2021-04-09T16:56:10-05:00 2020-06-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2019-07-01 942541328 SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN SHEE 9252089994 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 RICK WERNER TRUSTEE 9252089994 2021-04-09 1 JESSICA R ROSTER P01317380 9252779100 2019 2022-09-23 18:48:47Z RICK WERNER 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 337560078 0 X N/A X 1979 CA TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS 15 0 1304 0 0 0 0 0 126788100 120782774 3555650 15666216 0 0 130343750 136448990 0 0 102857876 94914593 66238 57202 0 0 0 5260955 5198094 108185069 100169889 22158681 36279101 207792868 221679948 49712325 36819222 158080543 184860726 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 X 0 0 1 1304 1 0 0 0 0 0 0 0 0 X 15 0 0 1 0 0 0 0 0 1 1 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 PAUL STECKEL TRUSTEE 4.00 X 0 0 0 CHRIS ENFANTINO TRUSTEE 2.00 X 0 0 0 BOB BRAMLETT TRUSTEE 2.00 X 0 0 0 DUANE DAVIES TRUSTEE 2.00 X 0 0 0 MITCHELL HOPPE TRUSTEE - PAST 2.00 X 0 0 0 BRIAN MASTERS TRUSTEE 4.00 X 0 0 0 JOSEPH A MARACCINI TRUSTEE 2.00 X 0 0 0 DOMINIC TORREANO TRUSTEE 1.00 X 0 0 0 RICHARD WERNER TRUSTEE 4.00 X 0 0 0 KEITH DIAS TRUSTEE 2.00 X 0 0 0 SEAN O'DONOGHUE TRUSTEE 4.00 X 0 0 0 RANDY ATTAWAY TRUSTEE 2.00 X 0 0 0 RICHARD KOENIG TRUSTEE 2.00 X 0 0 0 BRIAN WERNER TRUSTEE 2.00 X 0 0 0 KATHY DE JONG ALT. TRUSTEE 2.00 X 0 0 0 ERIC HAYNES 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 2622850 BLUE SHIELD OF CALIFORNIA 50 BEALE STREET SAN FRANCISCO CA 941051808 CLAIMS PROCESSING 987086 DELTA DENTAL OF CALIFORNIA PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS PROCESSING 463561 NORTHWEST PLAN SERVICES INC 160 W SANTA CLARA STREET SUITE 15 SAN JOSE CA 95113 CONSULTING 174000 PART D ADVISORS INC 17199 N LAUREL PARK DR STE 400 LIVONIA MI 48152 CONSULTING 128997 7 EMPLOYER CONTRIBUTIONS 900099 104824510 104824510 EMPLOYEE CONTRIBUTIONS 900099 12624717 12624717 RXADVANCE REBATE 900099 1508729 1508729 MEDICARE - D REBATES 900099 1382083 1382083 MISC. INCOME 900099 432390 432390 10345 10345 120782774 3756587 3756587 213020717 201111088 11909629 11909629 11909629 136448990 120782774 0 15666216 94914593 57202 2403832 81663 70459 104084 2249022 222630 6960 40839 PCORI FEE 18600 MISCELLANEOUS EXPENSE 5 100169889 -146264 -219166 31267963 62040340 26288204 20598109 63897 53579 121087157 139207086 29231911 207792868 221679948 1101226 821295 957151 1027927 47653948 34970000 49712325 36819222 X 0 0 0 0 158080543 184860726 158080543 184860726 207792868 221679948 36279101 -9498918 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 25741000 CLAIMS PAYABLE & INCURRED BUT NOT REPORTED CLAIMS 9229000 34970000 X 126845988 -9498918 -9498918 136344906 104084 104084 136448990 109683805 0 109683805 104084 -9618000 -9513916 100169889 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, 2020, 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 2017. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS 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/OR UNEMPLOYMENT BENEFITS PROVIDED UNDER THE PLAN. 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 11B 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 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 1A: THE PLAN'S THIRD-PARTY ADMINISTRATOR FILES ONE 1099 ON BEHALF OF ALL THE PLANS THEY ADMINISTER FOR THE VARIOUS "INDEPENDENT CONTRACTORS." THEREFORE, THIS QUESTION HAS BEEN ANSWERED AS ZERO FOR THIS ORGANIZATION. 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 1 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, 2020, THERE ARE APPROXIMATELY 263 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 & B MECHANICAL, INC. A G C, INC A I M SHEET METAL INC A. ZAHNER CO. AAERO HEATING & S/M CO ABCO MECHANICAL CONTR ABM BUILDING SOLUTIONS, LLC ACCEL AIR SYSTEMS INC. ACCO ENGINEERED SYS ACI MECHANICAL INC. ADVANCED AIRE SYSTEMS ADVANCED PIPING DESIGN, LLC ADVANCED SOLUTIONS,INC ADVNC AIR TECHNOLOGIES AGC INC. AIR CONDITIONING SYSTEM AIR EXCHANGE AIR SYSTEMS SERVICE & CONST. AIR SYSTEMS, INC. AIRCAL HTG. & S/M AIRCO MECHANICAL, INC. AIRE SHEET METAL AIRTEC SERVICE AKIMA, LLC ALL BAY MECHANICAL, INC. ALL TEMPERATURE SERVICE AIR ALLIED HTG & AIR COND ALPHA AIR BALANCING AG ALPINE MECH SERVICE CO AMERICAN METAL PROD ANAYA CONSTRUCTION ANDERSON ROWE & BUCKLEY ANNING JOHNSON APEX MECHANICAL, INC. APOLLO SHEET METAL INC. DBA ARENA & SONS ASCO SERVICE, INC. ASSOCIATED AIR BAL. & CERTIFIC AUTOMATED SOLUTIONS GROUP AXIS MECHANICAL, INC. BAY AREA HVAC, INC. BAY CITY MECHANICAL SVC, LLC BAY MOUNTAIN AIR BAY POINT CONTROL BAYSIDE HTG & A/C BC RESTAURANT EQUIPMENT BECKER ELECTRIC INC. DBA BEL AIR MECHANICAL BELL PRODUCTS BERLIN FOOD EQUIPMENT BEST CONTRACTING SERVICES BIM DESIGNS, INC. BLOCKA CONSTR INC BOGNER SHEET METAL BRADY AIR SERVICE, INC. BROADWAY MECH. CONTRACTORS BROADWAY S/M MFG INC BUENA VISTA CONSTRUCTION BULLARD'S HEATING & AIR, INC. BURLINGAME HTG VENT CO CALIFORNIA AIR INC CALIFORNIA CLIMATE SYSTEMS CALIFORNIA UNITED MECHANICAL, CARQUINEZ HEATING A/C & S/M 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 CRITCHFIELD MECHANICAL CROWN CORR, INC. CROWN SHEET METAL & 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. DURR ENERGY MECHANIX INC. 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 GLOBAL SPECIALTIES DIRECT, INC HARDIN & SONS, INC. HARRIS BAY AREA, LLC HARRIS MONTAIN WEST, LLC HEATHORN & ASSOCIATES DBA HOLDERS AIR CONDITIONING & H-SQUARE MECHANICAL, INC. HVAC CAD SERVICES INC HVAC SERVICE HEATING & A/C INC HYDRA VENTURES, INC. I E S INDOO ENVIRO SVS ICOM MECHANICAL INDEPENDENT AIR BALANCE, INC. INNOVATIVE MECH INC INTECH MECHANICAL CO., INC. IZMIRIAN ROOFING & S/M JACOBSEN ALVES GOODEILL INC. JAMES LONG CONSTRUCTION JASON MECHANICAL, INC. JEFFCO CUSTOM METALS, INC. JENSEN MECHANICAL, INC. JEROME & HORNER SHEET METAL JMS MECHANICAL K & M INSTALLATION KAMRAN METAL WORKS, INC. KEL AIRE HTG KELL MECHANICAL HEATING & AC KINETIC MECHANICAL SERVICE INC KINETIC SYSTEMS, INC KT MECHANICAL INC. L J KRUSE COMPANY LARGE'S METAL FAB LASLEY MECHANICAL LAWSON MECHANICAL LEFCO INC M T B INCORPORATED M.E.S.A. 3, INC MARELICH MECHANICAL CO MARTINEZ SHEET METAL MATRIX HEATING, INC. MAUCK SHEET METAL WORKS MECHANICAL SERVICES LLC MELROSE METAL PRODUCTS MESA ENERGY SYSTEMS INC. MG MCGRATH, INC. MILESTONE CONTRACTORS INC. DBA MINA METALS MIRADOR CONSTRUCTION MONARCH MECHANICAL MONSTER MECHANICAL, INC. MONTEREY MECHANICAL CO MSR MECHANICAL LLC MURRAY PLUMBING & HTG CORP. NATIONAL AIR BALANCE COMPANY NATIONAL SHOP FAB INC. NEW ENGLAND S/M AND MECH. CO. NORTH BAY COMMERCIAL SVCS INC O C MCDONALD CO., INC. OCEAN PARK MECHANICAL, INC. OJV CONSTRUCTION OMNI SHEET METAL, INC. ORSON MECHANICAL CO., INC. OTAVILLA MECHANICAL CONTR. INC PACIFIC COAST BALANCING PACIFIC COAST TRANE SVC PACIFIC TEST AND BALANCE, INC. PAN-PACIFIC MECHANICAL, LLC PARAGON MECHANICAL INC PATRIOT CONTRACTING, INC. PERFORMANCE AIR SERVICE, INC. PETERSON MECHANICAL, INC. PIONEER ROOFING ORGANIZATION POMI MECHANICAL INC. PRECISION CAD SERVICES, INC. PRIME MECHANICAL SERVICE, INC. PROJECT BUILT, INC. QUALTECH MECHANICAL, INC. R E MILANO PLUMBING CORP. R J MECHANICAL, INC RAY L HELLWIG MECH REACO HEATING & A/C REBARBER ENT.INC. RECIP L002 RECIP L007 LOCAL 7 ZONE 1 RECIP L012 RECIP L016 RECIP L020 RECIP L026 RECIP L048 RECIP L049 RECIP L066 RECIP L073 RECIP L162 RECIP L399 RECIP-SASMI RMI MECHANICAL, INC. RODRIGUEZ SHEET METAL RS ANALYSIS, INC. RVTDESK, 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 SERVICE METAL PROD INC SHEET METAL WORKERS SHEET METAL WRKS LU 104 SHELDON MECHANICAL SILICON VALLEY MECHANICAL, INC SIMPSON SHEET METAL, INC. SMITH ELECTRIC SMW 104 BAY AREA IND TRAIN FUN SOLDATE S/M HEATING & AIR SOUTHLAND INDUSTRIES SOUTHWEST DESIGN & SUPPLY CO. STANDARD S/M & MARINE STATE OF CA. DEPT. OF CORRECT. STATE SHEET METAL WORKS STUMBAUGH & ASSOCIATES, INC. SUPERIOR MECH. SERVICES, INC. SVALA CONSTRUCTION, INC. T.A.B.C.O. INC TECTA AMERICA SACRAMENTO, INC. THE TIN MAN THERMA, LLC THERMAL MECHANICAL, INC. T-I LOCAL 103 T-I LOCAL 162 T-I LU 359 ARIZONA TRUST FUND T-I NORTHWEST SMW T-I SMW NATIONAL PENSION FUND T-O LOCAL 105 SMW TRUST FUND T-O LOCAL 137 T-O LOCAL 206 T-O LOCAL 206 T-O LOCAL 273 SMW T-O LOCAL 32 SMW T-O LOCAL 88 T-O LU 17 SMW T-O LU 18 T-O LU 218 SMW H&W FUND T-O LU 270 SHEET METAL HEALTH T-O LU 359 ARIZONA TRUST FUND T-O LU 4 SHEET METAL WORKERS T-O LU 441 SHEET METAL T-O LU 54 SHEET METAL WORKERS T-O LU 66 NORTHWEST S/M WORKER T-O LU 67 T-O LU 83 T-O LU 9 SMW T-O SMW NATIONAL PENSION FUND VACATION REFUND FROM MEMBER VAL'S PLUMBING & HEATING INC. VAN MULDER SHEET METAL VENTEC VERDEGAAL HEATING INC WCASM INC, DBA WEST COAST ASM WEST COAST FIRESTOPPING, INC. WEST COAST MECHANICAL WEST COAST TEST AND BALANCE WESTERN ALLIED MECHANICAL, INC YOUR WARM FRIEND,INC.