2017-01-23T15:43:05-06:00 2016-06-30 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2015-07-01 416255919 ISD #535 HEALTH AND DENTAL CARE TRUST ISD5 5073284225 615 SEVENTH STREET SW ROCHESTER MN 55902 JOHN CARLSON EXECUTIVE DIRECTOR OF FINANCE 5073284225 2017-01-13 1 SHERRI WESSELS P00888088 5074347000 2015 2021-01-29 14:40:06Z JOHN CARLSON 615 SEVENTH STREET SW ROCHESTER MN 55902 28706897 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 26285380 28656358 15566 50539 0 0 26300946 28706897 0 0 0 0 493702 408086 0 0 0 22973488 27495996 23467190 27904082 2833756 802815 12190185 13161141 3098721 3266862 9091464 9894279 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 1054 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 BART GRAFSTROM TRUSTEE 0.20 X 0 77213 24233 STEVE GIFFORD TRUSTEE 0.20 X 0 0 0 WAYNE WOXLAND TRUSTEE 0.20 X 0 0 0 BROOKE BASS TRUSTEE/PLAN ADMINISTRATOR 0.20 X 0 131741 29276 ANNE BECKER TRUSTEE 0.20 X 0 7200 0 0 216154 53509 0 0 1 0 MAYO CLINIC HOSPITAL ROCHESTER 1216 2ND ST SW ROCHESTER MN 55902 MEDICAL CLAIMS 7764527 MAYO CLINIC 200 1ST ST SW ROCHESTER MN 55905 MEDICAL CLAIMS 6458406 COMPREHENSIVE CARE SERVICES - PRIME THER PO BOX 64668 ST PAUL MN 55164 PRESCRIPTION DRUG CLAIMS 3599702 OLMSTED MEDICAL CENTER HOSPITAL 1650 4TH STREET SE ROCHESTER MN 55904 MEDICAL CLAIMS 1473221 OLMSTED MEDICAL CENTER CLINIC 210 9TH STREET SE ROCHESTER MN 55904 MEDICAL CLAIMS 1291148 5 PREMIUM CHARGES 525100 28656358 28656358 28656358 50539 50539 28706897 28656358 0 50539 287567 102885 17634 3562 1097 CLAIM EXPENSES 27488568 MINOR EQUIPMENT 1498 DUES & SUBSCRIPTIONS 884 SOFTWARE EXPENSE 244 143 27904082 10251572 7489354 0 0 10494 6960 1873327 5594863 54792 69964 12190185 13161141 797268 972823 2301453 2294039 3098721 3266862 X 9091464 9894279 9091464 9894279 12190185 13161141 802815 0 X X 0 1 X 1 0 0 SELF-INSURANCE CLAIMS PAYABLE 1943462 NET PENSION LIABILITY 258023 COMPENSATED ABSENCES PAYABLE 52278 DEFERRED INFLOW - PENSION 40276 2294039 0 0 0 BROOKE BASS TRUSTEE/PLAN ADMINISTRATOR 0 131741 0 0 0 0 0 12513 0 16763 0 161017 0 0 FORM 990, PART VI, SECTION B, LINE 11 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 55902 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. 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