2012-06-05T13:01:05-05:00 2011-08-31 HEMMING MORSE CPA'S AND CONSULTANTS 160 SPEAR STREET SUITE 1900 SAN FRANCISCO CA 94105 990 2010-09-01 941291152 CEMENT MASONS HEALTH & WELFARE FUND FOR NORTHERN CALIFORNIA CEME 7078643300 220 CAMPUS LANE FAIRFIELD CA 945341499 EDWARD SMITH 7078643300 2012-06-05 1 4158364000 2010 2016-02-24 21:20:13Z EDWARD SMITH 220 CAMPUS LANE FAIRFIELD CA 945341499 50273261 0 X N/A X 1953 CA SEE PART III LINE 4A 8 8 0 0 0 0 0 0 18959317 20370053 1225545 1231767 1146892 808374 21331754 22410194 0 0 18553299 22648104 0 0 0 0 0 1570807 1591789 20124106 24239893 1207648 -1829699 27597358 24098516 11840534 10220475 15756824 13878041 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 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 0 1 52 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 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 SHAWN BARNES 5.00 X 0 0 0 ROBERT DUMESNIL 5.00 X 0 0 0 BRIAN GARDNER 5.00 X 0 0 0 MARK REYNOSA 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 GREG LEVY 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 776626 ANTHEM BLUE CROSS PO BOX 629 WOODLAND HILLS CA 91365 MEDICAL ADMINISTRATION 254030 THE SEGAL COMPANY 100 MONTGOMERY STREET SAN FRANCISCO CA 94104 CONSULTING 192529 DELTA DENTAL 100 1ST STREET SAN FRANCISCO CA 94105 DENTAL ADMINISTRATION 101006 4 EMPLOYER CONTRIBUTIONS 900099 16377239 16377239 EMPLOYEE CONTRIBUTIONS 900099 3713380 3713380 COBRA CONTRIBUTIONS 900099 279434 279434 20370053 844437 844437 28250397 27863067 387330 387330 387330 DRUG REBATES & REFUNDS 900099 808161 808161 OTHER INCOME 900099 213 213 808374 22410194 21565757 0 844437 22648104 776626 130436 28760 54922 7505 12960 BENEFIT SERVICE FEES 387398 BENEFIT CONSULTANTS 192529 PRINTING & STATIONERY 653 24239893 1630325 1782709 2298142 2564383 30000 30000 2500 6313 22770740 18881039 865651 834072 27597358 24098516 155449 100529 11685085 10119946 11840534 10220475 X 0 0 0 0 15756824 13878041 15756824 13878041 27597358 24098516 X -1829699 -49084 X X 0 1 0 X 0 0 CLAIMS PAYABLE - IBNR 1425000 DUE TO NORTHERN CALIFORNIA CEMENT MASONS ADMINISTRATION, INC. 218061 GROUP INSURED PREMIUMS PAYABLE 755645 SELF-FUNDED BENEFIT CLAIMS PAYABLE 2155240 BANK OF HOURS 5566000 10119946 22410194 24239893 -1829699 -49084 -49084 -1878783 22361110 -49084 -49084 22410194 0 22410194 24239893 0 24239893 0 24239893 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -49,084. 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 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