2018-02-12T20:15:51-06:00 2017-03-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2016-04-01 911106482 CEMENT MASONS AND PLASTERERS HEALTH AND WELFARE TRUST CEME 2064417574 PO BOX 34203 SEATTLE WA 98124 ERIC COFFELT CHAIRMAN 2064419386 2018-02-02 1 MICHAEL T MEAD CPA P01893207 4252506100 2018-02-02 67.137.57.251 2018-02-02 14:36:32 PS P 757A344A9F492B99F4DBC36D20E5EEF65915C547 1C4AA1E388E3DC50B055405D9AA64341548DFCA7 2016 2021-01-29 14:40:06Z ERIC COFFELT 6362 6TH AVE S SEATTLE WA 98108 40303825 0 X N/A X 1980 WA TO PROVIDE HEALTH AND WELFARE BENEFITS TO QUALIFIED PARTICIPANTS 10 10 8 0 0 0 0 0 11964735 14452533 253796 199411 243521 191866 12462052 14843810 0 0 12191103 11576746 0 0 0 0 0 962665 1096383 13153768 12673129 -691716 2170681 14750557 17176378 8510394 8513957 6240163 8662421 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 0 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 1 818 0 1 8 1 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X WELFARE & PENSION ADMINISTRATION 2064417574 2815 2ND AVE STE 300 SEATTLE WA 98121 X X FRANK BENISH TRUSTEE 1.00 X 0 0 0 ROYAL ROBINSON TRUSTEE 1.00 X 0 0 0 JOHN KEARNS TRUSTEE 1.00 X 0 0 0 JOHN SALINAS TRUSTEE 1.00 X 0 0 0 ERIC COFFELT TRUSTEE 1.00 X X 0 0 0 JOSEPH HANNAN TRUSTEE 1.00 X 0 0 0 GARRETT CONDEL TRUSTEE 1.00 X X 0 0 0 DICK METTLER TRUSTEE 1.00 X 0 0 0 ANDREW LEDBETTER TRUSTEE 1.00 X 0 0 0 PATRICK MCQUEEN TRUSTEE 1.00 X 0 0 0 LARRY WHITE TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 WPAS INC PO BOX 34203 SEATTLE WA 98124 ADMINISTRATION SERVICES 501138 AETNA INC 151 FARMINGTON AVENUE HARTFORD CT 06156 CLAIMS PROCESSING 270618 2 EMPLOYER CONTRIBUTIONS 900099 13149097 13149097 EMPLOYEE CONTRIBUTIONS 900099 1187044 1187044 RETIREE CONTRIBUTIONS 900099 116392 116392 14452533 220580 220580 25438846 25460015 -21169 -21169 -21169 FORMULARY REBATES 900099 183949 183949 LIQUIDATED DAMAGES 900099 7917 7917 191866 14843810 14644399 0 199411 11576746 772503 86873 34534 36402 53002 42730 6357 812 5119 4548 ACA TRANSITIONAL REINSU 45590 DUES, REGISTRATIONS AND 5698 LOST WAGES 2215 12673129 12045 63056 650235 955811 1685248 1434640 1000 2753 12402029 14720118 14750557 17176378 432702 226957 8077692 8287000 8510394 8513957 X 0 0 0 0 6240163 8662421 6240163 8662421 14750557 17176378 2170681 251577 0 X X 0 1 X 1 0 0 LAG MONTH ELIGIBILITY COVERAGE 1509000 ACCUMULATED ELIGIBILITY CREDITS 4554000 CLAIMS INCURRED BUT NOT REPORTED 2224000 8287000 X 15058985 251577 251577 14807408 36402 36402 14843810 12362974 0 12362974 36402 273753 310155 12673129 PART X, LINE 2: THE PLAN ADMINISTRATOR HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF MARCH 31, 2017, 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 LAG MONTHS ELIGIBILIT COVERAGE 134000. CHANGE IN ACCUMULATED ELIGIBILITY CREDITS 102000. CHANGE IN INCURRED BUT NOT REPORTED CLAIMS 11000. CHANGE IN PREMIUMS PAYABLE 26753. FORM 990, PART VI, SECTION A, LINE 3 THE DAY TO DAY OPERATIONS OF THE TRUST ARE MANAGED BY WELFARE & PENSION ADMINISTRATION, INC. 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. 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