2018-11-14T14:46:18-06:00 2017-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2017-01-01 416023462 MINNESOTA CEMENT MASONS HEALTH AND WELFARE FUND MINN 6512561804 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 DAVE SCHUTTA TRUSTEE 6512561804 2018-11-12 1 LARRY WOOD P00634996 9528413950 12.235.239.120 2018-11-12 17:59:35 CS P 0938D8DB5C4DDE853E46E76E68F7A068926B230F 0938D8DB5C4DDE853E46E76E68F7A068926B230F 2017 2019-02-21 02:37:17Z DAVE SCHUTTA 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 15050497 0 X N/A X 1960 MN TO PROVIDE HEALTH BENEFITS 8 1 9 0 0 0 0 0 11800682 12068556 570200 460824 0 0 12370882 12529380 0 0 11434117 10874525 0 0 0 0 0 612198 581369 12046315 11455894 324567 1073486 19442214 20987179 113782 75079 19328432 20912100 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 1 284 0 1 9 1 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 6512561804 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 TIM WORKE TRUSTEE - CHAIRMAN 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 STEVE FRITZ TRUSTEE - PAST 2.00 X 0 0 0 DAVE SCHUTTA TRUSTEE 2.00 52.00 X 0 96147 58249 BRIAN GULLICKSON TRUSTEE 2.00 44.00 X 0 104850 58510 JARROD ASLESON TRUSTEE 2.00 44.00 X 0 61448 32157 MIKE SYVERSRUD TRUSTEE 2.00 44.00 X 0 89173 58510 GREG MASSEY TRUSTEE - PAST 2.00 46.00 X 0 29563 20563 GREG JOHNSON TRUSTEE - PAST 2.00 44.00 X 0 46782 29338 0 427963 257327 0 0 1 0 HEALTHPARTNERS 8170 33RD AVE S BLOOMINGTON MN 55425 CLAIMS ADMINISTRATION 510364 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD STE 325 MENDOTA HTS MN 55120 THIRD PARTY ADMINISTRATOR 213160 2 EMPLOYER CONTRIBUTIONS 900099 10108415 10108415 HRA EMPLOYER CONTRIBUT 900099 1196001 1196001 PARTICIPANT/RETIREE CO 900099 272993 272993 PRESCRIPTION DRUG REBA 900099 251634 251634 STOP-LOSS SETTLEMENTS 900099 131085 131085 108428 108428 12068556 415954 415954 2565987 2521117 44870 44870 44870 12529380 12068556 0 460824 10874525 267509 78704 24898 55109 91029 30895 13730 11694 FEES MANDATED BY ACA 5575 DUES AND SUBSCRIPTIONS 2226 11455894 1236697 1187819 3829005 5838313 1164243 939306 265 15501 13212004 13006240 19442214 20987179 109825 45974 3957 1603 0 27502 113782 75079 X 0 0 0 0 19328432 20912100 19328432 20912100 19442214 20987179 1073486 510182 0 X 0 1 X 1 0 0 DUE TO BROKER 27502 27502 X 12984453 510182 510182 12474271 55109 55109 12529380 11400785 0 11400785 55109 55109 11455894 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 AN UNCERTAIN POSITION 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 96147 0 0 0 0 0 39809 0 18440 0 154396 0 0 BRIAN GULLICKSON TRUSTEE 0 104850 0 0 0 0 0 39922 0 18588 0 163360 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. 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. 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