2011-06-09T17:59:56-05:00 2010-08-31 HEMMING MORSE CPA'S AND CONSULTANTS 160 SPEAR STREET SUITE 1900 SAN FRANCISCO CA 94105 990 2009-09-01 941291152 CEMENT MASONS HEALTH & WELFARE FUND FOR NORTHERN CALIFORNIA CEME 7078643300 220 CAMPUS LANE FAIRFIELD CA 945341499 EDWARD SMITH 7078643300 2011-06-09 1 4158364000 2009 2016-02-24 21:20:13Z 220 CAMPUS LANE FAIRFIELD CA 945341499 56757044 0 X N/A X 1953 CA SEE PART III LINE 4A 7 7 0 0 0 0 0 21895589 18959317 -116717 1225545 797280 1146892 22576152 21331754 0 29985585 18553299 0 0 0 1857712 1570807 31843297 20124106 -9267145 1207648 30405794 27597358 16723967 11840534 13681827 15756824 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 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 1282 0 0 0 0 0 0 0 0 0 0 0 7 7 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 1 1 0 0 0 X EDWARD SMITH 7078643300 220 CAMPUS LANE fairfield CA 945341499 X bill koponen 5.00 X 0 0 0 THOMAS R ESTRADA 5.00 X 0 0 0 brian gardner 5.00 X 0 0 0 BYRON C LONEY 5.00 X 0 0 0 keith shanks 5.00 X 0 0 0 ben espinoza 5.00 X 0 0 0 hecTOR CORTEZ 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 703462 BLUE CROSS OF CALIFORNIA PO BOX 7000 VAN NUYS CA 91470 MEDICAL ADMINISTRATION 274088 the segal company 100 montgomery street san fraNCISCO CA 94104 consulting 159299 DELTA DENTAL 100 1ST STREET SAN FRANCISCO CA 94105 DENTAL ADMINISTRATION 108222 4 EMPLOYER CONTRIBUTIONS 900099 15175041 15175041 EMPLOYEE CONTRIBUTIONS 900099 3499227 3499227 COBRA CONTRIBUTIONS 900099 285049 285049 18959317 953558 953558 35697277 35425290 271987 271987 271987 DRUG REBATES & REFUNDS 900099 866304 866304 OTHER INCOME 900099 280588 280588 1146892 21331754 20378196 0 953558 18553299 703462 174782 25850 60333 4930 16318 BENEFIT SERVICE FEES 422547 BENEFIT CONSULTANTS 159299 PRINTING & STATIONERY 3286 20124106 3474188 1630325 2138706 2298142 30000 30000 2500 2500 24145808 22770740 614592 865651 30405794 27597358 161318 155449 16562649 11685085 16723967 11840534 X 0 0 0 0 13681827 15756824 13681827 15756824 30405794 27597358 X 0 1 1 X 0 0 CLAIMS PAYABLE - IBNR 2700000 DUE TO NORTHERN CALIFORNIA CEMENT MASONS ADMINISTRATION, INC. 148098 group insured premiums payable 780247 self-funded benefit claims payable 2122740 bank of hours 5934000 11685085 21331754 20124106 1207648 867349 867349 2074997 22199103 867349 867349 21331754 0 21331754 20124106 0 20124106 0 20124106 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 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 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 NORTHERN CALIFORNIA CEMENT MASONS FUNDS ADMINISTRATION INC 220 CAMPUS LANE FAIRFIELD CA 94534 941583754 TO PROVIDE ADMINISTRATIVE SERVICES CA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0