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 411242261 MEDICA HEALTH PLANS MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 MARK L BAIRD CFO 9529922058 2014-11-14 1 TODD A JACKSON P00092672 6123324300 2013 2015-11-30 17:44:51Z DAVID TILFORD 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 1652886943 0 X WWW.MEDICA.COM X 1973 MN MEDICA'S MISSION IS TO MEET OUR CUSTOMERS' NEED 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 1569 0 4616556 4203603 0 0 1739770823 1396459145 17703859 14125222 837299 1888065 1758311981 1412472432 11218300 1254801 1448611093 1204147936 107801496 111121112 0 0 0 146196590 100265009 1713827479 1416788858 44484502 -4316426 681817662 686464242 239757907 281950229 442059755 404514013 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 1184696756 1230893746 MEDICA HEALTH PLANS (MHP) IN 2013 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 130,007 MEDICA MEMBERS - 91.9% OF MHP'S TOTAL ENROLLMENT - WERE IN MINNESOTA STATE PROGRAMS AS OF 12/31/2013. THERE WERE 85,195 PREPAID MEDICAL ASSISTANCE (MEDICAID) MEMBERS, 26,959 MINNESOTACARE MEMBERS, AND 17,853 SPECIAL NEEDS BASIC CARE MEMBERS.IN 2013 MEDICA HEALTH PLANS ACHIEVED THE HIGHEST RANKINGS IN MINNESOTA FROM THE NCQA. THAT RANKING PLACED MHP AMONG THE TOP 11 MEDICAID HMO PLANS IN THE UNITED STATES. MEDICA HEALTH PLANS HAS BEEN IN THE TOP 20 OF NCQA'S ANNUAL RANKINGS OF U.S. HEALTH INSURERS SINCE 2005.IN 2013 MEDICA HEALTH PLANS MINNESOTA MEDICAID HMO WAS ACCREDITED BY THE NCQA. 17488104 13342938 IN 2013 MHP PROVIDED FULLY INSURED COMMERCIAL HMO HEALTH INSURANCE COVERAGE TO GROUPS AND INDIVIDUALS IN MINNESOTA. AS OF 12/31/2013, THE ENROLLMENT IN MHP FULLY INSURED MINNESOTA GROUP PLANS WAS 1,092. MHP IN 2013 INSURED 66 PERSONS WHOSE COVERAGE WAS CONVERTED FROM GROUP INSURANCE TO INDIVIDUAL INSURANCE.THE 1,158 TOTAL FOR PERSONS WITH FULLY INSURED COVERAGE REPRESENTED 0.8% OF MHP'S TOTAL ENROLLMENT AS OF 12/31/2013. 1963076 1379150 IN 2013 MHP PROVIDED MEDICARE-RELATED PRODUCTS IN MINNESOTA. ENROLLMENT IN THOSE PRODUCTS WAS 10,234 OR 7.2% OF MHP'S TOTAL ENROLLMENT. MHP'S MEDICARE-RELATED MEMBERSHIP IN MINNESOTA INCLUDED 9,800 MEMBERS WITH MINNESOTA SENIOR HEALTH OPTIONS (MSHO) COVERAGE, FOR PEOPLE AGE 65 AND OLDER AND ELIGIBLE FOR BOTH MEDICARE AND MEDICAID; 229 MEMBERS WITH MEDICARE ADVANTAGE SPECIAL NEEDS PLAN COVERAGE FOR SENIORS WITH CHRONIC CONDITIONS; AND 205 MEMBERS WITH MEDICARE SUPPLEMENTAL AND PRIVATE FEE FOR SERVICE (PFFS) COVERAGE.THE PRIVATE FEE-FOR-SERVICE (PFFS) PRODUCTS UNDER CMS CONTRACT INCLUDE A VARIETY OF CO-PAY PLANS, PLANS WHICH COVER MEDICAL ONLY, AND PLANS THAT INCLUDE PRESCRIPTION DRUG COVERAGE. THESE PLANS UTILIZE A DEEMED NETWORK WHERE ALL MEDICARE CERTIFIED PROVIDERS MAY BE UTILIZED, AS LONG AS THEY AGREE TO MEDICARE PAYMENT ASSIGNMENT. 1254801 1254801 146531129 MEDICA HEALTH PLANS (MHP) AND COMMUNITY BENEFIT - 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 2013 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.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.AS OF 12/31/2013, 91.9% OF MHP ENROLLMENT WAS IN STATE OF MINNESOTA HEALTH CARE PROGRAMS (COVERED IN PSA 4A & 4B). THE TOTAL ENROLLMENT WAS 130,007. 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 2013 PERFORMANCE ON BEHALF OF THE STATE OF MINNESOTA WAS EFFICIENT WITH MORE THAN 96-CENTS OF EACH STATE PROGRAM DOLLAR SPENT TO PROVIDE CARE. CONTRIBUTIONS BY MEDICA ON BEHALF OF MEMBERS BEYOND CONTRACTED SERVICES - IN 2013 MHP SPENT $11.21 MILLION TO PROVIDE ADDITIONAL, BEYOND-CONTRACT SUPPORT ON BEHALF OF MEDICAL ASSISTANCE, MINNESOTACARE, MEDICARE SPECIAL NEEDS PLANS, SPECIAL NEEDS BASIC CARE PLAN MEMBERS AND OTHER MINNESOTA HEALTH CARE PROGRAM MEMBERS. 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. MEDICA ANNUALLY HELPS FUND A NUMBER OF COLLABORATIVE EDUCATION AND TRAINING SEMINARS AND CONFERENCES IN ITS SERVICE AREA.HEALTH AND WELLNESS PROGRAMS PROVIDING COMMUNITY BENEFIT - MEDICA ANNUALLY UNDERTAKES A VARIETY OF INITIATIVES TO MAKE HEALTH CARE MORE AFFORDABLE, AVAILABLE AND EFFECTIVE. EXAMPLES OF PERFORMANCE AND VALUE INCLUDE IMPROVING CARE EFFICIENCY, REDUCING THE COST OF CARE, REDUCTION IN ER VISITS, REDUCTION IN HOSPITAL ADMISSIONS, IMPROVE THE OUTCOMES OF CARE, IMPROVED A1C, CHOLESTEROL LEVELS, INCREASED PARTICIPATION IN EXERCISE AND NUTRITION PROGRAMS, AND IMPROVED MEDICATION MANAGEMENT.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 2013 THE CORE MY HEALTH REWARDS FROM MEDICA PROGRAM WAS PROVIDED AT NO ADDITIONAL CHARGE TO FULLY INSURED GROUPS. 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 2013 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.NOTE - THE AMOUNT OF REVENUE REPORTED IN PROGRAM 4D IN THE AMOUNT OF $146,531,129 IS RELATED TO ALLOCATION OF EXPENSES TO RELATED ORGANIZATIONS, AND IS ALREADY REPORTED IN COLUMN C OF THE FUNCTIONAL EXPENSES. 1254801 1254801 146531129 1205402737 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 1 250 0 1 1569 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 JOHN BUCK CHAIR 15.00 X X 105500 0 0 ESTHER TOMLJANOVICH VICE CHAIR 10.00 X X 72500 0 0 KRIS SANDA SECRETARY 10.00 X X 70250 0 0 DAVID TILFORD PRESIDENT/CEO 40.00 X X 1494977 0 34565 PETER KELLY MD DIRECTOR 10.00 X 68000 0 0 AARON L REYNOLDS EVP/TREASURER/CFO 40.00 X 818082 0 35746 JAMES P JACOBSON SVP 40.00 X 456056 0 45228 JANA L JOHNSON SVP 40.00 X 667847 0 40451 GLENN E ANDIS SVP 40.00 X 519793 0 44459 ROBERT LONGENDYKE SVP 40.00 X 434534 0 40045 DEBBY S KNUTSON SVP 40.00 X 423430 0 25436 MARK L BAIRD SVP 40.00 X 484895 0 42290 TIMOTHY D THULL SVP 40.00 X 415998 0 52944 JOHN W NAYLOR SVP 40.00 X 540107 0 78466 MARK WERNER SVP 40.00 X 420971 0 47931 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 40.00 X 398614 0 41301 RICHARD H SYKORA GM/VP 40.00 X 466723 0 38322 DANNETTE M COLEMAN GM/VP 40.00 X 380277 0 33164 THOMAS JIM GUYN MD VP 40.00 X 399119 0 37976 BARBARA LYNCH VP 40.00 X 360771 0 31842 8998444 0 670166 212 0 1 0 UNITED HEALTHCARE SERVICES INC 9900 BREN DR E MN008-T380 MINNETONKA MN 55343 CLAIMS PROCESSING 91488680 DAHL CONSULTING INC 418 COUNTY ROAD D E ST PAUL MN 55117 TEMP SERVICES 11640862 NTT DATA INC 5601 GRANITE PARKWAY SUITE 1000 PLANO TX 75024 TECHNOLOGY SERVICES 9258416 HEALTHEDGE SOFTWARE INC 30 CORPORATE DR BURLINGTON MA 01803 TECHNOLOGY SERVICES 3666312 CONCORD INC 509 2ND AVE S HOPKINS MN 55343 TECHNOLOGY SERVICES 783837 34 MEDICAID REVENUE 524114 1230893764 1230893764 INTERCOMPANY ADMIN FEES 561000 146531129 146531129 GROUP & INDIVIDUAL PREMIUMS 524114 13405646 9095247 4310399 DENTAL REVENUE 541900 4249456 4249456 MEDICARE REVENUE 524114 1379150 1379150 1396459145 11712848 11712848 5549714 3966023 1583691 1583691 1583691 238860862 236448488 2412374 2412374 2412374 MEDICA TAX PARTNERSHIP 900099 306157 306157 MN EXCHANGE PARTNERSHIP 561499 -1783 -1783 304374 1412472432 1392146963 4616556 15708913 1254801 1254801 1204147936 1204147936 7480501 7480501 81770969 81770969 5606856 5606856 9640574 9640574 6622212 6622212 1313836 1313836 456000 456000 523204 523204 1529084 1529084 5087331 5087331 4017783 4017783 8186139 8186139 8064813 8064813 505487 505487 672012 672012 250407 250407 12843147 12843147 1246744 1246744 OUTSOURCED SERVICES 26928722 26928722 PREMIUM TAXES 16488452 16488452 PRINTING AND PUBLICATIO 7120536 7120536 5031312 5031312 1416788858 1205402737 211386121 0 5792174 6325685 119293590 25776967 84326924 89654172 117466537 20148062 93680219 97318475 326705482 293185386 68708875 52019273 105494682 681817662 686464242 239605872 281746313 152035 203916 239757907 281950229 X 442059755 404514013 442059755 404514013 681817662 686464242 X -4316426 2308623 -35537939 X 0 1 X 1 0 18675799 18675799 81824804 9907769 71917035 16965934 10240293 6725641 97318475 PRUDENTIAL INVESTMENT 68708875 C 68708875 INVESTMENT RELATED RECEIVABLES 1545815 HEALTH CARE RECEIVABLES 24184741 DUE FROM AFFILIATES 10243403 FUNDS HELD BY REINSURED COMPANIES 67688233 ACCOUNTS RECEIVABLE RELATING TO UNINSURED PLANS 1832490 105494682 X 1792498466 -1779491 -1779491 1794277957 -381805525 -381805525 1412472432 1796813109 381803742 381803742 1415009367 1779491 1779491 1416788858 PART X, LINE 2: AS OF DECEMBER 31, 2013, THE COMPANY'S TAX YEARS 2012 AND 2013 REMAIN OPEN TO EXAMINATION BY THE INTERNAL REVENUE SERVICE (IRS) AND VARIOUS STATE AUTHORITIES. THE IRS HAS COMPLETED ITS REVIEW OF TAX YEARS 2008, 2009, 2010 AND 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS EXPENSE -1,529,084. INTEREST EXPENSE RECLASSED AS EXPENSE -250,407. PART XI, LINE 4B - OTHER ADJUSTMENTS: MN HEALTH INFO EXCHANGE K-1 -1,783. INTERCOMPANY ADMIN FEES RECLASSED FROM EXPENSE 146,531,129. REINSURANCE EXPENSE RECLASSED TO REVENUE -528,334,871. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTERCOMPANY ADMIN FEES RECLASSED AS REVENUE -146,531,129. REINSURANCE EXPENSE RECLASSED TO REVENUE 528,334,871. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSE RECLASSED AS REVENUE 1,529,084. INTEREST EXPENSE RECLASSED AS REVENUE 250,407. 1 INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT 8009 34TH AVE SO STE 1200 BLOOMINGTON MN 55425 411782168 501(C)(3) 1254801 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 798534 0 493620 0 202823 0 18325 0 16240 0 1529542 0 0 0 AARON L REYNOLDS EVP/TREASURER/CFO 448534 0 257294 0 112254 0 18325 0 17421 0 853828 0 0 0 JAMES P JACOBSON SVP 261395 0 136808 0 57853 0 18325 0 26903 0 501284 0 0 0 JANA L JOHNSON SVP 269167 0 129115 0 269565 0 18325 0 22126 0 708298 0 210851 0 GLENN E ANDIS SVP 303747 0 147586 0 68460 0 19575 0 24884 0 564252 0 0 0 ROBERT LONGENDYKE SVP 266259 0 112768 0 55507 0 18325 0 21720 0 474579 0 0 0 DEBBY S KNUTSON SVP 257031 0 116960 0 49439 0 15200 0 10236 0 448866 0 0 0 MARK L BAIRD SVP 310575 0 114085 0 60235 0 18325 0 23965 0 527185 0 0 0 TIMOTHY D THULL SVP 256853 0 122538 0 36607 0 32144 0 20800 0 468942 0 0 0 JOHN W NAYLOR SVP 345705 0 169113 0 25289 0 53746 0 24720 0 618573 0 0 0 MARK WERNER SVP 248041 0 150000 0 22930 0 33277 0 14654 0 468902 0 0 0 THEODORE J LOFTNESS VP & MEDICAL DIRECTOR 243380 0 101329 0 53905 0 19575 0 21726 0 439915 0 0 0 RICHARD H SYKORA GM/VP 228885 0 81403 0 156435 0 18325 0 19997 0 505045 0 109457 0 DANNETTE M COLEMAN GM/VP 245000 0 91549 0 43728 0 19575 0 13589 0 413441 0 0 0 THOMAS JIM GUYN MD VP 261411 0 88010 0 49698 0 14162 0 23814 0 437095 0 0 0 BARBARA LYNCH VP 230154 0 83496 0 47121 0 11959 0 19883 0 392613 0 0 0 PART I, LINE 4B THE FOLLOWING RECEIVED PAYMENTS FROM A NON-QUALIFIED RETIREMENT PLAN: DAVID TILFORD $61,817 AARON REYNOLDS $28,858 GLENN ANDIS $15,126 JANA JOHNSON $117,324 MARK BAIRD $12,666 ROBERT LONGENDYKE $10,905 JAMES JACOBSON $11,744 DEBBY KNUTSON $ 9,178 RICHARD SYKORA $63,582 TIMOTHY THULL $ 4,837 DANNETTE COLEMAN $ 7,773 THEODORE LOFTNESS $10,043 THOMAS (JIM) GUYN $6,846 BARBARA LYNCH $5,776 PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATIONS OPERATING EARNINGS. 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 REVIEWS 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 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 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 -35,539,722. MN HEALTH INFO EXCHANGE K-1 1,783. 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 AFFILIATD 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