2016-11-14T10:39:29-06:00 2015-12-31 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2015-01-01 411812461 MEDICA FOUNDATION MEDI 9529922058 401 CARLSON PARKWAY CW 104 MINNETONKA MN 55305 MARK L BAIRD CFO 9529922058 2016-11-10 1 TODD A JACKSON P00092672 6123324300 2015 2017-02-10 21:41:12Z ROBERT LONGENDYKE 401 CARLSON PARKWAY CW 104 MINNETONKA MN 55305 6869141 0 X WWW.MEDICAFOUNDATION.ORG X 1996 MN OUR MISSION IS TO FUND COMMUNITY-BASED INITIATIVES AND PROGRAMS THAT SUPPORT THE NEEDS OF MEDICA'S CUSTOMERS AND THE GREATER COMMUNITY BY IMPROVING THEIR HEALTH AND REMOVING BARRIERS TO HEALTH CARE SERVICES. 5 5 0 0 0 0 500 4000000 0 0 909256 868343 0 0 909756 4868343 1398975 1489500 0 0 246831 257397 0 0 0 339167 328089 1984973 2074986 -1075217 2793357 25304259 26540615 1375664 1432707 23928595 25107908 X THE FOUNDATION GENERALLY SEEKS TO FUND COMMUNITY-BASED PROGRAMS AND INITIATIVES THAT CAN PROVIDE SUSTAINABLE AND MEASURABLE IMPROVEMENTS IN THE AVAILABILITY, ACCESS, AND QUALITY OF HEALTHCARE. 0 0 395000 395000 BEHAVIORAL HEALTH: THIS FUNDING PRIORITY SEEKS PROGRAMS THAT FOCUS ON DEVELOPING CAPABILITIES OR CHANGING PROCESSES RELATED TO THE CONTINUUM OF BEHAVIORAL HEALTH CARE SERVICE INTERVENTIONS, ACCESSIBILITY AND SUSTAINABILITY. THIS INCLUDES PROGRAMS THAT ADDRESS GAPS IN CURRENT SERVICE, INTEGRATE PHYSICAL AND MENTAL HEALTH, PROVIDE SUPPORTIVE SERVICE AND CASE MANAGEMENT AND ADDRESS NEEDS IDENTIFIED BY THE MINNESOTA 10X10 ASSERTIVE COMMUNITY TREATMENT (ACT) INITIATIVE. 300000 300000 EARLY CHILDHOOD HEALTH: THIS FUNDING PRIORITY SEEKS PROGRAMS THAT FOCUS ON HEALTHY FAMILIES TO FOSTER OPTIMAL GROWTH AND DEVELOPMENT OF YOUNG CHILDREN. THIS INCLUDES PROGRAMS THAT IMPROVE ACCESS TO PRENATAL AND POSTNATAL CARE; PARENTING; PREVENTION, INCLUDING CHILD AND TEEN CHECKUPS; DENTAL SERVICES AND SOCIAL AND EMOTIONAL HEALTH. PROGRAMMING FOCUSES ON CHILDREN AGES BIRTH THROUGH AGE TWELVE AND MAY INVOLVE PARENTS, CAREGIVERS, HEALTH CARE PROVIDERS AND THE OVERALL COMMUNITY. 200000 200000 ORGANIZATIONAL CORE MISSION SUPPORT: THE MEDICA FOUNDATION PROVIDES GRANTS TO SUPPORT THE HEALTH-RELATED PROGRAMMING OF NONPROFIT ORGANIZATIONS LOCATED OUTSIDE OF THE TWIN CITIES METROPOLITAN AREA. THESE GRANTS PROVIDE CRITICAL SUPPORT TO SMALL ORGANIZATIONS, WHICH STRENGTHENS REGIONAL AND RURAL COMMUNITIES. 594500 594500 MEDICA FOUNDATION HAS THE FOLLOWING OTHER PROGRAM SERVICES:1) STRATEGIC GRANT - TOTAL EXPENSES: $200,000; GRANTS: $200,0002) MEDICA FOUNDATION GENERAL FUNDING - TOTAL EXPENSES: $244,500; GRANTS: $244,5003) ALZHEIMER'S DISEASE - TOTAL EXPENSES: $150,000; GRANTS: $150,000 594500 594500 1489500 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 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 0 1 0 1 7 0 1 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X MARY QUIST 9529922058 401 CARLSON PARKWAY CP330 MINNETONKA MN 55305 JOHN BUCK CHAIR 15.00 X X 0 97000 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 0 68000 0 BURTON COHEN DIRECTOR 2.00 X 0 5500 0 DARYL DURUM DIRECTOR 10.00 X 0 63000 0 SAMUEL LEON MD DIRECTOR 10.00 X 0 70000 0 MARK L BAIRD TREASURER/CFO & SVP 40.00 X 0 1119992 43204 JAMES P JACOBSON SECRETARY/SVP 40.00 X 0 635112 43765 ROBERT LONGENDYKE EXECUTIVE DIRECTOR/MHP SVP 40.00 X 0 618413 41399 DAVID TILFORD PRESIDENT/CEO 40.00 X 0 2294734 34907 GLENN E ANDIS SVP 40.00 X 0 743529 44541 DEBBY S KNUTSON SVP 40.00 X 0 584623 29526 JANA L JOHNSON SVP 40.00 X 0 663305 43604 TIMOTHY D THULL SVP 40.00 X 0 706984 42650 JOHN W NAYLOR SVP 40.00 X 0 1027856 81860 DANNETTE M COLEMAN SVP 40.00 X 0 603174 28097 MARK WERNER MD SVP 40.00 X 0 527360 48269 RICHARD H SYKORA GM/VP 40.00 X 0 497996 41817 BARBARA LYNCH VP 40.00 X 0 457904 34191 ANDREW E DAVIS VP 40.00 X 0 476600 37703 GEOFFREY J BARTSH VP 40.00 X 0 490395 62022 MARY QUIST VP 40.00 X 0 448513 41881 0 12199990 699436 0 0 1 0 0 4000000 4000000 668165 668165 2200976 2000798 200178 200178 200178 4868343 0 0 868343 1489500 1489500 215483 215483 28529 28529 13385 13385 148515 148515 357 357 22163 22163 94065 94065 2761 2761 10165 10165 BOARD EXPENSES 27500 27500 DUES, MEMBERSHIP & SUBS 15450 15450 PUBLIC RELATIONS 5750 5750 COMMUNITY OUTREACH 923 923 440 440 2074986 1489500 585486 0 255538 886111 62478 32991 24986243 25621513 25304259 26540615 1336675 1399467 38989 33240 1375664 1432707 X 23928595 25107908 23928595 25107908 25304259 26540615 2793357 -1614044 0 X 0 0 0 X X 1 MEDICA HEALTH PLANS SEC 501(C)(4) 411242261 9 1 1489500 0 1 1489500 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 FORM 990, SCHEDULE A, SECTION A, LINE 3B MEDICA HEALTH PLANS, THE SUPPORTED PARENT ORGANIZATION, IS A 501(C)(4) ORGANIZATION. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS ANY CHANGE IN EXEMPT STATUS OR ACTIVITIES OF MEDICA HEALTH PLANS WOULD BE KNOWN BY THE FOUNDATION. FORM 990, SCHEDULE A, SECTION A, LINE 3C THE MEDICA FOUNDATION MONITORS THE USE OF GRANT FUNDS THROUGH SEVERAL MECHANISMS. ALL GRANTEES ARE ASKED TO SUBMIT PROGRESS REPORTS RELATED TO THE GRANT FUNDING. UPDATES ON PROGRAM GRANTS ARE RECEIVED DURING AND AT THE END OF THE GRANT PERIOD. SEE SCHEDULE I, PART I, LINE 2 NARRATIVE FOR ADDITIONAL INFORMATION RELATED TO THE PROCESS USED FOR GRANT MONITORING. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 SHORT TERM INVESTMENTS 25621513 F 25621513 PAYABLE TO MEDICA HEALTH PLANS 33240 33240 1 METROPOLITAN AREA AGENCY ON AGING 2365 N MCKNIGHT RD SUITE 3 NORTH ST PAUL MN 55109 411774247 501(C)(3) 150000 THROUGH A STATEWIDE COLLABORATION, PREPARE MINNESOTA FOR THE PERSONAL, SOCIAL AND BUDGETARY IMPACTS OF ALZHEIMER'S DISEASE AND RELATED DEMENTIAS BY FOSTERING DEMENTIA AND AGE FRIENDLY COMMUNITIES. CENTER FOR ALCOHOL & DRUG TREATMENT 314 WEST SUPERIOR ST DULUTH MN 55802 410847934 501(C)(3) 100000 CLEARPATH WILL BE A MEDICALLY ASSISTED TREATMENT PROGRAM, LICENSED AS AN OTP. INITIALLY, OUR FOCUS WILL BE OPIOID DEPENDENT PATIENTS. THE CLINIC IS EMBEDDED IN A RECOVERY-ORIENTED SYSTEM OF CARE THAT INCLUDES DETOX, RESIDENTIAL TREATMENT, OUTPATIENT TREATMENT, INDIVIDUAL COUNSELING, CARE MANAGEMENT AND OTHER SERVICES. NEIGHBORHOOD HEALTH CARE NETWORK C/O WEST SIDE COMMUNITY HEALTH CENTER 153 CESAR CHAVEZ ST ST PAUL MN 55107 410990979 501(C)(3) 100000 TO DEVELOP A CARE COORDINATION INFRASTRUCTURE TO SUPPORT THE 10 FQHC MEMBERS WITH THEIR ACO DEVELOPMENT SO EACH FQHC CAN BE AN ACTIVE PARTICIPANT IN THE STATE OF MINNESOTA'S INTEGRATED HEALTH PARTNERSHIPS(IHP)/MEDICAID DEMONSTRATION PROGRAM. FRASER LTD 2902 SOUTH UNIVERSITY DRIVE FARGO ND 58103 450226418 501(C)(3) 50000 FRASER, LTD. WILL PROVIDE MOBILE BEHAVIORAL HEALTH SERVICES TO TRANSITION AGE YOUTH AT-RISK OF HOMELESSNESS OR WHO ARE EXPERIENCING HOMELESSNESS TO INCREASE HOUSING PERMANENCE AND STABILITY. HEALTHEAST FOUNDATION 1690 UNIVERSITY AVENUE 250 ST PAUL MN 55104 411602044 501(C)(3) 50000 DRIVEN BY KAREN CD TASKFORCE (KCDT) INPUT, THIS PROJECT SEEKS TO DEVELOP AND FIELD TEST A CULTURALLY-RELEVANT, BRIEF INTERVENTION AND CHEMICAL DEPENDENCY (CD) ASSESSMENT TOOLS FOR KAREN REFUGEES. 180 DEGREES INC 236 CLIFTON AVENUE MINNEAPOLIS MN 55403 237153536 501(C)(3) 50000 180 DEGREES' SAFE AND SOUND CENTER FOR GIRLS PROVIDES SUPPORTIVE STAFF, SECURE SHELTER, AND INTEGRATED PHYSICAL, MENTAL AND CHEMICAL HEALTH PROGRAMMING FOR SEXUALLY TRAFFICKED AND EXPLOITED GIRLS AND YOUNG WOMEN. NORTHSIDE ACHIEVEMENT ZONE 2123 WEST BROADWAY AVE SUITE 100 MINNEAPOLIS MN 55411 300238807 501(C)(3) 50000 WE WILL EXPAND SUPPORT FOR ADDRESSING, MITIGATING AND PREVENTING BEHAVIORAL HEALTH CHALLENGES AMONG NAZ-ENROLLED NORTH MINNEAPOLIS FAMILIES THROUGH TRAINING AND INFRASTRUCTURE DEVELOPMENT, MOVING FROM A REACTIVE TO A PROACTIVE STANCE. TOUCHSTONE MENTAL HEALTH 2312 SNELLING AVENUE MINNEAPOLIS MN 55404 411920740 501(C)(3) 50000 EXPAND THE TOUCHSTONE HEALTH AND WELLNESS CENTER WITH THE QUADRANT IV INTEGRATED HEALTH INITIATIVE, INCLUDING HEALTH COACHING, TO IMPROVE BEHAVIORAL AND PHYSICAL HEALTH OUTCOMES FOR ADULTS WITH SERIOUS MENTAL ILLNESSES. VAIL PLACE 23 - 9TH AVENUE SOUTH HOPKINS MN 55343 411394766 501(C)(3) 50000 A PARTNERSHIP BETWEEN VAIL PLACE AND NORTH MEMORIAL HEALTH CARE TO FULLY DEVELOP A TOTAL CARE COLLABORATIVE, A WHOLE-HEALTH MODEL OFFERING INTEGRATED MEDICAL AND BEHAVIORAL HEALTH CARE. YOUTHLINK 41 NORTH 12TH STREET MINNEAPOLIS MN 55403 411341773 501(C)(3) 50000 BASED ON IDENTIFIED GAPS IN THE CONTINUUM OF SERVICES, MENTAL HEALTH AND RELATED ANCILLARY CARE WILL BE INTEGRATED INTO YOUTHLINK'S DROP-IN CENTER FOR HOMELESS YOUTH. INTERMEDIATE SCHOOL DISTRICT 287 1820 XENIUM LANE PLYMOUTH MN 55441 410970130 50000 THE DISTRICT 287 TRAUMA-REACTIVE STUDENT PROJECT WILL ENGAGE CORNERSTONE TO PROVIDE PREVENTION AND SUPPORT SERVICES FOR SECA STUDENTS, USING A TRAUMA-INFORMED APPROACH TO PROMOTE EMOTIONAL REGULATION AND HEALTHY INTERACTIONS. MARCH OF DIMES MINNESOTA CHAPTER EDINA MN 55439 131846366 501(C)(3) 50000 MEDICA FOUNDATION'S SUPPORT IS REQUESTED FOR YEAR ROUND PARTNERSHIP ON THREE VITAL EVENTS FOR MARCH OF DIMES - MARCH FOR BABIES, SIGNATURE CHEF EVENT, AND NURSE OF THE YEAR AWARDS 2016. COMMUNITY HEALTH CHARITIES 121 HENNEPIN AVENUE SOUTH MINNEAPOLIS MN 55401 136167225 501(C)(3) 41970 COMMUNITY HEALTH CHARITIES PARTNERS WITH NEARLY 200 MINNESOTA EMPLOYERS YEAR-ROUND TO ENGAGE MORE THAN 260,000 EMPLOYEES WITH THE HEALTH CAUSES OF OUR 38 WELL KNOWN AND TRUSTED MEMBER HEALTH CHARITIES. OUR MEMBERS INCLUDE HEALTH ORGANIZATIONS SUCH AS THE RONALD MCDONALD HOUSE, MARCH OF DIMES AND ST. JUDE CHILDREN'S RESEARCH HOSPITAL. GREATER TWIN CITIES UNITED WAY 404 SOUTH EIGHTH STREET MINNEAPOLIS MN 55404 411973442 501(C)(3) 33030 THIS GRANT TO UNITED WAY'S ANNUAL FUND WOULD SUPPORT HUMAN SERVICES FOR MORE THAN 500,000 PEOPLE IN THE REGION LIVING AT OR NEAR POVERTY. IT WOULD CREATE PATHWAYS OUT OF POVERTY THROUGH EDUCATION AND JOB TRAINING AND STRENGTHEN THE SAFETY NET TO PREVENT HUNGER, HOMELESSNESS, DOMESTIC VIOLENCE, AND HEALTH PROBLEMS. A CHANCE TO GROW 1800 SECOND STREET NE MINNEAPOLIS MN 55418 411444113 501(C)(3) 30000 WE WILL EXPAND THE MOBILE VISION PROGRAM SUPPORTED BY MEDICA LAST YEAR WITH HEAD START CENTERS IN MINNEAPOLIS AND RAMSEY COUNTIES TO PROVIDE EXAMS, GLASSES AND VISION CARE. CORNERHOUSE INTERAGENCY CHILD ABUSE EVALUATION AND TRAINING CENTER 2502 10TH AVENUE SOUTH MINNEAPOLIS MN 55404 411640731 501(C)(3) 30000 THE REDESIGNED CORNERHOUSE HOME VISITING PROGRAM WILL PROVIDE SIX MONTHS OF INTENSIVE IN-HOME CRISIS COUNSELING, PARENT EDUCATION, AND ADVOCACY SERVICES FOR CHILDREN AND FAMILIES RECOVERING FROM THE TRAUMA OF ABUSE. LAKES & PINES COMMUNITY ACTION COUNCIL INC 1700 MAPLE AVE EAST MORA MN 55051 410900982 501(C)(3) 30000 THE DENTAL DAYS PROGRAM BRINGS DENTAL CARE PROFESSIONALS INTO THE COMMUNITY WHERE THERE ARE VERY FEW OR NO DENTAL CARE PROFESSIONALS THAT WILL ACCEPT STATE ASSISTED DENTAL CARE. CHURCHES UNITED IN MINISTRY 102 W SECOND STREET DULUTH MN 55802 411227969 501(C)(3) 30000 SERVICES AND INTERVENTIONS FOR RECENTLY HOMELESS PARENTS AND THEIR CHILDREN AGED 0 TO 5, TO SUPPORT EARLY CHILDHOOD HEALTH, WITH A SPECIAL EMPHASIS ON CHILDREN FROM PRE-BIRTH TO AGE 1. PACT FOR FAMILIES COLLABORATIVE (PUTTING ALL COMMUNITIES TOGETHER) 2200 23RD ST NE SUITE 2030 WILLMAR MN 56201 411857830 30000 PROJECT SUCCEED (SUPPORTING AND UNDERSTANDING CHILDREN'S COGNITIVE AND EMOTIONAL EARLY DEVELOPMENT) INTENDS TO INCREASE THE CAPACITY FOR PARENTS AND PROFESSIONALS TO RESPOND TO THE SOCIAL AND EMOTIONAL NEEDS OF CHILDREN. CHILDREN'S DENTAL SERVICES 636 BROADWAY STREET NE MINNEAPOLIS MN 55413 410857929 501(C)(3) 30000 CDS WILL IMPLEMENT AN INNOVATIVE, EVIDENCED-BASED MEDICAL/DENTAL SERVICES INTEGRATION PROJECT. 1,000 LOW-INCOME CHILDREN AND PREGNANT WOMEN WILL RECEIVE MEDICAL AND DENTAL SERVICES IN NORTH MINNEAPOLIS AND NORTHWEST HENNEPIN COUNTY. ST DAVID'S CENTER FOR CHILD & FAMILY DEVELOPMENT 3395 PLYMOUTH ROAD MINNETONKA MN 55305 411429208 501(C)(3) 30000 THE PROJECT EXPANDS ST. DAVID'S CENTER'S CHILDREN'S MENTAL HEALTH SERVICES INTO FAMILY SERVING AGENCIES AND CLASSROOM SETTINGS IN CARVER COUNTY AND THE ROBBINSDALE AREA. THE FAMILY PARTNERSHIP 414 SOUTH 8TH STREET MINNEAPOLIS MN 55404 410693858 501(C)(3) 30000 DEMONSTRATE A MODEL CURRENTLY UNAVAILABLE IN HIGH-QUALITY EARLY LEARNING/CHILDCARE FOR POVERTY-STRICKEN CHILDREN: THERAPY GROUPS IN CLASSROOMS FOR PRESCHOOLERS IMPEDED BY ADVERSITY; ENHANCE PARENTAL NURTURING AND BEHAVIOR MANAGEMENT; MEASURE OUTCOMES. WASHBURN CENTER FOR CHILDREN 1100 GLENWOOD AVENUE MINNEAPOLIS MN 55405 410711618 501(C)(3) 30000 WASHBURN CENTER'S DAY TREATMENT PROGRAM EXPANSION WILL PROVIDE EARLY MENTAL HEALTH INTERVENTION AND HELP CHILDREN AGES THREE TO NINE DEVELOP THE SOCIAL, EMOTIONAL AND BEHAVIORAL SKILLS NEEDED TO BE SUCCESSFUL. SIMPSON HOUSING SERVICES INC 2100 PILLSBURY AVENUE SOUTH MINNEAPOLIS MN 55404 411759477 501(C)(3) 25000 FUNDING TO EXPAND EARLY CHILDHOOD PROGRAMMING FOR FAMILIES EXPERIENCING HOMELESSNESS. STAFF WILL WORK ONE-ON-ONE WITH FAMILIES TO ENCOURAGE HEALTHY DEVELOPMENT AND POSITIVE RELATIONSHIPS. BETTER FUTURES MINNESOTA 2620 MINNEHAHA AVENUE SOUTH MINNEAPOLIS MN 55406 450550557 501(C)(3) 10000 FURTHER DEVELOP AND ASSESS BETTER FUTURES' MENTAL HEALTH AND SUBSTANCE ABUSE INTEGRATED CARE STRATEGY FOR PARTICIPANTS WITH SERIOUS AND PERSISTENT MENTAL ILLNESS AND CO-OCCURRING BEHAVIORAL HEALTH CONDITIONS. AMERICAN RED CROSS 1201 WEST RIVER PARKWAY MINNEAPOLIS MN 55454 530196605 501(C)(3) 10000 THE HEROES BREAKFAST IS A FUNDRAISING/RECOGNITION EVENT TO HONOR AND ACKNOWLEDGE LOCALINDIVIDUALS WHO HAVE GONE ABOVE AND BEYOND THE CALL OF DUTY WITH A HEROIC ACT TO SAVE LIVES. SEVEN INDIVIDUALS ARE HONORED THROUGH DISTINCT AWARDS FOR THEIR ACTS OF BRAVERY. AMERICAN HEART ASSOCIATION 4701 WEST 77TH STREET MINNEAPOLIS MN 55435 135613797 501(C)(3) 7500 HEART DISEASE IS THE NO. 1 KILLER OF WOMEN, CAUSING 1 IN 3 DEATHS EACH YEAR. GO RED FOR WOMEN IS THE AMERICAN HEART ASSOCIATION'S SOLUTION TO SAVE WOMEN'S LIVES BY EDUCATING AND CONNECTING MILLIONS OF WOMEN OF ALL AGES. FUNDS PROVIDE EDUCATION AND RESEARCH FOR WOMEN. BRIDGES OF HOPE PO BOX 742 BRAINERD MN 56401 721538846 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION INTERCULTURAL MUTUAL ASSISTANCE ASSOCIATION 2500 VALLEYHIGH DRIVE NW ROCHESTER MN 55901 411497753 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION ELY COMMUNITY RESOURCE INC 40 N 1ST AVE E ELY MN 55731 411333048 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION LIGHT THE LEGACY 619 WEST ST GERMAIN SUITE 216 ST CLOUD MN 56301 472673813 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION ACCESS NORTH CENTER FOR INDEPENDENT LIVING OF NORTHEASTERN MINNESOTA 1309 EAST 40TH STREET HIBBING MN 55746 411425959 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION LUTHERAN SOCIAL SERVICE OF MINNESOTA 2485 COMO AVENUE ST PAUL MN 55108 410872993 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION CENTRAL MN TASK FORCE ON BATTERED WOMEN PO BOX 367 ST CLOUD MN 56302 411344743 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION LEISURE EDUCATION FOR EXCEPTIONAL PEOPLE INC 929 N 4TH ST MANKATO MN 56001 411403190 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION BOYS & GIRLS CLUB OF ROCHESTER 1026 EAST CENTER STREET ROCHESTER MN 55904 411945875 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION LUTHERAN SOCIAL SERVICE OF MINNESOTA 2485 COMO AVENUE ST PAUL MN 55108 410872993 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION NORTH SHORE HORIZONS INC 127 7TH STREET TWO HARBORS MN 55616 411451736 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION ADVOCACY AND INCLUSION MATTER OF WEST CENTRAL MINNESOTA 200 SW 4TH STREET SUITE 25 WILLMAR MN 56201 416038594 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION WEST CENTRAL INDUSTRIES INC PO BOX 813 / 1300 22ND ST SW WILLMAR MN 56201 410872939 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION GENERATIONS HEALTH CARE INITIATIVES 130 W SUPERIOR ST SUITE 700 DULUTH MN 55802 412000473 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION INTERFAITH CAREGIVERS--FAITH IN ACTION IN FARIBAULT CO 415 SOUTH GROVE STREET SUITE 5 BLUE EARTH MN 56031 261554757 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION ARC MIDSTATE PO BOX 251 ST CLOUD MN 56302 237577023 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION CHILDREN'S DENTAL HEALTH SERVICES UNITED WAY BUILDING ROCHESTER MN 55902 203677586 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION OUR SAVIOR'S LUTHERAN CHURCH 4831 GRAND AVE DULUTH MN 55807 410907199 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION YWCA OF MANKATO 127 SOUTH 2ND STREET SUITE 200 MANKATO MN 56001 410711619 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION PROJECT LULU 2109 MINNESOTA AVENUE DULUTH MN 55802 460856629 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION WEST CENTRAL INITIATIVE 1000 WESTERN AVE FERGUS FALLS MN 56537 363453471 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION WELLSPRING FAITH IN ACTION 108 8TH ST S SUITE 7 ST JAMES MN 56081 710949569 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION NORTHLAND FOUNDATION 202 WEST SUPERIOR STREET SUITE 610 DULUTH MN 55802 411554455 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION THIRD STREET CLINIC 360 DIVISION AVENUE SUITE 200 GRAND FORKS ND 58201 450433253 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION GRANITE FALLS LIVING AT HOMEBLOCK NURSE PROGRAM 752 PRENTICE STREET GRANITE FALLS MN 56241 411971745 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION FAMILY RESOURCE CENTER ST CROIX VALLEY INC 857 MAIN ST BALDWIN WI 54002 391943404 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION ASSUMPTION COMMUNITY SERVICES INC 615 1ST ST N COLD SPRING MN 56320 800276405 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION MONTICELLO CHRISTIAN SOCIAL SERVICES INC PO BOX 1220 MONTICELLO MN 55362 411668149 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION RANGE RESPITE PROJECT INC 1309 20TH STREET SOUTH VIRGINIA MN 55792 411726790 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION KNUTE NELSON FOUNDATION 420 12TH AVENUE EAST ALEXANDRIA MN 56308 411451486 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION FAMILY HEALTHCARE CENTER 301 NP AVENUE FARGO ND 58102 450430628 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION CARE CLINIC 1407 W 4TH ST RED WING MN 55066 270540451 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION PEARL BATTERED WOMEN'S RESOURCE CENTER 210 2ND AVENUE SW SUITE 104 MILACA MN 56353 411706195 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION PROJECT CARE FREE CLINIC 3112 6TH AVENUE EAST HIBBING MN 55746 273176137 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION HELPING HANDS OUTREACH 101 PLYMOUTH STREET HOLDINGFORD MN 56340 010697213 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION VINE FAITH IN ACTION 421 EAST HICKORY STREET MANKATO MN 56001 411802861 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION WOMEN'S HEALTH CENTER OF DULUTH PA 32 EAST FIRST STREET SUITE 300 DULUTH MN 55802 411444270 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION HERO HEALTHCARE EQUIPMENT RECYCLING ORGANIZATION 5012 53RD STREET SOUTH SUITE C FARGO ND 58104 450457109 501(C)(3) 5000 SUPPORT HEALTH-RELATED PROGRAMMING CORE TO THE ORGANIZATION'S MISSION ISD 47 SAUK RAPIDSRICE 30 S 4TH AVENUE SAUK RAPIDS MN 56379 416000219 5000 THRIVE WILL PROVIDE A TWO DAY TRAINING AND FOLLOW UP CONSULTATION FOR PROFESSIONALS TO ADDRESS NEEDS OF CHILDREN AGE THREE TO THIRD GRADE WHO HAVE EXPERIENCED TRAUMA OR TOXIC STRESS. ASCENSION PLACE INC 1803 BRYANT AVENUE NORTH MINNEAPOLIS MN 55411 411396238 501(C)(3) 5000 THE PROJECT WILL SUPPORT CHILDREN'S HEALTHY DEVELOPMENT VIA INDOOR AND OUTDOOR EXPERIENCES THAT CONTRIBUTE TO DEVELOPING LANGUAGE, FINE AND GROSS MOTOR SKILLS, CREATIVITY, COGNITIVE SKILLS, BRAIN DEVELOPMENT AND PROBLEM SOLVING. PARTNERSHIP RESOURCES INC 1069 10TH AVENUE SE MINNEAPOLIS MN 55414 410837660 501(C)(3) 5000 GRANT FUNDS WILL SUPPORT THE THIRD REHABILITATES: MINNEAPOLIS-ST. PAUL DISABILITIES FILM FESTIVAL (RFF). SPECIFICALLY, FUNDS WILL ALSO HELP WITH THE MINNESOTA WORKERS OF ALL ABILITIES CHALLENGE. FUNDS WILL BE USED TO PROMOTE, EVALUATE, AND FACILITATE THE CHALLENGE AS THE KEY COMPONENT OF THE ONE TO TWO DAY FESTIVAL. AMERICAN CANCER SOCIETY MIDWEST DIVISION MENDOTA HEIGHTS MN 551201158 410724036 501(C)(3) 10000 THE AMERICAN CANCER SOCIETY MAKING STRIDES AGAINST BREAST CANCER WALK IS A POWERFUL EVENT TO RAISE AWARENESS AND FUNDS TO END BREAST CANCER. IT IS THE LARGEST NETWORK OF BREAST CANCER AWARENESS EVENTS IN THE NATION, UNITING NEARLY 300 COMMUNITIES TO FINISH THE FIGHT. NATIONAL ALLIANCE ON MENTAL ILLNESS - MINNESOTA 800 TRANSFER ROAD SUITE 31 ST PAUL MN 55114 411317030 501(C)(3) 5000 THE NAMIWALK IS THE LARGEST AWARENESS RAISING ANTI-STIGMA WALK IN THE STATE AND ONE OF THE LARGEST ACROSS THE COUNTRY. PEOPLE FROM ALL WALKS OF LIFE COME TOGETHER DEMONSTRATING SUPPORT FOR PEOPLE WHOSE LIVES ARE IMPACTED BY MENTAL ILLNESSES. ALZHEIMER'S ASSOCIATION MINNESOTA - NORTH DAKOTA 7900 WEST 78TH STREET SUITE 100 MINNEAPOLIS MN 55439 411361624 501(C)(3) 5000 SPONSOR THE WALK TO END ALZHEIMER'S, THE WORLD'S LARGEST EVENT TO RAISE AWARENESS AND FUNDS FOR ALZHEIMER'S CARE, SUPPORT AND RESEARCH. WALK TO END ALZHEIMER'S UNITES THE ENTIRE COMMUNITY - FAMILIES, FRIENDS, CO-WORKERS, SOCIAL GROUPS AND MORE IN A DISPLAY OF STRENGTH AND DEDICATION IN THE FIGHT AGAINST DEMENTIA. 71 PART I, LINE 2: THE MEDICA FOUNDATION MONITORS THE USE OF GRANT FUNDS THROUGH SEVERAL MECHANISMS. ALL GRANTEES ARE ASKED TO SUBMIT PROGRESS REPORTS RELATED TO THE GRANT FUNDING. UPDATES ON PROGRAM GRANTS ARE RECEIVED DURING AND AT THE END OF THE GRANT PERIOD. ADDITIONALLY, THE FOUNDATION ENGAGES A COMMITTEE OF EMPLOYEES TO WORK DIRECTLY WITH GRANT RECIPIENTS TO PROVIDE OVERSIGHT AND SUPPORT TO HELP ENSURE GRANT OBJECTIVES ARE ACCOMPLISHED. THE COMMITTEE FUNCTIONS UNDER THE DIRECTION OF FOUNDATION STAFF. COMMITTEE MEMBERS REVIEW PROPOSALS, PERFORM SITE VISITS AND PROVIDE QUARTERLY UPDATES FOR THE BOARD OF DIRECTORS. 0 1 0 0 0 0 1 0 0 MARK L BAIRD TREASURER/CFO & SVP 0 393715 0 446274 0 280003 0 20538 0 25216 0 1165746 0 253153 JAMES P JACOBSON SECRETARY/SVP 0 280785 0 296199 0 58128 0 19213 0 26296 0 680621 0 34948 ROBERT LONGENDYKE EXECUTIVE DIRECTOR/MHP SVP 0 286104 0 272579 0 59730 0 20538 0 22595 0 661546 0 32842 DAVID TILFORD PRESIDENT/CEO 0 803980 0 1287906 0 202848 0 19213 0 17913 0 2331860 0 172111 GLENN E ANDIS SVP 0 326901 0 343403 0 73225 0 20538 0 25858 0 789925 0 46395 DEBBY S KNUTSON SVP 0 271866 0 257327 0 55430 0 19213 0 12000 0 615836 0 29476 JANA L JOHNSON SVP 0 286751 0 313106 0 63448 0 20538 0 24822 0 708665 0 38481 TIMOTHY D THULL SVP 0 301450 0 293235 0 112299 0 19213 0 25220 0 751417 0 53951 JOHN W NAYLOR SVP 0 369515 0 522755 0 135586 0 55054 0 28805 0 1111715 0 110669 DANNETTE M COLEMAN SVP 0 299239 0 248366 0 55569 0 20538 0 9313 0 633025 0 20945 MARK WERNER MD SVP 0 155088 0 336465 0 35807 0 39088 0 9926 0 576374 0 0 RICHARD H SYKORA GM/VP 0 239971 0 211535 0 46490 0 20538 0 22884 0 541418 0 22288 BARBARA LYNCH VP 0 244155 0 167219 0 46530 0 14307 0 21506 0 493717 0 0 ANDREW E DAVIS VP 0 279992 0 176227 0 20381 0 37703 0 1695 0 515998 0 0 GEOFFREY J BARTSH VP 0 238609 0 222796 0 28990 0 36340 0 27294 0 554029 0 6278 MARY QUIST VP 0 248542 0 154384 0 45587 0 20538 0 22972 0 492023 0 0 PART I, LINE 3 MEDICA FOUNDATION, THE FILING ORGANZATION DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION MEDICA HEALTH PLANS 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, LINE 4B THE FOLLOWING RECEIVED A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION: DAVID TILFORD $ 60,239 JAMES P JACOBSON $ 12,232 MARY QUIST $ 14,936 GLENN E ANDIS $ 16,238 TIMOTHY D THULL $ 41,166 DEBBY S KNUTSON $ 10,317 MARK L BAIRD $119,990 JANA L JOHNSON $ 13,468 JOHN W NAYLOR $ 50,865 DANNETTE M COLEMAN $ 11,975 RICHARD H SYKORA $ 7,801 BARBARA LYNCH $ 6,400 GEOFFREY J BARTSH $ 2,745 PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO OPERATING EARNINGS OF MEDICA HEALTH PLANS. SCHEDULE 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 VI, SECTION B, LINE 11 MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND FINANCE MANAGER REVIEW THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY OF FORM 990 WILL ALSO BE PRESENTED TO THE BOARD OF DIRECTORS. 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 FOUNDATION 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 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 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, 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, MEDICA RESEARCH INSTITUTE, MEDICA AFFILIATED SERVICS, MEDICA INSURANCE COMPANY, MEDICA SELF-INSURED, AND MEDICA HEALTH MANAGEMENT). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH COVERAGE MN 501(C)(4) MEDICA HOLDING COMPANY 0 MEDICA HEALTH PLANS OF WISCONSIN 401 CARLSON PARKWAY MINNETONKA MN 55305 411843804 HEALTH COVERAGE MN 501(C)(4) MEDICA HOLDING COMPANY 0 MEDICA HOLDING COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING COMPANY/NO ACTIVITY MN 501(C)(4) N/A 0 MEDICA RESEARCH INSTITUTE 401 CARLSON PARKWAY MINNETONKA MN 55305 270600894 RESEARCH FOUNDATION MN 501(C)(3) 509(A)(3) I MEDICA HOLDING COMPANY 0 MEDICA INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 411490988 HEALTH INSURANCE MN MEDICA AFFILIATED SERVICES C 0 MEDICA SELF-INSURED 401 CARLSON PARKWAY MINNETONKA MN 55305 411479417 THIRD PARTY ADMINISTRATOR MN MEDICA AFFILIATED SERVICES C 0 MEDICA AFFILIATED SERVICES 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MEDICA HOLDING COMPANY C 0 MEDICA HEALTH MANAGEMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MANAGEMENT MN MEDICA AFFILIATED SERVICES C 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 MEDICA HEALTH PLANS C 4000000 ACTUAL AMOUNT MEDICA HEALTH PLANS N 179573 ACTUAL AMOUNT MEDICA HEALTH PLANS O 257397 ACTUAL AMOUNT MEDICA HEALTH PLANS P 94065 ACTUAL AMOUNT