2016-11-07T08:48:45-06:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2015-01-01 416023461 MINNESOTA & NORTH DAKOTA BRICKLAYERS & ALLIED CRAFTWORKERS HEALTH FUND MINN 6512561801 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 MICHAEL COOK CHAIRMAN 6512561801 2016-10-31 1 DOUG BERTOSSI P00637990 6123764500 2015 2017-02-10 21:41:12Z MICHAEL COOK 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 48953753 0 X N/A X 1961 MN PROVIDE HEALTH & WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 8 2 18 7 0 0 0 0 16819393 20708640 3815211 2750855 0 0 20634604 23459495 0 0 18096551 19161013 0 0 0 0 0 1661307 1703102 19757858 20864115 876746 2595380 60905133 60675871 480682 505693 60424451 60170178 PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 0 0 PAYMENT OF HOSPITAL, MEDICAL, DENTAL, DISABILITY, DEATH, AND VISION BENEFITS FOR 1,606 UNION MEMBERS AND THEIR DEPENDENTS. 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 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 701 0 18 1 0 0 0 0 0 0 X 8 2 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561900 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 X X MICHAEL COOK SEE SCHEDULE O 1.00 52.00 X X 0 0 0 PAUL WIESE MANAGEMENT TRUSTEE - SECRE 1.00 0.00 X X 0 0 0 ROGER BUIRGE UNION TRUSTEE 1.00 0.00 X 0 0 0 MARK CARON SEE SCHEDULE O 1.00 40.00 X 0 0 0 DARRIN DROSKY MANAGEMENT - ALTERNATE TRU 1.00 0.00 X 0 0 0 MICHAEL GANZ SEE SCHEDULE O 1.00 46.00 X 0 0 0 FRANK GRAZZINI II MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 MONICA KELLEY MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL LAPENSKY MANAGEMENT - ALTERNATE TRU 1.00 1.00 X 0 0 0 STAN PACZYNSKI SEE SCHEDULE O 1.00 42.00 X 0 0 0 RON RASLEY MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 TERRY WONG SEE SCHEDULE O 1.00 41.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 PLAN ADMINISTRATOR 884816 LEONARD O'BRIEN SPENCER GALE & SAYRE 100 SOUTH FIFTH STREET SUITE 2500 MINNEAPOLIS MN 554021234 LEGAL 239043 MEDICA DBA SELECT CARE ROUTE CP260 401 CARLSON PKWY PO BO MINNEAPOLIS MN 554409310 PPO 196357 MILLIMAN INC ONE PENNSYLVANIA PLAZA 38TH FLOOR NEW YORK NY 10119 ADMINISTRATION SERVICES 110794 4 CONTRIBUTIONS 525100 20708640 20708640 20708640 1626866 1626866 26618247 25494258 1123989 1123989 1123989 23459495 20708640 0 2750855 19161013 814608 239011 21000 152964 134514 141085 5847 17757 TRANSITIONAL REINSURANC 176316 20864115 1583910 1910448 12812069 16476200 1451385 1778950 56615 320050 30708 28109 44697734 39817436 272712 344678 60905133 60675871 381889 375080 98793 130613 480682 505693 X 0 0 0 0 60424451 60170178 60424451 60170178 60905133 60675871 2595380 -2849653 0 X 0 1 X 1 0 0 ADVANCE CONTRIBUTIONS FROM EMPLOYEES FOR FUTURE COVERAGE 22178 ESCROW BOND LIABILITY 108435 130613 X 20456878 -2849653 -2849653 23306531 152964 152964 23459495 20711151 0 20711151 152964 152964 20864115 PART X, LINE 2: THE VEBA TRUST FUNDING BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICES (IRS) DATED FEBRUARY 27, 1963, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2015 OR 2014 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2012. ALL AGAPE CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 6160 6160 0 0 0 DAVIS MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 4144 4144 0 0 0 HICKS CONCRETE CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 32854 32854 0 0 0 INSTALLATION CONCEPTS CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 1694 1694 0 0 0 INTERIOR FLOORS & FIXTURES CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 198 198 0 0 0 LAKE COUNTRY MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 7325 7325 0 0 0 STRIP RIGHT CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 3818 3818 0 0 0 LARSON MASONRY CONSTRUCTION CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 2780 2780 0 0 0 LONDON BRICK CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 91141 91141 0 0 0 MACPHERSON TOWNE COMPANY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 79741 79741 0 0 0 MORTERSON MASONRY LLC CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 78495 78495 0 0 0 NORTHLAND CONCRETE & MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 11700 11700 0 0 0 320050 FORM 990, PART VI, SECTION A, LINE 7A THE UNION AND CONTRACTOR'S ASSOCIATION EACH APPOINT 50% OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WAS REVIEWED BY THE BOARD OF TRUSTEES IN CONJUNCTION WITH THE REVIEW OF THE ANNUAL AUDIT. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS DISCUSSED ANNUALLY BY THE BOARD OF TRUSTEES TO ENSURE THE TRUSTEES UNDERSTAND THE CONFLICT OF INTEREST POLICY AND UNDERSTANDS THE FUND IS A TAX-EXEMPT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. PER THE POLICY, ANY PERSON DISCOVERING A CONFLICT SHOULD DISCLOSE IT IMMEDIATELY TO THE CHAIRMAN OF THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES DETERMINES IF A CONFLICT EXISTS AND MAY PLACE APPROPRIATE RESTRICTIONS ON THE INDIVIDUAL OR TRANSACTIONS AFFECTED AT THEIR DISCRETION. ANY CONFLICTS ARE DOCUMENTED IN MEETING MINUTES. NO SUCH CONFLICTS AROSE DURING THE YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE FUND'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990 PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE FUND. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. THE FOLLOWING RELATED ORGANIZATIONS REPORTED COMPENSATION FOR A TRUSTEE LISTED ON THE MINNESOTA & NORTH DAKOTA BRICKLAYERS & ALLIED CRAFTWORKERS HEALTH FUND: MICHAEL COOK, UNION TRUSTEE - CHAIRMAN BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 STAN PACZYNSKI, UNION - ALTERNATE TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 MARK CARON, UNION - ALTERNATE TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 MICHAEL GANZ, UNION TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 TERRY WONG, UNION TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 MN & ND BRICKLAYERS AND ALLIED CRAFTSWORKERS PENSION FUND 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 516029930 PROVIDER RETIREMENT BENEFITS TO UNION MEMBERS MN 401(A) N/A N/A 0 MN & ND BRICKLAYERS AND ALLIED CRAFTSWORKERS VACATION FUND 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 237068471 PROVIDE VACATION BENEFITS TO UNION MEMBERS. MN 501(C)(9) N/A N/A 0 MN & ND BRICKLAYERS AND ALLIED CRAFTSWORKERS APPRENTICE FUND 328 UNITED LABOR CTR 312 CENTRAL AV MINNEAPOLIS MN 55414 416319702 PROVIDE TRAINING AND RETRAINING TO CURRENT AND PROSPECTIVE UNION MEMBERS MN 501(C)(4) N/A N/A 0 MINNESOTA CERAMIC TILE AND ALLIED TRADES RETIREMENT FUND 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 416059404 PROVIDE RETIREMENT BENEFITS TO UNION MEMBERS. MN 401(A) N/A N/A 0 BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO 1 MINNESOTANORTH DAKOTA 312 CENTRAL AVE SUITE 328 MINNEAPOLIS MN 55414 411716458 PROTECT AND IMPROVE THE GENERAL WELFARE OF ITS MEMBERS AND EMPLOYEES MN 501(C)(5) N/A N/A 0 ASSOCIATED GENERAL CONTRACTORS OF MINNESOTA INC 525 PARK STREET NO 110 ST PAUL MN 55103 410132580 REPRESENTING MEMBERS INVOLVED IN MINNESOTA'S CONSTRUCTION INDUSTRY MN 501(C)(6) N/A N/A 0 CITY OF ST PAUL CITY OF MINNEAPOLIS ST PAUL PUBLIC SCHOOLS UNIVERSITY OF MINNESOTA CMS LLC D R FRANTZ CONCRETE CONST OPUS CORPORATION RAM CONSTRUCTION SERVICES A D B CONSTRUCTION CO INC A J SPANJERS CO ACME TUCKPOINTING & RESTOR ADVANCE TERRAZZO & TILE CO ALVIN BENIKE INC AMERICAN MAS RESTORATION CORP ANDERSON MAS & CONCRETE INC AXEL H OHMAN INC B & D ASSOCIATES INC BOB'S SPARKLE WASH CAMCO CONSTRUCTION INC CARCIOFINI COMPANY INC CARLSON-LAVINE INC CD TILE & STONE INC COMMERCIAL MASONRY INC COMMERCIAL SPECIALTY CONTRACT CON'S MASONRY INC CONSTRUCTION 25 LLC CONTRACT CAULKING CROSSTOWN MASONRY INC D J KRANZ CO INC DAROLD BERGER MASONRY INC DAYCO CONCRETE DEBCON II DBA O'CONNOR CONST DZIEDZIC CAULKING INC EICHOLTZ MASONRY INC EXCALIBUR CAULKING INC EXTERIOR BUILDING SERVICES INC FABCON INC FLEMMING TILE INC FRANDRUP MASONRY INC GEORGE P REINTJES CO INC GEORGE SIEGFRIED CONST CO GLASS DESIGN INC GORDON CONST OF MAHNOMEN INC GRANITE-TOPS INSTALLATION INC GRAZZINI BROTHERS CO GRESSER COMPANIES INC HANSON STRUCT PRCST MIDWST INC HAUGEN MASONRY CONTRACTORS INC HEYMANN CONSTRUCTION CO HOLLENBACK & NELSON INC HOVLAND INC HUESMAN SCHREIBER MASONRY INCOR INSTALLATION INC INDUSTRIAL MAINTENANCE SERVICE INSTALLATION CONCEPTS INC J E DUNN CONSTRUCTION COMPANY JAMES STEELE CONSTRUCTION CO JOHNNY MASONRY INC JOHNSON CARPET KASELLA CONCRETE INC KIFFMEYER INC KNUTSON CONSTRUCTION SERVICES LAKEHEAD CONSTRUCTORS INC LANDWEHR CRANE SERVICES LLC LEE'S CERAMICS INC M A MORTENSON CO MACPHERSON-TOWNE CO MAERTENS-BRENNY CONSTRUCTION MARK 1 RESTORATION COMPANY MARKET & JOHNSON INC MAVO SYSTEMS INC MCGOUGH CONSTRUCTION CO INC MOLIN CONCRETE PRODUCTS NATUS INSTALLATIONS NEECK CONSTRUCTION INC NORTHLAND CONCRETE & MASONRY PARAMOUNT CONCRETE & MAS INC RESTORATION SYSTEMS INC RIGHTWAY CAULKING ROYL MASONRY SCHLEIS FLOOR COVERING INC SERICE CONSTRUCTION INC SHEEHY CONSTRUCTION CO SHOTLEY CONSTRUCTION INC SMITH-SHARPE FIRE BRICK SUPPLY STEENBERG - WATRUD CONST INC STONE CONSTRUCTION INC STRIPE RIGHT INC SUNRISE SPECIALTY CONTR TAILORED FOAM INC THE JAMAR COMPANY WEISE MASONRY INC WESTERN SPECIALTY CONTRACTORS WTG TERRAZZO & TILE INC YAW CONSTRUCTION GROUP INC YOUNG MASONRY INC ZACHMAN PRECAST INC 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RELATED ORGANIZATIONS TAXABLE AS AN INDIVIDUAL OR SOLE PROPRIETOR: CONTRACT TILE & CARPET, INC. RELATED ORGANIZATIONS THAT NO TAX CLASSIFICATION WAS GIVEN FOR: ADVANCED MASONRY RESTORATION ALWAYS TILE & STONE LLC APPRENTICESHIP, TC BRICKLAYERS ARDAGH GLASS INC. B & M MASONRY INC BAC INTERNATIONAL FUND BAC LOCAL UNION 15 BEDROCK-FLINT INC BLACKHAWK TILE & STONE INC BOOKER CONST INC BRICKLAYER FRINGE BENEFIT FUND BRICKLAYERS LOCAL #1 BRICKLAYERS OF INDIANA BUILDING RESTORATION CORP C R MEYER & SONS COMPANY CHESLEY AND SONS INC CHICAGO TILE INSTITUTE CHICAGO TUCKPOINTERS #52 D & D STONE, LLC DEL'S CONSTRUCTION CO INC EAGLE CAULKING ENGELSMA CONSTRUCTION INC FORSLAND JONES GABEL MASONRY CONSTRUCTION INC GAGE BROTHERS CAULKING GOFF MASONRY LLC GUSTAFSON & GOUDGE INC HAMMERLUND'S CHAMPION STEELE HANSON MASONRY & CONCRETE LLC HARBOR CITY MASONRY INC HARLAN FALCK & SON INC HARRISON TILE CO INC INTERNAT'L MASONRY INSTITUTE INTL MASONRY TRAINING & EDUCA IOWA BUILDERS RETIREMENT PLAN IOWA LABORERS DISTRICT COUNCIL JOHNSON & NELSON KNUTSON CONSTRIUCTION SERVICES LANGER CONSTR CO LONDON BRICK LOUHI & KIVELA MASONRY INC MASONRY INDUSTRY TRUST ADMIN MASONRY INSTITUTE MAVERICK CUTTING & BREAKING METROPOLITAN TILE & MARBLE MICHIGAN BAC BENEFIT FUNDS MIDWESTERN MASONRY INC MINNESOTA CEMENT MASONS MOSAICA LLC NIKKEL TILE INC NORTHWESTERN MARBLE & GRANITE PATZOLDT CONCRETE & MASONRY LL PELLAND-SWENSON & ASSOC PROJECT RESTORATIONS INC REFRACTORY SERVICE INC RESCH'S TILE INC RICE LAKE CONSTRUCTION GROUP SEEDORFF MASONRY, INC SERVAIS TILE & STONE, INC. SPECIAL SCHOOL DISTRICT #1 STRETAR MASONRY & CONCRETE INC SUMMIT CONCRETE & MAS CONST TAUNTON ELECTRICAL CORPORATION TCR ENTERPRISES DBA J&K MASON TED KENNE CONSTRUCTION THE CAULKERS COMPANY INC TOTAL CONSTRUCTION & EQUIPMENT TWIN CITY TILE & MARBLE CO UNITED MASONRY INC UNITED REFACTORIES INC WELLS CONCRETE PRODUCTS CO WISCONSIN MASONS FRINGE FUNDS