2022-07-13T16:19:04-05:00 2021-08-31 450250958 EIDE BAILLY LLP 10681 FOOTHILL BLVD STE 300 RANCHO CUCAMONGA CA 917303831 990 2020-09-01 941291152 CEMENT MASONS HEALTH & WELFARE FUND FOR NORTHERN CALIFORNIA CEME 4155368253 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 GREG LEVY PLAN ADMINISTRATOR 4155368253 2022-06-29 1 GREG LEVY 999009999 CATHERINE L GRAY CPA P01294460 9094664410 2022-06-29 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z GREG LEVY 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 136284269 0 X N/A X 1953 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 9 9 0 9 596201 0 0 0 41343369 41717643 2135853 596201 15152 0 43494374 42313844 0 0 35910432 35895215 0 0 0 0 0 2274214 2238613 38184646 38133828 5309728 4180016 73504227 79264458 20244312 19571106 53259915 59693352 NONE 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 3,400 ELIGIBLE PARTICIPANTS ACCORDING TO THE TERMS OF THE COLLECTIVE BARGAINING AGREEMENTS BETWEEN THE EMPLOYERS AND THE UNION 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 0 0 CA X DANIEL FSEHA 4155368253 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 BRIAN GARDNER CHAIRMAN 5.00 X X 0 0 0 SHAWN BARNES TRUSTEE 5.00 X 0 0 0 JENNA CARLSON TRUSTEE 5.00 X 0 0 0 ANDREW VASCONI TRUSTEE 5.00 X 0 0 0 GREG LEVY CO CHAIRMAN 5.00 X X 0 105084 42557 JERRY ZAMORA TRUSTEE 5.00 X 0 0 0 JEFF PATTON TRUSTEE 5.00 X 0 123591 42557 CHESTER MURPHY TRUSTEE 5.00 X 0 0 0 CODY BIK TRUSTEE 5.00 X 0 126659 42557 0 355334 127671 0 0 1 0 ZENITH AMERICAN SOLUTIONS 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 ADMINISTRATION 557716 NORTHERN CALIFORNIA CEMENT MASONS ADMIN 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 ADMINISTRATION 433578 ANTHEM BLUE CROSS OF CALIFORNIA PO BOX 60007 LOS ANGELES CA 90060 HEALTHCARE 398508 SEGAL CONSULTING 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 CONSULTING 196493 DELTA DENTAL 560 MISSION STREET SAN FRANCISCO CA 94105 HEALTHCARE 193915 5 EMPLOYER CONTRIBUTIONS 900099 37445251 37445251 EMPLOYEE CONTRIBUTIONS 900099 2839900 2839900 COBRA CONTRIBUTIONS 900099 1325299 1325299 REBATES AND SUBSIDIES 900099 66322 66322 TPL SUBROGRATION 900099 25183 25183 15688 15688 41717643 772766 772766 93793860 93970425 -176565 -176565 -176565 42313844 41717643 596201 0 35895215 991295 110400 11030 74623 196493 105747 ACA TRANSACTIONAL REINS 739454 BENEFIT SERVICE FEES 9571 38133828 17974994 21475949 936890 1551109 4727708 4851645 30000 30000 7900 8244 45650498 47274874 4176237 4072637 73504227 79264458 293756 5723106 19950556 13848000 20244312 19571106 X 0 0 0 0 53259915 59693352 53259915 59693352 73504227 79264458 4180016 1649418 604003 0 X X 0 1 X 0 0 0 U.S. GOVERNMENT OBLIGATIONS 18129467 F CORPORATE OBLIGATIONS 20644937 F MUTUAL FUND 8500470 F 47274874 INTEREST RECEIVABLE 164761 LIQUDATED DAMAGES AND RELATED INTEREST 111892 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATIONS, INC 3795976 MEMBERSHIP CERTIFICATE 8 4072637 CLAIMS INCURRED BUT NOT REPORTED 1761000 BANK OF HOURS LIABILITY 12087000 13848000 X 43963262 1649418 1649418 42313844 0 42313844 38133828 0 38133828 0 38133828 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FIN ANCIAL ACCOUNTING STANDARDS BOARD. THE TRUST ADMINISTRATOR BELIEVES THAT THE TRUST HAS NOT TAKEN UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS AS A TAX LIABILITY. 0 0 0 CODY BIK TRUSTEE 0 116123 0 0 0 10536 0 24149 0 18408 0 169216 0 0 JEFF PATTON TRUSTEE 0 113942 0 0 0 9649 0 24149 0 18408 0 166148 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES OR KEY EMPLOYEES TO THE ADMINISTRATOR, THE NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION, INC FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE TRUSTEES HAVE DESIGNATED THE ADMINISTRATOR TO REVIEW THE FORM 990 PRIOR TO SIGNING AND FILING. THE CHAIRMAN AND CO-CHAIRMAN REVIEW THE FORM. FORM 990, PART VI, SECTION B, LINE 12C THE ENTITY REGULARLY AND CONSISTENTLY MONTIORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY DURING BOARD MEETINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT AUDITOR. CEMENT MASONS PENSION FUND FOR NORTHERN CALIFORNIA 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 946277669 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A N/A 0 CEMENT MASONS VACATION AND HOLIDAY FUND FOR NORTHERN CALIFORNIA 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 946108055 TO PROVIDE VACATION AND HOLIDAY BENEFITS TO ELIGIBLE PARTICIPANTS CA 501(C)(9) N/A 0 CEMENT MASONS APPRENTICESHIP AND TRAINING FUND FOR NORTHERN CALIFORNIA 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 946428343 TO PROVIDE TRAINING TO ELIGIBLE PARTICIPANTS CA 501(C)(5) N/A 0 CEMENT MASONS & PLASTERERS LOCAL 528 CEMENT MASONS & PLASTERS LU797 CEMENT MASONS 400 CEMENT MASONS-JATC THE NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION INC 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 941583754 TO PROVIDE ADMINSTRATIVE SERVICES FOR RELATED CEMENT MASONS TRUST FUNDS CA N/A C 0 7M GENERAL ENGINEERING INC A J BUILDING SPECIALTIES A M CONCRETE INC A RUIZ CONSTRUCTION CO & ASSOC INC 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A RELATED ORGANIZATION BECAUSE THEY ARE OBLIGATED TO CONTRIBUTE TO THE PLAN PURSUANT TO THE TERMS IN THE COLLECTIVE BARGAINING OR PARTICIPATION AGREEMENT. THE ADMINISTRATIVE OFFICE ONLY MAINTAINS THE DATA NECESSARY TO FULFILL THE OBLIGATION TO CONTRIBUTE, IT DOES NOT MAINTAIN SPECIFIC BUSINESS DATA REGARDING THE EMPLOYERS, SUCH AS ENTITY TYPE OR TAX INFORMATION.