2022-11-14T13:41:06-06:00 2021-12-31 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2021-01-01 823520467 CUAD Health Benefits Trust CUAD 7012503926 2005 N Kavaney Dr Ste 201 Bismarck ND 58501 Jeff Olson Chair 7012503926 2022-11-10 1 Jeff Olson 999009999 Lisa Chaffee CPA P00193453 7012551091 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Jeff Olson 2005 N Kavaney Dr Ste 201 Bismarck ND 58501 11419816 0 X N/A X 2018 ND To provide health, dental, and vision benefits to employees of participating employers. 14 0 0 14 5487 0 0 0 6265539 11414329 4933 5487 0 0 6270472 11419816 0 0 3430215 7226847 0 0 0 0 0 2012351 3181854 5442566 10408701 827906 1011115 2705795 3708893 1135282 384776 1570513 3324117 None 0 0 In 2021 the Trust provided health, dental, and/or vision benefits to a total of 1,115 active participants, and 13 retired or separated participants for the 34 participating employers. 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 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 2 0 1 0 1 1 0 0 0 0 0 0 0 X 14 0 1 0 1 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 X Karla Clark 7012503926 2005 N Kavaney Dr Ste 201 Bismarck ND 58501 X Jeff Olson Chairperson 0.10 40.00 X X 0 184219 33458 Sean Rinkenberger Vice Chairperson 0.10 40.00 X X 0 172949 39979 Mindee Kohlman Secretary 0.10 40.00 X X 0 180510 0 Bob Herrington Alternate (See Sch O Explanation) 0.10 40.00 X 0 0 0 Justin Maddison Trustee 0.10 40.00 X 0 211575 0 Harold Hagen Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 Jeff Meyer Trustee 0.10 40.00 X 0 309620 0 Jeff Schmidt SD Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 Holly Jones SD Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 Keith Robbennolt SD Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 Floyd Rummel III SD Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 Brenda Schmidt SD Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 Tanya Hobson SD Trustee 0.10 40.00 X 0 136300 0 Ryan Goehner SD Trustee (See Sch O Explanation) 0.10 40.00 X 0 0 0 0 1195173 73437 0 0 1 0 Blue Cross Blue Shield 4510 13th Ave S Fargo ND 58121 Administrative Fees 664593 Wellmark 1601 W Madison Street Sioux Falls SD 57104 Administrative Fees 195441 2 Member Contributions 525100 11414329 11414329 11414329 5487 5487 11419816 11414329 5487 0 7226847 12000 13800 995332 30061 Stop Loss Fees 1976378 154283 10408701 2554535 2944129 139897 755414 11363 9350 2705795 3708893 4970 742489 258278 387823 126498 1135282 384776 X 0 0 0 0 1570513 3324117 1570513 3324117 2705795 3708893 X 1011115 742489 X 0 1 X 0 0 0 Broker Fees Payable 12225 Premium Tax Payable 114273 126498 X 11419816 0 11419816 0 11419816 10408701 0 10408701 0 10408701 Part X, Line 2: 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 it has taken an uncertain position that more likely than not would not be sustained upon examination by the Internal Revenue Service. The Plan is subject to routine audits by taxing jurisdictions; however, there are currently no audits for any tax periods in progress. 0 0 0 Jeff Meyer Trustee 0 267120 0 42500 0 0 0 0 0 0 0 309620 0 0 Jeff Olson Chairperson 0 165056 0 16744 0 2419 0 7500 0 25958 0 217677 0 0 Sean Rinkenberger Vice Chairperson 0 153989 0 16132 0 2828 0 19279 0 20700 0 212928 0 0 Justin Maddison Trustee 0 201500 0 10075 0 0 0 0 0 0 0 211575 0 0 Mindee Kohlman Secretary 0 161580 0 18930 0 0 0 0 0 0 0 180510 0 0 Form 990, Part VI, Section A, line 1a The Board of Trustees consists of employees of the contributing employers and as such the board members are compensated by the contributing employers for the services they provide as employees of their respective employer. Due to this, they are not considered independent Trustees. Form 990, Part VI, Section A, line 2 Sean Rinkenberger and Jeff Olson have a business relationship. Form 990, Part VI, Section A, line 4 The bylaw changes were to address the addition of SD and the SD (sub) trustees. The Sub Trust shall be administered by Sub Trust Trustees, which shall consist of at least seven (7) Sub Trust Trustees or such other number established by the Sub Trust Trustees from time to time. Sub Trust Trustees must be participants in one of the CUAD Health Benefit Plans at the time of his or her initial appointment or reappointment as Sub Trust Trustee and shall at all times be an Employee of an Employer domiciled in South Dakota. If these qualifications are not met by a Sub Trust Trustee, the Sub Trust Trustee shall be deemed to have resigned on the first day these conditions are not met. Form 990, Part VI, Section A, line 7a The Trust shall be administered by the Benefit Plan Trustees, which shall consist of at least seven Trustees or such other number established by the Trustees from time to time. Form 990, Part VI, Section A, line 8b There are no committees that are able to act on behalf of the board. Form 990, Part VI, Section B, line 11b A copy of the Form 990 will be provided to the board prior to its filing and will be reviewed at the next regularly scheduled board meeting after the Form 990 is filed. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, and financial statements available to the public. Form 990, Part VII, Section A, Columns (E) and (F): The compensation reported in columns E and F represent compensation paid by our member credit unions to their employee for services the employee provides to the member credit union as their employee. No portion of this compensation is provided for the services provided by our Trustees as a Trustee of the Credit Union Association of the Dakotas Health Benefits Plan Trust. Reasonable Effort to Obtain Compensation: CUAD Health Benefit Trust e-mailed the trustees and alternatives of the board with voting powers requesting compensation and benefits paid by a related organization. The organization was able to obtain compensation for six trustees. They were unable to obtain the requested information from the remaining seven trustees and one alternate. Form 990, Part XI, line 9: Adjustment for prior year member contributions included in deferred revenue 742,489. AREA COMMUNITY CREDIT UNION AVANTI FEDERAL CREDIT UNION BLACK HILLS FEDERAL CREDIT UNION COMMUNITY CREDIT UNION COTEAU VALLEY FEDERAL CREDIT UNION Credit Union Association of the Dakotas 2005 N Kavaney Dr Bismarck ND 58501 204608169 Promote Member Credit Unions 501(c)(6) N/A 0 DAKOTA PLAINS CREDIT UNION DAKOTA RAIL LINE FEDERAL CREDIT UNION DAKOTA WEST CREDIT UNION DAKOTALAND FEDERAL CREDIT UNION EAST RIVER FEDERAL CREDIT UNION EXPLORERS FEDERAL CREDIT UNION FIRST COMMUNITY CREDIT UNION FLASHER COMMUNITY CREDIT UNION FREEDOM COMMUNITY CREDIT UNION HEALTHCARE PLUS FEDERAL CREDIT UNION HOMETOWN CREDIT UNION HURON AREA EDUCATION FEDERAL CREDIT UNION LEVO FEDERAL CREDIT UNION MED PARK CREDIT UNION M-O FEDERAL CREDIT UNION NORSTAR FEDERAL CREDIT UNION NORTH STAR COMMUNITY CREDIT UNION NORTHERN HILLS FEDERAL CREDIT UNION PRAIRIE FEDERAL CREDIT UNION RAILWAY CREDIT UNION RIVERFORK FEDERAL CREDIT UNION SENTINEL FEDERAL CREDIT UNION UNITED SAVINGS CREDIT UNION UNIVERSITY FEDERAL CREDIT UNION VOYAGE FEDERAL CREDIT UNION VUE COMMUNITY CREDIT UNION WESTERN COOPERATIVE CREDIT UNION Krabseth Agency (Part of western Cooperative CU) Mid America Service Corporation 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1