2012-11-14T07:55:19-06:00 2011-12-31 420714325 MCGLADREY LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2011-01-01 411843804 MEDICA HEALTH PLANS OF WISCONSIN MEDI 9529922058 401 CARLSON PARKWAY MINNETONKA MN 553055387 AARON REYNOLDS 9529922058 2012-11-12 1 TODD A JACKSON P00092672 6123324300 2011 2016-02-24 21:20:13Z DAVID TILFORD 401 CARLSON PARKWAY MINNETONKA MN 553055387 56077 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 11 0 0 0 0 0 0 0 0 0 0 0 56077 0 56077 0 0 -5339 0 0 0 0 0 0 114773 106870 109434 106870 -109434 -50793 2970144 2974977 2287083 2342709 683061 632268 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 0 255 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. 255 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 11 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 0 0 0 WI X MARY QUIST 9529922058 PO BOX 9310 CP 330 MINNEAPOLIS MN 554409310 JOHN BUCK 15.00 X X 0 95000 0 ESTHER TOMLJANOVICH 10.00 X X 0 67000 0 KRIS SANDA 10.00 X X 0 67000 0 DAVID TILFORD 40.00 X X 0 2223128 171530 BURTON COHEN 7.00 X 0 61000 0 DARYL DURUM 10.00 X 0 66000 0 PETER KELLY MD 10.00 X 0 62000 0 SAMUEL LEON MD 7.00 X 0 59000 0 RAJESH AGGARWAL 7.00 X 0 60000 0 EARL STRATTON 10.00 X 0 63000 0 AUSTIN SULLIVAN 10.00 X 0 66000 0 BEN BACHE-WIIG MD 10.00 X 0 65000 0 AARON REYNOLDS 40.00 X 0 1194598 114174 JAMES P JACOBSON 40.00 X 0 553401 68830 CHARLES J FAZIO 40.00 X 0 641132 62078 JANA L JOHNSON 40.00 X 0 595642 77516 GLENN E ANDIS 40.00 X 0 658334 83949 DEBBY S KNUTSON 40.00 X 0 549914 59517 SIMEON SCHINDELMAN 40.00 X 0 622772 80957 JOHN CHOMEAU 40.00 X 0 340114 43554 TIM THULL 40.00 X 0 374662 62118 THEODORE J LOFTNESS 40.00 X 0 656841 68909 MARK L BAIRD 40.00 X 0 544943 74373 RICHARD H SYKORA 40.00 X 0 474838 66212 JOHN NAYLOR 40.00 X 0 473453 69611 DANETTE COLEMAN 40.00 X 0 376746 57272 STEPHEN WICZEK 0.00 X 0 44000 0 TOM L HENKE 0.00 X 0 283484 0 0 11339002 1160600 0 1 1 0 0 REVERSAL OF CLAIMS RES 524298 56077 56077 56077 56077 56077 0 0 106423 106423 RECORDING FEES 447 447 106870 0 106870 0 2967210 2974683 218 2716 294 2970144 2974977 2287083 2342709 2287083 2342709 X 683061 632268 683061 632268 2970144 2974977 -50793 0 X 0 0 0 0 56077 106870 -50793 -50793 PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN STATUTORY BASIS ACCOUNTING NONADMITTED ASSETS 1 1 0 0 0 0 1 0 0 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 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. 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. PROCESS FOR DETERMINING COMPENSATION 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. AVERAGE HOURS PER WEEK 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. 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 FOUNDATION DBA MEDICA RESEARCH INSTITUTE 401 CARLSON PARKWAY MINNETONKA MN 55305 270600894 RESEARCH FOUNDATION MN 501(C)(3) 509(A)(3) I MEDICA HOLDING COMPANY 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 MEDICA HEALTH PLANS Q 106423 ACTUAL INTEREST PAID