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Contract No. 2013 2524
2®y3 2S?4. COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION Columbia Heights,Minnesota AUDITED FINANCIAL STATEMENTS For the Year Ended December 31,2012 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION TABLE OF CONTENTS ELECTED OFFICIALS AND ADMINISTRATION .................................................................. 1 INDEPENDENT AUDITOR'S REPORT..................................................................................... 2 BASIC FINANCIAL STATEMENTS Statement of Fiduciary Net Position—Special Pension Trust Fund............................................ 6 Statement of Changes in Fiduciary Net Position—Special Pension Trust Fund......................... 7 Notes to the Financial Statements................................................................................................ 9 REPORT ON LEGAL COMPLIANCE........................................................................................ 14 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION ORGANIZATION December 31,2012 Board of Trustees Position Term Expires Troy Neurauter President December 31,2013 Ben Uden Vice President December 31,2012 Shannon Abbott Secretary December 31,2014 William Shutte Treasurer December 31,2014 Tom Flermoen Trustee December 31,2012 Andy Hall Trustee December 31,2013 Ex Officio Gary Peterson Mayor Walt Fehst City Manager Gary Gorman Fire Chief 1 -q'*V Y****6D Expert advice. When you need it.' INDEPENDENT AUDITOR'S REPORT Board of Trustees Columbia Heights Fire Department Volunteer Relief Association Columbia Heights,Minnesota Report on the Financial Statements -We have audited the accompanying financial statements of the Special Pension Trust Fund of the Columbia Heights Fire Department Volunteer Relief Association, Columbia Heights,Minnesota, as of and for the year ended December 31, 2012, and the related Notes to the Financial Statements,which collectively comprise the Association's basic financial statements as listed in the Table of Contents. Management's Responsibility for the Financial Statements Management is responsible for the preparation and fair presentation of these financial statements in accordance with accounting principles generally accepted in the United States of America;this includes the design,implementation and maintenance of internal control relevant to the preparation and fair presentation of financial statements that are free from material misstatement,whether due to fraud or error. Auditor's Responsibility Our responsibility is to express opinions on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America. Those Standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement. An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor's judgment,including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments,the auditor considers internal control relevant to the Association's preparation and fair presentation of the financial statements in order to design audit procedures that are appropriate in the circumstances,but not for the purpose of expressing an opinion on the effectiveness of the Association's internal control. Accordingly,we express no such opinion. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of significant accounting estimates made by management, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion. 2 KD`V Opinions In our opinion, the financial statements referred to above present fairly,in all material respects,the respective financial position of the Special Pension Trust Fund of the Columbia Heights Fire Department Relief Association, Columbia Heights,Minnesota, as of December 31,2012, and the respective changes in financial position thereof for the year then ended in accordance with accounting principles generally accepted in the United States of America. Other Matters Omitted Required Supplementary Information The Association has omitted the Management's Discussion and Analysis that accounting principles generally accepted in the United States of America require to be presented to supplement the basic financial statements. Such missing information, although not part of the basic financial statements,is required by the Governmental Accounting Standards Board (GASB), who considers it to be an essential part of the financial reporting for placing the basic financial statements in an appropriate operation, economic or historical context. Our opinion on the basic financial statements is not affected by this missing information. KERN,DEWENTER,VIERS, LTD. Bloomington,Minnesota June 19,2013 3 (THIS PAGE LEFT BLANK INTENTIONALLY) 4 BASIC FINANCIAL STATEMENTS 5 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION STATEMENT OF FIDUCIARY NET ASSETS - SPECIAL PENSION TRUST FUND December 31,2012 ASSETS Cash $ 11,693 Investments: Minnesota State Board of Investments 1,353,599 Accounts Receivable 5,000 Total Assets 1,370.292 LIABILITIES Accounts Payable 2,200 NET POSITION Held in Trust for Pension Benefits $ 1,368,092 The Notes to the Financial Statements are an integral part of this statement. 6 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION STATEMENT OF CHANGES IN FIDUCIARY NET ASSETS- SPECIAL PENSION TRUST FUND For the Year Ended December 31,2012 ADDITIONS Contributions State of Minnesota $ 64,464 State of Minnesota - Supplemental Benefit 2,000 Total Contributions 66,464 Investment Income Interest and Dividends 3 Net Appreciation in Fair Value of Investments 174,597 Net Investment Income 174,600 Total Additions 241,064 DEDUCTIONS Benefit Distributions 236,767 Audit and Actuarial Services 4,545 Salaries 2,200 Miscellaneous 1,300 Total Deductions 244,812 Net Decrease (3,748) NET POSITION Beginning of Year 1,371,840 End of Year $ 1,368,092 The Notes to the Financial Statements are an integral part of this statement. 7 (THIS PAGE LEFT BLANK INTENTIONALLY) 8 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION NOTES TO THE FINANCIAL STATEMENTS December 31,2012 NOTE 1—SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES A. Fund Accounting The resources of the Columbia Heights Fire Department Volunteer Relief Association(the "Association") are accounted for in one fund: Special Fund—This Fund is a pension trust fund for the accumulation of resources to be used for retirement,dependency and disability annuity payments of appropriate amounts and at appropriate times in the future. Resources are contributed from the 2%insurance premium tax and amortization aid from the State of Minnesota. B. Measurement Focus,Basis of Accounting and Financial Statement Presentation The fiduciary fund financial statements are reported using the economic resources measurement focus and the accrual basis of accounting. Revenues are recorded when they are earned and expenses are recorded when a liability is incurred, regardless of the timing of related cash flow. C. Deposits and Investments The Association's cash and cash equivalents are considered to be cash on hand, demand deposits and highly liquid debt instruments purchased with original maturities of three months or less from the date of acquisition. Investments are stated at fair value. Minnesota Statutes require that all deposits be protected by federal depository insurance, corporate surety bonds or collateral. The market value of collateral pledged must equal 110%of the deposits not covered by Federal Deposit Insurance Corporation(FDIC)insurance or corporate surety bonds. Minnesota Statutes authorizes the Association to invest in obligations of the U.S. Treasury, agencies and instrumentalities, shares of investment companies whose only investments are in the aforementioned securities, obligations of the State of Minnesota or its municipalities, bankers' acceptances, future contracts, corporate bonds,common stock and foreign stock of the highest quality,mutual funds and in the State Board of Investments. The Association has not adopted a deposit policy to address custodial credit risk for deposits. The Association does not have formal policies in place to address interest rate risk, credit risk, concentration of credit risk or custodial credit risk for investments. Custodial Credit Risk—Deposits: For deposits,this is the risk that in the event of bank failure, the Association's deposits may not be returned to it. The Association does not have a policy addressing this risk. Interest Rate Risk: This is the risk that market values of securities in a portfolio would decrease due to changes in market interest rates. Credit Risk: This is the risk that an issuer or other counterparty to an investment will not fulfill its obligations. State law limits investments in commercial papers and corporate bonds to the top two ratings issued by nationally recognized statistical rating organizations. 9 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION NOTES TO THE FINANCIAL STATEMENTS December 31,2012 NOTE 1—SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES C. Deposits and Investments (Continued) Concentration of Credit Risk: This is the risk of loss attributed to the magnitude of an investment in a single issuer. Custodial Credit Risk—Investments: For an investment,this is the risk that in the event of the failure of the counterparty,the Association will not be able to recover the value of its investments or collateral securities that are in the possession of an outside party. E. Valuation of Investments The Association recognizes investment income when it is earned. Investments are reported at fair value. Securities traded on a national or an international exchange, are valued at the last reported sales price at current exchange rates. There are no investments in,loans to or leases with parties related to the pension plan. NOTE 2—DEPOSITS AND INVESTMENTS A. Deposits In accordance with applicable Minnesota Statutes,the Association maintains deposits at depository financial institutions authorized by the Association's Board. As of December 31,2012, the Association's bank balance of$ 11,693 was insured by FDIC insurance. The Association's deposits had a book balance as follows: Checking $ 6,331 Savings 5,362 Total Deposits $ 11,693 B. Investments As of December 31, 2012,the Association's only investment of$ 1,353,599 was with the State Board of Investments. The Association's investments with the State Board of Investment are not subject to credit risk, custodial credit risk or concentration of credit risk. 10 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION NOTES TO THE FINANCIAL STATEMENTS December 31, 2012 NOTE 2—DEPOSITS AND INVESTMENTS C. Balances The following is a summary of total deposits and investments: Deposits(Note 2.A.) $ 11,693 Investments(Note 2.B.) 1,353,599 Total Deposits and Investments $ 1,365,292 Deposits and investments are presented in the December 31,2012 basic financial statements as follows: Statement of Fiduciary Net Assets: Cash $ 11,693 Investments 1,353,599 Total $ 1,365,292 NOTE 3—PLAN DESCRIPTION A. Identification of the Plan Firefighters of the Columbia Heights(the"City") are members of the Association. The Association is the administrator of a single-employer defined contribution lump sum pension plan available to firefighters that was established on February 18, 1942, and operates under the provisions of Minnesota Statutes Section 424A. The Association is governed by a board of nine members. Six of the Board Members are elected by the members of the Association for three-year terms and the City Mayor, City Manager and Fire Chief are appointed as ex officio,voting members. For financial reporting purposes, the Association's financial statements were not included with the City's financial statements because the Association is not a component unit of the City. B. Current Membership As of December 31,2012, membership data related to the Association was: Active Plan Participants 22 Inactive/Deferred Members 15 Total 3'7 11 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION NOTES TO THE FINANCIAL STATEMENTS December 31,2012 NOTE 3—PLAN DESCRIPTION C. Benefit Provisions The exclusive pension provided by the Association is a defined contribution lump sum service pension as defined in Minnesota Statutes Section 424A.02. No contributions are required from the plan members. The plan is funded by contributions from the 2%fire aid from the State of Minnesota, investment earnings and discretionary contributions from the City. A member shall be eligible to share in the contribution and forfeitures,if any, for a plan year only if the member is credited with at least one month of service during the plan year, and either(a)is a member on December 31 of the plan year or(b) terminated membership for reasons other than death or disability. Contributions to be made to the Special Pension Trust Fund and forfeitures, if any, for a plan year shall be allocated among the individuals entitled to a share in the contribution for such plan year, in the ratio that the months of service credited during such plan year for each individual bears to the months of service credited during such plan year for all such individuals. Each member who is at least 50 years of age,has retired from the Columbia Heights Fire Department (the"Fire Department"),has served at least five years of active service with such department before retirement and has been a member of the Association in good standing at least five years prior to such retirement is eligible to receive a distribution of his/her vested individual account balance. A member who becomes permanently unable to serve as an active firefighter in the Fire Department because of a total and permanent disability arising from active service in the Fire Department shall be eligible to collect,upon approval of the Board of Trustees, a disability benefit from the Association an amount equal to the service pension amount in his/her account balance. The entire account of a member shall be distributed as survivor benefits in a lump sum to the member's beneficiaries. According to the bylaws of the Association and pursuant to Minnesota Statutes 424A.02, Subd.2 and 4, members who retire with less than 10 years of service and have reached the age of 50 years and have completed at least 5 years of active membership are entitled to a reduced service pension not to exceed the amount calculated by multiplying the member's service pension for the completed years of service times the applicable nonforfeitable percentage of pension as shown as follows. Completed Years Nonforfeitable Percentage of Service of Pension Amount 5 40 6 52 7 64 8 76 9 88 10 and Thereafter 100 12 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION NOTES TO THE FINANCIAL STATEMENTS December 311 2012 NOTE 3—PLAN DESCRIPTION C. Benefit Provisions (Continued) The payment amount will be calculated by using the amount payable per value of the member's account multiplied by the appropriate percentage as defined above. Former members eligible to receive a distribution may choose from any of the following payment methods: • Single lump sum payable to the retiree; or • Lump sum payment to an eligible insurance carrier on behalf of the retiree; or • Installment payments or • Rollover to qualifying IRA These benefit provisions may be amended by a favorable vote of two-thirds of members present and voting,provided a quorum exists at any regular or special meeting. This benefit amendment must also be ratified by the City Council. D. Contributions Made The State of Minnesota contributes amortization aid,or a 2%fire aid,in accordance with state statute requirements. The State Legislature may amend contribution requirements of the City and State. Contributions totaling $ 64,464 were made by the State,in accordance with state statute requirements for the year ended December 31, 2012. 13 KDV Expert advice When you need it.' REPORT ON LEGAL COMPLIANCE Board of Trustees Columbia Heights Fire Department Volunteer Relief Association Columbia Heights,Minnesota We have audited, in accordance with auditing standards generally accepted in the United States of America, the financial statements of the Columbia Heights Fire Department Volunteer Relief Association, Columbia Heights, Minnesota, as of and for the year ended December 31, 2012, and the related notes to the financial statements, and have issued our report thereon dated June 19,2013. The Minnesota Legal Compliance Audit Guide for Political Subdivisions, promulgated by the State Auditor pursuant to Minn. Stat. § 6.65, contains three categories of compliance to be tested in audits of relief associations: deposits and investments, conflicts of interest, and relief associations. In connection with our audit, nothing came to our attention that caused us to believe that the relief failed to comply with the provisions of the Minnesota Legal Compliance Audit Guide for Political Subdivisions. However, our audit was not directed primarily toward obtaining knowledge of such noncompliance. Accordingly, had we performed additional procedures, other matters may have come to our attention regarding the relief's noncompliance with the above referenced provisions. This report is intended solely for the information and use those charged with governance and management of the relief and the State Auditor and is not intended to be and should not be used by anyone other than these specified parties. KERN,DEWENTER,VIERS, LTD. Bloomington,Minnesota June 19,2013 14 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION Columbia Heights,Minnesota COMMUNICATIONS LETTER For the Year Ended December 31,2012 COLUMBIA HEIGHTS FIRE DEPARTEMENT RELIEF ASSOCIATION TABLE OF CONTENTS REPORT ON MATTERS IDENTIFIED AS A RESULT OF THE AUDIT OF THE FINANCIAL STATEMENTS............................................................... I MATERIALWEAKNESS.............................................................................................................. 3 REQUIRED COMMUNICATION................................................................................................ 4 Y -'4* 4s,DV Expert advice. When you need it.dM11 REPORT ON MATTERS IDENTIFIED AS A RESULT OF THE AUDIT OF THE FINANCIAL STATEMENTS Board of Trustees Columbia Heights Fire Department Volunteer Relief Association Columbia Heights,Minnesota in planning and performing our audit of the financial statements of the Columbia Heights Fire Department Volunteer Relief Association, Columbia Heights,Minnesota, as of and for the year ended December 31, 2012, in accordance with auditing standards generally accepted in the United States of America, we considered the Association's internal control over financial reporting(internal control)as a basis for designing our auditing procedures that are appropriated in the circumstances for the purpose of expressing an opinion on the financial statements,but not for the purpose of expressing an opinion on the effectiveness of the Association's internal control. Accordingly,we do not express an opinion on the effectiveness of the Association's internal control. Our consideration of internal control was for the limited purpose described in the preceding paragraph and was not designed to identify all deficiencies in internal control that might be material weaknesses or significant deficiencies and,therefore, material weaknesses or significant deficiencies may exist that were not identified. However, as discussed below,we identified certain deficiencies in internal control that we consider to be material weaknesses. A deficiency in internal control exists when the design or operation of a control does not allow management or employees, in the normal course of performing their assigned functions,to prevent or detect and correct,misstatements on a timely basis. A material weakness is a deficiency,or combination of deficiencies in internal control, such that there is a reasonable possibility that a material misstatement of the Association's financial statements will not be prevented or detected and corrected on a timely basis. The material weaknesses identified are described within this letter. A significant deficiency is a deficiency, or combination of deficiencies,in internal control that is less severe than a material weakness, yet important enough to merit attention by those charged with governance. The matters discussed herein were considered by us during our audit and they do not modify the opinion expressed in our Independent Auditor's Report dates June 19,2013,on such statements 1 KD. "V This communication is intended solely for the information and use of the Board of Trustees and the Association members and is not intended to be and should not be used by anyone other than these specified parties. KERN, DEWENTER, VIERE, LTD. Bloomington, Minnesota June 19, 2013 2 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION MATERIAL WEAKNESSES December 31,2012 PREPARATION OF FINANCIAL STATEMENTS The Association does not have an internal control system designed to provide for the preparation of the financial statements being audited. As auditors, we were requested to draft the financial statements and accompanying Notes to the Financial Statements. This circumstance is not unusual in an association of your size. This condition increases the risk that errors could occur which would not be detected and corrected in a timely manner. Even though all management decisions related to financial reporting are made by the Association's management and approval of the financial statements lies with management, it is the responsibility of management and those charged with governance to make the decision whether to accept the degree of risk associated with this condition because of--ost or other considerations. LACK OF SEGREGATION OF ACCOUNTING DUTIES During the year ended December 31, 2012, the Association had a lack of segregation of accounting duties due to a limited number of members performing these functions. The lack of adequate segregation of accounting duties could adversely affect the Association's ability to initiate,record,process and report financial data consistent with the assertions of management in the financial statements. The Board of Trustees is aware of this condition,but has determined the cost of obtaining desirable segregation of accounting duties exceeds the benefits, which could be derived. Because of this,the Board of Trustees has determined a complete segregation of accounting duties is impractical to correct. The Board of Trustees and Association representatives must remain aware of this situation and should continually monitor the systems in place, including changes that occur. 3 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION REQUIRED COMMUNICATION December 31,2012 We have audited the financial statements of the Association for the year ended December 31,2012 and have issued our report dated June 19, 2013. Professional standards require that we provide you with the following information related to our audit. OUR RESPONSIBILITY UNDER AUDITING STANDARDS GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA As stated in our engagement letter, our responsibility,as described by professional standards,is to express an opinion about whether the financial statements prepared by management with your oversight are fairly presented,in all material respects, in conformity with accounting principles generally accepted in the United States of America. Our audit of the financial statements does not relieve you or management of your responsibilities. Our responsibility is to plan and perform our audit to obtain reasonable, but not absolute, assurance that the financial statements are free of material misstatement. As part of our audit,we considered the internal control of the Association. Such considerations were solely for the purpose of determining our audit procedures and not to provide any assurance concerning such internal control. We are responsible for communicating significant matters related to the audit that are,in our professional judgment,relevant to your responsibilities in overseeing the financial reporting process. However, we are not required to design procedures specifically to identify such matters. As part of obtaining reasonable assurance about whether the Association's financial statements are free of material misstatement, we performed tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements,noncompliance with which could have a direct and material effect on the determination of financial statement amounts. However, providing an opinion on compliance with those provisions was not an objective of our audit. PLANNED SCOPE AND TIMING OF THE AUDIT We performed the audit according to the planned scope and timing previously communicated to you. QUALITATIVE ASPECTS OF ACCOUNTING PRACTICES Management is responsible for the selection and use of appropriate accounting policies. In accordance with the terms of our engagement letter, we will advise management about the appropriateness of accounting policies and their application. The significant accounting policies used by the Association are described in Note I to the financial statements. No new accounting policies were adopted and the application of existing policies was not changed during 2012. We noted no transactions entered into during the year for which there is a lack of authoritative guidance or consensus. There are no significant transactions that have been recognized in the financial statements in a different period than when the transaction occurred. Accounting estimates are an integral part of the financial statements prepared by management and are based on management's knowledge and experience about past and current events and assumptions about future events. Certain accounting estimates are particularly sensitive because of their significance to the financial statements and because of the possibility that future events affecting them may differ significantly from those expected. No significant accounting estimates were required in the preparation of the financial statements. The disclosures in the financial statements are neutral, consistent and clear. 4 COLUMBIA HEIGHTS FIRE DEPARTMENT VOLUNTEER RELIEF ASSOCIATION REQUIRED COMMUNICATION December 31,2012 DIFFICULTIES ENCOUNTERED IN PERFORMING THE AUDIT We encountered no difficulties in dealing with management in performing and completing our audit. CORRECTED AND UNCORRECTED MISSTATEMENTS Professional standards require us to accumulate all known and likely misstatements identified during the audit,other than those that are trivial, and communicate them to the appropriate level of management. Management did not identify and we did not notify them of any uncorrected financial statement misstatements. DISAGREEMENTS WITH MANAGEMENT For purposes of this letter, professional standards define a disagreement with management as a financial accounting, reporting or auditing matter,whether or not resolved to our satisfaction that could be significant to the financial statements or the auditor's report. We are pleased to report that no such disagreements arose during the course of our audit. MANAGEMENT REPRESENTATIONS We requested certain representations from management which were provided to us in the management representation letter. MANAGEMENT CONSULTATIONS WITH OTHER INDEPENDENT ACCOUNTANTS In some cases,management may decide to consult with other accountants about auditing and accounting matters, similar to obtaining a"second opinion"on certain situations. If a consultation involves application of an accounting principle to the Association's financial statements or a determination of the type of auditor's opinion that may be expressed on those statements,our professional standards require the consulting accountant to check with us to determine that the consultant has all the relevant facts. We are not aware of any consultations by the Association's management with other accountants during the course of our audit. OTHER ISSUES We generally discuss a variety of matters, including the application of accounting principles and auditing standards,with management each year prior to retention as the Association's auditors. However,these discussions occurred in the normal course of our professional relationship and our responses were not a condition to our retention. OTHER INFORMATION IN DOCUMENTS CONTAINING AUDITED FINANCIAL STATEMENTS We have not reviewed, and it is our understanding,that no other published documents exist that contain audited financial statement information, for which we are currently auditing. As stated in our engagement letter, if you publish or reproduce the financial statements or make reference to our Firm name in relation to such documents, you agree to provide us with a copy of the final reproduced material for our approval before it is distributed. 5 Form RF-12 Reporting Form 2012 Financial,Investment and Plan Information for the Year Ended 12/31/12 Relief Name: Columbia Heights Fire Relief Association (Office use only) Please provide the address,email address and telephone numbers for the work location(s)at which you conduct relief association business.THIS CONTACT INFORMATION IS PUBLIC;IT WILL BE AVAILABLE TO ANYONE ON REQUEST. Relief Association Officers Primary Contact President First Name: Troy Last Name: Neurauter Address: 825 41 st Ave NE City: Columbia Heights State: MN ZIP: 55421 Telephone: (763)706-3650 Fax: Email: Q Secretary First Name: Shannon Last Name: Abbott Address: 825 41 st Ave NE City: Columbia Heights State: MN ZIP: 55421 Telephone: (763)706-3650 Fax: Email: Q Treasurer First Name: William Last Name: Shutte Address: 825 41 st Ave NE City: Columbia Heights State: MN ZIP: 55421 Telephone: (763)706-3650 Fax: Email: If applicable,Secretary of the independent nonprofit firefighting corporation: First Name: Last Name: Address: City: State: MN ZIP: Telephone: Fax: Email: Form RF-12 Columbia Heights Fire Relief Association Section 1 - Plan Information A.Fire Department Affiliation&Member Counts The Fire Relief Association is associated with:(choose one) (9) A municipality which has a fire department. Q An independent nonprofit firefighting corporation which contracts with municipalities. Enter the appropriate number: 22 Active members in the Relief Association Lump sum service distributions 15 Inactive members who are defierred Lump sum survivor distributions Other inactive members(medical and other leave) Lump sum disability distributions 37 Total Active+Inactive with Relief Association Monthly benefit recipients (retired,disabled and survivor) B. Vesting&Ancillary Benefits(must be stated in bylaws) Years re uired for full vesting in: Partial Vesting in Bylaws? Years required for partial vesting in: 10 Fire Department Yes Q No �EIRelief Fire D artment © 10 Relief Association Association 50 Minimum age to receive retirement benefits Amount Per Short-term Disability Long-term Disability balance Survivor Benefit balance C.Plan Type& Information Q Defined Benefit Lump Sum O Defined Benefit Monthly* Q Defined Benefit Monthly*/Lump Sum *You must submit an ACTUARIAL.YALUA TI[lN if one was prepared this year. An actuarial valuation must be prepared every other year_ In addition,an updated actuarial valuation must be prepared each time you change your benefit. Defined Contribution^ ^You must submit an ALLOCATION TABLE showing the name of each member,the beginning account balance for each account,allocations to each account for 2012 and ending account balance. You may use the allocation table provided by the Office of the State Auditor or your own form. D.Bonding,Bylaws &Resolutions © Yes Q No Is the Treasurer bonded for at least 10%of assets?(Amount of bond need not exceed$500,000) LS 110001000 Amount Q Yes d No Is the Secretary bonded? Q Yes © No Did you amend your bylaws for 2012? Q Yes (0) No Did you modify your benefits for 2012? Form RF-12 Columbia Heights Fire Relief Association Section 2 -Investments Special Fund General Fund Cash(including all non-interest bearing accounts at banks,credit unions or thrift institutions) 6,331 Certificates of Deposit(time deposits) Other interest bearing accounts(at banks,credit unions or thrifts, including Money Market Accounts) 5,362 Treasury Bonds&Bills Domestic Stock International Stock Corporate Bonds(domestic) Government Bonds(domestic) Corporate and Government Bonds(international) Venture Capital,Resource or Real Estate Limited Partnerships State Board of Investment(SBI) - Bond Market 394,294 State Board of Investment(SBI) - Common Stock 477,540 State Board of Investment(SBI) - Growth Share 481,765 State Board of Investment(SBI) - Income Share State Board of Investment(SBI) - International Share State Board of Investment(SBI) - Money Market Mutual Funds and Exchange Traded Funds: List mutual funds(including Money Market mutual funds)and exchange traded funds held at 12/31/2012 below. 0 0 Other Other Total Investments at 12/31/2012 1.365292 0 List mutual funds and exchange traded funds below Amount 12/31/2012 Ticker Symbol Fund/Account Name Special Fund General Fund Contact for investment information First Name: Last Name: Business Name Business Telephone Business Email Form RF-12 Columbia Heights Fire Relief Association Section 3-Financial Information Special Fund General Fund A.Total Net Assets as of December 31,2011 1,371,8401 p Revenues-2012 State Fire Aid 64,464 State 10%Supplemental Reimbursement 2,000 Municipal/Independent Fire Department Contributions Member Contributions/Dues Interest&Dividends 3 Appreciation/(Depreciation)in Fair Market Value(Realized or unrealized) 174,597 LESS:Investment Management Fees Fundraising Revenue Outside Donations Outside Donations Outside Donations Other Income Other Income Other Income B. Total Revenues 24110641- 41,064 p Benefit Expenditures-2012 Service Pensions -Retirees 236,767 Service Pensions -Monthly Service Pensions-Survivors Service Pensions-Disabled Illness or Short-term Disability I. Total Benefit Expenditures 236.-671 Administrative Expenditures-2012 Salmi' 2,200 Conventions&Meetings Dues Training Professional Fees (Actuarial,Audit and Legal) 4,545 Bond Investment Performance Evaluation Fundraising Expenses Other Expenditures Consulting 1,300 Other Expenditures Other Expenditures Other Expenditures Other Expenditures Other Expenditures 2. Total Administrative Expenditures 8 045 0 C.Total Expenditures(1 +2) 244,8121 � D.Transfers (Can be made from General Fund to Special Fund only) E. Total Net Assets at December 31,2012(A+B-C+/-D) 1.368,002 0 Form RF-12 Columbia Heights Fire Relief Association Section 3-Financial Information(Continued) F. Selected Assets and Liabilities -Special Fund General Fund Accounts Receivable(Other than interest income receivable) 5,000 Interest or Dividends Receivable Other Assets Accounts Payable or Other Liabilities 2,200 Accrued Liability-2012 G.Pension Payments:Defined Benefit Lump Sum and Defined Contribution Plans Regular Supplemental Retirement Benefit Benefit Total Benefit Columbia Heights Fire Relief Association Total: 234,76; .2,0001 236.767 Yearly Vesting Benefit Regular Supplemental Name % Amount Retirement Benefit Benefit Total Benefit Dana Alexon 921 108,0631 107,0631 1,0001 108,063 Date of Entry Sep. LOA Total Years Benefit Birth Date Date and BIS (&months if offered) Return to Service Member? T e imn'dd/yyyy mm/dd/yyyy mm dd yyyy (months) Years Months D 12/4.11961 2/1/1981 3/15/2005 621 18 11 Yearly Vesting Benefit Regular Supplemental Name % Amount Retirement Benefit Benefit Total Benefit Steven Hall 1 1001 128,7041 127,7041 1,0001 128.704 Date of Entry Sep. LOA Total Years Benefit Birth Date Date and BIS (&months if offered) Return to Service Member? L T mmdd/yM mmdd.'yyyy mm/dd/yyyy (months) Years Months e fn C 1 7/9/1955 4/1/1988 6/1/20111 171 211 =9 Benefit Type Codes Column Descriptions A. Service Pension-Active,Fully Vested Date of Birth-Date of Birth of member.(mmvdd/yyyy) B. Service Pension-Active,Partially Vested Entry&Separation Date-Dates member began and ended service C. Service Pension-Deferred,Fully Vested with fire department.(mm/dd'yyyy) D. Service Pension-Deferred,Partially Vested I Leaves of Absence and Breaks in Service-Cumulative time in E. Survivor Benefit leave status in months from fire department. F. Illness,Short-term Disability G. Long-term or Permanent Disability Total Years-Years of service,less leaves of absence,with fire department. Only use months if partial years are allowed in bylaws. Vesting%-Percentage due to member per bylaw provisions. Yearly Benefit Amount-Amount per year of service used to compute regular benefit. Use bylaw amount at time of separation. Regular Retirement Benefit-Years(and months,if offered)x Yearly Benefit x Vesting%+Deferred Interest,if paid. Supplemental-Benefit under Minn.Stat. §424A.10. Total Benefit-Regular+Supplemental Return to Service Member?-Select"Yes"if member returned to active service and membership under the retum-to-service law. Form RF-12 Columbia Heights Fire Relief Association Section 4-Signatures Relief and Municipal Certification We certify that to the best of our knowledge and belief,the information presented in this report is true and accurate: Signature:RELIEF ASSOCIATION PRESIDENT,SECRETARY,OR TREASURER DATE First Name Last Name Title 7/1 Signature MU PAL CLERK*See instructions DATE BUSINESS TELEPHONE LC 6-0baJ61+ First Name Last Name (If the relief association is affiliated with an Independent Firefighting Corporation serving more than one community,the municipal clerk for the largest community served by the fire department must sign) Auditor or Accountant Certification Associations with Assets and Liabilities LESS THAN$200,000 An independent accountant may certify the reporting form below or,if qualified as a certified public accountant,provide a separate attestation report by March 31,2013. Pursuant to Minn.Stat.§69.051,subd.1 a(b),1 have examined the preceding statement of revenues,expenditures/expenses and total net assets (including investment information)of the Special Fund and the General Fund,and hereby certify this financial information is presented in conformity with Minn.Stat.§69.051,subd. I a(a),except if noted on the signed,dated sheet attached. First Name Last Name NAME OF AUDITOR/ACCOUNTANT NAME OF FIRM Street Address City State Zip Code ADDRESS OF FIRM Signature:AUDITOR/ACCOUNTANT DATE BUSINESS TELEPHONE FAX NUMBER EMAIL ADDRESS Associations with Assets or Liabilities of At Least $200,000 Pursuant to Minn.Stat.§69.051,subd. 1(3),a certified public accountant,public accountant,or the state auditor most attest to,and submit,audited financial statement of the relief association to the Office of the State Auditor. The Reporting Form and audit report must be submitted by June 30,2013. Form SID-12 Investment Disclosure Report Form (Total Market Value Less Than $25 Million) For the Year Ended December 31, 2012 Public Pension Plan Name Columbia Heights Fire Relief Association Contact Person Troy Neurauter First Name Last Name Investment Advisor/Broker First Name Last Name When completing the attached form, make sure the Public Pension Plan includes ALL SPECIAL FUND ACCOUNTS in each quarter's total portfolio market values including checking accounts, savings accounts,brokerage accounts,etc. If, on January 1, 2012, the Public Pension Plan's total market value of assets was less than $25 million, and the fund has never filed using Form BID, the Public Pension Plan must file using Form SID. If the Public Pension Plan equals or exceeds $25 million in total market value, the Public Pension Plan must file Form BID. Once the Public Pension Plan has filed Form BID, it will be required to file Form BID in the future regardless of asset size. The Public Pension Plan may include computed time-weighted rates of return with the report, in addition to all other required information, as applicable. If returns are supplied, the method used to calculate rates of return must comply with that specified in law. Has the Public Pension Plan collected and retained the following information: (Please retain and be able to submit individual account or portfolio data to the Office of the State Auditor on request.) - Signed Broker Certification form(s)(BC-1)? C. Yes L No 1,t` N/A - Signed Statements of Economic Interest? Q 'i e> 0 Id,, - Signed Investment Business Recipient Disclosure Form? (D Yes (D No - The market value of each investment account and investment portfolio at the beginning of the calendar year and for each quarter ti) Yes C) No pursuant to Minn. Stat. § 356.219,subd.3(g)? - The date and amount of each injection and withdrawal to each investment account and investment portfolio pursuant to Minn. i) 'Yes C) Nra Stat. §356.219, subd. 3(g)? - Did the Public Pension Plan amend its investment policy statement () Yes (I-k' No in 2012? Failure to file investment disclosure reporting forms as required by law will result in the withholding of all state fire aid or state appropriation to which the Public Pension Plan may otherwise be entitled (Minn.Stat.;356.219). Form SID-12 Section 1 Investment Disclosure Report Form End of Year Asset Allocation- 12/31/12 Public Pension Plan Name Columbia Heights Fire Relief Association Special Fund Market Value 12/31/12 Cash(including all non-interest bearing accounts at banks,credit unions or thrift institutions) $ 6,331 Certificates of Deposit(time deposits) Other interest bearing accounts(at banks,credit unions or thrifts including Money Market accounts) $ 5,362 Treasury Bonds and Bills Domestic Stock International Stock Corporate Bonds(domestic) Government Bonds(domestic) Corporate and Government Bonds(international) Venture Capital,Resource,or Real Estate Limited Partnerships State Board of Investment(SBI) - Bond Market $ 394,294 State Board of Investment(SBI) - Common Stock $ 477,540 State Board of Investment(SBI) - Fixed Interest State Board of Investment(SBI) - Growth Share $ 481,765 State Board of Investment(SBI) - Income Share State Board of Investment(SBI) - International Share State Board of Investment(SBI) - Money Market Mutual Funds and Exchange Traded Funds. List mutual funds(include Money Market mutual funds)and exchange traded funds held at 12/31/12 below. $ - Other Describe here. Other Describe here. Total Investments at 12/31/12(Must equal 4th quarter ending value) $ 1,365,292 List mutual funds and exchange traded funds below Ticker Symbol Fund/Account Name Mkt Value 12/31/12 Form SID-12 Section 2 Market Values: First Quarter Beginning Value 1,307,886 (December 31,201 I/January 1,2012) First Quarter Ending Value 1,498,553 (March 31,2012) Second Quarter Ending Value 1,469,937 (June 30,2012) Third Quarter Ending Value 1,300,965 (September 30,2012) Fourth Quarter Ending Value 11365,292 (December 31,2012) Cash Flows In State Aid Description,if needed. 2/21/2012 $ 63,554 State Aid Description,if needed. 11/6/2012 $ 64,464 Choose Type Description,if needed. Choose Date Enter Amount Choose Type Description,if needed. Choose Date Enter Amount Choose Type Description,if needed. Choose Date Inter Amount Choose Type Description,if needed. Choose Date Enter Amount Choose Type Description,if needed. Choose Date Enter Amount Cash Flows Out Salary President Stipend 2/21/2012 $ 1,000 Salary Treasurer Stipend 2/21/2012 $ 800 Salary Secretary Stipend 2/21/2012 $ 800 Benefit Payment Steven Hall Pension Payment 8/24/2012 $ 128,704 Benefit Payment Dana Alexon Pension Payment 8/28/2012 $ 108,063 Administrative Expense Consulting Fee 11/23/2012 $ 1,000 Administrative Expense Audit Fee 11/27/2012S 4,545 Administrative Expense Consulting Fee 12/31/2012 $ 300 Investment Management Fees Choose Type Description,if needed. Choose Date Enter Amount Choose Type Description,if needed. Choose Date Enter Amount Choose Tie Description,if needed. Choose Date Enter Amount Choose Type Description,if needed. Choose Date Enter Amount Choose Type Description,if needed. Choose Date Enter Amount