2013-11-12T17:42:08-06:00 2012-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2012-01-01 416187750 MINNESOTA LABORERS HEALTH AND WELFARE FUND MINN 6512561900 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 TIM MACKEY 6512561900 2013-11-06 1 ERIC C BAERTSCH P00964071 9528413950 2012 2016-03-07 17:11:31Z TIM MACKEY 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 107778003 0 X WWW.MINNESOTALABORERS.ORG X 1968 MN PROVIDE HEALTH AND WELFARE BENEFITS 14 1 62 0 0 0 0 0 77722466 88955974 6112445 5316077 0 0 83834911 94272051 0 0 69366908 74752123 0 0 0 0 0 2170010 2029014 71536918 76781137 12297993 17490914 265577163 303246606 1207494 979505 264369669 302267101 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 1323 0 1 62 1 0 0 0 0 0 0 0 0 X 14 1 0 1 0 0 0 0 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 GARY REED 1.00 54.00 X X 0 130326 68232 JAMES BRADY 1.00 40.00 X 0 140455 75627 DAVE SAUNDERS 1.00 40.00 X 0 114307 62935 TOM HAUGH 1.00 50.00 X 0 111805 59710 MITCH TREPTOW 1.00 X 0 0 0 TIM MACKEY 1.00 40.00 X X 0 113947 62731 DAVE BORST 1.00 40.00 X 0 67880 0 TOM VEVEA 1.00 X X 0 0 0 DANIEL SHOEMAKER 1.00 X 0 0 0 JOHN NESSE 1.00 X X 0 0 0 BART BODWAY 1.00 X 0 0 0 GREG BOELKE 1.00 X 0 0 0 MIKE HART 1.00 X 0 0 0 0 678720 329235 0 0 1 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD MENDOTA HEIGHTS MN 55120 CONTRACT ADMINISTRATOR 2014382 MEDICA 401 CARLSON PARKWAY MINNETONKA MN 55305 PREFERRED PROVIDER ORGANIZATION ACCESS 1049052 ENVISION PHARMACEUTICAL SERVICES INC 2181 E AURORA ROAD TWINSBURG MN 44087 PREFERRED PROVIDER ORGANIZATION ACCESS 258872 MCGRANN SHEA CARNIVAL STRAUGN & LAMB 800 NICOLLET MALL STE 2600 MINNEAPOLIS MN 554027035 LEGAL COUNSEL 232208 DELTA DENTAL OF MINNESOTA 500 WASHINGTON AVENUE S MINNEAPOLIS MN 55415 PREFERRED PROVIDER ORGANIZATION ACCESS 208464 9 EMPLOYER CONTRIBUTIONS 900099 82452807 82452807 PARTICIPANT CONTRIBUTIONS 900099 5799913 5799913 MEDICARE PART D SUBSIDY 900099 363793 363793 PRESCRIPTION REBATES 900099 203282 203282 COBRA SUBSIDY INCOME 900099 70812 70812 65367 65367 88955974 3839859 3839859 14982170 13505952 1476218 1476218 1476218 94272051 88955974 0 5316077 74752123 427239 343995 103570 592429 174926 327313 10119 39451 GOVERNMENT COMPLIANCE 9972 76781137 -1669093 -1396776 17023359 17702212 6383352 7389489 41447152 55731453 202037318 223662835 355075 157393 265577163 303246606 527050 500262 680444 479243 1207494 979505 X 0 0 0 0 264369669 302267101 264369669 302267101 265577163 303246606 17490914 20406518 0 X 0 1 X 1 0 0 LIMITED PARTNERSHIPS 17169598 F MUTUAL FUND - NON PUBLICLY TRADED 19465975 F COMMON COLLECTIVE TRUST FUNDS 187027262 F 223662835 DEFERRED INCOME 140381 DUE TO BROKER 338862 479243 X 114086140 20406518 20406518 93679622 592429 592429 94272051 76188708 0 76188708 592429 592429 76781137 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 0 0 0 GARY REED 0 109626 0 0 0 20700 0 53920 0 14312 0 198558 0 0 JAMES BRADY 0 140455 0 0 0 0 0 60775 0 14852 0 216082 0 0 DAVE SAUNDERS 0 114307 0 0 0 0 0 48446 0 14489 0 177242 0 0 TOM HAUGH 0 93005 0 0 0 18800 0 45398 0 14312 0 171515 0 0 TIM MACKEY 0 113947 0 0 0 0 0 48242 0 14489 0 176678 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 8B THE PLAN HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 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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EMPLOYER 0 TOTAL CONSTRUCTION CLEAN UP CONTRIBUTING EMPLOYER 0 TOTAL MECHANICAL SERV INC CONTRIBUTING EMPLOYER 0 TRAXLER CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 TREVOR HANSEN CONTRIBUTING EMPLOYER 0 TRI STATE MASONRY INC CONTRIBUTING EMPLOYER 0 TRIANGLE UNDERGROUND CONTRIBUTING EMPLOYER 0 TRI-CITY CONCRETE CONTR CONTRIBUTING EMPLOYER 0 TRUESDELL CORP OF WISC CONTRIBUTING EMPLOYER 0 TRUESDELL CORPORTION MIDWEST CONTRIBUTING EMPLOYER 0 TURNER BROS CONTRIBUTING EMPLOYER 0 TWIN CITIES SPECIALTIES INC CONTRIBUTING EMPLOYER 0 TWIN CITY CONC PROD CONTRIBUTING EMPLOYER 0 TWIN CITY TUNNELING INC CONTRIBUTING EMPLOYER 0 ULLAND BROS INC CONTRIBUTING EMPLOYER 0 UNITED PIPING INC CONTRIBUTING EMPLOYER 0 UNITED REFRACTORIES INC CONTRIBUTING EMPLOYER 0 UNITED WATER & SEWER CO CONTRIBUTING EMPLOYER 0 UNIVERSAL PAINTING AND DRYWALL CONTRIBUTING EMPLOYER 0 UNIVERSITY OF MINNESOTA CONTRIBUTING EMPLOYER 0 UP NORTH BUILDERS INC CONTRIBUTING EMPLOYER 0 URBAN COMPANIES CONTRIBUTING EMPLOYER 0 US PIPELINE 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