2024-02-08T09:25:09-06:00 2023-03-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-04-01 911106482 CEMENT MASONS AND PLASTERERS HEALTH AND WELFARE TRUST CEME 2064417574 PO BOX 34203 SEATTLE WA 98124 ERIC COFFELT CHAIRMAN 2064419386 2024-01-30 1 ERIC COFFELT 999009999 0 MICHAEL MEAD CPA P01893207 4252506100 2024-01-30 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ERIC COFFELT 6362 6TH AVE S SEATTLE WA 98108 39074789 0 X N/A X 1980 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS 12 4 16 12 0 0 0 0 20828426 21860425 1263426 610512 432129 452302 22523981 22923239 0 0 16755626 21768610 0 0 0 0 0 1627969 1608686 18383595 23377296 4140386 -454057 34182132 35177344 10803881 13589605 23378251 21587739 TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS AS SPECIFIED BY THE PLAN. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS AS SPECIFIED BY THE PLAN. 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 1 498 0 1 16 1 0 0 0 0 0 0 0 0 X 12 4 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X WELFARE & PENSION ADMINISTRATION 2064417574 7525 SE 24TH ST 200 MERCER ISLAND WA 98040 X X ERIC COFFELT CHAIR/TRUSTEE 1.00 X X 0 0 0 GARRETT CONDEL SECRETARY/TRUSTEE 1.00 X X 0 0 0 JOHN SALINAS TRUSTEE 1.00 X 0 0 0 ANDREW LEDBETTER TRUSTEE 1.00 X 0 0 0 FRANK BENISH TRUSTEE 1.00 X 0 0 0 PATRICK MCQUEEN TRUSTEE 1.00 X 0 0 0 CORY YALOWICKI TRUSTEE 1.00 X 0 0 0 EDWARD CASE TRUSTEE 1.00 X 0 0 0 JUSTIN PALACHUK TRUSTEE 1.00 X 0 0 0 TRAVIS METZGER TRUSTEE 1.00 X 0 0 0 BOB TIMMONS START 1222 TRUSTEE 1.00 X 0 0 0 RAYMOND DUMAS START 123 TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 WPAS INC PO BOX 34203 SEATTLE WA 98124 ADMINISTRATION SERVICES 911176 AETNA INC 151 FARMINGTON AVENUE HARTFORD CT 06156 CLAIMS PROCESSING 381070 2 EMPLOYER CONTRIBUTIONS 900099 20307720 20307720 RETIREE CONTRIBUTIONS 900099 1323342 1323342 EMPLOYEE CONTRIBUTIONS 900099 229363 229363 21860425 649988 649988 16112074 16151550 -39476 -39476 -39476 FORMULARY REBATES 900099 381045 381045 LIQUIDATED DAMAGES 900099 71257 71257 452302 22923239 22312727 0 610512 21768610 1293417 34274 64687 58912 54756 63815 8437 1025 6021 15277 DUES, REGISTRATIONS AND 8065 23377296 1521848 3479304 0 1394253 1764362 2625991 6212 7519 28042710 24799362 2847000 2870915 34182132 35177344 463881 214315 10340000 13375290 10803881 13589605 X 0 0 0 0 23378251 21587739 23378251 21587739 34182132 35177344 -454057 -1336455 0 X X 0 1 X 1 0 0 REAL ASSET INCOME 2870915 F 2870915 CLAIMS PAYABLE 148072 ACCUMULATED ELIGIBILITY CREDITS 10179218 CLAIMS INCURRED BUT NOT REPORTED 3048000 13375290 X 21527872 -1336455 -1336455 22864327 58912 58912 22923239 20562735 0 20562735 58912 2755649 2814561 23377296 PART X, LINE 2: THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF MARCH 31, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN CLAIMS PAYABLE 85202. CHANGE IN ACCUMULATED ELIGIBILITY CREDITS 2720447. CHANGE IN INCURRED BUT NOT REPORTED CLAIMS -50000. FORM 990, PART VI, SECTION A, LINE 1A THE GOVERNING BODY HAS NOT DELEGATED BROAD AUTHORITY TO ANY COMMITTEES. FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE TRUST ARE MANAGED BY WELFARE & PENSION ADMINISTRATION SERVICE, INC. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES THAT ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE ENTIRE BOARD OF TRUSTEES AND THE TRUST ATTORNEY ARE PROVIDED A COPY OF THE FORM 990 FOR THEIR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES AND SERVICE PROVIDERS ARE SENT LETTERS ON AN ANNUAL BASIS REQUESTING KNOWLEDGE OF ANY CONFLICTS IN INTEREST OR RELATED PARTY TRANSACTIONS. THE TRUST COUNSEL ALSO MONITORS THE PLAN'S THIRD PARTY SERVICE PROVIDERS ON AN ONGOING BASIS AND REPORTS BACK TO THE TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FROM THE PLAN'S ADMINISTRATOR. FORM 990, PART VII, SECTION A, LINE 6: TRUSTEES ARE NOT COMPENSATED BY THE TRUST, COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED TAX EXEMPT ORGANIZATIONS IS REPORTED ON FORM 990 FILED WITH THE IRS BY RELATED TAX-EXEMPT ORGANIZATIONS. IF YOU WOULD LIKE ADDITIONAL INFORMATION PLEASE CONTACT THE PLAN ADMINISTRATOR. FORM 990. PAGE 11, PART XI, LINE 2C: THE OVERSIGHT PROCESS AND METHOD OF SELECTING THE INDEPENDENT AUDITOR HAS NOT CHANGED FROM PRIOR YEARS. OPCMIA LOCAL 528 6362 6TH AVE S SEATTLE WA 98108 910222689 SUPPORTING LOCAL WA 501(C)(5) N/A N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS THE FILING ORGANIZATION IS A TAFT-HARTLEY MULTI-EMPLOYER TRUST THAT PROVIDES HEALTH BENEFITS TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. AS OF MARCH 31, 2023, THERE ARE APPROXIMATELY 169 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 ADMINISTRATION 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.C.S. A-1 LANDSCAPING & CONSTRUCTION, INC. AAA CONCRETE, INC. 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