2022-11-14T10:59:30-06:00 2021-12-31 135565207 KPMG LLP 90 S 7TH ST STE 4200 MINNEAPOLIS MN 55402 990 2021-01-01 411843804 MEDICA COMMUNITY HEALTH PLAN 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 136714210 0 X WWW.MEDICA.COM X 1996 WI TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 11 10 0 0 0 0 0 0 119352266 113918877 2398044 1934462 0 0 121750310 115853339 0 0 76941340 95150702 0 0 0 0 0 17168396 23033144 94109736 118183846 27640574 -2330507 167894405 134243555 28452836 28182710 139441569 106060845 X TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 0 0 95150702 0 113918877 SEE SCHEDULE O. 95150702 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 12882 0 1 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI 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 2863360 43901 RAJESH AGGARWAL DIRECTOR 0.00 10.00 X 0 97875 0 BRIGD BONNER DIRECTOR 0.00 10.00 X 0 79875 0 JOHN BUCK CHAIR & DIRECTOR 0.00 15.00 X X 0 140500 0 PETER KELLY DIRECTOR 0.00 10.00 X 0 88875 0 SAMUEL LEON DIRECTOR 0.00 10.00 X 0 82375 0 EARL STRATTON DIRECTOR 0.00 10.00 X 0 113750 0 JOHN STANOCH VICE CHAIR & DIRECOR 0.00 10.00 X X 0 103750 0 ESTHER TOMLJANOVICH DIRECTOR 0.00 6.00 X 0 77250 0 MARY TWINEM DIRECTOR 0.00 10.00 X 0 95375 0 GAYE ADAMS-MASSEY DIRECTOR 0.00 10.00 X 0 70500 0 MARK L BAIRD SVP & CFO 0.00 40.00 X 0 1288249 46819 DAVID H ELLENBOGEN SVP SEC & GENERAL COUNSEL 0.00 40.00 X 0 683704 90914 JAMES P JACOBSON SVP SEC & GENERAL COUNSEL 0.00 0.00 X 0 467502 13265 0 6252940 194899 0 1 1 0 MEDICA SERVICES COMPANY 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 LEASED EMPLOYEES 10563037 1 PREMIUM REVENUE 524114 113918877 113918877 113918877 1666991 1666991 21128342 20860871 267471 267471 267471 115853339 113918877 0 1934462 95150702 95150702 65744 65744 27645 27645 22599 22599 3954600 3954600 580676 580676 167944 167944 1160057 1160057 253504 253504 7814 7814 13355 13355 876670 876670 89304 89304 LEASED EMPLOYEES 10563037 10563037 PREMIUM TAXES 2620082 2620082 ALL OTHER EXPENSES 2312499 2312499 PRINTING AND PUBLICATIO 317614 317614 118183846 95150702 23033144 0 0 0 73758279 32392304 0 0 141342 76057 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 78912129 83290848 0 0 0 0 15082655 18484346 167894405 134243555 11513938 4660704 0 0 1157337 1047097 0 0 0 0 0 0 0 0 0 0 15781561 22474909 28452836 28182710 X 0 0 0 0 139441569 106060845 139441569 106060845 167894405 134243555 X -2330507 -493 -31049724 X 0 1 X 1 0 0 OTHER LT SECURITIES 83290848 C 83290848 CSR RECEIVABLES 15000 INVESTMENT INTEREST RECEIVABLES 534237 HEALTHCARE RECEIVABLES 2013904 REINSURANCE 15921205 18484346 CLAIMS PAYABLE 11658478 INTERCOMPANY PAYABLE 10816431 22474909 X 115853339 0 115853339 0 115853339 118183846 0 118183846 0 118183846 PART X, LINE 2: THE COMPANY RECOGNIZES TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. X X X X X 0 1 0 0 0 1 1 0 0 JOHN W NAYLOR PRESIDENT & CEO 0 1043892 0 1597510 0 221958 0 20012 0 23889 0 2907261 0 212924 MARK L BAIRD SVP & CFO 0 489477 0 693738 0 105034 0 22275 0 24544 0 1335068 0 92356 DAVID H ELLENBOGEN SVP SEC & GENERAL COUNSEL 0 509159 0 120133 0 54412 0 66025 0 24889 0 774618 0 51000 JAMES P JACOBSON SVP SEC & GENERAL COUNSEL 0 36473 0 397600 0 33429 0 11400 0 1865 0 480767 0 6631 PART I, LINE 3 MEDICA COMMUNITY HEALTH PLAN, THE FILING ORGANIZATION DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY MEDICA SERVICES COMPANY, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION MEDICA SERVICES COMPANY UTILIZES THE FOLLOWING; COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B THE FOLLOWING RECEIVED A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION. MARK L. BAIRD - $92,356 JOHN W. NAYLOR - $212,924 DAVID H. ELLENBOGEN - $51,000 JAMES P. JACOBSON - $6,631 PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATION'S 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 COMMUNITY HEALTH PLAN (THE COMPANY) IS ORGANIZED AND SHALL BE OPERATED FOR THE PROMOTION OF SOCIAL WELFARE, INCLUDING THE OPERATION OF A HEALTH INSURANCE ORGANIZATION AND OTHER ACTIVITIES INCIDENTAL THERETO. IT IS A WHOLLY OWNED SUBSIDIARY OF MEDICA HOLDING COMPANY (MHC) WHICH IS A NON-PROFIT, TAX EXEMPT CORPORATION. THE COMPANY IS TAX-EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE. THE COMPANY OFFERS COMPREHENSIVE HEALTH CARE COVERAGE; ALL PRODUCTS ARE MEDICARE ADVANTAGE, OR QUALIFIED HEALTH PLANS (QHPS). QHPS ARE DEFINED BY THE AFFORDABLE CARE ACT (ACA) AND FALL WITHIN THE METAL LEVELS GOLD, SILVER AND BRONZE, AS WELL AS CATASTROPHIC FOR THOSE UNDER AGE 30 OR THOSE WITH A HARDSHIP (AS DEEMED BY THE EXCHANGE). ADDITIONALLY, THE PRODUCTS FOLLOW THE RESPECTIVE ESSENTIAL HEALTH BENEFITS (EHBS), ABOVE AND BEYOND THOSE REQUIRED OF QHPS BY THE ACA, AS DETERMINED BY THE BENCHMARK/DEFAULT PLAN (AS DEFINED BY ACA) FOR MINNESOTA AND WISCONSIN. THE QHP INDIVIDUAL CHOICE PRODUCT OFFERS ACCESS TO THE LARGEST NETWORK: NEARLY 33,000 PROVIDERS OF ALL TYPES AT MORE THAN 6,000 OFFICES, CLINICS AND HOSPITALS IN MINNESOTA, NORTH DAKOTA, SOUTH DAKOTA AND WESTERN WISCONSIN. THE QHP PRODUCT, ENGAGE BY MEDICA, IS AVAILABLE IN WESTERN WISCONSIN AND SOUTHEASTERN MINNESOTA. THE ENGAGE BY MEDICA PRODUCT FEATURES ACCESS TO MAYO CLINIC HEALTH SYSTEM DOCTORS PLUS OTHERS IN NORTHERN IOWA, SOUTHERN MINNESOTA, AND WESTERN WISCONSIN, WITH OVER 12,000 PRIMARY AND SPECIALTY CARE DOCTORS. THE COMPANY OFFERS MEDICARE ADVANTAGE PRODUCTS IN PORTIONS OF NEBRASKA AND IOWA, OFFERING THE MEDICA ADVANTAGE SOLUTION PRODUCT IN THE ELEVEN COUNTY OMAHA/LINCOLN/COUNCIL BLUFFS AREA. THE MEDICA ADVANTAGE SOLUTION PRODUCT OFFERS AN HMO OPTION WITH CHI HEALTH AND A BROADER NETWORK PPO OPTION. THE ADVANTAGE SOLUTION NETWORK HAS 1,600+ PRIMARY CARE AND SPECIALTY CARE DOCTORS. THE COMPANY CONTRACTS WITH PROVIDERS IN WISCONSIN, MINNESOTA, SOUTH DAKOTA, NORTH DAKOTA, NEBRASKA AND IOWA TO MAKE HEALTH CARE SERVICES AVAILABLE TO ITS ENROLLEES. THE PROVIDER CONTRACTS INCLUDE HOLD-HARMLESS PROVISIONS FOR THE PROTECTION OF POLICYHOLDERS. THE CONTRACTS HAVE A ONE- OR TWO-YEAR TERM AND MAY BE TERMINATED IMMEDIATELY FOR BREACH OF CONTRACT IF THE PROVIDER LOSES HIS/HER LICENSE TO PROVIDE CONTRACTED SERVICES. HOSPITALS ARE REIMBURSED USING A VARIETY OF METHODS INCLUDING FEE-FOR-SERVICE (FFS), DISCOUNTED FFS, PER DIEM, PER CASE AND/OR PER STAY BASIS. THE COMPANY CURRENTLY MARKETS DIRECTLY TO INDIVIDUALS, USING INDEPENDENT AGENCIES, PAYING A FLAT DOLLAR COMMISSION ON NEW AND RENEWAL BUSINESS. THE COMPANY ALSO MARKETS POLICIES DIRECTLY ONLINE AND OVER THE PHONE. DURING 2020, THE COMPANY STARTED OFFERING MEDICARE ADVANTAGE PRODUCTS IN NEBRASKA. DURING 2021, MEDICARE ADVANTAGE ENROLLMENT WAS 261 MEMBERS, OR 2.1% OF MCHP'S TOTAL ENROLLMENT. MEDICARE ADVANTAGE IS A HEALTH PLAN THAT PROVIDES ALL ENROLLEES PART A AND B BENEFITS. FORM 990, PART VI, SECTION A, LINE 3 MEDICA COMMUNITY HEALTH PLAN HAS ENTERED INTO AN ADMINISTRATIVE SERVICE AGREEMENT WITH MEDICA SERVICES COMPANY (MSC), A RELATED EXEMPT ORGANIZATION. THROUGH THIS AGREEMENT, MSC LEASES ITS EMPLOYEES AND PROVIDES VARIOUS MANAGEMENT/ADMINISTRATIVE SERVICES TO MEDICA COMMUNITY HEALTH PLAN AND MEDICA COMMUNITY HEALTH PLAN PAYS FOR SUCH SERVICES THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION A, LINE 6 THE POLICY HOLDERS ARE CONSIDERED MEMBERS, BUT DO NOT PAY DUES. FORM 990, PART VI, SECTION B, LINE 11B MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND FINANCE DIRECTOR 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 MEDICA COMMUNITY HEALTH PLAN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION. WHICH USES THE FOLLOWING PROCESS TO DETERMINE COMPENSATION. THE PERSONNEL AND COMPENSATION COMMITTEE, AS DESCRIBED IN THE CHARTER, REVIEWS AND OBTAINS THE BOARD'S APPROVAL FOR TOTAL COMPENSATION FOR THE PRESIDENT/CEO. THE COMMITTEE ALSO REVIEWS AND APPROVES TOTAL COMPENSATION RECOMMENDATIONS MADE BY THE CEO FOR THE EXECUTIVE AND SENIOR VICE PRESIDENTS, AND REVIEWS ALL OFFICER COMPENSATION AND ANNUAL PERFORMANCE GOALS APPROVED BY THE CEO. THE COMMITTEE REVIEW AND MAKES RECOMMENDATIONS TO THE BOARD REGARDING OFFICER AND NON-OFFICER COMPENSATION GUIDELINES FOR MEDICA AND ITS SUBSIDIARIES, PERIODICALLY REVIEWING MARKET DATA TO ASSESS MEDICA'S COMPETITIVE POSITION. OUTSIDE THE CHARTER, THE PERSONNEL AND COMPENSATION COMMITTEE WORKS WITH AN OUTSIDE CONSULTANT TO REVIEW MARKET DATA THAT AIDS IN SETTING THE COMPENSATION FOR THE OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 MEDICA DOES NOT CONSIDER ITS CONFLICT OF INTEREST POLICY TO BE A CONFIDENTIAL OR PROPRIETARY DOCUMENT. THEREFORE, MEDICA WOULD MAKE THIS POLICY AVAILABLE TO ANYONE WHO REQUESTS IT. CERTAIN OF THE MEDICA ENTITIES ARE REQUIRED TO FILE ANNUAL FINANCIAL STATEMENTS WITH THE REGULATORS. MEDICA CONSIDERS FINANCIAL STATEMENTS THAT ARE FILED WITH THE REGULATORS TO BE PUBLIC DOCUMENTS. FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART VII, SECTION 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 NONADMITTED ASSETS 2,200,276. REPAYMENT & CHANGE IN SURPLUS NOTES -33,250,000. MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH COVERAGE MN 501(C)(4) N/A MHC 0 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) LINE 12B MHC 0 MEDICA HOLDING COMPANY (MHC) 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING COMPANY MN 501(C)(4) N/A N/A 0 SSM HEALTH PLAN INC 10101 WOODFIELD LANE ST LOUIS MO 63132 831979548 HEALTH COVERAGE MO 501(C)(4) N/A MFCJVN 0 MS COMMUNITY NFP JV LLC (MFCJVN) 401 CARLSON PARKWAY MINNETONKA MN 55305 873268926 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 HEALTH MANAGMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MANAGEMENT MN MAS C 0 MEDICA AFFILIATED SERVICES (MAS) 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MHC C 0 MMSI INC 401 CARLSON PARKWAY MINNETONKA MN 55305 411547003 THIRD PARTY ADMIN MN MAS C 0 MEDICA SERVICES COMPANY LLC 401 CARLSON PARKWAY MINNETONKA MN 55305 852902940 ADMIN. SERVICES MN MAS C 0 DEAN HEALTH PLAN INC 1277 DEMING WAY MADISON WI 53717 391535024 HEALTH INSURANCE WI DHI C 0 DEAN HEALTH INSURANCE INC (DHI) PO BOX 56099 MADISON WI 53705 391830837 HEALTH INSURANCE WI MSCJV C 0 SSM HEALTH INSURANCE COMPANY 10101 WOODFIELD LANE ST LOUIS MO 63132 834718249 HEALTH INSURANCE MO MSCJV C 0 DEAN HEALTH SERVICES COMPANY LLC 1277 DEMING WAY MADISON WI 53717 842933639 ADMIN. SERVICES WI MSCJV C 0 MS COMMUNITY JV LLC (MSCJV) 401 CARLSON PARKWAY MINNETONKA MN 55305 873240022 HOLDING COMPANY MN MHC C 0 MEDICA REGIONAL INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 854111612 HEALTH INSURANCE MN MAS C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0