2017-11-13T11:38:03-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2016-01-01 416023461 MINNESOTA & NORTH DAKOTA BRICKLAYERS & ALLIED CRAFTWORKERS HEALTH FUND MINN 6512561801 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 MICHAEL COOK CHAIRMAN 6512561801 2017-11-08 1 DOUG BERTOSSI P00637990 6123764500 67.137.57.251 2017-11-08 16:28:05 CS P B4CEFC48486AD23E31E8D5C62CADEAB4C6800BE3 EB257C677C23210A1BABF3CC3C8E15734A982BF5 2016 2017-02-10 21:41:12Z MICHAEL COOK 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 96150777 0 X N/A X 1961 MN PROVIDE HEALTH & WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 8 1 26 8 0 0 0 0 20708640 22236396 2750855 5043052 0 0 23459495 27279448 0 0 19161013 18696794 0 0 0 0 0 1703102 1579384 20864115 20276178 2595380 7003270 60675871 66819423 505693 259430 60170178 66559993 PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 0 0 PAYMENT OF HOSPITAL, MEDICAL, DENTAL, DISABILITY, DEATH, AND VISION BENEFITS FOR 1,693 UNION MEMBERS AND THEIR DEPENDENTS. 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 1 0 0 0 0 0 0 0 0 0 1 0 0 1 300 0 26 1 0 0 0 0 0 0 X 8 1 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 0 1 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561900 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 X X MICHAEL COOK SEE SCHEDULE O 1.00 52.00 X X 0 0 0 PAUL WIESE MANAGEMENT TRUSTEE - SECRE 1.00 40.00 X X 0 0 0 ROGER BUIRGE UNION TRUSTEE 1.00 0.00 X 0 0 0 DARRIN DROSKY MANAGEMENT - ALTERNATE TRU 1.00 40.00 X 0 0 0 MICHAEL GANZ SEE SCHEDULE O 1.00 46.00 X 0 0 0 FRANK GRAZZINI II MANAGEMENT TRUSTEE 1.00 40.00 X 0 0 0 MONICA KELLEY MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL LAPENSKY MANAGEMENT - ALTERNATE TRU 1.00 40.00 X 0 0 0 STAN PACZYNSKI SEE SCHEDULE O 1.00 42.00 X 0 0 0 RON RASLEY MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 TERRY WONG SEE SCHEDULE O 1.00 41.00 X 0 0 0 REBECCA NOHAVA UNION TRUSTEE - ALTERNATE 1.00 40.00 X 0 0 0 0 0 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 PLAN ADMINISTRATOR 814231 HEALTH PARTNERS 8170 33RD AVE S BLOOMINGTON MN 55425 PPO 656328 LOSGS 100 SOUTH FIFTH STREET SUITE 2500 MINNEAPOLIS MN 554021234 LEGAL 153076 BAC SERVICE CORP 100 SOUTH FIFTH STREET SUITE 2500 MINNEAPOLIS MN 554021234 ADMINISTRATION SERVICES 119925 4 CONTRIBUTIONS 525100 22236396 22236396 22236396 1699016 1699016 72215365 68871329 3344036 3344036 3344036 27279448 22236396 0 5043052 18696794 904062 153076 45400 162545 82988 113926 4318 18140 TRANSITIONAL REINSURANC 94929 20276178 1910448 1676100 16476200 7333084 1778950 1809004 320050 107996 28109 3956 39817436 55663518 344678 225765 60675871 66819423 375080 241124 130613 18306 505693 259430 X 0 0 0 0 60170178 66559993 60170178 66559993 60675871 66819423 7003270 -613455 0 X 0 1 X 1 0 0 ADVANCE CONTRIBUTIONS FROM EMPLOYEES FOR FUTURE COVERAGE 18306 18306 X 26503448 -613455 -613455 27116903 162545 162545 27279448 20113633 0 20113633 162545 162545 20276178 PART X, LINE 2: THE VEBA TRUST FUNDING BENEFITS OF THE PLAN RECEIVED AN EXEMPTION LETTER FROM THE INTERNAL REVENUE SERVICES (IRS) DATED FEBRUARY 27, 1963, STATING THAT THE TRUST IS TAX-EXEMPT UNDER THE PROVISIONS OF SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC). HOWEVER, AS A RESULT OF THE PLAN'S FUNDING POLICY, FROM TIME TO TIME THE TRUST MAY BE SUBJECT TO INCOME TAXES. NO FEDERAL OR STATE INCOME TAXES HAVE BEEN RECORDED IN 2016 OR 2015 FOR UNRELATED BUSINESS TAXABLE INCOME. IN ADDITION, THE PLAN AND TRUST ARE REQUIRED TO OPERATE IN CONFORMITY WITH THE IRC TO MAINTAIN THE TAX-EXEMPT STATUS OF THE TRUST. THE PLAN ADMINISTRATOR BELIEVES THAT THE PLAN IS BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC AND, THEREFORE, BELIEVES THAT THE RELATED TRUST IS TAX-EXEMPT. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE PLAN MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE PLAN HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. COMMERCIAL MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 1879 1879 0 0 0 HARBOR CITY MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 84267 84267 0 0 0 INSTALLATION CONCEPTS CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 14108 14108 0 0 0 LONDON BRICK CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 7742 7742 0 0 0 107996 FORM 990, PART VI, SECTION A, LINE 7A THE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION 1 MINNESOTA/NORTH DAKOTA AND THE ASSOCIATED GENERAL CONTRACTORS OF MINNESOTA EACH APPOINT 50% OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 WAS REVIEWED BY THE BOARD OF TRUSTEES IN CONJUNCTION WITH THE REVIEW OF THE ANNUAL AUDIT. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS DISCUSSED ANNUALLY BY THE BOARD OF TRUSTEES TO ENSURE THE TRUSTEES UNDERSTAND THE CONFLICT OF INTEREST POLICY AND UNDERSTANDS THE FUND IS A TAX-EXEMPT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX EXEMPT PURPOSES. PER THE POLICY, ANY PERSON DISCOVERING A CONFLICT SHOULD DISCLOSE IT IMMEDIATELY TO THE CHAIRMAN OF THE BOARD OF TRUSTEES. THE BOARD OF TRUSTEES DETERMINES IF A CONFLICT EXISTS AND MAY PLACE APPROPRIATE RESTRICTIONS ON THE INDIVIDUAL OR TRANSACTIONS AFFECTED AT THEIR DISCRETION. ANY CONFLICTS ARE DOCUMENTED IN MEETING MINUTES. NO SUCH CONFLICTS AROSE DURING THE YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE FUND'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990 PART VII, SECTION A, LINE 1A TRUSTEES ARE NOT COMPENSATED BY THE FUND. COMPENSATION PAID TO TRUSTEES EMPLOYED BY OTHER RELATED ORGANIZATIONS IS REPORTED ON THE FORM 990 FILED WITH THE INTERNAL REVENUE SERVICE BY THE RELATED TAX-EXEMPT ORGANIZATION. THE FOLLOWING RELATED ORGANIZATIONS REPORTED COMPENSATION FOR A TRUSTEE LISTED ON THE MINNESOTA & NORTH DAKOTA BRICKLAYERS & ALLIED CRAFTWORKERS HEALTH FUND: MICHAEL COOK, UNION TRUSTEE - CHAIRMAN BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 STAN PACZYNSKI, UNION - ALTERNATE TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 MICHAEL GANZ, UNION TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 TERRY WONG, UNION TRUSTEE BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO. 1 MINNESOTA/NORTH DAKOTA EIN: 41-1716458 MN & ND BRICKLAYERS AND ALLIED CRAFTSWORKERS PENSION FUND 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 516029930 PROVIDE RETIREMENT BENEFITS TO UNION MEMBERS MN 401(A) N/A N/A 0 MN & ND BRICKLAYERS AND ALLIED CRAFTSWORKERS VACATION FUND 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 237068471 PROVIDE VACATION BENEFITS TO UNION MEMBERS. MN 501(C)(9) N/A N/A 0 MN & ND BRICKLAYERS AND ALLIED CRAFTSWORKERS APPRENTICE FUND 328 UNITED LABOR CTR 312 CENTRAL AV MINNEAPOLIS MN 55414 416319702 PROVIDE TRAINING AND RETRAINING TO CURRENT AND PROSPECTIVE UNION MEMBERS MN 501(C)(4) N/A N/A 0 MINNESOTA CERAMIC TILE AND ALLIED TRADES RETIREMENT FUND 2520 PILOT KNOB RD MENDOTA HEIGHTS MN 55120 416059404 PROVIDE RETIREMENT BENEFITS TO UNION MEMBERS. MN 401(A) N/A N/A 0 BRICKLAYERS AND ALLIED CRAFTWORKERS LOCAL UNION NO 1 MINNESOTANORTH DAKOTA 312 CENTRAL AVE SUITE 328 MINNEAPOLIS MN 55414 411716458 PROTECT AND IMPROVE THE GENERAL WELFARE OF ITS MEMBERS AND EMPLOYEES MN 501(C)(5) N/A N/A 0 ASSOCIATED GENERAL CONTRACTORS OF MINNESOTA INC 525 PARK STREET NO 110 ST PAUL MN 55103 410132580 REPRESENTING MEMBERS INVOLVED IN MINNESOTA'S CONSTRUCTION INDUSTRY MN 501(C)(6) N/A N/A 0 CITY OF ST PAUL CITY OF MINNEAPOLIS ST PAUL PUBLIC SCHOOLS UNIVERSITY OF MINNESOTA CMS LLC D R FRANTZ CONCRETE CONST OPUS CORPORATION RAM CONSTRUCTION SERVICES ADVANCE TERRAZZO & TILE CO B & D ASSOCIATES INC BOB'S SPARKLE WASH CAMCO CONSTRUCTION INC EICHOLTZ MASONRY INC GEORGE SIEGFRIED CONST CO HOLLENBACK & NELSON INC JOHNNY MASONRY INC M A MORTENSON CO MACPHERSON-TOWNE CO MARKET & JOHNSON INC MIDWEST PRECAST SERVICES LLC RIGHTWAY CAULKING THE CAULKERS COMPANY INC WESTERN SPECIALTY CONTRACTORS A D B CONSTRUCTION CO INC ACME TUCKPOINTING & RESTOR ALVIN BENIKE INC AMERICAN MAS RESTORATION CORP ANDERSON MAS & CONCRETE INC AXEL H OHMAN INC B & M MASONRY INC BEDROCK-FLINT INC CARCIOFINI COMPANY INC CARLSON-LAVINE INC CD TILE & STONE INC COMMERCIAL MASONRY INC COMMERCIAL SPECIALTY CONTRACT CON'S MASONRY INC CONTRACT CAULKING CROSSTOWN MASONRY INC D J KRANZ CO INC DAROLD BERGER MASONRY INC DAYCO CONCRETE DEL'S CONSTRUCTION CO INC DZIEDZIC CAULKING INC EXTERIOR BUILDING SERVICES INC FLEMMING TILE INC FRANDRUP MASONRY INC GRAZZINI BROTHERS CO GRESSER COMPANIES INC HARBOR CITY MASONRY INC HAUGEN MASONRY CONTRACTORS INC HOVLAND INC INSTALLATION CONCEPTS INC J E DUNN CONSTRUCTION COMPANY JOHNSON & NELSON JOHNSON CARPET KASELLA CONCRETE INC KIFFMEYER INC KNUTSON CONSTRUCTION SERVICES LAKEHEAD CONSTRUCTORS INC LEE'S CERAMICS INC LOUHI & KIVELA MASONRY INC MAERTENS-BRENNY CONSTRUCTION MAVO SYSTEMS INC MCGOUGH CONSTRUCTION CO INC MORTENSON MASONRY INC PARAMOUNT CONCRETE & MAS INC RESTORATION SYSTEMS INC ROYL MASONRY SCHLEIS FLOOR COVERING INC SEBCO INC SERICE CONSTRUCTION INC SHEEHY CONSTRUCTION CO SMITH-SHARPE FIRE BRICK SUPPLY STONE CONSTRUCTION INC STRETAR MASONRY & CONCRETE INC STRIPE RIGHT INC SUNRISE SPECIALTY CONTR THE JAMAR COMPANY UNITED REFACTORIES INC WEISE MASONRY INC WTG TERRAZZO & TILE INC ZACHMAN PRECAST INC HANSON MASONRY & CONCRETE LLC STEENBERG - WATRUD CONST INC FABCON INC GRANITE-TOPS INSTALLATION INC HUESMAN SCHREIBER MASONRY INCOR INSTALLATION INC NORTHLAND CONCRETE & MASONRY A J SPANJERS CO DEBCON II DBA O'CONNOR CONST GORDON CONST OF MAHNOMEN INC MARK 1 RESTORATION COMPANY MOLIN CONCRETE PRODUCTS RICE LAKE CONSTRUCTION GROUP BRICKLAYERS AND ALLIED CRAFTWORKERS SERVICE CORPORATION 2520 PILOT KNOB ROAD MENDOTA HEIGHTS MN 55120 811520819 COLLECT CONTRIBUTIONS MN NO C 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 RELATED ORGANIZATIONS TAXABLE AS AN INDIVIDUAL OR SOLE PROPRIETOR: CONTRACT TILE & CARPET, INC. RELATED ORGANIZATIONS THAT NO TAX CLASSIFICATION WAS GIVEN FOR: ADVANCED MASONRY RESTORATION ALWAYS TILE & STONE LLC ANCHOR GLASS CONTAINER INC. BAC INTERNATIONAL FUND BAC LOCAL UNION 15 CONSTRUCTION IND OF CENTRAL IL D & D STONE, LLC DULUTH & VIRGINIA BLDG TRADE EAGLE CAULKING ENGELSMA CONSTRUCTION INC FORSLAND JONES FOWLER & HAMMER INC GABEL MASONRY CONSTRUCTION INC GAGE BROTHERS CAULKING GAGNON INCORPORATED GOFF MASONRY LLC GUSTAFSON & GOUDGE INC HARLAN FALCK & SON INC HARRISON TILE CO INC HICKS CONCRETE CONST INNOVATIVE MASONRY RESTORATION INTERNAT'L MASONRY INSTITUTE INTL MASONRY TRAINING & EDUCA IOWA LABORERS DISTRICT COUNCIL JOHNSON TERRAZZO CO INC KANSAS BLDG TRADES H&W LANGER CONSTR CO LARSON MASONRY CONSTRUCTION M C MAGNEY CONST MAGNEY CONSTRUCTION INC MAJESTIC TILE & STONE INC MASONRY INDUSTRY TRUST ADMIN MASONRY INSTITUTE METROPOLITAN TILE & MARBLE MIDWESTERN MASONRY INC MINNESOTA CEMENT MASONS MOSAICA LLC NIKKEL TILE INC NORTHWEST ADMINISTRATORS, INC NORTHWESTERN MARBLE & GRANITE PATZOLDT CONCRETE & MASONRY LL PELLAND-SWENSON & ASSOC PROJECT RESTORATIONS INC REFRACTORY SERVICE INC RESCH'S TILE INC SERVAIS TILE & STONE, INC. SPECIAL SCHOOL DISTRICT #1 STEBBINS ENGINEERING SUMMIT CONCRETE & MAS CONST TCR ENTERPRISES DBA J&K MASON TED KENNE CONSTRUCTION TOTAL CONSTRUCTION & EQUIPMENT TWIN CITY TILE & MARBLE CO WELLS CONCRETE PRODUCTS CO WISCONSIN MASONS FRINGE FUNDS