2015-03-16T18:20:51-05:00 2014-06-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2013-07-01 942541328 SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN SHEE 9252089999 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 BRUCE WORD TRUSTEE 9252089999 2015-03-18 1 JESSICA R ROSTER P01317380 9252779100 2013 2016-02-25 16:41:14Z BRUCE WORD 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 110671007 0 X N/A X 1979 CA TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS 16 0 1037 0 0 0 0 0 87555394 84392210 1452277 1970647 198230 0 89205901 86362857 0 0 67247111 71938376 0 0 0 0 0 4036546 4186163 71283657 76124539 17922244 10238318 78472521 90217711 27150378 24579454 51322143 65638257 TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYEMENT 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 1208 0 1 1037 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 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 6.50 X 0 0 0 MITCHELL HOPPE TRUSTEE 1.00 X 0 0 0 BRETT RISLEY TRUSTEE 2.00 X 0 0 0 JOSEPH A MARACCINI TRUSTEE 5.00 X 0 0 0 PAUL ARSENAULT TRUSTEE 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 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 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 2271551 BLUE SHIELD OF CALIFORNIA 50 BEALE STREET SAN FRANCISCO CA 941051808 CLAIMS PROCESSING 464912 DELTA DENTAL OF CALIFORNIA PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS PROCESSING 367783 KAUFMAN & GOBLE 160 W SANTA CLARA STREET SUITE 15 SAN JOSE CA 95113 CONSULTING 145250 ENVISION PHARMACEUTICAL SERVICES 1100 INVESTMENT BOULEVARD ELDORADO HILLS CA 95762 ADMINISTRATION 128829 5 EMPLOYER CONTRIBUTIONS 900099 72146147 72146147 EMPLOYEE CONTRIBUTIONS 900099 11176889 11176889 MEDICARE - D REBATES 900099 935050 935050 SETTLEMENT & OTHER 900099 100724 100724 HRA WELLNESS REWARDS INCOME 900099 33400 33400 84392210 2215045 2215045 24063752 24308150 -244398 -244398 -244398 86362857 84392210 0 1970647 71938376 2184571 75083 36002 125183 1493654 175182 5137 29763 OTHER EXPENSES 61588 76124539 -248263 -259249 5323485 3853891 15624483 14832638 50968 50616 57721848 71739815 78472521 90217711 472874 509241 876351 917213 25801153 23153000 27150378 24579454 X 0 0 0 0 51322143 65638257 51322143 65638257 78472521 90217711 10238318 4077796 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILTY CREDITS 17467000 CLAIMS PAYABLE & INCURRED BUT NOT REPORTED 5686000 23153000 X 90315470 4077796 4077796 86237674 125183 125183 86362857 78561356 0 78561356 125183 -2562000 -2436817 76124539 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, 2014, 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 2011. 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 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. 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. 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 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, 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, 2014, 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 G C, INC A I M SHEET METAL AAERO HEATING & S/M CO AAXON MECHANICAL INC. ABCO MECHANICAL CONTR ACCEL AIR SYSTEMS INC. ACCO ENGINEERED SYS ACI MECHANICAL INC. ADVANCED AIRE SYSTEMS AIR CONDITIONING SYSTEM AIR EXCHANGE AIR SYSTEMS ACQUISTION AIR SYSTEMS OF SACRAMENTO AIRCAL HTG. & S/M AIRCO COMMERCIAL SERV AIRCO MECHANICAL, INC. AIRE MECHANICAL AIRE SHEET METAL AIRTEC SERVICE AKIMA, LLC ALL BAY MECHANICAL, INC. ALL TEMPERATURE SERVICE AIR ALLEN HTG & SHEET METAL ALLIED HTG & AIR COND ALPHA AIR BALANCING AG ALPINE MECH SERVICES AMERICAN METAL PROD ANDERSON ROWE & BUCKLEY ANNING JOHNSON APEX MECHANICAL, INC. ARENA & SONS ASCO SERVICE, INC. ASSOCIATED AIR BAL. & CERTIFIC AUTOMATED SOLUTIONS GROUP AXIS MECHANICAL BAL-AIR MECHANICAL, INC. 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 BLUE MOUNTAIN AIR BOGNER SHEET METAL BOHN HEATING BONESO BROTHERS CONSTRUCT. INC BRADY AIR CONDITNG. BROADWAY MECH. CONTRACTORS BROADWAY S/M MFG INC BRUNS BELMONT CONSTRUCTION INC BULLARD'S HEATING & AIR, INC. BURLINGAME HTG VENT CO CAL-AIR/JOHNSON CONTROLS, INC. CALIFORNIA AIR INC CARMINE AIR CONDITIONING, INC. CARQUINEZ HEATING A/C & S/M CARTER CONGI & LEE INC. CER MECHANICAL CORPORATION CHAMPION INDUSTRIAL CONTRACTOR CHUTE SYSTEMS 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. 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 DELUCCHI MECHANICAL DEPENDABLE SHEET METAL 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. FOOTHILL AIR COND FRANK M BOOTH GEORGE WILSON INC GLOBAL SPECIALTIES DIRECT, INC GOLDEN GATE S/M H-SQUARE MECHANICAL, INC. HAWK MECHANICAL, INC. HEATHORN & ASSOCIATES HEATHORN MECH. SERVICES, INC. HVAC CAD SERVICES INC I E S INDOO ENVIRO SVS ICOM MECHANICAL INDEPENDENT AIR BALANCE 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 KAMRAN METAL WORKS, INC. KEL AIRE HTG KENT M LIM & CO INC KINETIC SYSTEMS, INC KINETICS MECHANICAL SVC KT MECHANICAL INC. L J KRUSE COMPANY LARGE'S METAL FAB LAWSON MECHANICAL LEFCO INC LYLES MECHANICAL COMPANY, INC. 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 MECHANICAL TECHNOLOGIES CORP MELROSE METAL PRODUCTS MESA ENERGY SYSTEMS INC. MICHAEL D BURNS COMPANY, INC. MILESTONE CONTRACTORS INC. MINA METALS MONARCH MECHANICAL MONSTER MECHANICAL, INC. MONTEREY MECHANICAL CO NATIONAL AIR BALANCE NORGE AIR, INC. NORTH BAY COMMERCIAL SERVICES O C MCDONALD CO., INC. OMNI SHEET METAL, INC. PACIFIC COAST BALANCING 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 MECHANICAL, INC. PIONEER ROOFING ORGANIZATION POMI MECHANICAL INC. PRIME MECHANICAL SERVICE, INC. PRO TEMP MECHANICAL INC. PSF MECHANICAL, INC. QUALTECH MECHANICAL, INC. R H TINNEY R J MECHANICAL, INC RANGEL HTG VENT RAY L HELLWIG MECH REBARBER ENT.INC. RELIANCE ENTERPRISES RICS SHEET METAL INC RMI MECHANICAL, INC. RODRIGUEZ SHEET METAL RS ANALYSIS, INC. RYMAC, INC. S & H CONSTRUCTION, 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 WRKS LU 104 SHEPHARD MECHANICAL CONTRACTOR 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 OF CALIFORNIA STATE SHEET METAL WORKS STREIMER SHEET METAL STRUCTURAL & REFRIGERATION MEC SUPERIOR AIR HANDLING SUPERIOR MECH. SERVICES, INC. T.A.B.C.O. INC THERMA CORP. THERMAL MECHANICAL TRAYER ENGINEERING TULLEY MECHANICAL, INC. UNITED MECHANICAL, INC. VAL'S PLUMBING VALLEY PROCESS SYSTEMS VALLEY SHEET METAL CO VAN MULDER SHEET METAL VENTEC VERDEGAAL HEATING INC VERTEX 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 YOUR WARM FRIEND,INC.