CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 401k Plan overview

Plan Name	CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN
Plan identification number	501

CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

CEMENT MASONS - EMPLOYERS TRUST has sponsored the creation of one or more 401k plans.

Company Name:	CEMENT MASONS - EMPLOYERS TRUST
Employer identification number (EIN):	936023044
NAIC Classification:	238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01
501	2017-01-01	TRUDY HORN
501	2016-01-01	TRUDY HORN
501	2015-01-01	TRUDY HORN
501	2014-01-01	TRUDY HORN
501	2013-01-01	TRUDY HORN
501	2012-01-01	TRUDY HORN
501	2011-01-01	TRUDY HORN
501	2010-01-01	TRUDY HORN
501	2009-01-01	TRUDY HORN

Plan Statistics for CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN

401k plan membership statisitcs for CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN

Measure	Date	Value
2022: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	555
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	476
Number of retired or separated participants receiving benefits	2022-01-01	65
Total of all active and inactive participants	2022-01-01	541
Total participants	2022-01-01	541
Number of employers contributing to the scheme	2022-01-01	120
2021: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	582
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	484
Number of retired or separated participants receiving benefits	2021-01-01	71
Total of all active and inactive participants	2021-01-01	555
Total participants	2021-01-01	555
Number of employers contributing to the scheme	2021-01-01	118
2020: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	584
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	512
Number of retired or separated participants receiving benefits	2020-01-01	70
Total of all active and inactive participants	2020-01-01	582
Total participants	2020-01-01	582
Number of employers contributing to the scheme	2020-01-01	113
2019: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	578
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	504
Number of retired or separated participants receiving benefits	2019-01-01	80
Total of all active and inactive participants	2019-01-01	584
Total participants	2019-01-01	584
Number of employers contributing to the scheme	2019-01-01	119
2018: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	538
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	486
Number of retired or separated participants receiving benefits	2018-01-01	92
Total of all active and inactive participants	2018-01-01	578
Total participants	2018-01-01	578
Number of employers contributing to the scheme	2018-01-01	124
2017: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	534
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	444
Number of retired or separated participants receiving benefits	2017-01-01	94
Total of all active and inactive participants	2017-01-01	538
Total participants	2017-01-01	538
Number of employers contributing to the scheme	2017-01-01	124
2016: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	493
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	430
Number of retired or separated participants receiving benefits	2016-01-01	104
Total of all active and inactive participants	2016-01-01	534
Total participants	2016-01-01	534
Number of employers contributing to the scheme	2016-01-01	103
2015: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	516
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	385
Number of retired or separated participants receiving benefits	2015-01-01	108
Total of all active and inactive participants	2015-01-01	493
Total participants	2015-01-01	0
Number of employers contributing to the scheme	2015-01-01	80
2014: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	517
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	393
Number of retired or separated participants receiving benefits	2014-01-01	123
Total of all active and inactive participants	2014-01-01	516
Total participants	2014-01-01	0
Number of employers contributing to the scheme	2014-01-01	73
2013: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	467
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	377
Number of retired or separated participants receiving benefits	2013-01-01	140
Total of all active and inactive participants	2013-01-01	517
Total participants	2013-01-01	0
Number of employers contributing to the scheme	2013-01-01	71
2012: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	541
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	327
Number of retired or separated participants receiving benefits	2012-01-01	140
Total of all active and inactive participants	2012-01-01	467
Total participants	2012-01-01	0
Number of employers contributing to the scheme	2012-01-01	78
2011: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	484
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	389
Number of retired or separated participants receiving benefits	2011-01-01	152
Total of all active and inactive participants	2011-01-01	541
Total participants	2011-01-01	541
Number of employers contributing to the scheme	2011-01-01	107
2010: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	448
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	320
Number of retired or separated participants receiving benefits	2010-01-01	164
Total of all active and inactive participants	2010-01-01	484
Total participants	2010-01-01	484
Number of employers contributing to the scheme	2010-01-01	112
2009: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	567
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	291
Number of retired or separated participants receiving benefits	2009-01-01	157
Total of all active and inactive participants	2009-01-01	448
Total participants	2009-01-01	448
Number of employers contributing to the scheme	2009-01-01	78

Financial Data on CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN

Measure	Date	Value
2022 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2022-12-31	$-78,379
Total unrealized appreciation/depreciation of assets	2022-12-31	$-78,379
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$3,678,824
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$3,753,791
Total income from all sources (including contributions)	2022-12-31	$7,159,387
Total loss/gain on sale of assets	2022-12-31	$-765,984
Total of all expenses incurred	2022-12-31	$7,874,230
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$7,416,333
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$7,832,512
Value of total assets at end of year	2022-12-31	$8,183,466
Value of total assets at beginning of year	2022-12-31	$8,973,276
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$457,897
Total interest from all sources	2022-12-31	$104,058
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$38,369
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$107,950
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$358,394
Participant contributions at end of year	2022-12-31	$24,632
Participant contributions at beginning of year	2022-12-31	$27,806
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-12-31	$52,540
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-12-31	$363,002
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$2,953,687
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$3,070,214
Other income not declared elsewhere	2022-12-31	$28,811
Administrative expenses (other) incurred	2022-12-31	$39,501
Liabilities. Value of operating payables at end of year	2022-12-31	$145,811
Liabilities. Value of operating payables at beginning of year	2022-12-31	$195,071
Total non interest bearing cash at end of year	2022-12-31	$270,076
Total non interest bearing cash at beginning of year	2022-12-31	$1,312,551
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-714,843
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$4,504,642
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$5,219,485
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$21,846
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$2,018,458
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$698,788
Value of interest in pooled separate accounts at end of year	2022-12-31	$0
Income. Interest from US Government securities	2022-12-31	$38,867
Income. Interest from corporate debt instruments	2022-12-31	$61,434
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$94,382
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$215,917
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$215,917
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$3,757
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$2,322,494
Asset value of US Government securities at end of year	2022-12-31	$2,608,608
Asset value of US Government securities at beginning of year	2022-12-31	$1,925,721
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$7,474,118
Employer contributions (assets) at end of year	2022-12-31	$688,863
Employer contributions (assets) at beginning of year	2022-12-31	$657,326
Income. Dividends from common stock	2022-12-31	$38,369
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$5,093,839
Asset. Corporate debt instrument debt (other) at end of year	2022-12-31	$2,425,907
Asset. Corporate debt instrument debt (other) at beginning of year	2022-12-31	$1,759,458
Contract administrator fees	2022-12-31	$288,600
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-12-31	No
Assets. Corporate common stocks other than exployer securities at beginning of year	2022-12-31	$2,012,707
Liabilities. Value of benefit claims payable at end of year	2022-12-31	$579,326
Liabilities. Value of benefit claims payable at beginning of year	2022-12-31	$488,506
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Aggregate proceeds on sale of assets	2022-12-31	$3,961,319
Aggregate carrying amount (costs) on sale of assets	2022-12-31	$4,727,303
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2022-12-31	930809066
2021 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2021-12-31	$93,243
Total unrealized appreciation/depreciation of assets	2021-12-31	$93,243
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$3,753,791
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$3,688,480
Total income from all sources (including contributions)	2021-12-31	$9,257,437
Total loss/gain on sale of assets	2021-12-31	$195,281
Total of all expenses incurred	2021-12-31	$9,096,664
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$8,647,085
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$8,099,351
Value of total assets at end of year	2021-12-31	$8,973,276
Value of total assets at beginning of year	2021-12-31	$8,747,192
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$449,579
Total interest from all sources	2021-12-31	$88,094
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$22,110
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Administrative expenses professional fees incurred	2021-12-31	$105,940
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$387,400
Participant contributions at end of year	2021-12-31	$27,806
Participant contributions at beginning of year	2021-12-31	$27,052
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$363,002
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$399,562
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$3,070,214
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$2,941,844
Other income not declared elsewhere	2021-12-31	$759,358
Administrative expenses (other) incurred	2021-12-31	$32,252
Liabilities. Value of operating payables at end of year	2021-12-31	$195,071
Liabilities. Value of operating payables at beginning of year	2021-12-31	$233,203
Total non interest bearing cash at end of year	2021-12-31	$1,312,551
Total non interest bearing cash at beginning of year	2021-12-31	$1,420,767
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$160,773
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$5,219,485
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$5,058,712
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Investment advisory and management fees	2021-12-31	$22,787
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$698,788
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$657,333
Value of interest in pooled separate accounts at end of year	2021-12-31	$0
Income. Interest from US Government securities	2021-12-31	$36,539
Income. Interest from corporate debt instruments	2021-12-31	$51,520
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$215,917
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$245,889
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$245,889
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$35
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$2,654,456
Asset value of US Government securities at end of year	2021-12-31	$1,925,721
Asset value of US Government securities at beginning of year	2021-12-31	$1,788,715
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$7,711,951
Employer contributions (assets) at end of year	2021-12-31	$657,326
Employer contributions (assets) at beginning of year	2021-12-31	$682,427
Income. Dividends from common stock	2021-12-31	$22,110
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$5,992,629
Asset. Corporate debt instrument debt (other) at end of year	2021-12-31	$1,759,458
Asset. Corporate debt instrument debt (other) at beginning of year	2021-12-31	$1,643,170
Contract administrator fees	2021-12-31	$288,600
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2021-12-31	$2,012,707
Assets. Corporate common stocks other than exployer securities at beginning of year	2021-12-31	$1,882,277
Liabilities. Value of benefit claims payable at end of year	2021-12-31	$488,506
Liabilities. Value of benefit claims payable at beginning of year	2021-12-31	$513,433
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Aggregate proceeds on sale of assets	2021-12-31	$1,856,435
Aggregate carrying amount (costs) on sale of assets	2021-12-31	$1,661,154
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2021-12-31	930809066
2020 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$647,209
Total unrealized appreciation/depreciation of assets	2020-12-31	$647,209
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$3,688,480
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$3,404,768
Total income from all sources (including contributions)	2020-12-31	$9,494,506
Total loss/gain on sale of assets	2020-12-31	$3,946
Total of all expenses incurred	2020-12-31	$8,153,813
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$7,705,356
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$8,289,486
Value of total assets at end of year	2020-12-31	$8,747,192
Value of total assets at beginning of year	2020-12-31	$7,122,787
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$448,457
Total interest from all sources	2020-12-31	$81,753
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$28,254
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Administrative expenses professional fees incurred	2020-12-31	$121,445
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$365,469
Participant contributions at end of year	2020-12-31	$27,052
Participant contributions at beginning of year	2020-12-31	$29,989
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$399,562
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$78,486
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$2,941,844
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$2,775,853
Other income not declared elsewhere	2020-12-31	$443,858
Administrative expenses (other) incurred	2020-12-31	$31,423
Liabilities. Value of operating payables at end of year	2020-12-31	$233,203
Liabilities. Value of operating payables at beginning of year	2020-12-31	$109,409
Total non interest bearing cash at end of year	2020-12-31	$1,420,767
Total non interest bearing cash at beginning of year	2020-12-31	$933,234
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,340,693
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$5,058,712
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$3,718,019
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$20,789
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$657,333
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$313,130
Value of interest in pooled separate accounts at end of year	2020-12-31	$0
Income. Interest from US Government securities	2020-12-31	$33,641
Income. Interest from corporate debt instruments	2020-12-31	$47,417
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$245,889
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$223,846
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$223,846
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$695
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$2,654,899
Asset value of US Government securities at end of year	2020-12-31	$1,788,715
Asset value of US Government securities at beginning of year	2020-12-31	$1,808,727
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$7,924,017
Employer contributions (assets) at end of year	2020-12-31	$682,427
Employer contributions (assets) at beginning of year	2020-12-31	$621,284
Income. Dividends from common stock	2020-12-31	$28,254
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$5,050,457
Asset. Corporate debt instrument debt (other) at end of year	2020-12-31	$1,643,170
Asset. Corporate debt instrument debt (other) at beginning of year	2020-12-31	$1,485,676
Contract administrator fees	2020-12-31	$274,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2020-12-31	$1,882,277
Assets. Corporate common stocks other than exployer securities at beginning of year	2020-12-31	$1,628,415
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$513,433
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$519,506
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Aggregate proceeds on sale of assets	2020-12-31	$3,159,422
Aggregate carrying amount (costs) on sale of assets	2020-12-31	$3,155,476
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2020-12-31	930809066
2019 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$359,390
Total unrealized appreciation/depreciation of assets	2019-12-31	$359,390
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$3,404,768
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$3,479,164
Total income from all sources (including contributions)	2019-12-31	$8,902,385
Total loss/gain on sale of assets	2019-12-31	$180,528
Total of all expenses incurred	2019-12-31	$7,977,881
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$7,538,137
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$8,248,875
Value of total assets at end of year	2019-12-31	$7,122,787
Value of total assets at beginning of year	2019-12-31	$6,272,679
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$439,744
Total interest from all sources	2019-12-31	$86,408
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$27,184
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$111,357
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$401,534
Participant contributions at end of year	2019-12-31	$29,989
Participant contributions at beginning of year	2019-12-31	$34,803
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$78,486
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$80,669
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$2,775,853
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$2,802,978
Administrative expenses (other) incurred	2019-12-31	$37,721
Liabilities. Value of operating payables at end of year	2019-12-31	$109,409
Liabilities. Value of operating payables at beginning of year	2019-12-31	$100,497
Total non interest bearing cash at end of year	2019-12-31	$933,234
Total non interest bearing cash at beginning of year	2019-12-31	$994,165
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$924,504
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,718,019
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$2,793,515
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$15,866
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$313,130
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$298,666
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Income. Interest from US Government securities	2019-12-31	$33,382
Income. Interest from corporate debt instruments	2019-12-31	$47,403
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$223,846
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$269,919
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$269,919
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$5,623
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$2,482,975
Asset value of US Government securities at end of year	2019-12-31	$1,808,727
Asset value of US Government securities at beginning of year	2019-12-31	$1,506,685
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$7,847,341
Employer contributions (assets) at end of year	2019-12-31	$621,284
Employer contributions (assets) at beginning of year	2019-12-31	$651,086
Income. Dividends from common stock	2019-12-31	$27,184
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$5,055,162
Asset. Corporate debt instrument debt (other) at end of year	2019-12-31	$1,485,676
Asset. Corporate debt instrument debt (other) at beginning of year	2019-12-31	$1,190,402
Contract administrator fees	2019-12-31	$274,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2019-12-31	$1,628,415
Assets. Corporate common stocks other than exployer securities at beginning of year	2019-12-31	$1,246,284
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$519,506
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$575,689
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Aggregate proceeds on sale of assets	2019-12-31	$2,676,207
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$2,495,679
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Unqualified
Accountancy firm name	2019-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2019-12-31	930809066
2018 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$-70,374
Total unrealized appreciation/depreciation of assets	2018-12-31	$-70,374
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$3,479,164
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$2,999,270
Total income from all sources (including contributions)	2018-12-31	$7,957,335
Total loss/gain on sale of assets	2018-12-31	$48,805
Total of all expenses incurred	2018-12-31	$7,786,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$7,361,036
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$7,865,717
Value of total assets at end of year	2018-12-31	$6,272,679
Value of total assets at beginning of year	2018-12-31	$5,621,936
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$425,450
Total interest from all sources	2018-12-31	$75,423
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$21,455
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$108,140
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$469,814
Participant contributions at end of year	2018-12-31	$34,803
Participant contributions at beginning of year	2018-12-31	$39,243
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$80,669
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$34,684
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$2,802,978
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$2,803,468
Other income not declared elsewhere	2018-12-31	$16,309
Administrative expenses (other) incurred	2018-12-31	$28,800
Liabilities. Value of operating payables at end of year	2018-12-31	$100,497
Liabilities. Value of operating payables at beginning of year	2018-12-31	$86,901
Total non interest bearing cash at end of year	2018-12-31	$994,165
Total non interest bearing cash at beginning of year	2018-12-31	$500,558
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$170,849
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$2,793,515
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$2,622,666
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$13,710
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$298,666
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Income. Interest from US Government securities	2018-12-31	$29,907
Income. Interest from corporate debt instruments	2018-12-31	$40,738
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$269,919
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$319,208
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$319,208
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$4,778
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$2,784,606
Asset value of US Government securities at end of year	2018-12-31	$1,506,685
Asset value of US Government securities at beginning of year	2018-12-31	$1,664,503
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$7,395,903
Employer contributions (assets) at end of year	2018-12-31	$651,086
Employer contributions (assets) at beginning of year	2018-12-31	$614,134
Income. Dividends from common stock	2018-12-31	$21,455
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$4,576,430
Asset. Corporate debt instrument debt (other) at end of year	2018-12-31	$1,190,402
Asset. Corporate debt instrument debt (other) at beginning of year	2018-12-31	$1,113,492
Contract administrator fees	2018-12-31	$274,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2018-12-31	$1,246,284
Assets. Corporate common stocks other than exployer securities at beginning of year	2018-12-31	$1,336,114
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$575,689
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$108,901
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Aggregate proceeds on sale of assets	2018-12-31	$1,580,878
Aggregate carrying amount (costs) on sale of assets	2018-12-31	$1,532,073
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2018-12-31	930809066
2017 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$168,433
Total unrealized appreciation/depreciation of assets	2017-12-31	$168,433
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,999,270
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,726,491
Total income from all sources (including contributions)	2017-12-31	$7,943,719
Total loss/gain on sale of assets	2017-12-31	$121,210
Total of all expenses incurred	2017-12-31	$8,296,348
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$7,974,502
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$7,556,747
Value of total assets at end of year	2017-12-31	$5,621,936
Value of total assets at beginning of year	2017-12-31	$5,701,786
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$321,846
Total interest from all sources	2017-12-31	$76,789
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$20,540
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$129,036
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$486,782
Participant contributions at end of year	2017-12-31	$39,243
Participant contributions at beginning of year	2017-12-31	$39,965
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$34,684
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$35,089
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$2,803,468
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$2,561,480
Administrative expenses (other) incurred	2017-12-31	$30,810
Liabilities. Value of operating payables at end of year	2017-12-31	$86,901
Liabilities. Value of operating payables at beginning of year	2017-12-31	$64,365
Total non interest bearing cash at end of year	2017-12-31	$500,558
Total non interest bearing cash at beginning of year	2017-12-31	$388,755
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$-352,629
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$2,622,666
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$2,975,295
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Income. Interest from US Government securities	2017-12-31	$27,701
Income. Interest from corporate debt instruments	2017-12-31	$47,644
Value of interest in common/collective trusts at end of year	2017-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$319,208
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$250,041
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$250,041
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$1,444
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$6,220,358
Asset value of US Government securities at end of year	2017-12-31	$1,664,503
Asset value of US Government securities at beginning of year	2017-12-31	$1,427,171
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$7,069,965
Employer contributions (assets) at end of year	2017-12-31	$614,134
Employer contributions (assets) at beginning of year	2017-12-31	$589,533
Income. Dividends from common stock	2017-12-31	$20,540
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$1,754,144
Asset. Corporate debt instrument debt (other) at end of year	2017-12-31	$1,113,492
Asset. Corporate debt instrument debt (other) at beginning of year	2017-12-31	$1,614,739
Contract administrator fees	2017-12-31	$162,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2017-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2017-12-31	$1,336,114
Assets. Corporate common stocks other than exployer securities at beginning of year	2017-12-31	$1,356,493
Liabilities. Value of benefit claims payable at end of year	2017-12-31	$108,901
Liabilities. Value of benefit claims payable at beginning of year	2017-12-31	$100,646
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Aggregate proceeds on sale of assets	2017-12-31	$2,705,368
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$2,584,158
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2017-12-31	930809066
2016 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$68,499
Total unrealized appreciation/depreciation of assets	2016-12-31	$68,499
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$2,726,491
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$2,541,261
Total income from all sources (including contributions)	2016-12-31	$6,975,257
Total loss/gain on sale of assets	2016-12-31	$-21,323
Total of all expenses incurred	2016-12-31	$7,639,152
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$7,278,046
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$6,818,205
Value of total assets at end of year	2016-12-31	$5,701,786
Value of total assets at beginning of year	2016-12-31	$6,180,451
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$361,106
Total interest from all sources	2016-12-31	$86,401
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$23,342
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$170,099
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$535,951
Participant contributions at end of year	2016-12-31	$39,965
Participant contributions at beginning of year	2016-12-31	$44,307
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$35,089
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$25,831
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$2,561,480
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$2,409,131
Other income not declared elsewhere	2016-12-31	$133
Administrative expenses (other) incurred	2016-12-31	$31,107
Liabilities. Value of operating payables at end of year	2016-12-31	$64,365
Liabilities. Value of operating payables at beginning of year	2016-12-31	$57,623
Total non interest bearing cash at end of year	2016-12-31	$388,755
Total non interest bearing cash at beginning of year	2016-12-31	$438,650
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-663,895
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,975,295
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,639,190
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Income. Interest from US Government securities	2016-12-31	$21,702
Income. Interest from corporate debt instruments	2016-12-31	$64,699
Value of interest in common/collective trusts at end of year	2016-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$250,041
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$265,780
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$265,780
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$5,650,487
Asset value of US Government securities at end of year	2016-12-31	$1,427,171
Asset value of US Government securities at beginning of year	2016-12-31	$1,739,076
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$6,282,254
Employer contributions (assets) at end of year	2016-12-31	$589,533
Employer contributions (assets) at beginning of year	2016-12-31	$450,593
Income. Dividends from common stock	2016-12-31	$23,342
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,627,559
Asset. Corporate debt instrument debt (other) at end of year	2016-12-31	$1,614,739
Asset. Corporate debt instrument debt (other) at beginning of year	2016-12-31	$1,775,487
Contract administrator fees	2016-12-31	$159,900
Assets. Corporate common stocks other than exployer securities at end of year	2016-12-31	$1,356,493
Assets. Corporate common stocks other than exployer securities at beginning of year	2016-12-31	$1,440,727
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$100,646
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$74,507
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$2,525,586
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$2,546,909
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2016-12-31	930809066
2015 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2015-12-31	$7,704
Total unrealized appreciation/depreciation of assets	2015-12-31	$7,704
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$2,541,261
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$2,289,682
Total income from all sources (including contributions)	2015-12-31	$6,056,331
Total loss/gain on sale of assets	2015-12-31	$52,227
Total of all expenses incurred	2015-12-31	$7,099,500
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$6,733,889
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$5,870,224
Value of total assets at end of year	2015-12-31	$6,180,451
Value of total assets at beginning of year	2015-12-31	$6,972,041
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$365,611
Total interest from all sources	2015-12-31	$97,983
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$22,190
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$182,309
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$555,979
Participant contributions at end of year	2015-12-31	$44,307
Participant contributions at beginning of year	2015-12-31	$44,923
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$25,831
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$37,060
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$2,409,131
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$2,165,144
Other income not declared elsewhere	2015-12-31	$6,003
Administrative expenses (other) incurred	2015-12-31	$29,702
Liabilities. Value of operating payables at end of year	2015-12-31	$57,623
Liabilities. Value of operating payables at beginning of year	2015-12-31	$57,684
Total non interest bearing cash at end of year	2015-12-31	$438,650
Total non interest bearing cash at beginning of year	2015-12-31	$312,092
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-1,043,169
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,639,190
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$4,682,359
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Income. Interest from US Government securities	2015-12-31	$23,157
Income. Interest from corporate debt instruments	2015-12-31	$74,820
Value of interest in common/collective trusts at end of year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$265,780
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$117,039
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$117,039
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$6
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$5,279,457
Asset value of US Government securities at end of year	2015-12-31	$1,739,076
Asset value of US Government securities at beginning of year	2015-12-31	$2,000,726
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$5,314,245
Employer contributions (assets) at end of year	2015-12-31	$450,593
Employer contributions (assets) at beginning of year	2015-12-31	$369,466
Income. Dividends from common stock	2015-12-31	$22,190
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$1,454,432
Asset. Corporate debt instrument debt (other) at end of year	2015-12-31	$1,775,487
Asset. Corporate debt instrument debt (other) at beginning of year	2015-12-31	$2,234,333
Contract administrator fees	2015-12-31	$153,600
Assets. Corporate common stocks other than exployer securities at end of year	2015-12-31	$1,440,727
Assets. Corporate common stocks other than exployer securities at beginning of year	2015-12-31	$1,856,402
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$74,507
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$66,854
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Aggregate proceeds on sale of assets	2015-12-31	$3,317,379
Aggregate carrying amount (costs) on sale of assets	2015-12-31	$3,265,152
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2015-12-31	930809066
2014 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$400,577
Total unrealized appreciation/depreciation of assets	2014-12-31	$400,577
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$2,289,682
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$2,332,924
Total income from all sources (including contributions)	2014-12-31	$6,894,033
Total loss/gain on sale of assets	2014-12-31	$-193,508
Total of all expenses incurred	2014-12-31	$7,630,479
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$7,293,928
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$6,530,100
Value of total assets at end of year	2014-12-31	$6,972,041
Value of total assets at beginning of year	2014-12-31	$7,751,729
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$336,551
Total interest from all sources	2014-12-31	$132,674
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$24,190
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$152,684
Was this plan covered by a fidelity bond	2014-12-31	No
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$586,134
Participant contributions at end of year	2014-12-31	$44,923
Participant contributions at beginning of year	2014-12-31	$50,879
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$37,060
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$43,858
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$2,165,144
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$2,165,306
Administrative expenses (other) incurred	2014-12-31	$30,267
Liabilities. Value of operating payables at end of year	2014-12-31	$57,684
Liabilities. Value of operating payables at beginning of year	2014-12-31	$83,825
Total non interest bearing cash at end of year	2014-12-31	$312,092
Total non interest bearing cash at beginning of year	2014-12-31	$424,828
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-736,446
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,682,359
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$5,418,805
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Income. Interest from US Government securities	2014-12-31	$15,844
Income. Interest from corporate debt instruments	2014-12-31	$116,786
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$117,039
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$383,393
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$383,393
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$44
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$5,746,924
Asset value of US Government securities at end of year	2014-12-31	$2,000,726
Asset value of US Government securities at beginning of year	2014-12-31	$1,387,523
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$5,943,966
Employer contributions (assets) at end of year	2014-12-31	$369,466
Employer contributions (assets) at beginning of year	2014-12-31	$545,603
Income. Dividends from common stock	2014-12-31	$24,190
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,547,004
Asset. Corporate debt instrument debt (other) at end of year	2014-12-31	$2,234,333
Asset. Corporate debt instrument debt (other) at beginning of year	2014-12-31	$2,932,098
Contract administrator fees	2014-12-31	$153,600
Assets. Corporate common stocks other than exployer securities at end of year	2014-12-31	$1,856,402
Assets. Corporate common stocks other than exployer securities at beginning of year	2014-12-31	$1,983,547
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$66,854
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$83,793
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$3,401,017
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$3,594,525
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2014-12-31	930809066
2013 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$217,646
Total unrealized appreciation/depreciation of assets	2013-12-31	$217,646
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$2,332,924
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$1,758,172
Total income from all sources (including contributions)	2013-12-31	$5,988,826
Total loss/gain on sale of assets	2013-12-31	$111,328
Total of all expenses incurred	2013-12-31	$6,346,325
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$6,003,444
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$5,472,132
Value of total assets at end of year	2013-12-31	$7,751,729
Value of total assets at beginning of year	2013-12-31	$7,534,476
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$342,881
Total interest from all sources	2013-12-31	$158,821
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$28,435
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$167,091
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$3,000,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$650,741
Participant contributions at end of year	2013-12-31	$50,879
Participant contributions at beginning of year	2013-12-31	$55,055
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$43,858
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$45,498
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$2,165,306
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$1,634,713
Other income not declared elsewhere	2013-12-31	$464
Administrative expenses (other) incurred	2013-12-31	$22,190
Liabilities. Value of operating payables at end of year	2013-12-31	$83,825
Liabilities. Value of operating payables at beginning of year	2013-12-31	$54,457
Total non interest bearing cash at end of year	2013-12-31	$424,828
Total non interest bearing cash at beginning of year	2013-12-31	$330,990
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-357,499
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$5,418,805
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$5,776,304
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Income. Interest from US Government securities	2013-12-31	$20,063
Income. Interest from corporate debt instruments	2013-12-31	$138,711
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$383,393
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$304,044
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$304,044
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$47
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$4,575,586
Asset value of US Government securities at end of year	2013-12-31	$1,387,523
Asset value of US Government securities at beginning of year	2013-12-31	$1,842,693
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$4,821,391
Employer contributions (assets) at end of year	2013-12-31	$545,603
Employer contributions (assets) at beginning of year	2013-12-31	$432,845
Income. Dividends from common stock	2013-12-31	$28,435
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,427,858
Asset. Corporate debt instrument debt (other) at end of year	2013-12-31	$2,932,098
Asset. Corporate debt instrument debt (other) at beginning of year	2013-12-31	$2,654,584
Contract administrator fees	2013-12-31	$153,600
Assets. Corporate common stocks other than exployer securities at end of year	2013-12-31	$1,983,547
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-12-31	$1,868,767
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$83,793
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$69,002
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Aggregate proceeds on sale of assets	2013-12-31	$3,535,793
Aggregate carrying amount (costs) on sale of assets	2013-12-31	$3,424,465
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2013-12-31	930809066
2012 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2012-12-31	$184,741
Total unrealized appreciation/depreciation of assets	2012-12-31	$184,741
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,758,172
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$2,304,242
Total income from all sources (including contributions)	2012-12-31	$5,334,386
Total loss/gain on sale of assets	2012-12-31	$17,838
Total of all expenses incurred	2012-12-31	$5,356,202
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$5,040,757
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$4,916,437
Value of total assets at end of year	2012-12-31	$7,534,476
Value of total assets at beginning of year	2012-12-31	$8,102,362
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$315,445
Total interest from all sources	2012-12-31	$176,261
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$38,740
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$146,315
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$2,000,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$936,220
Participant contributions at end of year	2012-12-31	$55,055
Participant contributions at beginning of year	2012-12-31	$60,564
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$45,498
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$51,258
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$1,634,713
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$2,176,119
Other income not declared elsewhere	2012-12-31	$369
Administrative expenses (other) incurred	2012-12-31	$18,930
Liabilities. Value of operating payables at end of year	2012-12-31	$54,457
Liabilities. Value of operating payables at beginning of year	2012-12-31	$51,181
Total non interest bearing cash at end of year	2012-12-31	$330,990
Total non interest bearing cash at beginning of year	2012-12-31	$607,848
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-21,816
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$5,776,304
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$5,798,120
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$90,277
Income. Interest from US Government securities	2012-12-31	$45,688
Income. Interest from corporate debt instruments	2012-12-31	$130,503
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$304,044
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$275,950
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$275,950
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$70
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$3,762,197
Asset value of US Government securities at end of year	2012-12-31	$1,842,693
Asset value of US Government securities at beginning of year	2012-12-31	$2,667,571
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$3,980,217
Employer contributions (assets) at end of year	2012-12-31	$432,845
Employer contributions (assets) at beginning of year	2012-12-31	$394,094
Income. Dividends from common stock	2012-12-31	$38,740
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$1,278,560
Asset. Corporate debt instrument debt (other) at end of year	2012-12-31	$2,654,584
Asset. Corporate debt instrument debt (other) at beginning of year	2012-12-31	$1,930,276
Contract administrator fees	2012-12-31	$150,200
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$1,868,767
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$2,024,524
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$69,002
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$76,942
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Aggregate proceeds on sale of assets	2012-12-31	$4,706,184
Aggregate carrying amount (costs) on sale of assets	2012-12-31	$4,688,346
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2012-12-31	930809066
2011 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-12-31	$154,367
Total unrealized appreciation/depreciation of assets	2011-12-31	$154,367
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$2,304,242
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,633,325
Total income from all sources (including contributions)	2011-12-31	$6,073,662
Total loss/gain on sale of assets	2011-12-31	$-160,744
Total of all expenses incurred	2011-12-31	$5,937,732
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$5,672,058
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$5,793,618
Value of total assets at end of year	2011-12-31	$8,102,362
Value of total assets at beginning of year	2011-12-31	$7,295,515
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$265,674
Total interest from all sources	2011-12-31	$157,620
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$31,622
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$108,425
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$2,000,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$653,791
Participant contributions at end of year	2011-12-31	$60,564
Participant contributions at beginning of year	2011-12-31	$53,026
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$51,258
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$45,007
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$2,176,119
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$1,560,857
Other income not declared elsewhere	2011-12-31	$97,179
Administrative expenses (other) incurred	2011-12-31	$24,049
Liabilities. Value of operating payables at end of year	2011-12-31	$51,181
Liabilities. Value of operating payables at beginning of year	2011-12-31	$30,191
Total non interest bearing cash at end of year	2011-12-31	$607,848
Total non interest bearing cash at beginning of year	2011-12-31	$378,285
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$135,930
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$5,798,120
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$5,662,190
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$90,277
Income. Interest from US Government securities	2011-12-31	$84,562
Income. Interest from corporate debt instruments	2011-12-31	$72,711
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$275,950
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$186,744
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$186,744
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$347
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$4,518,509
Asset value of US Government securities at end of year	2011-12-31	$2,667,571
Asset value of US Government securities at beginning of year	2011-12-31	$2,933,685
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$5,139,827
Employer contributions (assets) at end of year	2011-12-31	$394,094
Employer contributions (assets) at beginning of year	2011-12-31	$253,970
Income. Dividends from common stock	2011-12-31	$31,622
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,153,549
Asset. Corporate debt instrument debt (other) at end of year	2011-12-31	$1,930,276
Asset. Corporate debt instrument debt (other) at beginning of year	2011-12-31	$1,345,348
Contract administrator fees	2011-12-31	$133,200
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$2,024,524
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$2,099,450
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$76,942
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$42,277
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Aggregate proceeds on sale of assets	2011-12-31	$2,708,970
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$2,869,714
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2011-12-31	930809066
2010 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$423,015
Total unrealized appreciation/depreciation of assets	2010-12-31	$423,015
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,633,325
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,576,515
Total income from all sources (including contributions)	2010-12-31	$4,446,559
Total loss/gain on sale of assets	2010-12-31	$-24,028
Total of all expenses incurred	2010-12-31	$4,518,937
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$4,261,432
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$3,842,437
Value of total assets at end of year	2010-12-31	$7,295,515
Value of total assets at beginning of year	2010-12-31	$7,311,083
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$257,505
Total interest from all sources	2010-12-31	$150,869
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$28,835
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$102,829
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$2,000,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$520,262
Participant contributions at end of year	2010-12-31	$53,026
Participant contributions at beginning of year	2010-12-31	$41,597
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$45,007
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$57,228
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$1,560,857
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$1,424,656
Other income not declared elsewhere	2010-12-31	$25,431
Administrative expenses (other) incurred	2010-12-31	$22,076
Liabilities. Value of operating payables at end of year	2010-12-31	$30,191
Liabilities. Value of operating payables at beginning of year	2010-12-31	$43,125
Total non interest bearing cash at end of year	2010-12-31	$378,285
Total non interest bearing cash at beginning of year	2010-12-31	$267,438
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-72,378
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$5,662,190
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$5,734,568
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Income. Interest from US Government securities	2010-12-31	$58,483
Income. Interest from corporate debt instruments	2010-12-31	$91,439
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$186,744
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$547,048
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$547,048
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$947
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$3,466,312
Asset value of US Government securities at end of year	2010-12-31	$2,933,685
Asset value of US Government securities at beginning of year	2010-12-31	$2,855,320
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$3,322,175
Employer contributions (assets) at end of year	2010-12-31	$253,970
Employer contributions (assets) at beginning of year	2010-12-31	$268,541
Income. Dividends from common stock	2010-12-31	$28,835
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$795,120
Asset. Corporate debt instrument debt (other) at end of year	2010-12-31	$1,345,348
Asset. Corporate debt instrument debt (other) at beginning of year	2010-12-31	$1,319,973
Contract administrator fees	2010-12-31	$132,600
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$2,099,450
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$1,953,938
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$42,277
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$108,734
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Aggregate proceeds on sale of assets	2010-12-31	$2,478,590
Aggregate carrying amount (costs) on sale of assets	2010-12-31	$2,502,618
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	MIDDLETON & CO., CPA, PC
Accountancy firm EIN	2010-12-31	930809066

Form 5500 Responses for CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN

2022: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Multi-employer plan
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Multi-employer plan
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Multi-employer plan
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Multi-employer plan
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Multi-employer plan
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Multi-employer plan
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	6
Insurance contract or identification number 6130 Number of Individuals Covered 3 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $5,226 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	1
Insurance contract or identification number 1158 Number of Individuals Covered 204 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,121,578 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	2
Insurance contract or identification number 40000002 Number of Individuals Covered 15 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	3
Insurance contract or identification number OR052647 Number of Individuals Covered 492 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $21,805 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	4
Insurance contract or identification number 10001724 Number of Individuals Covered 983 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	5
Insurance contract or identification number 0000787 Number of Individuals Covered 12 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $42,765 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	190202956
Policy instance	14
Insurance contract or identification number 190202956 Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,188 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	7
Insurance contract or identification number S5820 Number of Individuals Covered 16 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Welfare Benefit Premiums Paid to Carrier USD $15,449 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number	47-MSL-00020605
Policy instance	8
Insurance contract or identification number 47-MSL-00020605 Number of Individuals Covered 426 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $23,149 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $23,149 Insurance broker organization code? 3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number	10001724
Policy instance	9
Insurance contract or identification number 10001724 Number of Individuals Covered 1084 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number	HCCLOT40416
Policy instance	10
Insurance contract or identification number HCCLOT40416 Number of Individuals Covered 426 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $8,049 Other welfare benefits provided TRANSPLANT COVERAGE Welfare Benefit Premiums Paid to Carrier USD $86,180 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,049 Insurance broker organization code? 3
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	R0279725500
Policy instance	11
Insurance contract or identification number R0279725500 Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,452 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 )
Policy contract number	HE354798 3737
Policy instance	12
Insurance contract or identification number HE354798 3737 Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,695 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 )
Policy contract number	318441497-1
Policy instance	13
Insurance contract or identification number 318441497-1 Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $4,148 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number	47-MSL-00020603
Policy instance	8
Insurance contract or identification number 47-MSL-00020603 Number of Individuals Covered 442 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $29,029 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $29,029 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	7
Insurance contract or identification number S5820 Number of Individuals Covered 18 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Welfare Benefit Premiums Paid to Carrier USD $18,699 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	6
Insurance contract or identification number 6130 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $5,559 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	5
Insurance contract or identification number 0000787 Number of Individuals Covered 16 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $55,131 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	4
Insurance contract or identification number 10001724 Number of Individuals Covered 1015 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	3
Insurance contract or identification number OR052647 Number of Individuals Covered 520 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $22,770 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number	10001724
Policy instance	9
Insurance contract or identification number 10001724 Number of Individuals Covered 1129 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number	HCCLOT40416
Policy instance	10
Insurance contract or identification number HCCLOT40416 Number of Individuals Covered 442 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $8,251 Other welfare benefits provided TRANSPLANT COVERAGE Welfare Benefit Premiums Paid to Carrier USD $86,226 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,251 Insurance broker organization code? 3
BANKERS LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61263 )
Policy contract number	206094238
Policy instance	11
Insurance contract or identification number 206094238 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $5,191 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	190202956
Policy instance	15
Insurance contract or identification number 190202956 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,188 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	2
Insurance contract or identification number 40000002 Number of Individuals Covered 16 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $22,080 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	1
Insurance contract or identification number 1158 Number of Individuals Covered 243 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $1,299,743 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 )
Policy contract number	318441497-1
Policy instance	14
Insurance contract or identification number 318441497-1 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,448 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 )
Policy contract number	HE354798 3737
Policy instance	13
Insurance contract or identification number HE354798 3737 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,530 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	R0279725500
Policy instance	12
Insurance contract or identification number R0279725500 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,452 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	7
Insurance contract or identification number S5820 Number of Individuals Covered 18 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Welfare Benefit Premiums Paid to Carrier USD $16,786 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	6
Insurance contract or identification number 6130 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $6,695 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	5
Insurance contract or identification number 0000787 Number of Individuals Covered 18 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $53,609 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	4
Insurance contract or identification number 10001724 Number of Individuals Covered 1059 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	3
Insurance contract or identification number OR052647 Number of Individuals Covered 546 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $23,100 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	2
Insurance contract or identification number 40000002 Number of Individuals Covered 16 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $26,503 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	1
Insurance contract or identification number 1158 Number of Individuals Covered 272 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Welfare Benefit Premiums Paid to Carrier USD $1,395,689 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number	47-MSL-00020603
Policy instance	8
Insurance contract or identification number 47-MSL-00020603 Number of Individuals Covered 444 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $27,701 Welfare Benefit Premiums Paid to Carrier USD $692,535 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $27,701 Insurance broker organization code? 3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number	10001724
Policy instance	9
Insurance contract or identification number 10001724 Number of Individuals Covered 1165 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ALLCARE HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 12253 )
Policy contract number	766QPM
Policy instance	11
Insurance contract or identification number 766QPM Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,251 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	190202956
Policy instance	16
Insurance contract or identification number 190202956 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,150 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 )
Policy contract number	318441497-1
Policy instance	15
Insurance contract or identification number 318441497-1 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,213 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 )
Policy contract number	HE354798 3737
Policy instance	14
Insurance contract or identification number HE354798 3737 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,179 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	R0279725500
Policy instance	13
Insurance contract or identification number R0279725500 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,440 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
BANKERS LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61263 )
Policy contract number	206094238
Policy instance	12
Insurance contract or identification number 206094238 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $4,286 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number	HCCLOT40416
Policy instance	10
Insurance contract or identification number HCCLOT40416 Number of Individuals Covered 441 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $8,196 Other welfare benefits provided TRANSPLANT COVERAGE Welfare Benefit Premiums Paid to Carrier USD $81,964 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,196 Insurance broker organization code? 3
ALLCARE HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 12253 )
Policy contract number	766QPM
Policy instance	12
Insurance contract or identification number 766QPM Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $1,668 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number	HCCLOT40416
Policy instance	11
Insurance contract or identification number HCCLOT40416 Number of Individuals Covered 401 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $7,703 Other welfare benefits provided TRANSPLANT COVERAGE Welfare Benefit Premiums Paid to Carrier USD $77,035 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,703 Insurance broker organization code? 3
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number	10001724
Policy instance	10
Insurance contract or identification number 10001724 Number of Individuals Covered 1188 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number	47-MSL-00020602
Policy instance	9
Insurance contract or identification number 47-MSL-00020602 Number of Individuals Covered 401 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $24,783 Welfare Benefit Premiums Paid to Carrier USD $619,567 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $24,783 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	8
Insurance contract or identification number S5820 Number of Individuals Covered 19 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Welfare Benefit Premiums Paid to Carrier USD $16,861 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	7
Insurance contract or identification number 6130 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $8,303 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	6
Insurance contract or identification number 0000787 Number of Individuals Covered 19 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $56,382 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	5
Insurance contract or identification number 10001724 Number of Individuals Covered 1049 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 529 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Welfare Benefit Premiums Paid to Carrier USD $22,457 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	3
Insurance contract or identification number 40000002 Number of Individuals Covered 21 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $29,182 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	2
Insurance contract or identification number 1158 Number of Individuals Covered 297 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Welfare Benefit Premiums Paid to Carrier USD $1,499,969 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
BANKERS LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61263 )
Policy contract number	206094238
Policy instance	13
Insurance contract or identification number 206094238 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $4,097 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number	R0551351400
Policy instance	14
Insurance contract or identification number R0551351400 Number of Individuals Covered 2 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,173 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 )
Policy contract number	HE354798 3737
Policy instance	15
Insurance contract or identification number HE354798 3737 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $3,122 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 )
Policy contract number	313458067-1
Policy instance	16
Insurance contract or identification number 313458067-1 Number of Individuals Covered 2 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MEDICARE HEALTH PLAN Welfare Benefit Premiums Paid to Carrier USD $4,438 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	1
Insurance contract or identification number 100570 Number of Individuals Covered 2 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $9,785 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number	947-6308
Policy instance	10
Insurance contract or identification number 947-6308 Number of Individuals Covered 398 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $6,789 Other welfare benefits provided TRANSPLANT COVERAGE Welfare Benefit Premiums Paid to Carrier USD $67,888 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $6,789 Insurance broker organization code? 3
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number	47-MSL-00020601
Policy instance	9
Insurance contract or identification number 47-MSL-00020601 Number of Individuals Covered 398 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $20,630 Welfare Benefit Premiums Paid to Carrier USD $515,750 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $20,630 Insurance broker organization code? 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	8
Insurance contract or identification number S5820 Number of Individuals Covered 19 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Welfare Benefit Premiums Paid to Carrier USD $19,925 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	7
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $11,620 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	6
Insurance contract or identification number 0000787 Number of Individuals Covered 19 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $53,555 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	5
Insurance contract or identification number 10001724 Number of Individuals Covered 1195 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 487 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $20,759 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	3
Insurance contract or identification number 40000002 Number of Individuals Covered 21 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $45,075 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	1
Insurance contract or identification number 100570 Number of Individuals Covered 6 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $22,918 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	2
Insurance contract or identification number 1158 Number of Individuals Covered 323 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Welfare Benefit Premiums Paid to Carrier USD $1,612,617 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	8
Insurance contract or identification number S5820 Number of Individuals Covered 19 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Welfare Benefit Premiums Paid to Carrier USD $17,189 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	1
Insurance contract or identification number 100570 Number of Individuals Covered 6 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,235 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	2
Insurance contract or identification number 1158 Number of Individuals Covered 332 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Welfare Benefit Premiums Paid to Carrier USD $1,613,337 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	3
Insurance contract or identification number 40000002 Number of Individuals Covered 22 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $52,550 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 449 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $19,980 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	5
Insurance contract or identification number 10001724 Number of Individuals Covered 994 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	6
Insurance contract or identification number 0000787 Number of Individuals Covered 19 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $50,188 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	7
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $11,236 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	7
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $10,100 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	1
Insurance contract or identification number 100570 Number of Individuals Covered 6 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $24,000 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	2
Insurance contract or identification number 1158 Number of Individuals Covered 335 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Welfare Benefit Premiums Paid to Carrier USD $1,535,772 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	3
Insurance contract or identification number 40000002 Number of Individuals Covered 25 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $54,852 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 423 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $16,472 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	5
Insurance contract or identification number 10001724 Number of Individuals Covered 1100 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	6
Insurance contract or identification number 0000787 Number of Individuals Covered 21 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $45,903 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	8
Insurance contract or identification number S5820 Number of Individuals Covered 21 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Welfare Benefit Premiums Paid to Carrier USD $13,544 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	8
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $10,570 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820/S5921
Policy instance	9
Insurance contract or identification number S5820/S5921 Number of Individuals Covered 23 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Welfare Benefit Premiums Paid to Carrier USD $11,889 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	7
Insurance contract or identification number 0000787 Number of Individuals Covered 24 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $57,634 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	6
Insurance contract or identification number 10001724 Number of Individuals Covered 321 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	105316
Policy instance	5
Insurance contract or identification number 105316 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,907 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 436 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $17,653 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	3
Insurance contract or identification number 40000002 Number of Individuals Covered 32 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $66,205 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	2
Insurance contract or identification number 1158 Number of Individuals Covered 400 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Welfare Benefit Premiums Paid to Carrier USD $1,446,478 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	1
Insurance contract or identification number 100570 Number of Individuals Covered 8 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,384 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	9
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided MED ADVANTAGE PLAN (MEDICARE MEMB.) Welfare Benefit Premiums Paid to Carrier USD $8,406 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	10
Insurance contract or identification number S5820 Number of Individuals Covered 25 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Welfare Benefit Premiums Paid to Carrier USD $11,219 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	2
Insurance contract or identification number 1158 Number of Individuals Covered 277 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $829,321 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	3
Insurance contract or identification number 40000002 Number of Individuals Covered 37 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $59,970 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 412 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,604 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	105316
Policy instance	5
Insurance contract or identification number 105316 Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,064 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	6
Insurance contract or identification number 10001724 Number of Individuals Covered 328 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	7
Insurance contract or identification number 0000787 Number of Individuals Covered 36 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $54,396 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	1
Insurance contract or identification number 100570 Number of Individuals Covered 8 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $28,042 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1485
Policy instance	8
Insurance contract or identification number 1485 Number of Individuals Covered 69 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $241,053 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	7
Insurance contract or identification number OR052647 Number of Individuals Covered 348 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $14,960 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	9
Insurance contract or identification number 1158 Number of Individuals Covered 227 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $757,538 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	10
Insurance contract or identification number 100570 Number of Individuals Covered 8 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $28,690 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	5
Insurance contract or identification number 10001724 Number of Individuals Covered 293 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	4
Insurance contract or identification number 0000787 Number of Individuals Covered 23 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $52,088 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1485
Policy instance	3
Insurance contract or identification number 1485 Number of Individuals Covered 82 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $299,389 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	2
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Other welfare benefits provided AARP MEDICARE RX Welfare Benefit Premiums Paid to Carrier USD $8,991 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	1
Insurance contract or identification number S5820 Number of Individuals Covered 25 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Welfare Benefit Premiums Paid to Carrier USD $10,902 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	105316
Policy instance	6
Insurance contract or identification number 105316 Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,435 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	8
Insurance contract or identification number 40000002 Number of Individuals Covered 39 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $56,109 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	5
Insurance contract or identification number 1158 Number of Individuals Covered 99 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $285,702 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	11
Insurance contract or identification number 1158 Number of Individuals Covered 265 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $720,209 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	40000002
Policy instance	10
Insurance contract or identification number 40000002 Number of Individuals Covered 42 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $56,877 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	9
Insurance contract or identification number OR052647 Number of Individuals Covered 427 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,146 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	105316
Policy instance	8
Insurance contract or identification number 105316 Number of Individuals Covered 1 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $6,105 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	7
Insurance contract or identification number 10001724 Number of Individuals Covered 275 Insurance policy start date 2010-08-01 Insurance policy end date 2011-07-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	6
Insurance contract or identification number 0000787 Number of Individuals Covered 24 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $54,721 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	6130
Policy instance	3
Insurance contract or identification number 6130 Number of Individuals Covered 2 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Other welfare benefits provided AARP MEDICARE RX Welfare Benefit Premiums Paid to Carrier USD $8,442 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	12
Insurance contract or identification number 100570 Number of Individuals Covered 9 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $29,634 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	4
Insurance contract or identification number OR052647 Number of Individuals Covered 184 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $11,185 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	S5820
Policy instance	2
Insurance contract or identification number S5820 Number of Individuals Covered 25 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Welfare Benefit Premiums Paid to Carrier USD $7,753 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number	10001724
Policy instance	1
Insurance contract or identification number 10001724 Number of Individuals Covered 339 Insurance policy start date 2010-08-01 Insurance policy end date 2011-07-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR054170
Policy instance	2
Insurance contract or identification number OR054170 Number of Individuals Covered 194 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $13,948 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1485
Policy instance	3
Insurance contract or identification number 1485 Number of Individuals Covered 95 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $279,946 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 )
Policy contract number	10001724
Policy instance	4
Insurance contract or identification number 10001724 Number of Individuals Covered 243 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Health Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	1158
Policy instance	5
Insurance contract or identification number 1158 Number of Individuals Covered 208 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $621,230 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000787
Policy instance	6
Insurance contract or identification number 0000787 Number of Individuals Covered 28 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Other welfare benefits provided AARP MEDICARE SUPPLEMENT Welfare Benefit Premiums Paid to Carrier USD $47,069 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	105316
Policy instance	8
Insurance contract or identification number 105316 Number of Individuals Covered 1 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $5,843 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 )
Policy contract number	10001724
Policy instance	7
Insurance contract or identification number 10001724 Number of Individuals Covered 300 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Dental Insurance Welfare Benefit Yes Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number	OR052647
Policy instance	9
Insurance contract or identification number OR052647 Number of Individuals Covered 282 Insurance policy start date 2009-08-01 Insurance policy end date 2010-07-31 Life Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,707 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number	222600
Policy instance	10
Insurance contract or identification number 222600 Number of Individuals Covered 40 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit Yes Other welfare benefits provided EMPLOYER SPONSORED MEDICARE PLAN Welfare Benefit Premiums Paid to Carrier USD $84,010 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number	13540
Policy instance	11
Insurance contract or identification number 13540 Number of Individuals Covered 20 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $59,695 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number	006130
Policy instance	12
Insurance contract or identification number 006130 Number of Individuals Covered 2 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $7,538 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number	005825
Policy instance	13
Insurance contract or identification number 005825 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $633 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number	100570
Policy instance	14
Insurance contract or identification number 100570 Number of Individuals Covered 13 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Health Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $26,754 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	0000165
Policy instance	1
Insurance contract or identification number 0000165 Number of Individuals Covered 27 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Other welfare benefits provided AARP MEDICARE RX Welfare Benefit Premiums Paid to Carrier USD $14,737 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Total amount of commissions paid to insurance broker USD $15,736 Total amount of fees paid to insurance company USD $1,914 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for group deferred annuity? No Are there contracts with allocated funds for types other than group deferred annuity or individual? No Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Contracts With Unallocated Funds Deposit Administration 0 Are there contracts with unallocated funds for contracts of type immediate participation guarantee? No Are there contracts with unallocated funds for contracts of type guaranteed investment? No Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit Yes Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit No Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Commission paid to Insurance Broker USD $15,736 Amount paid for insurance broker fees 1914 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3

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• CEMENT MASONS AND PLASTERERS VACATION SAVINGS PLAN TRUST [EIN = 886010565]
• CEMENT MASONS LOCAL 780 APPRENTICESHIP FUND [EIN = 510170643]
• CEMENT MASONS VACATION AND HOLIDAY TRUST FUND-DETROIT & VICINITY [EIN = 382106635]
• CEMENT MASONS LOCAL 526 SUPPLEMENTAL INCOME FUND [EIN = 237071390]
• CEMENT MASONS - EMPLOYERS PENSION PLAN [EIN = 936073070]
• CEMENT MASONS LOCAL UNION NO. 502 SAVINGS FUND [EIN = 366411337]
• CEMENT MASONS UNION LOCAL NO 527 TRUST FUND [EIN = 430650799]
• CEMENT MASONS LOCAL 780 PENSION FUND [EIN = 131626710]
• CEMENT MASONS AND PLASTERERS HEALTH AND WELFARE PLAN [EIN = 886010564]
• CEMENT MASONS LOCAL UNION NO. 111 PENSION FUND [EIN = 160988061]
• CEMENT MASONS LOCAL 524 PENSION PLAN [EIN = 310235930]
• CEMENT MASONS LOCAL 780 VACATION FUND [EIN = 136159177]
• CEMENT MASONS SOUTHERN CALIFORNIA HEALTH AND WELFARE FUND [EIN = 956042883]
• CEMENT MASONS SOUTHERN CALIFORNIA INDIVIDUAL RETIREMENT ACCOUNT DEFINED CONTRIBUTION TRUST [EIN = 953697340]
• CEMENT MASONS ANNUITY TRUST FUND FOR NORTHERN NEVADA [EIN = 880197939]
• CEMENT MASONS LOCAL NO. 43 ANNUITY PLAN [EIN = 311699383]
• CEMENT MASONS LOCAL 783 PENSION TRUST [EIN = 741976110]
• CEMENT MASONS INSTITUTE LOCAL 502 WELFARE TRUST FUND [EIN = 510191061]
• CEMENT MASONS LOCAL NO. 111 HEALTH & WELFARE FUND [EIN = 166095037]
• CEMENT MASONS LOCAL UNION NO. 518 VACATION FUND [EIN = 363439662]
• CEMENT MASONS LOCAL 526 RETIREMENT FUND [EIN = 251816854]
• CEMENT MASONS LOCAL NO. 567 PENSION PLAN [EIN = 726063351]
• CEMENT MASONS AND PLASTERERS LOCAL 518 DEFINED CONTRIBUTION FUND [EIN = 436098247]
• CEMENT MASONS LOCAL UNION 681 PENSION PLAN [EIN = 746091787]
• CEMENT MASONS AND PLASTERERS JOINT PENSION PLAN [EIN = 880135696]
• CEMENT MASONS & PLASTERERS LOCAL 518 HEALTH CARE FUND [EIN = 436039075]
• CEMENT MASONS LOCAL 502(B) PENSION FUND [EIN = 366136496]
• CEMENT MASONS LOCAL NO. 43 PENSION PLAN [EIN = 526111323]
• CEMENT MASONS JOINT APPRENTICESHIP AND TRAINING LOCAL NO. 404 TRUST FUND [EIN = 341165515]