2019-04-01T10:08:23-05:00 2018-06-30 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2017-07-01 416255919 ISD #535 HEALTH AND DENTAL CARE TRUST ISD5 5073284225 615 SEVENTH STREET SW ROCHESTER MN 55902 JOHN CARLSON EXECUTIVE DIRECTOR OF FINANCE 5073284225 2019-02-26 1 CRAIG POPENHAGEN P01587689 5074347000 67.137.57.251 2019-02-26 11:45:41 CS P 48DF7E18B51ED0D4ADE189227F60937B8E503023 AE419FF41DEE4B5733E7E5F8E31ABE2574D75352 2017 2019-02-21 02:37:17Z JOHN CARLSON 615 SEVENTH STREET SW ROCHESTER MN 55902 32601640 0 X N/A X 1982 MN TO PROVIDE SELF-INSURED HEALTH AND DENTAL INSURANCE FOR DISTRICT EMPLOYEES AND RETIREES. 5 2 0 0 0 0 0 0 31053168 32457108 119634 144532 0 0 31172802 32601640 0 0 0 0 447647 429339 0 0 0 30402811 26642740 30850458 27072079 322344 5529561 14001190 19369785 3859068 3698102 10142122 15671683 TO PROVIDE SELF-INSURED HEALTH AND DENTAL INSURANCE FOR DISTRICT EMPLOYEES AND RETIREES. 0 0 THE TRUST PROVIDES FOR EMPLOYER GROUP HEALTH AND DENTAL BENEFITS TO ELIGIBLE EMPLOYEES AND RETIREES. ESTABLISHED A HIGH DEDUCTIBLE HEALTH PLAN WITH AN HRA COMPONENT 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 X REBECCA PERLICH 5073284225 615 7TH STREET SW ROCHESTER MN 55902 EMILY LYNCH TRUSTEE 0.20 X 0 74700 16936 STEVE GIFFORD TRUSTEE 0.20 X 0 0 0 WAYNE WOXLAND TRUSTEE 0.20 X 0 0 0 JOHN CARLSON TRUSTEE/PLAN ADMINISTRATOR 0.20 X 0 137129 19680 GARY SMITH TRUSTEE 0.20 X 0 7200 0 0 219029 36616 0 0 1 0 MAYO CLINIC HOSPITAL ROCHESTER 1216 2ND ST SW ROCHESTER MN 55902 MEDICAL CLAIMS 7539406 MAYO CLINIC 200 1ST ST SW ROCHESTER MN 55905 MEDICAL CLAIMS 6094828 OLMSTED MEDICAL CENTER 210 9TH STREET SE ROCHESTER MN 55904 MEDICAL CLAIMS 3617785 PARTNERS IN EXCELLENCE 14301 EWING AVENUE BURNSVILLE MN 55306 MEDICAL CLAIMS 459628 MAYO CLINIC HEALTH SYSTEM LAKE CITY MED 500 W GRANT ST LAKE CITY MN 55041 MEDICAL CLAIMS 166685 5 PREMIUM CHARGES 525100 32457108 32457108 32457108 144532 144532 32601640 32457108 0 144532 301846 109277 18216 11282 258 CLAIM EXPENSES 26621267 SOFTWARE EXPENSE 8634 MISCELLANEOUS EXPENSE 924 FOOD EXPENSE 206 169 27072079 4581958 9804434 199 4160 9187941 9385505 231092 175686 14001190 19369785 1005835 990740 2853233 2707362 3859068 3698102 X 10142122 15671683 10142122 15671683 14001190 19369785 5529561 0 X X 0 1 X 1 0 0 SELF-INSURANCE CLAIMS PAYABLE 2222666 NET PENSION LIABILITY 306365 COMPENSATED ABSENCES PAYABLE 58313 DEFERRED INFLOW - PENSION 71360 NET OPEB LIABILITY 48658 2707362 0 0 0 JOHN CARLSON TRUSTEE/PLAN ADMINISTRATOR 0 137129 0 0 0 0 0 13116 0 6564 0 156809 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM 990 IS REVIEWED BY THE PLAN ADMINISTRATOR PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION C, LINE 19 THE TRUST MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C THE ROCHESTER PUBLIC SCHOOLS (INDEPENDENT SCHOOL DISTRICT #535) BOARD OF EDUCATION ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, LINE 9: TRUSTEES WHO CANNOT BE REACHED AT THE ORGANIZATION'S ADDRESS: STEVE GIFFORD WELLS FARGO FINANCIAL CENTER ROCHESTER 4368 SHETLAND PLACE NW ROCHESTER, MN 55912 WAYNE WOXLAND BCBS OF MN 1301 SOPPA DR. ST. CHARLES, MN 55972 FORM 990, PART VI, SECTION B, LINE 15 ISD #535 HEALTH AND DENTAL CARE TRUST DOES NOT HAVE ANY EMPLOYEES. THE SALARY, BENEFITS, AND PAYROLL TAX EXPENSE ON PAGE 10 OF THE FORM 990 ARE AMOUNTS THAT ARE ALLOCATED TO THE TRUST FROM ISD #535 FOR THE TRUST'S PORTION OF THE EXPENSES. FORM 990, PART VII, SECTION B, LINE 1 THE MEDICAL CLAIMS LISTED ON PART VII, SECTION B, LINE 1 ARE PAID BY BLUE CROSS BLUE SHIELD (BCBS) ON BEHALF OF THE TRUST AND BCBS IS RESPONSIBLE FOR ALL REQUIRED 1099 REPORTING. INDEPENDENT SCHOOL DISTRICT #535 615 7TH STREET SW ROCHESTER MN 55902 416002803 PUBLIC SCHOOL MN GOVERNMENTAL GOVERNMENTAL N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1