2024-11-14T17:58:08-06:00 2023-12-31 135565207 KPMG LLP 350 NORTH 5TH ST STE 600 MINNEAPOLIS MN 55401 990 2023-01-01 411843804 MEDICA COMMUNITY HEALTH PLAN MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 KRISTA DUSIL CFO 9529922058 2024-11-14 1 0 HOLLY MOEN P01800653 6123055000 2024-11-12 2023 2024-10-15 13:58:12Z ELIZABETH ERICKSON 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 169001066 0 X WWW.MEDICA.COM X 1996 WI TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 10 9 0 0 0 0 0 0 122724916 149373340 1525763 2681488 0 0 124250679 152054828 0 0 117840248 119095421 0 0 0 0 0 12193690 14820598 130033938 133916019 -5783259 18138809 129865512 148944995 28758374 30488524 101107138 118456471 X TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 0 0 119095421 0 149373340 SEE SCHEDULE O 119095421 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 13301 0 1 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X ELIZABETH ERICKSON 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 X DAVID ELLENBOGEN SVP SEC & GEN COUNSEL (THRU 12/23) 0.00 40.00 X X 0 773584 45018 ELIZABETH F ERICKSON PRESIDENT & CEO & CFO 0.00 40.00 X X 0 1203089 39039 JOHN NAYLOR PRESIDENT & CEO (THRU 9/23) 0.00 40.00 X X 0 2577014 28672 JOHN BUCK DIRECTOR & CHAIR 0.00 15.00 X X 0 163750 0 JOHN STANOCH DIRECTOR & VICE CHAIR 0.00 10.00 X X 0 121250 0 MARY TWINEM DIRECTOR 0.00 10.00 X 0 111000 0 PETER KELLEY DIRECTOR 0.00 10.00 X 0 112500 0 RAJ AGGARWAL DIRECTOR 0.00 10.00 X 0 119750 0 BRIGID BONNER DIRECTOR 0.00 10.00 X 0 108000 0 SAM LEON DIRECTOR 0.00 10.00 X 0 100250 0 GAYE ADAMS MASSEY DIRECTOR 0.00 10.00 X 0 95000 0 EARL STRATTON DIRECTOR 0.00 10.00 X 0 114750 0 MARY P QUIST TREASURER/INTERIM CFO 0.00 40.00 X 0 808429 49529 MARK L BAIRD FORMER SVP & CFO 0.00 0.00 X 0 552044 0 JAMES P JACOBSON FORMER SVP SEC & GEN COUNSEL 0.00 0.00 X 0 448077 0 0 7408487 162258 0 1 1 0 MEDICA SERVICES COMPANY 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 LEASED EMPLOYEES 7436662 1 PREMIUM REVENUE 524114 149373340 149373340 149373340 3089952 3089952 16537774 16946238 -408464 -408464 -408464 152054828 149373340 0 2681488 119095421 119095421 66001 66001 17837 17837 16103 16103 2188569 2188569 215530 215530 128926 128926 952313 952313 155383 155383 20527 20527 11563 11563 693405 693405 71496 71496 LEASED EMPLOYEES 7436662 7436662 OTHER EXPENSES 1410428 1410428 PREMIUM TAXES 1251805 1251805 PRINTING & PUBLICATION 184050 184050 133916019 119095421 14820598 0 0 0 19771457 30600320 0 0 4607869 13359638 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82967886 87083250 0 0 0 0 22518300 17901787 129865512 148944995 1900176 913433 0 0 1073338 762782 0 0 0 0 0 0 0 0 0 0 25784860 28812309 28758374 30488524 X 0 0 0 0 101107138 118456471 101107138 118456471 129865512 148944995 X 18138809 -789476 X 0 1 X 1 0 0 OTHER LT SECURITIES 87083250 F 87083250 INVESTMENT INTEREST RECEIVABLE 778715 CSR RECEIVABLE 311284 HEALTHCARE RECEIVABLE 1940082 REINSURANCE 14871706 17901787 INTERCOMPANY PAYABLE 13526396 CLAIMS PAYABLE 15285913 28812309 X 152054828 0 152054828 0 152054828 133916019 0 133916019 0 133916019 PART X, LINE 2: THE COMPANY RECOGNIZES TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. 1 X X X X X 0 1 0 0 0 1 1 0 0 JOHN NAYLOR PRESIDENT & CEO (THRU 9/23) 0 745040 0 1498719 0 333255 0 10532 0 18140 0 2605686 0 212534 ELIZABETH F ERICKSON PRESIDENT & CEO & CFO 0 487530 0 600051 0 115508 0 13200 0 25839 0 1242128 0 109692 MARY P QUIST TREASURER/INTERIM CFO 0 342386 0 349158 0 116885 0 13200 0 36329 0 857958 0 65748 DAVID ELLENBOGEN SVP SEC & GEN COUNSEL (THRU 12/23) 0 407024 0 249087 0 117473 0 13200 0 31818 0 818602 0 62813 MARK L BAIRD FORMER SVP & CFO 0 0 0 329888 0 222156 0 0 0 0 0 552044 0 32279 JAMES P JACOBSON FORMER SVP SEC & GEN COUNSEL 0 0 0 129138 0 318939 0 0 0 0 0 448077 0 91442 JOHN BUCK DIRECTOR & CHAIR 0 0 0 0 0 163750 0 0 0 0 0 163750 0 0 PART I, LINE 3 MEDICA COMMUNITY HEALTH PLAN, THE FILING ORGANIZATION DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY MEDICA SERVICES COMPANY, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION MEDICA HEALTH PLANS UTILIZES THE FOLLOWING; COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATION'S OPERATING EARNINGS. PART-I LINE-4B THE FOLLOWING RECEIVED A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA SERVICES COMPANY, A RELATED ORGANIZATION. MARK L. BAIRD - $32,279 MARY P. QUIST - $65,748 JOHN W. NAYLOR - $212,534 DAVID H. ELLENBOGEN - $62,813 JAMES P. JACOBSON - $91,442 FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: MEDICA COMMUNITY HEALTH PLAN (THE COMPANY) IS ORGANIZED AND SHALL BE OPERATED FOR THE PROMOTION OF SOCIAL WELFARE, INCLUDING THE OPERATION OF A HEALTH INSURANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. IT IS A WHOLLY OWNED SUBSIDIARY OF MEDICA HOLDING COMPANY (MHC) WHICH IS A NON-PROFIT, TAX EXEMPT CORPORATION. THE COMPANY IS TAX-EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. THE COMPANY OFFERS COMPREHENSIVE HEALTH CARE COVERAGE; ALL PRODUCTS ARE MEDICARE ADVANTAGE, OR QUALIFIED HEALTH PLANS (QHPS). QHPS ARE DEFINED BY THE AFFORDABLE CARE ACT (ACA) AND FALL WITHIN THE METAL LEVELS GOLD, SILVER AND BRONZE, AS WELL AS CATASTROPHIC FOR THOSE UNDER AGE 30 OR THOSE WITH A HARDSHIP (AS DEEMED BY THE EXCHANGE). ADDITIONALLY, THE PRODUCTS FOLLOW THE RESPECTIVE ESSENTIAL HEALTH BENEFITS (EHBS), ABOVE AND BEYOND THOSE REQUIRED OF QHPS BY THE ACA, AS DETERMINED BY THE BENCHMARK/DEFAULT PLAN (AS DEFINED BY ACA) FOR WISCONSIN AND ARIZONA. THE QHP PRODUCT, ESSENTIA CHOICE CARE WITH MEDICA, IS AVAILABLE IN WESTERN WISCONSIN, NORTHERN MINNESOTA, AND EASTERN NORTH DAKOTA. THE ESSENTIA CHOICE CARE PRODUCT FEATURES ACCESS TO ESSENTIA HEALTH DOCTORS PLUS OTHERS WITH OVER 3,000 PRIMARY AND SPECIALTY CARE PROVIDERS. THE QHP PRODUCT, ENGAGE BY MEDICA, IS AVAILABLE IN WESTERN WISCONSIN AND SOUTHEASTERN MINNESOTA. THE ENGAGE BY MEDICA PRODUCT FEATURES ACCESS TO MAYO CLINIC HEALTH SYSTEM DOCTORS PLUS OTHERS IN NORTHERN IOWA, SOUTHERN MINNESOTA, AND WESTERN WISCONSIN, WITH OVER 12,000 PRIMARY AND SPECIALTY CARE PROVIDERS. THE QHP PRODUCT, MEDICA PINNACLE, IS AVAILABLE IN MARICOPA COUNTY, ARIZONA. THE MEDICA PINNACLE PRODUCT FEATURES ACCESS TO ARIZONA CARE NETWORK, DIGNITY HEALTH, AND PHOENIX CHILDREN'S, WITH OVER 4,400 PRIMARY AND SPECIALTY CARE PROVIDERS. THE COMPANY OFFERS MEDICARE ADVANTAGE PRODUCTS IN PORTIONS OF NEBRASKA AND IOWA, OFFERING THE MEDICA ADVANTAGE SOLUTION PRODUCT IN THE ELEVEN COUNTY OMAHA/LINCOLN/COUNCIL BLUFFS AREA. THE MEDICA ADVANTAGE SOLUTION PRODUCT OFFERS AN HMO OPTION WITH CHI HEALTH AND A BROADER NETWORK PPO OPTION. THE ADVANTAGE SOLUTION NETWORK HAS 1,600+ PRIMARY CARE AND SPECIALTY CARE DOCTORS. THE COMPANY CONTRACTS WITH PROVIDERS IN WISCONSIN, MINNESOTA, SOUTH DAKOTA, NORTH DAKOTA, NEBRASKA AND IOWA TO MAKE HEALTH CARE SERVICES AVAILABLE TO ITS ENROLLEES. THE PROVIDER CONTRACTS INCLUDE HOLD-HARMLESS PROVISIONS FOR THE PROTECTION OF POLICYHOLDERS. THE CONTRACTS HAVE A ONE- OR TWO-YEAR TERM AND MAY BE TERMINATED IMMEDIATELY FOR BREACH OF CONTRACT IF THE PROVIDER LOSES HIS/HER LICENSE TO PROVIDE CONTRACTED SERVICES. HOSPITALS ARE REIMBURSED USING A VARIETY OF METHODS INCLUDING FEE-FOR-SERVICE (FFS), DISCOUNTED FFS, PER DIEM, PER CASE AND/OR PER STAY BASIS. THE COMPANY CURRENTLY MARKETS DIRECTLY TO INDIVIDUALS, USING INDEPENDENT AGENCIES, PAYING A FLAT DOLLAR COMMISSION ON NEW AND RENEWAL BUSINESS. THE COMPANY ALSO MARKETS POLICIES DIRECTLY ONLINE AND OVER THE PHONE. DURING 2020, THE COMPANY STARTED OFFERING MEDICARE ADVANTAGE PRODUCTS IN NEBRASKA. DURING 2023, MEDICARE ADVANTAGE ENROLLMENT WAS 782 MEMBERS, OR 5.4% OF MCHP'S TOTAL ENROLLMENT. MEDICARE ADVANTAGE IS A HEALTH PLAN THAT PROVIDES ALL ENROLLEES PART A AND B BENEFITS. FORM 990, PART VI, SECTION A, LINE 3 MEDICA COMMUNITY HEALTH PLAN HAS ENTERED INTO AN ADMINISTRATIVE SERVICE AGREEMENT WITH MEDICA SERVICES COMPANY (MSC), A RELATED TAXABLE ORGANIZATION. THROUGH THIS AGREEMENT, MSC LEASES ITS EMPLOYEES AND PROVIDES VARIOUS MANAGEMENT/ADMINISTRATIVE SERVICES TO MEDICA COMMUNITY HEALTH PLAN AND MEDICA COMMUNITY HEALTH PLAN PAYS FOR SUCH SERVICES THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 THE POLICY HOLDERS ARE CONSIDERED MEMBERS, BUT DO NOT PAY DUES. FORM 990, PART VI, SECTION B, LINE 11B MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S FINANCE STAFF REVIEWS THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY WILL BE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL EMPLOYEES OF MEDICA SERVICES COMPANY AND DIRECTORS OF ALL MEDICA ENTITIES COMPLETE A CONFLICT-OF-INTEREST DISCLOSURE AND ARE REQUIRED TO REVIEW THE CURRENT POLICY. ALL POTENTIAL CONFLICTS ARE REVIEWED BY LEGAL/COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 MEDICA COMMUNITY HEALTH PLAN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION. WHICH USES THE FOLLOWING PROCESS TO DETERMINE COMPENSATION. THE PERSONNEL AND COMPENSATION COMMITTEE, AS DESCRIBED IN THE CHARTER, REVIEWS AND OBTAINS THE BOARD'S APPROVAL FOR TOTAL COMPENSATION FOR THE PRESIDENT/CEO. THE COMMITTEE ALSO REVIEWS AND APPROVES TOTAL COMPENSATION RECOMMENDATIONS MADE BY THE CEO FOR THE EXECUTIVE AND SENIOR VICE PRESIDENTS, AND REVIEWS ALL OFFICER COMPENSATION AND ANNUAL PERFORMANCE GOALS APPROVED BY THE CEO. THE COMMITTEE REVIEW AND MAKES RECOMMENDATIONS TO THE BOARD REGARDING OFFICER AND NON-OFFICER COMPENSATION GUIDELINES FOR MEDICA AND ITS SUBSIDIARIES, PERIODICALLY REVIEWING MARKET DATA TO ASSESS MEDICA'S COMPETITIVE POSITION. OUTSIDE THE CHARTER, THE PERSONNEL AND COMPENSATION COMMITTEE WORKS WITH AN OUTSIDE CONSULTANT TO REVIEW MARKET DATA THAT AIDS IN SETTING THE COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 MEDICA DOES NOT CONSIDER ITS CONFLICT-OF-INTEREST POLICY TO BE A CONFIDENTIAL OR PROPRIETARY DOCUMENT. THEREFORE, MEDICA WOULD MAKE THIS POLICY AVAILABLE TO ANYONE WHO REQUESTS IT. CERTAIN OF THE MEDICA ENTITIES ARE REQUIRED TO FILE ANNUAL FINANCIAL STATEMENTS WITH THE REGULATORS. MEDICA CONSIDERS FINANCIAL STATEMENTS THAT ARE FILED WITH THE REGULATORS TO BE PUBLIC DOCUMENTS. FINANCIAL STATEMENTS, CONFLICT-OF-INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART VII, SECTION A, LINE 1: CERTAIN INDIVIDUALS REPORTED ON FORM 990, PART VII SPLIT THEIR TIME BETWEEN ALL ENTITIES UNDER MEDICA HOLDING COMPANY. THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. THE FOLLOWING CHANGES TO THE OFFICERS OF MEDICA COMMUNITY HEALTH PLAN OCCURRED DURING THE TAXABLE PERIOD: IN APRIL OF 2023 ELIZABETH F. ERICKSON WAS ELECTED CHIEF FINANCIAL OFFICER AND TREASURER, SUCCEEDING MARY P. QUIST AS FORMER INTERIM CHIEF FINANCIAL OFFICER AND TREASURER. ELIZABETH F. ERICKSON WAS SUBSEQUENTLY ELECTED INTERIM PRESIDENT IN SEPTEMBER OF 2023, AND ELECTED PRESIDENT AND CHIEF EXECUTIVE OFFICER IN NOVEMBER OF 2023. IN 2024 KRISTA DUSIL WAS APPOINTED AS CHIEF FINANCIAL OFFICER OF THE ORGANIZATION. FORM 990, PART VII JOHN STANOCH'S BOARD STIPEND WAS PAID TO STANOCH, LLC. FORM 990, PART XI, LINE 9: CHANGE IN NONADMITTED ASSETS -789,476. MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH COVERAGE MN 501(C)(4) N/A MHC 0 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) LINE 12B MHC 0 MEDICA HOLDING COMPANY (MHC) 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING COMPANY MN 501(C)(4) N/A N/A 0 MEDICAL CENTRAL HEALTH PLAN INC 10101 WOODFIELD LANE ST LOUIS MO 63132 831979548 HEALTH COVERAGE MO 501(C)(4) N/A MFCJVN 0 MS COMMUNITY NFP JV LLC (MFCJVN) 401 CARLSON PARKWAY MINNETONKA MN 55305 873268926 MN 0 0 0 MEDICA INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 411490988 HEALTH INSURANCE MN MAS C 0 MEDICA SELF-INSURED 401 CARLSON PARKWAY MINNETONKA MN 55305 411479417 THIRD PARTY ADMIN MN MAS C 0 MEDICA HEALTH MANAGMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MANAGEMENT MN MAS C 0 MEDICA AFFILIATED SERVICES (MAS) 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MHC C 0 MMSI INC 401 CARLSON PARKWAY MINNETONKA MN 55305 411547003 THIRD PARTY ADMIN MN MAS C 0 MEDICA SERVICES COMPANY LLC 401 CARLSON PARKWAY MINNETONKA MN 55305 852902940 ADMIN. SERVICES MN MAS C 0 DEAN HEALTH PLAN INC 1277 DEMING WAY MADISON WI 53717 391535024 HEALTH INSURANCE WI DHI C 0 DEAN HEALTH INSURANCE INC (DHI) PO BOX 56099 MADISON WI 53705 391830837 HEALTH INSURANCE WI MSCJV C 0 SSM HEALTH INSURANCE COMPANY 10101 WOODFIELD LANE ST LOUIS MO 63132 834718249 HEALTH INSURANCE MO MSCJV C 0 DEAN HEALTH SERVICES COMPANY LLC 1277 DEMING WAY MADISON WI 53717 842933639 ADMIN. SERVICES WI MSCJV C 0 MS COMMUNITY JV LLC (MSCJV) 401 CARLSON PARKWAY MINNETONKA MN 55305 873240022 HOLDING COMPANY MN MHC C 0 MEDICA REGIONAL INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 854111612 HEALTH INSURANCE MN MAS C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0