2021-11-15T09:15:04-06:00 2020-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH MINNEAPOLIS MN 55402 990 2020-01-01 010571840 MEDICA HOLDING COMPANY MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 MARK L BAIRD SVP & CFO, TREASURER 9529922058 2021-11-11 1 MARK BAIRD 999009999 HOLLY MOEN P01800653 6123055000 2021-11-11 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z MARK BAIRD 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 481640 0 X WWW.MEDICA.COM X 2002 MN TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 11 10 0 0 0 0 0 0 0 0 1101365 481640 0 0 1101365 481640 0 0 0 0 0 0 0 0 0 18861 97375 18861 97375 1082504 384265 56082504 396466769 0 0 56082504 396466769 TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 0 0 0 0 0 MEDICA HOLDING COMPANY IS THE HOLDING COMPANY FOR ALL OF THE MEDICA ENTITIES. THE GOAL OF MEDICA IS TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS, OUR EMPLOYEES. 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 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 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MN X MARY QUIST 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 X JOHN W NAYLOR PRESIDENT & CEO 0.00 40.00 X X 0 2691811 41659 RAJ AGGARAWL DIRECTOR 0.00 10.00 X 0 85000 0 BRIGID BONNER DIRECTOR 0.00 10.00 X 0 70000 0 JOHN BUCK DIRECTOR, CHAIR 0.00 15.00 X X 0 126625 0 PETER KELLY DIRECTOR 0.00 10.00 X 0 81250 0 SAM LEON DIRECTOR 0.00 10.00 X 0 78500 0 GAYE ADAMS MASSEY DIRECTOR 0.00 10.00 X 0 15000 0 JOHN STANOCH DIRECTOR, VICE CHAIR 0.00 10.00 X X 0 87875 0 EARL STRATTON DIRECTOR 0.00 10.00 X 0 99375 0 ESTHER TOMLJANOVICH DIRECTOR 0.00 6.00 X 0 74125 0 MARY TWINEM DIRECTOR 0.00 10.00 X 0 87250 0 MARK L BAIRD SVP & CFO, TREASURER 0.00 40.00 X 0 1252275 51449 JAMES P JACOBSON SVP & GEN COUNSEL, SECRETARY 0.00 40.00 X 0 847800 54490 DAVID H ELLENBOGEN SVP & GEN COUNSEL, SECRETARY 0.00 40.00 X 0 55108 688 0 5651994 148286 0 0 1 0 0 481640 481640 481640 0 0 481640 97375 97375 97375 0 97375 0 0 0 56082504 21760139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 62022620 0 311854620 0 0 0 0 0 829390 56082504 396466769 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 56082504 396466769 0 0 56082504 396466769 56082504 396466769 X 384265 340000000 X 0 0 0 0 0 SHORT TERM INVESTMENTS 311854620 F 311854620 0 1 0 0 0 0 1 0 0 JOHN W NAYLOR PRESIDENT & CEO 0 932685 0 1541855 0 217271 0 18378 0 23281 0 2733470 0 188737 MARK L BAIRD SVP & CFO, TREASURER 0 466139 0 673136 0 113000 0 22088 0 29361 0 1303724 0 84595 JAMES P JACOBSON SVP & GEN COUNSEL, SECRETARY 0 373654 0 390196 0 83950 0 22088 0 32402 0 902290 0 53911 PART I, LINE 3 MEDICA HOLDING COMPANY, THE FILING ORGANIZATION, DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION, MEDICA HEALTH PLANS 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 4B THE FOLLOWING RECEIVED A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION: MARK L. BAIRD - $84,595 JAMES P. JACOBSON - $53,911 JOHN W. NAYLOR- $188,737 SCHEDULE J PART 1 LINE 6B MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO OPERATING EARNINGS OF AFFILIATED MEDICA ENTITIES. SCHEDULE J PART II COLUMN F SCHEDULE J, PART II, COLUMN (F), COMPENSATION IN COLUMN (B) REPORTED AS DEFERRED IN PRIOR FORM 990: COLUMN (F) INCLUDES AMOUNTS VESTED IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B MEDICA'S TAX ADVISORS COMPLETE THE RETURN, 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 HEALTH 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 HOLDING COMPANY, THE FILING ORGANIZATION, DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION, WHICH USES THE FOLLOWING TO DETERMINE COMPENSATION: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY/STUDY, AND 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 STATEMENT 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 612(D). FORM 990 PART VII LINE SECTION B LINE 1: CERTAIN INDIVIDUALS REPORTED ON FORM 990, PART VII SPLIT THEIR TIME BETWEEN SEVERAL OF THE MEDICA ENTITIES (MEDICA HEALTH PLANS, MEDICA COMMUNITY HEALTH PLAN, MEDICA HOLDING COMPANY, MEDICA FOUNDATION, MEDICA SELF-INSURED, MEDICA AFFILIATED SERVICES, MEDICA HEALTH MANAGEMENT, MMSI, INC, MEDICA SERVICES COMPANY, MEDICA REGIONAL INSURANCE COMPANY, AND MEDICA INSURANCE COMPANY). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. FORM 990, PART XI, LINE 9: TRANSFER TO MRIC -10,000,000. TRANSFER TO MSC -10,000,000. TRANSFER FROM MIC 360,000,000. MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH COVERAGE MN 501(C)(4) N/A MH COMPANY 1 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) LINE 12B MH COMPANY 1 MEDICA COMMUNITY HEALTH PLAN 401 CARLSON PARKWAY MINNETONKA MN 55305 411843804 HEALTH COVERAGE MN 501(C)(4) N/A MH COMPANY 1 MEDICA INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 411490988 HEALTH INSURANCE MN MEDICA AFF C 0 MEDICA SELF-INSURED 401 CARLSON PARKWAY MINNETONKA MN 55305 411479417 THIRD PARTY ADMIN MN MEDICA AFF C 0 MEDICA HEALTH MANAGEMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MGMT MN MEDICA AFF C 0 MEDICA AFFILIATED SERVICES 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MH COMPANY C 1 MMSI INC 401 CARLSON PARKWAY MINNETONKA MN 55305 411547003 THIRD PARTY ADMIN MN MEDICA AFF C 0 MEDICA SERVICES COMPNAY LLC 401 CARLSON PARKWAY MINNETONKA MN 55305 852902940 ADMIN. SERVICES MN MEDICA AFF C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 MEDICA SERVICES COMPANY LLC R -10000000 MEDICA INSURANCE COMPANY S 360000000