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 411242261 MEDICA HEALTH PLANS MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 MARK L BAIRD CFO 9529922058 2016-11-10 1 TODD A JACKSON P00092672 6123324300 2015 2017-02-10 21:41:12Z DAVID TILFORD 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 2108568644 0 X WWW.MEDICA.COM X 1973 MN MEDICA'S MISSION IS TO MEET OUR CUSTOMERS' NEEDS FOR HEALTH PLAN PRODUCTS AND SERVICES. IN DOING SO, MEDICA WORKS WITH ITS MEMBERS AND PROVIDERS TO MAKE HEALTH CARE ACCESSIBLE, AFFORDABLE AND A MEANS BY WHICH ITS MEMBERS IMPROVE THEIR HEALTH. 5 4 1606 0 90908809 0 0 0 1882713161 1951942410 14203362 6178100 2006809 1741818 1898923332 1959862328 1254800 7900000 1318132740 1537555991 119494104 143929227 0 0 0 410913504 222278463 1849795148 1911663681 49128184 48198647 856911737 896765075 396812972 392762666 460098765 504002409 X MEDICA'S MISSION IS TO MEET OUR CUSTOMERS' NEEDS FOR HEALTH PLAN PRODUCTS AND SERVICES. IN DOING SO, WE WORK WITH MEMBERS AND PROVIDERS TO MAKE HEALTH CARE ACCESSIBLE, AFFORDABLE AND A MEANS BY WHICH OUR MEMBERS IMPROVE THEIR HEALTH. 0 0 1507523834 1664501188 MEDICA HEALTH PLANS (MHP) IN 2015 PROVIDED NONPROFIT HMO COVERAGE TO ENROLLEES IN THE STATE OF MINNESOTA'S MEDICAL ASSISTANCE, MINNESOTACARE, AND SPECIAL NEEDS BASIC CARE PROGRAMS. MEDICAL ASSISTANCE IS MINNESOTA'S MEDICAID PROGRAM. MINNESOTACARE IS A PUBLICLY SUBSIDIZED HEALTH CARE PROGRAM FOR RESIDENTS WHO DO NOT HAVE ACCESS TO AFFORDABLE HEALTH CARE COVERAGE. SPECIAL NEEDS BASIC CARE (SNBC) PROVIDES COVERAGE FOR INDIVIDUALS AGES 18-64 THAT ARE ON MEDICAL ASSISTANCE AND HAVE BEEN CERTIFIED WITH PHYSICAL, DEVELOPMENTAL OR MENTAL DISABILITIES.A TOTAL OF 187,783 MEDICA MEMBERS - 92.5% OF MHP'S TOTAL ENROLLMENT - WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/2015. THERE WERE 134,998 PREPAID MEDICAL ASSISTANCE PROGRAM (MEDICAID) MEMBERS, 30,254 MINNESOTACARE MEMBERS, AND 22,531 SPECIAL NEEDS BASIC CARE MEMBERS.IN THE NCQA 2015 HEALTH INSURANCE PLAN RATINGS, MEDICA'S MEDICAID HMO WAS THE HIGHEST-RATED MEDICAID PLAN IN MINNESOTA AND AMONG THE 40 HIGHEST-RATED MEDICAID PLANS IN THE UNITED STATES. MEDICA HEALTH PLANS' MINNESOTA MEDICAID HMO CURRENTLY HOLDS AN ACCREDITATION STATUS OF COMMENDABLE FROM NCQA. STATE OF MINNESOTA HEALTH CARE PROGRAMS:MINNESOTA REQUIRES STATE-LICENSED HMOS TO BE NONPROFIT AND TO PARTICIPATE IN STATE OF MINNESOTA HEALTH CARE PROGRAMS. MINNESOTA HEALTH CARE PROGRAMS COVER PEOPLE WHO CANNOT GET OR AFFORD HEALTH INSURANCE ELSEWHERE AND HELPS THEM PAY SOME OR ALL-MEDICAL BILLS. ACCORDING TO THE MINNESOTA DEPARTMENT OF HUMAN SERVICES, COVERAGE IS AVAILABLE FOR QUALIFYING INDIVIDUALS WHO MEET RULES ABOUT INCOME, ASSETS AND OTHER FACTORS. THESE PROGRAMS FOCUS ON PREGNANT WOMEN, FAMILIES AND CHILDREN, ADULTS WITH DISABILITIES, CHILDREN WITH DISABILITIES, PEOPLE 65 OR OLDER, ADULTS WITHOUT CHILDREN, AND LOW-INCOME ADULTS UNABLE TO FIND AFFORDABLE CARE. COVERAGE IS ALSO AVAILABLE FOR PEOPLE WHO MEET ELIGIBILITY RULES FOR NURSING HOME CARE, HOME CARE, FOR CHILDREN WHO HAVE A DISABILITY AND FOR EMPLOYED PERSONS WITH DISABILITIES.THE STATE OF MINNESOTA SETS RATES WHEN IT CONTRACTS WITH THE STATE'S NONPROFIT HMOS, PAYING A FIXED SUM PER ENROLLEE. MHP BEARS THE RISK FOR COSTS ABOVE THE PREDETERMINED RATE. MEDICA HEALTH PLAN'S 2015 PERFORMANCE ON BEHALF OF THE STATE OF MINNESOTA WAS EFFICIENT: - IN 2015 MEDICA HEALTH PLANS MEDICAL LOSS RATIO FOR STATE OF MINNESOTA HEALTH PROGRAMS WAS 91.1%. APPROXIMATELY 90-CENTS OF EACH STATE PROGRAM DOLLAR WENT TO PROVIDE CARE; - THE ADMINISTRATIVE COST RATIO WAS APPROXIMATELY 6.8% INCLUDING PREMIUM TAXES. 29500414 17255604 IN 2015 MHP PROVIDED FULLY INSURED COMMERCIAL HMO HEALTH INSURANCE COVERAGE TO GROUPS AND INDIVIDUALS IN MINNESOTA. AS OF 12/31/2015, THE ENROLLMENT IN MHP FULLY INSURED MINNESOTA GROUP PLANS WAS 4,910, WHICH WAS APPROXIMATELY 2.4% OF MHP'S TOTAL 2015 ENROLLMENT. 531743 257757 IN 2015, MHP PARTICIPATED IN MINNESOTA SENIOR HEALTH OPTIONS (MSHO), A MEDICARE-RELATED PRODUCT, IN MINNESOTA. ENROLLMENT IN THAT PRODUCT WAS 10,323 OR 5.1% OF MHP'S TOTAL ENROLLMENT. MSHO IS A PRODUCT FOR PEOPLE AGE 65 AND OLDER AND ELIGIBLE FOR BOTH MEDICARE AND MEDICAID. 7900000 7900000 179472768 MEDICA HEALTH PLANS INTERCOMPANY ADMINISTRATIVE AGREEMENTS:MHP HAS MANAGEMENT AGREEMENTS WITH RELATED ENTITIES TO PROVIDE ADMINISTRATIVE SERVICES. MHP IS REIMBURSED FOR THESE SERVICES MONTHLY. IN 2015, MHP WAS REIMBURSED FOR $179,472,768 IN INTERCOMPANY ADMINISTRATIVE EXPENSES, REPORTED AS REVENUE ON THE 990.CONTRIBUTIONS BY MEDICA ON BEHALF OF MEMBERS BEYOND CONTRACTED SERVICES:IN 2015 MHP SPENT APPROXIMATELY $4.5 MILLION TO PROVIDE ADDITIONAL, BEYOND-CONTRACT SUPPORT ON BEHALF OF THE FOLLOWING CATEGORIES OF MINNESOTA STATE HEALTH CARE PROGRAMS: PMAP FAMILIES AND CHILDREN; PMAP ADULTS WITHOUT CHILDREN; MSC+; MNCARE FAMILIES AND CHILDREN; MNCARE ADULTS WITHOUT CHILDREN; MSHO; SNBC.PROGRAMS INCLUDED: MY HEALTH REWARDS (MHR) PROGRAM; VALUE OF WAIVED FAMILY DEDUCTIBLES; MSC+ ELDERLY WAIVER FOR NON-ELIGIBLE MEMBERS; NON-MEDICARE PART D PHARMACY COPAYMENTS; AND NON-MEDICARE VALUE OF COST-SHARING WAIVED COPAYS.OTHER COMMUNITY BENEFITS: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 EFFORTS:MHP 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; MINNESOTA HEALTH INFORMATION EXCHANGE, WHICH CONNECTS DOCTORS, HOSPITALS AND CLINICS STATEWIDE. MEDICA ANNUALLY HELPS FUND A NUMBER OF COLLABORATIVE EDUCATION AND TRAINING SEMINARS AND CONFERENCES.HEALTH AND WELLNESS PROGRAMS PROVIDING COMMUNITY BENEFIT:MEDICA 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 CHILD AND TEEN CHECKUPS - 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 AND NUTRITION PROGRAMSASTHMA, DIABETES AND WEIGHT-LOSS CAMPS FOR CHILDREN: MEDICA FUNDS MEDICALLY SUPERVISED SUMMER CAMPS SO CHILDREN CAN LEARN HOW TO BETTER MANAGE CHRONIC CONDITIONS.MY HEALTH REWARDS FROM MEDICA INCLUDES AN ARRAY OF ONLINE TOOLS AND RESOURCES THAT MAKE IT EASY FOR MEDICA MEMBERS TO ASSESS THEIR HEALTH STATUS, AND TO CUSTOMIZE AND FOLLOW PERSONALIZED PROGRAMS FOR A HEALTHIER LIFESTYLE AND DIET. IN 2015, THE CORE MY HEALTH REWARDS FROM MEDICA PROGRAM WAS PROVIDED AT NO ADDITIONAL CHARGE TO FULLY INSURED GROUPS. FIT CHOICES BY MEDICA PROVIDED MEDICA MEMBERS WITH (A) A $20 MONTHLY MEMBERSHIP CREDIT FOR EXERCISING AT A PARTICIPATING HEALTH CLUB TWELVE OR MORE DAYS PER MONTH AND (B) THE OPPORTUNITY FOR PERSONAL COACHING AND A PERSONALIZED NUTRITION AND FITNESS PLAN. IN 2015, FIT CHOICES BY MEDICA WAS AVAILABLE AT NO COST TO MHP'S FULLY INSURED AND MINNESOTACARE MEMBERS. HEALTH AND WELLNESS COACHING:MEDICA'S HEALTH AND WELLNESS COACHING PROGRAM IS A SELF-DIRECTED PROGRAM OFFERING A WIDE VARIETY OF TOOLS AND RESOURCES TO HELP MEMBERS MAKE CHANGES TO IMPROVE THEIR HEALTH. HEALTH COACHING SUPPORT INCLUDES PRIVATE, CONFIDENTIAL ACCESS TO TRAINED HEALTH COACHES. THERE WAS NO COST TO MEDICA MEMBERS TO PARTICIPATE IN THE HEALTH AND WELLNESS COACHING PROGRAM.MEDICAL AND MENTAL HEALTH DISEASE MANAGEMENT AND PATIENT SUPPORT:MEDICA IN 2015 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. 7900000 7900000 179472768 1545455991 0 0 0 0 0 0 0 0 0 1 1 0 0 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 1175 0 1 1606 1 1 1 0 0 0 0 0 X 5 4 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X MARY QUIST 9529922058 401 CARLSON PARKWAY CP330 MINNETONKA MN 55305 DAVID TILFORD PRESIDENT/CEO 40.00 X X 2294734 0 34907 JOHN BUCK DIRECTOR 15.00 X X 97000 0 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 68000 0 0 EARL STRATTON DIRECTOR 10.00 X 64500 0 0 PETER KELLY MD DIRECTOR 10.00 X 63500 0 0 JAMES P JACOBSON SVP/SECRETARY 40.00 X 635112 0 43765 MARK L BAIRD CFO/SVP/TREASURER 40.00 X 1119992 0 43204 GLENN E ANDIS SVP 40.00 X 743529 0 44541 ROBERT LONGENDYKE SVP 40.00 X 618413 0 41399 DEBBY S KNUTSON SVP 40.00 X 584623 0 29526 JANA L JOHNSON SVP 40.00 X 663305 0 43604 TIMOTHY D THULL SVP 40.00 X 706984 0 42650 JOHN W NAYLOR SVP 40.00 X 1027856 0 81860 DANNETTE M COLEMAN GM/VP 40.00 X 603174 0 28097 MARK WERNER MD SVP 40.00 X 527360 0 48269 RICHARD H SYKORA GM/VP 40.00 X 497996 0 41817 BARBARA LYNCH VP 40.00 X 457904 0 34191 ANDREW E DAVIS VP 40.00 X 476600 0 37703 GEOFFREY J BARTSH VP 40.00 X 490395 0 62022 MARY QUIST VP 40.00 X 448513 0 41881 12189490 0 699436 312 0 1 0 UNITED HEALTHCARE SERVICES INC 9900 BREN DR E MN008-T380 MINNETONKA MN 55343 CLAIMS PROCESSING 98378125 DAHL CONSULTING INC 418 COUNTY ROAD D E ST PAUL MN 55117 TEMP SERVICES 14051582 LOFFLER COMPANIES INC 1101 EAST 78TH STREET SUITE 200 BLOOMINGTON MN 55420 PRINTING 1276641 HEALTHEDGE SOFTWARE INC 30 CORPORATE DR BURLINGTON MA 01803 TECHNOLOGY SERVICES 694563 ATOMIC DATA LLC 250 MARQUETTE AVENUE SUITE 225 MINNEAPOLIS MN 55401 TECHNOLOGY SERVICES 539560 36 MEDICAID REVENUE 524114 1661462516 1661462516 INTERCOMPANY ADMIN FEES 561000 179472768 179472768 GROUP & INDIVIDUAL PREMIUMS 524114 107680696 17225604 90455092 ACA VACCINE 524114 3038672 3038672 MEDICARE REVENUE 524114 248473 248473 39285 39285 1951942410 10241886 10241886 5426201 4138100 1288101 1288101 1288101 140504430 144568216 -4063786 -4063786 -4063786 MEDICA TAX PARTNERSHIP DENTAL REV 900099 453717 453717 453717 1959862328 1861487318 90908809 7466201 7900000 7900000 1537555991 1537555991 10319727 10319727 102640141 102640141 9611525 9611525 13353825 13353825 8004009 8004009 364950 364950 295000 295000 505709 505709 258743 258743 41479519 41479519 7941488 7941488 4762468 4762468 10221861 10221861 4857161 4857161 725874 725874 511820 511820 56113 56113 23621957 23621957 1444046 1444046 REINSURANCE 90229123 90229123 PREMIUM TAXES 22791549 22791549 PRINTING AND PUBLICATIO 8137885 8137885 4073197 4073197 1911663681 1545455991 366207690 0 17033570 7122848 235131277 294310693 91381387 78911787 116765604 25499245 94358747 91266359 271578475 323516795 68719038 67917188 78709243 33719405 856911737 896765075 280508823 245217267 116304149 147545399 396812972 392762666 X 460098765 504002409 460098765 504002409 856911737 896765075 X 48198647 1196740 -5491743 X 0 1 X 1 0 18775799 18775799 67824201 5420208 62403993 15916713 10311576 5605137 14248891 9767461 4481430 91266359 PRUDENTIAL INVESTMENT 67917188 C 67917188 X 1785104232 4714672 4714672 1780389560 179472768 179472768 1959862328 1739659064 -168689785 -168689785 1908348849 3314832 3314832 1911663681 PART X, LINE 2: THE COMPANY IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(4) OF THE IRC. THE COMPANY REALIZED A FEDERAL AND STATE INCOME TAX EXPENSE OF APPROXIMATELY $431,000 AND $211,000 IN 2015 AND 2014, RESPECTIVELY. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS EXPENSE -258,743. INTEREST EXPENSE RECLASSED AS EXPENSE -56,113. DEPRECIATION ON REAL ESTATE RECLASSED AS EXPENSE -2,999,976. STATUTORY GROSS UP FOR RENTAL INCOME 3,924,904. DENTAL EXPENSES (MEDICA TAX PARTNERSHIP K-1) 4,104,600. PART XI, LINE 4B - OTHER ADJUSTMENTS: MN HEALTH INFO EXCHANGE K-1 INTERCOMPANY ADMIN FEES RECLASSED FROM EXPENSE 179,472,768. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY ADMIN FEES RECLASSED AS REVENUE -179,472,768. STATUTORY GROSS UP FOR DEPRECIATION EXPENSE 2,753,479. STATUTORY GROSS UP FOR RENTAL INCOME 3,924,904. DENTAL EXPENSES (MEDICA TAX PARTNERSHIP K-1), RECLASSED AS REVENUE 4,104,600. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS REVENUE 258,743. INTEREST EXPENSE RECLASSED AS REVENUE 56,113. DEPRECIATION ON REAL ESTATE RECLASSED AS EXPENSE 2,999,976. 1 INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT 8009 34TH AVE SO STE 1200 BLOOMINGTON MN 55425 411782168 501(C)(3) 900000 ACTUAL AMOUNT SUPPORT THE BEST PRACTICES IN THE MEDICAL WORLD MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 501(C)(3) 4000000 ACTUAL AMOUNT SUPPORT OF THE MANY PROGRAMS CONDUCTED BY THE FOUNDATION. MEDICA RESEARCH INSTITUTE 401 CARLSON PARKWAY MINNETONKA MN 55305 270600894 501(C)(3) 3000000 ACTUAL AMOUNT SUPPORT OF THE MANY PROGRAMS CONDUCTED BY THE INSTITUTE. 3 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 0 1 0 0 0 1 1 0 0 DAVID TILFORD PRESIDENT/CEO 803980 0 1287906 0 202848 0 19213 0 17913 0 2331860 0 172111 0 JAMES P JACOBSON SVP/SECRETARY 280785 0 296199 0 58128 0 19213 0 26296 0 680621 0 34948 0 MARK L BAIRD CFO/SVP/TREASURER 393715 0 446274 0 280003 0 20538 0 25216 0 1165746 0 253153 0 GLENN E ANDIS SVP 326901 0 343403 0 73225 0 20538 0 25858 0 789925 0 46395 0 ROBERT LONGENDYKE SVP 286104 0 272579 0 59730 0 20538 0 22595 0 661546 0 32842 0 DEBBY S KNUTSON SVP 271866 0 257327 0 55430 0 19213 0 12000 0 615836 0 29476 0 JANA L JOHNSON SVP 286751 0 313106 0 63448 0 20538 0 24822 0 708665 0 38481 0 TIMOTHY D THULL SVP 301450 0 293235 0 112299 0 19213 0 25220 0 751417 0 53951 0 JOHN W NAYLOR SVP 369515 0 522755 0 135586 0 55054 0 28805 0 1111715 0 110669 0 DANNETTE M COLEMAN GM/VP 299239 0 248366 0 55569 0 20538 0 9313 0 633025 0 20945 0 MARK WERNER MD SVP 155088 0 336465 0 35807 0 39088 0 9926 0 576374 0 0 0 RICHARD H SYKORA GM/VP 239971 0 211535 0 46490 0 20538 0 22884 0 541418 0 22288 0 BARBARA LYNCH VP 244155 0 167219 0 46530 0 14307 0 21506 0 493717 0 0 0 ANDREW E DAVIS VP 279992 0 176227 0 20381 0 37703 0 1695 0 515998 0 0 0 GEOFFREY J BARTSH VP 238609 0 222796 0 28990 0 36340 0 27294 0 554029 0 6278 0 MARY QUIST VP 248542 0 154384 0 45587 0 20538 0 22972 0 492023 0 0 0 PART I, LINE 4B THE FOLLOWING RECEIVED PAYMENTS FROM A NON-QUALIFIED RETIREMENT PLAN: DAVID TILFORD $ 60,239 GLENN E ANDIS $ 16,238 JANA L JOHNSON $ 13,468 MARK L BAIRD $119,990 ROBERT LONGENDYKE $ 11,495 JAMES P JACOBSON $ 12,232 DEBBY S KNUTSON $ 10,317 RICHARD H SYKORA $ 7,801 TIMOTHY D THULL $ 41,166 DANNETTE M COLEMAN $ 11,975 BARBARA LYNCH $ 6,400 GEOFFREY J BARTSH $ 2,745 JOHN W NAYLOR $ 50,865 MARY QUIST $ 14,936 PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATIONS OPERATING EARNINGS. 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 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 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 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 THE BOARD'S PERSONNEL AND COMPENSATION COMMITTEE REVIEWS AND OBTAINS THE BOARD'S APPROVAL OF THE TOTAL COMPENSATION FOR THE PRESIDENT/CEO AND REVIEWS AND APPROVES THE TOTAL COMPENSATION RECOMMENDATIONS MADE BY THE CFO FOR THE EXECUTIVE AND SENIOR VICE PRESIDENTS; REVIEWS ALL OFFICER COMPENSATION AND PERFORMANCE GOALS APPROVED BY THE CEO ANNUALLY. THE PERSONNEL AND COMPENSATION COMMITTEE ALSO REVIEWS AND RECOMMENDS TO THE BOARD, OFFICER AND NON-OFFICER COMPENSATION GUIDELINES FOR THE COMPANY AND ITS SUBSIDIARIES PERIODICALLY REVIEWING MARKET DATA TO ASSESS THE COMPANY'S COMPETITIVE POSITION. PROCESS OUTSIDE THE CHARTER: THE PERSONNEL AND COMPENSATION COMMITTEE WORKS WITH AN OUTSIDE CONSULTANT IN REVIEWING MARKET COMPETITIVE 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 XI, LINE 9: CHANGE IN VALUE OF NONADMITTED ASSETS -2,738,264. MN HEALTH INFO EXCHANGE K-1 0. STAT GROSS UP FOR DEPRECIATION -2,753,479. 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 INSURANCE COMPANY, MEDICA SELF-INSURED, MEDICA AFFILIATED SERVICES, AND MEDICA HEALTH MANAGEMENT). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) 509(A)(3) II MEDICA HOLDING COMPANY 0 MEDICA HEALTH PLANS OF WISCONSIN 401 CARLSON PARKWAY MINNETONKA MN 55305 411843804 HEALTH COVERAGE MN 501(C)(4) N/A MEDICA HOLDING COMPANY 0 MEDICA HOLDING COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 010571840 HOLDING COMPANY/NO ACTIVITY MN 501(C)(4) N/A 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 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0