2016-09-15T11:24:30-05:00 2015-11-30 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2014-12-01 237115412 MINNESOTA TEAMSTERS CONSTRUCTION DIVISION FRINGE BENEFIT FUNDS MINN 6512561900 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 DAVID SCHRUNK TRUSTEE 6512561900 2016-09-07 1 ERIC C BAERTSCH P00964071 9528413950 2014 2017-02-10 21:41:12Z DAVID SCHRUNK 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 18905699 0 X N/A X 1970 MN PROVIDE HEALTH BENEFITS 8 8 0 0 0 0 0 0 13403571 13858783 328988 480531 0 5823 13732559 14345137 0 0 12079657 13556097 0 0 0 0 0 1071428 1275369 13151085 14831466 581474 -486329 25137908 24185079 161427 140101 24976481 24044978 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 1 390 0 1 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 MIKE WELCH TRUSTEE 2.00 X 0 0 0 MARTHA HENRICKSON TRUSTEE 1.00 X 0 0 0 ANDREW ERICHSON TRUSTEE 1.00 X 0 0 0 STEVE SAUER SECRETARY 1.00 X 0 0 0 JASON ZINS 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 LES KUNDO TRUSTEE - PAST 1.00 X 0 0 0 JEFF DIEDE TRUSTEE 1.00 X 0 0 0 ZACHARY RADZAK TRUSTEE 1.00 X 0 0 0 TOM NELTON ALTERNATE TRUSTEE 1.00 X 0 0 0 JOE BATTAGLIA ALTERNATE TRUSTEE 1.00 X 0 0 0 CHAD WARD ALTERNATE TRUSTEE 1.00 X 0 0 0 CHAD SORENSON ALTERNATE TRUSTEE - PAST 1.00 X 0 0 0 NICK JOHNSON TRUSTEE 1.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 ADMINISTRATIVE, CLAIMS PROCESSING, AUDIT 408480 BLUELINK TPA 1200 YANKEE DOODLE ROAD PO BOX 6 ST PAUL MN 55164 PPO ACCESS FEES 393902 SEGAL CONSULTING 333 WEST 34TH STREET NEW YORK NY 10001 ACTUARIAL CONSULTING 104940 3 EMPLOYER CONTRIBUTIONS 900099 13456001 13456001 PARTICIPANT CONTRIBUTIONS 900099 299121 299121 SUBROGATION SETTLEMENTS 900099 79903 79903 STOP LOSS RECOVERIES 900099 19519 19519 LIQUIDATED DAMAGES 900099 4239 4239 13858783 486916 486916 4554177 4560562 -6385 -6385 -6385 OTHER INCOME 900099 5823 5823 5823 14345137 13858783 0 486354 13556097 155732 77689 38787 13585 807226 52789 8983 7949 FEES MANDATED BY ACA 112492 GOVERNMENT COMPLIANCE 137 14831466 1298539 1044377 1360060 1656133 1297318 1174853 20935533 20290197 246458 19519 25137908 24185079 147612 125082 13815 15019 161427 140101 X 0 0 0 0 24976481 24044978 24976481 24044978 25137908 24185079 -486329 -445174 0 X 0 1 X 1 0 0 X 13886378 -445174 -445174 14331552 13585 13585 14345137 14817881 0 14817881 13585 13585 14831466 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. 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 FUND. FORM 990, PART VI, SECTION A, LINE 7A THE FUND 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 11 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. THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. 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 ADVANCED SERVICES INC CONTRIBUTING EMPLOYER 0 AGGREGATE INDUSTRIES CONTRIBUTING EMPLOYER 0 ALLIED BLACKTOP CONTRIBUTING EMPLOYER 0 AMES CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 APPALACHIAN PIPELINE CONTRACT CONTRIBUTING EMPLOYER 0 ARNT CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 BITUMINOUS ROADWAYS INC CONTRIBUTING EMPLOYER 0 BLUELINX CORPORATION CONTRIBUTING EMPLOYER 0 BOLLIG & SONS CONTRIBUTING EMPLOYER 0 BROCK-WHITE CO CONTRIBUTING EMPLOYER 0 BRYAN ROCK PRODUCTS INC CONTRIBUTING EMPLOYER 0 C C WINGER CONTRIBUTING EMPLOYER 0 C S MCCROSSAN INC CONTRIBUTING EMPLOYER 0 CAPPIES TRUCKING CONTRIBUTING EMPLOYER 0 CASPER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 CHARPS WELDING & FABRICATING CONTRIBUTING EMPLOYER 0 CHRIS JENSEN & SON CO CONTRIBUTING EMPLOYER 0 DEER RIVER TRUCKING CONTRIBUTING EMPLOYER 0 DULUTHSUPERIOR LANDFILL CONTRIBUTING EMPLOYER 0 DUNN BLACKTOP COMPANY 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 GABES CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 GEISLINGER & SONS CONTRIBUTING EMPLOYER 0 GRAZZINI BROTHERS & COMPANY CONTRIBUTING EMPLOYER 0 HAMMERLUND CONSTRUCTION CONTRIBUTING EMPLOYER 0 HARDRIVES INC CONTRIBUTING EMPLOYER 0 HAWKINSON CONST CO CONTRIBUTING EMPLOYER 0 HESELTON CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 HOOVER CONST CO CONTRIBUTING EMPLOYER 0 INDIANHEAD PIPELINE SERVICES CONTRIBUTING EMPLOYER 0 INFRASOURCE UNDERGROUND CONST CONTRIBUTING EMPLOYER 0 INTERCON CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 J KOSKI TRUCKING INC CONTRIBUTING EMPLOYER 0 JAMAR COMPANY CONTRIBUTING EMPLOYER 0 JMF CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 JMS LLC CONTRIBUTING EMPLOYER 0 JOHN A DALSIN & SON CONTRIBUTING EMPLOYER 0 JOLA SOPP INC CONTRIBUTING EMPLOYER 0 JULIAN M JOHNSON CONST CO CONTRIBUTING EMPLOYER 0 KGM CONTRACTORS CONTRIBUTING EMPLOYER 0 KNIFE RIVER MATERIALS CONTRIBUTING EMPLOYER 0 KRAEMER MINING & MATERIALS INC CONTRIBUTING EMPLOYER 0 LAKEHEAD CONSTRUCTORS CONTRIBUTING EMPLOYER 0 LINO LAKES LANDSCAPING CONTRIBUTING EMPLOYER 0 MANNCO TRUCKING INC CONTRIBUTING EMPLOYER 0 MCNAMARA CONTRACTING INC CONTRIBUTING EMPLOYER 0 MESABI BITUMINOUS INC 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 MINOT PAVING CO 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 PRECISION PIPELINE LLC CONTRIBUTING EMPLOYER 0 Q3 CONTRACTING CONTRIBUTING EMPLOYER 0 RAY JORDAN & SONS CONTRIBUTING EMPLOYER 0 RUM RIVER CONTRACTING 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 STANDARD SIDEWALK CONTRIBUTING EMPLOYER 0 SUMMIT MATERIALS DBA HAWKINSON 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 TONYS CONSTRUCTION CONTRIBUTING EMPLOYER 0 TRANSPORT & STRINGING CONTRIBUTING EMPLOYER 0 U S PIPELINE INC CONTRIBUTING EMPLOYER 0 ULLAND BROTHERS INC CONTRIBUTING EMPLOYER 0 UNITED PIPING INC CONTRIBUTING EMPLOYER 0 VEIT & COMPANY INC CONTRIBUTING EMPLOYER 0 VIITA'S EXCAVATING INC CONTRIBUTING EMPLOYER 0 WAGNER CONSTRUCTION CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1