MEDICA COMMUNITY HEALTH PLAN: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: MEDICA COMMUNITY HEALTH PLAN (EIN 41-1843804)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-15
IRS object ID: 201303199349304020
Schema version: 2012v2.1
Note: A later return for the same period supersedes this one.
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
Form 990
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-15T10:37:04-06:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	420714325	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MCGLADREY LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

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	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	411843804	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	MEDICA HEALTH PLANS OF WISCONSIN	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MEDI	NameControl
Phone	9529922058	Phone

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

Officer Officer

Field	Value	IRS element (for citing)
Name	MARK L BAIRD	Name
Title	CFO	Title
Phone	9529922058	Phone
Date Signed	2013-11-14	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	TODD A JACKSON	Name
PTIN	P00092672	PTIN
Phone	6123324300	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	DAVID TILFORD	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

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	1322	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c	X	Organization501c
Web Site	WWW.MEDICA.COM	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1996	YearFormation
State Legal Domicile	WI	StateLegalDomicile
Activity Or Mission Description	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.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	11	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	10	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	0	ContributionsGrantsPriorYear
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	0	ProgramServiceRevenuePriorYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	0	InvestmentIncomePriorYear
Investment Income Current Year	0	InvestmentIncomeCurrentYear
Other Revenue Prior Year	56077	OtherRevenuePriorYear
Other Revenue Current Year	1322	OtherRevenueCurrentYear
Total Revenue Prior Year	56077	TotalRevenuePriorYear
Total Revenue Current Year	1322	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	0	SalariesEtcPriorYear
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	106870	OtherExpensePriorYear
Other Expenses Current Year	107412	OtherExpensesCurrentYear
Total Expenses Prior Year	106870	TotalExpensesPriorYear
Total Expenses Current Year	107412	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-50793	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-106090	RevenuesLessExpensesCY
Total Assets BOY	2974977	TotalAssetsBOY
Total Assets EOY	2974511	TotalAssetsEOY
Total Liabilities BOY	2342709	TotalLiabilitiesBOY
Total Liabilities EOY	2448333	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	632268	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	526178	NetAssetsOrFundBalancesEOY
Mission Description	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.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	0	Expense
Revenue	1322	Revenue
Description	MEDICA'S HMO PRODUCTS PROVIDE EMPLOYER GROUPS WITH HEALTH COVERAGE AND HEALTH MAINTENANCE SERVICES. MANY OF THESE EMPLOYER GROUPS ARE SMALL BUSINESSES. MEDICA'S HMO PLANS PROVIDE IN-NETWORK ACCESS TO APPROXIMATELY 96% OF MINNESOTA PHYSICIANS. MEDICA HMO PLANS ALSO OFFER A WIDE RANGE OF CARE MANAGEMENT, CARE COORDINATION AND HEALTH PROMOTION PROGRAMS TO HELP MEMBERS IMPROVE AND MAINTAIN THEIR HEALTH.	Description
Described In501 C3	0	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	0	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	0	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	11	NbrVotingGoverningBodyMembers
Number Independent Voting Members	10	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	1	LocalChapters
Policies Reference Chapters	1	PoliciesReferenceChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	0	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	WI	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	MARY QUIST	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	9529922058	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 9310 CP 330	AddressLine1
City	MINNEAPOLIS	City
State	MN	State
ZIP Code	554409310	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (25 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
JOHN BUCK
CHAIR	15.00	X	X	0	103000	0
ESTHER TOMLJANOVICH
DIRECTOR	10.00	X	X	0	71000	0
KRIS SANDA
SECRETARY/VICE CHAIR	10.00	X	X	0	71000	0
DAVID TILFORD
PRESIDENT/CEO	40.00	X	X	0	2341634	234762
BURTON COHEN
DIRECTOR	7.00	X		0	62000	0
DARYL DURUM
DIRECTOR	10.00	X		0	79000	0
PETER KELLY MD
DIRECTOR	10.00	X		0	67000	0
SAMUEL LEON MD
DIRECTOR	7.00	X		0	64000	0
RAJESH AGGARWAL
DIRECTOR	10.00	X		0	69584	0
EARL STRATTON
DIRECTOR	10.00	X		0	68000	0
AUSTIN SULLIVAN
DIRECTOR	10.00	X		0	66000	0
AARON L REYNOLDS
TREASURER/EVP	40.00		X	0	1163231	132279
JAMES P JACOBSON
SVP	40.00		X	0	562531	73385
JANA L JOHNSON
SVP	40.00			0	609821	83051	X
GLENN E ANDIS
SVP	40.00			0	658316	99090	X
DEBBY S KNUTSON
SVP	40.00			0	537782	63055	X
SIMEON A SCHINDELMAN
SVP	40.00			0	972434	45261	X
TIMOTHY D THULL
SVP	40.00			0	439157	72723	X
JOHN W NAYLOR
SVP	40.00			0	597557	85911	X
ROBERT LONGENDYKE
SVP	40.00			0	565843	87116	X
THEODORE J LOFTNESS
VP	40.00			0	537639	85925		X
MARK L BAIRD
SVP	40.00			0	570073	82576		X
RICHARD H SYKORA
GM/VP	40.00			0	494428	71822		X
DANNETTE M COLEMAN
GM/VP	40.00			0	416891	65798		X
SCOTT REID
VP	40.00			0	410426	65054		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	0	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	11598347	TotalReportableCompFrmRltdOrgs
Total Other Compensation	1347808	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	REVERSAL OF CLAIMS RES	Description
Business Code	524298	BusinessCode
Total Revenue Column	1322	TotalRevenueColumn
Related Or Exempt Function Income	1322	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Other Revenue	1322	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1322	TotalRevenueColumn
Related Or Exempt Function Income	1322	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Interest Interest

Field	Value	IRS element (for citing)
Total	105965	Total
Management And General	105965	ManagementAndGeneral

Other Expenses OtherExpenses

Field	Value	IRS element (for citing)
Description	RECORDING FEES	Description
Total	1447	Total
Management And General	1447	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	107412	Total
Program Services	0	ProgramServices
Management And General	107412	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	2974683	BOY
EOY	2974511	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	294	BOY
EOY	0	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	2974977	BOY
EOY	2974511	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2342709	BOY
EOY	2448333	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2342709	BOY
EOY	2448333	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	632268	BOY
EOY	526178	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	632268	BOY
EOY	526178	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2974977	BOY
EOY	2974511	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-106090	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	0	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID TILFORD
PRESIDENT/CEO	0	765069	0	679359	0	897206	0	219987	0	14775	0	2576396	0	0
AARON L REYNOLDS
TREASURER/EVP	0	436332	0	282291	0	444608	0	115692	0	16587	0	1295510	0	0
JAMES P JACOBSON
SVP	0	262079	0	121279	0	179173	0	58604	0	14781	0	635916	0	0
JANA L JOHNSON
SVP	0	265235	0	139854	0	204732	0	68793	0	14258	0	692872	0	0
GLENN E ANDIS
SVP	0	289319	0	153743	0	215254	0	76940	0	22150	0	757406	0	0
DEBBY S KNUTSON
SVP	0	250456	0	115758	0	171568	0	56180	0	6875	0	600837	0	0
SIMEON A SCHINDELMAN
SVP	0	607572	0	237287	0	127575	0	30063	0	15198	0	1017695	0	0
TIMOTHY D THULL
SVP	0	247650	0	95936	0	95571	0	55721	0	17002	0	511880	0	0
JOHN W NAYLOR
SVP	0	297722	0	243064	0	56771	0	68809	0	17102	0	683468	0	0
ROBERT LONGENDYKE
SVP	0	258567	0	122217	0	185059	0	65419	0	21697	0	652959	0	0
THEODORE J LOFTNESS
VP	0	248987	0	100794	0	187858	0	63584	0	22341	0	623564	0	0
MARK L BAIRD
SVP	0	256576	0	132693	0	180804	0	65289	0	17287	0	652649	0	0
RICHARD H SYKORA
GM/VP	0	226128	0	110057	0	158243	0	58110	0	13712	0	566250	0	0
DANNETTE M COLEMAN
GM/VP	0	219450	0	100250	0	97191	0	54604	0	11194	0	482689	0	0
SCOTT REID
VP	0	207138	0	101870	0	101418	0	50982	0	14072	0	475480	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReference	ExplanationExplanation
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 $64,451 AARON REYNOLDS $27,891 GLENN E ANDIS $14,264 JANA L. JOHNSON $11,841 MARK BAIRD $10,614 ROBERT LONGENDYKE $10,660 JAMES JACOBSON $9,346 DEBBY S. KNUTSON $8,498 THEODORE J LOFTNESS $9,589 RICHARD H. SYKORA $8,102 TIMOTHY D. THULL $3,633 DANNETTE M. COLEMAN $6,446

Return ReferenceReturnReference

ExplanationExplanation

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 $64,451 AARON REYNOLDS $27,891 GLENN E ANDIS $14,264 JANA L. JOHNSON $11,841 MARK BAIRD $10,614 ROBERT LONGENDYKE $10,660 JAMES JACOBSON $9,346 DEBBY S. KNUTSON $8,498 THEODORE J LOFTNESS $9,589 RICHARD H. SYKORA $8,102 TIMOTHY D. THULL $3,633 DANNETTE M. COLEMAN $6,446

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
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 AND TAX MANAGER REVIEW THE RETURN BEFORE IT IS SIGNED BY THE CFO. A COPY WILL BE PROVIDED 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.
	MEDICA HEALTH PLANS OF WISCONSIN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANZATION. 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 COMPENSATION FOR MEDICA'S 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.
FORM 990, PART VI, SECTION B, LINES 15A AND B	N/A - MEDICA HEALTH PLANS OF WISCONSIN DOES NOT HAVE ANY EMPLOYEES. ALL COMPENSATION IS PAID BY MEDICA HEALTH PLANS, A RELATED ORGANZATION.	PROCESS FOR DETERMINING COMPENSATION
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 FOUNDATION). THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS.	AVERAGE HOURS PER WEEK

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg	Public Charity StatusPublicCharityStatus	Direct Controlling Entity NADirectControllingEntityNA
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)	MEDICA HOLDING COMPANY	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	1	509(A)(3) I

Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Controlled OrgControlledOrg
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 Ann Rents Royalties	1	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	0	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	0	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	0	DividendsRelatedOrganization
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	0	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	0	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	0	PerformOfServicesByOtherOrgs
Sharing Of Facilities	0	SharingOfFacilities
Sharing Of Paid Employees	0	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	0	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	1	OtherTransferToOtherOrg
Other Transfer From Other Org	0	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

Field	Value	IRS element (for citing)
Business Name Line1	MEDICA HEALTH PLANS	BusinessNameLine1

Field	Value	IRS element (for citing)
Transaction Type	A	TransactionType
Amount Involved	105964	AmountInvolved
Method Of Amt Determination	ACTUAL AMOUNT	MethodOfAmtDetermination