U.S. Department of Labor
Office of Labor-Management Standards
Washington, DC 20210 		FORM LM-2 LABOR ORGANIZATION ANNUAL REPORT Form Approved
Office of Management and Budget
No. 1245-0003
Expires: 08-31-2016
MUST BE USED BY LABOR ORGANIZATIONS WITH $250,000 OR MORE IN TOTAL ANNUAL RECEIPTS AND LABOR ORGANIZATIONS IN TRUSTEESHIP

This report is mandatory under P.L. 86-257, as amended.  Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or 440.
READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT.
For Official Use Only
1. FILE NUMBER
036-518
2. PERIOD COVERED
From01/01/2013
Through12/31/2013
3. (a) AMENDED - Is this an amended report:
No
(b) HARDSHIP - Filed under the hardship procedures:
No
(c) TERMINAL - This is a terminal report:No
4. AFFILIATION OR ORGANIZATION NAME
AUTO WORKERS AFL-CIO
5. DESIGNATION (Local, Lodge, etc.)
LOCAL UNION
 6. DESIGNATION NBR
402
7. UNIT NAME (if any)

8. MAILING ADDRESS (Type or print in capital letters)
First Name
DICK
 Last Name
SEVERS
P.O Box - Building and Room Number

Number and Street
3671 URBANA ROAD
City
SPRINGFIELD
State
OH		 ZIP Code + 4
45502


9. Are your organization's records kept at its mailing address?


Yes

Each of the undersigned, duly authorized officers of the above labor organization, declares, under penalty of perjury and other applicable penalties of law, that all of the information submitted in this report (including information contained in any accompanying documents) has been examined by the signatory and is, to the best of the undersigned individual's knowledge and belief, true, correct and complete (See Section V on penalties in the instructions.)
70. SIGNED:Jason L BarlowPRESIDENT71. SIGNED:Richard SeversTREASURER
Date:Mar 24, 2014Telephone Number:937-390-3327Date:Mar 24, 2014Telephone Number:937-390-3327
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
ITEMS 10 THROUGH 21 FILE NUMBER: 036-518
10. During the reporting period did the labor organization create or participate in the administration of a trust or a fund or organization, as defined in the instructions, which provides benefits for members or beneficiaries?Yes
11(a). During the reporting period did the labor organization have a political action committee (PAC) fund?No
11(b). During the reporting period did the labor organization have a subsidiary organization as defined in Section X of these Instructions?Yes
12. During the reporting period did the labor organization have an audit or review of its books and records by an outside accountant or by a parent body auditor/representative?Yes
13. During the reporting period did the labor organization discover any loss or shortage of funds or other assets? (Answer "Yes" even if there has been repayment or recovery.)No
14. What is the maximum amount recoverable under the labor organization's fidelity bond for a loss caused by any officer, employee or agent of the labor organization who handled union funds?$100,000
15. During the reporting period did the labor organization acquire or dispose of any assets in a manner other than purchase or sale?No
16. Were any of the labor organization's assets pledged as security or encumbered in any way at the end of the reporting period?No
17. Did the labor organization have any contingent liabilities at the end of the reporting period?No
18. During the reporting period did the labor organization have any changes in its constitution or bylaws, other than rates of dues and fees, or in practices/procedures listed in the instructions?No
19. What is the date of the labor organization's next regular election of officers?05/2014
20. How many members did the labor organization have at the end of the reporting period?1,050
21. What are the labor organization's rates of dues and fees?
Rates of Dues and Fees
Dues/FeesAmount UnitMinimumMaximum
(a) Regular Dues/Fees2 hrs straightpermonth1 hr SUB2 hrs straight
(b) Working Dues/Fees0per
(c) Initiation Fees20.00perone time
(d) Transfer Fees0per
(e) Work Permits0per

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT A - ASSETS AND LIABILITIES FILE NUMBER: 036-518

ASSETS
ASSETS Schedule
Number 		Start of Reporting Period
(A) 		End of Reporting Period
(B)
22. Cash $145,144$118,555
23. Accounts Receivable1$0$0
24. Loans Receivable2$0
25. U.S. Treasury Securities $0$0
26. Investments5$0$0
27. Fixed Assets6$843,391$843,391
28. Other Assets7$4,871$10,037
29. TOTAL ASSETS $993,406$971,983

LIABILITIES
LIABILITIES Schedule
Number 		Start of Reporting Period
(A) 		End of Reporting Period
(B)
30. Accounts Payable8$50,488$47,468
31. Loans Payable9$0$0
32. Mortgages Payable $0$0
33. Other Liabilities10$1,982$1,963
34. TOTAL LIABILITIES $52,470$49,431
35. NET ASSETS$940,936$922,552
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT B - RECEIPTS AND DISBURSEMENTS FILE NUMBER: 036-518

CASH RECEIPTSSCHAMOUNT
36. Dues and Agency Fees $494,597
37. Per Capita Tax $0
38. Fees, Fines, Assessments, Work Permits $5,220
39. Sale of Supplies $5,332
40. Interest $1,087
41. Dividends $2,244
42. Rents $32,589
43. Sale of Investments and Fixed Assets3$0
44. Loans Obtained9$0
45. Repayments of Loans Made2
46. On Behalf of Affiliates for Transmittal to Them $0
47. From Members for Disbursement on Their Behalf $2,152
48. Other Receipts14$56,798
49. TOTAL RECEIPTS $600,019
CASH DISBURSEMENTSSCHAMOUNT
50. Representational Activities15$48,933
51. Political Activities and Lobbying16$1,405
52. Contributions, Gifts, and Grants17$4,279
53. General Overhead18$20,883
54. Union Administration19$217,346
55. Benefits20$2,845
56. Per Capita Tax $287,742
57. Strike Benefits $0
58. Fees, Fines, Assessments, etc. $0
59. Supplies for Resale $12,013
60. Purchase of Investments and Fixed Assets4$0
61. Loans Made2
62. Repayment of Loans Obtained9$0
63. To Affiliates of Funds Collected on Their Behalf $0
64. On Behalf of Individual Members $950
65. Direct Taxes $29,300
  
66. Subtotal $625,696
67. Withholding Taxes and Payroll Deductions  
  67a. Total Withheld$28,580  
  67b. Less Total Disbursed$29,492  
  67c. Total Withheld But Not Disbursed -$912
68. TOTAL DISBURSEMENTS $626,608
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 1 - ACCOUNTS RECEIVABLE AGING SCHEDULE FILE NUMBER: 036-518

Entity or Individual Name
(A) 		Total Account Receivable
(B) 		90-180 Days
Past Due
(C) 		180+ Days
Past Due
(D) 		Liquidated Account
Receivable
(E)
Total of all itemized accounts receivable$0$0$0$0
Totals from all other accounts receivable    
Totals (Total of Column (B) will be automatically entered in Item 23, Column(B)) $0$0$0$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 2 - LOANS RECEIVABLE FILE NUMBER: 036-518

List below loans to officers, employees, or members which at any time during the reporting period exceeded $250 and list all loans to business enterprises regardless of amount.
(A) 		Loans
Outstanding at
Start of Period
(B) 		Loans Made
During Period
(C)
Repayments Received During Period
Cash
(D)(1) 		Other Than Cash
(D)(2)
Loans
Outstanding at
End of Period
(E)
Total of loans not listed above     
Total of all lines above$0$0$0$0$0
Totals will be automatically entered in... Item 24
Column (A) 		Item 61Item 45 Item 69
with Explanation 		Item 24
Column (B)
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 3 - SALE OF INVESTMENTS AND FIXED ASSETS FILE NUMBER: 036-518

Description (if land or buildings, give location)
(A) 		Cost
(B) 		Book Value
(C) 		Gross Sales Price
(D) 		Amount Received
(E)
Total of all lines above$0$0$0$0
Less Reinvestments$0
(The total from Net Sales Line will be automatically entered in Item 43)Net Sales$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 4 - PURCHASE OF INVESTMENTS AND FIXED ASSETS FILE NUMBER: 036-518

Description (if land or buildings, give location)
(A) 		Cost
(B) 		Book Value
(C) 		Cash Paid
(D)
Total of all lines above$0$0$0
 Less Reinvestments$0
(The total from Net Purchases Line will be automatically entered in Item 60.)Net Purchases$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 5 - INVESTMENTS FILE NUMBER: 036-518

Description
(A) 		Amount
(B)
Marketable Securities 
A. Total Cost
B. Total Book Value
C. List each marketable security which has a book value over $5,000 and exceeds 5% of Line B.  
Other Investments 
D. Total Cost
E. Total Book Value
F. List each other investment which has a book value over $5,000 and exceeds 5% of Line E.  Also, list each subsidiary for which separate reports are attached.  
G. Total of Lines B and E (Total will be automatically entered in Item 26, Column(B)) $0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 6 - FIXED ASSETS FILE NUMBER: 036-518

Description
(A) 		Cost or Other Basis
(B) 		Total Depreciation or
Amount Expensed
(C) 		Book Value
(D) 		Value
(E)
A. Land (give location)    
Land  1 :      3671 Urbana Rd$31,600 $31,600$31,600
Land  2 :      4945 Derr Rd$20,000 $20,000$20,000
Land  3 :       
B. Buildings (give location)    
Building  1 :      3671 Urbana Rd$378,832$378,832$378,832
Building  2 :      4945 Derr Rd$253,556$253,556$253,556
C. Automobiles and Other Vehicles
D. Office Furniture and Equipment$150,161$150,161$150,161
E. Other Fixed Assets$9,242$9,242$9,242
F. Totals of Lines A through E (Column(D) Total will be automatically entered in Item 27, Column(B)) $843,391$0$843,391$843,391
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 7 - OTHER ASSETS FILE NUMBER: 036-518

Description
(A) 		Book Value
(B)
Total (Total will be automatically entered in Item 28, Column(B)) $10,037
T-Shirts 447 @10.00$5,620
Jackets 158 @26.25$4,417
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 8 - ACCOUNTS PAYABLE AGING SCHEDULE FILE NUMBER: 036-518

Entity or Individual Name
(A) 		Total Account
Payable
(B) 		90-180 Days
Past Due
(C) 		180+ Days Past
Due
(D)
Liquidated Account
Payable
(E)
Total for all itemized accounts payable$47,468$0$0$0
Total from all other accounts payable$0$0$0$0
Totals (Total for Column(B) will be automatically entered in Item 30, Column(D)) $47,468$0$0$0
International UAW$45,370$0$0$0
Dept. #78108$2,098$0$0$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 9 - LOANS PAYABLE FILE NUMBER: 036-518

Source of Loans Payable at Any
Time During the Reporting Period
(A) 		Loans Owed at
Start of Period
(B) 		Loans Obtained
During Period
(C) 		Repayment
During Period
Cash
(D)(1) 		Repayment
During Period
Other Than Cash
(D)(2) 		Loans Owed at
End of Period
(E)
Total Loans Payable$0$0$0$0$0
Totals will be automatically entered in... Item 31
Column (C) 		Item 44Item 62 Item 69
with Explanation 		Item 31
Column (D)
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 10 - OTHER LIABILITIES FILE NUMBER: 036-518

Description
(A) 		Amount at End of Period
(B)
Total Other Liabilities (Total will be automatically entered in Item 33, Column(D)) $1,963
City of Urbana IncomeTax$19
City of Springfield Income Tax$147
School District Tax$1
Treasurer of State of Ohio$722
Ohio Bureau of Workers Comp$454
FUTA$620
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 11 - ALL OFFICERS AND DISBURSEMENTS TO OFFICERS FILE NUMBER: 036-518

(A)
Name		(B)
Title		(C)
Status		 (D)
Gross Salary
Disbursements
(before any
deductions) 		(E)
Allowances
Disbursed 		(F)
Disbursements for Official Business 		(G)
Other
Disbursements not reported in
(D) through (F) 		(H)
TOTAL
A
B
C 		BARLOW ,  JASON   L
PRESIDENT
C		$36,856$0$5,657$0$42,513
I
Schedule 15
Representational Activities 		24 % Schedule 16
Political Activities and Lobbying 		1 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		75 %
A
B
C 		BLIZARD ,  CHRISTO   L
1ST VICE-PRES.
C		$15,067$0$501$0$15,568
I
Schedule 15
Representational Activities 		7 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		4 % Schedule 19
Administration 		89 %
A
B
C 		ELDRIDGE ,  TODD   C
TRUSTEE
C		$1,547$0$0$0$1,547
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		100 %
A
B
C 		ENTLER ,  JAMES   J
GUIDE
C		$1,533$0$0$0$1,533
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		1 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		99 %
A
B
C 		HARSHAW ,  JEFFREY   A
EXEC. BOARD TRU
C		$1,587$0$0$0$1,587
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		13 % Schedule 19
Administration 		87 %
A
B
C 		KETTERMAN ,  TERRY   L
TRUSTEE CHAIRMA
C		$2,036$0$0$0$2,036
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		5 % Schedule 19
Administration 		95 %
A
B
C 		SCOTT ,  TODD  
BARGAINING CHAI
C		$1,554$0$754$0$2,308
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		100 %
A
B
C 		SEEGRAVES ,  THOMAS   R
SGT-AT-ARMS EXE
C		$1,871$0$0$0$1,871
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		12 % Schedule 19
Administration 		88 %
A
B
C 		SEVERS ,  RICHARD   L
FIN SECY
C		$10,050$0$2,261$0$12,311
I
Schedule 15
Representational Activities 		20 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		80 %
A
B
C 		STUCKEY ,  PEGGY   J
RECORDING SEC'Y
C		$2,393$0$578$0$2,971
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		100 %
Total Officer Disbursements$74,494$0$9,751$0$84,245
Less Deductions    $16,131
Net Disbursements    $68,114
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 12 - DISBURSEMENTS TO EMPLOYEES FILE NUMBER: 036-518

(A)
Name		(B)
Title		(C)
Other Payer		 (D)
Gross Salary
Disbursements
(before any
deductions) 		(E)
Allowances Disbursed 		(F)
Disbursements for Official Business 		(G)
Other Disbursements not reported in
(D) through (F) 		(H)
TOTAL
A
B
C 		CHAPMAN ,  JAMES   W
WORKER'S COMP. R
NA		$14,099$0$996$0$15,095
I
Schedule 15
Representational Activities 		3 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		97 %
A
B
C 		MCMANAMAY ,  SHERRY   M
SEC'Y/BOOK
NA		$26,991$0$1,010$0$28,001
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		100 %
TOTALS RECEIVED BY EMPLOYEES MAKING $10,000 OR LESS$23,436$0$3,036$0$26,472
I Schedule 15
Representational Activities 		14 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		33 % Schedule 19
Administration 		53 %
Total Employee Disbursements$64,526$0$5,042$0$69,568
Less Deductions    $12,449
Net Disbursements    $57,119
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 13 - MEMBERSHIP STATUS FILE NUMBER: 036-518

Category of Membership
(A) 		Number
(B) 		Voting Eligibility
(C)
Members (Total of all lines above) 1,050 
Agency Fee Payers*
Total Members/Fee Payers1,050 
*Agency Fee Payers are not considered members of the labor organization.
Regular Members1,050Yes
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
DETAILED SUMMARY PAGE - SCHEDULES 14 THROUGH 19 FILE NUMBER: 036-518

SCHEDULE 14   OTHER RECEIPTS
1. Named Payer Itemized Receipts$31,847
2. Named Payer Non-itemized Receipts$4,056
3. All Other Receipts$20,895
4. Total Receipts$56,798
     
     
SCHEDULE 17   CONTRIBUTIONS, GIFTS & GRANTS
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$0
4. To Employees$0
5. All Other Disbursements$4,279
6. Total Disbursements$4,279
SCHEDULE 15   REPRESENTATIONAL ACTIVITIES
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$8,550
3. To Officers$13,755
4. To Employees$4,159
5. All Other Disbursements$22,469
6. Total Disbursements$48,933
SCHEDULE 18   GENERAL OVERHEAD
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$1,156
4. To Employees$8,736
5. All Other Disbursements$10,991
6. Total Disbursements$20,883
SCHEDULE 16   POLITICAL ACTIVITIES AND LOBBYING
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$440
4. To Employees$0
5. All Other Disbursements$965
6. Total Disbursements$1,405
SCHEDULE 19   UNION ADMINISTRATION
1. Named Payee Itemized Disbursements$5,545
2. Named Payee Non-itemized Disbursements$30,375
3. To Officers$68,895
4. To Employees$56,673
5. All Other Disbursements$55,858
6. Total Disbursements$217,346
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 14 - OTHER RECEIPTS FILE NUMBER: 036-518

Name and Address
(A)
INTERNATIONAL UNION UAW
8000 E JEFFERSON AVENUE

DETROIT
MI
48214-0000
Type or Classification
(B)
LABOR UNION
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$31,847
Total Non-Itemized Transactions with this Payee/Payer$4,056
Total of All Transactions with this Payee/Payer for This Schedule$35,903
REIMB. ORG. TULSA TRIP05/13/2013$12,508
TRIP REIMB. (BET)09/10/2013$8,080
J.BARLOW/D.BLAKELY BET RE12/30/2013$5,762
13TH REBATE CHECK04/29/2013$5,497
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 15 - REPRESENTATIONAL ACTIVITIES FILE NUMBER: 036-518

Name and Address
(A)
TEXAS ROADHOUSE
1750 N BECHTLE AVENUE

SPRINGFIELD
OH
45504-0000
Type or Classification
(B)
CATERING
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$0
Total Non-Itemized Transactions with this Payee/Payer$8,550
Total of All Transactions with this Payee/Payer for This Schedule$8,550
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 16 - POLITICAL ACTIVITIES AND LOBBYING FILE NUMBER 036-518

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 17 - CONTRIBUTIONS, GIFTS & GRANTS FILE NUMBER: 036-518

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 18 - GENERAL OVERHEAD FILE NUMBER: 036-518

Name and Address
(A)




-1
Type or Classification
(B)
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer 
Total of All Transactions with this Payee/Payer for This Schedule$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 19 - UNION ADMINISTRATION FILE NUMBER: 036-518

Name and Address
(A)
CUSTOM PROMOTIONS INC.
17520 W. TWELVE MILE RD.

SOUTHFIELD
MI
48076-0000
Type or Classification
(B)
PROMOTIONAL ITEMS
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$13,061
Total of All Transactions with this Payee/Payer for This Schedule$13,061
Name and Address
(A)
GILLAM LAWNCARE & LANDSCAPING
9736 OLD COLUMBUS RD.

SOUTH VIENNA
OH
45369-0000
Type or Classification
(B)
LAWNCARE COMPANY
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$0
Total Non-Itemized Transactions with this Payee/Payer$7,496
Total of All Transactions with this Payee/Payer for This Schedule$7,496
Name and Address
(A)
OHIO EDISON
20 S LIMESTONE ST

SPRINGFIELD
OH
45502-0000
Type or Classification
(B)
UTILITY COMPANY
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$0
Total Non-Itemized Transactions with this Payee/Payer$9,818
Total of All Transactions with this Payee/Payer for This Schedule$9,818
Name and Address
(A)
WALLACE & TURNER INSURANCE AGE
616 N LIMESTONE ST

SPRINGFIELD
OH
45503-0000
Type or Classification
(B)
PROPERTY INSURANCE
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$5,545
Total Non-Itemized Transactions with this Payee/Payer$0
Total of All Transactions with this Payee/Payer for This Schedule$5,545
POLICY: CWP838126312/17/2013$5,545
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 20 - BENEFITS FILE NUMBER: 036-518

Description
(A) 		To Whom Paid
(B) 		Amount
(C)
Total of all lines above (Total will be automatically entered in Item 55.)$2,845
Workers Compension InsuranceBUREAU OF WORKERS COMPENSATION$1,106
Medical Fees- To Doc/Hosp as a Co-PayDR. CHALLA AJIT M.D. M.R.C.P.$400
Medical Fees- To Doc/Hosp as a Co-PayGASTRO CARE LLC$600
Medical Fees- To Doc/Hosp as a Co-PayRINEHART FAMILY HEALTH$70
Medical Fees- To Doc/Hosp as a Co-PaySCOTT WILKE D.C. M.H.A$140
Medical Fees- To Doc/Hosp as a Co-PaySHERRY MCMANAMAY$55
Medical Fees - OtherJODY FINNEY$55
Medical Fees - OtherSEAR'S OPTICAL$193
Medical Fees - OtherSHERRY MCMANAMAY$226
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
69. ADDITIONAL INFORMATION SUMMARY FILE NUMBER: 036-518


Question 10: Operations of the building corporation are handled through the books and records of the local union and therefore included in this report.

Question 11(b): Operations of the building corporation are handled through the books and records of the local union and therefore included in this report.

Question 12: : Audit was performed by UAW International Auditor.

Statement A,

Cash Begin Total: LINE 22A INCREASE BY 196.00 DUE TO VOIDED CHECK PREVIOUS YEAR

Schedule 13, Row1:Anyone who has applied and been accepted for membership is a regular member. Regular members pay full dues

Schedule 13, Row1:

Schedule 13 anyone who has applied and been accepted for membership is a regular member. Regular members pay full dues.
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)