2024-01-15T17:19:41-06:00 2023-02-28 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE S SUITE 550 EDINA MN 55435 990 2022-03-01 410905139 MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS HEALTH AND WELFARE FUND MINN 9528540795 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 RENA WONG TRUSTEE 9528540795 2024-01-15 1 RENA WONG 999009999 0 JACOB D EKLUND P01455813 9528413950 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z RENA WONG 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 55990563 0 X WWW.663BENEFITS.COM X 1966 MN PROVIDES HEALTH AND WELFARE BENEFITS 8 0 86 0 0 0 0 0 44936733 48471047 346791 171069 0 3556 45283524 48645672 0 0 38127823 43775670 0 0 0 0 0 1024059 704955 39151882 44480625 6131642 4165047 41658369 43133882 254204 85381 41404165 43048501 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 THE PLAN PROVIDES COMPREHENSIVE MEDICAL BENEFITS, INCLUDING DENTAL, VISION, PRESCRIPTION DRUG AND VARIOUS SUPPLEMENTAL BENEFITS, LIFE INSURANCE AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS AND BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 3 0 1 86 1 0 0 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X WILSON-MCSHANE CORPORATION 9528540795 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 WILLIAM SEEHAFER SECRETARY 1.00 X 0 0 0 JIM ALMSTED TRUSTEE 1.00 X 0 0 0 FRED MILLER TRUSTEE 1.00 X 0 0 0 KENT DIXON TRUSTEE 1.00 X 0 0 0 LAURA DALY ALTERNATE TRUSTEE 1.00 X 0 0 0 MATTHEW UTECHT CHAIRMAN - PAST 1.00 40.00 X 0 372421 23469 CALVIN P CRANDALL TRUSTEE - PAST 1.00 40.00 X 0 292203 23578 JIM SCHOMMER TRUSTEE 1.00 40.00 X 0 103447 22484 RENA WONG CHAIRMAN 1.00 40.00 X 0 159020 23578 DAVID BLITZSTEIN TRUSTEE 1.00 X 0 0 0 MICHAEL LACOSTE ALTERNATE TRUSTEE 1.00 40.00 X 0 50280 7020 SCOTT LARSON TRUSTEE 1.00 40.00 X 0 92892 23059 0 1070263 123188 0 0 1 0 WILSON-MCSHANE CORPORATION 3001 METRO DRIVE BLOOMINGTON MN 55425 CLAIMS PROCESSING AND ADMINISTRATION 1241103 UMR INC 400 EAST BUSINESS WAY SUITE 100 CINCINNATI OH 45241 NETWORK ACCESS FEES 1040123 EXPRESS SCRIPTS ONE EXPRESS WAY ST LOUIS MO 63121 NETWORK ACCESS FEES 116579 DELTA DENTAL OF MINNESOTA 500 WASHINGTON AVENUE SOUTH SUITE MINNEAPOLIS MN 554151163 NETWORK ACCESS FEES 112711 4 EMPLOYER CONTRIBUTIONS 900099 41723141 41723141 PARTICIPANT CONTRIBUTIONS 900099 3734586 3734586 PRESCRIPTION DRUG REBATES 900099 2416775 2416775 SUBROGATION SETTLEMENT 900099 587628 587628 LITIGATION SETTLEMENT 900099 8917 8917 48471047 265960 265960 7250000 7344891 -94891 -94891 -94891 MISCELLANEOUS REVENUE 900099 3556 3556 3556 48645672 48471047 0 174625 43775670 392000 81655 18203 129640 46426 14700 11011 FEES MANDATED BY ACA 11320 44480625 -41321 279712 7161010 3493528 4331125 4793731 9301 13278 2886829 3373448 27311425 31180185 41658369 43133882 236978 68850 17226 16531 254204 85381 X 0 0 0 0 41404165 43048501 41404165 43048501 41658369 43133882 4165047 -2520711 0 X 0 1 X 1 0 0 COMMON COLLECTIVE TRUSTS 27839648 F LIMITED PARTNERSHIP 3340537 F 31180185 X 45995321 -2520711 -2520711 48516032 129640 129640 48645672 44350985 0 44350985 129640 129640 44480625 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN UNCERTAIN TAX POSITIONS THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 MATTHEW UTECHT CHAIRMAN - PAST 0 372421 0 0 0 0 0 10275 0 13194 0 395890 0 0 CALVIN P CRANDALL TRUSTEE - PAST 0 292203 0 0 0 0 0 10408 0 13170 0 315781 0 0 RENA WONG CHAIRMAN 0 159020 0 0 0 0 0 10408 0 13170 0 182598 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE BOARD OF TRUSTEES RETAINS ULTIMATE RESPONSIBILITY, THE TRUSTEES HAVE DELEGATED THE DAY-TO-DAY ADMINISTRATIVE DUTIES TO WILSON-MCSHANE CORPORATION AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A THE PLAN IS ADMINISTERED BY A BOARD OF EIGHT TRUSTEES, FOUR EMPLOYER TRUSTEES ARE APPOINTED BY CONTRIBUTING EMPLOYERS AND FOUR UNION TRUSTEES ARE APPOINTED BY THE UNION. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO THE ADMINISTRATOR AND THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE IS REQUIRED TO ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT THEY HAVE READ AND UNDERSTAND THE CONFLICT OF INTEREST POLICY AND THAT TO THE BEST OF THEIR KNOWLEDGE THAT NEITHER THE TRUSTEE, NOR ANY RELATIVE OF THE TRUSTEE, HAS IN THE PAST YEAR ENGAGED IN AN ACTIVITY THAT DOES OR REASONABLY MAY CONSTITUTE A CONFLICT OF INTEREST. IN ADDITION, THE TRUSTEES ARE REQUIRED TO IMMEDIATELY COMMUNICATE ALL THE FACTS TO THE CHAIRMAN AND SECRETARY OF THE BOARD, IF THEY SENSE AN ACTION THE BOARD IS PURSUING, OR IS CONTEMPLATING PURSUING, MAY PRESENT A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS PENSION FUND 3001 METRO DRIVE STE 500 BLOOMINGTON MN 55425 410905139 PENSION BENEFIT FUND MN 401(A) N/A 0 UFCW LOCAL 663 CONTRIBUTING EMPLOYER 0 MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS VARIABLE ANNUITY PENSION 3001 METRO DRIVE STE 500 BLOOMINGTON MN 55425 832598425 PENSION BENEFIT FUND MN 401(A) N/A 0 ALMSTED ENTERPRISES INC CONTRIBUTING EMPLOYER 0 CHRISTOPHERSON MEATS CO CONTRIBUTING EMPLOYER 0 EVERETT'S FOODS INC CONTRIBUTING EMPLOYER 0 HAUG ENTERPRISES INCORPORATED CONTRIBUTING EMPLOYER 0 INGEBRETSEN'S CONTRIBUTING EMPLOYER 0 J & L ENTERPRISES CONTRIBUTING EMPLOYER 0 JERRY'S ENTERPRISES CONTRIBUTING EMPLOYER 0 KINGS SUPER MARKETS INC CONTRIBUTING EMPLOYER 0 KOWALSKI'S MARKET CONTRIBUTING EMPLOYER 0 LUND FOOD HOLDINGS INC CONTRIBUTING EMPLOYER 0 MINERS INC CONTRIBUTING EMPLOYER 0 MN MEAT MASTERS CONTRIBUTING EMPLOYER 0 MOUND FOODS INC CONTRIBUTING EMPLOYER 0 OXENDALE COMPANIES CONTRIBUTING EMPLOYER 0 PAULSON'S CONTRIBUTING EMPLOYER 0 RADEMACHERS CONTRIBUTING EMPLOYER 0 S & R QUISBERG INC CONTRIBUTING EMPLOYER 0 SHOREWOOD LLC CONTRIBUTING EMPLOYER 0 SUPER VALU INC CONTRIBUTING EMPLOYER 0 T & K FOODS INC CONTRIBUTING EMPLOYER 0 WILLSTON CORP CONTRIBUTING EMPLOYER 0 WILSON MCSHANE CORP CONTRIBUTING EMPLOYER 0 KNOWLANS CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1