2015-07-10T13:10:22-05:00 2014-08-31 942723629 HEMMING MORSE CPA'S AND CONSULTANTS 155 BOVET ROAD SUITE 600 SAN MATEO CA 94402 990 2013-09-01 941291152 CEMENT MASONS HEALTH & WELFARE FUND FOR NORTHERN CALIFORNIA CEME 7078643300 220 CAMPUS LANE FAIRFIELD CA 945341499 EDWARD SMITH SECRETARY 7078643300 2015-07-02 1 P01781096 4158364000 2013 2016-02-25 16:41:14Z 220 CAMPUS LANE FAIRFIELD CA 945341499 44516431 0 X N/A X 1953 CA SEE PART III LINE 4A 8 8 0 0 0 0 0 0 24506606 26838864 706766 497122 489035 392575 25702407 27728561 0 0 15415791 19689605 0 0 0 0 0 1938602 2069135 17354393 21758740 8348014 5969821 27472501 35650845 8211970 9379862 19260531 26270983 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 0 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 35 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 0 0 1 1 0 0 0 X EDWARD SMITH 7078643300 220 CAMPUS LANE FAIRFIELD CA 945341499 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 BEN ESPINOZA TRUSTEE 5.00 X 0 0 0 HECTOR CORTEZ 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 220 CAMPUS LANE FAIRFIELD CA 94534 ADMINISTRATOR 931845 ANTHEM BLUE CROSS PO BOX 629 WOODLAND HILLS CA 91365 CLAIMS ADMINISTRATOR 267482 THE SEGAL COMPANY 100 MONTGOMERY ST STE 500 SAN FRANCISCO CA 94104 CONSULTING 198617 DELTA DENTAL 100 FIRST STREET SAN FRANCISCO CA 94105 CLAIMS ADMINISTRATOR 112404 BULLIVANT HOUSER & BAILEY 888 SW FIFTH AVE STE 300 PORTLAND OR 97204 ATTORNEY 102898 5 EMPLOYER CONTRIBUTIONS 900099 23169841 23169841 EMPLOYEE CONTRIBUTIONS 900099 3445989 3445989 COBRA CONTRIBUTIONS 900099 223034 223034 26838864 544826 544826 16740166 16787870 -47704 -47704 -47704 REBATES AND SUBSIDIES 900099 379215 379215 SETTLEMENT INCOME 900099 13360 13360 392575 27728561 27183735 0 544826 19689605 931845 191470 27713 51370 198617 6946 39722 BENEFIT SERVICE FEES 471396 ACA TRANSITIONAL REINS. 116676 PRINTING & STATIONERY 30900 PATIENT CARE OUTCOME RE 2480 21758740 2985453 6276374 1384837 821633 3414481 3222771 30000 30000 5686 6131 18693105 22350573 958939 2943363 27472501 35650845 138423 299401 8073547 9080461 8211970 9379862 X 0 0 0 0 19260531 26270983 19260531 26270983 27472501 35650845 5969821 1040631 0 X X 0 1 X 1 0 0 INTEREST AND DIVIDENDS 115079 LIQUIDATED DAMAGES AND RELATED INTEREST 132721 REBATES AND SUBSIDIES 286308 MEMBERSHIP CERTIFICATE 8 DUE FROM NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION INC 2409247 2943363 CLAIMS PAYABLE - IBNR 960000 DUE TO NORTHERN CALIDORNIA CEMENT MASONS FUNDS ADMINISTRATION, INC 231649 GROUP INSURED PREMIUMS PAYABLE 991670 SELF-FUNDED BENEFIT CLAIMS PAYABLE 1775142 BANK OF HOURS 5122000 9080461 28769192 1040631 1040631 27728561 0 27728561 21758740 0 21758740 0 21758740 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 11 THE TRUSTEES HAVE DESIGNATED THE ADMINISTRATOR TO REVIEW THE FORM 990 PRIOR TO SIGNING AND FILING. 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 220 CAMPUS LANE FAIRFIELD CA 94534 946277669 TO PROVIDE PENSION BENEFITS TO ELIGIBLE PARTICIPANTS CA 401A N/A 0 CEMENT MASONS VACATION AND HOLIDAY FUND FOR NORTHERN CALIFORNIA 220 CAMPUS LANE FAIRFIELD CA 94534 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 220 CAMPUS LANE FAIRFIELD CA 94534 946428343 TO PROVIDE TRAINING TO ELIGIBLE PARTICIPANTS CA 501(C)(5) N/A 0 THE NORTHER CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION INC 220 CAMPUS LANE FAIRFIELD CA 94534 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 CALIFORNIA SKATE PARKS QLM INC MCFADDEN CONST INC CYPRESS MANDELA TRNG CTR MCKAY & CO. CONST. CHAPIN DON CO INC ASHBY JIMMY W CONSTR BOHANNAN CONCRETE INC DMCE CONCRETE & ENG CONTR MOUNTAIN CONSTRUCTION INC LOPEZ D JR GUERRA CONSTRUCTION GROUP WALLACE MARK MASONRY PENICK T.B. & SONS INC. BUSH ENGINEERING INC ON THE LEVEL CONCRETE PACIFIC INDUSTRIAL CONSTR ARGUELLO CONCRETE CONST. GILBERT E E CONST INC RAPELLA C & SONS INC NORTHWEST SURFACING ENHANCED CONCRETE CONSTR WHITING CONCRETE BMY CONSTRUCTION GP INC GRANT CONSTRUCTION INC BIONDI PAVING CO GRIFFITH COMPANY LUMINART DECORATIVE CONCR C & C CONSTRUCTION INC CVC CONSTRUCTION CORP TRITON STRCTRL CONCRETE MARNE CONSTRUCTION INC THOMPSON CONST GROUP INC SILICON VALLEY PAVING INC CALIFORNIA HI-TECH FLOORS NEWLAND ENTITIES INC EASTMONT BUILDERS CLARK/MCCARTHY JV BEEBE DIVERSIFIED LP MILLER & ELWOOD CONCRETE SEALS/BIEHLE INC CAZADORES CONSTR INC CELTIC CONSTRUCTION INC SCHREDER SEWARD L CONSTR SO NEV CM LOCAL 797 RECIP SO NEV CM LOCAL 797 RECIP CHICAGO CM LCL# 502 RECIP CHICAGO CM LCL# 502 RECIP HAWAII MASONS RECIP HAWAII MASONS RECIP NO NEVADA TF RECIP NO NEVADA TF RECIP SAN DIEGO CM TF RECIP SAN DIEGO CM TF RECIP SO CAL CM TF RECIP SO CAL CM TF RECIP PERINI BUILDING CO INC BRADCON DBA BRADLEY CONCR DIEDE CONSTRUCTION INC MINNESOTA CM TF RECIP MINNESOTA CM TF RECIP DURAN CONSTRUCTION GROUP PACIFIC PERFORMANCE ENT EIGHTY EIGHT CONCR CONSTR GRACE CONSTRUCTION CO INC ACCURATE SAWCUTTING INC BOMEL CONSTR CO INC DAN ELECTRIC AMES CONSTRUCTION INC FLATIRON-KIEWIT JV BAYMARR CONSTRUCTORS INC WALTON ENGINEERING INC COOPER ENGINEERING INC NESSCO CONSTRUCTION ZUMWALT CONSTRUCTION INC GRANADE D. G. INC CEN-CAL CONSTRUCTION JONES R A CONSTRUCTION VALVERDE CONSTRUCTION BROSAMER & WALL INC HTI POLYMER INC COMMERCIAL PLMBG & BLDG JW TAYLOR CONSTRUCTION R S C GENERAL & ENG INC SHAW & SONS CNCRT CNTRCTS M.J. DEAN CONSTRUCTION CEMCON INC SOUTHHILL CONTRCTNG CORP F. LODUCA CO. CANO ARCHITECTURE CONCRET DMZ BUILDERS DIACON INC DANCO BUILDERS FORM 990, PART IV, LINE 34 SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS: 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 OF CONTRIBUTING EMPLOYERS IS REPORTED ON PART VII, SUPPLEMENTAL INFORMATION. AMERICAN PAVING COMPANY AMOROSO S J CONST CO INC ALBANESE JOSEPH J INC ACME CONSTRUCTION CO INC ANNUZZI CONCRETE SVC INC ARB INC BIANCHI GEO CONSTR INC BRAY J L & SON INC CONCO COMPANIES DOLAN CONCRETE CONSTR FERRANDO F & CO GRANITE CONSTRUCTION CO HARRIS CONSTR CO INC JOHNSON AA & SON INC JOHNSON WESTERN GUNITE CO KAWEAH CONSTRUCTION CO LANDAVAZO BROS INC LAMON CONSTRUCTION CO INC MC GUIRE & HESTER MERLO LEWIS M INC MIHOLOVICH CONCR CO INC NICHOLSON D W CORP OTTO CONSTRUCTION PACIFIC MECHANICAL CORP RANSOME COMPANY ROEN C W CONSTR CO REED GEORGE INC TEICHERT A & SON INC UNGER CONSTR CO WATTIS CONSTR CO INC WEHNER R H CONSTR CO WEST VALLEY CONSTR CO APARICIO C CEM CONTR INC BERKELEY CEMENT INC BAY AREA PAVING CO MAGGIORA & GHILOTTI INC RUDOLPH & SLETTEN INC CLARK PACIFIC MBI MIDSTATE BARRIER INC WESTERN WATERPROOFING CO DEVINCENZI CONCRETE CONST WICKUM CONSTRUCTION BAY AREA CONCRETE INC HENSEL PHELPS CONST CO BAY CITIES PAV & GRAD INC F & H CONSTRUCTION F & H CONSTRUCTION JOHNSTON FLOYD CONST CO NOR-CAL CONCRETE CASEY-FOGLI CONCRETE CON COLEMAN BILL CONCRETE PANKOW CHARLES BLDRS LTD MAHER M F INC MAHER R & R CONST CO INC WEBCOR CONSTRUCTION, L.P. HARRIS R M CO CONTRI CONSTR CO M & M LIGHTWEIGHT CONCR CALIF ENG CONTRS INC SWISHER W E CEM CONTR CELL-CRETE CORP M C M CONSTRUCTION INC NADAR INC R & W CONCRETE CONTRS INC SPOSETO ENGINEERING INC TERA-LITE INC SWANSON CONSTRUCTION INC POPUCH CONCRETE CAL-WEST CONCRETE CUTTING D S S CO KNIFE RIVER PERFORMANCE MECH INC MYERS C C INC NEMETZ R A CONSTR CO INC KIEWIT POWER CONSTR CO YOUNG D W CONSTR CO INC PORTER CONCR CONSTR INC BAUMAN LANDSCAPE INC STACY & WITBECK INC KIEWIT INFRASTRUCTURE WES LYLES W M CO SAN JOSE CONSTRUCTION INC J M O'NEILL INC MCCARTHY BLDG COMPANIES D Y K INC GOLDEN BAY CONSTR INC URATA & SONS CEMENT MACLEAN DONALD S INC FRESNO CONCRETE CONSTR MURGA STRANGE & CHALMERS ALL FORMS INC JAEGER CONSTRUCTION INC SHASTA CONSTRUCTORS INC WHITESIDE CONSTRUCTION EVANS BROTHERS INC AMER CIVIL CONSTRS WEST C HAYDON CONSTRUCTION INC PAVEX/DIVISION OF GRANITE IMBIMBO CONCRETE ROBYN CONSTRUCTION INC CAREY CONSTRUCTION RGW CONSTRUCTION INC SHIMMICK CONSTR CO INC D P R CONSTRUCTION CARPENTER GREG CONCR INC BRAHMA CONSTRUCTION INC S J D CONSTRUCTION INC GHILOTTI BROTHERS INC BALL GORDON N INC GHILOTTI CONSTR COMPANY J.J.R. CONSTRUCTION INC RISING SUN CO/RSCO INC D L R BUILDERS JMB CONSTRUCTION INC T C B INDUSTRIAL N M N CONSTRUCTION Q & D CONSTRUCTION CO NAVAJO PIPELINES INC ROMERO GENERAL CONST CORP BROSAMER R & L INC WATERTIGHT RESTORATION IN PACIFIC EXCAVATION INC BLAISDELL CONSTR INC DRILL TECH DRILLING/SHOR MAHERCO INC A C L CONSTRUCTION CO INC STEELHEAD CONSTRUCTORS ALLIED-WEST CONSTRUCTION HATHAWAY DINWIDDIE CONSTR FLATIRON WEST INC MAHER R E INC VANGUARD CONSTRUCTION CHRISP COMPANY PALOMAR GRADING & PAVING ROEBBELEN CONTRACTING INC PAVE-TECH INC VIKING CONSTR CO INC SERRANO R E INC VASCONI A J GEN ENGINEER COFFMAN SPECIALTIES INC MARTIN BROS CONSTRUCTION WARD-HENSHAW CONST CO INC WARD-HENSHAW CONST CO INC GONSALVES J A & SON CONST INDUSTRIAL COMMERCIAL DOYLE'S WORK CO INC SYBLON REID RJS & ASSOCIATES ABEL'S CONCRETE ALL CONCRETE CONSTRUCTION WEST CONCRETE INC MASCON INC CHAZMAT CONCRETE CONSTR IMPERIAL SHOTCRETE INC SWINERTON BUILDERS DE HARO RAMIREZ GROUP HEAVEY MICHAEL CONSTR BIG B CONSTRUCTION INC R H CONCRETE YERBA BUENA ENG & CONSTR ROSAS BROTHERS CONSTR LC GEN ENG & CONSTR INC QUIMU CONTRACTING INC GIAMPOLINI/COURTNEY EMMETT'S EXCAVATION INC SPENCON CONSTRUCTION BOTHMAN ROBERT A INC HAZARD CONCRETE CONSTR HAZARD CONCRETE CONSTR MICHAM ORAL E INC WEBER TRACTOR SERVICE BROCK G & L CONST CO INC MARTIN GENERAL ENG INC GOLDEN STATE BRIDGE INC LEE ANDREW L INC DAWSON-MAULDIN CONSTRUC BALL CONSTRUCTION CO INC DISNEY CONSTRUCTION INC DIANI BUILDING CORP XL CONSTRUCTION SHOWTIME CONCRETE INC EMPIRE ENGINEERING & CONS TURNER GROUP CONSTRUCTION R N R CONSTRUCTION INC TEAM GHILOTTI INC DEPT OF CORR - REG ACCTG DEPT OF CORR - REG ACCTG SYNERGY PROJ MANAGEMENT SECURITY PAVING CO INC A M CONCRETE INC GSL CONSTRUCTION LYLES MECHANICAL COMPANY TERNO INC TUTOR-SALIBA CORPORATION ASSOCIATED SURFACE PREP ANOZIRA INC. RHOADES S.T. CONST INC SHIMMICK-SKANSKA JV J D PARTNERS CONCRETE BELMONTE'S CONCRETE SVCS J.U.V.,INC. J.U.V.,INC. B E I CONSTRUCTION INC VANIR CONSTR MANAGEMENT SUAREZ & MUNOZ CONSTR INC GEO CELL SOLUTIONS J M L ENG & CONSTR INC CALIFORNIA COMM POOLS INC TREICHEL CONCRETE CONSTR BRENEMAN INC. R & C CONSTRUCTION BECHTEL CONSTRUCTION CO A & S CONSTRUCTION INC LISTER CONSTRUCTION INC DOUGLAS BUILT CONSTR INC MYERS & SONS CONST LP V & G BUILDERS INC LEVEL 10 CONSTRUCTION, LP SETON PACIFIC CONSTR. BAY CONSTRUCTION CO HOOKER CREEK INC SEQUOIA CONSTR & DVLPMNT K & G CONCRETE PUMPING WARM SPRINGS CONSTRUCTORS STACY & WITBECK/HERZOG JV M H CONSTRUCTION MNGMT CO CONCRETE NORTH INC SKANSKA/SHIMMICK/HERZOG GALLINO DONALD F GEN CONT CEMENT MASONS-JATC CONCO-WEST INC NAT'L PLASTERING IND-JATF PENINSULA CONCRETE CONST MARTIN & FAHEY CONCRETE ESQUIVEL GRADING & PAVING H & H TRENCHING INC WARD'S CONCRETE INC CARTER KELLY INC FRANK ROBERT J CONSTR BENEDETTI CONC CONST G R N CONSTRUCTORS INC J T S CONSTRUCTION BRUNS BELMONT CONSTR MOUNTAIN DEVELOPMENT R A O CONSTRUCTION ROSS FORD CONSTRUCTION SOUZA M E CONSTR INC ADROIT CONSTRUCTION CO MC CLONE CONSTRUCTION CO ALLEN S W CONST INC SANSONE CO INC K I D CONSTRUCTION INC CEMENT MASONS 400 PLASTER/CEMENT MASONS 300 BUGLER CONSTRUCTION F M K CONSTRUCTION CUNNINGHAM & SONS INC BARRAZA'S FLOOR SYSTEMS GONZALEZ ROBERT AP & DECK WATERPROOFING SEQUOIA CONSTRUCTION SPEC F C I LEWIS JOHN CONCRETE SSC CONSTRUCTORS INC WALTERS & WOLF PRECAST TURCHET DINO CONS INC PILE CONSTRUCTION SOAVE CONSTRUCTION INC R C DECORATIVE CONCR INC D & G CONCRETE INC CENTRAL VALLEY