STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN (EIN 94-2541328)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-04-14
IRS object ID
201111049349300616
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-04-14T13:12:55-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LINDQUIST LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15000 EXECUTIVE PARKWAY SUITE 400AddressLine1
CitySAN RAMONCity
StateCAState
ZIP Code945834210ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN942541328EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLANBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSHEENameControl
Phone9252089999Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12610 Crow Canyon Road No 200AddressLine1
CitySan RamonCity
StateCAState
ZIP Code94583ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRUCE WORDName
TitletrusteeTitle
Phone9252089999Phone
Date Signed2011-04-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone9252779100Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer Personbruce wordNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12610 crow canyon road suite 200AddressLine1
Citysan ramonCity
StateCAState
ZIP Code94583ZIPCode
FieldValueIRS element (for citing)
Gross Receipts131990828GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Siten/aWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1979YearFormation
State Legal DomicileCAStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH benefits and Supplemental unemployment BENEFITSActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees66TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year68139674ProgramServiceRevenuePriorYear
Program Service Revenue CY62122845ProgramServiceRevenueCY
Investment Income Prior Year1236128InvestmentIncomePriorYear
Investment Income Current Year2315437InvestmentIncomeCurrentYear
Other Revenue Prior Year1276069OtherRevenuePriorYear
Other Revenue Current Year182276OtherRevenueCurrentYear
Total Revenue Prior Year70651871TotalRevenuePriorYear
Total Revenue Current Year64620558TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year71449023BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY73339707BenefitsPaidToMembersCY
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3811645OtherExpensePriorYear
Other Expenses Current Year3896897OtherExpensesCurrentYear
Total Expenses Prior Year75260668TotalExpensesPriorYear
Total Expenses Current Year77236604TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-4608797RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-12616046RevenuesLessExpensesCY
Total Assets BOY61940257TotalAssetsBOY
Total Assets EOY50844893TotalAssetsEOY
Total Liabilities BOY27608376TotalLiabilitiesBOY
Total Liabilities EOY26768089TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY34331881NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY24076804NetAssetsOrFundBalancesEOY
Mission DescriptionTo provide health benefits and supplemental unemployement benefits.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionPROVIDED HEALTH AND WELFARE benefits and Supplemental unemployment Benefits to PARTICIPANTS AND THEIR ELIGIBLE DEPENDENTS.Description
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961601NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees66NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement0RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Benesys IncBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9252089999TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12610 Crow Canyon Road Suite 200AddressLine1
CitySAN RAMONCity
StateCAState
ZIP Code94583ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationFormerFormer
gary schwenk
TRUSTEE4.00X000
GARLAND SELF JR
TRUSTEE1.00X000
CHRIS ENFANTINO
TRUSTEE1.00X000
bob bramlett
TRUSTEE1.00X000
BRUCE WORD
TRUSTEE6.50X000
mitchell hoppe
TRUSTEE1.00X000
tim O'connell
TRUSTEE2.00X000
MARK VAN DEN HEUvEL - PAST
TRUSTEE10.00X000
Kevin Van buskirk - PAST
TRUSTEE2.00X000
JOSEPH A MARACCINI
TRUSTEE5.00X000
Paul Steckel
tRUSTEE1.00X000
Carl Sanchez - PAST
TRUSTEE2.00X000
PAUL ARSENAULT
TRUSTEE2.00X000
RICHARD WERNER
tRUSTEE2.00X000
brett risley
trusTEE2.00X000
willie solis
truSTEE2.00X000
rob stoker
tRUSTEE2.00X000
william j leffler jr
tRUSTEE2.00X000
mike pence
trUSTEE2.00X000
ELDEN SHREVE
TRUSTEE1.00000X
Richard Buckley Jr
tRUSTEE0.50000X
anthony asher
truSTEE3.00000X
james conway
truSTEE4.00000X
philip j o'brien
tRUSTEE1.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Benesys Inc
2610 crow canyon road suite 200san ramonCA94583administration2156655
BLUE CROSS
11050 OLSON DRIVE SUITE 110RANCHO CORDOVACA94583ADMInistration518186
ENVISION
2181 E AURORA ROAD SUITE 201TWINSBURGOH44087administration134276
kaufman & goble
10 almaden boulevard suite 540san joseCA95113consulting126000
mcmorgan & company
1 bush street suite 800san franciscoCA94104investment management122911
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Employer Contributions9000995151469051514690
Employee Contributions90009993882549388254
Medicare - D Rebates90009910449011044901
ERRP INCOME900099175000175000
FieldValueIRS element (for citing)
Total Program Service Revenue62122845TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1526480TotalRevenueColumn
Exclusion$1,526,480ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities68159227Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities67370270Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities788957Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column788957TotalRevenueColumn
Exclusion$788,957ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionSettlement AgreementDescription
Business Code900099BusinessCode
Total Revenue Column182276TotalRevenueColumn
Related Or Exempt Function Income182276RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue182276TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column64620558TotalRevenueColumn
Related Or Exempt Function Income62305121RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,315,437ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total73339707Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2023016Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total61507Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total38900Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total139649Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1378514Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total200282Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7876Total

Insurance Insurance

FieldValueIRS element (for citing)
Total25569Total

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionOTHER expenseDescription
Total21584Total

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total77236604Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-1179944BOY
EOY-1275886EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2574513BOY
EOY5320483EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9665405BOY
EOY10817591EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY58957BOY
EOY54843EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY50821326BOY
EOY35927862EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY61940257BOY
EOY50844893EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY324993BOY
EOY369623EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY683075BOY
EOY771700EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY892783BOY
EOY661766EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY25707525BOY
EOY24965000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY27608376BOY
EOY26768089EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY34331881BOY
EOY24076804EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY34331881BOY
EOY24076804EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY61940257BOY
EOY50844893EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Accumulated Eligibilty Credits$19,586,000
Incurred but not Reported Claims$5,379,000
FieldValueIRS element (for citing)
Total Of Amounts24965000TotalOfAmounts
Total Revenue64620558TotalRevenue
Total Expenses77236604TotalExpenses
Excess Or Deficit For Year-12616046ExcessOrDeficitForYear
Net Unrealized GL On Investments2360969NetUnrealizedGLOnInvestments
Other-$332,000OtherAmount
Total Adjustments2028969TotalAdjustments
Excess Or Deficit Per FS-10587077ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt66841878TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments2360969NetUnrealizedGainsInvestments
Revenue Not Rptd F9902360969RevenueNotRptdF990
Revenue Subtotal64480909RevenueSubtotal
Investment Expenses Not Included139649InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt139649RevenueNotRptdOnFinStmt
Total Revenue Per Form99064620558TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt77428955TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal77428955ExpensesSubtotal
Investment Expenses Not Included2139649InvestmentExpensesNotIncluded2
Other Expenses Not Included-332000OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt-192351ExpensesNotRptdOnFinStmt
Total Expenses Per Form99077236604TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanation
Part XI, Line 8 - Other Adjustments:CHANGE IN BENEFIT OBLIGATIONS
Part XIII, Line 4b - Other Adjustments:CHANGE IN BENEFIT OBLIGATIONS

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 3the plan has contracted with benesys, inc to provide administrative services for the organization.
Form 990, Part VI, Section B, line 11A copy of the form 990 was provided to the board of trustees for review before it was filed.
Form 990, Part VI, Section C, line 19Upon request, the organization makes its governing documents, CONFLICT OF INTEREST POLICY and financial information available.
form 990, part xi, line 2c: the organization has a board of trustees that assumes responsibility for oversight of the audit of its financial statements and selection of an independent accountant. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR.
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
local 104 supplemental pension plan
2610 crow canyon road suite 200san ramonCA94583946560138the plan provides supplemental pension benefitsCA501AN/AN/A
sheet metal workers pension trust of northern california
2610 crow canyon road suite 200san ramonCA94583516115939the plan provides pension benefits to retireesCA501AN/AN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg