2011-04-14T13:12:55-05:00 2010-06-30 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2009-07-01 942541328 SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN SHEE 9252089999 2610 Crow Canyon Road No 200 San Ramon CA 94583 BRUCE WORD 9252089999 2011-04-14 1 9252779100 2009 2016-02-24 21:20:13Z bruce word 2610 crow canyon road suite 200 san ramon CA 94583 131990828 0 X n/a X 1979 CA TO PROVIDE HEALTH benefits and Supplemental unemployment BENEFITS 15 15 66 0 0 0 0 68139674 62122845 1236128 2315437 1276069 182276 70651871 64620558 0 71449023 73339707 0 0 0 3811645 3896897 75260668 77236604 -4608797 -12616046 61940257 50844893 27608376 26768089 34331881 24076804 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 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 1601 0 1 66 1 0 0 0 0 0 15 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 1 0 0 0 X Benesys Inc 9252089999 2610 Crow Canyon Road Suite 200 SAN RAMON CA 94583 X gary schwenk 4.00 X 0 0 0 GARLAND SELF JR 1.00 X 0 0 0 CHRIS ENFANTINO 1.00 X 0 0 0 bob bramlett 1.00 X 0 0 0 BRUCE WORD 6.50 X 0 0 0 mitchell hoppe 1.00 X 0 0 0 tim O'connell 2.00 X 0 0 0 MARK VAN DEN HEUvEL - PAST 10.00 X 0 0 0 Kevin Van buskirk - PAST 2.00 X 0 0 0 JOSEPH A MARACCINI 5.00 X 0 0 0 Paul Steckel 1.00 X 0 0 0 Carl Sanchez - PAST 2.00 X 0 0 0 PAUL ARSENAULT 2.00 X 0 0 0 RICHARD WERNER 2.00 X 0 0 0 brett risley 2.00 X 0 0 0 willie solis 2.00 X 0 0 0 rob stoker 2.00 X 0 0 0 william j leffler jr 2.00 X 0 0 0 mike pence 2.00 X 0 0 0 ELDEN SHREVE 1.00 X 0 0 0 Richard Buckley Jr 0.50 X 0 0 0 anthony asher 3.00 X 0 0 0 james conway 4.00 X 0 0 0 philip j o'brien 1.00 X 0 0 0 0 0 0 0 0 0 0 Benesys Inc 2610 crow canyon road suite 200 san ramon CA 94583 administration 2156655 BLUE CROSS 11050 OLSON DRIVE SUITE 110 RANCHO CORDOVA CA 94583 ADMInistration 518186 ENVISION 2181 E AURORA ROAD SUITE 201 TWINSBURG OH 44087 administration 134276 kaufman & goble 10 almaden boulevard suite 540 san jose CA 95113 consulting 126000 mcmorgan & company 1 bush street suite 800 san francisco CA 94104 investment management 122911 7 Employer Contributions 900099 51514690 51514690 Employee Contributions 900099 9388254 9388254 Medicare - D Rebates 900099 1044901 1044901 ERRP INCOME 900099 175000 175000 62122845 1526480 1526480 68159227 67370270 788957 788957 788957 Settlement Agreement 900099 182276 182276 182276 64620558 62305121 0 2315437 73339707 2023016 61507 38900 139649 1378514 200282 7876 25569 OTHER expense 21584 77236604 -1179944 -1275886 2574513 5320483 9665405 10817591 58957 54843 50821326 35927862 61940257 50844893 324993 369623 683075 771700 892783 661766 25707525 24965000 27608376 26768089 X 0 0 0 0 34331881 24076804 34331881 24076804 61940257 50844893 X 0 1 1 X 0 0 Accumulated Eligibilty Credits 19586000 Incurred but not Reported Claims 5379000 24965000 64620558 77236604 -12616046 2360969 -332000 2028969 -10587077 66841878 2360969 2360969 64480909 139649 139649 64620558 77428955 0 77428955 139649 -332000 -192351 77236604 Part XI, Line 8 - Other Adjustments: CHANGE IN BENEFIT OBLIGATIONS Part XIII, 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 C, line 19 Upon request, the organization makes its governing documents, CONFLICT OF INTEREST POLICY and financial information available. form 990, part xi, line 2c: the organization has a board of trustees that assumes responsibility for oversight of the audit of its financial statements and selection of an independent accountant. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. 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. 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 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0