2014-11-17T13:56:13-06:00 2013-12-31 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2013-01-01 411843804 MEDICA HEALTH PLANS OF WISCONSIN MEDI 9529922058 401 CARLSON PARKWAY MINNETONKA MN 553055387 MARK L BAIRD CFO 9529922058 2014-11-13 1 TODD A JACKSON P00092672 6123324300 2013 2015-11-30 17:44:51Z DAVID TILFORD 401 CARLSON PARKWAY MINNETONKA MN 553055387 1000 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 0 0 1000 1322 0 1322 1000 0 0 0 0 0 0 0 0 0 107412 24694 107412 24694 -106090 -23694 2974511 49985038 2448333 2045609 526178 47939429 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 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. 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 X 12 9 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 401 CARLSON PARKWAY CP330 MINNETONKA MN 55305 JOHN BUCK CHAIR 15.00 X X 0 105500 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 0 72500 0 KRIS SANDA SECRETARY 10.00 X X 0 70250 0 DAVID TILFORD PRESIDENT/CEO 40.00 X X 0 1494977 34565 JAMES P JACOBSON DIRECTOR/SVP 40.00 X X 0 456056 45228 PETER KELLY MD DIRECTOR 10.00 X 0 68000 0 SAMUEL LEON MD DIRECTOR 10.00 X 0 64750 0 RAJESH AGGARWAL DIRECTOR 10.00 X 0 71000 0 EARL STRATTON DIRECTOR 10.00 X 0 67000 0 AUSTIN SULLIVAN DIRECTOR 10.00 X 0 72000 0 AARON L REYNOLDS CFO/DIRECTOR/TREASURER 40.00 X X 0 818082 35746 DARYL DURUM DIRECTOR 10.00 X 0 75500 0 JANA L JOHNSON SVP 40.00 X 0 667847 40451 GLENN E ANDIS SVP 40.00 X 0 519793 44459 DEBBY S KNUTSON SVP 40.00 X 0 423430 25436 MARK L BAIRD SVP 40.00 X 0 484895 42290 TIMOTHY D THULL SVP 40.00 X 0 415998 52944 JOHN W NAYLOR SVP 40.00 X 0 540107 78466 ROBERT LONGENDYKE SVP 40.00 X 0 434534 40045 MARK WERNER SVP 40.00 X 0 420971 47931 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 40.00 X 0 398614 41301 RICHARD H SYKORA GM/VP 40.00 X 0 466723 38322 DANNETTE M COLEMAN GM/VP 40.00 X 0 380277 33164 THOMAS JIM GUYN MD VP 40.00 X 0 399119 37976 BARBARA LYNCH VP 40.00 X 0 360771 31842 0 9348694 670166 0 0 1 0 0 1000 1000 1000 0 0 1000 19987 19987 MISC EXP 4707 4707 24694 0 24694 0 2974511 49985038 2974511 49985038 2448333 7250 0 224955 0 1813404 2448333 2045609 X 526178 47939429 526178 47939429 2974511 49985038 X -23694 2448261 44988684 X 0 1 X 1 0 0 INTERCOMPANY PAYABLE 1813404 1813404 0 0 0 1000 1000 1000 23694 -1000 -1000 24694 0 24694 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. 0 1 0 0 0 1 1 0 0 DAVID TILFORD PRESIDENT/CEO 0 798534 0 493620 0 202823 0 18325 0 16240 0 1529542 0 0 JAMES P JACOBSON DIRECTOR/SVP 0 261395 0 136808 0 57853 0 18325 0 26903 0 501284 0 0 AARON L REYNOLDS CFO/DIRECTOR/TREASURER 0 448534 0 257294 0 112254 0 18325 0 17421 0 853828 0 0 JANA L JOHNSON SVP 0 269167 0 129115 0 269565 0 18325 0 22126 0 708298 0 210851 GLENN E ANDIS SVP 0 303747 0 147586 0 68460 0 19575 0 24884 0 564252 0 0 DEBBY S KNUTSON SVP 0 257031 0 116960 0 49439 0 15200 0 10236 0 448866 0 0 MARK L BAIRD SVP 0 310575 0 114085 0 60235 0 18325 0 23965 0 527185 0 0 TIMOTHY D THULL SVP 0 256853 0 122538 0 36607 0 32144 0 20800 0 468942 0 0 JOHN W NAYLOR SVP 0 345705 0 169113 0 25289 0 53746 0 24720 0 618573 0 0 ROBERT LONGENDYKE SVP 0 266259 0 112768 0 55507 0 18325 0 21720 0 474579 0 0 MARK WERNER SVP 0 248041 0 150000 0 22930 0 33277 0 14654 0 468902 0 0 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 0 243380 0 101329 0 53905 0 19575 0 21726 0 439915 0 0 RICHARD H SYKORA GM/VP 0 228885 0 81403 0 156435 0 18325 0 19997 0 505045 0 109457 DANNETTE M COLEMAN GM/VP 0 245000 0 91549 0 43728 0 19575 0 13589 0 413441 0 0 THOMAS JIM GUYN MD VP 0 261411 0 88010 0 49698 0 14162 0 23814 0 437095 0 0 BARBARA LYNCH VP 0 230154 0 83496 0 47121 0 11959 0 19883 0 392613 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 $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. 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. 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 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 MEDICA HEALTH PLANS E 30000000 ACTUAL AMOUNT MEDICA HEALTH PLANS R 368362 ACTUAL AMOUNT