2023-05-05T15:03:19-05:00 2022-06-30 WITHUMSMITHBROWNPC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2021-07-01 942541328 SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN % BENESYS INC SHEE 9252089999 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 RICK WERNER TRUSTEE 9252089999 2023-05-04 true RICK WERNER 999009999 JESSICA R ROSTER P01317380 9252779100 2023-05-04 2021 2023-04-26 12:10:37Z RICK WERNER 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 180710951 false X n/a X 1979 CA TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS 14 0 0 0 0 0 0 0 119274871 112547655 3140664 13061915 0 0 122415535 125609570 0 0 114089884 117628593 55834 50508 0 0 0 4989107 5136050 119134825 122815151 3280710 2794419 245411370 215380603 42360683 41913644 203050687 173466959 TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS. false false PROVIDED HEALTH AND WELFARE BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS TO PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. false false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 5 0 true 0 true false false false false false false false false X 14 0 false true false false false false false true true false false true true true true true true false false false CA X BENESYS INC 9252089994 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 X rick werner chairman 0.0 4.0 X 0 0 0 richard koenig TRUSTEE 0.0 2.0 X 0 0 0 brian werner - PAST TRUSTEE 0.0 2.0 X 0 0 0 brian masters TRUSTEE 0.0 2.0 X 0 0 0 dominic torreano TRUSTEE 0.0 2.0 X 0 0 0 keith dias TRUSTEE 0.0 2.0 X 0 0 0 joseph maraccini - PAST TRUSTEE 0.0 2.0 X 0 0 0 eric haynes TRUSTEE 0.0 2.0 X 0 0 0 sean o'donoghue TRUSTEE 0.0 2.0 X 0 0 0 bob bramlett trUSTEE 0.0 2.0 X 0 0 0 chris enfantino tRUSTEE 0.0 2.0 X 0 0 0 paul steckel tRUSTEE 0.0 2.0 X 0 0 0 kathy de jong TRUSTEE 0.0 2.0 X 0 0 0 duane davies trUSTEE 0.0 2.0 X 0 0 0 CASEY VAN DEN HEUVEL TRUSTEE 0.0 2.0 X 0 0 0 MIKE NESBITT TRUSTEE 0.0 2.0 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.0 0.0 X 0 0 0 0 0 0 0 false false false Benesys Inc 2610 crow canyon road suite 200 san ramon CA 94583 administration 2645746 NORTHWEST PLAN SERVICES INC 160 W SANTA CLARA Street Suite 15 san jose CA 95113 consulting 174000 BLUE SHIELD OF CALIFORNIA 50 BEALE STREET SAN FRANCISCO CA 941051808 CLAIMS PROCESSI 902832 DELTA DENTAL OF CALIFORNIA PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS PROCESSI 459891 10 0 Employee Contributions 900099 13319444 13319444 Employer Contributions 900099 91350204 91350204 Medicare - D Rebates 900099 1225387 1225387 PRESCRIPTION REBATES 900099 3307500 3307500 STOP LOSS INCOME 900099 3185591 3185591 159529 159529 112547655 3872145 3872145 0 0 0 0 0 64291151 55101381 9189770 9189770 9189770 0 0 0 0 0 0 0 0 0 0 125609570 112547655 13061915 0 0 0 117628593 0 0 0 0 0 50508 2493751 58152 49418 0 0 86278 2178870 0 199320 0 0 0 0 0 2290 0 0 0 48138 PCORI TAX 19833 122815151 -314204 -214511 49290528 35871954 0 0 22135473 21141120 0 0 0 0 0 0 0 0 50000 50000 0 0 174249573 158532040 0 0 0 0 0 0 0 0 245411370 215380603 948361 893879 0 0 1009322 1083765 0 0 0 0 0 0 0 0 0 0 40403000 39936000 42360683 41913644 X 0 0 0 0 203050687 173466959 203050687 173466959 245411370 215380603 2794419 -32378147 X X false true X true false 0 Accumulated Eligibility Credits 28356000 REPORTED CLAIMS 11580000 39936000 93145145 -32378147 -32378147 125523292 86278 86278 125609570 123195873 123195873 86278 -467000 -380722 122815151 PART X, LINE 2 THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF JUNE 30, 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN, OR EXPECTED TO BE TAKEN, THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FIANNCIEAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY THE TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN'S ADMINISTRATOR BELIEVES THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2019. PART XII, LINE 4B - OTHER ADJUSTMENTS CHANGE IN BENEFIT OBLIGATIONS Form 990, Part VI, Section A, Line 3 THE PLAN HAS CONTRACTED WITH BENESYS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B: A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF TRUSTEES FOR REVIEW BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C: TRUSTEES ARE REQUIRED TO DISCLOSE IN WRITING ANY RELATIONSHIPS OR INTEREST THAT COULD GIVE RISE TO A CONFLICT. IF THERE IS A CONFLICT OF INTEREST, THE CONFLICTING INTEREST IS FULLY DISCLOSED AND DOCUMENTED IN WRITING; THE TRUSTEE OR FIDUCIARY WITH THE CONFLICT OF INTEREST IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS,CONFLICT-OF-INTEREST POLICY AND FINANCIAL INFORMATION AVAILABLE. FORM 990, PART VII, SECTION A, LINE 1A: TRUSTEES ARE NOT COMPENSATED BY THE TRUST. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX EXEMPT ORGANIZATION. IF YOU WOULD LIKE ADDITIONAL INFORMATION, PLEASE CONTACT THE THIRD-PARTY ADMINISTRATOR, BENESYS, INC. FORM 990, PART XII LINE 2C THE ORGANIZATION HAS A BOARD OF TRUSTEES THAT ASSUMES RESPONSIBLITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. local 104 supplemental pension plan 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 946560138 SUPP PENSION CA 501A N/A NA false sheet metal workers pension trust of nor 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 516115939 PENSION BENEF CA 501A N/A NA false Sheet Metal workers International ASSN L 3232 CONSTITUTION DRIVE LIVERMORE CA 94551 940859420 Union CA 501C(5) N/A nA false false false false false false false false false false false false false false false false true false false false Identification of Related Organizations THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH AND WELFARE BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF JUNE 30, 2022, THERE ARE APPROXIMATELY 219 EMPLOYERS THAT CONTRIBUTE TO THE TRUST. THE ADMINISTRATIVE OFFICE MAINTAINS A DATABASE OF THESE CONTRIBUTING EMPLOYERS, INCLUDING NAMES, ADDRESSES AND OTHER CONTACT INFORMATION. THE FEDERAL TAX CLASSIFICATION (DISREGARDED ENTITY, TAX-EXEMPT ORGANIZATION, PARTNERSHIP, TAXABLE CORPORATION OR TRUST) FOR EACH CONTRIBUTING EMPLOYER IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED ON PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. A. ZAHNER CO. NORTH BAY COMMERCIAL SVCS INC A & B MECHANICAL, INC. ABM BUILDING SOLUTIONS, LLC ACS CONTROLS CORP. AAERO HEATING & S/M CO ABCO MECHANICAL CONTR ADVNC AIR TECHNOLOGIES ADVANCED SOLUTIONS,INC A I M SHEET METAL INC AIRCAL HTG. & S/M ACCO ENGINEERED SYS AIR CONDITIONING SYSTEMS AIR EXCHANGE AIR SYSTEMS SERVICE & CONST. AIRE SHEET METAL AKIMA, LLC ALLIED HTG & AIR COND ALPINE MECH SERVICE CO HEATHORN & ASSOCIATES DBA AMERICAN METAL PROD ANDERSON ROWE & BUCKLEY ANNING JOHNSON ARENA & SONS BAYSIDE HTG & A/C BAY CITY MECHANICAL BAY POINT CONTROL, INC. 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PIONEER ROOFING ORGANIZATION PRECISION CAD SERVICES, INC. PRIME MECHANICAL SERVICE, INC. RS ANALYSIS, INC. RMI MECHANICAL, INC. SCHAFERS S/M & MFG CO SERVICE METAL PROD INC SHEET METAL SYSTEMS, INC. - JATC FIRST YEAR APPRENTICE SMW 104 BAY AREA IND TRAIN FUN SHEET METAL WORKERS SHEET METAL WRKS LU 104 SILICON VALLEY MECHANICAL, INC SIMPSON SHEET METAL, INC. SOLDATE S/M HEATING & AIR SOUTHLAND INDUSTRIES WEST COAST MECHANICAL STANDARD S/M & MARINE STATE SHEET METAL WORKS STATE OF CA. DEPT. OF CORRECT. HARRIS BAY AREA, LLC BIM DESIGNS, INC. RVT DESK, INC. TEPS TOP NOTCH MECHANICAL, INC. STUMBAUGH & ASSOCIATES, INC. TRADEWINDS COOLING, LLC VAN MULDER SHEET METAL WESTCAL DESIGN AND BUILD, INC. WESTERN ALLIED MECHANICAL, INC WEST COAST TEST AND BALANCE YOUR WARM FRIEND,INC. JENSEN MECHANICAL, INC. R J MECHANICAL, INC R E MILANO PLUMBING CORP. T-O LU 67 RECIP L162 T-I LOCAL 003 SMW RECIP L016 T-I SMW LU #017 FUNDS OFFICE RECIP L026 T-I NORTHWEST SMW TI-LOCAL 058 RECIP L088 T-I LOCAL 162 T-I LOCAL 177 T-I LOCAL 268 SMW TRUST FUND T-I LOCAL 273 SMW RECIP L435 ACCEL AIR SYSTEMS INC. ACI MECHANICAL INC. SAL J ACOSTA MFG CO INC A G C, INC AIR SYSTEMS, INC. ACCO DBA GEORGE H. WILSON ALPHA AIR BALANCING AG ALL TEMPERATURE SERVICE AIR APEX MECHANICAL, INC. AIRTEC SERVICE ASCO SERVICE, INC. ASSOCIATED AIR BAL. & CERTIFIC AXIS MECHANICAL BAY AREA HVAC, INC. BAY AREA MECHANICAL, LLC BOGNER SHEET METAL FRANK M BOOTH DEHARO MECHANICAL INC. CHASE CONTRACTING, INC. COLD CRAFT COMFORT CONTROL SMITH MECHANICAL-ELECT.-PLBG CRITCHFIELD MECHANICAL DELLA MORA HTG,S/M, & A/C, INC DEBELLA MECHANICAL,INC AUTOMATED SOLUTIONS GROUP M.E.S.A. 3, INC ENVIRONMENTAL SYSTEMS INC. EXTREME AIR INC F S I FOOTHILL AC AND HEATING, INC. GAVILAN MECHANICAL, INC. WCASM INC, DBA WEST COAST ASM HAWAIIAN AIR CORPORATION ICOM MECHANICAL INDEPENDENT AIR BALANCE, INC. LARGE'S METAL FAB LEFCO INC OTAVILLA MECHANICAL CONTR. KT MECHANICAL INC. CALIFORNIA DRYWALL O C MCDONALD CO., INC. OMNI SHEET METAL, INC. METAL DESIGN & STRATEGY, INC. PACIFIC COAST TRANE SVC PACIFIC COAST BALANCING PARAGON MECHANICAL INC PERFORMANCE AIR SERVICE, INC. POURROY MANUFACTURING, INC. QUALTECH MECHANICAL, INC. STAINLESS FIXTURES, INC. WEST COAST FIRESTOPPING, INC. THERMAL MECHANICAL THERMA, LLC CALIFORNIA UNITED MECHANICAL, VAL'S PLUMBING VENTEC VERDEGAAL HEATING INC RODRIGUEZ SHEET METAL