2015-02-13T16:15:17-06:00 2012-12-31 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2012-01-01 411843804 MEDICA HEALTH PLANS OF WISCONSIN MEDI 9529922058 401 CARLSON PARKWAY MINNETONKA MN 553055387 MARK L BAIRD 9529922058 2015-01-14 1 TODD A JACKSON P00092672 6123324300 2012 2016-02-25 16:41:14Z X DAVID TILFORD 401 CARLSON PARKWAY MINNETONKA MN 553055387 1322 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. 11 10 0 0 0 0 0 0 0 0 0 0 56077 1322 56077 1322 0 0 0 0 0 0 0 0 0 106870 107412 106870 107412 -50793 -106090 2974977 2974511 2342709 2448333 632268 526178 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 0 1322 MEDICA'S HMO PRODUCTS PROVIDE EMPLOYER GROUPS WITH HEALTH COVERAGE AND HEALTH MAINTENANCE SERVICES. MANY OF THESE EMPLOYER GROUPS ARE SMALL BUSINESSES. MEDICA'S HMO PLANS PROVIDE IN-NETWORK ACCESS TO APPROXIMATELY 96% OF MINNESOTA PHYSICIANS. MEDICA HMO PLANS ALSO OFFER A WIDE RANGE OF CARE MANAGEMENT, CARE COORDINATION AND HEALTH PROMOTION PROGRAMS TO HELP MEMBERS IMPROVE AND MAINTAIN THEIR HEALTH. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 0 0 1 1 0 1 1 1 1 1 1 1 1 0 0 0 WI X MARY QUIST 9529922058 PO BOX 9310 CP 330 MINNEAPOLIS MN 554409310 JOHN BUCK 15.00 X X 0 103000 0 ESTHER TOMLJANOVICH 10.00 X X 0 71000 0 KRIS SANDA 10.00 X X 0 71000 0 DAVID TILFORD 40.00 X X 0 2341634 33615 BURTON COHEN 7.00 X 0 62000 0 DARYL DURUM 10.00 X 0 79000 0 PETER KELLY MD 10.00 X 0 67000 0 SAMUEL LEON MD 7.00 X 0 64000 0 RAJESH AGGARWAL 10.00 X 0 69584 0 EARL STRATTON 10.00 X 0 68000 0 AUSTIN SULLIVAN 10.00 X 0 66000 0 AARON L REYNOLDS 40.00 X 0 1163231 35591 JAMES P JACOBSON 40.00 X 0 562531 29681 JANA L JOHNSON 40.00 X 0 609821 32221 GLENN E ANDIS 40.00 X 0 658316 41337 DEBBY S KNUTSON 40.00 X 0 537782 21775 SIMEON A SCHINDELMAN 40.00 X 0 972434 28261 TIMOTHY D THULL 40.00 X 0 439157 45344 JOHN W NAYLOR 40.00 X 0 597557 68911 ROBERT LONGENDYKE 40.00 X 0 565843 39660 THEODORE J LOFTNESS 40.00 X 0 537639 41529 MARK L BAIRD 40.00 X 0 570073 35250 RICHARD H SYKORA 40.00 X 0 494428 31675 DANNETTE M COLEMAN 40.00 X 0 416891 30382 SCOTT REID 40.00 X 0 410426 32035 0 11598347 547267 0 0 1 0 0 REVERSAL OF CLAIMS RES 524298 1322 1322 1322 1322 1322 0 0 105965 105965 RECORDING FEES 1447 1447 107412 0 107412 0 2974683 2974511 294 0 2974977 2974511 2342709 2448333 2342709 2448333 X 632268 526178 632268 526178 2974977 2974511 -106090 0 X 0 1 X 1 0 0 1 0 0 0 0 0 0 0 DAVID TILFORD 0 765069 0 679359 0 897206 0 18840 0 14775 0 2375249 0 0 AARON L REYNOLDS 0 436332 0 282291 0 444608 0 19003 0 16588 0 1198822 0 0 JAMES P JACOBSON 0 262079 0 121279 0 179173 0 14900 0 14781 0 592212 0 0 JANA L JOHNSON 0 265235 0 139854 0 204732 0 17963 0 14258 0 642042 0 0 GLENN E ANDIS 0 289319 0 153743 0 215254 0 19187 0 22150 0 699653 0 0 DEBBY S KNUTSON 0 250456 0 115758 0 171568 0 14900 0 6875 0 559557 0 0 SIMEON A SCHINDELMAN 0 607572 0 237287 0 127575 0 13063 0 15198 0 1000695 0 0 TIMOTHY D THULL 0 247650 0 95936 0 95571 0 28342 0 17002 0 484501 0 0 JOHN W NAYLOR 0 297722 0 243064 0 56771 0 51809 0 17102 0 666468 0 0 ROBERT LONGENDYKE 0 258567 0 122217 0 185059 0 17963 0 21697 0 605503 0 0 THEODORE J LOFTNESS 0 248987 0 100794 0 187858 0 19188 0 22341 0 579168 0 0 MARK L BAIRD 0 256576 0 132693 0 180804 0 17963 0 17287 0 605323 0 0 RICHARD H SYKORA 0 226128 0 110057 0 158243 0 17963 0 13712 0 526103 0 0 DANNETTE M COLEMAN 0 219450 0 100250 0 97191 0 19188 0 11194 0 447273 0 0 SCOTT REID 0 207138 0 101870 0 101418 0 17963 0 14072 0 442461 0 0 PART I, LINE 3 MEDICA HEALTH PLANS OF WISCONSIN, THE FILING ORGANZATION 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 $64,451 AARON REYNOLDS $27,891 GLENN E ANDIS $14,264 JANA L. JOHNSON $11,841 MARK BAIRD $10,614 ROBERT LONGENDYKE $10,660 JAMES JACOBSON $9,346 DEBBY S. KNUTSON $8,498 THEODORE J LOFTNESS $9,589 RICHARD H. SYKORA $8,102 TIMOTHY D. THULL $3,633 DANNETTE M. COLEMAN $6,446 FORM 990, PART VI, SECTION A, LINE 6 THE POLICY HOLDERS ARE CONSIDERED MEMBERS, BUT DO NOT HAVE TO PAY DUES. FORM 990, PART VI, SECTION B, LINE 11 MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND TAX MANAGER REVIEW THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY WILL BE PROVIDED 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. MEDICA HEALTH PLANS OF WISCONSIN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANZATION. 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 COMPENSATION FOR MEDICA'S 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. ARTICLES AND BYLAWS, CONFLICT OF INTEREST POLICY, AND FORM 990S ARE AVAILABLE UPON REQUEST. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINES 15A AND B N/A - MEDICA HEALTH PLANS OF WISCONSIN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANZATION. AVERAGE HOURS PER WEEK 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 FOUNDATION). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. FORM 990, BOX B, AMENDED RETURN FORM 990 IS BEING AMENDED TO CORRECTLY REPORT DEFERRED COMPENSATION THAT WAS DOUBLE REPORTED ON THE ORIGINALLY FILED RETURN. DEFERRED COMPENSATION REPORTED IN PART VII, COLUMN (F) AND SCHEDULE J, PART II, COLUMN (C) HAS BEEN REDUCED TO ACCOUNT FOR THE PORTION OF DEFERRED COMPENSATION THAT WS INCLUDED IN REPORTABLE W-2 COMPENSATION. 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 1 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 MEDICA HEALTH PLANS A 105964 ACTUAL AMOUNT