2019-10-21T15:04:48-05:00 2018-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2018-01-01 776113549 NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN NORT 9252089992 PO BOX 1677 SAN RAMON CA 94583 SAL ROTOLO TRUSTEE 9252089992 2019-10-21 1 JESSICA R ROSTER P01317380 9252779100 66.7.226.66 2019-10-21 13:04:37 PD P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2018 2019-02-21 02:37:17Z SAL ROTOLO PO BOX 1677 SAN RAMON CA 94583 28938083 0 X N/A X 1995 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 0 0 0 0 0 0 24559689 27500697 480508 553755 0 0 25040197 28054452 0 0 24843169 26366968 0 0 0 0 0 1556467 1628296 26399636 27995264 -1359439 59188 24753375 25758450 9895276 11737255 14858099 14021195 TO PROVIDE HEALTH AND WELFARE BENEFITS 0 0 PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION AND EMPLOYERS. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 285 0 1 0 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X BENESYS INC 9252089992 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 X SAL ROTOLO TRUSTEE 2.00 X 0 0 0 RICK WERNER TRUSTEE 2.00 X 0 0 0 DENNIS CANEVARI TRUSTEE - PAST 2.00 X 0 0 0 JIM CONWAY TRUSTEE 2.00 X 0 0 0 MIKE LOPEZ TRUSTEE 2.00 X 0 0 0 RICHARD COOKE TRUSTEE - PAST 2.00 X 0 0 0 DUSTIN SACCONE TRUSTEE 2.00 X 0 0 0 ROB BELL TRUSTEE 2.00 X 0 0 0 MICHAEL MARK TRUSTEE 2.00 X 0 0 0 GARY MYERS TRUSTEE 2.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.00 X 0 1 0 0 1 0 0 0 0 0 BENESYS INC 2610 CROW CANYON ROAD SAN RAMON CA 945831768 CONTRACT ADMINISTRATOR 910647 BLUE SHIELD 50 BEALE STREET 20TH FLOOR SAN FRANCISCO CA 94105 COST CONTAINMENT 236040 2 EMPLOYER CONTRIBUTIONS 999999 23038968 23038968 RETIREE CONTRIBUTIONS 999999 4037308 4037308 MEDICARE-D REBATE 999999 291264 291264 PRESCRIPTION REBATE 999999 104342 104342 OTHER 999999 28815 28815 27500697 619809 619809 817577 883631 -66054 -66054 -66054 28054452 27500697 0 553755 26366968 874829 60129 49759 18816 538755 57724 9456 4159 14669 27995264 -63806 -64427 2620492 3000257 3848948 4878970 11934 1524 18335807 17942126 24753375 25758450 133217 155890 330059 313365 9432000 11268000 9895276 11737255 X 0 0 0 0 14858099 14021195 14858099 14021195 24753375 25758450 59188 -896092 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY 7548000 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 3720000 11268000 X 27139544 -896092 -896092 28035636 18816 18816 28054452 26140448 0 26140448 18816 1836000 1854816 27995264 PART X, LINE 2: THE PLAN'S ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN AND HAS CONCLUDED THAT, AS OF DECEMBER 31, 2018, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL 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 2015. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS FORM 990, PART VI, SECTION A, LINE 3 THE TRUST HAS CONTRACTED WITH BENESYS, INC. TO PROVIDE ADMINISTRATIVE SERVICES FOR THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO EACH GOVERNING BODY MEMBER. REVIEW OF FORM 990 WAS CONDUCTED BY THE BOARD OF TRUSTEES (THE GOVERNING BOARD) PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, 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; AND APPROVAL OF SUCH TRANSACTION IS DEPENDENT ON THE TRUSTEES DETERMINING THAT THE TRANSACTION IS IN THE BEST INTEREST OF THE TRUST AND THE TERMS OF THE TRANSACTION ARE FAIR WITH RESPECT TO TERMS AVAILABLE THROUGH ARMS-LENGTH TRANSACTIONS IN THE MARKETPLACE. FORM 990, PART VI, SECTION B, LINE 15 THE PLAN'S TRUSTEES ARE NOT PAID FOR THEIR SERVICES TO THE PLAN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT-OF-INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. 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 SERIVCE 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 BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. THIS PROCESS HAS NOT CHANGED. SHEET METAL WORKERS LOCAL UNION NO 104 2610 CROW CANYON ROAD SUITE 300 SAN RAMON CA 94583 940859420 LABOR UNION CA 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE R, 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 DECEMBER 31, 2018, THERE ARE APPROXIMATELY 96 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 ADMINISTRAIVE OFFICE AND IT COULD NOT BE REASONABLY OBTAINED. AS A RESULT, THE NAMES OF THE CONTRIBUTING EMPLOYERS ARE LISTED IN PART VII BELOW AND NOT ON PARTS II THROUGH IV BY FEDERAL TAX CLASSIFICATION. 3IN1 CONTROL, INC ABM BUILDING SOLUTIONS, LLC ACCO ENGINEERED SYSTEMS AIR CONTROL & DESIGN, INC. AIR CONTROL BALANCE, INC. AIR EXCHANGE, INC. AIR SYSTEMS SERVICE & CONSTR. AIRCO MECHANICAL INC. ATS PRODUCTS INC B N MECHANICAL INC BEST CONTRACTING SERVICES BOB HOLL SHEET METAL, INC. BONESO BROTHERS CONSTRUCT. INC BOS SHEET METAL BOTELHO WELDING SERVICE BOTNER MANUFACTURING INC BRICE MECH. CONTRACTORS, INC. BROWN S/M & MECHANICAL CA DEPT PRISON-CDCR REG ACCTNG CALIFORNIA SHEET METAL CAPITAL SHEET METAL WRK CENTER PLUMBING CO CENTRAL VALLEY INSTALLATION CHAMPION INDUSTRIAL CONTR. CIRCO SYST BALANCE INC CLIMATE CONTROL, INC. COMFORT AIR, INC. CONSOLIDATED METAL FAB CRITCHFIELD MECHANICAL D.G. GRANADE, INC. DDK MECHANICAL, INC. DKM HEATING & A/C, INC. DOUGLAS HEATING AND COOLING DUCTMATE IND INC EFFICIENT ENRGY CONCPT EMCOR ARC SERVICE EMCOR/MESA ENERGY SERVICE EVOLUTION SHEET & METAL FAB. FRANK M BOOTH INC FRED L HILL HOLDER A/C & HEATING INDOOR ENVIROMENTAL SERVICES INTECH MECHANICAL CO. INC. J.R. BARTO HEATING & AC JAMES LONG CONSTRUCTION SVC K & M INSTALLATIONS KINETICS MECH SERVICE INC. KINGS COUNTY AIR COND KITCOR CORPORATION LAWSON MECHANICAL INC LILJA CORPORATION M.E.S.A. 3, INC MECHANICAL DRAFT AND DESIGN MELROSE METAL PRODUCTS METAL DESIGN & STRATEGY, INC. MINA METALS MONTAGUE COMPANY MORRIS SHEET METAL MTECH CORP. NATIONAL AIR BALANCE NATIONAL ENERGY MGMT INST. CO NEW ENGLAND S/M AND MECH. CO. NICRO INC NIECO CORPORATION NOLL / NORWESCO LLC NOR-CAL METAL FABRICATORS O E S S/M & FAB PACIFIC TEST & BALANCE, INC. PAN-PACIFIC MECHANICAL PATTON SHEET METAL WORK PERFORMANCE AIR SERVICE, INC. PINASCO INC R.B. SPENCER, INC. RAGLEN SYSTEM BALANCE RAM MECHANICAL, INC. RS ANALYSIS, INC. RUTHERFORD CO., INC. S/M IND JOINT APP COMM SACTO VALLEY APPR FUND SHEET METAL WORKERS 104 DIST 2 SMITH HEATING AIR COND STARACE MECHANICAL STRATEGIC MECHANICAL INC. SUPERIOR AIR HANDLING T D R ENTERPRISE T.A.B.C.O. TECTA AMERICA SACRAMENTO, INC. TERMINAL MANUFACTURING TOP NOTCH MECHANICAL, INC. TOWN & COUNTRY HEATING & COOL. VALLEY MECHANICAL CORPORATION VIC MYERS SHEET METAL W A CALL MFG CO W. V. ALTON, INC. - S/A WAGNER MECHANICAL WELLMADE PRODUCTS