2020-11-12T10:39:58-06:00 2019-12-31 KPMG LLP 4200 Wells Fargo Ctr 90 S 7th Minneapolis MN 55402 990 2019-01-01 411843804 Medica Community Health Plan % MARY QUIST MEDI 9529922058 401 CARLSON PARKWAY MINNETONKA MN 55305 MARK L BAIRD CFO 9529922058 2020-11-10 true MONROE J GIERL P01413237 6123055000 2020-11-09 127.0.0.1 41438720203175000003 2020-11-12 P D62D24C6D336028470863B0825818D0C3237C4FC D753EA4DD2A09437EBC7FC39E786EC2504231D00 2019 2021-04-22 16:20:28Z JOHN NAYLOR 401 CARLSON PARKWAY MINNETONKA MN 55305 292248015 false X WWW.MEDICA.COM X 1996 WI TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 10 9 0 0 0 0 0 0 82979356 81223724 827344 2094987 0 0 83806700 83318711 0 0 57297438 53585498 0 0 0 0 0 8519247 5911967 65816685 59497465 17990015 23821246 145323663 136926904 54032011 21832129 91291652 115094775 X TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. false false 53585498 81223724 SEE SCHEDULE O. 53585498 false false false false false false false false false false true false true true true true true false false false false false false false false false false false true false false false false false false false false false false false false false true false true false true 11814 0 true 0 false false false false false false false false X 10 9 false true true false true false false true true false false true true true true true true false false false WI X MARY QUIST 9529922058 PO BOX 9310 CP330 MINNEAPOLIS MN 55440 X John W Naylor President & CEO 0.0 40.0 X X 0 1977413 42410 Mark Baird SVP & CFO, Treasurer 0.0 40.0 X 0 1036756 52987 James P Jacobson SVP & Gen Counsel, Secretary 0.0 40.0 X 0 716604 54361 John Buck Director, Chair 0.0 15.0 X X 0 126500 0 John Stanoch Director, Vice Chair 0.0 10.0 X X 0 97250 0 Earl Stratton Director 0.0 10.0 X 0 88750 0 Raj Aggarwal Director 0.0 10.0 X 0 83125 0 Mary Twinem Director 0.0 10.0 X 0 81625 0 Sam Leon Director 0.0 10.0 X 0 78375 0 Peter Kelly Director 0.0 10.0 X 0 75625 0 Esther Tomljanovich Director 0.0 6.0 X 0 75250 0 Brigid Bonner Director 0.0 10.0 X 0 62500 0 0 4499773 149758 0 false true false Medica Health Plans 401 Carlson Parkway CP 330 MINNETONKA MN 55305 Leased Employees 3560639 1 0 Premium Revenue 524114 81223724 81223724 81223724 2016298 2016298 0 0 0 0 0 209007993 208929304 78689 78689 78689 0 0 0 0 0 0 0 0 0 0 83318711 81223724 2094987 0 0 0 53585498 53585498 0 0 0 0 0 0 0 41866 41866 9808 9808 8630 8630 0 0 632000 632000 171532 171532 79641 79641 298703 298703 0 96305 96305 15002 15002 0 7546 7546 0 0 394616 394616 28010 28010 Premium Taxes 183362 183362 Printing and Publications 162086 162086 Leased Employees 3560639 3560639 All Other Expenses 222221 222221 59497465 53585498 5911967 0 0 0 95886667 41944527 0 0 1100883 7238917 0 0 0 0 0 0 0 0 0 0 0 0 0 0 44950750 76472966 0 0 0 0 3385363 11270494 145323663 136926904 1088617 410730 0 0 1068430 1009438 0 0 0 0 0 0 0 0 0 0 51874964 20411961 54032011 21832129 X 0 0 0 0 91291652 115094775 91291652 115094775 145323663 136926904 X 23821246 -994 -17129 X false true X true false OTHER LT SECURITIES 76472966 C 76472966 INVESTMENT INTEREST RECEIVABLE 170500 HEALTHCARE RECEIVABLES 709339 REINSURANCE 9849423 LT CASH RESERVES 541232 11270494 0 CLAIMS PAYABLE 6353222 INTERCOMPANY PAYABLE 14058739 20411961 X 83318711 83318711 83318711 59497465 59497465 59497465 Sch D 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. false true false false false true true false false Mark Baird SVP & CFO, Treasurer 0 441413 0 487061 0 108282 0 25900 0 29036 0 1091692 0 80481 James P Jacobson SVP & Gen Counsel, Secretary 0 355261 0 282829 0 78514 0 25900 0 30219 0 772723 0 50257 John W Naylor President & CEO 0 873526 0 911378 0 192509 0 20627 0 23767 0 2021807 0 164475 Sch J 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. Sch J Part I Line 4b THE FOLLOWING RECEIVED A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION. MARK L. BAIRD $80,481 JAMES P. JACOBSON $50,257 JOHN W. NAYLOR $164,475 Sch J Part I Line 6a & 6b MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO OPERATING EARNINGS OF MEDICA HEALTH PLANS AND RELATED ORGANIZATIONS. Sch J 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 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. Form 990 Part VI 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. FORM 990 PART VI LINE 4 THE BYLAW CHANGES DECOUPLE "OFFICERS" FROM "VICE PRESIDENTS" BY REMOVING REFERENCES TO VICE PRESIDENTS AND SENIOR VICE PRESIDENTS IN THE BYLAWS AND BY ELIMINATING THE REQUIREMENT THAT THE BOARD MUST APPROVE THE CEO'S APPOINTMENT OF SENIOR VICE PRESIDENTS AND ABOVE. UNDER THE BYLAWS AS REVISED, THE BOARD WILL ONLY APPROVE THE APPOINTMENT OF "OFFICERS" OF THE COMPANY - DEFINED AS THE PRESIDENT AND CEO, THE TREASURER AND CFO, THE SECRETARY, AND ANY OTHER OFFICERS THE BOARD "DEEMS NECESSARY FOR THE OPERATION AND MANAGEMENT" OF THE COMPANY. UNDER THE REVISED BYLAWS, VICE PRESIDENTS AND SENIOR VICE PRESIDENTS WILL NO LONGER BE PRESUMED TO BE "OFFICERS" OF THE COMPANY (OTHER THAN THOSE NOTED ABOVE), UNLESS SPECIFICALLY APPOINTED BY THE CEO AND APPROVED BY THE BOARD. Form 990 Part VI Line 6 THE POLICY HOLDERS ARE CONSIDERED MEMBERS, BUT DO NOT PAY DUES. Form 990 Part VI 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 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 Line 15a MEDICA COMMUNITY HEALTH PLAN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANIZATION. MEDICA HEALTH PLANS 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 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, AND MMSI, INC). 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 CHANGES IN NET ASSETS: CHANGE IN STATUTORY BASIS ACCOUNTING NONADMITTED ASSETS ($17,129) MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH CVRGE MN 501(C)(4) MH COMPANY false MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) Line 12b MH COMPANY false MEDICA HOLDING COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING CO MN 501(C)(4) NA false MEDICA INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 411490988 HEALTH INSURANCE MN MEDICA AFF C Corp 0 0 false MEDICA SELF-INSURED 401 CARLSON PARKWAY MINNETONKA MN 55305 411479417 THIRD PARTY ADMIN MN MEDICA AFF C Corp 0 0 false MEDICA HEALTH MANAGMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MGMT MN MEDICA AFF C Corp 0 0 false MEDICA AFFILIATED SERVICES 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MH COMPANY C Corp 0 0 false MMSI Inc 401 CARLSON PARKWAY MINNETONKA MN 55305 411547003 THIRD PARTY ADMIN MN MEDICA AFF C Corp 0 0 false false false false false true false false false false false false false false true true true false false false Medica Health Plans e 33250000 BOOK Medica Health Plans n 2351328 BOOK Medica Health Plans o 3560639 BOOK Medica Health Plans p 3345176 BOOK