2019-07-15T15:10:40-05:00 2018-08-31 952648289 VAVRINEK TRINE DAY & CO 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2017-09-01 941291152 CEMENT MASONS HEALTH & WELFARE FUND FOR NORTHERN CALIFORNIA CEME 4155368253 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 PLAN ADMINSTRATOR PLAN ADMINISTRATOR 4155368253 2019-07-15 1 JENNIFER SNOW P01882015 9094664410 69.170.7.86 2019-07-15 15:08:32 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 79ACAE867A9DB9871DCF109F9EDC9C017100E02E 2017 2019-02-21 02:37:17Z 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 97068747 0 X N/A X 1953 CA SEE PART III LINE 4A 8 8 0 0 0 0 0 0 33985409 39076872 825492 205291 523362 399372 35334263 39681535 0 0 28773534 29502718 0 0 0 0 0 2134869 1899958 30908403 31402676 4425860 8278859 52681394 62550905 14746994 15853555 37934400 46697350 NONE 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO 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 0 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 0 0 0 0 0 0 0 0 0 X 8 8 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 SUITE 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 MARK REYNOSA TRUSTEE 5.00 X 0 0 0 GREG LEVY TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 ADMINISTRATION 433953 ANTHEM BLUE CROSS OF CALIFORNIA PO BOX 60007 LOS ANGELES CA 90060 HEALTHCARE 347843 NORTHERN CALIFORNIA CEMENT MASONS ADMIN 1600 HARBOR BAY PARKWAY SUITE 200 ALAMEDA CA 94502 ADMINISTRATION 285376 SEGAL CONSULTING 100 MONTGOMERY STREET SUITE 500 SAN FRANCISCO CA 94104 CONSULTING 155025 DELTA DENTAL 560 MISSION STREET SAN FRANCISCO CA 94105 HEALTHCARE 139566 5 EMPLOYER CONTRIBUTIONS 900099 35107905 35107905 EMPLOYEE CONTRIBUTIONS 900099 2749066 2749066 COBRA CONTRIBUTIONS 900099 1219901 1219901 39076872 976593 976593 56615910 57387212 -771302 -771302 -771302 REBATES AND SUBSIDIES 900099 346097 346097 SETTLEMENT INCOME 900099 48164 48164 LIQUIDATED DAMAGES AND RELATED IN 900099 5111 5111 399372 39681535 38704942 0 976593 29502718 741536 105003 30168 98016 170025 83337 36319 BENEFIT SERVICE FEES 635554 31402676 4751538 13462418 524880 668986 3953029 4441776 30000 30000 172409 11361 39349738 39889071 3899800 4047293 52681394 62550905 106327 210608 14640667 15642947 14746994 15853555 X 0 0 0 0 37934400 46697350 37934400 46697350 52681394 62550905 8278859 484091 0 X X 0 1 X 1 0 0 INTEREST AND DIVIDENDS 197251 LIQUDATED DAMAGES AND RELATED INTEREST 111892 REBATES AND SUBSIDIES 138000 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATIONS, INC 3372435 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS PENSION FUND 227707 MEMBERSHIP CERTIFICATE 8 4047293 DUE TO NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION, INC. 26728 PREMIUMS PAYABLE 2522211 CLAIMS PAYABLE 2274008 CLAIMS INCURRED BUT NOT REPORTED 1337000 BANK OF HOURS LIABILITY 9483000 15642947 X 40165626 484091 484091 39681535 0 39681535 31402676 0 31402676 0 31402676 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. 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. 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 NORTHER 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.