2023-11-07T11:46:32-06:00 2022-12-31 WITHUMSMITHBROWNPC 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2022-01-01 776113549 Northern California Sheet Metal Workers Health Care Plan % BENESYS INC NORT 9252089992 3240B Constitution Drive Livermore CA 94551 SAL ROTOLO Chair 9252089992 2023-11-06 true SAL ROTOLO 999009999 JESSICA R ROSTER P01317380 9252779100 2022 2023-04-26 12:10:37Z SAL ROTOLO PO BOX 1677 SAN RAMON CA 94583 41961807 false X N/A X 1995 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 0 0 0 0 0 0 28832357 32857758 417946 1452000 17853 1243207 29268156 35552965 0 0 27594186 29735604 0 0 0 0 0 1551573 1710730 29145759 31446334 122397 4106631 31126708 31882697 9971017 10753176 21155691 21129521 TO PROVIDE HEALTH AND WELFARE BENEFITS. PROVIDED HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS COVERED UNDER THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE UNION AND EMPLOYERS. false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 5 0 true 0 false false false false false false false false X 8 0 false true false false false false false true false false false true true true true true true false false false CA X BENESYS INC 9252089992 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 X sal rotolo Chair 2.0 0.0 X X 0 0 0 jim conway Co-Chair 2.0 0.0 X X 0 0 0 rick werner trustee 2.0 0.0 X 0 0 0 mike lopez trustee 2.0 0.0 X 0 0 0 Dustin Saccone trustee 2.0 0.0 X 0 0 0 Chris May Trustee 2.0 0.0 X 0 0 0 Michael Mark trustee 2.0 0.0 X 0 0 0 Gary Myers trustee 2.0 0.0 X 0 0 0 SEE SCH O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 0.0 0.0 X 0 0 0 0 0 0 0 false false false BENESYS INC 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 CONTRACT ADMIN 942818 Blue Shield 50 Beale Street 20th Floor San Francisco CA 94105 COST CONTAINMENT 213414 Delta Dental 560 Mission ST 1300 SAN FRANCISCO CA 94105 Contract Admin 104540 3 0 Employer Contributions 900099 25602715 25602715 Participant Contributions 900099 4202522 4202522 STOP LOSS INSURANCE REIMB 900099 2312238 2312238 MEDICARE-D SUBSIDY 900099 332817 332817 Prescription Rebates 900099 407466 407466 32857758 542619 542619 0 0 0 0 0 7318223 6408842 909381 909381 909381 0 0 0 0 0 0 0 0 0 Other income 900099 20938 20938 LEGAL SETTLEMENT 900099 1222269 1222269 1243207 35552965 34100965 1452000 0 0 0 29735604 0 0 0 0 0 0 890431 64338 40232 0 0 31035 589888 0 69687 0 0 0 0 0 647 0 0 0 24472 31446334 X -71678 -37556 4765529 8378156 0 0 5582302 5389862 0 0 0 0 0 0 0 0 23389 31353 0 0 20827166 18120882 0 0 0 0 0 0 0 0 31126708 31882697 183423 118616 0 0 321594 333560 0 0 0 0 0 0 0 0 0 0 9466000 10301000 9971017 10753176 X 0 0 0 0 21155691 21129521 21155691 21129521 31126708 31882697 4106631 -4132801 X X false true X true false 0 Accumulated Eligibility Credits 8088000 CLAIMS PAYABLE IBNR 2213000 10301000 X 31389129 -4132801 -4132801 35521930 31035 31035 35552965 30580299 30580299 31035 835000 866035 31446334 Form 990, 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, 2022 and 2021, 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. Form 990, Sch D, Part XII, Line 4B: CHANGES IN BENEFIT OBLIGATIONS : $835,000 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 3232 Constitution Drive Livermore CA 94551 940859420 Labor Union CA 501(C)(5) N/A nA false false false false false false false false false false false false false false false false false false false false 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, 2022, THERE ARE APPROXIMATELY 76 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. ABM BUILDING SOLUTIONS, LLC ACCO ENGINEERED SYSTEMS AIR CONTROL BALANCE, INC. AIR SYSTEMS SERVICE & CONSTR. AIR SYSTEMS, INC. AIRCO MECHANICAL INC. AMERICAN MECHANICAL SYSTEMS ATS PRODUCTS INC B & L MECHANICAL, INC. B N MECHANICAL INC BEST CONTRACTING SERVICES BLOCKA CONSTRUCTION INC BOS SHEET METAL BOTNER MANUFACTURING INC BRICE MECH. CONTRACTORS, INC. BROWN S/M & MECHANICAL CA DEPT PRISON-CDCR REG ACCTNG CALIFORNIA SHEET METAL, INC. CALIFORNIA UNITED MECH. INC. CAPITAL SHEET METAL WRK CHAMPION INDUSTRIAL CIRCO SYSTEM BALANCE, INC. CL HEATING AND AIR, INC. COMFORT AIR, INC. CONSOLIDATED METAL FAB DDK MECHANICAL, INC. DKM HEATING & A/C, INC. DUCTMATE IND INC ECO HVAC CONTRACTING DBA AGRS EMCOR ARC SERVICE EMCOR/MESA ENERGY SERVICE FRANK M BOOTH INC FRED L HILL GIFFIN, INC. INDOOR ENVIRONMENTAL SERVICES INTECH MECHANICAL CO., LLC INTECH MECHANICAL CO., INC. J. BOONE MECHANICAL, INC. JACOBSEN ALVES GOODEILL, INC. JAMES LONG CONSTRUCTION SVC KINETICS MECH SERVICE INC. LEVEL UP STEEL, INC. M.E.S.A. 3, INC M2 ENERGY SERVICES, INC. MONTAGUE COMPANY NATIONAL AIR BALANCE NATIONAL ENERGY MGMT INST. CO NEW ENGLAND S/M AND MECH. CO. NICRO INC NIECO CORPORATION OJV CONSTRUCTION, INC. OMNI SHEET METAL, INC. PACIFIC TEST & BALANCE, INC. PATTON SHEET METAL WORK R.B. SPENCER, INC. RAGLEN SYSTEM BALANCE RAM MECHANICAL, INC. RS ANALYSIS, INC. S/M IND JOINT APP COMM SACTO VALLEY APPR FUND SHEET METAL WORKERS 104 DIST 2 SIMPSON STRONG-TIE INC SMITH HEATING AIR COND SOUTHLAND INDUSTRIES STARACE MECHANICAL STRATEGIC MECHANICAL INC. SUNSET CONSTRUCTION T.A.B.C.O. TERMINAL MANUFACTURING TOP NOTCH MECHANICAL, INC. TOWN & COUNTRY HEATING & COOL. TRADEWINDS COOLING, LLC W A CALL MFG CO WAGNER MECHANICAL WELLMADE PRODUCTS WESTERN STATES COUNCIL