2015-10-02T14:33:45-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-01-01 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 2015-10-01 1 DOUG BERTOSSI P00637990 6123764500 2014 2016-02-25 16:41:14Z MICHAEL COOK 2520 PILOT KNOB ROAD NO 325 MENDOTA HEIGHTS MN 55120 38823150 0 X N/A X 1961 MN PROVIDE HEALTH & WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 8 2 21 12 0 0 0 0 16056682 16819393 3581339 3815211 0 0 19638021 20634604 0 0 19581377 18096551 0 0 0 0 0 1597444 1661307 21178821 19757858 -1540800 876746 60269029 60905133 336760 480682 59932269 60424451 PROVIDE HEALTH AND WELFARE BENEFITS TO UNION MEMBERS AND THEIR DEPENDENTS. 0 0 PAYMENT OF HOSPITAL, MEDICAL, DENTAL, DISABILITY, DEATH, AND VISION BENEFITS FOR 1,515 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 1 895 0 21 1 0 0 0 0 0 0 X 8 2 0 0 0 0 0 0 0 1 1 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 MICHAEL COOK SEE SCHEDULE O 1.00 52.00 X X 0 1 0 PAUL WIESE MANAGEMENT TRUSTEE - SECRETARY 1.00 0.00 X X 0 0 0 ROGER BUIRGE UNION TRUSTEE 1.00 0.00 X 0 0 0 MARK CARON SEE SCHEDULE O 1.00 40.00 X 0 0 0 DARRIN DROSKY MANAGEMENT - ALTERNATE TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL GANZ SEE SCHEDULE O 1.00 46.00 X 0 0 0 FRANK GRAZZINI II MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 MONICA KELLEY MANAGEMENT TRUSTEE 1.00 1.00 X 0 0 0 MICHAEL LAPENSKY MANAGEMENT - ALTERNATE TRUSTEE 1.00 1.00 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 0 1 0 0 0 0 0 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 PLAN ADMINISTRATOR 899682 MEDICA DBA SELECT CARE ROUTE CP260 401 CARLSON PKWY PO BO MINNEAPOLIS MN 554409310 PPO 197170 FELHABER LARSON FENLON & VOGT 444 CEDAR STREET SUITE 2100 ST PAUL MN 551012136 LEGAL 125174 3 CONTRIBUTIONS 525100 16819393 16819393 16819393 1604541 1604541 20399216 18188546 2210670 2210670 2210670 20634604 16819393 0 3815211 18096551 859518 201376 34045 147796 113593 104781 5009 18060 TRANSITIONAL REINSURANC 177129 19757858 1838816 1583910 12588244 12812069 1206654 1451385 13346 56615 0 30708 44302951 44697734 319018 272712 60269029 60905133 185453 381889 151307 98793 336760 480682 X 0 0 0 0 59932269 60424451 59932269 60424451 60269029 60905133 876746 -384564 0 X 0 1 X 1 0 0 ADVANCE CONTRIBUTIONS FROM EMPLOYEES FOR FUTURE COVERAGE 98793 98793 X 20102244 -384564 -384564 20486808 147796 147796 20634604 19610062 0 19610062 147796 147796 19757858 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 2014 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 ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2011. ALL AGAPE CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 6018 6018 0 0 0 DAVIS MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 4049 4049 0 0 0 CHAMPION STEEL CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 303 303 0 0 0 CHAMPION STEEL CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 467 467 0 0 0 HICKS CONCRETE CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 32099 32099 0 0 0 INSTALLATION CONCEPTS CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 2200 2200 0 0 0 INTERIOR FLOORS & FIXTURES CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 193 193 0 0 0 LAKE COUNTRY MASONRY CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 7157 7157 0 0 0 PROJECT RESTORATION CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 279 279 0 0 0 STRIP RIGHT CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 3730 3730 0 0 0 SUNRISE SPECIALTY CONTRACTING CONTRIBUTING EMPLOYER LATE CONTRIBUTIONS X 120 120 0 0 0 56615 FORM 990, PART VI, SECTION B, LINE 11 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 MARK CARON, 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 PROVIDER 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 A D B CONSTRUCTION CO INC A J SPANJERS CO A&M CONSTRUCTION INC ACME TUCKPOINTING & RESTOR ADVANCE TERRAZZO & TILE CO ALVIN BENIKE INC AMERICAN MAS RESTORATION CORP ANDERSON MAS & CONCRETE INC AXEL H OHMAN INC B & D ASSOCIATES INC B & M MASONRY INC BEDROCK-FLINT INC BOB'S SPARKLE WASH CAMCO CONSTRUCTION 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 DEBCON II DBA O'CONNOR CONST DEL'S CONSTRUCTION CO INC DZIEDZIC CAULKING INC EICHOLTZ MASONRY INC EXCALIBUR CAULKING INC EXTERIOR BUILDING SERVICES INC FABCON INC FLEMMING TILE INC FRANDRUP MASONRY INC GEORGE P REINTJES CO INC GEORGE SIEGFRIED CONST CO GLASS DESIGN INC GORDON CONST OF MAHNOMEN INC GRANITE-TOPS INSTALLATION INC GRAZZINI BROTHERS CO GRESSER COMPANIES INC HANSON STRUCT PRCST MIDWST INC HARBOR CITY MASONRY INC HAUGEN MASONRY CONTRACTORS INC HEYMANN CONSTRUCTION CO HOLLENBACK & NELSON INC HOVLAND INC HUESMAN SCHREIBER MASONRY INCOR INSTALLATION INC INDUSTRIAL MAINTENANCE SERVICE INSTALLATION CONCEPTS INC J E DUNN CONSTRUCTION COMPANY JAMES STEELE CONSTRUCTION CO JOHNNY MASONRY INC JOHNSON & NELSON JOHNSON CARPET KASELLA CONCRETE INC KIFFMEYER INC KNUTSON CONSTRUCTION SERVICES LAKEHEAD CONSTRUCTORS INC LANDWEHR CRANE SERVICES LLC LEE'S CERAMICS INC LOUHI & KIVELA MASONRY INC M A MORTENSON CO MACPHERSON-TOWNE CO MAERTENS-BRENNY CONSTRUCTION MARK 1 RESTORATION COMPANY MARKET & JOHNSON INC MAVO SYSTEMS INC MCGOUGH CONSTRUCTION CO INC MOLIN CONCRETE PRODUCTS MORTENSON MASONRY INC NATUS INSTALLATIONS NEECK CONSTRUCTION INC NORTHLAND CONCRETE & MASONRY PARAMOUNT CONCRETE & MAS INC RESTORATION SYSTEMS INC RICE LAKE CONSTRUCTION GROUP RIGHTWAY CAULKING ROYL MASONRY SCHLEIS FLOOR COVERING INC SEAL-TREAT INC SEBCO INC SERICE CONSTRUCTION INC SHEEHY CONSTRUCTION CO SHOTLEY CONSTRUCTION INC SMITH-SHARPE FIRE BRICK SUPPLY STEENBERG - WATRUD CONST INC STONE CONSTRUCTION INC STRETAR MASONRY & CONCRETE INC STRIPE RIGHT INC SUNRISE SPECIALTY CONTR TAILORED FOAM INC THE CAULKERS COMPANY INC THE JAMAR COMPANY UNITED REFACTORIES INC WEISE MASONRY INC WESTERN WATERPROOFING WTG TERRAZZO & TILE INC YAW CONSTRUCTION GROUP INC YOUNG MASONRY INC ZACHMAN PRECAST INC 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 RELATED ORGANIZATIONS TAXABLE AS AN INDIVIDUAL OR SOLE PROPRIETOR: HANSON MASONRY & CONCRETE LLC RELATED ORGANIZATIONS THAT NO TAX CLASSIFICATION WAS GIVEN FOR: ADVANCED MASONRY RESTORATION ARDAGH GLASS INC. ATOMIC ARCHITECTUAL SHEET METAL BLACKHAWK TILE & STONE INC BUILDING RESTORATION CORP C R MEYER & SONS COMPANY CONSTRUCTION IND OF CENTRAL IL D & D STONE, LLC EAGLE CAULKING ENGELSMA CONSTRUCTION INC GABEL MASONRY CONSTRUCTION INC GAGE BROTHERS CAULKING GOFF MASONRY LLC GUSTAFSON & GOUDGE INC HAMMERLUND'S CHAMPION STEELE HARBOR CITY MASONRY INC HARLAN FALCK & SON INC HARRISON TILE CO INC HAWKEYE FLOORING COMPANY LANGER CONSTR CO LONDON BRICK M C MAGNEY CONST MAVERICK CUTTING & BREAKING METROPOLITAN TILE & MARBLE MIDWESTERN MASONRY INC MOSAICA LLC NEW JERSEY B.A.C. NIKKEL TILE INC NORTHWESTERN MARBLE & GRANITE PELLAND-SWENSON & ASSOC PROJECT RESTORATIONS INC REFRACTORY SERVICE INC RESCH'S TILE INC S & S MASONRY INC. SEEDORFF MASONRY, INC SERVAIS TILE & STONE, INC. SPECIAL SCHOOL DISTRICT #1 SUMMIT CONCRETE & MAS CONST TCR ENTERPRISES DBA J&K MASON TED KENNE CONSTRUCTION TOTAL CONSTRUCTION & EQUIPMENT TWIN CITY TILE & MARBLE CO UNITED MASONRY INC WELLS CONCRETE PRODUCTS CO WISCONSIN MASONS FRINGE FUNDS WITCHER CONSTRUCTION