2011-11-08T18:05:33-06:00 2010-12-31 LINDQUIST LLP 5000 EXECUTIVE PARKWAY SUITE 400 SAN RAMON CA 94583 990 2010-01-01 776113549 NORTHERN CALIFORNIA SHEET METAL WORKERS HEALTH CARE PLAN NORT 9252089994 PO BOX 1677 SAN RAMON CA 94583 DENNIS CANEVARI 9252089994 2011-11-08 1 9252779100 2010 2016-03-07 17:11:31Z DENNIS CANEVARI PO BOX 1677 SAN RAMON CA 94583 28858035 0 X N/A X 1995 CA TO PROVIDE HEALTH AND WELFARE BENEFITS. 8 8 0 0 0 0 0 0 18508501 16971469 -434855 468508 58061 8058 18131707 17448035 0 0 19256262 16610421 0 0 0 0 0 1255214 1274869 20511476 17885290 -2379769 -437255 22597728 21124088 8001223 6439999 14596505 14684089 TO PROVIDE HEALTH AND WELFARE BENEFITS 0 0 PROVIDED HEALTH 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 1 0 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 0 1 1800 0 1 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 0 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 MARK BOWERS 2.00 X 0 0 0 SAL ROTOLO 2.00 X 0 0 0 MATTHEW SMITH 2.00 X 0 0 0 TONY LEDOUX 2.00 X 0 0 0 FRANK FLORES 2.00 X 0 0 0 DENNIS CANEVARI 2.00 X 0 0 0 KEN PIERSON 2.00 X 0 0 0 LONNIE PETTY 2.00 X 0 0 0 0 0 0 0 0 0 0 BENESYS INC 2610 CROW CANYON ROAD SAN RAMON CA 945831768 CONTRACT ADMINISTRATOR 801940 BLUE CROSS OF CA 120 MONUMENT CIRCLE INDIANAPOLIS IN 46204 COST CONTAINMENT 153227 2 EMPLOYER CONTRIBUTIONS 900099 12494598 12494598 PARTICIPANT CONTRIBUTI 900099 3983091 3983091 MEDICARE PART D SUBSID 900099 275507 275507 COBRA SUBSIDY 900099 218273 218273 16971469 468508 468508 11410000 11410000 0 0 SECURITIES LITIGATION 900099 8058 8058 8058 17448035 16971469 0 476566 16610421 751336 32860 36110 52632 307619 72553 5323 16436 17885290 -298148 -269573 15253562 1578059 2806897 2563940 14978 13970 4820439 17237692 22597728 21124088 92782 103862 334441 338137 7574000 5998000 8001223 6439999 X 0 0 0 0 14596505 14684089 14596505 14684089 22597728 21124088 X -437255 524839 X X 0 1 1 X 0 0 CLAIMS PAYABLE AND INCURRED BUT NOT REPORTED 1264000 ACCUMULATED ELIGIBILITY CREDITS 4734000 5998000 17448035 17885290 -437255 524839 -1576000 -1051161 -1488416 17920242 524839 524839 17395403 52632 52632 17448035 19408658 0 19408658 52632 -1576000 -1523368 17885290 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFIT OBLIGATIONS. PART XIII, LINE 4B - OTHER ADJUSTMENTS: CHANGE 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 11 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, LINES 15A AND 15B: THE PLAN'S BOARD OF 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 524,839. FORM 990, PART XIII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT AUDITOR. SHEET METAL WORKERS LOCAL 162 DEFINED CONTRIBUTION RETIREMENT PLAN PO BOX 1677 SAN RAMON CA 94583 776138076 TO PROVIDE PENSION BENEFITS CA 501(A) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0