2013-11-05T11:26:20-06:00 2012-12-31 320043599 LEGACY PROFESSIONALS LLP 311 S WACKER DRIVE STE 4000 CHICAGO IL 60606 990 2012-01-01 846029106 COLORADO SHEET METAL WORKERS' LOCAL 9 FAMILY HEALTH PLAN COLO 3039221213 PO BOX 27910 DENVER CO 80227 ERIC DEBEY 3039221213 2013-11-05 1 TIMOTHY CIBULKA P00841100 3123680500 2012 2016-03-07 17:11:31Z ERIC DEBEY PO BOX 27910 DENVER CO 80227 8496081 0 X N/A X 1964 CO HEALTH AND WELFARE FUND 3 0 0 0 0 0 0 0 8329183 7563765 476684 211508 6545 1310 8812412 7776583 0 0 9188202 8318436 0 0 0 0 0 426978 400057 9615180 8718493 -802768 -941910 13373567 13163762 63125 86918 13310442 13076844 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 TO PROVIDE MEDICAL AND LIFE INSURANCE BENEFITS TO THE ELIGIBLE DEPENDENTS, BENEFICIARIES AND PARTICIPANTS OF THE PLAN. 0 0 0 0 0 0 0 0 0 1 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 5 0 1 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X ERIC DEBEY 3039221213 PO BOX 27910 DENVER CO 80227 X DWAYNE STEPHENS 3.00 44.00 X 0 85250 35257 ERIC DEBEY 6.00 44.00 X 0 80962 35257 THOMAS P KEATING 4.00 40.00 X 0 96668 11300 RANDY MITCHELL 4.00 44.00 X 0 81224 35257 MARY MARTIN 20.00 X 0 0 0 0 344104 117071 0 0 0 0 CIGNA 3900 E MEXICO AVENUE STE 1100 DENVER CO 80210 BENEFIT CONTRACT ADMINISTRATOR 454129 1 CONTRACTOR CONTRIB. 900099 6716215 6716215 PARTICIPANT & RETIREE 900099 610262 610262 SASMI CONTRIBUTIONS 900099 120604 120604 REBATE INCOME 900099 111466 111466 MEDICARE PART D SUBSID 900099 5218 5218 7563765 125293 125293 805713 719498 86215 86215 86215 MISCELLANEOUS INCOME 900099 1310 1310 1310 7776583 7563765 0 212818 8318436 54999 99967 41994 16493 136545 12245 1613 1200 6105 12993 HRA RETIREE FEES AND EX 8701 MISCELLANEOUS 7202 8718493 -32689 -65630 512499 357232 892451 706716 10322 7954 698 698 0 0 5899707 5369008 6091277 6788482 13373567 13163762 15613 16842 47512 61076 0 9000 63125 86918 X 0 0 0 0 13310442 13076844 13310442 13076844 13373567 13163762 -941910 708312 0 X 0 1 X 1 0 698 698 0 0 COMMON COLLECTIVE TRUST FUNDS 5215145 F LIMITED PARTNERSHIP 1573337 F 6788482 DUE TO PENSION PLAN 9000 9000 8141242 708312 736725 1445037 6696205 16493 1063885 1080378 7776583 8748073 736725 736725 8011348 16493 690652 707145 8718493 PART XI, LINE 2D - OTHER ADJUSTMENTS: REMITTANCE FROM FAMILY HEALTH PLAN TO MEDICARE PLAN 736,725. PART XI, LINE 4B - OTHER ADJUSTMENTS: EMPLOYER CONTRIBUTIONS - MEDICARE PLAN ALLOCATION 327,160. REMITTANCE FROM FAMILY HEALTH PLAN TO MEDICARE PLAN 736,725. PART XII, LINE 2D - OTHER ADJUSTMENTS: REMITTANCE FROM FAMILY HEALTH PLAN TO MEDICARE PLAN 736,725. PART XII, LINE 4B - OTHER ADJUSTMENTS: MEDICARE RETIREE BENEFITS 643,013. MEDICARE PLAN ADMINISTRATIVE EXPENSES 47,639. PART X: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATION EXPIRES. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTATOR PRIOR TO FILING. AFTER THE BOARD'S REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICT OF INTEREST POLICY - THE FUND IS AN EMPLOYEE WELFARE BENEFIT PLAN GOVERNED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). UNDER ERISA, IT IS THE CONTINUING RESPONSIBILITY OF EACH MEMBER OF THE BOARD OF TRUSTEES TO REVIEW TRANSACTIONS FOR POTENTIAL CONFLICTS OF INTEREST, IMMEDIATELY DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, AND TAKE APPROPRIATE ACTION UPON DISCOVERY OF SUCH CONFLICT (E.G., BY THE AFFECTED TRUSTEE RECUSING HIMSELF FROM ANY DECISION RELATED TO SUCH TRANSACTION). TO ASSIST THE TRUSTEES IN IDENTIFYING AND MANAGING ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, THE FUND DISTRIBUTES TO EACH TRUSTEE, OFFICE AND KEY EMPLOYEE (IF ANY) AN ANNUAL QUESTIONNAIRE ASKING FOR INFORMATION REGARDING INTERESTS THAT COULD GIVE RISE TO A CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO ANY PARTICIPANT IN THE PLAN UPON REQUEST AT THE FUND OFFICE. FORM 990, PART VII, LINE 1A THE ADMINISTRATOR OF THE PLAN IS ALSO THE ADMINISTRATOR OF THE RELATED PENSION PLAN AND THE OFFICE MANAGER OF THE LOCAL UNION. THE UNION INITIALLY PAYS FOR THE ADMINISTRATOR'S SALARY AND BENEFITS. AMOUNTS ARE REIMBURSED ON A MONTHLY BASIS BASED ON AN ALLOCATION APPROVED BY THE TRUSTEES. PLAN TRUSTEE THOMAS KEATING RECEIVED COMPENSATION FROM A RELATED ORGANIZATION DURING THE YEAR. AS A SPONSORING ORGANIZATION TO THE FUND, SHEET METAL AND AIR CONDITIONING CONTRACTORS COLORADO CHAPTER (SMACNA) IS CONSIDERED RELATED TO THE PLAN UNDER THIS FORM'S DEFINITION OF RELATED ENTITIES. COMPENSATION RECEIVED BY TRUSTEE KEATING IS REPORTED ON PAGE 7, PART VII, LINE 1A. FORMER TRUSTEE DWAYNE STEPHENS AND TRUSTEES ERIC DEBEY AND RANDY MITCHELL RECEIVED COMPENSATION FROM A RELATED ORGANIZATION DURING THE YEAR. AS A CONTRIBUTING EMPLOYER TO THE FUND, SHEET METAL WORKERS INTERNATIONAL ASSOCIATION LOCAL 9 (THE LOCAL) IS CONSIDERED RELATED TO THE PLAN UNDER THIS FORM'S DEFINITION OF RELATED ENTITIES. COMPENSATION RECEIVED BY THESE INDIVIDUALS IS REPORTED ON PAGE 7, PART VII, LINE 1A. FORM 990, PART XXI, LINE 2B: FINANCIAL STATEMENTS EFFECTIVE JANUARY 1, 2012, THE TRUSTEES APPROVED A RESOLUTION TO ESTABLISH A SEPARATE PLAN FOR RETIRED PARTICIPANTS. THE SHEET METAL WORKERS' LOCAL 9 MEDICARE RETIREE PLAN AND THE SHEET METAL WORKERS' LOCAL 9 FAMILY HEALTH PLAN OPERATE UNDER ONE TRUST AGREEMENT AND EACH PLAN ISSUES SEPARATE AUDITED FINANCIAL STATEMENTS. BOTH PLANS ARE REPORTED ON THIS FORM 990 ON A CONSOLIDATED BASIS. FORM 990, SCHEDULE R, PART IV THE FORM 990 INSTRUCTIONS DEFINE RELATED ORGANIZATIONS TO INCLUDE EMPLOYERS WHO CONTRIBUTE TO VOLUNTARY EMPLOYEE BENEFICIARY ORGANIZATIONS (VEBA). THE PLAN IS ALSO A MULTI-EMPLOYER PLAN OPERATED UNDER THE TAFT-HARTLEY ACT OF 1947 AND THE EMPLOYEE RETIREMENT INCOME SECURITY ACT (ERISA) WHICH PROVIDES HEALTH AND WELFARE BENEFITS TO EMPLOYEES (AND DEPENDENTS) OF CONTRIBUTING EMPLOYERS WHO MAKE CONTRIBUTIONS TO THE PLAN AS REQUIRED UNDER A COLLECTIVE BARGAINING AGREEMENT AND/OR PARTICIPATION AGREMENT. COLORADO SHEET METAL WORKERS LOCAL 9 PENSION FUND 7510 W MISSISSIPPI AVE 200 LAKEWOOD CO 80226 840783596 TO PROVIDE RETIREMENT BENEFITS FOR ELIGIBLE PARTICIPANTS CO 401(A) N/A N/A 0 SHEET METAL WORKERS LOCAL 9 JATC 1515 W 47TH AVENUE DENVER CO 80211 846039791 TRAINING FUND / CONTRIBUTING EMPLOYER CO 501(C)(3) N/A N/A 0 SHEET METAL WORKERS INTERNATIONAL LOCAL 9 7510 W MISSISSIPPI AVE 200 LAKEWOOD CO 80226 840318035 LOCAL UNION / SPONSORING ORGANIZATION CO 501(C)(5) N/A N/A 0 SHEET METAL & AIR CONDITIONING CONTRACTORS COLORADO CHAPTER 1114 W 7TH AVENUE DENVER CO 80204 840473302 EMPLOYER ASSOCIATION / SPONSORING ORGANIZATION CO 501(C)(6) N/A N/A 0 2-H MECHANICAL LLC CONTRIBUTING EMPLOYER 0 API INC CONTRIBUTING EMPLOYER 0 AIR RIGHT INC CONTRIBUTING EMPLOYER 0 AIR SYSTEMS INC CONTRIBUTING EMPLOYER 0 ALEUT GLOBAL SOLUTIONS CONTRIBUTING EMPLOYER 0 AM HEATING & AIR CONTRIBUTING EMPLOYER 0 AMERICAN STAINLESS STEEL CORP CONTRIBUTING EMPLOYER 0 BALANCE TECHNOLOGIES CONTRIBUTING EMPLOYER 0 BELL PLUMBING AND HEATING CONTRIBUTING EMPLOYER 0 BLACKSTONE TEST & BAL INC CONTRIBUTING EMPLOYER 0 CADWERKX LLC CONTRIBUTING EMPLOYER 0 CLASSIC METALS INC CONTRIBUTING EMPLOYER 0 CMS MECHANICAL SERVICES INC CONTRIBUTING EMPLOYER 0 COLORADO SHEET METAL INC CONTRIBUTING EMPLOYER 0 COMPLETE MECHANICAL BALANCING INC CONTRIBUTING EMPLOYER 0 DALF-DENVER AREA LABOR FEDERATION CONTRIBUTING EMPLOYER 0 DENVER TEST & BALANCE CO INC CONTRIBUTING EMPLOYER 0 DIVERSE SHEET METAL LLC CONTRIBUTING EMPLOYER 0 EAGLE AIR TEST & BALANCE CONTRIBUTING EMPLOYER 0 ENERGY BALANCE AND INTEGRATION CONTRIBUTING EMPLOYER 0 FOUR WYNNS MECHANICAL CONTRIBUTING EMPLOYER 0 HEABLER METAL PRODUCTS CONTRIBUTING EMPLOYER 0 HEATING & PLUMBING ENGINEERS INC CONTRIBUTING EMPLOYER 0 HERCULES INDUSTRIES INC CONTRIBUTING EMPLOYER 0 J B HENDERSON CONSTRUCTION CONTRIBUTING EMPLOYER 0 JEDI BALANCING INC CONTRIBUTING EMPLOYER 0 JPG ENGINEERING INC CONTRIBUTING EMPLOYER 0 KLOPPENBERG LLC CONTRIBUTING EMPLOYER 0 LEGACY MECHANICAL INC CONTRIBUTING EMPLOYER 0 MG MCGRATH INC CONTRIBUTING EMPLOYER 0 MARIA CUSTOM SHEET METAL CONTRIBUTING EMPLOYER 0 MECH ONE INC CONTRIBUTING EMPLOYER 0 MIDWEST COLORADO SPRINGS INC CONTRIBUTING EMPLOYER 0 MOUNTAIN STATES SHEET METAL CONTRIBUTING EMPLOYER 0 MURPHY COMPANY CONTRIBUTING EMPLOYER 0 N M INDUSTRIAL SERVICES LLC CONTRIBUTING EMPLOYER 0 NOSTALGIC METALS CONTRIBUTING EMPLOYER 0 ONE TON SHEET METAL INC CONTRIBUTING EMPLOYER 0 PARKER SHEET METAL INC CONTRIBUTING EMPLOYER 0 PRECISION TEST & BALANCE INC CONTRIBUTING EMPLOYER 0 RED'S SHEET METAL INC CONTRIBUTING EMPLOYER 0 SCHERER METALS INC CONTRIBUTING EMPLOYER 0 SINGLETON SHEET METAL WORKS CONTRIBUTING EMPLOYER 0 SKYLINE HEATING & AIR COND CONTRIBUTING EMPLOYER 0 SMW JATC CONTRIBUTING EMPLOYER 0 SUMMIT CONTRACTING LLC CONTRIBUTING EMPLOYER 0 SUPERIOR BALANCE & COMMISSIONING INC CONTRIBUTING EMPLOYER 0 TAB SERVICES INC CONTRIBUTING EMPLOYER 0 TOLIN MECHANICAL SYSTEMS CONTRIBUTING EMPLOYER 0 TRAUTMAN & SHREVE INC CONTRIBUTING EMPLOYER 0 U S TEST & BALANCE CORP CONTRIBUTING EMPLOYER 0 US ENGINEERING CO CONTRIBUTING EMPLOYER 0 VISION AIR HVAC INC CONTRIBUTING EMPLOYER 0 WALRATH HEATING & AC CO INC CONTRIBUTING EMPLOYER 0 WESTON SOLUTIONS INC CONTRIBUTING EMPLOYER 0 WESTWIND MECHANICAL INC CONTRIBUTING EMPLOYER 0 SHEET METAL WORKERS INTERNATIONAL LOCAL 9 CONTRIBUTING EMPLOYER 0 ACE KITCHEN INSTALLATION CONTRIBUTING EMPLOYER 0 DUNRIGHT BALANCING CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 1