2013-11-01T11:35:17-05:00 2012-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2012-01-01 776113549 NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN NORT 9252089994 PO BOX 1677 SAN RAMON CA 94583 DENNIS CANEVARI 9252089994 2013-11-01 1 JESSICA R ROSTER P01317380 9252779100 2012 2016-02-24 21:20:13Z DENNIS CANEVARI PO BOX 1677 SAN RAMON CA 94583 24760109 0 X N/A X 1995 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 0 0 0 0 0 0 16776752 19181226 849081 614366 103711 0 17729544 19795592 0 0 17646380 17910665 0 0 0 0 0 1249337 1266488 18895717 19177153 -1166173 618439 19849871 20840692 6874674 6693763 12975197 14146929 TO PROVIDE HEALTH AND WELFARE BENEFITS 0 0 PROVIDED HEALTH 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 1378 0 1 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 9252089994 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 X MARK BOWERS 2.00 X 0 0 0 SAL ROTOLO 2.00 X 0 0 0 MATTHEW SMITH 2.00 X 0 0 0 TONY LEDOUX 2.00 X 0 0 0 FRANK FLORES 2.00 X 0 0 0 DENNIS CANEVARI 2.00 X 0 0 0 LONNIE PETTY 2.00 X 0 0 0 RICHARD COOKE 2.00 X 0 0 0 JIM CONWAY 2.00 X 0 0 0 MIKE LOPEZ 2.00 X 0 0 0 DAVID LAWSON 2.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS INC 2610 CROW CANYON ROAD SAN RAMON CA 945831768 CONTRACT ADMINISTRATOR 828872 ANTHEM BLUE CROSS OF CA 120 MONUMENT CIRCLE INDIANAPOLIS IN 46204 COST CONTAINMENT 104421 2 EMPLOYER CONTRIBUTIONS 900099 14935944 14935944 PARTICIPANT CONTRIBUTIONS 900099 3875877 3875877 MEDICARE-D REBATE 900099 330997 330997 OTHER INCOME 900099 38408 38408 19181226 453232 453232 5125651 4964517 161134 161134 161134 19795592 19181226 0 614366 17910665 785174 31274 35600 24712 304712 63138 5200 16678 19177153 -200216 -71209 1232430 2015552 2596982 3112958 14882 13928 16205793 15769463 19849871 20840692 149162 93641 337512 321122 6388000 6279000 6874674 6693763 X 0 0 0 0 12975197 14146929 12975197 14146929 19849871 20840692 618439 553293 0 X X 0 1 X 1 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1295000 ACCUMULATED ELIGIBILITY CREDITS 4984000 6279000 X 20324173 553293 553293 19770880 24712 24712 19795592 19261441 0 19261441 24712 -109000 -84288 19177153 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2012, 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 2009. 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 11 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, LINES 15A AND 15B: 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. 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 162 DC RETIREMENT PLAN PO BOX 1677 SAN RAMON CA 94583 776138076 TO PROVIDE PENSION BENEFITS CA 501(A) N/A N/A 0 SHEET METAL WORKERS LOCAL UNION NO 104 2610 CROWN CANYON ROAD 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, 2012, THERE ARE APPROXIMATELY 103 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. ACCO ENGINEERED SYSTEMS, INC. AIR CONTROL BALANCING AIR SYSTEMS OF SACRAMENTO AIR SYSTEMS, INC. AIRCO COMMERCIAL SVC AIRCO MECHANICAL INC. ATS PRODUCTS INC. B N MECHANICAL INC. BAY CITY MECHANICAL BEST CONTRACTING SERVICES, INC. BOS SHEET METAL, INC. BOTNER MANUFACTURING INC. BRICE MECHANICAL BROWN SHEET METAL & MECHANICAL, INC. BRUNS BELMONT CONSTRUCTION INC. CA DEPT PRISON-CDCR REG ACCTNG CALIF STATE UNIVERSITY CALIFORNIA SHEET METAL INC. CAPITAL SHEET METAL WRK CARTER, CONG & LEE, INC. DBA CARTER AIR BALANCE CO. CENTER PLUMBING CO. CHAMPION INDUSTRIAL CONTRACTORS INC. CIRCO SYSTEM BALANCE, INC. CLIMATE CONTROL, INC. COMFORT AIR, INC. CONSOLIDATED METAL FAB CROWN CORR, INC. CUSTOM SHEET METAL, INC. DDK MECHANICAL, INC. DKM HEATING & A/C, INC. DUCTMATE INDUSTRIES, INC. EFFICIENT ENERGY CONCEPTS, INC. FINAL AIR BALANCE CO INC. FRANK M BOOTH FRED L HILL FRESNO & VICINITY SHEET METAL INDUSTRY APPRENTICESHIP & TRAINING TRUST FUND G.E.S. SHEET METAL INC. GRASS VALLEY AIR CONDITIONING HARRIS SUPERIOR CA INC. HENDERSON BROTHERS HOLDER A/C & HEATING INDEPENDENT TEST & BALANCE OF AUBURN INDOOR ENVIRONMENTAL INTECH MECHANICAL COMPANY, INC. J H SIMPSON CO. JOHNSON CONTROLS/CAL-AIR KAMRAN METALWORKS, INC. KINETICS MECHANICAL SERVICE, INC. KOLLER PLBG CO INC. LAWSON MECHANICAL CONTRACTORS LEFCO INCORPORATED LEGALLO MECHANICAL LIBERTY DUCT LILJA CORPORATION LUPPEN & HAWLEY INC. LYLES MECHANICAL CO. MARELICH MECHANICAL CO. INC. MARTIN INDUSTRIES, INC. MATRIX HG, INC. MCGILL AIRFLOW LLC MENDENHALL MFG., INC. MESA ENERGY SYSTEMS, INC. MESA3 / MECHANICAL ENVIRONMENTAL SYSTEMS ANALYSIS & ADJUSTMENT AGENCY, INC. METALCRAFTERS INC. MONTAGUE COMPANY MONTEREY MECHANICAL CO. MT ROSE HEATING & AIR COND. INC. NATIONAL AIR BALANCE NEW ENGLAND SHEET METAL WORKS, INC. NICRO, INC. NIECO CORPORATION NOLL / NORWESCO LLC NOR-CAL METAL FABRICATORS NORTHERN CALIFORNIA VALLEY SHEET METAL INDUSTRY JATTF O.E.S. SHEETMETAL & FABRICATION, INC. OMNI SHEET METAL, INC. PACIFIC METAL FABRICATORS PATTON SHEET METAL WORKS, INC. PINASCO INC. PUBLIC WORKS APPRENTICE R. B. SPENCER, INC. RAGLEN SYSTEM BALANCE RAM MECHANICAL, INC. RAY L. HELLWIG MECH RM CHRIS SHEET METAL, INC. RS ANALYSIS, INC. SAHARGUN PLUMBING SHEET METAL WORKERS LOCAL UNION NO 104 SHEPHARD MECHANICAL CONTRACTORS, INC. SIMPSON STRONG-TIE INC. SMITH ELECTRIC SERVICE SMITH HEATING AIR COND SOUTHLAND INDUSTRIES STANTON MECHANICAL, INC. STRATEGIC MECHANICAL INC. TERMINAL MANUFACTURING COMPANY LLC THERMAPRO MECHANICAL VIC MYERS INC. W A CALL MFG CO INC. W.V. ALTON, INC. WAGNER MECHANICAL WELLMADE PRODUCTS WESTERN STATES COUNCIL