2016-03-15T00:00:00-05:00 2015-06-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2014-07-01 942541328 SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN SHEE 9252089999 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 RICK WERNER TRUSTEE 9252089999 2016-03-16 1 JESSICA R ROSTER P01317380 9252779100 2014 2016-08-17 19:52:53Z RICK WERNER 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 107387502 0 X N/A X 1979 CA TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS 16 0 940 0 0 0 0 0 84392210 91868534 1970647 2719767 0 0 86362857 94588301 0 0 71938376 77810730 0 50823 0 0 0 4186163 4621988 76124539 82483541 10238318 12104760 90217711 105885560 24579454 28576757 65638257 77308803 TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS. 0 0 PROVIDED HEALTH AND WELFARE BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS TO PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS. 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 1207 0 1 940 1 0 0 0 0 0 0 X 16 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BENESYS INC 9252089999 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 X PAUL STECKEL TRUSTEE 4.00 X 0 0 0 GARLAND SELF JR TRUSTEE 1.00 X 0 0 0 CHRIS ENFANTINO TRUSTEE 1.00 X 0 0 0 BOB BRAMLETT TRUSTEE 1.00 X 0 0 0 BRUCE WORD TRUSTEE (PAST) 6.50 X 0 0 0 MITCHELL HOPPE TRUSTEE 1.00 X 0 0 0 BRETT RISLEY TRUSTEE (PAST) 2.00 X 0 0 0 JOSEPH A MARACCINI TRUSTEE 5.00 X 0 0 0 PAUL ARSENAULT TRUSTEE (PAST) 2.00 X 0 0 0 RICHARD WERNER TRUSTEE 2.00 X 0 0 0 WILLIE SOLIS TRUSTEE 2.00 X 0 0 0 ROB STOKER TRUSTEE (PAST) 2.00 X 0 0 0 STEVE LOPEZ TRUSTEE 2.00 X 0 0 0 SEAN O'DONOGHUE TRUSTEE 2.00 X 0 0 0 RANDY ATTAWAY TRUSTEE 2.00 X 0 0 0 ANTHONY URBINA TRUSTEE 2.00 X 0 0 0 KEITH DIAS 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 SUITE 200 SAN RAMON CA 94583 ADMINISTRATION 2330750 BLUE SHIELD OF CALIFORNIA 50 BEALE STREET SAN FRANCISCO CA 941051808 CLAIMS PROCESSING 571678 DELTA DENTAL OF CALIFORNIA PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS PROCESSING 374375 KAUFMAN & GOBLE 160 W SANTA CLARA STREET SUITE 15 SAN JOSE CA 95113 CONSULTING 148250 ENVISION PHARMACEUTICAL SERVICES 1100 INVESTMENT BOULEVARD ELDORADO HILLS CA 95762 ADMINISTRATION 146811 6 EMPLOYER CONTRIBUTIONS 900099 79320599 79320599 EMPLOYEE CONTRIBUTIONS 900099 11262738 11262738 MEDICARE - D REBATES 900099 1015654 1015654 SETTLEMENT INCOME 900099 263902 263902 OTHER 900099 5641 5641 91868534 2808573 2808573 12710395 12799201 -88806 -88806 -88806 94588301 91868534 0 2719767 77810730 50823 2187005 58658 41170 166646 1633293 210482 8539 30287 TRANSITIONAL INSURANCE 285898 MISCELLANEOUS 10 82483541 -259249 -365858 3853891 10665105 14832638 15804537 50616 50264 71739815 79731512 90217711 105885560 509241 724566 917213 904191 23153000 26948000 24579454 28576757 X 0 0 0 0 65638257 77308803 65638257 77308803 90217711 105885560 12104760 -434214 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILTY CREDITS 20118000 CLAIMS PAYABLE & INCURRED BUT NOT REPORTED 6830000 26948000 X 93987441 -434214 -434214 94421655 166646 166646 94588301 78521895 0 78521895 166646 3795000 3961646 82483541 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, 2015, 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 IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2012. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OLIGATIONS 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 11 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. 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. FORM 990, PART V, LINE 2A: THE PLAN DOES NOT HAVE ANY EMPLOYEES; HOWEVER, CERTAIN PARTICIPANTS OF THE PLAN RECEIVED A FORM W-2 FOR TAXABLE DOMESTIC PARTNER BENEFITS AND UNEMPLOYMENT BENEFITS PROVIDED UNDER THE PLAN. LOCAL 104 SUPPLEMENTAL PENSION PLAN 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 946560138 THE PLAN PROVIDES SUPPLEMENTAL PENSION BENEFITS CA 501A N/A N/A 0 SHEET METAL WORKERS PENSION TRUST OF NORTHERN CALIFORNIA 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 516115939 THE PLAN PROVIDES PENSION BENEFITS TO RETIREES CA 501A N/A N/A 0 SHEET METAL WORKERS INTERNATIONAL ASSN LOCAL UNION NO 104 2610 CROW CANYON ROAD SUITE 300 SAN RAMON CA 94583 940859420 UNION CA 501C(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, IDENTIFICATIN 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, 2015, THERE ARE APPROXIMATELY 238 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 G C, INC A I M SHEET METAL INC AAERO HEATING & S/M CO AAXON MECHANICAL, INC. ABCO MECHANICAL CONTR ABM BUILDING SOLUTIONS, LLC ACCEL AIR SYSTEMS INC. ACCO ENGINEERED SYS ACI MECHANICAL INC. ADVANCED AIRE SYSTEMS AIR CONDITIONING SYSTEM AIR CONNECTION AIR EXCHANGE AIR PERFECTION HEATING & AC AIR SYSTEMS ACQUISTION AIR SYSTEMS OF SACRAMENTO AIRCAL HTG. & S/M AIRCO COMMERCIAL SERV AIRCO MECHANICAL, INC. AIRE SHEET METAL AIRTEC SERVICE AKIMA, LLC ALBION SHEET METAL ALES INSTALLATIONS ALL BAY MECHANICAL, INC. ALL TEMPERATURE SERVICE AIR ALLEN HTG & SHEET METAL ALLIED HTG & AIR COND ALPHA AIR BALANCING AG ALPINE MECH SERVICE CO AMERICAN METAL PROD ANDERSON ROWE & BUCKLEY ANDY'S ROOFING CO., INC. ANNING JOHNSON APEX MECHANICAL, INC. ARENA & SONS ASCO SERVICE, INC. ASSOCIATED AIR BAL. & CERTIFIC AUTOMATED SOLUTIONS GROUP AXIS MECHANICAL BANGAR CONTRACTORS CORPORATION BAY AREA BAL & CLEAN BAY CITY MECHANICAL BAY POINT CONTROL BAYSIDE HTG & A/C BEL AIR MECHANICAL BELL PRODUCTS BERLIN FOOD EQUIPMENT BEST CONTRACTING SERVICES BLOCKA CONSTR INC BOGNER SHEET METAL BOHN HEATING BONESO BROTHERS CONSTRUCT. INC BRADY AIR CONDITIONING BROADWAY MECH. CONTRACTORS BROADWAY S/M MFG INC BRUNS BELMONT CONSTRUCTION INC BUENA VISTA CONSTRUCTION BULLARD'S HEATING & AIR, INC. BURLINGAME HTG VENT CO C M F, INC. CAL-AIR/JOHNSON CONTROLS, INC. CALIFORNIA AIR INC CARMINE AIR CONDITIONING, INC. CARQUINEZ HEATING A/C & S/M CARTER CONGI & LEE INC. DBA CER MECHANICAL CORPORATION CHAMPION INDUSTRIAL CONTRACTOR CITY MECHANICAL, INC. CLINTON HTG & AIR COND COLD CRAFT COLTON HEATING COMFORT AIR, INC. COMFORT CONTROL COMFORT DYNAMICS INC. CONGI INC. DBA CARTER AIR CONTROL AIR NORTH INC CRANE HEATING & AIR COND. CRITCHFIELD MECHANICAL CROWN CORR, INC. CROWN SKYLIGHTS, INC. CULINARY STAINLESS FABRICATORS DDK MECHANICAL, INC. DEBELLA MECHANICAL,INC DEGREE HVAC, INC. DEHARO MECHANICAL INC. DELCON HEATING & A/C, INC. DELLA MORA HTG,S/M, & A/C, INC DEPENDABLE SHEET METAL DESERT MECHANICAL, INC. DOWDLE & SONS MECHANICAL, INC DOWNING HEATING & AIR COND. DYNAMIC MECHANICAL ENVIRONMENTAL SYSTEMS INC. EXTREME AIR INC F S I F. W. SPENCER & SON, INC. FAIRVIEW HEATING & A/C FERTADO HEATING & AIR, INC. FINAL AIR BALANCE FOOTHILL AIR COND FRANK M BOOTH GEORGE NARSO DBE GEHVAC CO. GEORGE WILSON INC GLOBAL SPECIALTIES DIRECT, INC HAWK MECHANICAL, INC. HEATHORN & ASSOCIATES DBA H-SQUARE MECHANICAL, INC. HVAC CAD SERVICE I E S INDOO ENVIRO SVS ICOM MECHANICAL INDEPENDENT AIR BALANCE DBA INNOVATIVE MECH INC INTECH MECHANICAL CO., INC. IZMIRIAN ROOFING & S/M JAMES LONG CONSTRUCTION JEFFCO CUSTOM METALS, INC. JENSEN MECHANICAL, INC. JEROME & HORNER SHEET METAL JET MECHANICAL, INC. JIM'S AIR SYSTEMS JMS MECHANICAL K & M INSTALLATION KEL AIRE HTG KENT M LIM & CO INC KINETIC SYSTEMS, INC KINETICS MECHANICAL SVC KITCOR CORPORATION KODIAK UNION ROOFINGS SERVICE L J KRUSE COMPANY LARGE'S METAL FAB LAWSON MECHANICAL LEFCO INC LETNER ROOFING LYLES MECHANICAL COMPANY, INC. M & M S/M AND RAIN GUTTER CORP M T B INCORPORATED M.E.S.A. 3, INC MARELICH MECHANICAL CO MARKEN MECHANICAL SERVICES MARTINEZ SHEET METAL MATRIX HEATING, INC. MAUCK SHEET METAL WORKS MC MECHANICAL MECHANICAL TECHNOLOGIES CORP MELROSE METAL PRODUCTS MESA ENERGY SYSTEMS INC. METAL DESIGN & STRATEGY, INC. MG MCGRATH, INC. MICHAEL D BURNS COMPANY, INC. MILESTONE CONTRACTORS INC. DBA MINA METALS MONARCH MECHANICAL MONSTER MECHANICAL, INC. MONTEREY MECHANICAL CO NATIONAL AIR BALANCE NORGE AIR, INC. DBA O C MCDONALD CO., INC. OJV SHEET METAL & RAIN GUTTERS OMNI SHEET METAL, INC. ORSON MECHANICAL CO., INC. PACIFIC COAST TRANE SVC PACIFIC TEST AND BALANCE, INC. PAN-PACIFIC MECHANICAL PARAGON MECHANICAL INC PAUL WEST HTG. INC. PENN AIR CONTROL, INC. PERFORMANCE AIR SERVICE, INC. PETERSON H.V.A.C. PETERSON MECHANICAL, INC. PIONEER ROOFING ORGANIZATION POMI MECHANICAL INC. PRIME MECHANICAL SERVICE, INC. PSF MECHANICAL, INC. R H TINNEY R J MECHANICAL, INC RANGEL HTG VENT DBA RAY L HELLWIG MECH REACO HEATING & A/C REBARBER ENT.INC. RECIP L088 RECIP L273 SMW LU #273 RELIANCE ENTERPRISES RICS SHEET METAL INC RMI MECHANICAL, INC. RODRIGUEZ SHEET METAL RS ANALYSIS, INC. S & L PAYTON, INC SAL J ACOSTA MFG CO INC SANTA CLARA VLY CNTCRS SCHAFERS S/M & MFG CO SELCO HTG & A/C SERVICE MECHANICAL, INC. SERVICE METAL PROD INC SHEET METAL WORKERS SHEET METAL WRKS LU 104 SHEPHARD MECHANICAL CONTRACTOR SIERRA VALLEY HOME CORP. SILICON VALLEY MECH SIMPSON SHEET METAL, INC. SMW 104 BAY AREA IND TRAIN FUN SOUTHLAND INDUSTRIES STALEY'S SHEET METAL STANDARD S/M & MARINE STARS & STRIPS MECHANICAL STATE SHEET METAL WORKS STREIMER SHEET METAL STRUCTURAL & REFRIGERATION MEC SUPERIOR AIR HANDLING DBA SUPERIOR MECH. SERVICES, INC. T.A.B.C.O. INC TECTA AMERICA SACRAMENTO, INC. THE TIN MAN THERMA CORP. THERMAL MECHANICAL THREE CORD ENTERPRISES INC. T-I PACIFIC COAST SHIPYARDS TRAYER ENGINEERING TULLEY MECHANICAL, INC. UNITED MECHANICAL, INC. V. MARTINICO & SONS S/M VALLEY SEAMLESS RAIN GUTTER VALLEY SHEET METAL CO VAL'S PLUMBING VAN MULDER SHEET METAL VENTEC VERDEGAAL HEATING INC VERTEX MECHANICAL INC VIRGINIA MECHANICAL, INC. WATERPROOFING ASSOCIATES WCASM INC, DBA WEST COAST ASM WEATHER MASTERS, INC. WEST COAST TEST AND BALANCE WESTATES MECH CORP WESTERN ALLIED MECHANICAL, INC WESTERN ENGINEERING SUPPLY CO WESTLAND HEATING & A/C INC. YOUR WARM FRIEND,INC.