2023-11-09T13:21:36-06:00 2022-12-31 320043599 LEGACY PROFESSIONALS LLP 6800 FRANCE AVENUE SO SUITE 550 EDINA MN 55435 990 2022-01-01 416023675 MISCELLANEOUS DRIVERS AND HELPERS LOCAL 638 HEALTH WELFARE EYE & DENTAL MISC 9528540795 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 MARTIN LAWRENCE CHAIRMAN 9528540795 2023-11-07 1 MARTIN LAWRENCE 999009999 0 ERIC C BAERTSCH P00964071 9528413950 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARTIN LAWRENCE 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 133105677 0 X N/A X 1953 MN TO PROVIDE HEALTH BENEFITS 6 0 0 0 0 0 0 0 76489293 83300054 2177288 763915 57 57 78666638 84064026 0 0 69828505 70943549 27000 21000 0 0 0 3047161 3092629 72902666 74057178 5763972 10006848 89661981 90006663 176354 104828 89485627 89901835 TO PROVIDE HEALTH BENEFITS 0 0 THE PLAN PROVIDES HEALTH, VISION, DENTAL, DISABILITY, PRESCRIPTION DRUG AND GROUP LIFE INSURANCE BENEFITS FOR ELIGIBLE PARTICIPANTS AND THEIR DEPENDENTS OR BENEFICIARIES. 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 10 0 1 0 0 0 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X WILSON-MCSHANE CORPORATION 9528540795 3001 METRO DRIVE 500 BLOOMINGTON MN 55425 MARTIN LAWRENCE CHAIRMAN 2.00 60.00 X 0 152284 59421 SCOTT LECY TRUSTEE 2.00 56.00 X 0 143577 59061 STEVE SEVIOLA TRUSTEE 2.00 50.00 X 0 143577 59036 STEVE HAWLEY SECRETARY 2.00 X 9000 0 0 LOWELL BIALICK TRUSTEE 2.00 X 0 0 0 AL GUDIM TRUSTEE 2.00 X 10500 0 0 MARK RIME TRUSTEE - PAST 2.00 X 1500 0 0 21000 439438 177518 0 0 1 0 BLUECROSS AND BLUESHEILD OF MN PO BOX 64560 ST PAUL MN 55164 MEDICAL BENEFIT MANAGER 1094028 WILSON-MCSHANE CORPORATION 3001 METRO DRIVE SUITE 500 BLOOMINGTON MN 55425 PLAN ADMIN/CLAIMS ADMIN 1083604 ERICKSON BELL BECKMAN & QUINN PA 1700 HIGHWAY 36 WEST SUITE 110 ROSEVILLE MN 55113 ATTORNEY 124581 3 EMPLOYER CONTRIBUTIONS 900099 77255008 77255008 PRESCRIPTION REBATES 900099 3533434 3533434 RETIREE CONTRIBUTIONS 900099 1824795 1824795 SUBROGATIONS 900099 535247 535247 COBRA CONTRIBUTIONS 900099 151570 151570 83300054 1653586 1653586 48151980 49041651 -889671 -889671 -889671 LITIGATION SETTLEMENT 900099 57 57 57 84064026 83300054 0 763972 70943549 21000 370000 164224 25990 350321 2061918 12136 28679 56664 FEES MANDATED BY ACA 22697 74057178 6300817 10385882 1700991 1815482 8163510 10575027 73496663 67230272 89661981 90006663 176354 104828 176354 104828 X 0 0 0 0 89485627 89901835 89485627 89901835 89661981 90006663 10006848 -9590640 0 X 0 1 X 1 0 0 X 74123065 -9590640 -9590640 83713705 350321 350321 84064026 73706857 0 73706857 350321 350321 74057178 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 MARTIN LAWRENCE CHAIRMAN 0 141484 0 0 0 10800 0 33197 0 26224 0 211705 0 0 SCOTT LECY TRUSTEE 0 132777 0 0 0 10800 0 32258 0 26803 0 202638 0 0 STEVE SEVIOLA TRUSTEE 0 132777 0 0 0 10800 0 32233 0 26803 0 202613 0 0 FORM 990, PART VI, SECTION A, LINE 3 ALTHOUGH THE TRUSTEES RETAIN 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 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PROVIDED TO THE ENTIRE BOARD OF TRUSTEES FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE TRUSTEES REVIEW THE PLAN'S CONFLICT OF INTEREST POLICY ANNUALLY. IN ADDITION, TO ENSURE THE PLAN OPERATES IN A MANNER CONSISTENT WITH ITS PURPOSE AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX EXEMPT STATUS AND FIDUCIARY OBLIGATIONS, PERIODIC REVIEWS OF COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ARE CONDUCTED BY THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PLAN'S PARTICIPANTS. THESE DOCUMENTS CAN BE OBTAINED BY REQUEST AT THE OFFICE OF THE THIRD PARTY ADMINISTRATOR. MISCELLANEOUS DRIVERS HELPERS AND WAREHOUSEMEN UNION LOCAL NO 638 CONTRIBUTING EMPLOYER 0 ST CLOUD METROPOLITAN TRANSIT COMMISSION CONTRIBUTING EMPLOYER 0 TEAMSTERS LOCAL 320 CONTRIBUTING EMPLOYER 0 TEAMSTERS JOINT COUNCIL 32 CONTRIBUTING EMPLOYER 0 AMERICAN FISH & SEAFOOD CONTRIBUTING EMPLOYER 0 ARCHITECTURAL SALES CONTRIBUTING EMPLOYER 0 BACHMANS CONTRIBUTING EMPLOYER 0 HEINRICH ENVELOPE CORPORATION CONTRIBUTING EMPLOYER 0 INNO-FLEX CORPORATION CONTRIBUTING EMPLOYER 0 KRONICK INDUSTRIES INC CONTRIBUTING EMPLOYER 0 NATIONAL PURITY LLC CONTRIBUTING EMPLOYER 0 OLSEN FISH COMPANY CONTRIBUTING EMPLOYER 0 TARGET CENTER ARENA MANAGEMENT LLC CONTRIBUTING EMPLOYER 0 UNITED PARCEL SERVICE CONTRIBUTING EMPLOYER 0 STAR TRIBUNE - FLEET CONTRIBUTING EMPLOYER 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1