STRATEGY STUDIO / PUBLIC DATA EXPLORER

CEMENT MASONS & PLASTERS HEALTH & WELFARE TRUST: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
CEMENT MASONS & PLASTERS HEALTH & WELFARE TRUST (EIN 88-6010564)
Tax period
2013-07-01 to 2014-06-30
Filed
2015-04-30
IRS object ID
201541209349301169
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-04-30T14:06:36-07:00ReturnTs
Tax Period End2014-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BERRY & CO CPAS LTDBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line17030 SMOKE RANCH RDAddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code891281202ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN886010564EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CEMENT MASONS & PLASTERERS HEALTH & WELFARE TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCEMEBusinessNameControlTxt
Phone7027348601PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14240 W FLAMINGO RDAddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code89103ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARC LEAVITTPersonNm
Person TitleTRUSTEEPersonTitleTxt
Phone7027348601PhoneNum
Signature2015-04-30SignatureDt

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJAY D BOOTH CPAPreparerPersonNm
Phone7025150408PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMARC LEAVITTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line14240 W FLAMINGO RDAddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code89103ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$5,562,492GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501cYes (X)Organization501cInd
Website AddressN/AWebsiteAddressTxt
Type Of Organization TrustYes (X)TypeOfOrganizationTrustInd
Formation1968FormationYr
Legal Domicile StateNVLegalDomicileStateCd
Activity Or MissionPROVIDE MEDICAL, VISION, DENTAL, LIFE AND DISABILITY TO PARTICIPANTSActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee6TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$3,513,767PYProgramServiceRevenueAmt
CY Program Service Revenue$3,778,663CYProgramServiceRevenueAmt
PY Investment Income$527,396PYInvestmentIncomeAmt
CY Investment Income$224,218CYInvestmentIncomeAmt
PY Other Revenue$189,977PYOtherRevenueAmt
CY Other Revenue$82,030CYOtherRevenueAmt
PY Total Revenue$4,231,140PYTotalRevenueAmt
CY Total Revenue$4,084,911CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$3,676,728PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$3,750,330CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,813PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$913CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$573,883PYOtherExpensesAmt
CY Other Expenses$583,849CYOtherExpensesAmt
PY Total Expenses$4,252,424PYTotalExpensesAmt
CY Total Expenses$4,335,092CYTotalExpensesAmt
PY Revenues Less Expenses-$21,284PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$250,181CYRevenuesLessExpensesAmt
Total Assets BOY$10,127,385TotalAssetsBOYAmt
Total Assets EOY$9,969,970TotalAssetsEOYAmt
Total Liabilities EOY$0TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$10,127,385NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$9,969,970NetAssetsOrFundBalancesEOYAmt
MissionPROVIDE MEDICAL, VISION, DENTAL, LIFE AND DISABILITY TO PARTICIPANTSMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescPROVIDE MEDICAL, VISION, DENTAL, LIFE AND DISABILITY TO PARTICIPANTSDesc
Described In Section501c3falseDescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document337IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee6EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BENESYS ADMINISTRATORSBusinessNameLine1
FieldValueIRS element (for citing)
Phone7024152180PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14240 W FLAMINGO RD SUTIE 200AddressLine1
CityLAS VEGASCity
StateNVState
ZIP Code89103ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
MARC LEAVITT
TRUSTEE1.00Yes (X)
PAUL BENIGNO
TRUSTEE1.00Yes (X)
KEVIN EDNER
TRUSTEE1.00Yes (X)
LLOYD MARTIN
TRUSTEE1.00Yes (X)
TOM PFUNDSTEIN
TRUSTEE1.00Yes (X)
BRADY STEVENS
TRUSTEE1.00Yes (X)
DANIEL O'SHEA
TRUSTEE1.00Yes (X)
BOB CAMPBELL
TRUSTEE1.00Yes (X)
MEL TOUSSEAU
TRUSTEE1.00Yes (X)
KIM CHRISTENSEN
TRUSTEE1.00Yes (X)
FieldValueIRS element (for citing)
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
BENESYS ADMINISTRATORS
4240 W FLAMINGO RD SUITE 200LAS VEGASNV89103ADMINISTRATOR$281,026
BROWNSTEIN HYATT FARBER SCHRECK
100 NORTH CITY PARKWAY SUITE 1600LAS VEGASNV89106LEGAL$116,363
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmt
EMPLOYER CONTRIBUTIONS900099$3,768,718
EMPLOYEE CONTRIBUTIONS900099$9,945
FieldValueIRS element (for citing)
Total Program Service Revenue$3,778,663TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$201,799TotalRevenueColumnAmt
Exclusion$201,799ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$1,500,000SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,477,581SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$22,419SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$22,419TotalRevenueColumnAmt
Exclusion$22,419ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RETIREE DRUG SUBSIDY900099$64,301$64,301
OTHER900099$17,729$17,729
FieldValueIRS element (for citing)
Other Revenue Total$82,030OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,084,911TotalRevenueColumnAmt
Related Or Exempt Func Income$3,860,693RelatedOrExemptFuncIncomeAmt
Exclusion$224,218ExclusionAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$3,750,330TotalAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$913TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$111,919TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$41,651TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$13,530TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$336,491TotalAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$68,019TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$4,868TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$7,371TotalAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$4,335,092TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,226,811BOYAmt
EOY$760,958EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$8,900,574BOYAmt
EOY$9,209,012EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$10,127,385BOYAmt
EOY$9,969,970EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

FieldValueIRS element (for citing)
BOY$10,127,385BOYAmt
EOY$9,969,970EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,127,385BOYAmt
EOY$9,969,970EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$10,127,385BOYAmt
EOY$9,969,970EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$250,181ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$92,766NetUnrlzdGainsLossesInvstAmt
Method Of Accounting CashYes (X)MethodOfAccountingCashInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Rev Etc Audited Fincl Stmt$4,565,099TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$92,766NetUnrealizedGainsInvstAmt
Other Revenue$400,952OtherRevenueAmt
Revenue Not Reported$493,718RevenueNotReportedAmt
Revenue Subtotal$4,071,381RevenueSubtotalAmt
Investment Expenses Not Incld$13,530InvestmentExpensesNotIncldAmt
Revenue Not Reported Fincl Stmt$13,530RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$4,084,911TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$4,619,061TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$297,499OtherExpensesIncludedAmt
Expenses Not Reported$297,499ExpensesNotReportedAmt
Expenses Subtotal$4,321,562ExpensesSubtotalAmt
Investment Expenses Not Incld2$13,530InvestmentExpensesNotIncld2Amt
Expenses Not Rpt Fincl Stmt$13,530ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$4,335,092TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt XI Line 2dADJUSTMENTS MADE TO REFLECT CASH BASIS FORM 990
Pt XII Line 2dADJUSTMENTS MADE TO REFLECT CASH BASIS FORM 990

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pt VI, Line 11bCOPIES OF FORM 990 WERE PROVIDED TO THE GOVERNING BODY MEMBERS BY EMAIL PRIOR TO
Pt VI, Line 11bTHE FORM 990 BEING FILED. NO REVIEW WAS OR WILL BE CONDUCTED.
Pt VI, Line 12cTHE ORGANIZATION'S TRUSTEES HAVE A DUTY TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST.
Pt VI, Line 12cPOTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ALSO REVIEWED FOR
Pt VI, Line 12cCOMPLIANCE WITH ERISA REQUIREMENTS.
Pt VI, Line 19THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL
Pt VI, Line 19STATEMENTS ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail (8 entries)

ExplanationExplanationTxt
SCHEDULE R, IDENTIFICATION OF RELATED ORGANIZATIONS. THE FILING ORGANIZATION IS A
TAFT-HARTLEY MULTIEMPLOYER TRUST THAT PROVIDES HEALTH & WELFARE BENEFITS
TO ELIGIBLE EMPLOYEES AND THEIR DEPENDENTS. THE ADMINISTRATIVE OFFICE MAINTAINS A
DATABASE OF CONTRIBUTING EMPLOYERS HOWEVER, CERTAIN INFORMATION THAT IS REQUIRED
TO BE REPORTED ON SCHEDULE R SUCH AS EMPLOYER LEGAL STRUCTURE (CORPORATION,
PARTNERSHIP, ETC) IS NOT ON FILE WITH THE ADMINISTRATIVE OFFICE AND IT COULD
NOT BE REASONABLY OBTAINED AS A RESULT, THE CONTRIBUTING EMPLOYERS HAVE NOT
BEEN INCLUDED ON SCHEDULE R.