2021-10-28T16:02:21-05:00 2020-12-31 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2020-01-01 776113549 NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN NORT 9252089992 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 SAL ROTOLO TRUSTEE 9252089992 2021-10-28 1 SAL ROTOLO 999009999 JESSICA R ROSTER P01317380 9252779100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X SAL ROTOLO PO BOX 1677 SAN RAMON CA 94583 32101623 0 X N/A X 1995 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 0 0 0 0 0 0 0 31315571 28655760 915384 440980 0 0 32230955 29096740 0 0 29091224 24723754 0 0 0 0 0 1767111 1564352 30858335 26288106 1372620 2808634 27204559 30520368 10473435 10079978 16731124 20440390 TO PROVIDE HEALTH AND WELFARE BENEFITS 0 0 PROVIDED HEALTH AND WELFARE 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 6 0 1 0 0 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 9252089992 3240B CONSTITUTION DRIVE LIVERMORE CA 94551 X SAL ROTOLO TRUSTEE 2.00 X 0 0 0 RICK WERNER TRUSTEE 2.00 X 0 0 0 JIM CONWAY TRUSTEE 2.00 X 0 0 0 MIKE LOPEZ TRUSTEE 2.00 X 0 0 0 DUSTIN SACCONE TRUSTEE 2.00 X 0 0 0 CHRIS MAY TRUSTEE 2.00 X 0 0 0 MICHAEL MARK TRUSTEE 2.00 X 0 0 0 GARY MYERS TRUSTEE 2.00 X 0 0 0 ROB BELL TRUSTEE - PAST 2.00 X 0 0 0 SEE SCHEDULE O FOR COMPENSATION PAID BY RELATED ORGANIZATIONS 1.00 X 0 1 0 0 1 0 0 0 0 0 BENESYS INC 3240B CONSITUTION DRIVE LIVERMORE CA 94551 CONTRACT ADMINISTRATOR 910355 BLUE SHIELD 50 BEALE STREET 20TH FLOOR SAN FRANCISCO CA 94105 COST CONTAINMENT 198130 2 EMPLOYER CONTRIBUTIONS 900099 23738471 23738471 PARTICIPANT CONTRIBUTIONS 900099 4075246 4075246 RXADVANCE REBATES 900099 578497 578497 MEDICARE-D REBATE 900099 253970 253970 OTHER 900099 9576 9576 28655760 386137 386137 3059726 3004883 54843 54843 54843 29096740 28655760 0 440980 24723754 857792 58249 46804 31007 473860 79680 1438 15522 26288106 -42662 -159592 4130675 5636864 5319025 5208248 2980 16317 17794541 19818531 27204559 30520368 307590 160658 315845 333320 9850000 9586000 10473435 10079978 X 0 0 0 0 16731124 20440390 16731124 20440390 27204559 30520368 2808634 900632 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILITY CREDITS 7272000 INCURRED BUT NOT REPORTED CLAIMS 2314000 9586000 X 29966365 900632 900632 29065733 31007 31007 29096740 26521099 0 26521099 31007 -264000 -232993 26288106 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, 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 THE PLAN IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE FISCAL YEARS PRIOR TO 2017. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGES 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 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 2610 CROW CANYON ROAD SUITE 300 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, 2020, THERE ARE APPROXIMATELY 88 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. 3IN1 CONTROL, INC ABM BUILDING SOLUTIONS, LLC ACCO ENGINEERED SYSTEMS AIR AMERICAN, INC. AIR CONTROL BALANCE, INC. AIR EXCHANGE, INC. AIR SYSTEMS SERVICE & CONSTR. AIR SYSTEMS, INC. AIRCO MECHANICAL B & L MECHANICAL, INC. B N MECHANICAL INC BEST CONTRACTING SERVICES BLOCKA CONSTRUCTION INC BOS SHEET METAL BOTELHO WELDING SERVICE BRICE MECH. CONTRACTORS, INC. BROWN S/M & MECHANICAL CA DEPT PRISON-CDCR REG ACCTNG CALIFORNIA CLIMATE SYSTEMS CALIFORNIA SHEET METAL CAPITAL SHEET METAL WRK CENTER PLUMBING CO CHAMPION INDUSTRIAL CONTR. CIRCO SYST BALANCE INC COMFORT AIR, INC. CRITCHFIELD MECHANICAL DDK MECHANICAL, INC. DESERT MECHANICAL DGS GENERAL SVCS/STATE OF CA DKM HEATING & A/C, INC. DUCTMATE IND INC EMCOR ARC SERVICE EMCOR/MESA ENERGY SERVICE F.P. CONSTRUCTION FRANK M BOOTH INC FRED L HILL FSI HARRIS MOUNTAIN WEST, LLC INDOOR ENVIRONMENTAL SERVICES INTECH MECHANICAL CO J. BOONE MECHANICAL, INC. JAMES LONG CONSTRUCTION SRVCS JOHN W. MCDOUGALL CO., INC. K & M INSTALLATION KAMRAN METALWORKS, INC KINETICS MECH SERVICE INC. LAWSON MECHANICAL M.E.S.A. 3, INC MCCLANAHAN, INC. NATIONAL AIR BALANCE NATIONAL ENERGY MGMT INST. CO NEW ENGLAND S/M AND MECH. CO. NEW ENGLAND S/M WORKS NICRO INC NIECO CORPORATION O E S S/M & FAB OTAVILLA MECHANICAL CONTR. INC PACIFIC TEST & BALANCE, INC. PAN-PACIFIC MECHANICAL PATTON SHEET METAL WORK PERFORMANCE MECH. SYSTEMS INC. R.B. SPENCER, INC. RAGLEN SYSTEM BALANCE RAM MECHANICAL, INC. RECIP L104 RECIP L105 ROLAND CONSTRUCTION RS ANALYSIS, INC. RUTHERFORD CO., INC. S/M IND JOINT APP COMM SACTO VALLEY APPR FUND SHEET METAL WORKERS 104 DIST 2 SMITH HEATING AIR COND SMITH MECHANICAL-ELECT.-PLBG SO CAL CUSTOM, INC. SOUTHLAND INDUSTRIES STRATEGIC MECHANICAL INC. T.A.B.C.O. TECTA AMERICA SACRAMENTO, INC. TERRA PACIFIC WASTE MGMT T-I LOCAL 104 T-I RECIP LOCAL 3 TOP BUILT, INC. TOP NOTCH MECHANICAL, INC. TOWN & COUNTRY HEATING AND W A CALL MFG CO WAGNER MECHANICAL WESTERN STATES COUNCIL