MEDICA COMMUNITY HEALTH PLAN: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MEDICA COMMUNITY HEALTH PLAN (EIN 41-1843804)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-17
- IRS object ID
- 201433219349306748
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-17T13:56:13-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MCGLADREY LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 NICOLLET MALL SUITE 1100 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411843804 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MEDICA HEALTH PLANS OF WISCONSIN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MEDI | BusinessNameControlTxt |
| Phone | 9529922058 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 CARLSON PARKWAY | AddressLine1 |
| City | MINNETONKA | City |
| State | MN | State |
| ZIP Code | 553055387 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MARK L BAIRD | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9529922058 | PhoneNum |
| Signature | 2014-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TODD A JACKSON | PreparerPersonNm |
| PTIN | P00092672 | PTIN |
| Phone | 6123324300 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVID TILFORD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 CARLSON PARKWAY | AddressLine1 |
| City | MINNETONKA | City |
| State | MN | State |
| ZIP Code | 553055387 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,000 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | WWW.MEDICA.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,000 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,322 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $1,322 | PYTotalRevenueAmt |
| CY Total Revenue | $1,000 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $107,412 | PYOtherExpensesAmt |
| CY Other Expenses | $24,694 | CYOtherExpensesAmt |
| PY Total Expenses | $107,412 | PYTotalExpensesAmt |
| CY Total Expenses | $24,694 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$106,090 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$23,694 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,974,511 | TotalAssetsBOYAmt |
| Total Assets EOY | $49,985,038 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,448,333 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,045,609 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $526,178 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $47,939,429 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Desc | 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. MHPW DID NOT WRITE BUSINESS IN THE STATE OF WISCONSIN FROM THE 2008 THROUGH DECEMBER 31, 2013. 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. MHPW FILED NEW PRODUCTS WHICH ARE COMPLIANT WIHT THE ACA FOR EFFECTIVE DATES BEGINNING JANUARY 1, 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.MHPW INTRODUCED INDIVIDUAL (NON-GROUP) PRIVATE INDIVIDUAL INSURANCE PLANS FOR 2014 IN VARIOUS MINNESOTA COUNTIES TO BE SOLD ON MNSURE, MINNESOTA'S STATE-RUN EXCHANGE AS WELL AS OFFERING THOSE PLANS OUTSIDE OF THE EXCHANGE. | Desc |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY QUIST | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9529922058 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 CARLSON PARKWAY CP330 | AddressLine1 |
| City | MINNETONKA | City |
| State | MN | State |
| ZIP Code | 55305 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| JOHN BUCK | ||||||||
| CHAIR | 15.00 | Yes (X) | Yes (X) | $0 | $105,500 | $0 | ||
| ESTHER TOMLJANOVICH | ||||||||
| VICE CHAIR | 10.00 | Yes (X) | Yes (X) | $0 | $72,500 | $0 | ||
| KRIS SANDA | ||||||||
| SECRETARY | 10.00 | Yes (X) | Yes (X) | $0 | $70,250 | $0 | ||
| DAVID TILFORD | ||||||||
| PRESIDENT/CEO | 40.00 | Yes (X) | Yes (X) | $0 | $1,494,977 | $34,565 | ||
| JAMES P JACOBSON | ||||||||
| DIRECTOR/SVP | 40.00 | Yes (X) | Yes (X) | $0 | $456,056 | $45,228 | ||
| PETER KELLY MD | ||||||||
| DIRECTOR | 10.00 | Yes (X) | $0 | $68,000 | $0 | |||
| SAMUEL LEON MD | ||||||||
| DIRECTOR | 10.00 | Yes (X) | $0 | $64,750 | $0 | |||
| RAJESH AGGARWAL | ||||||||
| DIRECTOR | 10.00 | Yes (X) | $0 | $71,000 | $0 | |||
| EARL STRATTON | ||||||||
| DIRECTOR | 10.00 | Yes (X) | $0 | $67,000 | $0 | |||
| AUSTIN SULLIVAN | ||||||||
| DIRECTOR | 10.00 | Yes (X) | $0 | $72,000 | $0 | |||
| AARON L REYNOLDS | ||||||||
| CFO/DIRECTOR/TREASURER | 40.00 | Yes (X) | Yes (X) | $0 | $818,082 | $35,746 | ||
| DARYL DURUM | ||||||||
| DIRECTOR | 10.00 | Yes (X) | $0 | $75,500 | $0 | |||
| JANA L JOHNSON | ||||||||
| SVP | 40.00 | $0 | $667,847 | $40,451 | Yes (X) | |||
| GLENN E ANDIS | ||||||||
| SVP | 40.00 | $0 | $519,793 | $44,459 | Yes (X) | |||
| DEBBY S KNUTSON | ||||||||
| SVP | 40.00 | $0 | $423,430 | $25,436 | Yes (X) | |||
| MARK L BAIRD | ||||||||
| SVP | 40.00 | $0 | $484,895 | $42,290 | Yes (X) | |||
| TIMOTHY D THULL | ||||||||
| SVP | 40.00 | $0 | $415,998 | $52,944 | Yes (X) | |||
| JOHN W NAYLOR | ||||||||
| SVP | 40.00 | $0 | $540,107 | $78,466 | Yes (X) | |||
| ROBERT LONGENDYKE | ||||||||
| SVP | 40.00 | $0 | $434,534 | $40,045 | Yes (X) | |||
| MARK WERNER | ||||||||
| SVP | 40.00 | $0 | $420,971 | $47,931 | Yes (X) | |||
| THEODORE J LOFTNESS | ||||||||
| VP & MEDICAL DIRECTOR | 40.00 | $0 | $398,614 | $41,301 | Yes (X) | |||
| RICHARD H SYKORA | ||||||||
| GM/VP | 40.00 | $0 | $466,723 | $38,322 | Yes (X) | |||
| DANNETTE M COLEMAN | ||||||||
| GM/VP | 40.00 | $0 | $380,277 | $33,164 | Yes (X) | |||
| THOMAS JIM GUYN MD | ||||||||
| VP | 40.00 | $0 | $399,119 | $37,976 | Yes (X) | |||
| BARBARA LYNCH | ||||||||
| VP | 40.00 | $0 | $360,771 | $31,842 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $9,348,694 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $670,166 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,000 | TotalRevenueColumnAmt |
| Exclusion | $1,000 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,000 | ExclusionAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,987 | TotalAmt |
| Management And General | $19,987 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISC EXP | Desc |
| Total | $4,707 | TotalAmt |
| Management And General | $4,707 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,694 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $24,694 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,974,511 | BOYAmt |
| EOY | $49,985,038 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,974,511 | BOYAmt |
| EOY | $49,985,038 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,448,333 | BOYAmt |
| EOY | $7,250 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $224,955 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,813,404 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,448,333 | BOYAmt |
| EOY | $2,045,609 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $526,178 | BOYAmt |
| EOY | $47,939,429 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $526,178 | BOYAmt |
| EOY | $47,939,429 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,974,511 | BOYAmt |
| EOY | $49,985,038 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$23,694 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $2,448,261 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $44,988,684 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PAYABLE | Desc |
| Amt | $1,813,404 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,813,404 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $0 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $0 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,000 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,000 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $1,000 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $23,694 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$1,000 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$1,000 | ExpensesNotReportedAmt |
| Expenses Subtotal | $24,694 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $24,694 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INTEREST INCOME RECLASSED FROM EXPENSE 1,000. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | INTEREST INCOME RECLASSED AS REVENUE -1,000. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (16 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID TILFORD | ||||||||||||||
| PRESIDENT/CEO | $0 | $798,534 | $0 | $493,620 | $0 | $202,823 | $0 | $18,325 | $0 | $16,240 | $0 | $1,529,542 | $0 | $0 |
| JAMES P JACOBSON | ||||||||||||||
| DIRECTOR/SVP | $0 | $261,395 | $0 | $136,808 | $0 | $57,853 | $0 | $18,325 | $0 | $26,903 | $0 | $501,284 | $0 | $0 |
| AARON L REYNOLDS | ||||||||||||||
| CFO/DIRECTOR/TREASURER | $0 | $448,534 | $0 | $257,294 | $0 | $112,254 | $0 | $18,325 | $0 | $17,421 | $0 | $853,828 | $0 | $0 |
| JANA L JOHNSON | ||||||||||||||
| SVP | $0 | $269,167 | $0 | $129,115 | $0 | $269,565 | $0 | $18,325 | $0 | $22,126 | $0 | $708,298 | $0 | $210,851 |
| GLENN E ANDIS | ||||||||||||||
| SVP | $0 | $303,747 | $0 | $147,586 | $0 | $68,460 | $0 | $19,575 | $0 | $24,884 | $0 | $564,252 | $0 | $0 |
| DEBBY S KNUTSON | ||||||||||||||
| SVP | $0 | $257,031 | $0 | $116,960 | $0 | $49,439 | $0 | $15,200 | $0 | $10,236 | $0 | $448,866 | $0 | $0 |
| MARK L BAIRD | ||||||||||||||
| SVP | $0 | $310,575 | $0 | $114,085 | $0 | $60,235 | $0 | $18,325 | $0 | $23,965 | $0 | $527,185 | $0 | $0 |
| TIMOTHY D THULL | ||||||||||||||
| SVP | $0 | $256,853 | $0 | $122,538 | $0 | $36,607 | $0 | $32,144 | $0 | $20,800 | $0 | $468,942 | $0 | $0 |
| JOHN W NAYLOR | ||||||||||||||
| SVP | $0 | $345,705 | $0 | $169,113 | $0 | $25,289 | $0 | $53,746 | $0 | $24,720 | $0 | $618,573 | $0 | $0 |
| ROBERT LONGENDYKE | ||||||||||||||
| SVP | $0 | $266,259 | $0 | $112,768 | $0 | $55,507 | $0 | $18,325 | $0 | $21,720 | $0 | $474,579 | $0 | $0 |
| MARK WERNER | ||||||||||||||
| SVP | $0 | $248,041 | $0 | $150,000 | $0 | $22,930 | $0 | $33,277 | $0 | $14,654 | $0 | $468,902 | $0 | $0 |
| THEODORE J LOFTNESS | ||||||||||||||
| VP & MEDICAL DIRECTOR | $0 | $243,380 | $0 | $101,329 | $0 | $53,905 | $0 | $19,575 | $0 | $21,726 | $0 | $439,915 | $0 | $0 |
| RICHARD H SYKORA | ||||||||||||||
| GM/VP | $0 | $228,885 | $0 | $81,403 | $0 | $156,435 | $0 | $18,325 | $0 | $19,997 | $0 | $505,045 | $0 | $109,457 |
| DANNETTE M COLEMAN | ||||||||||||||
| GM/VP | $0 | $245,000 | $0 | $91,549 | $0 | $43,728 | $0 | $19,575 | $0 | $13,589 | $0 | $413,441 | $0 | $0 |
| THOMAS JIM GUYN MD | ||||||||||||||
| VP | $0 | $261,411 | $0 | $88,010 | $0 | $49,698 | $0 | $14,162 | $0 | $23,814 | $0 | $437,095 | $0 | $0 |
| BARBARA LYNCH | ||||||||||||||
| VP | $0 | $230,154 | $0 | $83,496 | $0 | $47,121 | $0 | $11,959 | $0 | $19,883 | $0 | $392,613 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $61,817 AARON REYNOLDS $28,858 GLENN E ANDIS $15,126 JANA L JOHNSON $117,324 MARK BAIRD $12,666 ROBERT LONGENDYKE $10,905 JAMES P JACOBSON $11,744 DEBBY S KNUTSON $9,178 THEODORE J LOFTNESS $10,043 RICHARD H. SYKORA $63,582 TIMOTHY D. THULL $4,837 DANNETTE M. COLEMAN $7,773 THOMAS (JIM) GUYN $6,846 BARBARA LYNCH $5,776 |
| PART I, LINE 6 | MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO OPERATING EARNINGS OF MEDICA HEALTH PLANS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 REVIEWS 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 -11,316. DIVIDEND RECEIVED FROM AFFILIATE 15,000,000. SURPLUS NOTE ISSUED TO AFFILIATE 30,000,000. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDICA HEALTH PLANS | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411242261 | HEALTH COVERAGE | MN | 501(C)(4) | MEDICA HOLDING COMPANY | Yes (1) | ||
| MEDICA FOUNDATION | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411812461 | FOUNDATION | MN | 501(C)(3) | MEDICA HOLDING COMPANY | Yes (1) | 509(A)(3) II | |
| MEDICA HOLDING COMPANY | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 010571840 | HOLDING COMPANY/NO ACTIVITY | MN | 501(C)(4) | 0 | N/A | ||
| MEDICA RESEARCH INSTITUTE | |||||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 270600894 | RESEARCH FOUNDATION | MN | 501(C)(3) | MEDICA HOLDING COMPANY | 0 | 509(A)(3) I | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | Yes (1) | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| MEDICA HEALTH PLANS | ||
| E | $30,000,000 | ACTUAL AMOUNT |
| MEDICA HEALTH PLANS | ||
| R | $368,362 | ACTUAL AMOUNT |
Comments