STRATEGY STUDIO / PUBLIC DATA EXPLORER

MINNESOTA CEMENT MASONS HEALTH AND WELFARE FUND: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MINNESOTA CEMENT MASONS HEALTH AND WELFARE FUND (EIN 41-6023462)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-12
IRS object ID
201232869349300323
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-10-12T11:40:23-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN320043599EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LEGACY PROFESSIONALS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line16800 FRANCE AVENUE SO SUITE 550AddressLine1
CityEDINACity
StateMNState
ZIP Code55435ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN416023462EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MINNESOTA CEMENT MASONS HEALTH & WELFAREBusinessNameLine1
Business Name Line2C/O ZENITH AMERICAN SOLUTIONSBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlMINNNameControl
Phone6512561804Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12520 PILOT KNOB ROAD NO 325AddressLine1
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGREGORY MASSEYName
TitleTRUSTEETitle
Phone6512561804Phone
Date Signed2012-10-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameERIC C BAERTSCHName
PTINP00964071PTIN
Phone9528413950Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGREGORY MASSEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12520 PILOT KNOB ROAD NO 325AddressLine1
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode
FieldValueIRS element (for citing)
Gross Receipts10185236GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1960YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH BENEFITSActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees7TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7024636ProgramServiceRevenuePriorYear
Program Service Revenue CY7081031ProgramServiceRevenueCY
Investment Income Prior Year320085InvestmentIncomePriorYear
Investment Income Current Year260760InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year22246OtherRevenueCurrentYear
Total Revenue Prior Year7344721TotalRevenuePriorYear
Total Revenue Current Year7364037TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year6078713BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY5883416BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year560154OtherExpensePriorYear
Other Expenses Current Year687449OtherExpensesCurrentYear
Total Expenses Prior Year6638867TotalExpensesPriorYear
Total Expenses Current Year6570865TotalExpensesCurrentYear
Revenues Less Expenses Prior Year705854RevenuesLessExpensesPriorYear
Revenues Less Expenses CY793172RevenuesLessExpensesCY
Total Assets BOY11059116TotalAssetsBOY
Total Assets EOY11800517TotalAssetsEOY
Total Liabilities BOY53698TotalLiabilitiesBOY
Total Liabilities EOY55044TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY11005418NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY11745473NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH BENEFITSMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTO PROVIDE HEALTH CARE, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS OR BENEFICIARIESDescription
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096254NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees7NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ZENITH AMERICAN SOLUTIONSBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6512561804TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12520 PILOT KNOB ROAD SUITE 325AddressLine1
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
GREG JOHNSON
TRUSTEE2.00X000
GREG MASSEY
SECRETARY2.00X000
ARLAND ANDERSON
CHAIRMAN2.00X000
STEVE BULACH
TRUSTEE2.00X000
ROBERT RIDGE
TRUSTEE2.00X000
DAVE SCHUTTA
TRUSTEE2.00X00332
PAM GRAVES
ALTERNATE TRUSTEE-PAST2.00X000
MIKE SYVERSRUD
ALTERNATE TRUSTEE2.00X000
TIM WORKE
TRUSTEE2.00X000
DAVID JOSLIN
TRUSTEE2.00X000
JAMES TURITTO
ALTERNATE TRUSTEE2.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation332TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ZENITH AMERICAN SOLUTIONS INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12520 PILOT KNOB ROAD SUITE 325AddressLine1
CityMENDOTA HEIGHTSCity
StateMNState
ZIP Code55120ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesTHIRD PARTY ADMINISTRATORDescriptionOfServices
Compensation302185Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
EMPLOYER CONTRIB90009963903026390302
SELF-PAY CONTRIB900099690729690729
FieldValueIRS element (for citing)
Total Program Service Revenue7081031TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column241483TotalRevenueColumn
Exclusion$241,483ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2840476Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2821199Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities19277Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column19277TotalRevenueColumn
Exclusion$19,277ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
CATALYST RX REBATES90009922186$22,186
ERRP REIMBURSEMENTS90009960$60
FieldValueIRS element (for citing)
Total Other Revenue22246TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7364037TotalRevenueColumn
Related Or Exempt Function Income7081031RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$283,006ExclusionAmount

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total5883416Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total100926Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total13300Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total35620Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total461769Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total42880Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total13778Total

Insurance Insurance

FieldValueIRS element (for citing)
Total9015Total

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotal
GOVERNMENT COMPLIANCE7826
DUES & SUBSCRIPTIONS2335

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6570865Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY438217BOY
EOY588028EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3775587BOY
EOY4109203EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY413044BOY
EOY542301EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY10475BOY
EOY3065EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6421793BOY
EOY6557920EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11059116BOY
EOY11800517EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY53698BOY
EOY55044EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY53698BOY
EOY55044EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY11005418BOY
EOY11745473EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11005418BOY
EOY11745473EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11059116BOY
EOY11800517EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses793172ReconcilationRevenueExpenses
Reconcilation Other Changes-53117ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings
Total Revenue7364037TotalRevenue
Total Expenses6570865TotalExpenses
Excess Or Deficit For Year793172ExcessOrDeficitForYear
Net Unrealized GL On Investments-53117NetUnrealizedGLOnInvestments
Total Adjustments-53117TotalAdjustments
Excess Or Deficit Per FS740055ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt7275300TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-53117NetUnrealizedGainsInvestments
Revenue Not Rptd F990-53117RevenueNotRptdF990
Revenue Subtotal7328417RevenueSubtotal
Investment Expenses Not Included35620InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt35620RevenueNotRptdOnFinStmt
Total Revenue Per Form9907364037TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6535245TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal6535245ExpensesSubtotal
Investment Expenses Not Included235620InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt35620ExpensesNotRptdOnFinStmt
Total Expenses Per Form9906570865TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3ALTHOUGH 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 11FORM 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 12CTHE 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 19THE 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.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -53117.CHANGES IN NET ASSETS OR FUND BALANCES: