2015-11-16T15:26:46-06:00 2014-12-31 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2014-01-01 411242261 MEDICA HEALTH PLANS MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 MARK L BAIRD CFO 9529922058 2015-11-13 1 TODD A JACKSON P00092672 6123324300 2014 2016-02-25 16:41:14Z DAVID TILFORD 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 2090854668 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, WE WORK WITH OUR MEMBERS AND PROVIDERS TO MAKE HEALTH CARE ACCESSIBLE, AFFORDABLE AND A MEANS BY WHICH OUR MEMBERS IMPROVE THEIR HEALTH. 5 4 1581 0 290857820 -965736 0 0 1396459145 1882713161 14125222 14203362 1888065 2006809 1412472432 1898923332 1254801 1254800 1204147936 1318132740 111121112 119494104 0 0 0 100265009 410913504 1416788858 1849795148 -4316426 49128184 686464242 856911737 281950229 396812972 404514013 460098765 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 1290505938 1401288600 MEDICA HEALTH PLANS (MHP) IN 2014 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 171,483 MEDICA MEMBERS - 93.3% OF MHP'S TOTAL ENROLLMENT - WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/2014. THERE WERE 129,953 PREPAID MEDICAL ASSISTANCE PROGRAM (MEDICAID) MEMBERS, 20,329 MINNESOTACARE MEMBERS, AND 21,201 SPECIAL NEEDS BASIC CARE MEMBERS. IN NCQA'S 2014 SURVEY OF CONSUMER SATISFACTION, PREVENTION AND TREATMENT, MEDICA'S MEDICAID HMO WAS RANKED #1 IN MINNESOTA AND #18 AMONG MEDICAID HMO PLANS IN THE UNITED STATES. MEDICA'S MEDICAID HMO HAS SINCE 2005 BEEN IN THE TOP 20 OF NCQA'S ANNUAL RANKINGS OF U.S. MEDICAID PLANS. IN 2014 MEDICA HEALTH PLANS MINNESOTA MEDICAID HMO RECEIVED THE HIGHEST ACCREDITATION STATUS, EXCELLENT, FROM THE 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 2014 PERFORMANCE ON BEHALF OF THE STATE OF MINNESOTA WAS EFFICIENT:- IN 2014 MEDICA HEALTH PLANS MEDICAL LOSS RATIO FOR STATE OF MINNESOTA HEALTH PROGRAMS WAS 89.9%. APPROXIMATELY 90-CENTS OF EACH STATE PROGRAM DOLLAR WENT TO PROVIDE CARE; - THE ADMINISTRATIVE COST RATIO WAS APPROXIMATELY 6.5% INCLUDING PREMIUM TAXES. 15826948 10742879 IN 2014 MHP PROVIDED FULLY INSURED COMMERCIAL HMO HEALTH INSURANCE COVERAGE TO GROUPS AND INDIVIDUALS IN MINNESOTA. AS OF 12/31/2014, THE ENROLLMENT IN MHP FULLY INSURED MINNESOTA GROUP PLANS WAS 624, WHICH WAS APPROXIMATELY 0.3% OF MHP'S TOTAL 2014 ENROLLMENT. 11799854 12282701 IN 2014 MHP PARTICIPATED IN MINNESOTA SENIOR HEALTH OPTIONS (MSHO), A MEDICARE-RELATED PRODUCT, IN MINNESOTA. ENROLLMENT IN THAT PRODUCT WAS 9,990 OR 5.4% OF MHP'S TOTAL ENROLLMENT. MSHO IS A PRODUCT FOR PEOPLE AGE 65 AND OLDER AND ELIGIBLE FOR BOTH MEDICARE AND MEDICAID. 1254800 1254800 167995085 MEDICA HEALTH PLANS (MHP), A NON-PROFIT HEALTH MAINTENANCE ORGANIZATION (HMO), IS A SUBSIDIARY OF MEDICA HOLDING COMPANY (MHC), A NON-PROFIT, TAXABLE CORPORATION. MEDICA HEALTH PLANS (MHP) IS LICENSED UNDER MINNESOTA STATUTES CHAPTER 62D AS A MINNESOTA NONPROFIT HEALTH MAINTENANCE ORGANIZATION (HMO), REGULATED BY THE MINNESOTA DEPARTMENT OF HEALTH (MDH). IT IS INCORPORATED AS A NONPROFIT ORGANIZATION UNDER MINNESOTA STATUTES CHAPTER 317A. MHP IS AUTHORIZED TO PROVIDE PREPAID COMPREHENSIVE HMO SERVICES AND IN 2014 DID SO TO THREE MARKET SEGMENTS: 1) STATE OF MINNESOTA HEALTH CARE PROGRAMS; 2) COMMERCIAL FULLY INSURED GROUPS AND INDIVIDUALS CONVERTED FROM GROUP PLANS; AND 3) MEDICARE (THESE THREE PROGRAMS ARE EXPLAINED IN MORE DETAIL IN PSA'S 4A, B & C).TO MEET ITS MISSION AND ITS TAX-EXEMPT OBLIGATION AS AN ORGANIZATION DESCRIBED UNDER IRC 501(C)(4), MHP PROVIDED SIGNIFICANT COMMUNITY BENEFITS.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 2014, MHP WAS REIMBURSED FOR $167,995,085 IN INTERCOMPANY ADMINISTRATIVE EXPENSES, REPORTED AS REVENUE ON THE 990.CONTRIBUTIONS BY MEDICA ON BEHALF OF MEMBERS BEYOND CONTRACTED SERVICES - IN 2014 MHP SPENT APPROXIMATELY $4.03 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.EXPENDITURES INCLUDED: MY HEALTH REWARDS (MHR) PROGRAM, $345,068; VALUE OF WAIVED FAMILY DEDUCTIBLES, $202,378; MSC+ ELDERLY WAIVER FOR NON-ELIGIBLE MEMBERS, $1,368,292; NON-MEDICARE PART D PHARMACY COPAYMENTS, $1,005,623; NON-MEDICARE VALUE OF COST-SHARING WAIVED COPAYS, $748,170; ADDITIONAL SERVICES, $359,983.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 PROGRAMS.ASTHMA, 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 2014 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 2014 FIT CHOICES BY MEDICA WAS AVAILABLE AT NO COST TO MHP'S FULLY INSURED AND MINNESOTACARE MEMBERS. IN A MEDICA STUDY OF FIT CHOICES PARTICIPATION, AFTER TWO YEARS, THE AVERAGE MONTHLY MEDICAL COSTS OF STUDY PARTICIPANTS WERE 33.6% LOWER THAN THOSE IN A MATCHED CONTROL GROUP. PEOPLE NOT ENROLLED IN THE FIT CHOICES PROGRAM AND WHO DID NOT EXERCISE TWELVE TIMES A MONTH WERE 43% TO 105% MORE LIKELY TO HAVE BEEN TO A CLINIC, HOSPITAL OR EMERGENCY ROOM.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 2014 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. 1254800 1254800 167995085 1319387540 0 0 0 0 0 0 0 0 0 1 1 0 1 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 1222 0 1 1581 1 1 1 0 0 0 0 0 X 5 4 0 0 0 0 1 1 0 1 1 0 0 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 2141543 0 33964 JOHN BUCK CHAIR 15.00 X X 104000 0 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 72000 0 0 KRIS SANDA SECRETARY (1/1 - 6/24) 10.00 X X 50500 0 0 EARL STRATTON DIRECTOR 10.00 X 65000 0 0 PETER KELLY MD DIRECTOR 10.00 X 65000 0 0 AARON L REYNOLDS EVP/TREASURER/CFO UNTIL 1/3 40.00 X 1272691 0 2781 JAMES P JACOBSON SVP/SECRETARY (6/24 - 12/31) 40.00 X 804926 0 42839 MARK L BAIRD SVP/TREASURER 40.00 X 764070 0 41382 GLENN E ANDIS SVP 40.00 X 687695 0 44139 ROBERT LONGENDYKE SVP 40.00 X 574272 0 39052 DEBBY S KNUTSON SVP 40.00 X 544478 0 28673 JANA L JOHNSON SVP 40.00 X 631713 0 44310 TIMOTHY D THULL SVP 40.00 X 626414 0 57564 JOHN W NAYLOR SVP 40.00 X 863684 0 80315 DANNETTE M COLEMAN GM/VP 40.00 X 547697 0 33140 MARK WERNER MD SVP 40.00 X 870323 0 81244 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 40.00 X 435469 0 34669 RICHARD H SYKORA GM/VP 40.00 X 479430 0 39976 BARBARA LYNCH VP 40.00 X 436827 0 30795 ANDREW DAVIS VP 40.00 X 433600 0 49730 GEOFFREY J BARTSH VP 40.00 X 422232 0 53207 THOMAS JIM GUYN MD FORMER VP 0.00 X 334965 0 4453 13228529 0 742233 279 1 1 0 UNITED HEALTHCARE SERVICES INC 9900 BREN DR E MN008-T380 MINNETONKA MN 55343 CLAIMS PROCESSING 90335233 DAHL CONSULTING INC 418 COUNTY ROAD D E ST PAUL MN 55117 TEMP SERVICES 7658486 LOFFLER COMPANIES INC 1101 EAST 78TH STREET SUITE 200 BLOOMINGTON MN 55420 PRINTING 1362064 NTT DATA INC 5601 GRANITE PARKWAY SUITE 1000 PLANO TX 75024 TECHNOLOGY SERVICES 943686 HEALTHEDGE SOFTWARE INC 30 CORPORATE DR BURLINGTON MA 01803 TECHNOLOGY SERVICES 679966 27 MEDICAID REVENUE 524114 1401288600 1401288600 GROUP & INDIVIDUAL PREMIUMS 524114 301146775 10744672 290402103 INTERCOMPANY ADMIN FEES 561000 167995085 167995085 MEDICARE REVENUE 524114 12282701 12282701 1882713161 12518819 12518819 5229808 3676917 1552891 1552891 1552891 189938962 188254419 1684543 1684543 1684543 MEDICA TAX PARTNERSHIP DENTAL REV 900099 455717 455717 MN EXCHANGE PARTNERSHIP 561499 -1799 -1799 453918 1898923332 1592309259 290857820 15756253 1254800 1254800 1318132740 1318132740 11228211 11228211 83538011 83538011 7427049 7427049 10557205 10557205 6743628 6743628 1563469 1563469 489656 489656 497888 497888 641772 641772 33992996 33992996 7294733 7294733 4111656 4111656 12096611 12096611 4728753 4728753 465610 465610 703895 703895 20069 20069 23081392 23081392 1355913 1355913 REINSURANCE 291823556 291823556 PREMIUM TAXES 18571397 18571397 PRINTING AND PUBLICATIO 6872409 6872409 2601729 2601729 1849795148 1319387540 530407608 0 6325685 17033570 25776967 235131277 89654172 91381387 115104811 20746064 97318475 94358747 293185386 271578475 68708875 68719038 105494682 78709243 686464242 856911737 281746313 280508823 203916 116304149 281950229 396812972 X 404514013 460098765 404514013 460098765 686464242 856911737 X 49128184 4286713 2169855 X 0 1 X 1 0 18775799 18775799 67824201 3724603 64099598 15010733 9007206 6003527 13494078 8014255 5479823 94358747 PRUDENTIAL INVESTMENT 68719038 C 68719038 INVESTMENT RELATED RECEIVABLES 1373987 HEALTH CARE RECEIVABLES 31083628 DUE FROM AFFILIATES 8335039 FUNDS HELD BY REINSURED COMPANIES 30307414 ACCOUNTS RECEIVABLE RELATING TO UNINSURED PLANS 4618360 ACCOUNTS RECEIVABLE RELATING TO REINSURERS 1477145 FEDERAL & FOREIGN INCOME TAX RECOVERABLE 1513670 78709243 X 1735508872 184999 184999 1735323873 163599460 163599460 1898923333 1688598175 -162104920 -162104920 1850703095 -907946 -907946 1849795149 PART X, LINE 2: THE COMPANY IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(4) OF THE IRC. FOLLOWING AN EXAMINATION OF MHP FOR THE 2008-2011 TAX YEARS DURING 2013, MEDICA AGREED TO RECOGNIZE REINSURANCE ACTIVITY WITH MIC AS UNRELATED BUSINESS INCOME (UBI), NET OF ANY INVESTMENT INCOME GENERATED BY THE TRANSACTION. THE ADJUSTMENTS RESULTED IN ADDITIONAL TAX OF $938,000 FOR THE 2008-2011 TAX YEARS. THE COMPANY REALIZED A FEDERAL AND STATE INCOME TAX EXPENSE OF APPROXIMATELY $211,000 AND $3,198,000 IN 2014 AND 2013, RESPECTIVELY. THE FEDERAL PROVISION IS INCLUDED IN THE INCOME TAX EXPENSE IN THE STATUTORY STATEMENTS OF REVENUE AND EXPENSES. THE STATE INCOME TAX EXPENSE PROVISION IS INCLUDED IN ADMINISTRATIVE EXPENSES IN THE STATUTORY STATEMENTS OF REVENUE AND EXPENSES. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS EXPENSE -641,772. INTEREST EXPENSE RECLASSED AS EXPENSE -20,069. DEPRECIATION ON REAL ESTATE RECLASSED AS EXPENSE -2,824,039. STATUTORY GROSS UP FOR RENTAL INCOME 3,670,879. PART XI, LINE 4B - OTHER ADJUSTMENTS: MN HEALTH INFO EXCHANGE K-1 -1,799. INTERCOMPANY ADMIN FEES RECLASSED FROM EXPENSE 167,995,085. DENTAL EXPENSES (MEDICA TAX PARTNERSHIP K-1) -4,393,826. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY ADMIN FEES RECLASSED AS REVENUE -167,995,085. STATUTORY GROSS UP FOR DEPRECIATION EXPENSE 2,219,286. STATUTORY GROSS UP FOR RENTAL INCOME 3,670,879. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS REVENUE 641,772. INTEREST EXPENSE RECLASSED AS REVENUE 20,069. DEPRECIATION ON REAL ESTATE RECLASSED AS EXPENSE 2,824,039. DENTAL EXPENSES (MEDICA TAX PARTNERSHIP K-1), RECLASSED AS REVENUE -4,393,826. 1 INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT 8009 34TH AVE SO STE 1200 BLOOMINGTON MN 55425 411782168 501(C)(3) 1254800 SUPPORT THE BEST PRACTICES IN THE MEDICAL WORLD 1 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 801761 0 1171817 0 167965 0 18850 0 16424 0 2176817 0 49589 0 AARON L REYNOLDS EVP/TREASURER/CFO UNTIL 1/3 73127 0 1116390 0 83174 0 2200 0 2029 0 1276920 0 0 0 JAMES P JACOBSON SVP/SECRETARY (6/24 - 12/31) 272788 0 244224 0 287914 0 18850 0 24957 0 848733 0 136437 0 MARK L BAIRD SVP/TREASURER 366696 0 332927 0 64447 0 18850 0 24150 0 807070 0 14512 0 GLENN E ANDIS SVP 315969 0 309255 0 62471 0 20150 0 24907 0 732752 0 12889 0 ROBERT LONGENDYKE SVP 277234 0 245402 0 51636 0 18850 0 21001 0 614123 0 9040 0 DEBBY S KNUTSON SVP 264271 0 231717 0 48490 0 18850 0 10579 0 573907 0 8174 0 JANA L JOHNSON SVP 276275 0 300850 0 54588 0 20150 0 25138 0 677001 0 10558 0 TIMOTHY D THULL SVP 281062 0 306440 0 38912 0 35123 0 23256 0 684793 0 5696 0 JOHN W NAYLOR SVP 354783 0 484724 0 24177 0 52182 0 29343 0 945209 0 0 0 DANNETTE M COLEMAN GM/VP 286923 0 214625 0 46149 0 20150 0 13801 0 581648 0 8641 0 MARK WERNER MD SVP 345060 0 500000 0 25263 0 58640 0 23775 0 952738 0 0 0 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 236 0 422070 0 13163 0 20150 0 15462 0 471081 0 0 0 RICHARD H SYKORA GM/VP 234973 0 203698 0 40759 0 20150 0 20505 0 520085 0 6049 0 BARBARA LYNCH VP 237568 0 157640 0 41619 0 12140 0 19117 0 468084 0 5752 0 ANDREW DAVIS VP 250535 0 161684 0 21381 0 32072 0 18374 0 484046 0 0 0 GEOFFREY J BARTSH VP 229168 0 171099 0 21965 0 27821 0 26064 0 476117 0 0 0 THOMAS JIM GUYN MD FORMER VP 47688 0 281198 0 6079 0 1946 0 2596 0 339507 0 0 0 PART I, LINE 4B THE FOLLOWING RECEIVED PAYMENTS FROM A NON-QUALIFIED RETIREMENT PLAN: DAVID TILFORD $49,589 GLENN E ANDIS $12,889 JANA L JOHNSON $10,558 MARK BAIRD $14,512 ROBERT LONGENDYKE $9,040 JAMES P JACOBSON $136,437 DEBBY S KNUTSON $8,174 RICHARD H. SYKORA $6,049 TIMOTHY D. THULL $5,696 DANNETTE M. COLEMAN $8,641 BARBARA LYNCH $5,752 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 ENTITIES OF MEDICA 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 FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF NONADMITTED ASSETS 4,387,342. MN HEALTH INFO EXCHANGE K-1 1,799. STAT GROSS UP FOR DEPRECIATION -2,219,286. 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) 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 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0