2017-11-09T12:02:21-06:00 2016-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2016-01-01 416187750 MINNESOTA LABORERS HEALTH AND WELFARE FUND MINN 6512561900 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 TIM MACKEY TRUSTEE 6512561900 2017-10-30 1 ERIC C BAERTSCH P00964071 9528413950 12.197.118.215 2017-10-30 16:25:12 CD P 611F71761DA557811C6832571D80EF68BADC29AD 611F71761DA557811C6832571D80EF68BADC29AD 2016 2018-03-14 21:41:22Z TIM MACKEY 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 242568232 0 X WWW.MINNESOTALABORERS.ORG X 1968 MN PROVIDE HEALTH AND WELFARE BENEFITS 14 1 95 0 0 0 0 0 125166468 126766481 5364700 9487583 255121 128658 130786289 136382722 0 0 85719735 101089723 0 0 0 0 0 3406513 2962536 89126248 104052259 41660041 32330463 426244049 480253664 2184391 2058781 424059658 478194883 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 TO PROVIDE HEALTH, DENTAL, AND DEATH BENEFITS TO THE ELIGIBLE DEPENDENTS, BENEFICIARIES AND PARTICIPANTS OF THE PLAN. 0 0 0 0 0 0 0 0 0 0 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 1347 0 1 95 1 0 0 0 0 0 0 0 0 X 14 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 INC 6512561900 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 TIM MACKEY TRUSTEE-UNION 1.00 40.00 X X 0 163374 37610 DAVE BORST TRUSTEE-UNION 1.00 40.00 X 0 77883 50837 TODD PUFAHL TRUSTEE-UNION (SECRETARY) 1.00 40.00 X 0 156198 84952 STEVE BUCK TRUSTEE-UNION 1.00 40.00 X 0 151628 43654 MITCHELL NOHRENBERG TRUSTEE-UNION - PAST 1.00 40.00 X 0 119701 35658 BILL COX TRUSTEE-UNION 1.00 40.00 X 0 56274 38425 DAN OLSON TRUSTEE-UNION 1.00 20.00 X 0 30665 30935 JOEL SMITH TRUSTEE-UNION 1.00 40.00 X 0 109147 37917 DANIEL SHOEMAKER TRUSTEE-EMPLOYER 1.00 X 0 0 0 JOHN NESSE TRUSTEE-EMPLOYER/CHAIRMAN 1.00 X 0 0 0 GREG BOELKE TRUSTEE-EMPLOYER - PAST 1.00 X 0 0 0 TOM MILLER TRUSTEE-EMPLOYER 1.00 X 0 0 0 MIKE CAIRL TRUSTEE-EMPLOYER 1.00 X 0 0 0 HEATHER GRAZZINI TRUSTEE-EMPLOYER 1.00 X 0 0 0 JOHN BARTZ TRUSTEE-EMPLOYER 1.00 X 0 0 0 STEVE HALGREN TRUSTEE-EMPLOYER - PAST 1.00 X 0 0 0 JESSE ROUSCH TRUSTEE-EMPLOYER 1.00 X 0 0 0 0 864870 359988 0 0 1 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD MENDOTA HEIGHTS MN 55120 CONTRACT ADMINISTRATOR 2797866 COMPREHENSIVE CARE SERVICES 1200 YANKEE DOODLE ROAD EAGAN MN 55122 PREFERRED PROVIDER ORGANIZATION ACCESS 2395181 DELTA DENTAL OF MN 500 WASHINGTON AVE S STE 2060 MINNEAPOLIS MN 554151163 PREFERRED PROVIDER ORGANIZATION ACCESS 291039 MCGRANN SHEA CARNIVAL STRAUGN & LAMB 800 NICOLLET MALL STE 2600 MINNEAPOLIS MN 554027035 LEGAL COUNSEL 262119 UNION BANK AND TRUST COMPANY 312 CENTRAL AVE SE MINNEAPOLIS MN 55414 INVESTMENT CUSTODIAL AND BANKING 159918 7 EMPLOYER CONTRIBUTIONS 900099 118696518 118696518 PARTICIPANT CONTRIBUTIONS 900099 6892230 6892230 PRESCRIPTION REBATES 900099 699731 699731 MEDICARE PART D SUBSIDY 900099 380904 380904 LIQUIDATED DAMAGES 900099 97098 97098 126766481 7326775 7326775 108346318 106185510 2160808 2160808 2160808 VIRTUAL CREDIT CARD FEE REIMBURSE 900099 108670 108670 LEGAL FEES RECOVERY 900099 14192 14192 OTHER INCOME 900099 5796 5796 128658 136382722 126766481 0 9616241 101089723 475830 276311 108305 605470 213616 451095 21091 48589 TEMP REINSURANCE FEE 668925 PCORI FEE 61625 HEALTHWORKS COALITION 20000 GOVERNMENT COMPLIANCE 11679 104052259 -755462 -270623 56038923 20609301 9196187 8742857 85811409 104583904 274885000 344799246 1067992 1788979 426244049 480253664 1653834 1256214 178111 530557 624456 2184391 2058781 X 0 0 0 0 424059658 478194883 424059658 478194883 426244049 480253664 32330463 21804762 0 X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 44912178 F MUTUAL FUND - NON PUBLICLY TRADED 20788401 F COMMON COLLECTIVE TRUST FUNDS 279098667 F 344799246 DUE TO BROKER 624456 624456 X 157567822 21804762 21804762 135763060 605470 14192 619662 136382722 103432597 0 103432597 605470 14192 619662 104052259 PART X, LINE 2: THE PLAN FILES FORM 990, RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, AND FORM 5500, ANNUAL RETURN/REPORT OF EMPLOYEE BENEFIT PLAN. THE PLAN'S RETURNS ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE UNTIL THE APPLICABLE STATUTE OF LIMITATIONS EXPIRE. PART XI, LINE 4B - OTHER ADJUSTMENTS: LEGAL FEES RECOVERY PART XII, LINE 4B - OTHER ADJUSTMENTS: LEGAL FEES RECOVERY 0 0 0 TIM MACKEY TRUSTEE-UNION 0 163374 0 0 0 0 0 23482 0 14128 0 200984 0 0 TODD PUFAHL TRUSTEE-UNION (SECRETARY) 0 156198 0 0 0 0 0 68552 0 16400 0 241150 0 0 STEVE BUCK TRUSTEE-UNION 0 151628 0 0 0 0 0 27663 0 15991 0 195282 0 0 MITCHELL NOHRENBERG TRUSTEE-UNION - PAST 0 119701 0 0 0 0 0 21016 0 14642 0 155359 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES RETAIN THE ULTIMATE RESPONSIBILITY, THE BOARD OF TRUSTEES HAS 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 7 UNION TRUSTEES AND 7 EMPLOYER TRUSTEES. OF THE 7 EMPLOYER TRUSTEES, 4 ARE APPOINTED BY ASSOCIATED GENERAL CONTRACTORS, 1 BY MECA AND 2 BY THE MASONRY CONTRACTORS. OF THE 7 UNION TRUSTEES, 3 ARE APPOINTED BY LOCAL 563, 1 FROM EACH OF THE FOLLOWING: LOCAL 1091, LOCAL 1097, THE LABORERS' INTERNATIONAL UNION OF NORTH AMERICA AND THE LABORERS DISTRICT COUNCIL OF MINNESOTA AND NORTH DAKOTA. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR PRIOR TO FILING. AFTER THE BOARD'S REVIEW, THE FORM IS APPROVED AND FILED. FORM 990, PART VI, SECTION B, LINE 12C TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH ITS PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS OR ITS FIDUCIARY OBLIGATIONS, TRUSTEES ARE REQUIRED TO FOLLOW THE CONFLICT OF INTEREST POLICY WHICH STATES THAT ANY TRUSTEE WHO SENSES THAT A COURSE OF ACTION HE OR SHE HAS PURSUED, IS PRESENTLY PURSUING, OR IS CONTEMPLATING PURSUING MAY PRESENT A CONFLICT OF INTEREST, TO IMMEDIATELY COMMUNICATE ALL THE FACTS TO THE CHAIRMAN AND SECRETARY OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO ANY PARTICIPANT IN THE PLAN UPON REQUEST AT THE FUND OFFICE. 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