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 411843804 MEDICA HEALTH PLANS OF WISCONSIN MEDI 9529922058 401 CARLSON PARKWAY MINNETONKA MN 553055387 MARK L BAIRD CFO 9529922058 2015-11-13 1 TODD A JACKSON P00092672 6123324300 2014 2016-04-25 22:37:26Z DAVID TILFORD 401 CARLSON PARKWAY MINNETONKA MN 553055387 30557763 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. 12 9 0 0 0 0 0 0 0 30557763 1000 0 0 0 1000 30557763 0 0 0 20801689 0 2209095 0 0 0 24694 2733516 24694 25744300 -23694 4813463 49985038 57761700 2045609 10186025 47939429 47575675 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 20801689 30557763 MEDICA HEALTH PLANS OF WISCONSIN (MHPW) IS LICENSED AS A NON-PROFIT HEALTH SERVICE CORPORATION (INSURANCE SERVICE COMPANY) IN THE STATE OF WISCONSIN. 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.MHPW WAS ORIGINALLY LICENSED BY THE STATE OF WISCONSIN IN NOVEMBER, 1996. IN JULY 2008 MHPW NOVATED (TRANSFERRED) ITS MEMBERSHIP AND CONTRACTUAL OBLIGATIONS FOR INSURANCE PRODUCTS TO MEDICA INSURANCE COMPANY (MIC), ALSO A SUBSIDIARY OF MEDICA HOLDING COMPANY.MHPW DID NOT SOLICIT MEMBERSHIP IN THE STATE OF WISCONSIN FROM THE 2008 NOVATION THROUGH DECEMBER 31, 2012. IN THE PERIOD 2008-2013 MHPW HAD ZERO NET PREMIUMS EARNED. MHPW IN 2013 ALSO BECAME LICENSED IN THE STATE OF MINNESOTA AS A MN STATUTES 62C NONPROFIT HEALTH SERVICE CORPORATION. DURING 2013 MHPW SUBMITTED PRICING FOR PLAN OFFERINGS THROUGH THE HEALTH INSURANCE EXCHANGES WITHIN THE STATES OF MINNESOTA AND WISCONSIN AND BEGAN OBTAINING NEW MEMBERS WITH COVERAGE EFFECTIVE JANUARY 1, 2014. IN 2014 THE STATE OF WISCONSIN ASKED MHPW TO HELP CONSUMERS IN THREE WISCONSIN COUNTIES BORDERING MINNESOTA IN WHICH NO INSURERS WERE OFFERING COVERAGE. MHPW CREATED INDIVIDUAL (NON-GROUP) ACA-COMPLIANT QUALIFYING HEALTH PLANS SPECIFICALLY FOR THESE UNDERSERVED WISCONSIN COUNTIES: ST. CROIX, PIERCE AND POLK, AND ALSO OFFERED THESE PLANS OUTSIDE OF THE HEALTH CARE EXCHANGE. FOR 2015 SIX (6) ADDITIONAL WISCONSIN COUNTIES WERE ADDED TO THE MHPW SERVICE AREA: ASHLAND, BAYFIELD, BURNETT, DOUGLAS, SAWYER, AND WASHBURN.MHPW ALSO INTRODUCED INDIVIDUAL (NON-GROUP) PRIVATE INDIVIDUAL INSURANCE PLANS FOR 2014 AND 2015 IN VARIOUS MINNESOTA COUNTIES TO BE SOLD ON MNSURE, MINNESOTA'S STATE-RUN EXCHANGE, AS WELL AS OFFERING THOSE PLANS OUTSIDE OF THE EXCHANGE. 20801689 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 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 1478 0 1 0 0 0 0 0 0 0 X 12 9 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 2141543 33964 JOHN BUCK CHAIR 15.00 X X 0 104000 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 0 72000 0 KRIS SANDA SECRETARY UNTIL 6/24/14 10.00 X X 0 50500 0 JAMES P JACOBSON SECRETARY (6/24-12/31)/SVP 40.00 X X 0 804926 42839 AARON L REYNOLDS CFO/DIRECTOR UNTIL 1/3/14 40.00 X X 0 1272691 2781 MARK L BAIRD TREASURER/SVP 40.00 X X 0 764070 41382 PETER KELLY MD DIRECTOR 10.00 X 0 65000 0 SAMUEL LEON MD DIRECTOR 10.00 X 0 71000 0 RAJESH AGGARWAL DIRECTOR 10.00 X 0 67000 0 EARL STRATTON DIRECTOR 10.00 X 0 65000 0 AUSTIN SULLIVAN DIRECTOR 10.00 X 0 70000 0 DARYL DURUM DIRECTOR 10.00 X 0 72500 0 JOHN STANOCH DIRECTOR 6.00 X 0 33000 0 JANA L JOHNSON SVP 40.00 X 0 631713 44310 GLENN E ANDIS SVP 40.00 X 0 687695 44139 DEBBY S KNUTSON SVP 40.00 X 0 544478 28673 TIMOTHY D THULL SVP 40.00 X 0 626414 57564 JOHN W NAYLOR SVP 40.00 X 0 863684 80315 DANNETTE M COLEMAN GM/VP 40.00 X 0 547697 33140 ROBERT LONGENDYKE SVP 40.00 X 0 574272 39052 MARK WERNER MD SVP 40.00 X 0 870323 81244 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 40.00 X 0 435469 34669 RICHARD H SYKORA GM/VP 40.00 X 0 479430 39976 BARBARA LYNCH VP 40.00 X 0 436827 30795 ANDREW DAVIS VP 40.00 X 0 433600 49730 GEOFFREY J BARTSH VP 40.00 X 0 422231 53207 THOMAS JIM GUYN MD FORMER VP 0.00 X 0 334965 4453 0 13542028 742233 0 1 1 0 0 PREMIUM REVENUE 524114 30557763 30557763 30557763 30557763 30557763 0 0 20801689 20801689 1704538 1704538 151545 151545 215413 215413 137599 137599 31902 31902 9991 9991 10159 10159 342938 342938 693604 693604 148844 148844 83896 83896 246823 246823 96487 96487 9500 9500 14363 14363 409 409 470960 470960 27666 27666 PREMIUM TAXES 378937 378937 PRINTING AND PUBLICATIO 140227 140227 26810 26810 25744300 20801689 4942611 0 49985038 52927203 484876 0 4349621 49985038 57761700 7250 3634687 224955 1559678 1813404 4991660 2045609 10186025 X 47939429 47575675 47939429 47575675 49985038 57761700 X 4813463 -5177217 X 0 1 X 1 0 0 HEALTHCARE RECEIVABLES 4349423 INVESTMENT INTEREST RECEIVABLE 198 4349621 INTERCOMPANY PAYABLE 1301675 CLAIMS PAYABLE 3689985 4991660 30557763 0 30557763 0 30557763 25744300 0 25744300 0 25744300 0 1 0 0 0 1 1 0 0 DAVID TILFORD PRESIDENT/CEO 0 801761 0 1171817 0 167965 0 18850 0 16424 0 2176817 0 49589 JAMES P JACOBSON SECRETARY (6/24-12/31)/SVP 0 272788 0 244224 0 287914 0 18850 0 24957 0 848733 0 136437 AARON L REYNOLDS CFO/DIRECTOR UNTIL 1/3/14 0 73127 0 1116390 0 83174 0 2200 0 2029 0 1276920 0 0 MARK L BAIRD TREASURER/SVP 0 366696 0 332927 0 64447 0 18850 0 24150 0 807070 0 14512 JANA L JOHNSON SVP 0 276275 0 300850 0 54588 0 20150 0 25138 0 677001 0 10558 GLENN E ANDIS SVP 0 315969 0 309255 0 62471 0 20150 0 24907 0 732752 0 12889 DEBBY S KNUTSON SVP 0 264271 0 231717 0 48490 0 18850 0 10579 0 573907 0 8174 TIMOTHY D THULL SVP 0 281062 0 306440 0 38912 0 35123 0 23256 0 684793 0 5696 JOHN W NAYLOR SVP 0 354783 0 484724 0 24177 0 52182 0 29343 0 945209 0 0 DANNETTE M COLEMAN GM/VP 0 286923 0 214625 0 46149 0 20150 0 13801 0 581648 0 8641 ROBERT LONGENDYKE SVP 0 277235 0 245401 0 51636 0 18850 0 21001 0 614123 0 9040 MARK WERNER MD SVP 0 345060 0 500000 0 25263 0 58640 0 23775 0 952738 0 0 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 0 236 0 422070 0 13163 0 20150 0 15462 0 471081 0 0 RICHARD H SYKORA GM/VP 0 234973 0 203698 0 40759 0 20150 0 20505 0 520085 0 6049 BARBARA LYNCH VP 0 237568 0 157640 0 41619 0 12140 0 19118 0 468085 0 5752 ANDREW DAVIS VP 0 250535 0 161684 0 21381 0 32072 0 18374 0 484046 0 0 GEOFFREY J BARTSH VP 0 229168 0 171098 0 21965 0 27821 0 26064 0 476116 0 0 THOMAS JIM GUYN MD FORMER VP 0 47688 0 281198 0 6079 0 1946 0 2596 0 339507 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 $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 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 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 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. 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 -5,177,217. DIVIDEND RECEIVED FROM AFFILIATE SURPLUS NOTE ISSUED TO AFFILIATE 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 2390578 ACTUAL AMOUNT MEDICA HEALTH PLANS O 2209095 ACTUAL AMOUNT MEDICA HEALTH PLANS P 3214357 ACTUAL AMOUNT