MEDICA COMMUNITY HEALTH PLAN: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MEDICA COMMUNITY HEALTH PLAN (EIN 41-1843804)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201213199349300806
- Schema version
- 2011v1.2
- 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) |
|---|---|---|
| Timestamp | 2012-11-14T07:55:19-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 2011-01-01 | 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 | AARON REYNOLDS | Name |
| Title | CFO | Title |
| Phone | 9529922058 | Phone |
| Date Signed | 2012-11-12 | 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 | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | 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 | 56077 | 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 | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | 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 | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 56077 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 0 | TotalRevenuePriorYear |
| Total Revenue Current Year | 56077 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | -5339 | 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 | 114773 | OtherExpensePriorYear |
| Other Expenses Current Year | 106870 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 109434 | TotalExpensesPriorYear |
| Total Expenses Current Year | 106870 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -109434 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -50793 | RevenuesLessExpensesCY |
| Total Assets BOY | 2970144 | TotalAssetsBOY |
| Total Assets EOY | 2974977 | TotalAssetsEOY |
| Total Liabilities BOY | 2287083 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2342709 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 683061 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 632268 | 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 | 255 | Expense |
| 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 |
| Total Program Service Expense | 255 | TotalProgramServiceExpense |
| 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | 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 | 1 | 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 (28 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 | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| JOHN BUCK | |||||||||
| CHAIR | 15.00 | X | X | 0 | 95000 | 0 | |||
| ESTHER TOMLJANOVICH | |||||||||
| VICE CHAIR | 10.00 | X | X | 0 | 67000 | 0 | |||
| KRIS SANDA | |||||||||
| SECRETARY | 10.00 | X | X | 0 | 67000 | 0 | |||
| DAVID TILFORD | |||||||||
| PRESIDENT/CEO | 40.00 | X | X | 0 | 2223128 | 171530 | |||
| BURTON COHEN | |||||||||
| DIRECTOR | 7.00 | X | 0 | 61000 | 0 | ||||
| DARYL DURUM | |||||||||
| DIRECTOR | 10.00 | X | 0 | 66000 | 0 | ||||
| PETER KELLY MD | |||||||||
| DIRECTOR | 10.00 | X | 0 | 62000 | 0 | ||||
| SAMUEL LEON MD | |||||||||
| DIRECTOR | 7.00 | X | 0 | 59000 | 0 | ||||
| RAJESH AGGARWAL | |||||||||
| DIRECTOR | 7.00 | X | 0 | 60000 | 0 | ||||
| EARL STRATTON | |||||||||
| DIRECTOR | 10.00 | X | 0 | 63000 | 0 | ||||
| AUSTIN SULLIVAN | |||||||||
| DIRECTOR | 10.00 | X | 0 | 66000 | 0 | ||||
| BEN BACHE-WIIG MD | |||||||||
| DIRECTOR | 10.00 | X | 0 | 65000 | 0 | ||||
| AARON REYNOLDS | |||||||||
| TREASURER/EVP/CAO | 40.00 | X | 0 | 1194598 | 114174 | ||||
| JAMES P JACOBSON | |||||||||
| SVP/GENERAL COUNSEL | 40.00 | X | 0 | 553401 | 68830 | ||||
| CHARLES J FAZIO | |||||||||
| CMO/SVP | 40.00 | 0 | 641132 | 62078 | X | ||||
| JANA L JOHNSON | |||||||||
| SVP OPERATIONS | 40.00 | 0 | 595642 | 77516 | X | ||||
| GLENN E ANDIS | |||||||||
| SVP GOVERNMENT PROGRAMS | 40.00 | 0 | 658334 | 83949 | X | ||||
| DEBBY S KNUTSON | |||||||||
| SVP HRLF | 40.00 | 0 | 549914 | 59517 | X | ||||
| SIMEON SCHINDELMAN | |||||||||
| SVP COMMERICAL MARKETS | 40.00 | 0 | 622772 | 80957 | X | ||||
| JOHN CHOMEAU | |||||||||
| GM/VP CHA | 40.00 | 0 | 340114 | 43554 | X | ||||
| TIM THULL | |||||||||
| SVP CIO | 40.00 | 0 | 374662 | 62118 | X | ||||
| THEODORE J LOFTNESS | |||||||||
| VP REGIONAL HEALTH SERVICE | 40.00 | 0 | 656841 | 68909 | X | ||||
| MARK L BAIRD | |||||||||
| SVP FINANCE | 40.00 | 0 | 544943 | 74373 | X | ||||
| RICHARD H SYKORA | |||||||||
| GM/VP PRICE & ACCOUNT | 40.00 | 0 | 474838 | 66212 | X | ||||
| JOHN NAYLOR | |||||||||
| VP/GM COMM SALES, RENEWALS & ACCT SVCS | 40.00 | 0 | 473453 | 69611 | X | ||||
| DANETTE COLEMAN | |||||||||
| VP & GM INDIV & FAMILY BUSINESS | 40.00 | 0 | 376746 | 57272 | X | ||||
| STEPHEN WICZEK | |||||||||
| FORMER DIRECTOR | 0.00 | 0 | 44000 | 0 | X | ||||
| TOM L HENKE | |||||||||
| FORMER KEY EMPLOYEE | 0.00 | 0 | 283484 | 0 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 11339002 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1160600 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | 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 | 56077 | TotalRevenueColumn |
| Related Or Exempt Function Income | 56077 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 56077 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 56077 | TotalRevenueColumn |
| Related Or Exempt Function Income | 56077 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106423 | Total |
| Management And General | 106423 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | RECORDING FEES | Description |
| Total | 447 | Total |
| Management And General | 447 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106870 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 106870 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2967210 | BOY |
| EOY | 2974683 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 218 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2716 | BOY |
| EOY | 294 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2970144 | BOY |
| EOY | 2974977 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2287083 | BOY |
| EOY | 2342709 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2287083 | BOY |
| EOY | 2342709 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 683061 | BOY |
| EOY | 632268 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 683061 | BOY |
| EOY | 632268 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2970144 | BOY |
| EOY | 2974977 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -50793 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 0 | FSAudited |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
| Total Revenue | 56077 | TotalRevenue |
| Total Expenses | 106870 | TotalExpenses |
| Excess Or Deficit For Year | -50793 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -50793 | ExcessOrDeficitPerFS |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PART XI, LINE 8 - OTHER ADJUSTMENTS: | Identifier |
| Explanation | CHANGE IN STATUTORY BASIS ACCOUNTING NONADMITTED ASSETS | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | 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 | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)
| 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 | |||||||||||||
| 0 | 716388 | 0 | 1355364 | 0 | 151376 | 0 | 160702 | 0 | 10828 | 0 | 2394658 | 0 | 0 |
| AARON REYNOLDS | |||||||||||||
| 0 | 417853 | 0 | 685774 | 0 | 90971 | 0 | 100814 | 0 | 13360 | 0 | 1308772 | 0 | 0 |
| JAMES P JACOBSON | |||||||||||||
| 0 | 255315 | 0 | 278150 | 0 | 19936 | 0 | 54968 | 0 | 13862 | 0 | 622231 | 0 | 0 |
| CHARLES J FAZIO | |||||||||||||
| 0 | 201387 | 0 | 390860 | 0 | 48885 | 0 | 54670 | 0 | 7408 | 0 | 703210 | 0 | 0 |
| JANA L JOHNSON | |||||||||||||
| 0 | 258965 | 0 | 316734 | 0 | 19943 | 0 | 62914 | 0 | 14602 | 0 | 673158 | 0 | 0 |
| GLENN E ANDIS | |||||||||||||
| 0 | 270321 | 0 | 329280 | 0 | 58733 | 0 | 70053 | 0 | 13896 | 0 | 742283 | 0 | 0 |
| DEBBY S KNUTSON | |||||||||||||
| 0 | 243561 | 0 | 264270 | 0 | 42083 | 0 | 52540 | 0 | 6977 | 0 | 609431 | 0 | 0 |
| SIMEON SCHINDELMAN | |||||||||||||
| 0 | 333466 | 0 | 269661 | 0 | 19645 | 0 | 67572 | 0 | 13385 | 0 | 703729 | 0 | 0 |
| JOHN CHOMEAU | |||||||||||||
| 0 | 154357 | 0 | 167111 | 0 | 18646 | 0 | 33943 | 0 | 9611 | 0 | 383668 | 0 | 0 |
| TIM THULL | |||||||||||||
| 0 | 207206 | 0 | 149749 | 0 | 17707 | 0 | 47318 | 0 | 14800 | 0 | 436780 | 0 | 0 |
| THEODORE J LOFTNESS | |||||||||||||
| 0 | 246500 | 0 | 267815 | 0 | 142526 | 0 | 56792 | 0 | 12117 | 0 | 725750 | 0 | 0 |
| MARK L BAIRD | |||||||||||||
| 0 | 250700 | 0 | 273312 | 0 | 20931 | 0 | 58802 | 0 | 15571 | 0 | 619316 | 0 | 0 |
| RICHARD H SYKORA | |||||||||||||
| 0 | 221283 | 0 | 233427 | 0 | 20128 | 0 | 51576 | 0 | 14636 | 0 | 541050 | 0 | 0 |
| JOHN NAYLOR | |||||||||||||
| 0 | 284034 | 0 | 170774 | 0 | 18645 | 0 | 54972 | 0 | 14639 | 0 | 543064 | 0 | 0 |
| DANETTE COLEMAN | |||||||||||||
| 0 | 214366 | 0 | 144551 | 0 | 17829 | 0 | 48573 | 0 | 8699 | 0 | 434018 | 0 | 0 |
| STEPHEN WICZEK | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 44000 | 0 | 0 | 0 | 0 | 0 | 44000 | 0 | 0 |
| TOM L HENKE | |||||||||||||
| 0 | 36748 | 0 | 225000 | 0 | 21736 | 0 | 0 | 0 | 0 | 0 | 283484 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 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, LINES 4A-B | THE FOLLOWING RECEIVED A SEVERANCE PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION. TOM L. HENKE $54,849 STEPHEN WICZEK $44,000 THE FOLLOWING RECEIVED A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION. DAVID TILFORD $44,254 AARON REYNOLDS $23,293 CHARLES J FAZIO $ 9,929 TOM L HENKE $21,736 GLENN E ANDIS $12,098 DEBBY S. KNUTSON $ 7,469 THEODORE J LOFTNESS $52,435 THE FOLLOWING PARTICIPATED IN, BUT DID NOT RECEIVE A PAYMENT, FROM A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN FROM MEDICA HEALTH PLANS, A RELATED ORGANIZATION: JAMES JACOBSON JANA L JOHNSON SIMEON SCHINDELMAN MARK L BAIRD RICHARD H SYKORA JOHN CHOMEAU |
| PART I, LINE 6 | MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE OPERATING EARNINGS OF MEDICA HEALTH PLANS. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 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 A, LINE 7A | MEMBERS ELECT THE CONSUMER BOARD MEMBERS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | MEDICA'S TAX ADVISORS COMPLETE THE RETURN, MEDICA'S CONTROLLER AND DIRECTOR OF TREASURY 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 HEEALTH 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 FOUR 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 FOUNDATION DBA 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 |
|---|---|---|---|---|---|---|---|---|
| MEDICA INSURANCE COMPANY | ||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411490988 | HEALTH INSURANCE | MN | MEDICA AFFILIATED SERVICES | C |
| MEDICA SELF-INSURED | ||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411479417 | THIRD PARTY ADMINISTRATOR | MN | MEDICA AFFILIATED SERVICES | C |
| MEDICA HEALTH MANAGEMENT | ||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 208005519 | HEALTH MANAGEMENT | MN | MEDICA AFFILIATED SERVICES | C |
| MEDICA AFFILIATED SERVICES | ||||||||
| 401 CARLSON PARKWAY | MINNETONKA | MN | 55305 | 411716415 | HOLDING COMPANY | MN | MEDICA HOLDING COMPANY | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | 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 |
| 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 | Q | TransactionType |
| Amount Involved | 106423 | AmountInvolved |
| Method Of Amt Determination | ACTUAL INTEREST PAID | MethodOfAmtDetermination |
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