655,537

(A) Name and business address	(B) Description of services	(C) Compensation
BLUE CROSS BLUE SHIELD 300 EAST RANDOLPH STREET CHICAGO,IL60601	CLAIMS PROCESSING	193,467
SEGAL CONSULTING 1800 M STREET NW SUITE 900 S WASHINGTON,DC20036	ACTUARY	102,800



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 2

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 above	1f

g	Noncash contributions included in lines 1a - 1f:$	1g

h Total. Add lines 1a-1f.......

		Business Code
2a	EMPLOYER CONTRIBUTIONS	525100	5,854,052	5,854,052
b	PARTICIPANT CONTR.	525100	46,260	46,260
c	LIQUIDATED DAMAGES	525100	8,943	8,943
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		5,909,255

3 Investment income (including dividends, interest, and othersimilar amounts) ......			366,468			366,468
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			6,275,723	5,909,255	0	366,468

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......	4,998,003
5	Compensation of current officers, directors, trustees, and key employees ...........	12,079
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........	50,817
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	19,104
9	Other employee benefits .......	21,426
10	Payroll taxes ...........	5,295
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	26,102
c	Accounting ...........	41,483
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	20,860
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	102,800
12	Advertising and promotion ....
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	8,411
17	Travel ............	2,339
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 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	CLAIMS COST MANAGEMENT	23,832
b	DATA PROCESSING EXPENSE	14,631
c	MAINTENANCE	8,199
d	PRINTING,STATIONARY & O	5,754
e	All other expenses	20,424
25	Total functional expenses. Add lines 1 through 24e	5,381,559
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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			1
2	Savings and temporary cash investments .........		1,248,960	2	502,962
3	Pledges and grants receivable, net ......			3
4	Accounts receivable, net .............		492,329	4	764,390
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				6
7	Notes and loans receivable, net ...........			7
8	Inventories for sale or use ............			8
9	Prepaid expenses and deferred charges ......		1,537	9	1,675
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 .		11,203,114	11	13,665,804
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 ...........			15
16	Total assets. Add lines 1 through 15 (must equal line 33)...		12,945,940	16	14,934,831

17	Accounts payable and accrued expenses .....	249,045	17	168,366
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	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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..	249,045	26	168,366

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	12,696,895	29	14,766,465
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	0	31	0
32	Total net assets or fund balances ...........	12,696,895	32	14,766,465
33	Total liabilities and net assets/fund balances ........	12,945,940	33	14,934,831