2020-07-15T09:41:43-05:00 2019-08-31 450250958 EIDE BAILLY LLP 3130 CROW CANYON PL STE 300 SAN RAMON CA 945831386 990 2018-09-01 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 2020-07-15 1 THERESA MONTGOMERY P00232100 9254804000 2020-07-15 99.110.55.147 2020-07-15 09:41:19 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 327E456370A643C83A1BB4325D39191A230D016A 2018 2021-09-10 13:11:23Z GREG LEVY 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 173140259 0 X N/A X 1953 CA TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS 9 9 0 9 0 0 0 0 39076872 39344262 205291 2185960 399372 170800 39681535 41701022 0 0 29502718 39870961 0 0 0 0 0 1899958 2302150 31402676 42173111 8278859 -472089 62550905 66977541 15853555 20215263 46697350 46762278 NONE 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO APPROXIMATELY 2,500 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 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 2 0 1 0 0 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 X DANIEL FSEHA 4155368253 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 X SHAWN BARNES TRUSTEE 5.00 X 0 0 0 JERRY ZAMORA TRUSTEE 5.00 X 0 0 0 BRIAN GARDNER TRUSTEE 5.00 X 0 0 0 JENNA CARLSON TRUSTEE 5.00 X 0 0 0 KEITH SHANKS TRUSTEE 5.00 X 0 0 0 CODY BIK TRUSTEE 5.00 X 0 0 0 ANDREW VASCONI TRUSTEE 5.00 X 0 0 0 GREG LEVY TRUSTEE 5.00 X 0 0 0 JEFF PATTON TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 NORTHERN CALIFORNIA CEMENT MASONS ADMIN 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 ADMINISTRATION 508568 ZENITH AMERICAN SOLUTIONS 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 ADMINISTRATION 474342 ANTHEM BLUE CROSS OF CALIFORNIA PO BOX 60007 LOS ANGELES CA 90060 HEALTHCARE 361357 SEGAL CONSULTING 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 CONSULTING 254404 DELTA DENTAL 560 MISSION STREET SAN FRANCISCO CA 94105 HEALTHCARE 172107 5 EMPLOYER CONTRIBUTIONS 900099 36324832 36324832 EMPLOYEE CONTRIBUTIONS 900099 2801625 2801625 COBRA CONTRIBUTIONS 900099 217805 217805 39344262 1140728 1140728 132484469 131439237 1045232 1045232 1045232 REBATES AND SUBSIDIES 900099 115885 115885 SETTLEMENT INCOME 900099 27365 27365 LIQUIDATED DAMAGES AND RELATED IN 900099 26477 26477 1073 1073 170800 41701022 39515062 0 2185960 39870961 982909 106228 26739 103663 254404 113809 32649 BENEFIT SERVICE FEES 681749 42173111 13462418 15141364 668986 1776777 4441776 4471691 30000 30000 11361 0 39889071 41498453 4047293 4059256 62550905 66977541 210608 273060 15642947 19942203 15853555 20215263 X 0 0 0 0 46697350 46762278 46697350 46762278 62550905 66977541 -472089 537017 0 X X 0 1 X 0 0 0 U.S. GOVERNMENT OBLIGATIONS 19095824 F CORPORATE OBLIGATIONS 17064342 F MUTUAL FUND 5338287 F 41498453 INTEREST AND DIVIDENDS 178035 LIQUDATED DAMAGES AND RELATED INTEREST 111892 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATIONS, INC 3534430 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS PENSION FUND 234891 MEMBERSHIP CERTIFICATE 8 4059256 DUE TO NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION, INC. 33051 PREMIUMS PAYABLE 2180678 CLAIMS PAYABLE 3880474 CLAIMS INCURRED BUT NOT REPORTED 1761000 BANK OF HOURS LIABILITY 12087000 19942203 X 42134376 537017 537017 41597359 103663 103663 41701022 37776515 0 37776515 103663 4292933 4396596 42173111 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FNIANCIAL 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. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN NET BENEFIT OBLIGATION 4,292,933. 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. 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 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 C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 PARTS II, III, AND IV - IDENTIFICATION OF RELATED TAX ORGANIZATIONS IN A MULTIEMPLOYER PLAN, A CONTRIBUTING EMPLOYER IS CONSIDERED 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.