2021-11-13T11:35:45-06:00 2020-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90 S 7TH MINNEAPOLIS MN 54402 990 2020-01-01 411843804 MEDICA COMMUNITY HEALTH PLAN 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 L BAIRD 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 306472223 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 81223724 119352266 2094987 2398044 0 0 83318711 121750310 0 0 53585498 76941340 0 0 0 0 0 5911967 17168396 59497465 94109736 23821246 27640574 136926904 167894405 21832129 28452836 115094775 139441569 X TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 0 0 76941340 0 119352266 SEE SCHEDULE O.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 QUALIFIED HEALTH PLANS (QHP) AS 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 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 ENGAGE BY MEDICA PRODUCT OFFERS 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.ALTRUPRIME FEATURES ALTRU AND IS AVAILABLE IN NORTHEASTERN MINNESOTA.ENGAGE FEATURES MAYO HEALTH SYSTEM AND IS AVAILABLE IN WESTERN WISCONSIN AND SOUTHEASTERN MINNESOTA.THE COMPANY CONTRACTS WITH PROVIDERS IN WISCONSIN, MINNESOTA, SOUTH DAKOTA AND NORTH DAKOTA 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. MEDICARE ADVANTAGE ENROLLMENT WAS 225 MEMBERS, OR 2.2% OF MCHP'S TOTAL ENROLLMENT. MEDICARE ADVANTAGE IS A HEALTH PLAN THAT PROVIDES ALL ENROLLEES PART A AND B BENEFITS. 76941340 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 1 0 1 12528 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 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 CAHIR 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 MEDICA HEALTH PLANS 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 LEASED EMPLOYEES 7541760 1 PREMIUM REVENUE 524114 119352266 119352266 119352266 1877632 1877632 185242325 184721913 520412 520412 520412 121750310 119352266 0 2398044 76941340 76941340 101746 101746 20517 20517 12314 12314 3067813 3067813 301196 301196 152873 152873 744176 744176 180402 180402 8180 8180 7765 7765 681274 681274 57435 57435 LEASED EMPLOYEES 7541760 7541760 PREMIUM TAXES 2115183 2115183 ALL OTHER EXPENSES 1938477 1938477 PRINTING AND PUBLICATIO 237285 237285 94109736 76941340 17168396 0 0 0 41944527 73758279 0 0 7238917 141342 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 76472966 78912129 0 0 0 0 11270494 15082655 136926904 167894405 410730 11513938 0 0 1009438 1157337 0 0 0 0 0 0 0 0 0 0 20411961 15781561 21832129 28452836 X 115094775 139441569 0 0 115094775 139441569 136926904 167894405 X 27640574 486 -3294266 X 0 1 X 1 0 0 OTHER LT SECURITIES 78912129 C 78912129 CSR RECEIVABLES 16381 HEALTHCARE RECEIVABLES 1026994 REINSURANCE 13463969 INV. INTEREST RECEIVABLE 575311 15082655 CLAIMS PAYABLE 12542860 INTERCOMPANY PAYABLE 3238701 15781561 X 121750310 0 121750310 0 121750310 94109736 0 94109736 0 94109736 PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON INCOME DERIVED FROM ACTIVITIES THAT ARE IN FURTHERANCE OF ITS EXEMPT PURPOSE. THE COMPANY MAY BE SUBJECT TO INCOME TAXATION ON UNRELATED BUSINESS INCOME. 0 1 0 0 0 1 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 COMMUNITY HEALTH PLAN, THE FILING ORGANIZATION DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION MEDICA HEALTH PLANS 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 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 PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO OPERATING EARNINGS OF MEDICA HEALTH PLANS AND RELATED ORGANIZATIONS. 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 VI, SECTION A, LINE 3 MEDICA COMMUNITY HEALTH PLAN HAS ENTERED INTO AN ADMINISTRATIVE SERVICE AGREEMENT WITH MEDICA HEALTH PLANS (MHP), A RELATED EXEMPT ORGANIZATION. THROUGH THIS AGREEMENT, MHP 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. THE ADMINISTRATIVE SERVICE AGREEMENT WAS MOVED TO MEDICA SERVICES COMPANY (MSC) IN NOVEMEBER OF 2020. 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, 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 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 -3,294,266. MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH COVERAGE MN 501(C)(4) MH COMPANY 0 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) LINE 12B MH COMPANY 0 MEDICA HOLDING COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING COMPANY MN 501(C)(4) N/A 0 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 MANAGMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MANAGEMENT MN MEDICA AFF C 0 MEDICA AFFILIATED SERVICES 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MH COMPANY C 0 MMSI INC 401 CARLSON PARKWAY MINNETONKA MN 55305 411547003 THIRD PARTY ADMIN MN MEDICA AFF C 0 MEDICA SERVICES COMPANY LLC 401 CARLSON PARKWAY MINNETONKA MN 55305 852902940 ADMIN SERVICES MN MEDICA AFF C 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 MEDICA HEALTH PLANS E 33250000 BOOK MEDICA HEALTH PLANS N 9626637 BOOK MEDICA HEALTH PLANS O 7541759 BOOK MEDICA HEALTH PLANS P 5328721 BOOK