2013-10-15T13:31:34-05:00 2012-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2012-01-01 416023462 MINNESOTA CEMENT MASONS HEALTH & WELFARE C/O ZENITH AMERICAN SOLUTIONS MINN 6512561804 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 GREGORY MASSEY 6512561804 2013-10-09 1 ERIC C BAERTSCH P00964071 9528413950 2012 2016-02-25 16:41:14Z GREGORY MASSEY 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 11460636 0 X N/A X 1960 MN TO PROVIDE HEALTH BENEFITS 8 1 3 0 0 0 0 0 7081031 7989287 260760 381781 22246 33151 7364037 8404219 0 0 5883416 6944511 0 0 0 0 0 687449 552004 6570865 7496515 793172 907704 11800517 13282667 55044 69806 11745473 13212861 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS OR BENEFICIARIES 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 1 226 0 1 3 1 0 0 0 0 0 0 0 0 X 8 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561804 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 GREG JOHNSON 2.00 X 0 91539 51756 GREG MASSEY 2.00 X 0 90359 55205 ARLAND ANDERSON 2.00 X 0 0 0 STEVE BULACH 2.00 X 0 0 0 ROBERT RIDGE 2.00 X 0 91189 51756 DAVE SCHUTTA 2.00 X 0 36713 20121 STEVE FRITZ 2.00 X 0 0 0 MIKE SYVERSRUD 2.00 X 0 77694 51756 TIM WORKE 2.00 X 0 0 0 DAVID JOSLIN 2.00 X 0 0 0 JAMES TURITTO 2.00 X 0 0 0 0 387494 230594 0 0 0 0 ZENITH AMERICAN SOLUTIONS INC 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HEIGHTS MN 55120 THIRD PARTY ADMINISTRATOR 305854 FELHABER LARSON FENLON & VOGT 444 CEDAR STREET SUITE 2100 ST PAUL MN 55101 ATTORNEY 119482 2 EMPLOYER CONTRIB 900099 7462454 7462454 SELF-PAY CONTRIB 900099 526833 526833 7989287 310164 310164 3128034 3056417 71617 71617 71617 CATALYST RX REBATES 900099 33151 33151 33151 8404219 7989287 0 414932 6944511 208590 119482 44804 3000 40506 65464 39776 11324 9420 GOVERNMENT COMPLIANCE 8158 DUES & SUBSCRIPTIONS 1480 7496515 588028 400327 4109203 4684336 542301 499342 3065 7050 6557920 7691612 11800517 13282667 55044 69806 55044 69806 X 0 0 0 0 11745473 13212861 11745473 13212861 11800517 13282667 907704 559684 0 X 0 1 X 1 0 0 X 8923397 559684 559684 8363713 40506 40506 8404219 7456009 0 7456009 40506 40506 7496515 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. FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE BOARD OF TRUSTEES RETAINS THE ULTIMATE RESPONSIBILITY, THEY HAVE DELEGATED THE DAY TO DAY ADMINISTRATIVE DUTIES TO ZENITH AMERICAN SOLUTIONS AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PROVIDED TO, REVIEWED, AND APPROVED BY THE ENTIRE BOARD OF TRUSTEES BEFORE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES EVALUATE ANY POSSIBLE CONFLICTS OF INTEREST ANNUALLY WITH THE PLAN'S ATTORNEY. IN ADDITION, TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH NONPROFIT PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS LAWFUL STATUS AND FIDUCIARY OBLIGATIONS, PERIODIC REVIEWS OF COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ARE CONDUCTED. FORM 990, PART VI, SECTION C, LINE 19 THE PLAN MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. 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