2020-09-24T16:07:10-05:00 2019-11-30 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2018-12-01 237115412 MINNESOTA TEAMSTERS CONSTRUCTION DIVISION FRINGE BENEFIT FUNDS MINN 6512561900 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 ZACHARY RADZAK TRUSTEE 6512561900 2020-09-17 1 ERIC C BAERTSCH P00964071 9528413950 12.235.239.120 2020-09-17 15:38:30 CD P A24C396881565D8DD952BCD29DDA40AB79E1ECAF 18D8E43A51057115C97B638ED8AC001B64A20B00 2018 2022-01-07 14:23:13Z ZACHARY RADZAK 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 29072314 0 X N/A X 1970 MN PROVIDE HEALTH BENEFITS 8 8 5 0 0 0 0 0 14858134 17523024 356429 489847 9885 707 15224448 18013578 0 0 16827820 17988873 0 0 0 0 0 455940 419361 17283760 18408234 -2059312 -394656 20359065 20622776 18928 31245 20340137 20591531 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 5 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 SUITE 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 STEVE 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 MOLLY BARNES TRUSTEE 1.00 X 0 0 0 DAVE SCHRUNK CHAIRMAN 2.00 X 0 0 0 WAYNE PERLEBERG TRUSTEE 1.00 X 0 0 0 TOM NELTON ALTERNATE TRUSTEE 1.00 X 0 0 0 ZACHARY RADZAK TRUSTEE 2.00 X 0 0 0 CHAD WARD ALTERNATE TRUSTEE 1.00 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 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD SUITE 325 MEDOTA HEIGHTS MN 55120 ADMINISTRATIVE, CLAIMS PROCESSING, AUDIT 416641 BLUELINK TPA 1200 YANKEE DOODLE ROAD PO BOX 6 ST PAUL MN 55164 PPO ACCESS FEES 341550 2 EMPLOYER CONTRIBUTIONS 900099 16152820 16152820 PRESCRIPTION REBATES 900099 653686 653686 PARTICIPANT CONTRIBUTI 900099 425658 425658 STOP LOSS REFUNDS 900099 252590 252590 SUBROGATION SETTLEMENT 900099 30629 30629 7641 7641 17523024 335452 335452 11213131 11058736 154395 154395 154395 OTHER INCOME 900099 707 707 707 18013578 17523024 0 490554 17988873 168010 63296 38744 15717 67000 48829 7588 3880 FEES MANDATED BY ACA 6297 18408234 1030452 1126661 2010647 2508087 1825887 1719444 15476357 15162153 15722 106431 20359065 20622776 10480 24120 8448 7125 18928 31245 X 0 0 0 0 20340137 20591531 20340137 20591531 20359065 20622776 -394656 646050 0 X 0 1 X 1 0 0 X 18643911 646050 646050 17997861 15717 15717 18013578 18392517 0 18392517 15717 15717 18408234 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE THE 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. SIX ALTERNATE TRUSTEES ARE APPOINTED, THREE FROM THE EMPLOYER ASSOCIATION AND THREE 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 PLAN OFFICE. MN TEAMSTERS CONSTRUCTION DIV PENSION FUND 2520 PILOT KNOB ROAD STE 325 MENDOTA HEIGHTS MN 55120 416187751 TO PROVIDE PENSION BENEFITS MN 401(A) 0 MN TEAMSTERS CONSTRUCTION DIV JATC FUND 2520 PILOT KNOB ROAD STE 325 MENDOTA HEIGHTS MN 55120 411676452 TO PROVIDE TRAINING FOR APPRENTICES MN 501(C)(9) 0 TEAMSTERS NATIONAL TRAINING CENTER CONTRIBUTING EMPLOYER 0 ABERCROMBIE PIPELINE SERVICE CONTRIBUTING EMPLOYER 0 ADVANCED SERVICES INC CONTRIBUTING EMPLOYER 0 AGGREGATE INDUSTRIES CONTRIBUTING EMPLOYER 0 ALLIED BLACKTOP CONTRIBUTING EMPLOYER 0 AMES CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 ARNOLD'S CUSTOM SEEDING CONTRIBUTING EMPLOYER 0 ARNT CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 ARROWHEAD CONCRETE WORKS INC CONTRIBUTING EMPLOYER 0 ASTECH CORP CONTRIBUTING EMPLOYER 0 ATLAS TRENCHLESS LLC CONTRIBUTING EMPLOYER 0 BELAIR EXCAVATING CONTRIBUTING EMPLOYER 0 BITUMINOUS ROADWAYS INC CONTRIBUTING EMPLOYER 0 BOLLIG & SONS CONTRIBUTING EMPLOYER 0 BRENNY-DAHL BLOCK COMPANY CONTRIBUTING EMPLOYER 0 BRENT'S BIFFIES INC CONTRIBUTING EMPLOYER 0 BROTHERS PIPELINE CORP CONTRIBUTING EMPLOYER 0 C S MCCROSSAN INC CONTRIBUTING EMPLOYER 0 CASPER CONSTRUCTION CONTRIBUTING EMPLOYER 0 CHARPS LLC CONTRIBUTING EMPLOYER 0 CLEM'S TRUCKING LLC CONTRIBUTING EMPLOYER 0 DEER RIVER TRUCKING CONTRIBUTING EMPLOYER 0 DOUGLAS-KERR UNDERGROUND LLC CONTRIBUTING EMPLOYER 0 DULUTH READY MIX CONCRETE INC CONTRIBUTING EMPLOYER 0 DULUTHSUPERIOR LANDFILL CONTRIBUTING EMPLOYER 0 DUN TRANSPORT & STRINGING CONTRIBUTING EMPLOYER 0 DUNN BLACKTOP COMPANY CONTRIBUTING EMPLOYER 0 EAST RANGE READY MIX CONCRETE CONTRIBUTING EMPLOYER 0 ENTERTAINMENT PARTNERS CONTRIBUTING EMPLOYER 0 F M TRUCKING COMPANY CONTRIBUTING EMPLOYER 0 FOREST LAKE CONTRACTING CONTRIBUTING EMPLOYER 0 FPI PAVING CONTRACTORS INC CONTRIBUTING EMPLOYER 0 FRATTALONE CONSTRUCTION CONTRIBUTING EMPLOYER 0 GRAZZINI BROTHERS & COMPANY CONTRIBUTING EMPLOYER 0 HAWKINSON CONST CO CONTRIBUTING EMPLOYER 0 HESELTON CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 HOOVER CONST CO CONTRIBUTING EMPLOYER 0 ICE DAM STEAM TEAM & OUTDOOR CONTRIBUTING EMPLOYER 0 JAMAR COMPANY CONTRIBUTING EMPLOYER 0 JMAC CONTRIBUTING EMPLOYER 0 JMF CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 JMS PORTAJOHN LLC CONTRIBUTING EMPLOYER 0 JOHN A DALSIN & SON CONTRIBUTING EMPLOYER 0 JOLA SOPP INC CONTRIBUTING EMPLOYER 0 KGM CONTRACTORS CONTRIBUTING EMPLOYER 0 KIMINSKI PAVING INC CONTRIBUTING EMPLOYER 0 KIRK EXCAVATING & CONSTRUCTION CONTRIBUTING EMPLOYER 0 KNIFE RIVER MATERIALS CONTRIBUTING EMPLOYER 0 KS ENERGY SERVICES CONTRIBUTING EMPLOYER 0 KTM CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 LAKEHEAD CONCRETE WORKS INC CONTRIBUTING EMPLOYER 0 LAKEHEAD CONSTRUCTORS CONTRIBUTING EMPLOYER 0 LINO LAKES LANDSCAPING CONTRIBUTING EMPLOYER 0 MAHKAHTA TRUCKING CONTRIBUTING EMPLOYER 0 MANNCO TRUCKING INC CONTRIBUTING EMPLOYER 0 MCNAMARA CONTRACTING INC CONTRIBUTING EMPLOYER 0 MDL TRUCKING LLC CONTRIBUTING EMPLOYER 0 MESABI BITUMINOUS CONTRIBUTING EMPLOYER 0 METROPOLITAN MECH CONTRS CONTRIBUTING EMPLOYER 0 MICHELS CORPORATION CONTRIBUTING EMPLOYER 0 MIDWEST TRANSPORT CONTRIBUTING EMPLOYER 0 MINGER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MINNESOTA LIMITED INC CONTRIBUTING EMPLOYER 0 MINNESOTA PAVING & MATERIALS CONTRIBUTING EMPLOYER 0 MINOT PAVING CO INC CONTRIBUTING EMPLOYER 0 MORROW TRUCKING INC CONTRIBUTING EMPLOYER 0 NEMANICH TRUCKING CONTRIBUTING EMPLOYER 0 NORTH PINE AGGREGATE INC CONTRIBUTING EMPLOYER 0 NORTHERN IMPROVEMENT CO CONTRIBUTING EMPLOYER 0 NORTHLAND CONSTRUCTORS OF CONTRIBUTING EMPLOYER 0 NORTHWEST ASPHALT CO CONTRIBUTING EMPLOYER 0 PCI ROADS LLC CONTRIBUTING EMPLOYER 0 PE BEN USA INC CONTRIBUTING EMPLOYER 0 PENHALL COMPANY DBA HWY SERV CONTRIBUTING EMPLOYER 0 PETERSON BROS ROOFING & CONST CONTRIBUTING EMPLOYER 0 PINE BEND PAVING INC CONTRIBUTING EMPLOYER 0 PORTABLE JOHN SERVICES CONTRIBUTING EMPLOYER 0 PRECISION PIPELINE LLC CONTRIBUTING EMPLOYER 0 Q3 CONTRACTING CONTRIBUTING EMPLOYER 0 RAY JORDAN & SONS CONTRIBUTING EMPLOYER 0 SCHWARTZ REDI-MIX INC CONTRIBUTING EMPLOYER 0 SHAFER CONTRACTING CO INC CONTRIBUTING EMPLOYER 0 SINNOTT CONTRACTING LLC CONTRIBUTING EMPLOYER 0 SOLBERG AGGREGATE CO CONTRIBUTING EMPLOYER 0 SOUTHEAST DIRECTIONAL DRILLIN CONTRIBUTING EMPLOYER 0 SOVDE ENTERPRISES INC CONTRIBUTING EMPLOYER 0 STACK BROTHERS MECHANICAL CONTRIBUTING EMPLOYER 0 STANDARD SIDEWALK CONTRIBUTING EMPLOYER 0 SUMMIT MATERIALS DBA HAWKINSON CONTRIBUTING EMPLOYER 0 SUPERIOR-DULUTH REDI MIX CONTRIBUTING EMPLOYER 0 T A SHIFSKY & SONS INC CONTRIBUTING EMPLOYER 0 T G MERCER CONTRIBUTING EMPLOYER 0 THE BOLDT COMPANY CONTRIBUTING EMPLOYER 0 THOMAS AND SONS CONTRIBUTING EMPLOYER 0 TILLER CORPORTION CONTRIBUTING EMPLOYER 0 TR SERVICES OF FARMERVILLE LLC CONTRIBUTING EMPLOYER 0 ULLAND BROTHERS INC CONTRIBUTING EMPLOYER 0 VEIT & COMPANY INC CONTRIBUTING EMPLOYER 0 VIITA'S EXCAVATING INC CONTRIBUTING EMPLOYER 0 WAGNER CONSTRUCTION CONTRIBUTING EMPLOYER 0 WHM CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1