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 411843804 MEDICA HEALTH PLANS OF WISCONSIN MEDI 9529922058 401 CARLSON PARKWAY MINNETONKA MN 553055387 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 MINNETONKA MN 553055387 69703899 0 X WWW.MEDICA.COM X 1996 WI 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. 13 10 0 0 0 0 0 0 30557763 66498899 0 4743 0 0 30557763 66503642 0 0 20801689 66480000 2209095 6221153 0 0 0 2733516 6249106 25744300 78950259 4813463 -12446617 57761700 67759912 10186025 27657927 47575675 40101985 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 66480000 77830383 MEDICA HEALTH PLANS OF WISCONSIN (MHPW) 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. MHPW 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. PRIOR TO JANUARY 1, 2014, MEDICA HEALTH PLANS WISCONSIN WAS DORMANT. SINCE JANUARY 1, 2014, THE COMPANY WRITES NEW BUSINESS IN THE INDIVIDUAL AND FAMILY BUSINESS MARKET IN MINNESOTA AND WISCONSIN.THE COMPANY MARKETS INDIVIDUAL POLICIES, BOTH ON- AND OFF-EXCHANGE, IN ALMOST ALL MINNESOTA COUNTIES. THE FEW EXCEPTIONS ARE GENERALLY IN THE SPARSELY POPULATED FAR NORTHEASTERN AND NORTH CENTRAL REGIONS OF THE STATE. ALL PRODUCTS SOLD BY THE COMPANY ARE CONSIDERED OPEN ACCESS; THE SELECTION OF A PRIMARY CARE PROVIDER/CLINIC IS NOT REQUIRED, AND NO REFERRALS ARE NECESSARY AS LONG AS CARE IS RECEIVED IN-NETWORK. IN 2014, THE COMPANY SOLD INDIVIDUAL POLICIES (BOTH ON- AND OFF-EXCHANGE) IN THE WISCONSIN COUNTIES OF PIERCE, POLK AND ST. CROIX. FOR 2015, MEDICA HEALTH PLANS OF WISCONSIN WILL ADD 6 OTHER COUNTIES TO THE SALES AREA: BAYFIELD, DOUGLAS, BURNETT, WASHBURN, SAWYER, AND ASHLAND.THE COMPANY CONTRACTS WITH PROVIDERS IN WISCONSIN, MINNESOTA, SOUTH DAKOTA AND NORTH DAKOTA TO MAKE HEALTH CARE SERVICES AVAILABLE TO ITS ENROLLEES. PROVIDERS EXECUTE ONE OR SOMETIMES TWO CONTRACTS COVERING SERVICES PROVIDED TO ENROLLEES OF THE COMPANY, MEDICA HEALTH PLANS (A MINNESOTA-DOMICILED HMO), MEDICA INSURANCE COMPANY, AND MEDICA SELF-INSURED. 66480000 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 1 1 0 1 1824 0 1 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X MARY QUIST 9529922058 PO BOX 9310 CP330 MINNEAPOLIS MN 554409310 DAVID TILFORD PRESIDENT/CEO 40.00 X X 0 2294734 34907 JOHN BUCK CHAIR 15.00 X X 0 97000 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 0 68000 0 JAMES P JACOBSON SECRETARY 40.00 X X 0 635112 43765 MARK L BAIRD CFO/SVP/TREASURER 40.00 X X 0 1119992 43204 PETER KELLY MD DIRECTOR 10.00 X 0 63500 0 SAMUEL LEON MD DIRECTOR 10.00 X 0 70000 0 RAJESH AGGARWAL DIRECTOR 10.00 X 0 64500 0 EARL STRATTON DIRECTOR 10.00 X 0 64500 0 AUSTIN SULLIVAN DIRECTOR 10.00 X 0 64500 0 DARYL DURUM DIRECTOR 10.00 X 0 63000 0 JOHN STANOCH DIRECTOR 6.00 X 0 51500 0 MARY TWINEM DIRECTOR 10.00 X 0 23000 0 JANA L JOHNSON SVP 40.00 X 0 663305 43604 GLENN E ANDIS SVP 40.00 X 0 743529 44541 DEBBY S KNUTSON SVP 40.00 X 0 584623 29526 TIMOTHY D THULL SVP 40.00 X 0 706984 42650 JOHN W NAYLOR SVP 40.00 X 0 1027856 81860 DANNETTE M COLEMAN GM/VP 40.00 X 0 603174 28097 ROBERT LONGENDYKE SVP 40.00 X 0 618413 41399 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 12525990 699436 0 0 1 0 0 PREMIUM REVENUE 524114 66498899 66498899 66498899 3205000 3200257 4743 4743 4743 66503642 66498899 0 4743 66480000 66480000 4779151 4779151 447534 447534 621784 621784 372684 372684 16993 16993 13736 13736 23547 23547 116000 116000 1931378 1931378 369773 369773 221751 221751 475952 475952 226160 226160 33798 33798 23831 23831 1099890 1099890 67238 67238 PREMIUM TAXES 1061225 1061225 PRINTING AND PUBLICATIO 378918 378918 188916 188916 78950259 66480000 12470259 0 52927203 7090508 484876 7005132 0 42914196 4349621 10750076 57761700 67759912 3634687 6761775 1559678 8278705 4991660 12617447 10186025 27657927 X 47575675 40101985 47575675 40101985 57761700 67759912 X -12446617 4972927 X 0 1 X 1 0 0 OTHER LT SECURITIES 42914196 C 42914196 HEALTHCARE RECEIVABLES 10597309 INVESTMENT INTEREST RECEIVABLE 152767 10750076 INTERCOMPANY PAYABLE 2365672 CLAIMS PAYABLE 10251775 12617447 X 66503642 0 66503642 0 66503642 78950259 0 78950259 0 78950259 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 DAVID TILFORD PRESIDENT/CEO 0 803980 0 1287906 0 202848 0 19213 0 17913 0 2331860 0 172111 JAMES P JACOBSON SECRETARY 0 280785 0 296199 0 58128 0 19213 0 26296 0 680621 0 34948 MARK L BAIRD CFO/SVP/TREASURER 0 393715 0 446274 0 280003 0 20538 0 25216 0 1165746 0 253153 JANA L JOHNSON SVP 0 286751 0 313106 0 63448 0 20538 0 24822 0 708665 0 38481 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 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 GM/VP 0 299239 0 248366 0 55569 0 20538 0 9313 0 633025 0 20945 ROBERT LONGENDYKE SVP 0 286104 0 272579 0 59730 0 20538 0 22595 0 661546 0 32842 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 HEALTH PLANS OF WISCONSIN, 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 SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION. DAVID TILFORD $ 60,239 GLENN E ANDIS $ 16,238 JANA L JOHNSON $ 13,468 MARK 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 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 A, LINE 6 THE POLICY HOLDERS ARE CONSIDERED MEMBERS, BUT DO NOT PAY DUES. 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 PRIOR TO FILING. 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 HEALTH PLANS OF WISCONSIN 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, 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 XI, LINE 9: CHANGE IN STATUTORY BASIS ACCOUNTING NONADMITTED ASSETS 4,972,927. 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, AND MEDICA RESEARCH INSTITUTE). 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 1 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) 509(A)(3) II MEDICA HOLDING COMPANY 1 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 HEALTH MANAGEMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MANAGEMENT MN MEDICA AFFILIATED SERVICES C 0 MEDICA AFFILIATED SERVICES 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MEDICA HOLDING COMPANY 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 ACTUAL AMOUNT MEDICA HEALTH PLANS N 6133847 ACTUAL AMOUNT MEDICA HEALTH PLANS O 6221153 ACTUAL AMOUNT MEDICA HEALTH PLANS P 10150483 ACTUAL AMOUNT