MEDICA CENTRAL HEALTH PLAN: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- MEDICA CENTRAL HEALTH PLAN (EIN 83-1979548)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-08
- IRS object ID
- 202333129349304503
- Schema version
- 2022v5.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-08T15:27:27-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 S 7TH ST STE 4200 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 831979548 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SSM HEALTH PLAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SSMH | BusinessNameControlTxt |
| Phone | 3149947800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 WOODFIELD LANE | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RANDY RUPLINGER | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 3149947800 | PhoneNum |
| Signature | 2023-10-23 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | RANDY | PersonFirstNm |
| Person Last | RUPLINGER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | 0 | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HOLLY MOEN | PreparerPersonNm |
| PTIN | P01800653 | PTIN |
| Phone | 6123055000 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WELLFIRST HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID DOCHERTY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10101 WOODFIELD LANE | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 63132 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $13,270,557 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | WWW.SSMHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2018 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,174,081 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,178,845 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$38,236 | PYInvestmentIncomeAmt |
| CY Investment Income | $91,712 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $9,135,845 | PYTotalRevenueAmt |
| CY Total Revenue | $13,270,557 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,714,973 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,462,913 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,049,804 | PYOtherExpensesAmt |
| CY Other Expenses | $13,125,363 | CYOtherExpensesAmt |
| PY Total Expenses | $15,764,777 | PYTotalExpensesAmt |
| CY Total Expenses | $17,588,276 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$6,628,932 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$4,317,719 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,646,843 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,724,325 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,507,890 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,065,715 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,138,953 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,658,610 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,708,234 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $13,178,845 | RevenueAmt |
| Desc | SSM HEALTH PLAN WILL OPERATE A HEALTH MAINTENANCE ORGANIZATION(HMO). THE HMO OFFERS MEDICARE ADVANTAGE PRODUCT IN MO AND IL AND INDIVIDUAL PRODUCT IN IL. | Desc |
| Total Program Service Expenses | $11,708,234 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DEAN SUTTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6088274301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1277 DEMING WAY | AddressLine1Txt |
| City | MADISON | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53717 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| DAVID DOCHERTY | |||||||
| DHP PRESIDENT & MKT LEADER | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $756,855 | $17,850 |
| MARY P QUIST | |||||||
| SVP FIN & CORP CONTROLLER | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $663,642 | $55,294 |
| JOHN W NAYLOR | |||||||
| PRESIDENT & CEO | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $2,835,957 | $44,105 |
| DAVID H ELLENBOGEN | |||||||
| SVP SEC & GENERAL COUNSEL | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $735,741 | $99,633 |
| DAVID WEBSTER | |||||||
| CHIEF CLINIC & PROV STRAT OFF | 0.00 | 40.00 | Yes (X) | $0 | $1,201,328 | $141,229 | |
| KAREN DENISE REWERTS | |||||||
| VP OF FINANCIAL OPERATIONS | 1.00 | 50.00 | Yes (X) | $0 | $805,590 | $262,109 | |
| TIMOTHY ALLEN JOHNSON | |||||||
| VP - MEDICAL GROUP OPERATIONS | 1.00 | 40.00 | Yes (X) | $0 | $686,907 | $268,404 | |
| RANDALL J COMBS | |||||||
| CFO | 1.00 | 40.00 | Yes (X) | $0 | $1,879,739 | $971,053 | |
| MATTHEW NAMMACK KINSELLA | |||||||
| REGIONAL CP FINANCE - WI | 1.00 | 40.00 | Yes (X) | $0 | $571,367 | $199,440 | |
| MARK L BAIRD | |||||||
| SVP & CFO | 0.00 | 40.00 | Yes (X) | Yes (X) | $0 | $1,039,962 | $27,542 |
| RANDY RUPLINGER | |||||||
| SVP FP&A & DHP CFO | 1.00 | 40.00 | Yes (X) | $0 | $563,326 | $45,107 | |
| DEAN SUTTON | |||||||
| VP & DEPUTY GEN COUNSEL | 1.00 | 40.00 | Yes (X) | $0 | $334,274 | $13,929 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $12,074,688 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $2,145,695 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PREMIUM REVENUE | Desc |
| Business | 524114 | BusinessCd |
| Total Revenue Column | $13,178,845 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,178,845 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,178,845 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $91,712 | TotalRevenueColumnAmt |
| Exclusion | $91,712 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,270,557 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,178,845 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $91,712 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,616,307 | TotalAmt |
| Management And General | $3,616,307 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,346 | TotalAmt |
| Management And General | $80,346 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $514,343 | TotalAmt |
| Management And General | $514,343 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $251,917 | TotalAmt |
| Management And General | $251,917 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,370 | TotalAmt |
| Management And General | $2,370 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,789 | TotalAmt |
| Management And General | $4,789 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,248 | TotalAmt |
| Management And General | $50,248 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,113 | TotalAmt |
| Management And General | $7,113 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,268 | TotalAmt |
| Management And General | $38,268 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,103,559 | TotalAmt |
| Program Services | $10,626,003 | ProgramServicesAmt |
| Management And General | $477,556 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $540,856 | TotalAmt |
| Management And General | $540,856 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $247,884 | TotalAmt |
| Program Services | $247,884 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $225,494 | TotalAmt |
| Program Services | $225,494 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,315 | TotalAmt |
| Program Services | $94,315 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,332 | TotalAmt |
| Program Services | $33,332 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,862 | TotalAmt |
| Program Services | $5,862 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $807 | TotalAmt |
| Program Services | $807 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,300 | TotalAmt |
| Program Services | $43,300 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,422 | TotalAmt |
| Program Services | $20,422 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| OTHER EXPENSES | $434,178 | $406,190 | $27,988 |
| TAXES | $164,234 | $4,625 | $159,609 |
| LICENSES | $73,079 | $73,079 | |
| BOOKS/SUBSCRIPTIONS | $35,253 | $35,253 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,588,276 | TotalAmt |
| Program Services | $11,708,234 | ProgramServicesAmt |
| Management And General | $5,880,042 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,801,789 | BOYAmt |
| EOY | $8,367,836 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $71,136 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $224,188 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $939,909 | BOYAmt |
| EOY | $924,804 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,905,145 | BOYAmt |
| EOY | $136,361 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,646,843 | BOYAmt |
| EOY | $9,724,325 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,828,422 | BOYAmt |
| EOY | $2,229,194 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,132 | BOYAmt |
| EOY | $98,405 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $587,336 | BOYAmt |
| EOY | $738,116 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,507,890 | BOYAmt |
| EOY | $3,065,715 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,138,953 | BOYAmt |
| EOY | $6,658,610 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,138,953 | BOYAmt |
| EOY | $6,658,610 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,646,843 | BOYAmt |
| EOY | $9,724,325 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$4,317,719 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $4,837,376 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| DUE TO AFFILIATES | $678,289 |
| OTHER ACCRUED EXPENSES | $59,827 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $738,116 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,232,289 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,232,289 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $38,268 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $38,268 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,270,557 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,550,008 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,550,008 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $38,268 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $38,268 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $17,588,276 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | SSM HEALTH PLAN'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF A RELATED ORGANIZATION, MS COMMUNITY NFP JV, LLC (MSJV). MSJV EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2022 OR 2021. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOHN W NAYLOR | ||||||||||||||
| PRESIDENT & CEO | $0 | $1,064,714 | $0 | $1,511,877 | $0 | $259,366 | $0 | $19,605 | $0 | $24,500 | $0 | $2,880,062 | $0 | $250,332 |
| RANDALL J COMBS | ||||||||||||||
| CFO | $0 | $1,144,254 | $0 | $475,226 | $0 | $260,259 | $0 | $938,234 | $0 | $32,819 | $0 | $2,850,792 | $0 | $475,226 |
| DAVID WEBSTER | ||||||||||||||
| CHIEF CLINIC & PROV STRAT OFF | $0 | $448,209 | $0 | $475,026 | $0 | $278,093 | $0 | $109,666 | $0 | $31,563 | $0 | $1,342,557 | $0 | $272,815 |
| KAREN DENISE REWERTS | ||||||||||||||
| VP OF FINANCIAL OPERATIONS | $0 | $589,253 | $0 | $159,192 | $0 | $57,145 | $0 | $231,797 | $0 | $30,312 | $0 | $1,067,699 | $0 | $211,135 |
| MARK L BAIRD | ||||||||||||||
| SVP & CFO | $0 | $336,343 | $0 | $548,698 | $0 | $154,921 | $0 | $12,200 | $0 | $15,342 | $0 | $1,067,504 | $0 | $84,354 |
| TIMOTHY ALLEN JOHNSON | ||||||||||||||
| VP - MEDICAL GROUP OPERATIONS | $0 | $524,379 | $0 | $160,818 | $0 | $1,710 | $0 | $234,817 | $0 | $33,587 | $0 | $955,311 | $0 | $160,818 |
| DAVID H ELLENBOGEN | ||||||||||||||
| SVP SEC & GENERAL COUNSEL | $0 | $395,550 | $0 | $261,312 | $0 | $78,879 | $0 | $74,554 | $0 | $25,079 | $0 | $835,374 | $0 | $75,880 |
| DAVID DOCHERTY | ||||||||||||||
| DHP PRESIDENT & MKT LEADER | $0 | $748,120 | $0 | $0 | $0 | $8,735 | $0 | $17,850 | $0 | $0 | $0 | $774,705 | $0 | $0 |
| MATTHEW NAMMACK KINSELLA | ||||||||||||||
| REGIONAL CP FINANCE - WI | $0 | $395,809 | $0 | $165,836 | $0 | $9,722 | $0 | $163,175 | $0 | $36,265 | $0 | $770,807 | $0 | $108,201 |
| MARY P QUIST | ||||||||||||||
| SVP FIN & CORP CONTROLLER | $0 | $329,723 | $0 | $268,265 | $0 | $65,654 | $0 | $23,638 | $0 | $31,656 | $0 | $718,936 | $0 | $58,551 |
| RANDY RUPLINGER | ||||||||||||||
| SVP FP&A & DHP CFO | $0 | $554,440 | $0 | $0 | $0 | $8,886 | $0 | $17,842 | $0 | $27,265 | $0 | $608,433 | $0 | $0 |
| DEAN SUTTON | ||||||||||||||
| VP & DEPUTY GEN COUNSEL | $0 | $325,178 | $0 | $406 | $0 | $8,690 | $0 | $8,502 | $0 | $5,427 | $0 | $348,203 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO IS COMPENSATED BY MEDICA SERVICES COMPANY, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION MEDICA SERVICES COMPANY USES A 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: MARY P. QUIST - $58,551 MARK L. BAIRD - $84,354 JOHN W. NAYLOR - $250,332 DAVID H. ELLENBOGEN - $75,880 DAVID WEBSTER - $272,815 KAREN DENISE REWERTS - $211,135 TIMOTHY ALLEN JOHNSON - $160,818 RANDALL J. COMBS - $475,226 MATTHEW NAMMACK KINSELLA - $108,201 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE CORPORATION IS MS COMMUNITY NFP JV, LLC, A DELAWARE LIMITED LIABILITY COMPANY. BOTH SSM HEALTH PLAN AND MS COMMUNITY NFP JV, LLC ARE PART OF THE INTEGRATED HEALTH CARE SYSTEM KNOWN AS MEDICA HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER HAS THE POWER TO APPOINT ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS AND APPOINT AND REMOVE DIRECTORS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER HAS THE FOLLOWING POWERS: A. TO ESTABLISH AND CHANGE THE MISSION, PHILOSOPHY AND VALUES OF THE CORPORATION; B.TO APPROVE ADDITIONAL, SUCCESSOR OR REPLACEMENT MEMBERS; C. TO APPOINT AND REMOVE THE DIRECTORS; D. TO APPOINT AND REMOVE THE PRESIDENT AND OTHER OFFICERS OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER OF ANY OPERATING DIVISION OF THE CORPORATION; E. TO APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION AS PROVIDED THEREIN; F. TO APPROVE AMENDMENTS TO THE BYLAWS OF THE CORPORATION; G. TO APPROVE THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION; H. TO APPROVE THE FORMATION OF A CONTROLLED SUBSIDIARY OR A REMOTELY CONTROLLED SUBSIDIARY; I. TO APPROVE THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; J. TO APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF ANOTHER LEGAL ENTITY OR AN INTEREST IN ANOTHER LEGAL ENTITY; K. TO AUTHORIZE OR APPROVE THE ACQUISITION OR DISPOSITION BY THE CORPORATION OF REAL PROPERTY OR ANY INTEREST IN REAL PROPERTY; L. TO ESTABLISH CENTRALIZED EMPLOYEE BENEFIT, INSURANCE, INVESTMENT, FINANCING, CORPORATE RESPONSIBILITY, PERFORMANCE ASSESSMENT AND IMPROVEMENT AND OTHER OPERATIONAL AND SUPPORT PROGRAMS; TO REQUIRE THE PARTICIPATION OF THE CORPORATION IN SUCH PROGRAMS; AND TO AUTHORIZE THE OPENING AND CLOSING OF BANK ACCOUNTS AND INVESTMENT ACCOUNTS IN THE NAME OF THE CORPORATION IN CONNECTION WITH SUCH PROGRAMS; M. TO APPROVE THE ANNUAL BUDGET AND STRATEGIC, FINANCIAL AND HUMAN RESOURCES PLAN OF THE CORPORATION; N. TO APPOINT THE AUDITOR AND CORPORATE COUNSEL FOR THE CORPORATION; O. TO AUTHORIZE AND APPROVE THE BORROWING OF MONEY AND ENTERING INTO FINANCIAL GUARANTIES BY THE CORPORATION, INCLUDING ACTIONS RELATING TO THE FORMATION, JOINING, OPERATION, WITHDRAWAL FROM AND TERMINATION OF A CREDIT GROUP OR AN OBLIGATED GROUP AND THE GRANTING OF SECURITY INTERESTS IN THE PROPERTY OF THE CORPORATION; P. TO REQUIRE THE CORPORATION TO TRANSFER ASSETS, INCLUDING BUT NOT LIMITED TO CASH, TO THE MEMBER OR TO ANY OTHER ENTITY EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED IN 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED, OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW, WHICH IS CONTROLLED BY THE MEMBER, TO THE EXTENT NECESSARY TO ACCOMPLISH THE MISSION, GOALS AND OBJECTIVES OF THE MEMBER AS DETERMINED BY THE MEMBER; Q. TO APPROVE THE TRANSFER OF ASSETS BY THE CORPORATION TO ANY ENTITY OTHER THAN THE MEMBER, OTHER THAN TRANSFERS MADE IN THE ORDINARY COURSE OF OPERATIONS OF THE CORPORATION WHICH WILL NOT REQUIRE MEMBER APPROVAL; AND R. TO DETERMINE THE EXTENT TO WHICH AND THE MANNER IN WHICH THE POWERS DESCRIBED IN THIS SECTION WHICH ARE RESERVED TO THE MEMBER WITH RESPECT TO THE CORPORATION ARE TO BE INCLUDED IN THE GOVERNING DOCUMENTS OF ANY CONTROLLED SUBSIDIARY, REMOTELY CONTROLLED SUBSIDIARY OR NON-CONTROLLED SUBSIDIARY AND EXERCISED WITH RESPECT TO ANY CONTROLLED SUBSIDIARY, ANY REMOTELY CONTROLLED SUBSIDIARY OR ANY NON-CONTROLLED SUBSIDIARY; S. TO APPROVE ANY FINANCIAL STATEMENTS FOR ANY FISCAL YEAR, CHANGE THE FISCAL YEAR OF THE CORPORATION OR CHANGE THE BASIS OF THE CORPORATION'S ACCOUNTING POLICIES, OTHER THAN AS REQUIRED BY GENERALLY ACCEPTED ACCOUNTING PRINCIPLES, AS APPLICABLE; T. TO ENTER INTO, EXTEND, RENEW OR MODIFY ANY MATERIAL CONTRACT OR MAKE ANY CAPITAL EXPENDITURE WHICH INVOLVES PAYMENTS EXCEEDING $500,000, OTHER THAN CONTRACTS OR TRANSACTIONS INCLUDED IN THE ANNUAL BUDGET OR AN APPROVED VARIANCE THEREFROM; U. TO EXECUTE OR OTHERWISE ENTER INTO ANY EMPLOYMENT AGREEMENT, HIRE OR FIRE (WITH OR WITHOUT CAUSE) OR SET OR AMEND THE COMPENSATION LEVEL OF ANY OFFICER OF THE CORPORATION OR OTHER SIMILARLY COMPENSATED PERSON; V. TO FILE ANY CLAIM OR LAWSUIT AGAINST ANY PERSON EXCEPT WHERE THE AMOUNT CLAIMED IS LESS THAN $500,000 OR SETTLE ANY CLAIM OR LAWSUIT OR RELEASE ANY DEBT OWED THE CORPORATION EXCEPT WHERE THE AMOUNT IS LESS THAN $500,000; W. TO CONFESS A JUDGMENT AGAINST THE CORPORATION OR ALLOW A JUDGMENT BY DEFAULT TO BE RENDERED AGAINST THE CORPORATION WITHOUT ENGAGING LEGAL COUNSEL TO PROVIDE THE CORPORATION WITH AN OPPORTUNITY TO DEFEND AGAINST SUCH JUDGMENT; X. TO PAY THE DEBTS OF ANY OTHER PERSON (OTHER THAN INTER-COMPANY TRANSFERS OF MONEY AMONG THE CORPORATION AND ITS COMMONLY CONTROLLED AFFILIATES), FURNISH ANY SURETYSHIP OR GUARANTEE FOR THE OBLIGATIONS OF ANY THIRD PARTY OR INDEMNIFY ANY PERSON EXCEPT AS SPECIFICALLY PROVIDED IN THESE BYLAWS; OR Y. TO CHANGE THE NAME OF THE CORPORATION OR ANY BRAND NAMES USED BY THE CORPORATION Z. UPDATING THE MEMBER OF SHP TO MS COMMUNITY NFP JV, LLC; AA. CHANGES TO RESERVE POWERS OF THE MEMBER; AND AB. UPDATING DIRECTOR NUMBERS AND TERM LENGTH. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S FINANCE STAFF REVIEW 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 | A RELATED ORGANIZATION UTILIZED THE FOLLOWING TO DETERMINE COMPENSATION: (1) INDEPENDENT COMPENSATION CONSULTANT; (2) COMPENSATION SURVEY OR STUDY; (3) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| 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 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. ARTICLES AND BYLAWS, CONFLICT OF INTEREST POLICY, AND FORM 990S ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VII, SECTION B, 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. |
| FORM 990, PART IX, LINE 11G | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,626,003. MANAGEMENT AND GENERAL EXPENSES 477,556. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,103,559. |
| FORM 990, PART XI, LINE 9: | CHANGE IN NONADMITTED ASSETS -162,624. PAID-IN CAPITAL 5,000,000. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDICA FOUNDATION | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411812461 | FOUNDATION | MN | 501(C)(3) | LINE 12B | MHC | 0 | |
| MEDICA COMMUNITY HEALTH PLAN | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411843804 | HEALTH COVERAGE | MN | 501(C)(4) | N/A | MHC | 0 | |
| MEDICA HOLDING COMPANY | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 010571840 | HOLDING COMPANY | MN | 501(C)(4) | N/A | 0 | N/A | |
| MEDICA HEALTH PLANS | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411242261 | HEALTH COVERAGE | MN | 501(C)(4) | N/A | MHC | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MS COMMUNITY NFP JV (MFCJVN) LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 CARLSON PARKWAY | AddressLine1Txt |
| City | MINNETONKA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55305 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 873268926 | EIN |
| Primary Activities | HOLDING COMPANY | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MHC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | 0 | PredominantIncomeTypeTxt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (12 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 AFFILIATED SERVICES (MAS) | |||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411716415 | HOLDING COMPANY | MN | MHC | C | 0 |
| MEDICA HEALTH MANAGEMENT | |||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 208005519 | HEALTH MANAGEMENT | MN | MAS | C | 0 |
| MMSI INC | |||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411547003 | HEALTH INSURANCE | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |