2017-01-13T12:53:18-06:00 2016-02-29 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE S SUITE 550 EDINA MN 55435 990 2015-03-01 410905139 MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS HEALTH AND WELFARE FUND MINN 9528540795 3001 METRO DRIVE NO 500 BLOOMINGTON MN 55425 MATT UTECHT CHAIRMAN 9528540795 2017-01-11 1 LARRY WOOD P00634996 9528413950 2015 2021-01-29 14:40:06Z MATT UTECHT 3001 METRO DRIVE NO 500 BLOOMINGTON MN 55425 37780104 0 X WWW.653BENEFITS.COM X 1966 MN PROVIDES HEALTH AND WELFARE BENEFITS 8 0 86 0 0 0 0 0 36341479 34844302 794701 88284 401 4330 37136581 34936916 0 0 47313982 32272796 0 0 0 0 0 1641940 1374539 48955922 33647335 -11819341 1289581 16325433 17674791 320000 268435 16005433 17406356 PROVIDE HEALTH AND WELFARE BENEFITS 0 0 THE PLAN PROVIDES COMPREHENSIVE MEDICAL BENEFITS, INCLUDING DENTAL, VISION, PRESCRIPTION DRUG AND VARIOUS SUPPLEMENTAL BENEFITS, LIFE INSURANCE AND DISABILITY BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS AND BENEFICIARIES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 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 2 0 1 86 1 0 0 0 0 0 0 0 0 X 8 0 0 1 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 X SUSAN KNOBLAUCH 9528540795 3001 METRO DRIVE SUITE 500 BLOOMINGTON MN 55425 WILLIAM SEEHAFER SECRETARY 1.00 X 0 0 0 JIM ALMSTED TRUSTEE 1.00 X 0 0 0 FRED MILLER TRUSTEE 1.00 X 0 0 0 KENT DIXON TRUSTEE 1.00 X 0 0 0 TRACY MCDONALD ALTERNATE TRUSTEE 1.00 X 0 0 0 MATT UTECHT CHAIRMAN 1.00 40.00 X 0 204760 15038 RICHARD MILBRATH TRUSTEE 1.00 40.00 X 0 125843 15039 PAUL CRANDALL TRUSTEE 1.00 40.00 X 0 154399 15038 STEVE MILNER TRUSTEE 1.00 40.00 X 0 95026 15038 DOUG RIGERT ALTERNATE TRUSTEE - PAST 1.00 40.00 X 0 95540 15038 0 675568 75191 0 1 1 0 WILSON-MCSHANE CORPORATION 3001 METRO DRIVE BLOOMINGTON MN 55425 CLAIMS PROCESSING AND ADMINISTRATION 1458904 BLUECROSS BLUESHIELD OF MN 3535 BLUE CROSS ROAD ST PAUL MN 55122 NETWORK ACCESS FEES 400046 ANDERSON HELGEN DAVIS & CEFALU PA 333 SOUTH 7TH STREET SUITE 310 MINNEAPOLIS MN 55402 LEGAL & SUBROGATION FEES 152313 SEGAL 3800 AMERICAN BLVD WEST BLOOMINGTON MN 55431 ACTUARIAL CONSULTING 138442 4 EMPLOYER CONTRIBUTIONS 900099 33380905 33380905 PARTICIPANT CONTRIBUTI 900099 809932 809932 PRESCRIPTION DRUG REBA 900099 403362 403362 SUBROGATION SETTLEMENT 900099 250103 250103 34844302 63220 63220 2868252 2843188 25064 25064 25064 OTHER REIMBURSEMENTS 900099 4330 4330 4330 34936916 34844302 0 92614 32272796 384000 152313 31500 76720 194290 43314 4955 8433 FEES MANDATED BY ACA 479014 33647335 1880315 3525576 277937 383300 2643871 2722877 16746 13013 3646049 4290732 7860515 6739293 16325433 17674791 293098 247022 26902 21413 320000 268435 X 0 0 0 0 16005433 17406356 16005433 17406356 16325433 17674791 1289581 111342 0 X 0 1 X 1 0 0 COLLECTIVE INVESTMENT FUNDS 6739293 F 6739293 X 34971538 111342 111342 34860196 76720 76720 34936916 33570615 0 33570615 76720 76720 33647335 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 LIMITATION EXPIRES. 0 0 0 MATT UTECHT CHAIRMAN 0 204760 0 0 0 0 0 6729 0 8309 0 219798 0 0 PAUL CRANDALL TRUSTEE 0 154399 0 0 0 0 0 6729 0 8309 0 169437 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE BOARD OF TRUSTEES RETAINS ULTIMATE RESPONSIBILITY, THE TRUSTEES HAVE DELEGATED THE DAY-TO-DAY ADMINISTRATIVE DUTIES TO WILSON-MCSHANE CORPORATION AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A THE FUND IS ADMINISTERED BY A BOARD OF EIGHT TRUSTEES, FOUR EMPLOYER TRUSTEES ARE APPOINTED BY EMPLOYERS AND FOUR UNION TRUSTEES ARE APPOINTED BY THE UNION. FORM 990, PART VI, SECTION A, LINE 8B THE PLAN HAS NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PROVIDED TO AND REVIEWED BY EITHER THE ADMINISTRATOR OR THE ENTIRE BOARD OF TRUSTEES PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH TRUSTEE IS REQUIRED TO ANNUALLY SIGN A STATEMENT WHICH AFFIRMS EACH TRUSTEE: HAS READ AND UNDERSTANDS THE CONFLICT OF INTEREST POLICY AND THAT TO THE BEST OF THEIR KNOWLEDGE THAT NEITHER THE TRUSTEE, NOR ANY RELATIVE OF THE TRUSTEE, HAS IN THE PAST YEAR ENGAGED IN AN ACTIVITY THAT DOES OR REASONABLY MAY CONSTITUTE A CONFLICT OF INTEREST. IN ADDITION, THE TRUSTEES ARE REQUIRED TO NOTIFY THE ENTIRE BOARD IF THEY SENSE AN ACTION THE BOARD IS PURSUING, OR IS CONTEMPLATING PURSUING, MAY PRESENT A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO PARTICIPANTS UPON REQUEST. MINNEAPOLIS RETAIL MEAT CUTTERS AND FOOD HANDLERS PENSION FUND 3001 METRO DRIVE STE 500 BLOOMINGTON MN 55425 410905139 PENSION BENEFIT FUND MN 401(A) N/A 0 UFCW LOCAL 653 CONTRIBUTING EMPLOYER 0 ALMSTED ENTERPRISES INC CONTRIBUTING EMPLOYER 0 BERGAN'S SUPER VALU CONTRIBUTING EMPLOYER 0 BREDE EXPOSITION SERVICES CONTRIBUTING EMPLOYER 0 CHRISTOPHERSON MEATS CO CONTRIBUTING EMPLOYER 0 EVERETT'S FOODS INC CONTRIBUTING EMPLOYER 0 HAUG ENTERPRISES INCORPORATED CONTRIBUTING EMPLOYER 0 INGEBRETSEN'S CONTRIBUTING EMPLOYER 0 J & L ENTERPRISES CONTRIBUTING EMPLOYER 0 JERRY'S ENTERPRISES CONTRIBUTING EMPLOYER 0 KINGS SOUPER MARKETS INC CONTRIBUTING EMPLOYER 0 KNOWLAN'S FESTIVAL FOODS CONTRIBUTING EMPLOYER 0 KOWALSKI'S MARKET CONTRIBUTING EMPLOYER 0 LUND FOOD HOLDINGS INC CONTRIBUTING EMPLOYER 0 MINERS INC CONTRIBUTING EMPLOYER 0 MN MEAT MASTERS CONTRIBUTING EMPLOYER 0 MOUND FOODS INC CONTRIBUTING EMPLOYER 0 OXENDALE COMPANIES CONTRIBUTING EMPLOYER 0 PAULSON'S CONTRIBUTING EMPLOYER 0 RADERMACHERS CUB SHAKOPEE 1997 LLC CONTRIBUTING EMPLOYER 0 S & R QUISBERG INC CONTRIBUTING EMPLOYER 0 SHOREWOOD INC CONTRIBUTING EMPLOYER 0 SHOREWOOD LLC CONTRIBUTING EMPLOYER 0 SUPER VALU INC CONTRIBUTING EMPLOYER 0 T & K FOODS INC CONTRIBUTING EMPLOYER 0 WILLSTON CORP CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1