2023-11-13T14:48:35-06:00 2022-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2022-01-01 416023462 MINNESOTA CEMENT MASONS HEALTH AND WELFARE FUND MINN 6512561900 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 CHAD MORRIS TRUSTEE 6512561900 2023-10-31 1 CHAD MORRIS 999009999 0 JACOB D EKLUND P01455813 9528413950 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHAD MORRIS 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 19152467 0 X N/A X 1960 MN TO PROVIDE HEALTH BENEFITS 8 2 5 0 0 0 0 0 12747307 13566235 458823 82354 0 0 13206130 13648589 0 0 13331546 12857187 0 0 0 0 0 593799 577965 13925345 13435152 -719215 213437 24267811 22754532 69507 94402 24198304 22660130 TO PROVIDE HEALTH BENEFITS 0 0 TO PROVIDE HEALTH CARE, DENTAL, DEATH AND DISABILITY BENEFITS FOR ELIGIBLE MEMBERS AND THEIR DEPENDENTS OR BENEFICIARIES ON A SELF-INSURED BASIS. 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 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 5 1 0 0 0 0 0 0 0 0 0 0 X 8 2 0 1 0 0 0 1 0 1 0 0 0 1 1 1 1 0 0 0 0 0 X ZENITH AMERICAN SOLUTIONS 6512561900 2520 PILOT KNOB ROAD 325 MENDOTA HEIGHTS MN 55120 TIM WORKE TRUSTEE 2.00 X 0 0 0 SUBEN KANAGARATNAM TRUSTEE 2.00 X 0 0 0 STEVE BULACH TRUSTEE 2.00 X 0 0 0 MIKE SYVERSRUD TRUSTEE 2.00 44.00 X 0 118644 73284 JARROD ASLESON TRUSTEE 2.00 2.00 X 0 5277 1431 DAVID JOSLIN TRUSTEE - PAST 2.00 X 0 0 0 DAVE SCHUTTA TRUSTEE 2.00 46.00 X 0 120445 76616 BRIAN GULLICKSON TRUSTEE 2.00 44.00 X 0 120274 73284 BRIAN FARMER ALTERNATE TRUSTEE 2.00 0.50 X 0 0 0 MARTHA HENRICKSON TRUSTEE 2.00 X 0 0 0 CHAD MORRIS ALTERNATE TRUSTEE 2.00 44.00 X 0 120274 73284 0 484914 297899 0 0 1 0 HEALTHPARTNERS 8170 - 33RD AVENUE SO BLOOMINGTON MN 55425 CLAIMS ADMINISTRATION 617405 ZENITH AMERICAN SOLUTIONS 2520 PILOT KNOB ROAD SUITE 325 MENDOTA HTS MN 55120 THIRD PARTY ADMINISTRATOR 316270 2 EMPLOYER CONTRIBUTIONS 900099 11032555 11032555 HRA EMPLOYER CONTRIBUTIONS 900099 1278877 1278877 STOP-LOSS SETTLEMENTS 900099 417964 417964 PRESCRIPTION DRUG REBATES 900099 411096 411096 PARTICIPANT CONTRIBUTIONS 900099 259200 259200 166543 166543 13566235 373207 373207 5213025 5503878 -290853 -290853 -290853 13648589 13566235 0 82354 12857187 292169 89470 18200 56434 67905 16770 16185 9393 FEES MANDATED BY ACA 6171 DUES AND SUBSCRIPTIONS 5268 13435152 1340108 3084595 7304121 4891395 909737 881872 80771 10739 14633074 13885931 24267811 22754532 69507 94402 69507 94402 X 0 0 0 0 24198304 22660130 24198304 22660130 24267811 22754532 213437 -1751611 0 X 0 1 X 1 0 0 X 11840544 -1751611 -1751611 13592155 56434 56434 13648589 13378718 0 13378718 56434 56434 13435152 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE PLAN TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN UNCERTAIN TAX POSITIONS THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY TAX AUTHORITIES. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 0 0 DAVE SCHUTTA TRUSTEE 0 120445 0 0 0 0 0 54366 0 22250 0 197061 0 0 BRIAN GULLICKSON TRUSTEE 0 120274 0 0 0 0 0 52002 0 21282 0 193558 0 0 CHAD MORRIS ALTERNATE TRUSTEE 0 120274 0 0 0 0 0 52002 0 21282 0 193558 0 0 MIKE SYVERSRUD TRUSTEE 0 118644 0 0 0 0 0 52002 0 21282 0 191928 0 0 SIGNING OFFICER: SUBSEQUENT TO END OF YEAR, CHAD MORRIS WAS APPOINTED FROM AN ALTERNATE TRUSTEE ROLE TO A TRUSTEE ROLE. CHAD MORRIS IS THE PLAN'S PRINCIPAL OFFICER AND THE CURRENT YEAR SIGNER. 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 ZENITH AMERICAN SOLUTIONS AS THE THIRD PARTY ADMINISTRATOR OF THE PLAN. FORM 990, PART VI, SECTION A, LINE 7A THE PLAN IS GOVERNED BY EIGHT TRUSTEES, FOUR OF WHOM ARE APPOINTED BY THE RELATED LOCAL UNION, TWO OF WHOM ARE APPOINTED BY MINNESOTA CONCRETE AND MASONRY CONTRACTORS ASSOCIATION AND TWO OF WHOM ARE APPOINTED BY ASSOCIATED GENERAL CONTRACTORS OF MINNESOTA. THE LOCAL UNION AND THE TWO ORGANIZATIONS MAY EACH DESIGNATE AN ALTERNATE TRUSTEE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO AND REVIEWED BY THE ENTIRE BOARD OF TRUSTEES BEFORE IT 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. CEMENT MASONS LOCAL 633 CONTRIBUTING EMPLOYER 0 CITY OF MINNEAPOLIS CONTRIBUTING EMPLOYER 0 CITY OF ST PAUL CONTRIBUTING EMPLOYER 0 MN CEMENT PLAST SHOPHANDS CONTRIBUTING EMPLOYER 0 ST PAUL PUBLIC SCHOOLS CONTRIBUTING EMPLOYER 0 UNIVERSITY OF MINNESOTA CONTRIBUTING EMPLOYER 0 AP MIDWEST LLC CONTRIBUTING EMPLOYER 0 0 AVM CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 B & D ASSOCIATES LLC CONTRIBUTING EMPLOYER 0 0 CMS LLC CONTRIBUTING EMPLOYER 0 0 CONCRETE UNLIMITED LLC CONTRIBUTING EMPLOYER 0 0 CREATE CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 DIRTWORX LLC CONTRIBUTING EMPLOYER 0 0 ICON LLC CONTRIBUTING EMPLOYER 0 0 JEWELL SCANNING AND CORING LLC CONTRIBUTING EMPLOYER 0 0 KRAEMER NORTH AMERICA LLC CONTRIBUTING EMPLOYER 0 0 M A MORTENSON COMPANY CONTRIBUTING EMPLOYER 0 0 MCGOUGH CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 0 NEWTRON LLC CONTRIBUTING EMPLOYER 0 0 NORTHLAND CONSTRUCTORS LLC CONTRIBUTING EMPLOYER 0 0 OPUS DESIGN BUILD LLC CONTRIBUTING EMPLOYER 0 0 PCI ROADS LLC CONTRIBUTING EMPLOYER 0 0 REDSTONE CONSTRUCTION LLC CONTRIBUTING EMPLOYER 0 0 SS CONCRETE AND MASONRY LLP CONTRIBUTING EMPLOYER 0 0 TERRENE DEVELOPMENT LLC CONTRIBUTING EMPLOYER 0 0 THE CONCRETE COMPANY LLC CONTRIBUTING EMPLOYER 0 0 ULTRA CONCRETE LLC CONTRIBUTING EMPLOYER 0 0 ACOUSTICS ASSOCIATES INC CONTRIBUTING EMPLOYER 0 ALL PHASE CONTRACTING INC CONTRIBUTING EMPLOYER 0 ALVIN E BENIKE INC CONTRIBUTING EMPLOYER 0 AMES CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 AMERICAN CIVIL CONST W COAST CONTRIBUTING EMPLOYER 0 ARNIE MACKEY CONST INC CONTRIBUTING EMPLOYER 0 AXEL H OHMAN INC CONTRIBUTING EMPLOYER 0 B & H CONCRETE LANDSCAPING CONTRIBUTING EMPLOYER 0 BIGELOW BROTHERS PLASTERING CONTRIBUTING EMPLOYER 0 BITUMINOUS ROADWAYS INC CONTRIBUTING EMPLOYER 0 BOUGALIS INC CONTRIBUTING EMPLOYER 0 BRUCE'S CONTRACTING INC CONTRIBUTING EMPLOYER 0 BULACH CUSTOM ROCK CONTRIBUTING EMPLOYER 0 BUTLER CORING INC CONTRIBUTING EMPLOYER 0 C & C WINGER INC CONTRIBUTING EMPLOYER 0 C R CONCRETE INC CONTRIBUTING EMPLOYER 0 C R FISCHER AND SONS INC CONTRIBUTING EMPLOYER 0 C S MCCROSSAN CONST INC CONTRIBUTING EMPLOYER 0 CR MEYER AND SONS COMPANY CONTRIBUTING EMPLOYER 0 CARLSON LA VINE INC CONTRIBUTING EMPLOYER 0 CD SMITH CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 CONCRETE ARTS CONTRIBUTING EMPLOYER 0 CONCRETE IDEA INC CONTRIBUTING EMPLOYER 0 CONE CONSTRUCTION CONTRIBUTING EMPLOYER 0 CONSTRUCTION RESULTS CORP CONTRIBUTING EMPLOYER 0 CROSSTOWN MASONRY INC CONTRIBUTING EMPLOYER 0 DAVIS DRYWALL INC CONTRIBUTING EMPLOYER 0 DAYCO CONCRETE COMPANY INC CONTRIBUTING EMPLOYER 0 DIRT INC CONTRIBUTING EMPLOYER 0 DIVERSIFIED COATINGS INC CONTRIBUTING EMPLOYER 0 DOMINIONAIRE CONTRACTING INC CONTRIBUTING EMPLOYER 0 DONALD R FRANTZ CONST CO CONTRIBUTING EMPLOYER 0 DONLAR CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 DOYLE CONNER CO CONTRIBUTING EMPLOYER 0 ENCLOSE CONSTRUCTION SOLUTIONS CONTRIBUTING EMPLOYER 0 ENGELSMA CONSTRUCTION CONTRIBUTING EMPLOYER 0 ENGINEERING & CONST INNOVATION CONTRIBUTING EMPLOYER 0 ERICKSON BUILDERS CO INC CONTRIBUTING EMPLOYER 0 EXTERIOR BUILDING SERVICES CONTRIBUTING EMPLOYER 0 FLOOR TECHNOLOGIES INC CONTRIBUTING EMPLOYER 0 FOWLER & HAMMER INC CONTRIBUTING EMPLOYER 0 FOX VALLEY & VICINITYLAKE CO CONTRIBUTING EMPLOYER 0 FRITZ CONCRETE CONST INC CONTRIBUTING EMPLOYER 0 GENERAL FLOORING CONTRIBUTING EMPLOYER 0 GEORGE BOUGALIS & SONS CO CONTRIBUTING EMPLOYER 0 GEORGE SIEGFRIED CONTRIBUTING EMPLOYER 0 GRAHAM CONST SERVS INC CONTRIBUTING EMPLOYER 0 GRESSER COMPANIES INC CONTRIBUTING EMPLOYER 0 GRIDOR CONST INC CONTRIBUTING EMPLOYER 0 GROVE-JOHNSON COMPANY CONTRIBUTING EMPLOYER 0 GUSTAFSON & GOUDGE INC CONTRIBUTING EMPLOYER 0 HAMMERLUND INCORPORATED CONTRIBUTING EMPLOYER 0 HAWK CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 HMI (HOME MENDERS INC) CONTRIBUTING EMPLOYER 0 HOLLENBACK & NELSON INC CONTRIBUTING EMPLOYER 0 HOVLAND INC CONTRIBUTING EMPLOYER 0 IACARELLA CONSTUCTION CONTRIBUTING EMPLOYER 0 INTERSTATE IMPROVEMENT INC CONTRIBUTING EMPLOYER 0 JR JENSEN CONSTRUCTION CO CONTRIBUTING EMPLOYER 0 JE DUNN NORTH CENTRAL CONTRIBUTING EMPLOYER 0 JL THEIS INC CONTRIBUTING EMPLOYER 0 JMF CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 JOHNSON WILSON CONSTRUCTORS CONTRIBUTING EMPLOYER 0 JOSEPH CONST OF ST PAUL INC CONTRIBUTING EMPLOYER 0 KELLEHER CONSTRUTION INC CONTRIBUTING EMPLOYER 0 KGM CONTRACTORS INC CONTRIBUTING EMPLOYER 0 KIFFMEYER INC CONTRIBUTING EMPLOYER 0 KMAC INC CONTRIBUTING EMPLOYER 0 KNIFE LAKE CONCRETE INC CONTRIBUTING EMPLOYER 0 KNUTSON CONSTRUTION SERVICES CONTRIBUTING EMPLOYER 0 KOMITT CONCRETE INC CONTRIBUTING EMPLOYER 0 LS BLACK CONSTRUCTORS INC CONTRIBUTING EMPLOYER 0 LAKEHEAD CONSTRUTORS INC CONTRIBUTING EMPLOYER 0 LANDMARK CONTRACTORS INC CONTRIBUTING EMPLOYER 0 LANGER CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 LEGENDS CONCRETE INC CONTRIBUTING EMPLOYER 0 LENCI ENTERPRISES INC CONTRIBUTING EMPLOYER 0 LEWIS CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 LUNDA CONST CO CONTRIBUTING EMPLOYER 0 MAERTENS-BRENNY CONSTRUCTION CONTRIBUTING EMPLOYER 0 MAGNEY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MAP GENERAL MECHANICAL CONTR CONTRIBUTING EMPLOYER 0 MARKET & JOHNSON INC CONTRIBUTING EMPLOYER 0 MAVO SYSTEMS INC CONTRIBUTING EMPLOYER 0 MAX GRAY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MICHELS CONSTRUCTION CONTRIBUTING EMPLOYER 0 MICHELS COPRORATION CONTRIBUTING EMPLOYER 0 MICHELS ROAD & STONE INC CONTRIBUTING EMPLOYER 0 MIDDLETON CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 MIDWEST CONCRETE SPECIALTIES CONTRIBUTING EMPLOYER 0 MINNESOTA CONCRETE SPECIALTIES CONTRIBUTING EMPLOYER 0 MIRON CONSTRUCTION CO INC CONTRIBUTING EMPLOYER 0 MN STATE CURB & GUTTER CORP CONTRIBUTING EMPLOYER 0 MORCON CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 NEECK CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 NORTH COUNTRY CONCRETE INC CONTRIBUTING EMPLOYER 0 NORTHERN CONCRETE OF DULUTH CONTRIBUTING EMPLOYER 0 O'MALLEY CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 OLD CASTLE - ANCHOR BLOCK CONTRIBUTING EMPLOYER 0 PALMER SODERBERG INC CONTRIBUTING EMPLOYER 0 PARAGON COMPANY INC CONTRIBUTING EMPLOYER 0 PARK CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 PCL CONSTRUCTION SERVICES INC CONTRIBUTING EMPLOYER 0 QUALITY COATINGS LLC CONTRIBUTING EMPLOYER 0 QUALITY CUTTING & CORING INC CONTRIBUTING EMPLOYER 0 QUALITY DRYWALL & PLASTERING CONTRIBUTING EMPLOYER 0 RADOTICH INC CONTRIBUTING EMPLOYER 0 RAINBOW INC CONTRIBUTING EMPLOYER 0 RAM CONSTRUCTION SER OF MI INC CONTRIBUTING EMPLOYER 0 RESTORATION & CONSTRUCTION CONTRIBUTING EMPLOYER 0 RICE LAKE CONSTRUCTION GROUP CONTRIBUTING EMPLOYER 0 RIIHILUOMA RAY INC CONTRIBUTING EMPLOYER 0 RON KASSA CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 ROSTI CONSTRUCTION CONTRIBUTING EMPLOYER 0 RYAN COMPANIES US INC CONTRIBUTING EMPLOYER 0 RYAN CONTRACTING INC CONTRIBUTING EMPLOYER 0 S & R REINFORCING INC CONTRIBUTING EMPLOYER 0 S M HENTGES & SONS INC CONTRIBUTING EMPLOYER 0 SCHMIDT CURB COMPANY INC CONTRIBUTING EMPLOYER 0 SHAFER CONTRACTING COMPANY INC CONTRIBUTING EMPLOYER 0 SHEEHY CONSTRUCTION COMPANY CONTRIBUTING EMPLOYER 0 SIG OLSON & SONS PLASTERING CONTRIBUTING EMPLOYER 0 SNELSON COMPANIES INC CONTRIBUTING EMPLOYER 0 STANDARD SIDEWALK INC CONTRIBUTING EMPLOYER 0 STAFF CONCRETE CONST INC CONTRIBUTING EMPLOYER 0 STARTING LINE FLOOR COATINGS CONTRIBUTING EMPLOYER 0 STEENBERG-WATRUD CONST INC CONTRIBUTING EMPLOYER 0 STONE CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 SUMMIT CONCRETE & MASONRY CONS CONTRIBUTING EMPLOYER 0 SUPREME COATINGS & SUPPLY INC CONTRIBUTING EMPLOYER 0 SURFACE ART & PREP INC CONTRIBUTING EMPLOYER 0 SURFACE PROS LLC CONTRIBUTING EMPLOYER 0 SWANSON & YOUNGDALE INC CONTRIBUTING EMPLOYER 0 T CHRISTIAN CONSTRUCTION CONTRIBUTING EMPLOYER 0 T R CONCRETE INC CONTRIBUTING EMPLOYER 0 TAG CONSTRUCTION INC CONTRIBUTING EMPLOYER 0 THE BOLDT COMPANY CONTRIBUTING EMPLOYER 0 THE JAMAR COMPANY CONTRIBUTING EMPLOYER 0 THOMAS & SONS CONST INC CONTRIBUTING EMPLOYER 0 TI-ZACK CONCRETE INC CONTRIBUTING EMPLOYER 0 TOTAL CONSTRUCTION & EQUIPMENT CONTRIBUTING EMPLOYER 0 TWIN CITIES SPECIALTIES CONTRIBUTING EMPLOYER 0 WASCHE COMMERCIAL FINISHES INC CONTRIBUTING EMPLOYER 0 WENRICH CONSTRUCTION CONTRIBUTING EMPLOYER 0 WESTERN SPECIALTY CONTRACTORS CONTRIBUTING EMPLOYER 0 XCEL ENERGYNSP CONTRIBUTING EMPLOYER 0 ZENITH TECH INC CONTRIBUTING EMPLOYER 0 3-D CONCRETE & CONSTRUCTION CONTRIBUTING EMPLOYER 0 JOHN FOLEY MASONRY INC CONTRIBUTING EMPLOYER 0 CURB MASTERS INC CONTRIBUTING EMPLOYER 0 MICHELS PIPELINE CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1