INDEPENDENT SCHOOL DISTRICT NO 535 HEALTH & DENTAL CARE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
INDEPENDENT SCHOOL DISTRICT NO 535 HEALTH & DENTAL CARE (EIN 41-6255919)
Tax period
2012-07-01 to 2013-06-30
Filed
2013-12-06
IRS object ID
201343409349300809
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-12-06T10:13:57-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 217AddressLine1
CityAUSTINCity
StateMNState
ZIP Code55912ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN416255919EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ISD #535 HEALTH AND DENTAL CARE TRUSTBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlISD5NameControl
Phone5073284225Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1615 SEVENTH STREET SWAddressLine1
CityROCHESTERCity
StateMNState
ZIP Code55902ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBROOKE BASSName
TitleEXECUTIVE DIRECTOR OF HRTitle
Phone5073284225Phone
Date Signed2013-11-19DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameSHERRI WESSELSName
PTINP00888088PTIN
Phone5074347000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBROOKE BASSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1615 SEVENTH STREET SWAddressLine1
CityROCHESTERCity
StateMNState
ZIP Code55902ZIPCode
FieldValueIRS element (for citing)
Gross Receipts21798979GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization TrustXTypeOfOrganizationTrust
Year Formation1982YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE SELF-INSURED HEALTH AND DENTAL INSURANCE FOR DISTRICT EMPLOYEES AND RETIREES.ActivityOrMissionDescription
Nbr Voting Members Governing Body5NbrVotingMembersGoverningBody
Nbr Independent Voting Members2NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year128321ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year20472087ProgramServiceRevenuePriorYear
Program Service Revenue CY21790905ProgramServiceRevenueCY
Investment Income Prior Year6158InvestmentIncomePriorYear
Investment Income Current Year8074InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year20606566TotalRevenuePriorYear
Total Revenue Current Year21798979TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year381257SalariesEtcPriorYear
Salaries Etc Current Year389767SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year20885306OtherExpensePriorYear
Other Expenses Current Year22052790OtherExpensesCurrentYear
Total Expenses Prior Year21266563TotalExpensesPriorYear
Total Expenses Current Year22442557TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-659997RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-643578RevenuesLessExpensesCY
Total Assets BOY8195306TotalAssetsBOY
Total Assets EOY8046031TotalAssetsEOY
Total Liabilities BOY2757545TotalLiabilitiesBOY
Total Liabilities EOY3251848TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5437761NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY4794183NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE SELF-INSURED HEALTH AND DENTAL INSURANCE FOR DISTRICT EMPLOYEES AND RETIREES.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
DescriptionTHE TRUST PROVIDES FOR EMPLOYER GROUP HEALTH AND DENTAL BENEFITS TO ELIGIBLE EMPLOYEES AND RETIREES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
DescriptionESTABLISHED A HIGH DEDUCTIBLE HEALTH PLAN WITH AN HRA COMPONENTDescription
FieldValueIRS element (for citing)
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096230NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members5NbrVotingGoverningBodyMembers
Number Independent Voting Members2NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address1OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1REBECCA PERLICHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5073284225TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line110 9 1/2 STREET SEAddressLine1
CityROCHESTERCity
StateMNState
ZIP Code55904ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JUDY MCDONALD
TRUSTEE/PLAN ADMINISTRATOR0.20X011707414135
BART GRAFSTROM
TRUSTEE0.20X06980823163
STEVE GIFFORD
TRUSTEE0.20X000
WAYNE WOXLAND
TRUSTEE0.20X000
GARY SMITH
TRUSTEE0.20X072000
LARRY SMITH
TRUSTEE/PLAN ADMINISTRATOR0.20X011978129368
BROOKE BASS
TRUSTEE/PLAN ADMINISTRATOR0.20X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs313863TotalReportableCompFrmRltdOrgs
Total Other Compensation66666TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MAYO
PO BOX 1820MINNEAPOLISMN554801658MEDICAL CLAIMS7695156
MAYO CLINIC
PO BOX 1658MINNEAPOLISMN554801658HEALTH CLAIMS6458903
OLMSTED MEDICAL CENTER HOSPITAL
PO BOX 4300ROCHESTERMN55903HEALTH CLAIMS2686175
COMPREHENSIVE CARE SERVICES
1200 YANKEE DOODLE ROADEAGANMN55121CLAIMS PROCESSING CPU SYSTEMS400000
SUN LIFE FINANCIAL
1 SUN LIFE EXECUTIVE PARKWELLESLEY HILLSMA02481STOP LOSS CLAIMS236984
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPREMIUM CHARGESDescription
Business Code525100BusinessCode
Total Revenue Column21790905TotalRevenueColumn
Related Or Exempt Function Income21790905RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue21790905TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column8074TotalRevenueColumn
Exclusion$8,074ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column21798979TotalRevenueColumn
Related Or Exempt Function Income21790905RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$8,074ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total280838Total

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total92050Total

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total16879Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total650Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total24984Total

Travel Travel

FieldValueIRS element (for citing)
Total1962Total

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotal
CLAIM EXPENSES22018284
DUES & SUBSCRIPTIONS6676
FOOD EXPENSE234

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total22442557Total

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY8186962BOY
EOY4428981EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3297BOY
EOY15069EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY5047BOY
EOY6961EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY3595020EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8195306BOY
EOY8046031EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY839781BOY
EOY835088EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1917764BOY
EOY2416760EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2757545BOY
EOY3251848EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5437761BOY
EOY4794183EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5437761BOY
EOY4794183EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8195306BOY
EOY8046031EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-643578ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionSELF-INSURANCE CLAIMS PAYABLEDescription
Amount$2,416,760Amount
FieldValueIRS element (for citing)
Total Of Amounts2416760TotalOfAmounts

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NEW PROGRAM SERVICESFORM 990, PART III, LINE 2ESTABLISHED A HDHP WITH AN HRA
FORM 990, PART VI, SECTION B, LINE 11THE COMPLETED FORM 990 IS REVIEWED BY THE PLAN ADMINISTRATOR PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION C, LINE 19THE TRUST MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2CTHE 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.
TRUSTEES WHO CANNOT BE REACHED AT THE ORGANIZATION'S ADDRESSFORM 990, PART VI, LINE 9:STEVE GIFFORD WELLS FARGO FINANCIAL 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: THE TRUST DOES NOT HAVE ANY EMPLOYEES.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1INDEPENDENT SCHOOL DISTRICT #535BusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1615 7TH STREET SWAddressLine1
CityROCHESTERCity
StateMNState
ZIP Code55902ZIPCode
FieldValueIRS element (for citing)
EIN416002803EIN
Primary ActivitiesPUBLIC SCHOOLPrimaryActivities
Legal Domicile StateMNLegalDomicileState
Exempt Code SectionGOVERNMENTALExemptCodeSection
Public Charity StatusGOVERNMENTALPublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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