2020-11-12T09:41:53-06:00 2019-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2019-01-01 416023462 MINNESOTA CEMENT MASONS HEALTH AND WELFARE FUND MINN 6512561900 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 DAVE SCHUTTA TRUSTEE 6512561900 2020-11-02 1 LARRY WOOD P00634996 9528413950 12.235.239.120 2020-11-02 09:42:23 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 18D8E43A51057115C97B638ED8AC001B64A20B00 2019 2021-04-22 16:20:28Z DAVE SCHUTTA 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 19329884 0 X N/A X 1960 MN TO PROVIDE HEALTH BENEFITS 8 1 8 0 0 0 0 0 12110249 13295508 395030 683631 0 0 12505279 13979139 0 0 10534083 12795488 0 0 0 0 0 524647 546033 11058730 13341521 1446549 637618 22001251 23894278 51549 180688 21949702 23713590 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DENTAL, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS OR BENEFICIARIES ON A SELF-INSURED BASIS. 0 0 0 0 0 0 0 0 0 0 0 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 1 256 0 1 8 1 0 0 0 0 0 0 0 0 0 0 X 8 1 0 1 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561900 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 TIM WORKE TRUSTEE 2.00 X 0 0 0 STEVE BULACH TRUSTEE 2.00 X 0 0 0 DAVID JOSLIN TRUSTEE 2.00 X 0 0 0 SUBEN KANAGARATNAM TRUSTEE 2.00 X 0 0 0 DAVE SCHUTTA TRUSTEE 2.00 46.00 X 0 112443 66797 BRIAN GULLICKSON TRUSTEE 2.00 44.00 X 0 112754 63893 JARROD ASLESON TRUSTEE 2.00 3.00 X 0 7641 2822 MIKE SYVERSRUD TRUSTEE 2.00 44.00 X 0 99212 63893 CHAD MORRIS ALTERNATE TRUSTEE 2.00 44.00 X 0 111698 63893 0 443748 261298 0 0 1 0 HEALTHPARTNERS 8170 33RD AVE S BLOOMINGTON MN 55425 CLAIMS ADMINISTRATION 608122 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD STE 325 MENDOTA HTS MN 55120 THIRD PARTY ADMINISTRATOR 286143 2 EMPLOYER CONTRIBUTIONS 900099 10675443 10675443 HRA EMPLOYER CONTRIBUT 900099 1325626 1325626 STOP-LOSS SETTLEMENTS 900099 654867 654867 PRESCRIPTION DRUG REBA 900099 346127 346127 PARTICIPANT/RETIREE CO 900099 208253 208253 85192 85192 13295508 523321 523321 5511055 5350745 160310 160310 160310 13979139 13295508 0 683631 12795488 261520 82654 17200 60099 58001 26338 20214 9914 FEES MANDATED BY ACA 5848 DUES AND SUBSCRIPTIONS 4245 13341521 1409698 1305810 6384102 7458384 1127201 1006283 95778 11838 12984472 14111963 22001251 23894278 36449 60707 1479 0 13621 119981 51549 180688 X 0 0 0 0 21949702 23713590 21949702 23713590 22001251 23894278 637618 1126270 0 X 0 1 X 1 0 0 DUE TO BROKER 119981 119981 X 15045310 1126270 1126270 13919040 60099 60099 13979139 13281422 0 13281422 60099 60099 13341521 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 DAVE SCHUTTA TRUSTEE 0 112443 0 0 0 0 0 46513 0 20284 0 179240 0 0 BRIAN GULLICKSON TRUSTEE 0 112754 0 0 0 0 0 44491 0 19402 0 176647 0 0 MIKE SYVERSRUD TRUSTEE 0 99212 0 0 0 0 0 44491 0 19402 0 163105 0 0 CHAD MORRIS ALTERNATE TRUSTEE 0 111698 0 0 0 0 0 44491 0 19402 0 175591 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 ZENITH AMERICAN SOLUTIONS AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A THE PLAN IS GOVERNED BY EIGHT TRUSTEES, FOUR OF WHOM ARE APPOINTED BY THE RELATED LOCAL UNION, TWO OF WHOM ARE APPOINTED BY MINNESOTA CONCRETE AND MASONRY CONTRACTORS ASSOCIATION AND TWO OF WHOM ARE APPOINTED BY ASSOCIATED GENERAL CONTRACTORS OF MINNESOTA. THE UNION AND ASSOCIATIONS MAY EACH DESIGNATE AN ALTERNATE TRUSTEE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE 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 AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES EVALUATE ANY POSSIBLE CONFLICTS OF INTEREST ANNUALLY WITH THE PLAN'S ATTORNEY. IN ADDITION, TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH NONPROFIT 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 TO PARTICIPANTS UPON REQUEST. CEMENT MASONS LOCAL 633 CONTRIBUTING EMPLOYER 0 CITY OF MINNEAPOLIS CONTRIBUTING EMPLOYER 0 CITY OF ST PAUL CONTRIBUTING EMPLOYER 0 MN CEMENT PLAST SHOPHANDS JATC CONTRIBUTING EMPLOYER 0 ST PAUL PUBLIC SCHOOLS CONTRIBUTING EMPLOYER 0 UNIVERSITY OF MINNESOTA CONTRIBUTING EMPLOYER 0 CMS LLC CONTRIBUTING EMPLOYER 0 0 CONCRETE UNLIMITED LLC CONTRIBUTING EMPLOYER 0 0 CREATE CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 DIRTWORX LLC CONTRIBUTING EMPLOYER 0 0 ECCO CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 HANSON MASONRY & CONCRETE LLC CONTRIBUTING EMPLOYER 0 0 KRAEMER NORTH AMERICA LLC CONTRIBUTING EMPLOYER 0 0 MARCY CONSTRUCTION CO LLC CONTRIBUTING EMPLOYER 0 0 MCGOUGH CONSTRUCTION CO LLC CONTRIBUTING EMPLOYER 0 0 NORTHLAND CONSTRUCTORS LLC CONTRIBUTING EMPLOYER 0 0 OPUS DESIGN BUIDERS LLC CONTRIBUTING EMPLOYER 0 0 PCI ROADS LLC CONTRIBUTING EMPLOYER 0 0 QUALITY COATINGS LLC CONTRIBUTING EMPLOYER 0 0 REDSTONE CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 SS CONCRETE AND MASONRY LLP CONTRIBUTING EMPLOYER 0 0 STORMY LLC CONTRIBUTING EMPLOYER 0 0 ULTRA CONCRETE LLC CONTRIBUTING EMPLOYER 0 0 M A MORTENSON COMPANY CONTRIBUTING EMPLOYER 0 0 ICON LLC CONTRIBUTING EMPLOYER 0 0 AVM CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 B & D ASSOCIATES LLC CONTRIBUTING EMPLOYER 0 0 CREATIVE CURB LLC CONTRIBUTING EMPLOYER 0 0 TERRENE DEVELOPMENT LLC CONTRIBUTING EMPLOYER 0 0 THE CONCRETE COMPANY LLC CONTRIBUTING EMPLOYER 0 0 ADB CONSTRUCTION COMPANY INC CONTRIBUTING EMPLOYER 0 ADOLFSON & PETERSON CONSTRUCTION CONTRIBUTING EMPLOYER 0 ALVIN E BENIKE INC CONTRIBUTING EMPLOYER 0 AMES CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 ARNIE MACKEY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 ARTLOW SYSTEMS INC CONTRIBUTING EMPLOYER 0 AXEL H OHMAN INC CONTRIBUTING EMPLOYER 0 BAY AREA CONCRETE CONTRIBUTING EMPLOYER 0 BIGELOW BROTHERS PLASTERING CONTRIBUTING EMPLOYER 0 BITUMINOUS ROADWAYS INC CONTRIBUTING EMPLOYER 0 BOUGALIS INC CONTRIBUTING EMPLOYER 0 BRUCES CONTRACTING INC CONTRIBUTING EMPLOYER 0 BUDGET MAINTENANCE CONCRETE CONTRIBUTING EMPLOYER 0 BULACH CUSTOM ROCK CONTRIBUTING EMPLOYER 0 BUTLER CORING INC CONTRIBUTING EMPLOYER 0 C & C WINGER INC CONTRIBUTING EMPLOYER 0 C R CONCRETE INC CONTRIBUTING EMPLOYER 0 C R FISCHER AND SONS INC CONTRIBUTING EMPLOYER 0 C R MEYER AND SONS COMPANY CONTRIBUTING EMPLOYER 0 C S MCCROSSAN CONSTRUCTION CONTRIBUTING EMPLOYER 0 CARLSON LA VINE INC CONTRIBUTING EMPLOYER 0 CHARD TILING & EXCAVATION INC CONTRIBUTING EMPLOYER 0 CHIPPEWA CONCRETE SERVICES INC CONTRIBUTING EMPLOYER 0 CONCRETE IDEA INC CONTRIBUTING EMPLOYER 0 CONE CONSTRUCTION CONTRIBUTING EMPLOYER 0 CONSTRUCTION RESULTS CORP CONTRIBUTING EMPLOYER 0 CORVAL GROUP CONSTRUCTORS CONTRIBUTING EMPLOYER 0 CROSSTOWN MASONRY INC CONTRIBUTING EMPLOYER 0 CURB MASTERS INC CONTRIBUTING EMPLOYER 0 CUSTOM DRYWALL INC CONTRIBUTING EMPLOYER 0 DAVIS DRYWALL INC CONTRIBUTING EMPLOYER 0 DAYCO CONCRETE COMPANY INC CONTRIBUTING EMPLOYER 0 DIVERSIFIED COATINGS INC CONTRIBUTING EMPLOYER 0 DONALD R FRANTZ CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 DONLAR CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 DOYLE CONNER CO CONTRIBUTING EMPLOYER 0 EDC INSTALL SOLUTIONS CONTRIBUTING EMPLOYER 0 ENGINEERING & CONST INNOVATION CONTRIBUTING EMPLOYER 0 FLOOR TECHNOLOGIES INC CONTRIBUTING EMPLOYER 0 FOWLER & HAMMER INC CONTRIBUTING EMPLOYER 0 GAGE BROTHERS CAULKING INC CONTRIBUTING EMPLOYER 0 GEORGE BOUGALIS & SONS CO CONTRIBUTING EMPLOYER 0 GEORGE SIEGFRIED CONTRIBUTING EMPLOYER 0 GOEBEL CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 GRAHAM CONSTRUCTION SERVICES INC CONTRIBUTING EMPLOYER 0 GRESSER COMPANIES INC CONTRIBUTING EMPLOYER 0 GROVE-JOHNSON COMPANY CONTRIBUTING EMPLOYER 0 GUSTAFSON & GOUDGE INC CONTRIBUTING EMPLOYER 0 HAMMERLUND CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 HAWK CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 HMI (HOME MENDERS INC) CONTRIBUTING EMPLOYER 0 HOLLENBACK & NELSON INC CONTRIBUTING EMPLOYER 0 HOVLAND INC CONTRIBUTING EMPLOYER 0 IACARELLA CONSTRUCTION CONTRIBUTING EMPLOYER 0 INDUSTRIAL CONTRACTORS CONTRIBUTING EMPLOYER 0 INTERSTATE IMPROVEMENT INC CONTRIBUTING EMPLOYER 0 J R JENSEN CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 JE DUNN NORTH CENTRAL CONTRIBUTING EMPLOYER 0 JL THEIS INC CONTRIBUTING EMPLOYER 0 JMF CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 JOHNSON WILSON CONSTRUCTORS CONTRIBUTING EMPLOYER 0 JOSEPH CONST OF ST PAUL INC CONTRIBUTING EMPLOYER 0 KELLEHER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 KIFFMEYER INC CONTRIBUTING EMPLOYER 0 KMAC INC CONTRIBUTING EMPLOYER 0 KNIFE LAKE CONCRETE INC CONTRIBUTING EMPLOYER 0 KNUTSON CONSTRUCTION SERVICES CONTRIBUTING EMPLOYER 0 KOMITT CONCRETE INC CONTRIBUTING EMPLOYER 0 L S BLACK CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 LAKEHEAD CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 LANDMARK CONCRETE INC CONTRIBUTING EMPLOYER 0 LANGER CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 LENCI ENTERPRISES INC CONTRIBUTING EMPLOYER 0 LEWIS CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 LLOUHI & KIVELA MASONRY INC CONTRIBUTING EMPLOYER 0 LUNDA CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 MAERTENS-BRENNY CONSTRUCTION CONTRIBUTING EMPLOYER 0 MAGNEY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MARCY CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 MARKET & JOHNSON INC CONTRIBUTING EMPLOYER 0 MAX GRAY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MCGOUGH CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 MEYER CONTRACTING INC CONTRIBUTING EMPLOYER 0 MICHELS CORPORATION CONTRIBUTING EMPLOYER 0 MIDWEST CONCRETE SPECIALTIES CONTRIBUTING EMPLOYER 0 MINNESOTA CONCRETE SPECIALTIES CONTRIBUTING EMPLOYER 0 MN STATE CURB & GUTTER CORP CONTRIBUTING EMPLOYER 0 MIRON CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 MORCON CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MULCAHY NICHOLOUS CONTRIBUTING EMPLOYER 0 NEECK CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 NORTH COUNTRY CONCRETE INC CONTRIBUTING EMPLOYER 0 O'MALLEY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 PARAGON COMPANY INC CONTRIBUTING EMPLOYER 0 PCL CONSTRUCTION SERVICES INC CONTRIBUTING EMPLOYER 0 QUALITY CUTTING & CORING INC CONTRIBUTING EMPLOYER 0 QUALITY DRYWALL & PLASTERING CONTRIBUTING EMPLOYER 0 RAINBOW INC CONTRIBUTING EMPLOYER 0 RAM CONSTRUCTION SERVICE OF MI INC CONTRIBUTING EMPLOYER 0 RICE LAKE CONSTRUCTION GROUP CONTRIBUTING EMPLOYER 0 RIIHILUOMA RAY INC CONTRIBUTING EMPLOYER 0 RON KASSA CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 ROSTI CONSTRUCTION CONTRIBUTING EMPLOYER 0 RYAN COMPANIES US INC CONTRIBUTING EMPLOYER 0 RYAN CONTRACTING INC CONTRIBUTING EMPLOYER 0 S & R REINFORCING INC CONTRIBUTING EMPLOYER 0 S M HENTGES & SONS INC CONTRIBUTING EMPLOYER 0 SCHMIDT CURB COMPANY INC CONTRIBUTING EMPLOYER 0 SCHROEDER CONSTRUCTION SERVICE CONTRIBUTING EMPLOYER 0 SHAFER CONTRACTING COMPANY INC CONTRIBUTING EMPLOYER 0 SHAW LUNDQUIST ASSOCIATES INC CONTRIBUTING EMPLOYER 0 SHEEHY CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 SIG OLSON & SONS PLASTERING CONTRIBUTING EMPLOYER 0 STANDARD SIDEWALK INC CONTRIBUTING EMPLOYER 0 STAFF CONCRETE CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 STARTING LINE FLOOR COATINGS CONTRIBUTING EMPLOYER 0 STEENBERG-WATRUD CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 STERLING STONE & TILE INC CONTRIBUTING EMPLOYER 0 STONE CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 SUMMIT CONCRETE & MASONRY CONS CONTRIBUTING EMPLOYER 0 SURFACE ART & PREP INC CONTRIBUTING EMPLOYER 0 SWANSON & YOUNGDALE INC CONTRIBUTING EMPLOYER 0 TERRAZZO & CONCRETE REST CONTRIBUTING EMPLOYER 0 THE BOLDT COMPANY CONTRIBUTING EMPLOYER 0 THOMAS & SONS CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 TI-ZACK CONCRETE INC CONTRIBUTING EMPLOYER 0 TWIN CITIES SPECIALTIES CONTRIBUTING EMPLOYER 0 XCEL ENERGYNSP CONTRIBUTING EMPLOYER 0 ZENITH TECH INC CONTRIBUTING EMPLOYER 0 ACOUSTICS ASSOCIATES INC CONTRIBUTING EMPLOYER 0 DINGMAN CONCRETE & SCREED SERVICE CONTRIBUTING EMPLOYER 0 GLOBAL SPECIALTY CONTRIBUTING EMPLOYER 0 GRIDOR CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 HTI POLYMER INC CONTRIBUTING EMPLOYER 0 KGM CONTRACTORS INC CONTRIBUTING EMPLOYER 0 NORTHERN INDUSTRIAL ERECTORS CONTRIBUTING EMPLOYER 0 OLYMPIC COMPANIES INC CONTRIBUTING EMPLOYER 0 PALMER SODERBERG INC CONTRIBUTING EMPLOYER 0 PARK CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 SHELTON EXCAVATING INC CONTRIBUTING EMPLOYER 0 SUPREME COATING & SUPPLY INC CONTRIBUTING EMPLOYER 0 TOTAL CONSTRUCTION & EQUIPMENT CONTRIBUTING EMPLOYER 0 WEITZ COMPANY CONTRIBUTING EMPLOYER 0 WEST STAR CURB & CONCRETE CONTRIBUTING EMPLOYER 0 ALL PHASE CONTRACTING INC CONTRIBUTING EMPLOYER 0 FRENCH LAKE CURB COMPANY CONTRIBUTING EMPLOYER 0 JAMAR CONTRIBUTING EMPLOYER 0 JOHNNY MASONRY INC CONTRIBUTING EMPLOYER 0 KIEWIT INFRASTRUCTURE CO CONTRIBUTING EMPLOYER 0 LARSON MASONRY CONSTRUCTION CONTRIBUTING EMPLOYER 0 OLD CASTLE - ANCHOR BLOCK CONTRIBUTING EMPLOYER 0 STANDARD CONTRACTING INC CONTRIBUTING EMPLOYER 0 SULLIVAN CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1