2020-02-13T13:32:14-06:00 2019-04-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-05-01 411384754 IBEW 292 HEALTH CARE PLAN IBEW 7634938830 6900 WEDGWOOD ROAD N NO 425 MAPLE GROVE MN 55311 DANIEL FERGUSON TRUSTEE 7634938830 2020-02-12 1 STACY MEYER P00970265 6123764500 67.137.57.251 2020-02-12 12:12:27 CS P 80E1F4C36FD5403AFF9C3193509FEE9CEC8C2CF0 BD9A67EE937699C89923753B745A473E445EE389 2018 2020-09-22 18:59:49Z DANIEL FERGUSON 6900 WEDGWOOD ROAD N NO 425 MAPLE GROVE MN 55311 116396435 0 X WWW.IBEW292BENEFITS.ORG X 1980 MN TO PROVIDE HEALTH AND WELFARE BENEFITS. 6 0 192 9 0 0 0 0 65372792 69169500 2515534 7973742 70 0 67888396 77143242 0 0 62626184 70027276 861721 850568 0 0 0 1058019 833303 64545924 71711147 3342472 5432095 125335957 130398771 488314 331198 124847643 130067573 TO PROVIDE HEALTH CARE BENEFITS TO ELIGIBLE PARTICIPANTS AND THEIR BENEFICIARIES. 0 0 TO PROVIDE HEALTH AND WELFARE BENEFITS TO ELIGIBLE PARTICIPANTS UNDER THE TERMS OF THE PLAN DOCUMENT FOR 4,602 MEMBERS. 0 0 0 0 0 0 0 0 0 1 1 0 0 1 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 11 0 192 1 0 0 0 0 0 0 0 0 X 6 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X CARLA GRUETZMACHER 7634938830 6900 WEDGWOOD RD N SUITE 425 MAPLE GROVE MN 55311 PETER LINDAHL LABOR TRUSTEE 2.00 48.00 X X 0 114857 55161 DANIEL FERGUSON LABOR TRUSTEE, CHAIRMAN 2.00 48.00 X X 0 110143 53471 DAVID FRARY LABOR TRUSTEE 2.00 48.00 X 0 105115 53471 JENNIFER GASPERSICH LABOR TRUSTEE - ALTERNATE 2.00 48.00 X 0 94238 53471 LAURA KAROW MANAGEMENT TRUSTEE, SECRETARY 2.00 40.00 X X 0 0 0 PAUL KOSMIDES MANAGEMENT TRUSTEE 2.00 40.00 X 0 0 0 DAVID MANDERSON MANAGEMENT TRUSTEE 2.00 48.00 X 0 222972 47689 JERRY HEIN MANAGEMENT TRUSTEE - ALTERNATE 2.00 40.00 X 0 0 0 JEFFREY HEIMERL LABOR TRUSTEE 2.00 40.00 X 0 0 0 CARLA GRUETZMACHER ADMINISTRATIVE MANAGER 40.00 0.00 X 87999 0 33136 JODY ROE ADMINISTRATIVE MANAGER 40.00 0.00 X 106063 0 52952 194062 647325 349351 1 0 1 0 BLUE CROSS & BLUE SHIELD 3535 BLUE CROSS RD EAGAN MN 55122 CLAIMS NETWORK ACCESS 998654 DELTA DENTAL 500 WASHINGTON AVE S STE 2060 MINNEAPOLIS MN 55415 CLAIMS NETWORK ACCESS 240688 KUTAK ROCK LLP 60 S 6TH ST STE 3400 MINNEAPOLIS MN 55402 LEGAL 159199 3 EMPLOYER CONTRIBUTIONS 525100 58867022 58867022 PARTICIPANT CONTRIBUTIONS 525100 8114120 8114120 PRESCRIPTION REBATES 525100 1402039 1402039 STOP-LOSS REIMBURSEMENTS 525100 507100 507100 SUBROGATION SETTLEMENTS 525100 279219 279219 69169500 2583950 2583950 44642985 39253193 5389792 5389792 5389792 77143242 69169500 0 7973742 70027276 221213 78373 289528 45116 75422 140916 230478 27058 83490 222560 64619 51568 38800 34400 9125 63021 MEMBER EDUCATION 7453 EQUIPMENT MAINTENANCE 731 71711147 100 2196257 8149284 2672277 4695874 5119924 480415 370886 264140 137231 136034 126909 67302241 78688180 44572009 41224338 125335957 130398771 84045 108928 404269 222270 488314 331198 X 0 0 0 0 124847643 130067573 124847643 130067573 125335957 130398771 5432095 -212165 0 X 0 1 X 1 0 117352 100642 16710 146788 36589 110199 126909 GUARANTEED INVESTMENT CONTRACTS 24542553 F LIMITED PARTNERSHIPS 7667583 F AFL-CIO HOUSING INVESTMENT TRUST 4120866 F LIMITED LIABILITY COMPANIES 4893336 F 41224338 DUE TO BROKER - NET 222270 222270 X 74659229 -212165 -212165 74871394 83490 2188358 2271848 77143242 69439299 0 69439299 83490 2188358 2271848 71711147 PART X, LINE 2: THE VEBA TRUST FUNDING CERTAIN BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICE (IRS) DATED MARCH 26, 1981, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)9 OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. IN ADDITION, THE PLAN AND THE TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF IT HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 4B - OTHER ADJUSTMENTS: PRESCRIPTION DRUG REBATES 1,402,039. SUBROGATION SETTLEMENTS 279,219. STOP-LOSS REIMBURSEMENTS 507,100. PART XII, LINE 4B - OTHER ADJUSTMENTS: PRESCRIPTION DRUG REBATES 1,402,039. SUBROGATION SETTLEMENTS 279,219. STOP-LOSS REIMBURSEMENTS 507,100. 0 0 0 PETER LINDAHL LABOR TRUSTEE 0 114857 0 0 0 0 0 32486 0 22675 0 170018 0 0 DANIEL FERGUSON LABOR TRUSTEE, CHAIRMAN 0 110143 0 0 0 0 0 31532 0 21939 0 163614 0 0 DAVID FRARY LABOR TRUSTEE 0 105115 0 0 0 0 0 31532 0 21939 0 158586 0 0 DAVID MANDERSON MANAGEMENT TRUSTEE 0 161385 0 60000 0 1587 0 29322 0 18367 0 270661 0 0 JODY ROE ADMINISTRATIVE MANAGER 106063 0 0 0 0 0 36533 0 16419 0 159015 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THREE TRUSTEES ARE APPOINTED BY THE UNION AND THREE TRUSTEES ARE APPOINTED BY THE CONTRACTORS ASSOCIATION. THE UNION AND THE CONTRACTORS ASSOCIATION MAY ALSO APPOINT UP TO ONE ALTERNATE TRUSTEE, WHO WILL BE QUALIFIED TO ACT ONLY IN THE ABSENCE OF A TRUSTEE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE 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 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES REVIEW THE PLAN'S CONFLICT OF INTEREST POLICY ANNUALLY WITH THE PLAN ATTORNEY AND ARE REQUIRED TO SIGN AN ANNUAL CERTIFICATION OF COMPLIANCE WITH THE POLICY. IN ADDITION, TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH ITS PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS LAWFUL STATUS AND FIDUCIARY OBLIGATIONS, PERIODIC REVIEWS OF COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ARE CONDUCTED. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST AT THE PLAN OFFICE. ELECTRICAL WORKERS LOCAL NO 292 PENSION PLAN 6900 WEDGWOOD RD N 425 MAPLE GROVE MN 55311 416035616 PROVIDES PENSION BENEFITS TO MEMBERS AND BENEFICIARIES MN 401(A) 0 ELECTRICAL WORKERS LOCAL NO 292 DEFINED CONTRIBUTION AND 401K 6900 WEDGWOOD RD N 425 MAPLE GROVE MN 55311 411760754 PROVIDES ANNUITY AND RETIREMENT BENEFITS TO MEMBERS AND BENEFICIARIES MN 401(A) 0 ELECTRICAL WORKERS LOCAL NO 292 SUPPLEMENTAL UNEMP BENEFIT PLAN 6900 WEDGWOOD RD N 425 MAPLE GROVE MN 55311 411876011 PROVIDES UNEMPLOYMENT BENEFITS TO MEMBERS MN 501(C)(9) 0 ELECTRICAL WORKERS LOCAL NO 292 VACATION AND HOLIDAY PLAN 6900 WEDGWOOD RD N 425 MAPLE GROVE MN 55311 411701466 PROVIDES VACATION BENEFITS TO MEMBERS MN 501(C)(9) 0 CITY OF MINNEAPOLIS CONTRIBUTING EMPLOYER 0 CITY OF MPLS PARK BOARD CONTRIBUTING EMPLOYER 0 MINNEAPOLIS PUBLIC HOUSING CONTRIBUTING EMPLOYER 0 UNIVERSITY OF MINNESOTA CONTRIBUTING EMPLOYER 0 IBEW LOCAL 292 CONTRIBUTING EMPLOYER 0 MINNEAPOLIS CHAPTER NATIONAL ELECTRICAL CONTRACTORS CONTRIBUTING 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INC CONTRIBUTING EMPLOYER 0 RECORD AUTOMATIC DOORS INC CONTRIBUTING EMPLOYER 0 SECURITY CONTROL SYSTEMS INC CONTRIBUTING EMPLOYER 0 SIGNAL PERFECTION LTD CONTRIBUTING EMPLOYER 0 SNYDER ELECTRIC COMPANY CONTRIBUTING EMPLOYER 0 STATES ELECTRIC MANUFACTURING CO CONTRIBUTING EMPLOYER 0 STRUCTURED NETWORK SOLUTIONS INC CONTRIBUTING EMPLOYER 0 TELESYSTEMS INC CONTRIBUTING EMPLOYER 0 TOTAL FIRE ALARM S CONTRIBUTING EMPLOYER 0 TRICOM COMMUNICATIONS CONTRIBUTING EMPLOYER 0 TWENTY 4 SEVEN FIRE CONTRIBUTING EMPLOYER 0 AMERICAN MIDWEST POWER CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 SCHEDULE R OTHER RELATED ORGANIZATION THE FOLLOWING CONTRIBUTING EMPLOYER FAILED TO PROVIDE A RESPONSE REGARDING THE ENTITY'S TAX STATUS: FRED'S SERVICE