2023-10-02T10:01:59-05:00 2022-11-30 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2021-12-01 237115412 MINNESOTA TEAMSTERS CONSTRUCTION DIVISION FRINGE BENEFIT FUNDS MINN 6512561900 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 ZACHARY RADZAK TRUSTEE 6512561900 2023-10-02 1 ZACHARY RADZAK 999009999 ERIC C BAERTSCH P00964071 9528413950 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z ZACHARY RADZAK 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 29277952 0 X N/A X 1970 MN PROVIDE HEALTH BENEFITS 8 8 20 0 0 0 0 0 23219659 18748908 461112 -178739 2572 3611 23683343 18573780 0 0 15928400 23042067 0 0 0 0 0 390951 425158 16319351 23467225 7363992 -4893445 30866404 24844524 23524 18334 30842880 24826190 TO PROVIDE HEALTH CARE, DENTAL, DISABILITY, LIFE, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS TO MEMBERS. 0 0 PAYMENT OF HEALTH CARE, DENTAL, DISABILITY, LIFE, AND ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS FOR ELIGIBLE PARTICIPANTS AND DEPENDENTS AS PROVIDED BY THE SUMMARY PLAN DESCRIPTION. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 20 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 1 0 1 0 0 0 1 1 0 0 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS INC 6512561900 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 X CHAD NELSON TRUSTEE 1.00 X 0 0 0 ANDREW ERICHSON ALTERNATE TRUSTEE 1.00 X 0 0 0 STEVEN SAUER SECRETARY 2.00 X 0 0 0 JASON ZINS TRUSTEE 1.00 X 0 0 0 NICK JOHNSON ALTERNATE TRUSTEE 1.00 X 0 0 0 ZACHARY RADZAK CHAIRMAN 2.00 X 0 0 0 CHAD WARD TRUSTEE 2.00 X 0 0 0 SHANE BLOCK ALTERNATE TRUSTEE 1.00 X 0 0 0 RICH FREDERICK ALTERNATE TRUSTEE 1.00 X 0 0 0 JEFF DIEDE TRUSTEE 1.00 X 0 0 0 SCOTT KROONA TRUSTEE 1.00 X 0 0 0 JEFF OVESON ALTERNATE TRUSTEE 1.00 X 0 0 0 VIRGIL CHRISTOFFERSEN ALTERNATE TRUSTEE 1.00 X 0 0 0 JEFF ZAHN TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 ADMINISTRATION, CLAIMS PROCESSING, AUDIT 454985 BLUELINK TPA 1200 YANKEE DOODLE ROAD PO BOX 6 ST PAUL MN 55164 PPO ACCESS FEES 331107 2 EMPLOYER CONTRIBUTIONS 900099 16132604 16132604 STOP-LOSS CONTRIBUTIONS 900099 1847827 1847827 PRESCRIPTION DRUG REBATES 900099 329088 329088 SELF-PAY - EMPLOYEES 900099 303309 303309 SUBROGATION RECEIPTS 900099 136080 136080 18748908 446379 446379 10079054 10704172 -625118 -625118 -625118 CREDIT CARD FEE CONTRIBUTIONS 900099 2548 2548 LIQUIDATED DAMAGES 900099 1063 1063 3611 18573780 18748908 0 -175128 23042067 132599 65210 38510 15335 106386 43158 8195 6223 AFFORDABLE CARE ACT FEE 9174 GOVERNMENT COMPLIANCE 368 23467225 4045185 3541638 3123209 1723534 1728878 1281641 21163878 17753612 805254 544099 30866404 24844524 12337 9778 11187 8556 23524 18334 X 0 0 0 0 30842880 24826190 30842880 24826190 30866404 24844524 -4893445 -1123245 0 X 0 1 X 1 0 0 X 17435200 -1123245 -1123245 18558445 15335 15335 18573780 23451890 0 23451890 15335 15335 23467225 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. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THE TRUSTEES HAVE DELEGATED THE DAY TO DAY ADMINISTRATIVE DUTIES TO ZENITH AMERICAN SOLUTIONS INC. AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A THE PLAN IS ADMINISTERED BY FOUR EMPLOYER ASSOCIATION TRUSTEES AND FOUR UNION TRUSTEES. THE FOUR EMPLOYER ASSOCIATION TRUSTEES SHALL BE DESIGNATED BY THE EMPLOYER ASSOCIATION. THE FOUR UNION TRUSTEES SHALL BE DESIGNATED BY THE NEGOTIATING COMMITTEE. EIGHT ALTERNATE TRUSTEES ARE APPOINTED, FOUR FROM THE EMPLOYER ASSOCIATION AND FOUR FROM THE UNIONS. EACH TRUSTEE AND ALTERNATE TRUSTEE MAY BE REMOVED ONLY BY THE PARTY WHICH APPOINTED THEM. FORM 990, PART VI, SECTION A, LINE 8B THERE IS NO COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES BEFORE THE FORM 990 IS FILED. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS AT THE OFFICE OF THE THIRD PARTY ADMINISTRATOR IN MENDOTA HEIGHTS, MINNESOTA. 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