TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) SCOTT GALE........................................................................ ALTERNATE LABOR TRUSTEE	0.00 .......................	X
(2) BURT JOHNSON........................................................................ LABOR TRUSTEE	0.00 .......................	X
(3) JAMIE HERMANSEN........................................................................ LABOR TRUSTEE	0.00 .......................	X
(4) DAVE SCHRUNK........................................................................ ALTERNATE LABOR TRUSTEE	0.00 .......................	X
(5) MIKE DUFOUR........................................................................ LABOR TRUSTEE	0.00 .......................	X
(6) GREG MASSEY........................................................................ LABOR TRUSTEE CO-CHAIR	0.00 .......................	X	X
(7) GARY REED........................................................................ LABOR TRUSTEE	0.00 .......................	X
(8) JUDD STOKES........................................................................ ALTERNATE LABOR TRUSTEE	0.00 .......................	X
(9) CHARLIE ROBERTS........................................................................ LABOR TRUSTEE	0.00 .......................	X
(10) KENT PETERSON........................................................................ MANAGEMENT TRUSTEE CO-CHAI	0.00 .......................	X	X
(11) SCOTT WEICHT........................................................................ MANAGEMENT TRUSTEE	0.00 .......................	X
(12) MARK HUBBARD........................................................................ MANAGEMENT TRUSTEE	0.00 .......................	X
(13) TOM DEPAUW........................................................................ MANAGEMENT TRUSTEE	0.00 .......................	X
(14) DOUG OLSON........................................................................ MANAGEMENT TRUSTEE	0.00 .......................	X
(15) MICHAEL COOK........................................................................ ALTERNATE LABOR TRUSTEE	0.00 .......................	X
(16) JOHN NESSE........................................................................ ALTERNATE MANAGEMENT TRUST	0.00 .......................	X
(17) DAVE SEMERAD........................................................................ ALTERNATE MANAGEMENT TRUST	0.00 .......................	X

(A)
Name and Title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(D)
Reportable compensation from the organization (W- 2/1099-MISC)

(E)
Reportable compensation from related organizations (W- 2/1099-MISC)

(F)
Estimated amount of other compensation from the organization and related organizations

(1) SCOTT GALE........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(2) BURT JOHNSON........................................................................
LABOR TRUSTEE

0.00
.......................

(3) JAMIE HERMANSEN........................................................................
LABOR TRUSTEE

0.00
.......................

(4) DAVE SCHRUNK........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(5) MIKE DUFOUR........................................................................
LABOR TRUSTEE

0.00
.......................

(6) GREG MASSEY........................................................................
LABOR TRUSTEE CO-CHAIR

0.00
.......................

(7) GARY REED........................................................................
LABOR TRUSTEE

0.00
.......................

(8) JUDD STOKES........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(9) CHARLIE ROBERTS........................................................................
LABOR TRUSTEE

0.00
.......................

(10) KENT PETERSON........................................................................
MANAGEMENT TRUSTEE CO-CHAI

0.00
.......................

(11) SCOTT WEICHT........................................................................
MANAGEMENT TRUSTEE

0.00
.......................

(12) MARK HUBBARD........................................................................
MANAGEMENT TRUSTEE

0.00
.......................

(13) TOM DEPAUW........................................................................
MANAGEMENT TRUSTEE

0.00
.......................

(14) DOUG OLSON........................................................................
MANAGEMENT TRUSTEE

0.00
.......................

(15) MICHAEL COOK........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(16) JOHN NESSE........................................................................
ALTERNATE MANAGEMENT TRUST

0.00
.......................

(17) DAVE SEMERAD........................................................................
ALTERNATE MANAGEMENT TRUST

0.00
.......................

(A)
Name and Title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(D)
Reportable compensation from the organization (W- 2/1099-MISC)

(E)
Reportable compensation from related organizations (W- 2/1099-MISC)

(F)
Estimated amount of other compensation from the organization and related organizations

(18) GARY THADEN........................................................................
ALTERNATE MANAGEMENT TRUST

0.00
.......................

(19) MATT FAIRBANKS........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(20) MICHAEL HAWTHORNE........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(21) RUSS SCHERBER........................................................................
LABOR TRUSTEE

0.00
.......................

(22) MARK ZIEGLER........................................................................
MANAGEMENT TRUSTEE

0.00
.......................

(23) HEATHER GRAZZINI........................................................................
ALTERNATE MANAGEMENT TRUST

0.00
.......................

(24) MICHAEL HEIDEN........................................................................
ALTERNATE LABOR TRUSTEE

0.00
.......................

(A)
Name and business address

(B)
Description of services

WILSON - MCSHANE CORPORATION3001 METRO DRIVEBLOOMINGTONMN55425

PLAN ADMINISTRATOR

826,176

Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet

Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.

(A)
Total expenses

(B)
Program service expenses

(D)
Fundraising expenses

Grants and other assistance to governments and organizations in the United States. See Part IV, line 21

Grants and other assistance to individuals in the United States. See Part IV, line 22

Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16

Benefits paid to or for members

Compensation of current officers, directors, trustees, and key employees ....

Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....

Other salaries and wages

Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....

Other employee benefits .......

Payroll taxes ...........

Fees for services (non-employees):

Management ......

826,176

Legal .........

3,282

Accounting ...........

8,650

Lobbying ...........

Professional fundraising services. See Part IV, line 17

Investment management fees ......

Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........

Advertising and promotion ....

Office expenses .......

3,738

Information technology ......

Royalties ..

Occupancy ...........

Travel ............

Payments of travel or entertainment expenses for any federal, state, or local public officials ......

Conferences, conventions, and meetings ....

530

Interest ...........

Payments to affiliates .......

Depreciation, depletion, and amortization .....

233

Insurance ..............

7,209

Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)

DISPUTE RESOLUTION EXAM

71,835

MEDIATION & ARBITRATION

26,406

EXCLUSIVE PROVIDER FEE

7,779

OTHER EXPENSE

3,292

All other expenses

Total functional expenses. Add lines 1 through 24e

959,130

Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet

if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............		1
2	Savings and temporary cash investments .........	184,422	2	159,975
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	28,548	4	36,747
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............		8
9	Prepaid expenses and deferred charges ..........	1,229	9	2,440
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	22,918
b	Less: accumulated depreciation .....	10b	14,753	8,398	10c	8,165
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........		15
16	Total assets. Add lines 1 through 15 (must equal line 34)......	222,597	16	207,327
	17	Accounts payable and accrued expenses .........	9,506	17	16,064
18	Grants payable .................		18
19	Deferred revenue ................	20,474	19	18,394
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................		25
26	Total liabilities. Add lines 17 through 25.........	29,980	26	34,458
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............		27
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........	192,617	30	172,869
31	Paid-in or capital surplus, or land, building or equipment fund .....	0	31	0
32	Retained earnings, endowment, accumulated income, or other funds	0	32	0
33	Total net assets or fund balances ...........	192,617	33	172,869
34	Total liabilities and net assets/fund balances ........	222,597	34	207,327

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............

(A)
Beginning of year

(B)
End of year

Cash–non-interest-bearing .............

Savings and temporary cash investments .........

184,422

159,975

Pledges and grants receivable, net ...........

Accounts receivable, net .............

28,548

36,747

Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................

Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L

Notes and loans receivable, net .............

Inventories for sale or use ..............

Prepaid expenses and deferred charges ..........

1,229

2,440

10a

Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D

10a

22,918

Less: accumulated depreciation .....

10b

14,753

8,398

10c

8,165

Investments—publicly traded securities ..........

Investments—other securities. See Part IV, line 11 .....

Investments—program-related. See Part IV, line 11 .....

Intangible assets ...............

Other assets. See Part IV, line 11 ...........

Total assets. Add lines 1 through 15 (must equal line 34)......

222,597

207,327

Accounts payable and accrued expenses .........

9,506

16,064

Grants payable .................

Deferred revenue ................

20,474

18,394

Tax-exempt bond liabilities .............

Escrow or custodial account liability. Complete Part IV of Schedule D..

Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified

persons. Complete Part II of Schedule L..........

Secured mortgages and notes payable to unrelated third parties ..

Unsecured notes and loans payable to unrelated third parties ....

Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................

Total liabilities. Add lines 17 through 25.........

29,980

34,458

Organizations that follow SFAS 117 (ASC 958), check here MediumBullet

and complete lines 27 through 29, and lines 33 and 34.

Unrestricted net assets ..............

Temporarily restricted net assets ...........

Permanently restricted net assets ...........

Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet

and complete lines 30 through 34.

Capital stock or trust principal, or current funds ........

192,617

172,869

Paid-in or capital surplus, or land, building or equipment fund .....

Retained earnings, endowment, accumulated income, or other funds

Total net assets or fund balances ...........

192,617

172,869

Total liabilities and net assets/fund balances ........

222,597

207,327

	(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) .....
4	Aggregate value at end of year ........


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

		Amount
c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......	1	939,382
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................	2e	0
3	Subtract line 2e from line 1.....................	3	939,382
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b.......................	4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......	5	939,382

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........	1	959,130
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d......................	2e	0
3	Subtract line 2e from line 1.....................	3	959,130
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.......................	4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......	5	959,130

Return Reference	Explanation
PART X, LINE 2:	THE TRUST ESTABLISHED TO HOLD FUND ASSETS IS QUALIFIED PURSUANT TO SECTION 501(C)(9) OF THE INTERNAL REVENUE CODE (IRC) AND, ACCORDINGLY, THE TRUST'S NET INVESTMENT INCOME IS EXEMPT FROM INCOME TAXES. THE TRUST HAS OBTAINED A FAVORABLE TAX DETERMINATION LETTER FROM THE INTERNAL REVENUE SERVICE DATED SEPTEMBER 8, 1997. THE FUND HAS BEEN AMENDED SINCE RECEIVING THE DETERMINATION LETTER. HOWEVER, THE FUND ADMINISTRATOR AND THE FUND'S TAX COUNSEL BELIEVE THAT THE FUND IS DESIGNED AND IS CURRENTLY BEING OPERATED IN COMPLIANCE WITH THE APPLICABLE REQUIREMENTS OF THE IRC. 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 HAS ANALYZED THE TAX POSITIONS TAKEN BY THE PLAN, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2013 AND 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE PLAN ADMINISTRATOR BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2010.

Return Reference	Explanation
FORM 990, PART VI, SECTION B, LINE 11	WHEN THE AUDITOR HAS PREPARED THE FORM 990, IT IS GIVEN TO THE AUDIT COMMITTEE AND THE BOARD OF TRUSTEES FOR REVIEW. THE TRUSTEES ARE ALLOWED TIME IN WHICH TO EXAMINE THE FORM 990 AND COMMUNICATE WITH THE ADMINISTRATOR IN THE EVENT THE TRUSTEE HAS ANY QUESTIONS OR COMMENTS. AT THE REQUEST OF ANY TRUSTEE, OR IF THERE ARE QUESTIONS OR COMMENTS THAT CANNOT BE ADEQUATELY AND FULLY ADDRESSED, THE ADMINISTRATOR WILL ARRANGE A CONFERENCE CALL FOR ALL TRUSTEES TO DISCUSS THE FORM 990 AND WHETHER OR NOT REVISIONS ARE NEEDED BEFORE IT IS FINALIZED.
FORM 990, PART VI, SECTION B, LINE 12C	1. AT THE FIRST MEETING OF THE BOARD OF TRUSTEES OF THE UCCWCF HELD EACH YEAR, A COPY OF THE CONFLICTS OF INTEREST POLICY IS DISTRIBUTED TO THE TRUSTEES. IN ADDITION, A DISCLOSURE STATEMENT IS DISTRIBUTED TO EACH TRUSTEE. THE DISCLOSURE STATEMENT HAS BEEN PREPARED IN COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY. FUND COUNSEL EXPLAINS TO THE BOARD THE OPERATION OF THE CONFLICTS OF INTEREST POLICY, WHAT TYPES OF INTERESTS HAVE TO BE DISCLOSED AND THE ADMINISTRATIVE PROCEDURES FOR ADVISING THE ORGANIZATION REGARDING INTERESTS TO BE DISCLOSED. TRUSTEES ARE ASKED AT THAT MEETING TO COMPLETE THE DISCLOSURE FORM AND RETURN IT TO THE ADMINISTRATOR. THE FORM IS COMPLETED BY EACH OF THE BOARD OF TRUSTEES AND ANY SENIOR STAFF OF WILSON-MCSHANE CORPORATION WORKING ON THE UCCWCF. 2. THE FUND ADMINISTRATOR REVIEWS THE CONFLICT DISCLOSURES WHEN RETURNED, AND REFERS ANY WITH CONFLICTS FOR FURTHER REVIEW. 3. ANY CONFLICTS THAT ARE DISCLOSED ARE REVIEWED BY THE FUND CO-CHAIRS IN CONJUNCTION WITH FUND COUNSEL. ANY TRUSTEE THAT HAS DISCLOSED A CONFLICT OF INTEREST WOULD BE PROHIBITED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON ANY MOTION REGARDING THE MATTER THAT GAVE RISE TO THE CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.

Return Reference

Explanation

FORM 990, PART VI, SECTION B, LINE 11

WHEN THE AUDITOR HAS PREPARED THE FORM 990, IT IS GIVEN TO THE AUDIT COMMITTEE AND THE BOARD OF TRUSTEES FOR REVIEW. THE TRUSTEES ARE ALLOWED TIME IN WHICH TO EXAMINE THE FORM 990 AND COMMUNICATE WITH THE ADMINISTRATOR IN THE EVENT THE TRUSTEE HAS ANY QUESTIONS OR COMMENTS. AT THE REQUEST OF ANY TRUSTEE, OR IF THERE ARE QUESTIONS OR COMMENTS THAT CANNOT BE ADEQUATELY AND FULLY ADDRESSED, THE ADMINISTRATOR WILL ARRANGE A CONFERENCE CALL FOR ALL TRUSTEES TO DISCUSS THE FORM 990 AND WHETHER OR NOT REVISIONS ARE NEEDED BEFORE IT IS FINALIZED.

FORM 990, PART VI, SECTION B, LINE 12C

1. AT THE FIRST MEETING OF THE BOARD OF TRUSTEES OF THE UCCWCF HELD EACH YEAR, A COPY OF THE CONFLICTS OF INTEREST POLICY IS DISTRIBUTED TO THE TRUSTEES. IN ADDITION, A DISCLOSURE STATEMENT IS DISTRIBUTED TO EACH TRUSTEE. THE DISCLOSURE STATEMENT HAS BEEN PREPARED IN COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY. FUND COUNSEL EXPLAINS TO THE BOARD THE OPERATION OF THE CONFLICTS OF INTEREST POLICY, WHAT TYPES OF INTERESTS HAVE TO BE DISCLOSED AND THE ADMINISTRATIVE PROCEDURES FOR ADVISING THE ORGANIZATION REGARDING INTERESTS TO BE DISCLOSED. TRUSTEES ARE ASKED AT THAT MEETING TO COMPLETE THE DISCLOSURE FORM AND RETURN IT TO THE ADMINISTRATOR. THE FORM IS COMPLETED BY EACH OF THE BOARD OF TRUSTEES AND ANY SENIOR STAFF OF WILSON-MCSHANE CORPORATION WORKING ON THE UCCWCF. 2. THE FUND ADMINISTRATOR REVIEWS THE CONFLICT DISCLOSURES WHEN RETURNED, AND REFERS ANY WITH CONFLICTS FOR FURTHER REVIEW. 3. ANY CONFLICTS THAT ARE DISCLOSED ARE REVIEWED BY THE FUND CO-CHAIRS IN CONJUNCTION WITH FUND COUNSEL. ANY TRUSTEE THAT HAS DISCLOSED A CONFLICT OF INTEREST WOULD BE PROHIBITED FROM PARTICIPATING IN ANY DISCUSSION OR VOTING ON ANY MOTION REGARDING THE MATTER THAT GAVE RISE TO THE CONFLICT OF INTEREST.

FORM 990, PART VI, SECTION C, LINE 19

THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

UNION CONSTRUCTION CRAFTS WORKERS'
COMPENSATION FUND

Employer identification number

41-1835606

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2013

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No
(1) AMERECT INC
(2) ADOLFSON & PETERSON CONSTRUCTION
(3) BRAXTON HANCOCK & SONS INC
(4) CUSTOM DRYWALL INC
(5) DJ KRANZ CO INC
(6) ERC
(7) FRATTALONE COMPANIES INC
(8) GRESSER COMPANIES INC
(9) JORGENSON CONSTRUCTION INC
(10) LAKEHEAD CONSTRUCTORS INC
(11) LAMETTI & SONS INC
(12) LBP MECHANICAL INC
(13) MIDWEST ASPHALT CORPORATION
(14) MINUTI-OGLE CO INC
(15) MUSKA ELECTRIC
(16) OLYMPIC COMPANIES INC
(17) AE CONRAD COMPANY
(18) ARCHITECTURAL SALES OF MN
(19) BITUMINOUS ROADWAYS
(20) ENEBAK CONSTRUCTION COMPANY
(21) GRAHAM CONSTRUCTION SERVICES INC
(22) HORWITZ INC
(23) KILLMER ELECTRIC CO INC
(24) MAX GRAY CONSTRUCTION INC
(25) MCNAMARA CONTRACTING INC
(26) MIDWEST CONCRETE SPECIALTIES INC
(27) NORTHLAND GROUP OF CO-DULUTH INC
(28) NORTHWEST ASPHALT INC
(29) PREMIER ELECTRICAL CORPORATION
(30) PRESTIGE DRYWALL
(31) ROYL MASONRY
(32) RYAN COMPANIES US INC
(33) SERICE CONSTRUCTION INC
(34) TWIN CITY GLASS CONTRACTORS INC
(35) ACE ELECTRICAL CONTRACTORS INC
(36) HOOVER CONSTRUCTION COMPANY
(37) Q3 CONTRACTING INC
(38) PALMER-SODERBERG INC
(39) BALD EAGLE ERECTORS INC
(40) FRERICHS CONSTRUCTION COMPANY
(41) PAINTING BY NAKASONE
(42) TWIN CITY TILE AND MARBLE COMPANY
(43) CRAWFORD-MERZ ANDERSON CONSTRUCTION
(44) AXEL H OHMAN INC
(45) AMERICAN MASONRY RESTORATION CORP
(46) MASTER MECHANICAL INC
(47) JOHNSON-WILSON CONSTRUCTORS INC
(48) JULIUS B NELSON & SON INC
(49) TOTAL MECHANICAL SERVICES INC
(50) COOL AIR MECHANICAL INC
(51) JONES & OTTENWELLER INC
(52) KUECHLE UNDERGROUND INC
(53) CARCIOFINI COMPANY
(54) ABLE FENCE INC
(55) BOILER SERVICES INC
(56) FEHN COMPANIES INC
(57) VALLEY-RICH CO INC
(58) SHAW-LUNDQUIST ASSOCIATES INC
(59) RYAN CONTRACTING CO
(60) TEKTON CONSTRUCTION CO (STAHL)
(61) BCM CONSTRUCTION INC
(62) J&K MASONRY INC
(63) GL CONTRACTING INC
(64) KERN & TABERY INC
(65) HOLLENBACK & NELSON INC
(66) RIES ELECTRIC COMPANY
(67) NORTHERN DEWATERING INC
(68) CORPORATE MECHANICAL INC
(69) PLATINUM FLOORCOVERING
(70) STONE CONSTRUCTION INC
(71) TA SCHIFSKY & SONS INC
(72) THE CAULKERS COMPANY INC
(73) GEPHART ELECTRIC CO INC
(74) ALVIN E BENIKE INC
(75) GILBERT MECHANICAL CONTRACTORS INC
(76) CROSSTOWN MASONRY INC
(77) PREMIUM CARPET INSTALLATION INC
(78) SHANK CONSTRUCTORS INC
(79) EMERALD BUILDERS INC
(80) VIC'S CRANE & HEAVY HAUL INC
(81) WOODY'S REBAR CO INC
(82) NORTHLAND MECHANICAL CONTRACTORS
(83) CARL E JOHNSON PLUMBING & HEATING
(84) CENTURY CONSTRUCTION COINC
(85) COMMERCIAL DRYWALL INC
(86) DULUTH READY MIX CONCRETE INC
(87) AIR CONDITIONING ASSOCIATES INC
(88) THOMAS AND SONS CONSTRUCTION INC
(89) ARMSTRONG CRANE AND RIGGING CORP
(90) MODERN HEATING AND AIR CONDITIONING
(91) MINNEAPOLIS GLASS COMPANY
(92) FLANNERY CONSTRUCTION
(93) BREDAHL PLUMBING INC
(94) GEORGE F COOK CONSTRUCTION CO
(95) MORCON CONSTRUCTION INC
(96) LLOYD'S CONSTRUCTION SERVICES INC
(97) ALDO INC
(98) CAMCO CONSTRUCTION INC
(99) H&B SPECIALIZED PRODUCTS INC
(100) H&B ELEVATORS
(101) MEDINA ELECTRIC INC
(102) PRIOR LAKE AGGREGATES INC
(103) CM CONSTRUCTION COMPANY INC
(104) DOBOSZENSKI & SONS INC
(105) LINCO FAB INC
(106) WTG TERRAZZO & TILE INC
(107) BLOOMINGTON ELECTRIC COMPANY
(108) MEISINGER CONSTRUCTION CO INC
(109) IMPERIAL WALL INC
(110) S A JORDAN CONSTRUCTION INC
(111) ALL METRO GLASS INC
(112) DEL'S CONSTRUCTION INC
(113) MG MCGRATH INC
(114) RIESGRAF'S INSTALLATION CO INC
(115) ADVANCED MASONRY RESTORATION INC
(116) BURSCHVILLE CONSTRUCTION
(117) KGM CONTRACTORS INC
(118) LS BLACK CONSTRUCTORS INC
(119) MAX STEININGER
(120) SEAL TREAT INC
(121) SUMMIT CONCRETE & MASONRY CONSTRUCTION
(122) KIFFMEYER INC
(123) NORTHDALE CONSTRUCTION
(124) JAMES STEELE CONSTRUCTION CO
(125) LENCI ENTERPRISES INC
(126) HOVLAND INC
(127) ACME TUCKPOINTING & RESTORATION CO
(128) DZIEDZIC CAULKING INC
(129) GEORGE SIEGFRIED CONSTRUCTION CO
(130) MURPHY RIGGING & ERECTING INC
(131) PINE BEND PAVING INC
(132) ENGELSMA CONSTRUCTION INC
(133) LATOUR CONSTRUCTION INC
(134) MID-NORTHERN ELECTRIC
(135) CROSSTOWN MECHANICAL INC
(136) GREINER CONSTRUCTION INC
(137) NORTH COUNTRY CONCRETE INC
(138) NORTHWEST SHEETMETAL CO OF ST PAUL INC
(139) WAGNER CONSTRUCTION INC
(140) HARRISON TILE COMPANY
(141) J&K BUILDERS INC
(142) WINONA HEATING & VENTILATING CO INC
(143) DIVISION V SHEET METAL INC
(144) JOHNSON-NELSON MASONRY INC
(145) BRUCE NELSON PLUMBING & HEATING INC
(146) DCOR TEC INC
(147) MAGNEY CONSTRUCTION INC
(148) MINGER CONSTRUCTION INC
(149) NORTHERN INDUSTRIAL ERECTORS
(150) ROCKET CRANE SERVICE INC
(151) LAKE AREA ROOFING AND CONSTRUCTION INC
(152) MAJOR MECHANICAL INC
(153) ST GERMAIN'S CABINET INC
(154) KLAMM MECHANICAL CONTRACTORS INC
(155) KIRK ACOUSTICS INC
(156) PARKOS CONSTRUCTION COMPANY INC
(157) BUDGET PLUMBING CORP
(158) CD TILE & STONE INC
(159) ALBERS MECHANICAL CONTRACTORS INC
(160) FOREST LAKE CONTRACTING INC
(161) HARDRIVES INC
(162) MEYER CONTRACTING INC
(163) SHANNON'S INC
(164) RACHEL CONTRACTING INC
(165) PETERSON SHEET METAL
(166) TARRAF CONSTRUCTION INC
(167) RAINBOW INC
(168) E&J REBAR INC
(169) TEAM MECHANICAL INC
(170) KB SERVICE COMPANY
(171) BINDER HEATING & AIR CONDITIONING INC
(172) COMMERCIAL ROOFING INC
(173) SEPPI BROTHERS CONCRETE PRODUCTS CORP
(174) CAPITAL CITY GLASS INC
(175) KRAUS ANDERSON COMPANIES INC
(176) MP JOHNSON CONSTRUCTION
(177) UNITED REFRACTORIES INC
(178) KRAEMER CONSTRUCTION INC
(179) CURB MASTERS INC
(180) ENVIROBATE INC
(181) GAGNON INC
(182) SOLBERG AGGREGATE INC
(183) UNITED STATES MECHANICAL INC
(184) BILLMAN CONSTRUCTION INC
(185) BRAXTON & SONS INC
(186) WEISE MASONRY INC
(187) FITOL HINTZ CONSTRUCTION INC
(188) ULLAND BROTHERS INC
(189) CONSTRUCTION RESULTS CORPORATION
(190) ROBERT R SCHROEDER CONSTRUCTION INC
(191) STEINKRAUS PLUMBING INC
(192) SUNRAM CONSTRUCTION INC
(193) AW KUETTEL & SONS INC
(194) ARROWHEAD CONCRETE WORKS INC
(195) UNITED GLASS INC
(196) SM HENTGES & SONS INC
(197) AG O'BRIEN PLUMBING & HEATING CO
(198) COMMERCIAL PLUMBING & HEATING
(199) STERN DRYWALL INC
(200) ALLIANCE MECHANICAL SERVICES INC
(201) CLIMATE MAKERS INC
(202) RAMSEY EXCAVATING COMPANY INC
(203) KMH ERECTORS INC
(204) ANDERSON GLASS CO INC
(205) DRESEL CONTRACTING INC
(206) MAYER ELECTRIC CORPORATION
(207) SCHADEGG MECHANICAL INC
(208) PETERSON COMPANIES INC
(209) RAINVILLE-CARLSON INC
(210) HOMECO INSULATION INC
(211) ALLAN MECHANICAL INC
(212) RESTORATION SYSTEMS INC
(213) HOFFMAN CONCRETE INC
(214) NORTHERN GLASS & GLAZING INC
(215) WATSON-FORSBERG CO
(216) FRASER MORRIS ELECTRIC
(217) KNUTSON CONSTRUCTION SERVICES INC
(218) FORCED AIR INC DBA WENZEL HEAT & AC
(219) WASCHE COMMERCIAL FINISHES INC
(220) ASSOCIATED MECHANICAL CONTRACTORS INC
(221) SR WEIDEMA INC
(222) COMMERCIAL REFRIGERATION SYSTEMS INC
(223) RADOTICH INC
(224) STEINHAGEN ENTERPRISES INC
(225) KELLINGTON CONSTRUCTION INC
(226) GF JEDLICKI INC
(227) MID-CITY MECHANICAL CORP
(228) RAY RIIHILUOMA INC
(229) TIMCO CONSTRUCTION INC
(230) HAMMERLUND CONSTRUCTION INC
(231) HAMMERLUND CONSTRUCTORS INC
(232) R&R EXCAVATING INC
(233) SONUS INTERIORS INC
(234) LEGENDS CONCRETE INC
(235) MINT ROOFING INC
(236) AID ELECTRIC CORPORATION
(237) FAIRCON SERVICE COMPANY
(238) COMMERCIAL KITCHEN SERVICES INC
(239) ARNT CONSTRUCTION COMPANY INC
(240) SCHAEFER HARDWOOD FLOORS
(241) NORTH VALLEY INC
(242) OPTIMUM MECHANICAL SYSTEMS INC
(243) TORRINI COMPANIES
(244) MINNESOTA DIRT WORKS INC
(245) ALBERS MECHANICAL SERVICES INC
(246) HARBOR CITY MASONRY INC
(247) ST PAUL LINOLEUM & CARPET
(248) HIGH FIVE ERECTORS II
(249) FPI PAVING CONTRACTORS INC
(250) MULCAHY NICKOLAUS LLC
(251) VCI ENVIRONMENTAL INC
(252) LEGEND MECHANICAL INC
(253) STRUCTURES HARDSCAPES SPECIALISTS INC
(254) A J LYSNE CONTRACTING CORPORATION
(255) ZINTL INC
(256) PAAPE COMPANIES INC
(257) PATRIOT ERECTORS INC
(258) DANNY'S CONSTRUCTION CO INC
(259) PHILLIPPI EQUIPMENT CO INC
(260) BECKER BROTHERS INC
(261) NORTH PINE AGGREGATE INC
(262) METRO SHEET METAL INC
(263) SEITZ BROTHERS INC
(264) KUSSKE CONSTRUCTION COMPANY INC
(265) PEOPLES ELECTRIC COMPANY INC
(266) INSULATION MIDWEST INC
(267) SPRIGGS PLUMBING & HEATING INC
(268) SCHNEIDER COMPANY INC
(269) OWENS COMPANIES INC
(270) RON KASSA CONSTRUCTION INC
(271) MASTER ELECTRIC COMPANY INC
(272) LINDSTROM ENVIRONMENTAL INC
(273) ALLTECH ENGINEERING CORP
(274) MARATHON GROUP
(275) RW CARLSTROM CONSTRUCTION CO
(276) KAS INVESTMENT COMPANY
(277) PRISM COMMERCIAL & INDUSTRIAL PAINTING
(278) KUNZ CONSTRUCTION CO
(279) TED KENNE CONSTRUCTION
(280) JR JENSEN CONSTRUCTION CO
(281) PETERSON BROTHERS ROOFING & CONSTRUCTION
(282) PRAIRIE ELECTRIC COMPANY
(283) A J LYSNE CONTRACTING CORPORATION
(284) BOSTROM SHEET METAL WORKS INC
(285) BRITE LITE ELECTRIC CO INC
(286) CW HOULE INC
(287) CENTRAIRE HEATING & AIR CONDITIONING INC
(288) CHAMPION STEEL INC
(289) CIVIL AG GROUP INC
(290) DONLAR CONSTRUCTION CO
(291) GEISLINGER & SONS INC
(292) GLADSTONE CONSTRUCTION INC
(293) LEGACY COMPANIES
(294) LEVAHN BROTHERS INC
(295) MARCY CONSTRUCTION CO
(296) METROPOLITAN MECHANICAL CONTRACTORS
(297) MINNESOTA ACOUSTICS INC
(298) PINNACLE WALL SYSTEMS
(299) PROGRESSIVE BUILDING SYSTEMS
(300) RTL CONSTRUCTION INC
(301) SCHURCON INC
(302) SEBCO INC
(303) STERLING ELECTRIC CORPORATION
(304) THOMAS FINN COMPANY
(305) YAW CONTRUCTION GROUP INC

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2013

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation
SCHEDULE R, PART VII	UNABLE TO OBTAIN FEDERAL TAX CLASSIFICATION FOR THE FOLLOWING CONTRIBUTING EMPLOYERS: BELAIR EXCAVATING BERG DRYWALL, LLC BERG PAINTING, LLC BRIN NORTHWESTERN GLASS COMPANY COMMERCIAL FLOORING SERVICES, LLC CONTRACT TILE & CARPET, LLC DONALD R. FRANTZ CONCRETE CONSTRUCTION FPD POWER DEVELOPMENT, LLC HARRIS MECHANICAL J&L ELECTRICAL SERVICES F&L STEEL ERECTORS K. PEARSON MECHANICAL, LLC KBB, LLC MARS CARPET SALES MICS CONSTRUCTION SERVICES MINERAL SERVICES PLUS, LLC MINNESOTA UTILITIES & EXCAVATING NAC MECHANICAL & ELECTRICAL SERVICES NASSEFF MECHANICAL CONTRACTORS NORTHLAND CONCRETE & MASONRY COMPANY, LLC PCI ROADS, LLC RICE LAKE CONSTRUCTION GROUP S.G.O. ROOFING & CONSTRUCTION, LLC SOLID REFRIGERATION, LLC SOUTHSIDE PLUMBING & HEATING TRADE ACCESS, LLC VEIT COMPANIES WENZEL PLYMOUTH PLUMBING, LLC YALE MECHANICAL

Return Reference

Explanation

SCHEDULE R, PART VII

UNABLE TO OBTAIN FEDERAL TAX CLASSIFICATION FOR THE FOLLOWING CONTRIBUTING EMPLOYERS: BELAIR EXCAVATING BERG DRYWALL, LLC BERG PAINTING, LLC BRIN NORTHWESTERN GLASS COMPANY COMMERCIAL FLOORING SERVICES, LLC CONTRACT TILE & CARPET, LLC DONALD R. FRANTZ CONCRETE CONSTRUCTION FPD POWER DEVELOPMENT, LLC HARRIS MECHANICAL J&L ELECTRICAL SERVICES F&L STEEL ERECTORS K. PEARSON MECHANICAL, LLC KBB, LLC MARS CARPET SALES MICS CONSTRUCTION SERVICES MINERAL SERVICES PLUS, LLC MINNESOTA UTILITIES & EXCAVATING NAC MECHANICAL & ELECTRICAL SERVICES NASSEFF MECHANICAL CONTRACTORS NORTHLAND CONCRETE & MASONRY COMPANY, LLC PCI ROADS, LLC RICE LAKE CONSTRUCTION GROUP S.G.O. ROOFING & CONSTRUCTION, LLC SOLID REFRIGERATION, LLC SOUTHSIDE PLUMBING & HEATING TRADE ACCESS, LLC VEIT COMPANIES WENZEL PLYMOUTH PLUMBING, LLC YALE MECHANICAL

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE A WORKER'S COMP. COLLECTIVELY-BARGAINED PROGRAM AUTHORIZED UNDER MINNESOTA STATUTES.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	24
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	837,415	938,614
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	869	54
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	714
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	838,284	939,382
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	861,707	959,130
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	861,707	959,130
19	Revenue less expenses. Subtract line 18 from line 12.......	-23,423	-19,748
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	222,597	207,327
21	Total liabilities (Part X, line 26).............	29,980	34,458
22	Net assets or fund balances. Subtract line 21 from line 20.....	192,617	172,869

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )
	TO PROVIDE A WORKER'S COMPENSATION COLLECTIVELY-BARGAINED PROGRAM AUTHORIZED UNDER MINNESOTA STATUTES: TO PROVIDE ALTERNATIVE DISPUTE RESOLUTION RULES AND REGULATIONS WHICH WILL PROVIDE A METHOD OF RESOLVING CONTESTED WORKERS' COMPENSATION CASES WITHIN THE STATE OF MINNESOTA' TO IMPROVE THE SAFETY AND WELFARE OF WORKERS WHO ARE COVERED UNDER THE PROGRAM.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	0	0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......
			Business Code
2a	EMPLOYER CONTRIBUTIONS		900099	840,515	840,515
b	PHYSICIAN OPINIONS		900099	71,835	71,835
c	MEDIATION/ARBITRATION		900099	26,264	26,264
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			938,614
3	Investment income (including dividends, interest, and other similar amounts).......			54			54
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	LIQUIDATED DAMAGES		900099	714			714
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			714
12	Total revenue. See Instructions......			939,382	938,614	0	768

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................
b	Buildings ................
c	Leasehold improvements ............
d	Equipment ................
e	Other .................	22,918	14,753	8,165
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				8,165

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

1.(a) Description of liability		(b) Book value
Federal income taxes









Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................