2022-11-14T11:02:36-06:00 2021-12-31 135565207 KPMG LLP 90 S 7TH ST STE 4200 MINNEAPOLIS MN 55402 990 2021-01-01 411242261 MEDICA HEALTH PLANS MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 MARY QUIST INTERIM CFO 9529922058 2022-11-11 1 MARY QUIST 999009999 MONROE J GIERL P01413237 6123055000 2022-11-11 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z MARY QUIST 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 1864252533 0 X WWW.MEDICA.COM X 1973 MN TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 6 5 30 0 0 0 0 0 1141618194 1181111064 15720444 28126391 752250 8876786 1158090888 1218114241 9204000 183600 1004963583 1050241683 32175188 13049123 0 0 0 41066488 63484133 1087409259 1126958539 70681629 91155702 702929390 840677669 278107701 246099759 424821689 594577910 X TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 0 0 282487731 0 302200797 SEE SCHEDULE O. 13502072 0 8627407 SEE SCHEDULE O. 754251880 0 870282860 SEE SCHEDULE O. 183600 183600 0 CONTRIBUTIONS BY MEDICA ON BEHALF OF MEMBERS BEYOND CONTRACTED SERVICES IN 2021 MHP SPENT APPROXIMATELY $ 3.3 MILLION TO PROVIDE ADDITIONAL, NON-STATE PLAN SERVICES ON BEHALF OF THE FOLLOWING CATEGORIES OF MINNESOTA HEALTH CARE PROGRAMS: MSC+; MSHO; AND SNBC.NON-STATE PLAN SERVICES INCLUDED: VALUE OF WAIVED FAMILY DEDUCTIBLES; MSC+/MSHO ELDERLY WAIVER FOR NON-ELIGIBLE MEMBERS; NON-MEDICARE PART D PHARMACY COPAYMENTS; DRUGS NOT ELIGIBLE FOR REBATES; AND NON-MEDICARE VALUE OF COST-SHARING WAIVED COPAYS.MHP 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.COLLABORATIVE EFFORTSMHP DONATES FUNDING, EMPLOYEE TIME AND OTHER RESOURCES IN SUPPORT OF MORE THAN TWO DOZEN COLLABORATIVE EFFORTS WITH LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS. EXAMPLES INCLUDE: MINNESOTA COMMUNITY MEASUREMENT, WHICH PROMOTES COMMUNITY-BASED, EVIDENCE-BASED CARE, AND QUALITY COMPARISONS OF PROVIDER GROUPS AND CLINICS; INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT, WHICH PROVIDES EVIDENCE-GRADED GUIDELINES AND ASSESSMENTS.HEALTH AND WELLNESS PROGRAMS PROVIDING COMMUNITY BENEFITMEDICA UNDERTAKES A VARIETY OF INITIATIVES TO MAKE HEALTH CARE MORE AFFORDABLE, AVAILABLE AND EFFECTIVE. EXAMPLES INCLUDE:-IMPROVEMENTS IN RATES OF ANNUAL SCREENINGS AMONG MEMBERS FOR DISEASES SUCH AS CANCERS, HEART DISEASE AND DIABETES, PRE AND POST-BIRTH MATERNITY CARE, IMMUNIZATIONS, AND ANNUAL DENTAL VISITS.-REDUCTIONS IN MEDICALLY UNNECESSARY ER VISITS AND IN-PATIENT HOSPITAL ADMISSIONS-TYING PROVIDER REIMBURSEMENT TO IMPROVEMENTS IN CARE OUTCOMES, QUALITY AND EFFICIENCY-INCREASED PARTICIPATION IN EXERCISE.MEDICA'S SILVERSNEAKERS FITNESS PROGRAM OFFERED A LARGE, NATIONWIDE NETWORK OF GYMS AND FITNESS LOCATIONS. ADDITIONALLY, MEMBERS RECEIVED ONLINE ACCESS TO THOUSANDS OF ON-DEMAND WORKOUT VIDEOS AND CUSTOMIZABLE WORKOUT PROGRAMS ACCESSIBLE VIA A MOBILE APP CALLED MY HEALTH REWARDS WHICH ALSO OFFERS OPPORTUNITIES FOR PERSON TO PERSON DIRECT GUIDANCE IN CREATING A PERSONALIZED NUTRITION AND FITNESS PLAN. IN 2021, MEDICA OFFERED THE SILVERSNEAKERS PROGRAM TO MEMBERS IN MEDICARE ADVANTAGE PRODUCTS THAT INCLUDED THE MSHO AND SNBC SNP MINNESOTA STATE PROGRAMS. TOBACCO CESSATION COACHINGMEDICA'S TOBACCO CESSATION COACHING PROGRAM IS A SELF-DIRECTED PROGRAM OFFERING A WIDE VARIETY OF TOOLS AND RESOURCES TO HELP MEMBERS QUIT TOBACCO USE. COACHING SUPPORT INCLUDES PRIVATE, CONFIDENTIAL ACCESS TO TRAINED HEALTH COACHES. THERE WAS NO COST TO MEDICA MEMBERS TOPARTICIPATE IN THE TOBACCO CESSATION COACHING PROGRAM.IN 2021 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.THESE PROGRAMS 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. 183600 183600 0 1050425283 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 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 0 0 1 1265 0 1 30 1 0 0 0 0 0 0 0 0 0 0 X 6 5 0 1 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 0 0 0 MN X MARY QUIST 9529922058 401 CARLSON PARKWAY CP330 MINNETONKA MN 55305 X NAYLOR JOHN W PRESIDENT & CEO 40.00 0.00 X X 0 2863360 43901 JOHN BUCK DIRECTOR, CHAIR 15.00 0.00 X X 0 140500 0 PETER KELLY DIRECTOR 10.00 0.00 X 0 88875 0 JOHN STANOCH DIRECTOR, CHAIR 10.00 0.00 X X 0 103750 0 MARY TWINEM DIRECTOR 10.00 0.00 X 0 95375 0 ESTHER TOMLJANOVICH DIRECTOR 6.00 0.00 X 0 77250 0 BAIRD MARK L SVP & CFO 40.00 0.00 X 0 1288249 46819 ELLENBOGEN DAVID H SVP SEC & GENERAL COUNSEL 40.00 0.00 X 0 683704 90914 NELSON LORI L SVP PROV STRAT & NET MGT 40.00 0.00 X 0 743385 15949 REID SCOTT R SVP STRAT & BUS DVLPMT 40.00 0.00 X 0 676614 52049 ALTMANN LYNN SVP HUMAN RESOURCES 40.00 0.00 X 0 736923 54966 LINDQUIST THOMAS H SVP MARKETS 40.00 0.00 X 0 798405 44004 MACH JR JOHN R CHIEF MED OFFICER & SVP 40.00 0.00 X 0 603530 39490 GEYER ROBERT W SVP & CHIEF OPS OFFICER 40.00 0.00 X 0 1006067 121155 QUIST MARY P SVP FIN & CORP CONTROLLER 40.00 0.00 X 0 694530 51694 BRANSON KIMBERLY A VP BUSINESS TRANSFORMTN 40.00 0.00 X 0 682702 46700 BARTSH GEOFFREY J SVP MKTS GRWTH & RETNTN 40.00 0.00 X 0 719678 51314 CROWLEY PAUL R SVP MKTS OPS & EFFECTIVNS 40.00 0.00 X 0 750085 46869 KINSELLA ANN B VP & GM MEDICARE 40.00 0.00 X 0 636211 47427 JACOBSON JAMES P SVP SEC & GENERAL COUNSEL 40.00 0.00 X 0 467502 13265 LONGENDYKE ROBERT SVP & CHIEF MKTG OFFICER 40.00 0.00 X 0 317444 0 THULL TIMOTHY D SVP & CIO 40.00 0.00 X 0 462337 0 WHITE NICHOLE L SVP HEALTH SERVICES 40.00 0.00 X 0 683467 23497 0 15319943 790013 7 1 1 0 UNITED HEALTH CARE SERVICES INC 9900 BREN DR E MN008-T380 MINNETONKA MN 55343 CLAIMS PROCESSING 57191572 JOHN HANCOCK LIFE INSURANCE COMPANY 601 CONGRESS ST BOSTON MA 02210 RETIREMENT PLAN 31387512 MEDICA SERVICES COMPANY 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 LEASED EMPLOYEES 21994764 DOHERTY CONSULTING INC 418 COUNTY ROAD D E ST PAUL MN 55117 TEMP SERVICES 21785413 OPTUMINSIGHT INC 12125 TECHNOLOGY DRIVE EDEN PRAIRIE MN 55344 CONSULTING SERVICES 16712596 334 MEDICARE REVENUE 524114 870282860 870282860 MEDICAID REVENUE 524114 302200797 302200797 GROUP & INDIVIDUAL PRE 524114 8627407 8627407 1181111064 23356942 23356942 4740167 4620067 120100 120100 120100 646287674 641518225 4769449 4769449 4769449 HRI ADMIN REVENUE 900099 8756686 8756686 8756686 1218114241 1181111064 0 37003177 183600 183600 1050241683 1050241683 13049123 13049123 213188 213188 89645 89645 73284 73284 971385 971385 12823630 12823630 1882963 1882963 544594 544594 3761731 3761731 822040 822040 25338 25338 43306 43306 81018 81018 2842788 2842788 289586 289586 LEASE EMPLOYEES 21994764 21994764 PREMIUM TAXES 8496173 8496173 OTHER 7498769 7498769 PRINTING & PUBLICATION 1029931 1029931 1126958539 1050425283 76533256 0 12833160 7281830 39067714 133889675 0 0 60984502 78443518 0 0 0 0 0 0 0 0 0 0 97156738 22755429 80486670 74401309 475504655 473466504 0 0 0 0 0 0 34052689 73194833 702929390 840677669 276252510 244414521 0 0 1855191 1685238 0 0 0 0 0 0 0 0 0 0 278107701 246099759 X 0 0 0 0 424821689 594577910 424821689 594577910 702929390 840677669 X 91155702 10442844 68157675 X 0 1 X 1 0 18775799 18775799 67824201 15593838 52230363 10556738 7161591 3395147 74401309 INVESTMENT INCOME ACCRUED 1529978 UNINSURED PLANS RECEIVABLE 17726113 INTERCOMPANY RECEIVABLES 30003445 GENERAL EXPENSE RECEIVABLE 23377550 REINSURANCE RECOVERIES 557747 73194833 X 1221341951 6501485 6501485 1214840466 1052404 2221371 3273775 1218114241 1130186249 6501485 6501485 1123684764 1052404 2221371 3273775 1126958539 PART X, LINE 2: THE COMPANY IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(4) OF THE IRC, WITH THE EXCEPTION OF TAXES ON UNRELATED BUSINESS ACTIVITIES. THE FEDERAL UNRELATED BUSINESS INCOME TAX BENEFIT IS INCLUDED IN FEDERAL INCOME TAX BENEFIT IN THE STATUTORY STATEMENTS OF REVENUE AND EXPENSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: RECLASS FOR NII AND SGA EXPENSES 6,501,485. PART XI, LINE 4B - OTHER ADJUSTMENTS: STATUTORY GROSS UP FOR SGA EXPENSES 2,221,371. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS FOR NII AND SGA EXPENSES 6,501,485. PART XII, LINE 4B - OTHER ADJUSTMENTS: STATUTORY GROSS UP FOR SGA EXPENSES 2,221,371. 1 INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT 8009 34TH AVE S BLOOMINGTON MN 55425 411782168 501(C)(3) 183600 0 FMV 0 SUPPORT BEST PRACTICES IN MEDICAL WORLD 1 0 PART I, LINE 2: MEDICA HEALTH PLANS (MHP) DONATES TO 501(C)(3) ORGANIZATIONS. MHP HAS MEETINGS TO MONITOR THE WORK BEING DONE TO SUPPORT THE MISSION OF THE GRANT RECIPIENTS. X X X X X 1 1 0 0 0 1 1 0 0 NAYLOR JOHN W PRESIDENT & CEO 0 1043892 0 1597510 0 221958 0 20012 0 23889 0 2907261 0 212924 BAIRD MARK L SVP & CFO 0 489477 0 693738 0 105034 0 22275 0 24544 0 1335068 0 92356 GEYER ROBERT W SVP & CHIEF OPS OFFICER 0 428881 0 488442 0 88744 0 91928 0 29227 0 1127222 0 81395 LINDQUIST THOMAS H SVP MARKETS 0 374123 0 361793 0 62489 0 15025 0 28979 0 842409 0 55963 CROWLEY PAUL R SVP MKTS OPS & EFFECTIVNS 0 339502 0 355152 0 55431 0 17200 0 29669 0 796954 0 52182 ALTMANN LYNN SVP HUMAN RESOURCES 0 356305 0 316962 0 63656 0 22275 0 32691 0 791889 0 58737 ELLENBOGEN DAVID H SVP SEC & GENERAL COUNSEL 0 509159 0 120133 0 54412 0 66025 0 24889 0 774618 0 51000 BARTSH GEOFFREY J SVP MKTS GRWTH & RETNTN 0 340683 0 321897 0 57098 0 20825 0 30489 0 770992 0 53268 NELSON LORI L SVP PROV STRAT & NET MGT 0 353192 0 327180 0 63013 0 15025 0 924 0 759334 0 56968 QUIST MARY P SVP FIN & CORP CONTROLLER 0 327656 0 306704 0 60170 0 22275 0 29419 0 746224 0 53256 BRANSON KIMBERLY A VP BUSINESS TRANSFORMTN 0 323697 0 301976 0 57029 0 22275 0 24425 0 729402 0 52430 REID SCOTT R SVP STRAT & BUS DVLPMT 0 317768 0 302858 0 55988 0 22275 0 29774 0 728663 0 51441 WHITE NICHOLE L SVP HEALTH SERVICES 0 136937 0 340955 0 205575 0 11400 0 12097 0 706964 0 30658 KINSELLA ANN B VP & GM MEDICARE 0 322096 0 225307 0 88808 0 17200 0 30227 0 683638 0 83567 MACH JR JOHN R CHIEF MED OFFICER & SVP 0 310177 0 229023 0 64330 0 15025 0 24465 0 643020 0 48359 JACOBSON JAMES P SVP SEC & GENERAL COUNSEL 0 36473 0 397600 0 33429 0 11400 0 1865 0 480767 0 6631 THULL TIMOTHY D SVP & CIO 0 0 0 203663 0 258674 0 0 0 0 0 462337 0 63657 LONGENDYKE ROBERT SVP & CHIEF MKTG OFFICER 0 0 0 173160 0 144284 0 0 0 0 0 317444 0 16193 PART I, LINE 3 MEDICA HEALTH PLANS, THE FILING ORGANIZATION, DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID 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, LINES 4A-B 2021 SEVERANCE: TIMOTHY THULL - $40,985 THE FOLLOWING RECEIVED PAYMENTS FROM A NON-QUALIFIED RETIREMENT PLAN: NELSON, LORI L. $ -56,968 REID, SCOTT R - $51,441 ALTMANN, LYNN - $58,737 QUIST, MARY P. - $53,256 LONGENDYKE, ROBERT - $16,193 BRANSON, KIMBERLY A. - $52,430 BAIRD, MARK L. - $92,356 THULL, TIMOTHY D. - $63,657 JACOBSON, JAMES P. - $6,631 NAYLOR, JOHN W. - $212,924 BARTSH, GEOFFREY J. - $53,268 CROWLEY, PAUL R. - $52,182 WHITE, NICHOLE L. - $30,658 LINDQUIST, THOMAS H. - $55,963 MACH JR., JOHN R. - $48,359 GEYER, ROBERT W. - $81,395 ELLENBOGEN, DAVID H. - $51,000 KINSELLA, ANN B. - $83,567 PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATIONS OPERATING EARNINGS. PART II: 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 III, LINE 4A: PROGRAM SERVICE ACCOMPLISHMENTS MEDICA HEALTH PLANS (MHP) IN 2021 PROVIDED HMO COVERAGE TO ENROLLEES IN THE STATE OF MINNESOTA'S SENIOR CARE PLUS (MSC+) AND SPECIAL NEEDS BASIC CARE PROGRAMS (SNBC). MSC+ PROVIDES MANAGED CARE FOR LOW-INCOME PEOPLE IN MINNESOTA WHO ARE AGES 65 OR OLDER ON MEDICAL ASSISTANCE. SNBC PROVIDES MANAGED CARE FOR INDIVIDUALS AGES 18-64 ON MEDICAL ASSISTANCE AND ARE CERTIFIED WITH PHYSICAL, DEVELOPMENTAL OR MENTAL DISABILITIES. A TOTAL OF 16,515 MEDICA MEMBERS - 23.6% OF MHP'S TOTAL ENROLLMENT - WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/ 2021. THERE WERE 4,650 MINNESOTA SENIOR CARE PLUS MEMBERS AND 11,865 SPECIAL NEEDS BASIC CARE MEMBERS. STATE OF MINNESOTA HEALTH CARE PROGRAMS MINNESOTA REQUIRES A HEALTH PLAN THAT CONTRACTS WITH THE MINNESOTA DEPARTMENT OF HUMAN SERVICES (DHS) TO PROVIDE MANAGED CARE BE LICENSED BY THE MINNESOTA DEPARTMENT OF HEALTH (MDH) AS AN HMO. MINNESOTA HEALTH CARE PROGRAMS COVER PEOPLE WHO CANNOT GET OR AFFORD HEALTH INSURANCE ELSEWHERE AND HELPS THEM PAY SOME OR ALL MEDICAL BILLS. DHS MANAGES THE ENROLLMENT OF ENROLLEES AND ENFORCES ELIGIBILITY RULES THAT PERTAIN TO INCOME, ASSETS AND OTHER FACTORS. MEDICA'S MANAGED CARE PRODUCTS SERVE ADULTS WITH DISABILITIES, SOME CHILDREN WITH DISABILITIES, AND LOW-INCOME PEOPLE 65 OR OLDER. MANAGED CARE IS AVAILABLE FOR LOW-INCOME PEOPLE 65 OR OLDER WHO ARE ASSESSED TO REQUIRE AN INSTITUTIONAL LEVEL OF CARE. MINNESOTA DHS DETERMINES CAPITATED RATES AS A COMPONENT OF THE ANNUAL CONTRACT NEGOTIATION PROCESS WITH MHP AND PAYS MHP A FIXED RATE PER ENROLLEE PER MONTH. MHP BEARS THE RISK FOR THE TOTAL COST OF CARE FOR THESE ENROLLEES. -IN 2021 MEDICA HEALTH PLANS MEDICAL LOSS RATIO FOR STATE OF MINNESOTA HEALTH PROGRAMS WAS 89.3%. -THE ADMINISTRATIVE COST RATIO WAS APPROXIMATELY 6.7% INCLUDING PREMIUM TAXES. FORM 990, PART III, LINE 4B: PROGRAM SERVICE ACCOMPLISHMENTS IN 2021 MHP PROVIDED FULLY INSURED COMMERCIAL HMO HEALTH INSURANCE COVERAGE TO GROUPS AND INDIVIDUALS IN MINNESOTA. AS OF 12/31/2021 THE ENROLLMENT IN MHP FULLY INSURED MINNESOTA GROUP WAS 1,342 WHICH WAS APPROXIMATELY 1.9% OF MHP'S TOTAL 2021 ENROLLMENT. FORM 990, PART III, LINE 4C: PROGRAM SERVICE ACCOMPLISHMENTS IN 2020, MHP PARTICIPATED IN MINNESOTA SENIOR HEALTH OPTIONS (MSHO), A MEDICARE-RELATED PRODUCT, IN MINNESOTA. ENROLLMENT IN THAT PRODUCT WAS 10,180 OR 14.5% OF MHP'S TOTAL ENROLLMENT. MSHO IS A PRODUCT FOR PEOPLE AGE 65 AND OLDER AND ELIGIBLE IN 2021, MEDICA OFFERED MEDICARE ADVANTAGE AND MEDICARE SUPPLEMENT PLANS. MEDICARE ADVANTAGE HAD ENROLLMENT OF 27,845 MEMBERS OR 39.8% OF MHP'S TOTAL ENROLLMENT. MEDICARE ADVANTAGE IS A HEALTH PLAN THAT PROVIDES ALL ENROLLEES PART A AND PART B BENEFITS. MEDICARE SUPPLEMENT HAD ENROLLMENT OF 14,139 MEMBERS OR 20.2% OF MHP'S TOTAL ENROLLMENT. MEDICARE SUPPLEMENT IS A PLAN THAT HELPS PAY SOME HEALTH CARE COSTS THAT MEDICARE DOES NOT COVER, SUCH AS COPAYMENTS, COINSURANCE, AND DEDUCTIBLES. IN 2021, MEDICA BEGAN OFFERING I-SNP PLANS. I-SNP'S RESTRICT ENROLLMENT TO MA ELIGIBLE INDIVIDUALS WHO, FOR 90 DAYS OR MORE, HAVE HAD OR ARE EXPECTED TO NEED THE LEVEL OF SERVICES PROVIDED IN A LONG-TERM CARE(LTC) SNF, A LTC NURSING FACILITY, A SNF/NF, AN INTERMEDIATE CARE FACILITY FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES, OR AN INPATIENT PSYCHIATRIC FACILITY. I-SNP HAD ENROLLMENT OF 25 MEMBERS. FORM 990, PART VI, SECTION A, LINE 3 MEDICA HEALTH PLAN HAS ENTERED INTO AN ADMINISTRATIVE SERVICE AGREEMENT WITH MEDICA SERVICES COMPANY (MSC), A RELATED EXEMPT ORGANIZATION. THROUGH THIS AGREEMENT, MSC LEASES ITS EMPLOYEES AND PROVIDES VARIOUS MANAGEMENT/ADMINISTRATIVE SERVICES TO MEDICA HEALTH PLAN AND MEDICA HEALTH PLAN PAYS FOR SUCH SERVICES THROUGHOUT THE YEAR. 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 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 HEALTH PLANS AND DIRECTORS OF ALL MEDICA ENTITIES COMPLETE A CONFLICT OF INTEREST DISCLOSURE AND ARE REQUIRED TO REVIEW THE CONFLICT POLICY. ALL POTENTIAL CONFLICTS ARE REVIEWED BY LEGAL/COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 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 APPROAL 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 REVIEWS 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 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 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: CHANGE IN VALUE OF NONADMITTED ASSETS 68,157,675. 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 CVRGE MN 501(C)(4) N/A MHC 0 MEDICA HOLDING COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING CO MN 501(C)(4) N/A N/A 0 SSM HEALTH PLAN 10101 WOODFIELD LANE ST LOUIS MO 63132 831979548 HEALTH CVRGE MO 501(C)(4) N/A MFCJVN 0 MS COMMUNITY NFP JV LLC (MFCJVN) 401 CARLSON PARKWAY MINNETONKA MN 55305 873268926 HOLDING COMPANY MN MHC 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 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 MGMT 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0