2012-11-14T07:55:19-06:00 2011-12-31 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2011-01-01 411242261 MEDICA HEALTH PLANS MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 AARON REYNOLDS 9529922058 2012-11-12 1 TODD A JACKSON P00092672 6123324300 2011 2016-02-24 21:20:13Z DAVID TILFORD 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 1969972358 0 X WWW.MEDICA.COM X 1973 MN MEDICA'S MISSION IS TO MEET OUR CUSTOMERS' NEED FOR HEALTH PLAN PRODUCTS AND SERVICES. IN DOING SO, WE WORK WITH OUR MEMBERS AND PROVIDERS TO MAKE HEALTH CARE ACCESSIBLE, AFFORDABLE AND A MEANS BY WHICH OUR MEMBERS IMPROVE THEIR HEALTH. 12 11 1372 0 261331 237096 0 0 1706184411 1721786050 19424490 20476422 -728451 488499 1724880450 1742750971 11526241 10913725 1565038859 1473196095 98487054 98919793 0 0 0 21434630 145457268 1696486784 1728486881 28393666 14264090 675307053 718887557 275977683 302567425 399329370 416320132 X MEDICA'S MISSION IS TO MEET OUR CUSTOMERS' NEEDS FOR HEALTH PLAN PRODUCTS AND SERVICES. IN DOING SO, WE WORK WITH MEMBERS AND PROVIDERS TO MAKE HEALTH CARE ACCESSIBLE, AFFORDABLE AND A MEANS BY WHICH OUR MEMBERS IMPROVE THEIR HEALTH. 0 0 810367000 850974000 MEDICA HEALTH PLANS (MHP) IN 2011 PROVIDED NONPROFIT HMO COVERAGE TO ENROLLEES IN THE STATE OF MINNESOTA'S PREPAID MEDICAL ASSISTANCE (MEDICAID) AND MINNESOTACARE PROGRAMS. A TOTAL OF 150,656 MEDICA MEMBERS OR 86.1% OF MHP ENROLLMENT WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/2011: PREPAID MEDICAL ASSISTANCE PROGRAM 117,368 MEMBERS; MINNESOTACARE, 33,288. 61309000 76667000 MHP PROVIDED FULLY INSURED SMALL GROUP AND LARGE GROUP HMO HEALTH INSURANCE IN TWO STATES, MINNESOTA AND NORTH DAKOTA, AND TO 94 INDIVIDUALS WHO WERE CONVERTED FROM A GROUP PLAN. AS OF 12/31/2011, THE ENROLLMENT IN MHP FULLY INSURED MINNESOTA GROUP PLANS WAS 13,392 AND THE NORTH DAKOTA ENROLLMENT WAS 416. THE COMBINED TOTAL OF 13,768 REPRESENTED 7.9% OF MHP ENROLLMENT. IN 2011 MEDICA HAD THE HIGHEST ACCREDITATION STATUS, "EXCELLENT", (FROM NCQA) FOR ITS MINNESOTA COMMERCIAL HMO HEALTH PLANS IN MINNESOTA AND NORTH DAKOTA. 295828000 318614000 IN 2011 MHP PROVIDED MINNESOTA SENIOR HEALTH OPTIONS (MSHO), MEDICARE SUPPLEMENTAL AND FEE-FOR-SERVICE (FFS) COVERAGE TO 10,545 INDIVIDUALS, REPRESENTING 6.0% OF MHP ENROLLMENT IN MINNESOTA AND SOUTH DAKOTA. ENROLLMENT IN MSHO WAS 9,925 AS OF 12/31/2011. ENROLLMENT IN MEDICARE SUPPLEMENTAL AND FFS PRODUCTS TOTALED 620. THE PRIVATE FEE-FOR-SERVICE (PFFS) PRODUCTS UNDER CMS CONTRACT H2410 HAVE PLAN DESIGNS THAT INCLUDE A VARIETY OF CO-PAY PLANS, PLANS WHICH COVER MEDICAL ONLY, AND PLANS THAT INCLUDE PRESCRIPTION DRUG COVERAGE. THESE PLANS DO NOT LIMIT BENEFICIARIES TO A CONTRACTED MEDICAL PROVIDER NETWORK, BUT RATHER UTILIZE A DEEMED NETWORK WHERE ALL MEDICARE CERTIFIED PROVIDERS MAY BE UTILIZED, AS LONG AS THEY AGREE TO MEDICARE PAYMENT ASSIGNMENT. 316605820 10913725 337707000 MEDICA HEALTH PLANS (MHP) AND COMMUNITY BENEFITMHPMEDICA HEALTH PLANS (MHP), A SUBSIDIARY OF MEDICA HOLDING COMPANY (MHC), IS A NON-PROFIT, NON-TAXABLE CORPORATION, LICENSED UNDER MINNESOTA STATUTES CHAPTER 62D AS A MINNESOTA NONPROFIT HEALTH MAINTENANCE ORGANIZATION (HMO), AND REGULATED BY THE MINNESOTA DEPARTMENT OF HEALTH (MDH). IT IS INCORPORATED AS A NONPROFIT ORGANIZATION UNDER MINNESOTA STATUTES CHAPTER 317A AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE (IRC). MHP IS AUTHORIZED TO PROVIDE PREPAID COMPREHENSIVE HMO SERVICES AND IN 2011 DID SO TO THREE MARKET SEGMENTS: 1) STATE OF MINNESOTA HEALTH CARE PROGRAMS; 2) COMMERCIAL FULLY INSURED GROUPS AND INDIVIDUALS CONVERTED FROM GROUP PLANS; AND 3) MEDICARE (THESE THREE PROGRAMS ARE EXPLAINED IN MORE DETAIL IN PSA'S 4A, B & C).TO MEET ITS MISSION AND ITS TAX-EXEMPT OBLIGATION AS AN ORGANIZATION DESCRIBED UNDER IRC 501(C)(4), MHP PROVIDED SIGNIFICANT COMMUNITY BENEFITS. STATE OF MINNESOTA HEALTH CARE PROGRAMSMINNESOTA REQUIRES STATE-LICENSED HMOS TO BE NONPROFIT AND TO PARTICIPATE IN STATE OF MINNESOTA HEALTH CARE PROGRAMS. MINNESOTA HEALTH CARE PROGRAMS COVER PEOPLE WHO CANNOT GET OR AFFORD HEALTH INSURANCE ELSEWHERE AND HELPS THEM PAY SOME OR ALL MEDICAL BILLS. ACCORDING TO THE MINNESOTA DEPARTMENT OF HUMAN SERVICES, COVERAGE IS AVAILABLE FOR QUALIFYING INDIVIDUALS WHO MEET RULES ABOUT INCOME, ASSETS AND OTHER FACTORS. THESE PROGRAMS FOCUS ON PREGNANT WOMEN, FAMILIES AND CHILDREN, ADULTS WITH DISABILITIES, CHILDREN WITH DISABILITIES, PEOPLE 65 OR OLDER, ADULTS WITHOUT CHILDREN, AND 19 AND 20 YEAR OLDS. COVERAGE IS ALSO AVAILABLE FOR PEOPLE WHO MEET ELIGIBILITY RULES FOR NURSING HOME CARE, HOME CARE, FOR CHILDREN WHO HAVE A DISABILITY (MA-TEFRA PROGRAM) AND FOR EMPLOYED PERSONS WITH DISABILITIES (MA-EPD PROGRAM).AS OF 12/31/2011, 86.1% OF MHP ENROLLMENT WAS IN STATE OF MINNESOTA HEALTH CARE PROGRAMS (COVERED IN PSA 4A & 4B). THE PROGRAMS AND THE RESPECTIVE ENROLLMENT TOTALS WERE: PREPAID MEDICAL ASSISTANCE PROGRAM, 111,368 MEMBERS; MINNESOTACARE, 33,288 MEMBERS. IN TOTAL, AS OF 12/31/2011, MHP PROVIDED AND ADMINISTERED PREPAID COMPREHENSIVE HMO SERVICES TO 150,656 INDIVIDUALS ENROLLED IN STATE OF MINNESOTA HEALTH CARE PROGRAMS.THE STATE OF MINNESOTA SETS RATES WHEN IT CONTRACTS WITH THE STATE'S NONPROFIT HMOS, PAYING A FIXED SUM PER ENROLLEE. MHP BEARS THE RISK FOR COSTS ABOVE THE PREDETERMINED RATE. MHP'S PERFORMANCE ON BEHALF OF THE STATE OF MINNESOTA IS EFFICIENT. IN 2011 APPROXIMATELY 95 CENTS OF EACH STATE PROGRAM DOLLAR WENT TO PROVIDE CARE; THE ADMINISTRATIVE COST RATIO WAS APPROXIMATELY 6.0%.OTHER COMMUNITY BENEFIT PROGRAMS AND EXPENSES BY MHP ON BEHALF OF STATE OF MINNESOTA HEALTH CARE PROGRAMS INCLUDE: THE WAY TO BETTER HEALTH, $519,544; MSC+ ELDERLY WAIVER COVERAGE FOR ELIGIBLE MEMBERS, $249,017; FIT CHOICES FOR MINNESOTACARE MEMBERS, $158,100; $50,845 IN BENEFIT EXCEPTIONS FOR SERVICES NOT OTHERWISE COVERED TO HELP PMAP, MINNESOTACARE AND MSC/MSC+ MEMBERS STAY IN THEIR HOMES TO PRESERVE HEALTH; $149,950 IN BENEFIT EXCEPTIONS FOR SERVICES NOT OTHERWISE COVERED TO HELP MINNESOTA SENIOR HEALTH OPTIONS (MSHO) AND SPECIAL NEEDS BASIC COVERAGE (SNBC) MEMBERS STAY IN THEIR HOMES TO PRESERVE HEALTH; $602,744 IN MSHO ELDERLY WAIVER SERVICES TO HELP THOSE MEMBERS STAY IN THEIR HOMES.OTHER COMMUNITY BENEFITSMHP PROVIDED OTHER COMMUNITY BENEFITS WITH A WIDE RANGE OF PROGRAMS AND INITIATIVES TO PROMOTE PUBLIC AND INDIVIDUAL HEALTH, REDUCE DISPARITIES IN ACCESS TO CARE, IMPROVE HEALTH CARE SYSTEM PERFORMANCE, AND HELP PROVIDE FINANCIAL ASSISTANCE TO ACCESS CARE. MEDICA FOUNDATIONMHP IN 2011 CONTRIBUTED $3.5 MILLION TO ENABLE GRANTS BY THE MEDICA FOUNDATION, A 501(C)(3) NONPROFIT CHARITABLE GRANT-MAKING FOUNDATION, WHICH PROVIDES FUNDING FOR NUMEROUS NONPROFIT COMMUNITY ORGANIZATIONS THAT PROVIDE HEALTH-RELATED SERVICES TO THE COMMUNITY. THE MEDICA FOUNDATION IN 2011 MADE GRANTS TOTALING $2.5 MILLION TO SUPPORT MORE THAN 104 PROJECTS AROUND BEHAVIORAL HEALTH, DISPARITIES IN HEALTH CARE, HEALTHY LIVING, WORKSITE WELLNESS AND GENERAL HEALTH IMPROVEMENT. FROM 2003-2011 MEDICA FOUNDATION GRANTS TOTALED NEARLY $13 MILLION. MEDICA RESEARCH INSTITUTEIN 2011 MHP GAVE $6.5 MILLION TO SUPPORT THE MISSION OF THE MEDICA RESEARCH INSTITUTE. THE MEDICA RESEARCH INSTITUTE, ESTABLISHED IN JANUARY 2010, IS A NONPROFIT 501(C)(3) FOUNDATION AND A SISTER ORGANIZATION TO MEDICA HEALTH PLANS. ITS MISSION IS TO CONDUCT RESEARCH THAT GENERATES INFORMATION FOR TIMELY TRANSLATION INTO ACTIVITIES WHICH PROTECT HEALTH AND IMPROVE LIVES. COLLABORATIVE EFFORTSIN ADDITION, MHP DONATED FUNDING, EMPLOYEE TIME AND OTHER RESOURCES IN SUPPORT OF 47 LOCAL, STATE, REGIONAL AND NATIONAL COLLABORATIVE EFFORTS AND CHARITIES. EXAMPLES INCLUDE: MINNESOTA COMMUNITY MEASUREMENT, WHICH PROMOTES COMMUNITY-BASED, EVIDENCE-BASED CARE AND PROVIDES THE PUBLIC WITH QUALITY COMPARISONS OF PROVIDER GROUPS AND CLINICS; INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT, WHICH PROVIDES EVIDENCE-GRADED PRACTICAL GUIDELINES AND TECHNOLOGY ASSESSMENT REPORTS; AND, MINNESOTA HEALTH INFORMATION EXCHANGE, WHICH CONNECTS DOCTORS, HOSPITALS AND CLINICS STATEWIDE SO THEY CAN QUICKLY ACCESS MEDICAL RECORDS, IMPROVING SAFETY AND QUALITY.HEALTH AND WELLNESS PROGRAMS PROVIDING COMMUNITY BENEFITMHP UNDERTOOK ITS OWN INITIATIVES TO DECREASE HEALTH CARE COST AND IMPROVE QUALITY PROVIDED SIGNIFICANT BENEFITS TO ITS MEMBERS AND THEIR COMMUNITIES. EXAMPLES OF PERFORMANCE AND VALUE INCLUDE:- IMPROVING CARE EFFICIENCY, REDUCING THE COST OF CARE, INCLUDING: - 11.3% REDUCTION IN ER VISITS - 20.1% REDUCTION IN HOSPITAL ADMISSIONS- IMPROVE THE OUTCOMES OF CARE INCLUDING: - IMPROVED A1C, CHOLESTEROL LEVELS - INCREASED PARTICIPATION IN EXERCISE AND NUTRITION PROGRAMS - IMPROVED MEDICATION MANAGEMENTMY HEALTH MANAGER FROM MEDICA INCLUDES AN ARRAY OF ONLINE TOOLS AND RESOURCES THAT MAKE IT EASY FOR MEDICA MEMBERS TO ASSESS THEIR HEALTH STATUS, AND TO CUSTOMIZE AND FOLLOW PERSONALIZED PROGRAMS FOR A HEALTHIER LIFESTYLE AND DIET. MY HEALTH MANAGER FROM MEDICA WAS PROVIDED AT NO ADDITIONAL CHARGE TO FULLY INSURED GROUPS AND TO MINNESOTACARE MEMBERS. IN 2011 MORE THAN 97,000 MEDICA MEMBERS IN FULLY INSURED GROUPS AND 33,288 IN MINNESOTACARE HAD ACCESS TO MY HEALTH MANAGER FROM MEDICA.FIT CHOICES BY MEDICA PROVIDED MEDICA MEMBERS WITH (A) A $20 MONTHLY MEMBERSHIP CREDIT FOR EXERCISING AT A PARTICIPATING HEALTH CLUB EIGHT OR MORE DAYS PER MONTH AND (B) THE OPPORTUNITY FOR PERSONAL COACHING AND A PERSONALIZED NUTRITION AND FITNESS PLAN. IN 2011 FIT CHOICES BY MEDICA WAS AVAILABLE AT NO COST TO MHP'S FULLY INSURED AND MINNESOTACARE MEMBERS. IN A MEDICA STUDY OF FIT CHOICES PARTICIPATION, AFTER TWO YEARS, THE AVERAGE MONTHLY MEDICAL COSTS OF STUDY PARTICIPANTS WERE 33.6% LOWER THAN THOSE IN A MATCHED CONTROL GROUP. PEOPLE NOT ENROLLED IN THE FIT CHOICES PROGRAM AND WHO DID NOT EXERCISE EIGHT TIMES A MONTH WERE 43% TO 105% MORE LIKELY TO HAVE BEEN TO A CLINIC, HOSPITAL OR EMERGENCY ROOM.HEALTH AND WELLNESS COACHING MHP'S HEALTH AND WELLNESS COACHING PROGRAM IS A SELF-DIRECTED PROGRAM OFFERING A WIDE VARIETY OF TOOLS AND RESOURCES TO HELP MEMBERS MAKE CHANGES TO IMPROVE THEIR HEALTH. HEALTH COACHING SUPPORT INCLUDES PRIVATE, CONFIDENTIAL ACCESS TO TRAINED HEALTH COACHES. THERE WAS NO COST TO MEDICA MEMBERS TO PARTICIPATE IN THE HEALTH AND WELLNESS COACHING PROGRAM.MEDICAL AND MENTAL HEALTH DISEASE MANAGEMENT AND PATIENT SUPPORTIN 2011, MHP OFFERED A PORTFOLIO OF DISEASE MANAGEMENT PROGRAMS FOR PHYSICAL AND MENTAL HEALTH, TOBACCO CESSATION, HEALTHY PREGNANCY, COMMON CHRONIC MEDICAL DISEASES, AND RARE AND COMPLEX DISEASES. THEY PROVIDE EDUCATION AND RESOURCES THAT HELP SUPPORT THE MEMBERS' ABILITY TO MANAGE CHRONIC CONDITIONS. THE GOALS ARE TO IMPROVE HEALTH AND QUALITY OF LIFE, REDUCE COMPLICATIONS THROUGH EARLY INTERVENTION AND MONITORING, PROMOTE MEDICAL CARE AND COMPLIANCE WITH THE PATIENT'S PHYSICIAN-RECOMMENDED MEDICAL TREATMENT REGIMEN, AND TO IMPROVE SATISFACTION WITH HEALTH CARE SERVICES. MEDICA'S DISEASE MANAGEMENT PROGRAMS WERE PROVIDED AT NO ADDITIONAL CHARGE TO FULLY INSURED GROUPS, AND TO MINNESOTA STATE HEALTH CARE PROGRAM ENROLLEES SERVED BY MEDICA. THERE IS NO COST TO ELIGIBLE MEDICA MEMBERS. 316605820 10913725 337707000 1484109820 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 246 0 1 1372 1 1 1 0 0 0 0 0 X 12 11 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X MARY QUIST 9529922058 PO BOX 9310 CP 330 MINNEAPOLIS MN 554409310 JOHN BUCK 15.00 X X 95000 0 0 ESTHER TOMLJANOVICH 10.00 X X 67000 0 0 KRIS SANDA 10.00 X X 67000 0 0 DAVID TILFORD 40.00 X X 2223128 0 171530 BURTON COHEN 7.00 X 61000 0 0 DARYL DURUM 10.00 X 66000 0 0 PETER KELLY MD 10.00 X 62000 0 0 SAMUEL LEON MD 7.00 X 59000 0 0 RAJESH AGGARWAL 7.00 X 60000 0 0 EARL STRATTON 10.00 X 63000 0 0 AUSTIN SULLIVAN 10.00 X 66000 0 0 BEN BACHE-WIIG MD 10.00 X 65000 0 0 AARON REYNOLDS 40.00 X 1194598 0 114174 JAMES P JACOBSON 40.00 X 553401 0 68830 CHARLES J FAZIO 40.00 X 641132 0 62078 JANA L JOHNSON 40.00 X 595642 0 77516 GLENN E ANDIS 40.00 X 658334 0 83949 ROBERT LONGENDYKE 40.00 X 576176 0 74300 DEBBY S KNUTSON 40.00 X 549914 0 59517 SIMEON SCHINDELMAN 40.00 X 622772 0 80957 THEODORE J LOFTNESS 40.00 X 656841 0 68909 MARK L BAIRD 40.00 X 544943 0 74373 TIM THULL 40.00 X 374662 0 62118 RICHARD H SYKORA 40.00 X 474838 0 66212 JOHN CHOMEAU 40.00 X 340114 0 43554 JOHN NAYLOR 40.00 X 473453 0 69611 DANETTE COLEMAN 40.00 X 376746 0 57272 STEPHEN WICZEK 0.00 X 44000 0 0 TOM L HENKE 0.00 X 283484 0 0 11915178 0 1234900 152 1 1 0 UNITED HEALTHCARE SERVICES INC 9900 BREN DR E MN008-T380 MINNETONKA MN 55343 CLAIMS PROCESSING 91153250 DAHL CONSULTING INC 418 COUNTY ROAD D E ST PAUL MN 55117 TEMP SERVICES 5324915 LEVEL BRAND INC 724 NORTH 1ST STREET MINNEAPOLIS MN 55401 ADVERTISING 4385999 CDW DIRECT LLC 7145 BOONE AVE N BROOKLYN PARK MN 55128 TECHNOLOGY SERVICES 3081364 XEROX CORPORATION 701 DECATUR AVENUE NORTH MINNEAPOLIS MN 55427 COPY SERVICES 2449554 84 MEDICARE REVENUE 524114 1169587640 1169587640 SUBSCRIBER REVENUE 524114 407776605 407776605 INTERCOMPANY ADMIN FEE 561000 135206385 135206385 OTHER REVENUE 524114 6064893 6064893 DENTAL REVENUE 541900 3150527 3150527 1721786050 12465961 12465961 885000 310000 575000 575000 575000 234921848 226911387 8010461 8010461 8010461 MEDICA TAX PARTNERSHIP 900099 261331 261331 MN EXCHANGE PARTNERSHI 561499 -347832 -347832 -86501 1742750971 1721438218 261331 21051422 10913725 10913725 1473196095 1473196095 9959395 9959395 68363630 68363630 6141092 6141092 9005794 9005794 5449882 5449882 2054752 2054752 564000 564000 177831 177831 1476815 1476815 37422476 37422476 6564939 6564939 3153295 3153295 8998853 8998853 9464385 9464385 409376 409376 767609 767609 371853 371853 7914645 7914645 1196513 1196513 REINSURANCE 36619620 36619620 PREMIUM, STATE & FEDERA 17088446 17088446 PRINTING AND PUBLICATIO 6822323 6822323 BROKER COMMISSIONS 1791283 1791283 2598254 2598254 1728486881 1484109820 244377061 0 343031090 307823502 73380437 83746555 22722128 15002831 8650292 7719297 199371755 278618283 50873479 40979920 675307053 718887557 275376573 302307602 601110 259823 275977683 302567425 X 399329370 416320132 399329370 416320132 675307053 718887557 X 14264090 2726672 X 0 1 1 X 0 12254770 6032847 6221923 10467358 8969984 1497374 7719297 BONDS 277678281 C PREFERRED STOCK 940002 C 278618283 INVESTMENT RELATED RECEIVABLES 2142258 HEALTH CARE RECEIVABLES 4688296 DUE FROM AFFILIATES 4180631 FUNDS HELD BY REINSURED COMPANIES 29908735 ACCOUNTS RECEIVABLE RELATING TO UNINSURED PLANS 60000 40979920 1742750971 1728486881 14264090 -80280 2806952 2726672 16990762 1605468750 -1848668 -1848668 1607317418 135433553 135433553 1742750971 1590856828 -135781385 -135781385 1726638213 1848668 1848668 1728486881 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AS OF DECEMBER 31, 2011, THE COMPANY'S TAX YEARS 2008 THROUGH 2011 REMAIN OPEN TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) AND VARIOUS STATE AUTHORITIES. TAX YEARS 2008, 2009 AND 2010 ARE CURRENTLY UNDER EXAMINATION BY THE IRS. MANAGEMENT HAS NOT RECORDED AN AMOUNT FOR UNCERTAIN TAX POSITIONS FOR ANY MATTERS, INCLUDING THOSE CURRENTLY UNDER EXAMINATION. HOWEVER, THE ULTIMATE RESOLUTION OF THESE ITEMS IS DEPENDENT ON A NUMBER OF FACTORS. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF NONADMITTED ASSETS 2,459,116. MN HEALTH INFO EXCHANGE K-1 347,832. ROUNDING 4. TOTAL TO SCHEDULE D, PART XI, LINE 8: 2,806,952. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS EXPENSE -1,476,815. INTEREST EXPENSE RECLASSED AS EXPENSE -371,853. PART XII, LINE 4B - OTHER ADJUSTMENTS: MN HEALTH INFO EXCHANGE K-1 -347,832. INTERCOMPANY ADMIN FEES RECLASSED FROM EXPENSE 135,206,385. NET RENTAL INCOME RECLASSED FROM EXPENSE 575,000. PART XIII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY ADMIN FEES RECLASSED AS REVENUE -135,206,385. NET RENTAL INCOME RECLASSED AS REVENUE -575,000. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS REVENUE 1,476,815. INTEREST EXPENSE RECLASSED AS REVENUE 371,853. 1 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 501(C)(3) 3500000 SUPPORT OF THE MANY PROGRAMS CONDUCTED BY THE FOUNDATION. MEDICA RESEARCH FOUNDATION DBA MEDICA RESEARCH INSTITUTE 401 CARLSON PARKWAY MINNETONKA MN 55305 270600894 501(C)(3) 6500000 SUPPORT OF THE MANY PROGRAMS CONDUCTED BY THE FOUNDATION. INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT 8009 34TH AVE SO STE 1200 BLOOMINGTON MN 55425 411782168 501(C)(3) 913725 SUPPORT THE BEST PRACTICES IN THE MEDICAL WORLD 3 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MEDICA HEALTH PLANS DONATES FUNDS ANNUALLY TO ITS RELATED ORGANIZATIONS, MEDICA FOUNDATION AND MEDICA RESEARCH FOUNDATION DBA MEDICA RESEARCH INSTITUTE, AS WELL AS OTHER 501(C)(3) ORGANIZATIONS. THE FOUNDATIONS RETAIN RECORDS TO SUBSTANTIATE THE USE OF THESE FUNDS. X X X X X 1 1 0 0 0 1 0 0 0 DAVID TILFORD 716388 0 1355364 0 151376 0 160702 0 10828 0 2394658 0 0 0 AARON REYNOLDS 417853 0 685774 0 90971 0 100814 0 13360 0 1308772 0 0 0 JAMES P JACOBSON 255315 0 278150 0 19936 0 54968 0 13862 0 622231 0 0 0 CHARLES J FAZIO 201387 0 390860 0 48885 0 54670 0 7408 0 703210 0 0 0 JANA L JOHNSON 258965 0 316734 0 19943 0 62914 0 14602 0 673158 0 0 0 GLENN E ANDIS 270321 0 329280 0 58733 0 70053 0 13896 0 742283 0 0 0 ROBERT LONGENDYKE 250288 0 277552 0 48336 0 60297 0 14003 0 650476 0 0 0 DEBBY S KNUTSON 243561 0 264270 0 42083 0 52540 0 6977 0 609431 0 0 0 SIMEON SCHINDELMAN 333466 0 269661 0 19645 0 67572 0 13385 0 703729 0 0 0 THEODORE J LOFTNESS 246500 0 267815 0 142526 0 56792 0 12117 0 725750 0 0 0 MARK L BAIRD 250700 0 273312 0 20931 0 58802 0 15571 0 619316 0 0 0 TIM THULL 207206 0 149749 0 17707 0 47318 0 14800 0 436780 0 0 0 RICHARD H SYKORA 221283 0 233427 0 20128 0 51576 0 14636 0 541050 0 0 0 JOHN CHOMEAU 154357 0 167111 0 18646 0 33943 0 9611 0 383668 0 0 0 JOHN NAYLOR 284034 0 170774 0 18645 0 54972 0 14639 0 543064 0 0 0 DANETTE COLEMAN 214366 0 144551 0 17829 0 48573 0 8699 0 434018 0 0 0 STEPHEN WICZEK 0 0 0 0 44000 0 0 0 0 0 44000 0 0 0 TOM L HENKE 36748 0 225000 0 21736 0 0 0 0 0 283484 0 0 0 PART I, LINES 4A-B THE FOLLOWING RECEIVED A SEVERANCE PAYMENT: TOM L. HENKE $54,849 STEPHEN WICZEK $44,000 THE FOLLOWING RECEIVED PAYMENTS FROM A NON-QUALIFIED RETIREMENT PLAN: DAVID TILFORD $44,254 AARON REYNOLDS $23,293 CHARLES J FAZIO $ 9,929 TOM L HENKE $21,736 GLENN E ANDIS $12,098 ROBERT LONGENDYKE $ 9,112 DEBBY S KNUTSON $ 7,469 THEODORE J LOFTNESS $52,435 THE FOLLOWING PARTICIPATED IN, BUT DID NOT RECEIVE A PAYMENT, FROM A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION: JAMES JACOBSON JANA L JOHNSON SIMEON SCHINDELMAN MARK L BAIRD RICHARD H SYKORA JOHN CHOMEAU PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATIONS OPERATING EARNINGS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS EXIST WITHIN MEDICA HEALTH PLANS AS MEMBERS COVERED UNDER REGULATED INSURANCE PLANS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERSHIP OF MEDICA HEALTH PLANS ELECTS THE CONSUMER BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND DIRECTOR OF TREASURY REVIEW THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY WILL BE PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY ALL EMPLOYEES OF MEDICA HEALTH PLANS 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 THE BOARD'S PERSONNEL AND COMPENSATION COMMITTEE REVIEWS AND OBTAINS THE BOARD'S APPROVAL OF THE TOTAL COMPENSATION FOR THE PRESIDENT/CEO AND REVIEWS AND APPROVES THE TOTAL COMPENSATION RECOMMENDATIONS MADE BY THE CEO FOR THE EXECUTIVE AND SENIOR VICE PRESIDENTS; REVIEWS ALL OFFICER COMPENSATION AND PERFORMANCE GOALS APPROVED BY THE CEO ANNUALLY. THE PERSONNEL AND COMPENSATION COMMITTEE ALSO REVIEWS AND RECOMMENDS TO THE BOARD, OFFICER AND NON-OFFICER COMPENSATION GUIDELINES FOR THE COMPANY AND ITS SUBSIDIARIES PERIODICALLY REVIEWING MARKET DATA TO ASSESS THE COMPANY'S COMPETITIVE POSITION. PROCESS OUTSIDE THE CHARTER: THE PERSONNEL AND COMPENSATION COMMITTEE WORKS WITH AN OUTSIDE CONSULTANT IN REVIEWING MARKET COMPETITIVE 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. ARTICLES AND BYLAWS, CONFLICT OF INTEREST POLICY, AND FORM 990S ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -80,280. CHANGE IN VALUE OF NONADMITTED ASSETS 2,459,116. MN HEALTH INFO EXCHANGE K-1 347,832. ROUNDING 4. TOTAL TO FORM 990, PART XI, LINE 5: 2,726,672. AVERAGE HOURS PER WEEK FORM 990, PART VII, COLUMN B CERTAIN INDIVIDUALS REPORTED ON FORM 990, PART VII SPLIT THEIR TIME BETWEEN SEVERAL OF THE MEDICA ENTITIES (MEDICA HEALTH PLANS, MEDICA HEALTH PLANS WI, MEDICA FOUNDATION, AND MEDICA RESEARCH FOUNDATION). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL FOUR MEDICA ORGANIZATIONS. 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