2017-07-21T10:02:35-05:00 2016-12-31 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2016-01-01 352523608 Galaxy I Concord Corporation GALA 2132335700 515 S Flower St 49th Floor Los Angeles CA 90071 Scott Darling President & Secretary 2132335700 2017-07-21 1 Marek Rozowicz P01616027 3126343400 108.171.131.188 2017-07-21 10:02:25 CD P 4B8E1423B9F197D509CCF13AB357181C17C415CB 37AB53F3E1FE5B259FEACB8EAA64376B229EE5AE 2016 2021-01-29 14:40:06Z X Scott Darling 515 S Flower St 49th Floor Los Angeles CA 90071 375016 0 X N/A X 2014 DE Title Holding Company for rental real estate. 3 2 0 2 0 0 0 0 0 0 0 0 -356767 -610698 -356767 -610698 0 0 0 0 0 0 0 0 0 0 0 0 0 -356767 -610698 12088574 19363501 367860 1007469 11720714 18356032 Title Holding Company for rental real estate. 0 0 Entity holds title to real property for an exempt organization and collects income, pays expenses and submits the excess of income over expenses to the exempt organization. 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 0 0 0 1 0 0 1 0 0 0 1 0 0 0 0 0 0 CA X American Realty Advisors 2132335700 515 S Flower St 49th Floor Los Angeles CA 90071 X Stanley L Iezman Chairman & CEO, Treasurer 1.00 1.00 X X 0 0 0 Scott Darling President & Secretary 1.00 1.00 X X 0 0 0 Kirk Helgeson EVP/EMD, Investments 1.00 1.00 X X 0 0 0 0 0 0 0 0 0 0 Rainbow Waterproofing & Restoration 600 Treat Avenue San Francisco CA 94110 Capital Improvement Services 1580310 Richlen Partition Company 115 Aspen Drive Pacheco CA 94553 Capital Improvement Services 1223527 Dome Construction Corporation 393 E Grand Avenue South San Francisco CA 94080 Capital Improvement Services 903818 CBRE Inc PO Box 848844 Los Angeles CA 90084 Property Management Services 534313 American Realty Advisors 515 S Flower St 49th Floor Los Angeles CA 90071 Asset Management Services 114813 5 375016 985714 -610698 -610698 -610698 -610698 -610698 0 0 0 0 0 0 1617266 500 1414310 7730 7654 38578 41037 17886599 0 10420796 17886599 4204 13401 12088574 19363501 284031 835247 39478 97807 44351 74415 367860 1007469 X 0 0 11720793 17580533 -79 775499 11720714 18356032 12088574 19363501 X -610698 1386276 5859740 X 0 1 X 1 0 13881034 13881034 3814052 3814052 191513 191513 17886599 Security Deposits 74415 74415 X Part X, Line 2: The Separate Account is comprised of entities which are tax-exempt. Accordingly, no provision or liability for income taxes has been reflected in the accompanying consolidated financial statements. The Separate Account files tax returns as prescribed by the tax laws of the jurisdictions in which it operates. Accounting Standards Codification Topic 740, Income Taxes, requires the recognition of the impact of a tax position in the combined financial statements if that position is more likely than not of being sustained on a tax return upon examination by the relevant taxing authority, based on the technical merits of the position. At December 31, 2016, the Separate Account had no unrecognized tax benefits. American Realty Advisors Stanley L. Iezman, Board member, is the owner of American Realty Advisors 114813 Investment Management Fee 0 Form 990, Part VI, Section A, line 6 The sole stockholder is UFCW Northern California Employers Joint Pension Plan, as they have the rights to receive the organization's profits and net assets upon the organization's dissolution. They also have complete authority to elect the Board of Directors and Officers. Form 990, Part VI, Section A, line 8b The organization does not have the necessity for and has not established a committee with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The fund controller reviews the draft of the Form 990 submitted by the tax preparer for reasonableness, in comparison to prior year returns, as well as adjusted balances prior to finalization and submission. Form 990, Part VI, Section C, line 19 The governing documents are available upon request in writing. Form 990, Part XI, line 9: Capital Contributions 5,750,000. Operating Contributions 109,740. UFCW Northern California Employers Joint Pension Plan 1000 Burnett Avenue Suite 110 Concord CA 94520 946313554 Pension Fund CA Section 401(a) N/A 0 Galaxy II Concord Corporation 515 S Flower St 49th Floor Los Angeles CA 90071 900997279 Title Holding Company DE 501(c)(25) N/A UFCW Northern California Employers Joint Pension Plan 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0