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: 07-31-2019
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
542-249
2. PERIOD COVERED
From01/01/2017
Through12/31/2017
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
4911
7. UNIT NAME (if any)

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

Number and Street
1010 River Street
City
LANSING
State
MI		 ZIP Code + 4
489121030


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:Derrick C McDuffeyPRESIDENT71. SIGNED:Rose M Van SchoickTREASURER
Date:Mar 23, 2018Telephone Number:517-719-6512Date:Mar 23, 2018Telephone Number:517-372-7201
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
ITEMS 10 THROUGH 21 FILE NUMBER: 542-249
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?No
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?No
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?$168,000
15. During the reporting period did the labor organization acquire or dispose of any assets in a manner other than purchase or sale?Yes
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?06/2019
20. How many members did the labor organization have at the end of the reporting period?1,928
21. What are the labor organization's rates of dues and fees?
Rates of Dues and Fees
Dues/FeesAmount UnitMinimumMaximum
(a) Regular Dues/FeesTwo and a half hours of straight time pay per monthperper month2.5 hours2.5 hours
(b) Working Dues/Feesper
(c) Initiation Fees20perone time2020
(d) Transfer Feesper
(e) Work Permitsper

Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT A - ASSETS AND LIABILITIES FILE NUMBER: 542-249

ASSETS
ASSETS Schedule
Number 		Start of Reporting Period
(A) 		End of Reporting Period
(B)
22. Cash $616,157$652,052
23. Accounts Receivable1$0$0
24. Loans Receivable2$0$0
25. U.S. Treasury Securities $0$0
26. Investments5$0$0
27. Fixed Assets6$10,326$10,326
28. Other Assets7$4,770$4,358
29. TOTAL ASSETS $631,253$666,736

LIABILITIES
LIABILITIES Schedule
Number 		Start of Reporting Period
(A) 		End of Reporting Period
(B)
30. Accounts Payable8$54,295$53,428
31. Loans Payable9$0$0
32. Mortgages Payable $0$0
33. Other Liabilities10$1,294$1,187
34. TOTAL LIABILITIES $55,589$54,615
35. NET ASSETS$575,664$612,121
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
STATEMENT B - RECEIPTS AND DISBURSEMENTS FILE NUMBER: 542-249

CASH RECEIPTSSCHAMOUNT
36. Dues and Agency Fees $1,027,524
37. Per Capita Tax $0
38. Fees, Fines, Assessments, Work Permits $6,420
39. Sale of Supplies $160
40. Interest $3,540
41. Dividends $0
42. Rents $0
43. Sale of Investments and Fixed Assets3$0
44. Loans Obtained9$0
45. Repayments of Loans Made2$0
46. On Behalf of Affiliates for Transmittal to Them $0
47. From Members for Disbursement on Their Behalf $0
48. Other Receipts14$11,871
49. TOTAL RECEIPTS $1,049,515
CASH DISBURSEMENTSSCHAMOUNT
50. Representational Activities15$113,562
51. Political Activities and Lobbying16$3,840
52. Contributions, Gifts, and Grants17$13,835
53. General Overhead18$12,733
54. Union Administration19$130,318
55. Benefits20$52,882
56. Per Capita Tax $669,968
57. Strike Benefits $0
58. Fees, Fines, Assessments, etc. $0
59. Supplies for Resale $1,422
60. Purchase of Investments and Fixed Assets4$0
61. Loans Made2$0
62. Repayment of Loans Obtained9$0
63. To Affiliates of Funds Collected on Their Behalf $0
64. On Behalf of Individual Members $0
65. Direct Taxes $15,046
  
66. Subtotal $1,013,606
67. Withholding Taxes and Payroll Deductions  
  67a. Total Withheld$45,892  
  67b. Less Total Disbursed$45,910  
  67c. Total Withheld But Not Disbursed -$18
68. TOTAL DISBURSEMENTS $1,013,624
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 1 - ACCOUNTS RECEIVABLE AGING SCHEDULE FILE NUMBER: 542-249

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: 542-249

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: 542-249

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: 542-249

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: 542-249

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: 542-249

Description
(A) 		Cost or Other Basis
(B) 		Total Depreciation or
Amount Expensed
(C) 		Book Value
(D) 		Value
(E)
A. Land (give location)$0 $0$0
B. Buildings (give location)$0$0$0$0
C. Automobiles and Other Vehicles
D. Office Furniture and Equipment$10,326$0$10,326$10,326
E. Other Fixed Assets
F. Totals of Lines A through E (Column(D) Total will be automatically entered in Item 27, Column(B)) $10,326$0$10,326$10,326
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 7 - OTHER ASSETS FILE NUMBER: 542-249

Description
(A) 		Book Value
(B)
Total (Total will be automatically entered in Item 28, Column(B)) $4,358
Bibles$622
UAW Local 4911 Solidarity Bookcases$2,436
UAW Local 4911 T-Shirts$1,300
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 8 - ACCOUNTS PAYABLE AGING SCHEDULE FILE NUMBER: 542-249

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$0$0$0$0
Total from all other accounts payable$53,428$0$0$0
Totals (Total for Column(B) will be automatically entered in Item 30, Column(D)) $53,428$0$0$0
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 9 - LOANS PAYABLE FILE NUMBER: 542-249

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: 542-249

Description
(A) 		Amount at End of Period
(B)
Total Other Liabilities (Total will be automatically entered in Item 33, Column(D)) $1,187
State of Michigan Dept of Treasury$466
SUTA$107
FUTA$318
City of Lansing$296
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 11 - ALL OFFICERS AND DISBURSEMENTS TO OFFICERS FILE NUMBER: 542-249

(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 		BRAMER ,  RAYMOND  
GUIDE
C		$0$0$0$0$0
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 		NORCROSS ,  JANE   E
UNIT CHAIR
C		$907$0$305$0$1,212
I
Schedule 15
Representational Activities 		86 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		14 %
A
B
C 		NEAR ,  DAVID  
UNIT CHAIR
C		$2,710$1,950$190$0$4,850
I
Schedule 15
Representational Activities 		98 % Schedule 16
Political Activities and Lobbying 		1 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		1 %
A
B
C 		MUELLER ,  JERRY  
SGT AT ARMS
C		$0$0$0$0$0
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 		BROOKER ,  EILEEN  
RETIREE CHAIR
C		$0$0$29$0$29
I
Schedule 15
Representational Activities 		0 % Schedule 16
Political Activities and Lobbying 		52 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		48 %
A
B
C 		JONES ,  STEPHANIE  
TRUSTEE
C		$794$0$362$0$1,156
I
Schedule 15
Representational Activities 		10 % Schedule 16
Political Activities and Lobbying 		1 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		89 %
A
B
C 		MCDUFFEY ,  DERRICK  
PRESIDENT
C		$47,154$0$1,900$0$49,054
I
Schedule 15
Representational Activities 		96 % Schedule 16
Political Activities and Lobbying 		1 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		3 %
A
B
C 		SLONE ,  WILBERT  
VICE PRESIDENT
C		$845$0$112$0$957
I
Schedule 15
Representational Activities 		56 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		44 %
A
B
C 		FENBY ,  GERALD  
UNIT CHAIR
C		$1,425$0$563$0$1,988
I
Schedule 15
Representational Activities 		76 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		24 %
A
B
C 		QAWWEE ,  MUHAMMAD  
UNIT CHAIR
C		$1,648$2,400$824$0$4,872
I
Schedule 15
Representational Activities 		97 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		3 %
A
B
C 		VANSCHOICK ,  ROSE  
FINANCIAL SECRETARY
C		$78,047$0$1,038$0$79,085
I
Schedule 15
Representational Activities 		1 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		99 %
A
B
C 		WATSON ,  CHARLENE   L
RECORDING SECRETARY
N		$1,467$1,500$541$0$3,508
I
Schedule 15
Representational Activities 		32 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		68 %
A
B
C 		SIAD ,  KYMBERLYNN  
TRUSTEE
C		$1,318$0$302$0$1,620
I
Schedule 15
Representational Activities 		10 % Schedule 16
Political Activities and Lobbying 		1 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		89 %
A
B
C 		KREFT ,  MICHELINA  
TRUSTEE
C		$385$0$35$0$420
I
Schedule 15
Representational Activities 		7 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		93 %
Total Officer Disbursements$136,700$5,850$6,201$0$148,751
Less Deductions    $38,031
Net Disbursements    $110,720
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 12 - DISBURSEMENTS TO EMPLOYEES FILE NUMBER: 542-249

(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 		STENSKE ,  SANDRA   F
BOOKKEEPER
none		$25,109$0$327$0$25,436
I
Schedule 15
Representational Activities 		1 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		0 % Schedule 19
Administration 		99 %
TOTALS RECEIVED BY EMPLOYEES MAKING $10,000 OR LESS$14,601$0$3,529$0$18,130
I Schedule 15
Representational Activities 		81 % Schedule 16
Political Activities and Lobbying 		0 % Schedule 17
Contributions 		0 % Schedule 18
General Overhead 		4 % Schedule 19
Administration 		15 %
Total Employee Disbursements$39,710$0$3,856$0$43,566
Less Deductions    $7,861
Net Disbursements    $35,705
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 13 - MEMBERSHIP STATUS FILE NUMBER: 542-249

Category of Membership
(A) 		Number
(B) 		Voting Eligibility
(C)
Members (Total of all lines above) 1,928 
Agency Fee Payers*0
Total Members/Fee Payers1,928 
*Agency Fee Payers are not considered members of the labor organization.
Regular Members1,928Yes
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
DETAILED SUMMARY PAGE - SCHEDULES 14 THROUGH 19 FILE NUMBER: 542-249

SCHEDULE 14   OTHER RECEIPTS
1. Named Payer Itemized Receipts$10,045
2. Named Payer Non-itemized Receipts$0
3. All Other Receipts$1,826
4. Total Receipts$11,871
     
     
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$13,835
6. Total Disbursements$13,835
SCHEDULE 15   REPRESENTATIONAL ACTIVITIES
1. Named Payee Itemized Disbursements$7,150
2. Named Payee Non-itemized Disbursements$10,534
3. To Officers$61,881
4. To Employees$14,939
5. All Other Disbursements$19,058
6. Total Disbursements$113,562
SCHEDULE 18   GENERAL OVERHEAD
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$12,000
3. To Officers$0
4. To Employees$725
5. All Other Disbursements$8
6. Total Disbursements$12,733
SCHEDULE 16   POLITICAL ACTIVITIES AND LOBBYING
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$583
4. To Employees$0
5. All Other Disbursements$3,257
6. Total Disbursements$3,840
SCHEDULE 19   UNION ADMINISTRATION
1. Named Payee Itemized Disbursements$0
2. Named Payee Non-itemized Disbursements$0
3. To Officers$86,290
4. To Employees$27,902
5. All Other Disbursements$16,126
6. Total Disbursements$130,318
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 14 - OTHER RECEIPTS FILE NUMBER: 542-249

Name and Address
(A)
UAW INTERNATIONAL

8000 S JEFFERSON AVE
DETROIT
MI
Type or Classification
(B)
LABOR ORGANIZATION
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$10,045
Total Non-Itemized Transactions with this Payee/Payer$0
Total of All Transactions with this Payee/Payer for This Schedule$10,045
13TH REBATE CHECK05/10/2017$10,045
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 15 - REPRESENTATIONAL ACTIVITIES FILE NUMBER: 542-249

Name and Address
(A)
DETROIT TIGERS INC.
2100 WOODWARD AVENUE
ATTN: GROUP SALES
DETROIT
MI
48201
Type or Classification
(B)
BASEBALL TEAM
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$5,210
Total of All Transactions with this Payee/Payer for This Schedule$5,210
Name and Address
(A)
GRAND TRAVERSE RESORT
VILLAGE BLVD
100 GRAND TRAVERSE RESORT
ACME
MI
49610
Type or Classification
(B)
TRAVEL PYMT TO HOTEL
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$0
Total Non-Itemized Transactions with this Payee/Payer$5,324
Total of All Transactions with this Payee/Payer for This Schedule$5,324
Name and Address
(A)
UAW REGION 1-D

1940 W ATHERTON ROAD
FLINT
MI
48507
Type or Classification
(B)
MEETINGS/CONFERENCE
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer$7,150
Total Non-Itemized Transactions with this Payee/Payer$0
Total of All Transactions with this Payee/Payer for This Schedule$7,150
SUMMER/FALL SCHOOL07/20/2017$7,150
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 16 - POLITICAL ACTIVITIES AND LOBBYING FILE NUMBER 542-249

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: 542-249

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: 542-249

Name and Address
(A)
INTERNATIONAL UNION-UAW

8000 EAST JEFFERSON AVE
DETROIT
MI
48214-3963
Type or Classification
(B)
ORIENTATION BOOKS
Purpose
(C) 		Date
(D) 		Amount
(E)
Total Itemized Transactions with this Payee/Payer 
Total Non-Itemized Transactions with this Payee/Payer$12,000
Total of All Transactions with this Payee/Payer for This Schedule$12,000
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
SCHEDULE 19 - UNION ADMINISTRATION FILE NUMBER: 542-249

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 20 - BENEFITS FILE NUMBER: 542-249

Description
(A) 		To Whom Paid
(B) 		Amount
(C)
Total of all lines above (Total will be automatically entered in Item 55.)$52,882
MEDICAL BENEFITSSPARROW HUMAN RESOURCES$40,465
EMPLOYEE LIFE INSURANCEAUTO OWNERS LIFE INSURANCE$38
WORK COMP INSURANCE CARRIERACCIDENT FUND$1,632
DISBURSEMENTSSPARROW HEALTH SYSTEM$3,679
EMPLOYEE INSURANCESRELIANCE STANDARD LIFE INS CO$5,302
GROUP LIFE INSURANCEAUTO OWNERS INSURANCE$38
DENTAL INSURANCEDELTA DENTAL$1,690
LIFE INSURANCEAUTO OWNERS LIFE INSURANCE$38
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)
69. ADDITIONAL INFORMATION SUMMARY FILE NUMBER: 542-249


Question 10: Voluntary Employee Benefit Association (VEBA) is a retiree medical plan which UAW Local 4911 members contribute to via payroll deduction through Sparrow Hospital. The trust is administered by Richard Lichtenstein c/o Benefits Administrative Services Company.

Question 15: : A Bible is given to UAW members if they have an immediate family member that dies. A UAW Local 4911 tote bag is given to new members at a membership meeting if they attend the welcoming session.

Schedule 13, Row1:

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, Row1::

General Information:

General Information:
Form LM-2 (Revised 2010); (Tech. Rev. 2/2013)