2013-10-10T14:35:46-05:00 2012-11-30 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2011-12-01 237115412 MINNESOTA TEAMSTERS CONSTRUCTION DIVISION FRINGE BENEFIT FUNDS MINN 6512561900 C/O ZENITH AMER SOL 2520 PILOT KNOB RD NO 325 MENDOTA HEIGHTS MN 55120 MARTHA HENRICKSON 6512561900 2013-10-10 1 ERIC C BAERTSCH P00964071 9528413950 2011 2016-02-25 16:41:14Z MARTHA HENRICKSON C/O ZENITH AMER SOL 2520 PILOT KNOB RD NO MENDOTA HEIGHTS MN 55120 16450879 0 X N/A X 1970 MN PROVIDE HEALTH BENEFITS 8 8 0 0 0 0 0 0 10744970 12073020 707280 545123 3422 62 11455672 12618205 0 0 11189921 10446850 0 0 0 0 0 889135 878438 12079056 11325288 -623384 1292917 19841329 21844971 39354 90038 19801975 21754933 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 1 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 0 1 495 0 1 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 0 0 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 2.00 X 0 0 0 MARTHA HENRICKSON 1.00 X 0 0 0 TONY FRATTALONE 1.00 X 0 0 0 STEVE SAUER 1.00 X 0 0 0 JASON ZINS 1.00 X 0 0 0 DAVID LABORDE 2.00 X 0 0 0 DAVE SCHRUNK 1.00 X 0 0 0 WAYNE PERLEBERG 1.00 X 0 0 0 QUINTEN HAUSAUER 1.00 X 0 0 0 ZACHARY RADZAK 1.00 X 0 0 0 TOM NELTON 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 379868 BLUELINK TPA 1200 YANKEE DOODLE ROAD PO BOX 6 ST PAUL MN 55164 PPO ACCESS FEES 202254 2 EMPLOYER CONTRIBUTIONS 900099 11413715 11413715 PARTICIPANT CONTRIB 900099 341172 341172 STOP LOSS RECOVERIES 900099 264302 264302 LIQUIDATED DAMAGES 900099 33229 33229 SUBROGATION SETTLEMENT 900099 20602 20602 12073020 477797 477797 3900000 3832674 67326 67326 67326 TAX REFUND 900099 62 62 62 12618205 12073020 0 545185 10446850 146753 63583 38253 3315 553416 44484 2762 11641 GOVERNMENT COMPLIANCE 13263 MEMBERSHIP FEES 968 11325288 302399 412725 2022195 1997172 1242490 1084480 16274245 18350594 19841329 21844971 25725 34735 13629 18658 0 36645 39354 90038 X 0 0 0 0 19801975 21754933 19801975 21754933 19841329 21844971 X 1292917 660041 X 0 1 1 X 0 0 DUE TO BROKER 36645 36645 12618205 11325288 1292917 660041 660041 1952958 13274931 660041 660041 12614890 3315 3315 12618205 11321973 0 11321973 3315 3315 11325288 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 REPONSIBILITY, 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 660,041. 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 ALLIED BLACKTOP 10503 89TH AVE N MAPLE GROVE MN 55369 CONTRIBUTING EMPLOYER MN AMES CONSTRUCTION COMPANY 2000 AMES DRIVE BURNSVILLE MN 55306 CONTRIBUTING EMPLOYER MN ANDERSON CONTRACTING INC PO BOX 40 SOLWAY MN 56678 CONTRIBUTING EMPLOYER MN ARNT CONSTRUCTION COMPANY PO BOX 549 HUGO MN 55038 CONTRIBUTING EMPLOYER MN AUGUST OC FILMS INC 2835 N NAOMI ST BURBANK CA 91504 CONTRIBUTING EMPLOYER CA BELAIR EXCAVATING 2200 OLD HIGHWAY 8 NEW BRIGHTON MN 55112 CONTRIBUTING EMPLOYER MN BIG INCH FABRACATORS PO BOX 99 MONTEZUMA IN 47862 CONTRIBUTING EMPLOYER IN BILLMAN CONSTRUCTION INC 5010 MILLER TRUNK HERMANTOWN MN 55811 CONTRIBUTING EMPLOYER MN BITUMINOUS ROADWAYS INC 1520 COMMERCE DRIVE MENDOTA HEIGHTS MN 55120 CONTRIBUTING EMPLOYER MN BLUELINX CORPORATION 8175 JEFFERSON HWY MAPLE GROVE MN 55369 CONTRIBUTING EMPLOYER MN BOLLIG & SONS 11401 CTY RD 3 HOPKINS MN 55343 CONTRIBUTING EMPLOYER MN BROCK-WHITE CO 2575 KASOTA AVE ST PAUL MN 55108 CONTRIBUTING EMPLOYER MN BRYAN ROCK PRODUCTS INC PO BOX 215 SHAKOPEE MN 55379 CONTRIBUTING EMPLOYER MN C C WINGER 6872 HWY 135 N EMBARASS MN 55732 CONTRIBUTING EMPLOYER MN C S MCCROSSAN INC PO BOX 1240 MAPLE GROVE MN 55369 CONTRIBUTING EMPLOYER MN CAPPIES TRUCKING 1384 SYLVAN STREET ST PAUL MN 55117 CONTRIBUTING EMPLOYER MN CASPER CONSTRUCTION INC PO BOX 480 GRAND RAPIDS MN 55744 CONTRIBUTING EMPLOYER MN CHARPS WELDING & FABRICATING 527 TOWER STREET NW CLEARBROOK MN 56634 CONTRIBUTING EMPLOYER MN CHRIS JENSEN & SON CO 5300 STINSON AVE SUPERIOR WI 54880 CONTRIBUTING EMPLOYER WI DEER RIVER TRUCKING BOX 236 DEER RIVER MN 56636 CONTRIBUTING EMPLOYER MN DRILLERS INC 713 CENTRAL AVE NEBRASKA CITY NE 68410 CONTRIBUTING EMPLOYER NE DUNN BLACKTOP COMPANY BOX 208 WINONA MN 55987 CONTRIBUTING EMPLOYER MN EDUCATION AND TRAINING FUND 2520 PILOT KNOB ROAD MENDOTA HEIGHTS MN 55120 CONTRIBUTING EMPLOYER MN ENTERTAINMENT PARTNERS 2835 N NAOMI STREET BURBANK CA 91504 CONTRIBUTING EMPLOYER CA F M TRUCKING COMPANY 175 OLD HIGHWAY 8 SW NEW BRIGHTON MN 55112 CONTRIBUTING EMPLOYER MN FOREST LAKE CONTRACTING 14777 LAKE DRIVE FOREST LAKE MN 55025 CONTRIBUTING EMPLOYER MN FPI PAVING CONTRACTORS INC 3230 RICE ST ST PAUL MN 55126 CONTRIBUTING EMPLOYER MN FRATTALONE CONSTRUCTION 3205 SPRUCE STREET ST PAUL MN 55117 CONTRIBUTING EMPLOYER MN GEISLINGER & SONS PO BOX 437 WATKINS MN 55389 CONTRIBUTING EMPLOYER MN GRAYCOR TWO MID AMERICA PLAZA 400 OAKBROOK TERR IL 60181 CONTRIBUTING EMPLOYER IL GRAZZINI BROTHERS & COMPANY 1175 EAGAN INDUSTRIAL RD EAGAN MN 55121 CONTRIBUTING EMPLOYER MN HAMMERLUND CONSTRUCTION 3201 US HWY 2 GRAND RAPIDS MN 55744 CONTRIBUTING EMPLOYER MN HARDRIVES INC 14475 QUIRAM DRIVE ROGERS MN 55374 CONTRIBUTING EMPLOYER MN HAWKINSON CONST CO BOX 278 GRAND RAPIDS MN 55744 CONTRIBUTING EMPLOYER MN HESELTON CONSTRUCTION LLC PO BOX 246 FARIBAULT MN 55021 CONTRIBUTING EMPLOYER MN HOOVER CONST CO BOX 1007 VIRGINIA MN 55792 CONTRIBUTING EMPLOYER MN INFRASOURCE UNDERGROUND CONST 4033 E MORGAN RD YPSILANTI MI 48917 CONTRIBUTING EMPLOYER MI INTERCON CONSTRUCTION INC 5512 STATE RD 19 113 WAUNAKEE WI 53597 CONTRIBUTING EMPLOYER WI J KOSKI TRUCKING INC 310 BELKNAP ST SUPERIOR WI 54880 CONTRIBUTING EMPLOYER WI JAMAR COMPANY 1100 OLD HIGHWAY 8 NW NEW BRIGHTON MN 55112 CONTRIBUTING EMPLOYER MN JOHN A DALSIN & SON 2830 20TH AVE S MPLS MN 55407 CONTRIBUTING EMPLOYER MN JOLA SOPP INC PO BOX 738 EVELETH MN 55734 CONTRIBUTING EMPLOYER MN JULIAN M JOHNSON CONST CO 6191 140TH AVE NW RAMSEY MN 55303 CONTRIBUTING EMPLOYER MN KGM CONTRACTORS 9211 HWY 53 ANGORA MN 55703 CONTRIBUTING EMPLOYER MN KIRSCHER TRANSPORT 2001 N 9TH AVE VIRGINIA MN 55792 CONTRIBUTING EMPLOYER MN KNIFE RIVER MATERIALS PO BOX 40 BEMIDJI MN 56601 CONTRIBUTING EMPLOYER MN KNISH CORPORATION PO BOX 8 FARIBAULT MN 55021 CONTRIBUTING EMPLOYER MN KRAEMER MINING & MATERIALS INC ONE PLAINVIEW RD PLAIN WI 53577 CONTRIBUTING EMPLOYER WI LAKEHEAD CONSTRUCTORS 2916 HILL AVENUE SUPERIOR WI 54880 CONTRIBUTING EMPLOYER WI LEVINE & SON 3453 ZIMMERMAN RD DULUTH MN 55804 CONTRIBUTING EMPLOYER MN LINO LAKES LANDSCAPING 18400 LEXINGTON AVE WYOMING MN 55092 CONTRIBUTING EMPLOYER MN MANNCO TRUCKING INC 3626 COUNTY RD 120 INTL FALLS MN 56649 CONTRIBUTING EMPLOYER MN MCNAMARA CONTRACTING INC 16700 CHIPPENDALE AVE ROSEMOUNT MN 55068 CONTRIBUTING EMPLOYER MN MESABI BITUMINOUS INC BOX 728 GILBERT MN 55741 CONTRIBUTING EMPLOYER MN METROPOLITAN MECH CONTRS 7450 FLYING CLOUD DRIVE EDEN PRAIRIE MN 55344 CONTRIBUTING EMPLOYER MN MICHELS CORPORATION 817 WEST MAIN STREET BROWNSVILLE WI 53006 CONTRIBUTING EMPLOYER WI MIDWEST CONCRETE SPEC INC 16700 CHIPPENDALE AVE ROSEMOUNT MN 56068 CONTRIBUTING EMPLOYER MN MIDWEST SEEDING PO BOX 10 ROSEAU MN 56751 CONTRIBUTING EMPLOYER MN MILESTONE MATERIALS DIV OF MATHY CONSTRUCTION ROCHESTER MN 55906 CONTRIBUTING EMPLOYER MN MINGER CONSTRUCTION INC PO BOX 236 CHANHASSEN MN 55317 CONTRIBUTING EMPLOYER MN MINNESOTA LIMITED INC 18640 200TH STREET BIG LAKE MN 55309 CONTRIBUTING EMPLOYER MN MINOT PAVING CO INC PO BOX 1805 MINOT ND 58702 CONTRIBUTING EMPLOYER ND NEMANICH TRUCKING 7335 HWY 97 EVELETH MN 55734 CONTRIBUTING EMPLOYER MN NORTH AMERICAN BUSINESS SERVICE 2300 STEELES AVE W CONCORD ONTARIO CA CONTRIBUTING EMPLOYER CA NORTH AMERICAN BUSINESS SERVICE 2300 STEELES AVE W CONCORD ONTARIO CA CONTRIBUTING EMPLOYER CA NORTH PINE AGGREGATE INC 14551 LAKE DRIVE FOREST LAKE MN 55025 CONTRIBUTING EMPLOYER MN NORTHERN CLEARING 1805 MAIN STREET W ASHLAND WI 54806 CONTRIBUTING EMPLOYER WI NORTHERN IMPROVEMENT CO PO BOX 2846 FARGO ND 58108 CONTRIBUTING EMPLOYER ND NORTHERN IMPROVEMENT CO P O BOX 2846 FARGO ND 58108 CONTRIBUTING EMPLOYER ND NORTHERN INTERSTATE CONST INC 7895 E BAYFIELD ROAD SOUTH RANGE WI 54874 CONTRIBUTING EMPLOYER WI NORTHLAND CONSTRUCTORS OF 1420 LONDON ROAD 204 DULUTH MN 55805 CONTRIBUTING EMPLOYER MN NORTHWEST ASPHALT CO 1451 STAGECOACH RD SHAKOPEE MN 55379 CONTRIBUTING EMPLOYER MN OZ DIRECTIONAL DRILLING LLC 38220 N 103RD PL SCOTTSDALE AZ 85262 CONTRIBUTING EMPLOYER AZ PCI ROADS LLC 14123 42ND STREET NE ST MICHAELS MN 55376 CONTRIBUTING EMPLOYER MN PENHALL COMPANY DBA HWY SERV PO BOX 310 ROGERS MN 55374 CONTRIBUTING EMPLOYER MN PETERSON BROS ROOFING & CONST 481 BURGESS STREET ST PAUL MN 55117 CONTRIBUTING EMPLOYER MN PINE BEND PAVING INC PO BOX 72 VERMILLION MN 55085 CONTRIBUTING EMPLOYER MN PRECISION PIPELINE LLC 3314 56TH ST EAU CLAIRE WI 54703 CONTRIBUTING EMPLOYER WI PRIOR LAKE AGGREGATES INC PO BOX 309 PRIOR LAKE MN 55372 CONTRIBUTING EMPLOYER MN Q3 CONTRACTING 3066 SPRUCE STREET LITTLE CANADA MN 55117 CONTRIBUTING EMPLOYER MN RAY JORDAN & SONS 1901 KLONDIKE DR NE EAST BETHEL MN 55011 CONTRIBUTING EMPLOYER MN RUM RIVER CONTRACTING 31913 124TH STREET PRINCETON MN 55371 CONTRIBUTING EMPLOYER MN SCHWARTZ REDI-MIX INC 34882 SCENIC HWY BOVEY MN 55709 CONTRIBUTING EMPLOYER MN SHAFER CONTRACTING CO INC P O BOX 128 SHAFER MN 55074 CONTRIBUTING EMPLOYER MN SINNOTT CONTRACTING LLC PO BOX 16205 DULUTH MN 55816 CONTRIBUTING EMPLOYER MN SOLBERG AGGREGATE CO 10620 COURTHOUSE BLVD INVER GROVE HTS MN 55076 CONTRIBUTING EMPLOYER MN SOS TRUCKING PO BOX 218 WYNDMERE ND 58081 CONTRIBUTING EMPLOYER ND SOVDE ENTERPRISES INC 932 NAYLOR DR SE BEMIDJI MN 56601 CONTRIBUTING EMPLOYER MN STACK BROTHERS MECHANICAL 2425 24TH AVE E SUPERIOR WI 54880 CONTRIBUTING EMPLOYER WI STANDARD SIDEWALK PO BOX 49504 BLAINE MN 55449 CONTRIBUTING EMPLOYER MN SUMMIT MATERIALS DBA HAWKINSON 3000 RANGELINE ROAD GRAND RAPIDS MN 55744 CONTRIBUTING EMPLOYER MN T A SHIFSKY & SONS INC 2370 HWY 36 ST PAUL MN 55109 CONTRIBUTING EMPLOYER MN THE BOLDT COMPANY PO BOX 419 APPLETON WI 54912 CONTRIBUTING EMPLOYER WI THOMAS AND SONS PO BOX 303 ROGERS MN 55374 CONTRIBUTING EMPLOYER MN TILLER CORPORTION PO BOX 1480 MAPLE GROVE MN 55311 CONTRIBUTING EMPLOYER MN TOTAL CONSTRUCTION & EQUIPMENT 10195 INVER GROVE TR INVER GROVE HGHTS MN 55076 CONTRIBUTING EMPLOYER MN U S PIPELINE INC 950 ECHO LANE HOUSTON TX 77024 CONTRIBUTING EMPLOYER TX ULLAND BROTHERS INC BOX 340 CLOQUET MN 55720 CONTRIBUTING EMPLOYER MN UNITED PIPING INC 4510 AIRPORT ROAD DULUTH MN 55811 CONTRIBUTING EMPLOYER MN VEIT & COMPANY INC 14000 VEIT PLACE ROGERS MN 55374 CONTRIBUTING EMPLOYER MN WAGNER CONSTRUCTION PO BOX B S INTL FALLS MN 56679 CONTRIBUTING EMPLOYER MN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 CONTRIBUTING EMPLOYER INFORMATION FORM 990, SCHEDULE R, PARTS III AND IV THE INFORMATION REPORTED IN PARTS III AND IV REGARDING THE FUND'S CONTRIBUTING EMPLOYERS IS THE INFORMATION THAT WAS READILY AVAILABE TO THE FUND.