2018-07-17T16:20:37-05:00 2017-08-31 952648289 VAVRINEK TRINE DAY & CO LLP 1900 S NORFOLK STREET SUITE 225 SAN MATEO CA 94403 990 2016-09-01 941291152 CEMENT MASONS HEALTH & WELFARE FUND FOR NORTHERN CALIFORNIA CEME 8002515013 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 TRUSTEE TRUSTEE TRUSTEE 8002515013 2018-07-17 1 P01882015 9094664410 2016 2022-09-23 18:48:47Z X 1600 HARBOR BAY PARKWAY NO 200 ALAMEDA CA 94502 72191606 0 X N/A X 1953 CA SEE PART III LINE 4A 8 8 0 0 0 0 0 0 32173836 33985409 526853 825492 1715913 523362 34416602 35334263 0 0 27182305 28773534 0 0 0 0 0 2048710 2134869 29231015 30908403 5185587 4425860 47688403 52681394 14227857 14746994 33460546 37934400 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 22 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X SCOTT WALL 8002515013 1600 HARBOR BAY PARKWAY ALAMEDA CA 94502 X SHAWN BARNES TRUSTEE 5.00 X 0 0 0 ROBERT DUMESNIL TRUSTEE 5.00 X 0 0 0 BRIAN GARDNER TRUSTEE 5.00 X 0 0 0 MARK REYNOSA 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 JERRY ZAMORA TRUSTEE 5.00 X 0 0 0 GREG LEVY TRUSTEE 5.00 X 0 0 0 0 0 0 0 0 0 0 NORTHERN CALIFORNIA CEMENT MASONS FUNDS 1600 HARBOR BAY PARKWAY STE 200 ALAMEDA CA 94502 ADMINISTRATOR 696401 ANTHEM BLUE CROSS PO BOX 629 WOODLAND HILLS CA 91365 CLAIMS ADMINISTRATOR 362332 THE SEGAL COMPANY 100 MONTGOMERY ST STE 500 SAN FRANCISCO CA 94104 CONSULTING 236179 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATOR 137418 ZENITH AMERICAN SOLUTIONS 1600 HARBOR BAY PARKWAY STE 200 ALAMEDA CA 94502 ADMINISTRATOR 100672 5 EMPLOYER CONTRIBUTIONS 900099 30598634 30598634 EMPLOYEE CONTRIBUTIONS 900099 2972101 2972101 COBRA CONTRIBUTIONS 900099 414674 414674 33985409 807551 807551 36875284 36857343 17941 17941 17941 REBATES AND SUBSIDIES 900099 440619 440619 LIQUIDATED DAMAGED AND RELATED IN 900099 79243 79243 SETTLEMENT INCOME 900099 3500 3500 523362 35334263 34526712 0 807551 28773534 816644 141263 31502 78430 236179 4303 36419 BENEFIT SERVICE FEES 672573 PRINTING & STATIONERY 112946 ACA TRANSITIONAL REINS. 2352 BANK FEES 2258 30908403 9956355 4751538 3576428 524880 3444979 3953029 30000 30000 6595 172409 29498865 39349738 1175181 3899800 47688403 52681394 51023 106327 14176834 14640667 14227857 14746994 X 0 0 0 0 33460546 37934400 33460546 37934400 47688403 52681394 4425860 47994 0 X X 0 1 X 1 0 0 INTEREST AND DIVIDENDS 199258 LIQUIDATED DAMAGES AND RELATED INTEREST 111892 REBATES AND SUBSIDIES 138000 MEMBERSHIP CERTIFICATE 8 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION INC 3209857 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS PENSION FUND 240785 3899800 CLAIMS PAYABLE - IBNR 1780000 DUE TO NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION, INC 32577 GROUP INSURED PREMIUMS PAYABLE 1755077 SELF-FUNDED BENEFIT CLAIMS PAYABLE 2591442 BANK OF HOURS 8462000 DUE TO NORTHERN CALIFORNIA LABORERS FUNDS ADMINISTRATION, INC. 19571 14640667 X 35382257 47994 47994 35334263 0 35334263 30908403 0 30908403 0 30908403 PART X, LINE 2: THE TRUST HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL 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. THE TRUST ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS PRIOR TO AUGUST 31, 2014. 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 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 CONFLICT OF INTEREST POLICY IS MONITORED AND ENFORCED DURING BOARD MEETINGS FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES MAKE 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 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 FORM 990, PART IV, LINE 34 THE FILING ENTITY IS A 501(C)(9) VEBA WHO MUST LIST CONTRIBUTING EMPLOYERS ON SCHEDULE R. THE ADMINISTRATIVE OFFICE MAINTAINS A LIST OF CONTRIBUTIONS EMPLOYERS, HOWEVER, THAT LIST DOES NOT INCLUDE FEDERAL TAX CLASSIFICATION. THEREFORE, THE LIST CONTRIBUTING EMPLOYERS IS REPORTED ON PART VII, SUPPLEMENTAL INFORMATION. A M CONCRETE INC A. RUIZ CONSTRUCTION CO. & ASSOC INC ABEL'S CONCRETE ACME CONSTRUCTION CO INC ALB INCORPORATED ALBANESE JOSEPH J INC ALL CONCRETE CONSTRUCTION ALL FORMS INC ALL-AMERICAN CONSTR. INC ALLEN S W CONST INC ALLIED-WEST CONSTRUCTION ALTA ENGINEERING GROUP INC AMER CIVIL CNSTRS W CST L AMERICAN PAVING COMPANY ANNUZZI CONCRETE SVC INC ANZA ENGINEERING CORP AP & DECK WATERPROOFING APARICIO C CEM CONTR INC ARGUELLO CONCRETE CONST. ASSOCIATED SURFACE PREP AVELLINO CONSTRUCTION AVISON CONSTRUCTION INC BALL GORDON N INC BARRAZA'S FLOOR SYSTEMS BAUMAN LANDSCAPE INC BAY AREA CONCRETES INC. BAY AREA PAVING CO BAY CITIES PAV & GRAD INC BAY CONSTRUCTION CO. 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