2020-04-28T10:19:51-05:00 2019-06-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2018-07-01 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 2020-04-28 1 JESSICA R ROSTER P01317380 9252779100 66.7.226.66 2020-04-28 08:19:42 PD P D85FB602DC4FA66F28A631CB81EF53DF59ECABFA 92C7F91AD246760067C653CBF66B8BF12B4D5FD1 2018 2020-09-23 17:36:50Z RICK WERNER 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 138871307 0 X N/A X 1979 CA TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS 16 0 1216 0 0 0 0 0 116272347 126788100 3492058 3555650 0 0 119764405 130343750 0 0 103626628 102857876 76705 66238 0 0 0 4883690 5260955 108587023 108185069 11177382 22158681 177956558 207792868 49510806 49712325 128445752 158080543 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 1 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 1009 0 1 1216 1 0 0 0 0 0 0 0 0 X 16 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 GARLAND SELF JR TRUSTEE - PAST 1.00 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 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 2593846 BLUE SHIELD OF CALIFORNIA 50 BEALE STREET SAN FRANCISCO CA 941051808 CLAIMS PROCESSING 879637 DELTA DENTAL OF CALIFORNIA PO BOX 997330 SACRAMENTO CA 958997330 CLAIMS PROCESSING 404727 KAUFMANN & GOBLE 160 W SANTA CLARA STREET SUITE 15 SAN JOSE CA 95113 CONSULTING 173000 MCMORGAN & COMPANY ONE FRONT ST STE 500 SAN FRANCISCO CA 94111 INVESTMENT MANAGEMENT 108139 5 EMPLOYER CONTRIBUTIONS 900099 111292135 111292135 EMPLOYEE CONTRIBUTIONS 900099 12013511 12013511 MEDICARE - D REBATES 900099 1402235 1402235 MISC. INCOME 900099 830738 830738 STOP LOSS INCOME 900099 790258 790258 459223 459223 126788100 4057890 4057890 8025317 8527557 -502240 -502240 -502240 130343750 126788100 0 3555650 102857876 66238 2389589 93300 48654 254153 2194745 202736 21290 10721 28107 PCORI FEE 17648 MISCELLANEOUS EXPENSES 12 108185069 -198505 -146264 19176136 31267963 22139506 26288204 50264 63897 110075028 121087157 26714129 29231911 177956558 207792868 1000966 1101226 942192 957151 47567648 47653948 49510806 49712325 X 0 0 0 0 128445752 158080543 128445752 158080543 177956558 207792868 22158681 7476110 0 X X 0 1 X 1 0 0 WESTERN ASSET US CORE BOND, L.L.C. 29231911 F 29231911 ACCUMULATED ELIGIBILITY CREDITS 35585000 INCURRED BUT NOT REPORTED CLAIMS 12003000 DUE TO BROKER 65948 47653948 X 137565707 7476110 7476110 130089597 254153 254153 130343750 107373916 0 107373916 254153 557000 811153 108185069 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, 2019, 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 2016. 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. 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, 2019, THERE ARE APPROXIMATELY 221 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 A. ZAHNER CO. AAERO HEATING & S/M CO ABCO MECHANICAL CONTR ACCEL AIR SYSTEMS INC. ACCO DBA GEORGE H. WILSON ACCO ENGINEERED SYS ACI MECHANICAL INC. ADVANCED AIRE SYSTEMS ADVANCED PIPING DESIGN, LLC ADVANCED SOLUTIONS,INC ADVNC AIR TECHNOLOGIES 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 ANDERSON ROWE & BUCKLEY ANNING JOHNSON APEX MECHANICAL, INC. ARENA & SONS ASCO SERVICE, INC. ASSOCIATED AIR BAL. & CERTIFIC AUTOMATED SOLUTIONS GROUP AXIS MECHANICAL BAY AREA BAL & CLEAN BAY AREA HVAC, INC. BAY CITY MECHANICAL BAY CITY MECHANICAL SVC, LLC BAY MOUNTAIN AIR BAY POINT CONTROL BAYSIDE HTG & A/C BEL AIR MECHANICAL BELL PRODUCTS BERLIN FOOD EQUIPMENT BEST CONTRACTING SERVICES BLOCKA CONSTR INC BOGNER SHEET METAL BONESO BROTHERS CONSTRUCT. INC BRADY AIR CONDITNG. BROADWAY MECH. CONTRACTORS BROADWAY S/M MFG INC 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 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 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. EAGLE SHEET METAL ENVIRONMENTAL SYSTEMS INC. EXTREME AIR INC F S I F. W. SPENCER & SON, INC. FAIRVIEW HEATING & A/C FAIRVIEW HTG & AIR FERTADO HEATING & AIR, INC. FOOTHILL AIR COND FRANK M BOOTH GLOBAL SPECIALTIES DIRECT, INC HARDIN & SONS, INC. HARRIS MONTAIN WEST, LLC HEATHORN & ASSOCIATES DBA H-SQUARE MECHANICAL, INC. HVAC CAD SERVICE HVAC SERVICE HEATING & A/C INC HYDRA VENTURES, INC. I E S INDOO ENVIRO SVS ICOM MECHANICAL INDEPENDENT AIR BALANCE, INC. INNOVATIVE MECH INC IZMIRIAN ROOFING & S/M JAMES LONG CONSTRUCTION JASON MECHANICAL, INC. JEFFCO CUSTOM METALS, INC. JENSEN MECHANICAL, INC. JEROME & HORNER SHEET METAL JMS MECHANICAL JR BARTO HEATING & AIR 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 LAWSON MECHANICAL LEFCO INC M T B INCORPORATED M.E.S.A. 3, INC MARELICH MECHANICAL CO MARKEN MECHANICAL SERVICES MARTINEZ SHEET METAL MATRIX HEATING, INC. MAUCK SHEET METAL WORKS MECHANICAL DRAFT AND DESIGN MECHANICAL TECHNOLOGIES CORP 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 NATIONAL SHOP FAB INC. NORTH BAY COMMERCIAL SVCS INC O C MCDONALD CO., INC. OCEAN PARK MECHANICAL, INC. OMNI SHEET METAL, INC. ORSON MECHANICAL CO., INC. OTAVILLA MECHANICAL CONTR. PACIFIC COAST BALANCING PACIFIC COAST TRANE SVC PACIFIC TEST AND BALANCE, INC. PAN-PACIFIC MECHANICAL, LLC PARAGON MECHANICAL INC PERFORMANCE AIR SERVICE, INC. PETERSON MECHANICAL, INC. PIONEER ROOFING ORGANIZATION POMI MECHANICAL INC. PRIME MECHANICAL SERVICE, INC. PROJECT BUILT, INC. QUALTECH MECHANICAL, INC. R H TINNEY R J MECHANICAL, INC RAY L HELLWIG MECH REACO HEATING & A/C REBARBER ENT.INC. RECIP L026 RECIP L071 RECIP L162 RMI MECHANICAL, INC. RODRIGUEZ SHEET METAL RS ANALYSIS, 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 SELCO HTG & A/C SERVICE METAL PROD INC SHEET METAL WORKERS SHEET METAL WRKS LU 104 SILICON VALLEY MECHANICAL, INC SIMPSON SHEET METAL, INC. SMITH ELECTRIC SMW 104 BAY AREA IND TRAIN FUN SO CAL CUSTOM INC. SOLDATE S/M HEATING & AIR SOUTHLAND INDUSTRIES SOUTHWEST DESIGN & SUPPLY CO. STALEY'S SHEET METAL STANDARD S/M & MARINE STATE OF CA. DEPT. OF CORRECT. STATE SHEET METAL WORKS STUMBAUGH & ASSOCIATES, INC. T.A.B.C.O. INC THE TIN MAN THERMA, LLC THERMAL MECHANICAL T-I LOCAL 103 T-I LOCAL 162 T-O LOCAL 88 T-O LU 359 ARIZONA TRUST FUND TULLEY MECHANICAL, INC. VAL'S PLUMBING 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 WESTERN ENGINEERING SUPPLY CO YOUR WARM FRIEND,INC.