2016-01-13T11:36:21-06:00 2015-02-28 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE S SUITE 550 EDINA MN 55435 990 2014-03-01 410905139 MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS HEALTH AND WELFARE FUND MINN 9528540795 3001 METRO DRIVE NO 500 BLOOMINGTON MN 55425 MATT UTECHT CHAIRMAN 9528540795 2016-01-11 1 LARRY WOOD P00634996 9528413950 2014 2016-04-25 22:37:26Z MATT UTECHT 3001 METRO DRIVE NO 500 BLOOMINGTON MN 55425 83761708 0 X N/A X 1966 MN PROVIDES HEALTH AND WELFARE BENEFITS 8 0 83 0 0 0 0 0 37746189 36341479 1617755 794701 32014 401 39395958 37136581 0 0 46688283 47313982 0 0 0 0 0 728429 1641940 47416712 48955922 -8020754 -11819341 28056346 16325433 62126 320000 27994220 16005433 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 THE PLAN PROVIDES COMPREHENSIVE MEDICAL BENEFITS, INCLUDING DENTAL, VISION, PRESCRIPTION DRUG AND VARIOUS SUPPLEMENTAL BENEFITS, LIFE INSURANCE AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS AND BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 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 1388 0 1 83 1 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X SUSAN KNOBLAUCH 9528540795 3001 METRO DRIVE SUITE 500 BLOOMINGTON MN 55425 EDWARD KITZ TRUSTEE-PAST 1.00 X 0 0 0 BILL SEEHAFER SECRETARY 1.00 X X 0 0 0 RICHARD MILBRATH TRUSTEE 1.00 40.00 X 0 113919 15288 GREG LARSON TRUSTEE - PAST 1.00 40.00 X 0 85403 15537 PAUL CRANDALL TRUSTEE 1.00 40.00 X 0 125628 15537 FRED MILLER TRUSTEE 1.00 X 0 0 0 KENT DIXON TRUSTEE 1.00 X 0 0 0 MATT UTECHT CHAIRMAN 1.00 40.00 X X 0 188162 15537 JIM ALMSTED ALTERNATE TRUSTEE-PAST 1.00 X 0 0 0 WILLIAM SPARTZ ALTERNATE TRUSTEE-PAST 1.00 X 0 0 0 STEVE MILNER TRUSTEE 1.00 40.00 X 0 83478 15039 DOUG RIGERT ALTERNATE TRUSTEE 1.00 X 0 0 0 MIKE MORTENSEN ALTERNATE TRUSTEE-PAST 1.00 X 0 0 0 TRACY MCDONALD ALTERNATE TRUSTEE 1.00 X 0 0 0 0 596590 76938 0 0 1 0 WILSON-MCSHANE CORPORATION 3001 METRO DRIVE BLOOMINGTON MN 55425 CLAIMS PROCESSING AND ADMINISTRATION 1464000 BLUECROSS BLUESHIELD 3535 BLUE CROSS ROAD ST PAUL MN 55122 NETWORK ACCESS FEES 582686 ANDERSON HELGEN DAVIS & CEFALU PA 333 SOUTH 7TH STREET SUITE 310 MINNEAPOLIS MN 55402 LEGAL & SUBROGATION FEES 238459 DELTA DENTAL 3560 DELTA DENTAL DRIVE EAGAN MN 55122 BENEFIT ADMIN FEES 135234 4 EMPLOYER CONTRIBUTIONS 900099 34227605 34227605 PARTICIPANT CONTRIBUTI 900099 1321187 1321187 PRESCRIPTION DRUG REBA 900099 428810 428810 SUBROGATION SETTLEMENT 900099 363877 363877 36341479 290191 290191 47129637 46625127 504510 504510 504510 LITIGATION SETTLEMENT 900099 401 401 401 37136581 36341479 0 795102 47313982 384000 238459 31500 85353 114341 29076 5966 9405 FEES MANDATED BY ACA 743840 48955922 465387 1880315 236608 277937 2708283 2643871 24009 16746 24396284 3646049 7860515 225775 0 28056346 16325433 25498 293098 25398 26902 11230 0 62126 320000 X 0 0 0 0 27994220 16005433 27994220 16005433 28056346 16325433 -11819341 -169446 0 X 0 1 X 1 0 0 COLLECTIVE INVESTMENT FUNDS 7860515 F 7860515 X 36881782 -169446 -169446 37051228 85353 85353 37136581 48870569 0 48870569 85353 85353 48955922 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 LIMITATION EXPIRES. 0 0 0 MATT UTECHT CHAIRMAN 0 180681 0 0 0 7481 0 6729 0 8808 0 203699 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE BOARD OF TRUSTEES MAINTAIN ULTIMATE RESPONSIBILITY, THE BOARD OF TRUSTEES HAVE DELEGATED THE DAY-TO-DAY ADMINISTRATIVE DUTIES TO WILSON-MCSHANE CORPORATION AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE IS REQUIRED TO ANNUALLY SIGN A STATEMENT WHICH AFFIRMS EACH TRUSTEE: HAS READ AND UNDERSTANDS THE CONFLICT OF INTEREST POLICY AND THAT TO THE BEST OF THEIR KNOWLEDGE THAT NEITHER THE TRUSTEE, NOR ANY RELATIVE OF THE TRUSTEE, HAS IN THE PAST YEAR ENGAGED IN AN ACTIVITY THAT DOES OR REASONABLY MAY CONSTITUTE A CONFLICT OF INTEREST. IN ADDITION, THE TRUSTEES ARE REQUIRED TO NOTIFY THE ENTIRE BOARD IF THEY SENSE AN ACTION THE BOARD IS PURSUING, OR IS CONTEMPLATING PURSUING, MAY PRESENT A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS PENSION FUND 3001 METRO DRIVE STE 500 BLOOMINGTON MN 55425 410905139 PENSION BENEFIT FUND MN 401(A) N/A 0 UFCW LOCAL 653 CONTRIBUTING EMPLOYER 0 ALMSTED ENTERPRISES INC CONTRIBUTING EMPLOYER 0 BERGAN'S SUPER VALU CONTRIBUTING EMPLOYER 0 BREDE EXPOSITION SERVICES CONTRIBUTING EMPLOYER 0 CHRISTOPHERSON MEATS CO CONTRIBUTING EMPLOYER 0 DIAMOND LAKE INC CONTRIBUTING EMPLOYER 0 EVAS INC CONTRIBUTING EMPLOYER 0 EVERETT'S FOODS INC CONTRIBUTING EMPLOYER 0 FRESH SEASONS MARKET CONTRIBUTING EMPLOYER 0 HAUG ENTERPRISES INCORPORATED CONTRIBUTING EMPLOYER 0 INGEBRETSEN'S CONTRIBUTING EMPLOYER 0 J & L ENTERPRISES CONTRIBUTING EMPLOYER 0 JERRY'S ENTERPRISES CONTRIBUTING EMPLOYER 0 KINGS SUPER MARKETS INC CONTRIBUTING EMPLOYER 0 KNOWLAN'S FESTIVAL FOODS CONTRIBUTING EMPLOYER 0 KOWALSKI'S MARKET CONTRIBUTING EMPLOYER 0 LUND FOOD HOLDINGS INC CONTRIBUTING EMPLOYER 0 MINERS INC CONTRIBUTING EMPLOYER 0 MN MEAT MASTERS CONTRIBUTING EMPLOYER 0 MOUND FOODS INC CONTRIBUTING EMPLOYER 0 NELSON MEAT CO CONTRIBUTING EMPLOYER 0 OXENDALE COMPANIES CONTRIBUTING EMPLOYER 0 PAULSON'S CONTRIBUTING EMPLOYER 0 RADERMACHERS CUB SHAKOPEE 1997 LLC CONTRIBUTING EMPLOYER 0 ROUNDY'S SUPERMARKETS INC CONTRIBUTING EMPLOYER 0 S & R QUISBERG INC CONTRIBUTING EMPLOYER 0 SHOREWOOD INC CONTRIBUTING EMPLOYER 0 SHOREWOOD LLC CONTRIBUTING EMPLOYER 0 SUPER VALU INC CONTRIBUTING EMPLOYER 0 T & K FOODS INC CONTRIBUTING EMPLOYER 0 WILLISTON CORP CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1