2014-04-28T16:02:14-05:00 2013-06-30 522385296 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 945834210 990 2012-07-01 942541328 SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN SHEE 9252089999 2610 CROW CANYON ROAD NO 200 SAN RAMON CA 94583 BRUCE WORD 9252089999 2014-04-28 1 JESSICA R ROSTER P01317380 9252779100 2012 2015-11-30 17:44:51Z BRUCE WORD 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 116537809 0 X N/A X 1979 CA TO PROVIDE HEALTH BENEFITS AND SUPPLEMENTAL UNEMPLOYMENT BENEFITS 16 0 851 0 0 0 0 0 77761718 87555394 1248061 1452277 271055 198230 79280834 89205901 0 0 67446448 67247111 0 0 0 0 0 4332101 4036546 71778549 71283657 7502285 17922244 57025304 78472521 24265916 27150378 32759388 51322143 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 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 2300 0 1 851 1 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 9252089999 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 X PAUL STECKEL 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 BRETT RISLEY 2.00 X 0 0 0 JOSEPH A MARACCINI 5.00 X 0 0 0 PAUL ARSENAULT 2.00 X 0 0 0 RICHARD WERNER 2.00 X 0 0 0 WILLIE SOLIS 2.00 X 0 0 0 ROB STOKER 2.00 X 0 0 0 STEVE LOPEZ 2.00 X 0 0 0 SEAN O'DONOGHUE 2.00 X 0 0 0 RANDY ATTAWAY 2.00 X 0 0 0 ANTHONY URBINA 2.00 X 0 0 0 GARY SCHWENK 2.00 X 0 0 0 TIM O'CONNELL 2.00 X 0 0 0 WILLIAM J LEFFLER JR 2.00 X 0 0 0 MIKE PENCE 2.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS INC 2610 CROW CANYON ROAD SUITE 200 SAN RAMON CA 94583 ADMINISTRATION 2250068 BLUE SHIELD OF CALIFORNIA 50 BEALE STREET SAN FRANCISCO CA 941051808 CLAIMS PROCESSING 230524 BLUE CROSS OF CALIFORNIA 11050 OLSON DRIVE SUITE 110 RANCHO CORDOVA CA 95670 CLAIMS PROCESSING 225565 PREMIER HEALTHCARE EXCHANGE INC 2 CROSSROADS DRIVE BEDMINSTER NJ 07921 ADMINISTRATION 194552 KAUFMAN & GOBLE 10 ALMADEN BOULEVARD SUITE 540 SAN JOSE CA 95113 CONSULTING 144000 6 EMPLOYER CONTRIBUTIONS 900099 75697098 75697098 EMPLOYEE CONTRIBUTIONS 900099 10639357 10639357 MEDICARE - D REBATES 900099 1218939 1218939 87555394 1367167 1367167 27417018 27331908 85110 85110 85110 SETTLEMENT INCOME 900099 198230 198230 198230 89205901 87555394 0 1650507 67247111 2102263 60412 44855 105426 1463738 177743 11260 27826 OTHER EXPENSES 43023 71283657 -616204 -248263 9759314 5323485 15245169 15624483 50266 50968 32586759 57721848 0 0 57025304 78472521 365761 472874 823390 876351 296936 22779829 25801153 24265916 27150378 X 0 0 0 0 32759388 51322143 32759388 51322143 57025304 78472521 17922244 640511 0 X X 0 1 X 1 0 0 ACCUMULATED ELIGIBILTY CREDITS 17718000 CLAIMS PAYABLE & INCURRED BUT NOT REPORTED 7997000 DUE TO BROKER 86153 25801153 X 89740986 640511 640511 89100475 105426 105426 89205901 68157231 0 68157231 105426 3021000 3126426 71283657 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013, 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 2010. 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 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 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 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 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 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 JUNE 30, 2013, THERE ARE APPROXIMATELY 360 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 QUALITY HEATING & AIR, INC. AAERO HEATING & S/M CO ABCO MECHANICAL CONTR AC SYSTEMS, INC. ACCEL AIR SYSTEMS INC. ACCO ENGINEERED SYSTEMS, INC ADVANCED AIRE SYSTEMS ADVANCED SOLUTIONS HEATING AND AIR CONDITIONING, INC. AEOLIAN MECHANICAL, INC. AGC, INC. AIM SHEET METAL INC AIR CONDITIONING INNOVATIONS AIR EXCELLENCE INC AIR METRICS INC AIR SYSTEMS ACQUISTION AIR SYSTEMS OF SACTO AIRCAL HEATING & SHEET METAL, INC. AIRCO COMMERCIAL SERV AIRCO MECHANICAL, INC. AIRE MECHANICAL AIRE SHEET METAL INC AIRTEC SERVICE ALBION SHEET METAL ALL BAY MECHANICAL, INC ALL TEMPERATURE SERVICE AIR CONDITIONING INC. ALLEN HEATING AND SHEET METAL ALLEN SIMMONS HEATING & SHEETMETAL CO ALLIED HEATING & A/C ALPHA AIR BALANCING AG ALPINE MECH SERVICES ANDERSON ROWE & BUCKLEY A-NEED HEATING/COOLING INC. ANNING-JOHNSON COMPANY ANSIL CONSTRUCTION ENTERPRISES INC. APEX MECHANICAL, INC. ARENA & SONS ASCO SERVICE, INC. ASSOCIATED AIR BAL CO ATLAS HEATING & A/C DBA BAL-AIR MECHANICAL, INC. BAY AREA CONST. SPECIALTIES BAY CITY MECHANICAL BAY MOUNTAIN AIR BAY POINT CONTROL BAY POINT CONTROL, INC DBA MARINA MECHANICAL BAYSIDE HEATING & AIR CONDITIONING, INC. BEL AIR MECHANICAL BELL PRODUCTS BERLIN FOOD EQUIPMENT BEST CONTRACTING SERVICES, INC. BEUTLER CORPORATION BLOCKA CONSTRUCTION CO. BOHN INC. DBA BOHN HEATING AND SHEET METAL BONESO BROTHERS CONSTRUCTION, INC. BOS SHEET METAL, INC. BRADY AIR CONDITIONING BROADWAY MECHANICAL BULLARD'S HEATING & AIR, INC. BURLINGAME HEATING & VENTILATION, INC. CAL-AIR/JOHNSON CONTROLS, INC. CALIFORNIA AIR INC CALIFORNIA COOKING, INC. CARMINE AIR CONDITIONING, INC. CARQUINEZ HEATING, AIR CONDITIONING & SHEET METAL, INC. CARTER CONGI & LEE INC. DBA CENTRAL COAST AIR INC. DBA CIRCO SYSTEM BALANCE, INC. CITY MECHANICAL INC CLINTON HTG & AIR COND COLD CRAFT, INCORPORATED COLTON HEATING & SHEET METAL, INC. COLUMBIA MECHANICAL CONTRACTORS, INC. COMCO SHEET METAL COMFORT AIR, INC. COMFORT DYNAMICS INC CONTROL AIR NORTH INC CRANE HEATING & S/M CRITCHFIELD MECHANICAL CROWN INDUSTRIAL ENG CROWN SKYLIGHTS, INC. D&L DELLA MORA HEATING SHEET MEATL & AIE CONDITIONING INC. DE BELLA MECHANICAL INC DEGREE HVAC, INC. DEHARO MECHANICAL INC. DELCON HEATING & AC DELUCCHI MECHANICAL INC DEPENDABLE SHEET METAL DOWNING HEATING & AIR COND. ENERGY MANAGEMENT INC. ENVIRONMENTAL SYSTEMS INC OF NORTHERN CALIFORNIA EXTREME AIR, INC F.W. SPENCER & SON, INC. FAIRVIEW HEATING AND AIR CONDITIONING INC. FARR & PETERSON MECHANICAL, INC FERTADO HEATING & AIR, INC. FLANDERS HEAT & AIR SYSTEMS FONCO, INC. FOOTHILL AIR COND FOUR SEASONS HTG INC FOX MECHANICAL, INC. FRANK M BOOTH INC G S E CONSTRUCTION GAFFIGAN COMPANY GEO. H. WILSON, INC. GIFFIN, INC. GLOBAL SPECIALTIES DIRECT, INC GOLDEN GATE SHEET METAL WORKS, INC. HARRIS SUPERIOR CA INC HAWK MECHANICAL INC. HEATHORN & ASSOCIATES DBA H-SQUARE MECHANICAL, INC. HVAC CAD SERVICES INC I E S INDOO ENVIRO SVS ICOM MECHANICAL INNOVATIVE MECHANICAL INC. J.M.S. MECHANICAL JAMES LONG CONSTRUCTION SERVICES, INC. JAYCO MECHANICAL, INC. JENSEN MECHANICAL, INC. JEROME AND HORNER SHEET METAL INC JET MECHANICAL INC. JIM'S AIR SYSTEMS JOSEPH BRUNO SHEET METAL CO INC JOYCE BROTHERS METAL WORKS K & M INSTALLATION KAMRAN METAL WORKS, INC. KEL-AIRE KENT M. LIM & COMPANY, INC. KEVIN SULLIVAN HEATING & AIR, INC. KIMBERT SHEET METAL KINETIC SYSTEMS, INC KINETICS MECHANICAL SERVICES INC KT MECHANICAL INC. O/M L.J. KRUSE CO. LARGE'S METAL FABRICATION, INC LAWSON MECHANICAL CONTRACTORS LEFCO INCORPORATED M T B INCORPORATED MARELICH MECHANICAL CO. INC. MARK SHAFFER MARKEN MECHANICAL SERVICES INC MARTINEZ SHEET METAL MARTINICO & SONS MATRIX HEATING, INC. MAUCK SHEET METAL WORKS MELROSE METAL PRODUCTS, INC. MESA ENERGY SYSTEMS, INC MESA3 / MECHANICAL ENVIRONMENTAL SYSTEMS ANALYSIS & ADJUSTMENT AGENCY, INC. MICHAEL D. BURNS COMPANY, INC. MILESTONE CONTRACTORS INC. DBA MINA METALS COMPANY, INC MONTEREY MECHANICAL COMPANY MTECH CORP MURRAY PLUMBING & HTG CORP. NATIONAL AIR BALANCE NORGE AIR INC NORTH BAY COMMERCIAL SERVICES INC O C MCDONALD OMNI INDUSTRIES INC. DBA OMNI SHEET METAL, INC. ORSON MECHANICAL CO., INC. OWR MECHANICAL P S F MECHANICAL, INC. PACIFIC COAST BALANCING PACIFIC COAST TRANE SALES & SERVICE PACIFIC TEST AND BALANCE, INC. PARAGON MECHANICAL INC. PAUL WEST HEATING, INC. PENINSULA AIR CONDITIONING INC. PENINSULA SECURITY BLDG. CO. LTD. DBA IZMIRIAN ROOFING & SHEET METAL PENN AIR CONTROL, INC. PETERSON HEATING VENTILATING & AIR CONDITIONING, INC. PETERSON MECHANCIAL PINASCO PLUMBING AND HEATING PIONEER ROOFING ORGANIZATION PMI SERVICE INC POMI MECHANICAL INC. PRIME MECHANICAL SERVICE, INC. PRO TEMP MECHANICAL INC. PSF MECHANICAL INC QUALTECH MECHANICAL, INC. R & R MECHANICAL, INC R & T HEATING & SHEET METAL INC. DBA COMFORT CONTROL R H TINNEY R.J. MECHANICAL, INC. RANGEL HTG VENT DBA RAY L HELLWIG MECHANICAL, INC. REBARBER ENT.INC. REBHOLTZ MECHANICAL RELIANCE ENTERPRISES RICHARDSON HEATING & AIR COND. RICS SHEET METAL INC RMI MECHANICAL, INC. RS ANALYSIS, INC. RYMAC, INC. S & L PAYTON, INC S.J. AMOROSO CONSTRUCTION CO. SAL J ACOSTA MFG CO INC SANTA CLARA VALLEY CONTRACTORS ASSOCIATION SCHAFERS S/M & MFG CO SCHNEIDER ELECTRIC SELCO HTG & A/C SERVICE METAL PROD INC SHEET METAL WORKERS SHEET METAL WORKERS LOCAL UNION NO 104 SHEPHARD MECHANICAL CONTRACTORS, INC. SILICON VALLEY MECH SIMPSON SHEET METAL INC STE. C SMW 104 MONTEREY JAC FUND SO CTY REFRIGERATION SOUTHLAND INDUSTRIES STALEY'S SHEET METAL STANTON MECHANICAL STARS & STRIPS MECHANICAL STATE OF CALIFORNIA STATE SHEET METAL WORKS STRUCTURAL & REFRIGERATION MEC SUPERIOR MECH. SERVICES, INC. T & M HEATING & AIR CONDITIONING INC T.A.B.C.O. INC TEAMWRKX MECHANICAL INC. TECTA AMERICA SACRAMENTO, INC. THERMA CORP. THERMAL MECHANICAL TRAYER ENGINEERING TULLEY MECHANICAL, INC. UNITED MECHANICAL, INC. VALLEY PROCESS SYSTEMS VALLEY SHEET METAL CO VAL'S PLUMBING VAN MULDER SHEET METAL INC VERDEGAAL HEATING INC VERTEX MECHANICAL, INC. VIRGINIA MECHANICAL, INC. VOLORE & SON, INC. DBA WEATHER MASTERS, INC. WESTATES MECH CORP WESTERN ALLIED MECHANICAL, INC WESTERN ENGINEERING SUPPLY CO. INC WESTERN PLBG & HTG CO., INC. YOUR WARM FRIEND,INC.