2023-11-08T15:23:04-06:00 2022-12-31 135565207 KPMG LLP 90 S 7TH ST STE 4200 MINNEAPOLIS MN 55402 990 2022-01-01 010571840 MEDICA HOLDING COMPANY MEDI 9529922058 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 ELIZABETH ERICKSON PRESIDENT AND CEO 9529922058 2023-10-23 1 ELIZABETH ERICKSON 999009999 0 HOLLY MOEN P01800653 6123055000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ELIZABETH ERICKSON 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 1037106 0 X WWW.MEDICA.COM X 2002 MN TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 10 9 0 0 0 0 0 0 0 0 25184 1037106 0 0 25184 1037106 0 0 0 0 0 0 0 0 0 128481 652335 128481 652335 -103297 384771 521450691 602876570 0 108433048 521450691 494443522 TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS AND OUR EMPLOYEES. 0 0 0 0 0 MEDICA HOLDING COMPANY IS THE HOLDING COMPANY FOR ALL OF THE MEDICA ENTITIES. THE GOAL OF MEDICA IS TO BE THE TRUSTED HEALTH PLAN OF CHOICE FOR CUSTOMERS, MEMBERS, PARTNERS, OUR EMPLOYEES. 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MN X ELIZABETH ERICKSON 9529922753 401 CARLSON PARKWAY CP 330 MINNETONKA MN 55305 X JOHN W NAYLOR PRESIDENT & CEO 0.00 40.00 X X 0 2835957 44105 RAJESH AGGARWAL DIRECTOR 0.00 10.00 X 0 91875 0 BRIGID BONNER DIRECTOR 0.00 10.00 X 0 83250 0 JOHN BUCK DIRECTOR & CHAIR 0.00 15.00 X X 0 133000 0 PETER KELLY DIRECTOR 0.00 10.00 X 0 87375 0 SAMUEL LEON DIRECTOR 0.00 10.00 X 0 80750 0 GAYE ADAMS MASSEY DIRECTOR 0.00 10.00 X 0 71750 0 JOHN STANOCH DIRECTOR & VICE CHAIR 0.00 10.00 X 0 92625 0 EARL STRATTON DIRECTOR 0.00 10.00 X 0 92625 0 MARY TWINEM DIRECTOR 0.00 10.00 X X 0 87375 0 MARY P QUIST SVP FIN & CORP CONTROLLER 0.00 40.00 X 0 663642 55294 MARK L BAIRD SVP & CFO 0.00 40.00 X 0 1039962 27542 DAVID H ELLENBOGEN SVP SEC & GENERAL COUNSEL 0.00 40.00 X 0 735741 99633 ESTHER TOMLJANOVICH FORMER DIRECTOR 0.00 0.00 X 0 11500 0 JAMES P JACOBSON FORMER SVP SEC & GEN COUNSEL 0.00 0.00 X 0 595469 0 0 6702896 226574 0 1 1 0 0 1037106 1037106 1037106 0 0 1037106 470535 470535 181800 181800 652335 0 652335 0 0 0 37502109 122250106 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 77022620 178390303 157716528 11636573 0 0 0 0 249209434 290599588 521450691 602876570 0 153000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 108280048 0 108433048 X 521450691 494443522 0 0 521450691 494443522 521450691 602876570 X 384771 -6912304 -20479636 X 0 1 X 1 0 0 OTHER INVESTED ASSETS 3886552 OTHER RECEIVABLE 14440303 INVESTMENT IN SUBSIDIARIES 212272733 INTERCOMPANY ACCOUNT 60000000 290599588 INVESTMENT PAYABLE 108280048 108280048 X PART X, LINE 2: THE COMPANY RECOGNIZES TAX BENEFIT FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED ON EXAMINATION BY TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFITS RECOGNIZED IN THE FINANCIAL STATEMENTS FROM SUCH A POSITION ARE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. X X X X X 0 1 0 0 0 0 1 0 0 JOHN W NAYLOR PRESIDENT & CEO 0 1064714 0 1511877 0 259366 0 19605 0 24500 0 2880062 0 250332 MARK L BAIRD SVP & CFO 0 336343 0 548698 0 154921 0 12200 0 15342 0 1067504 0 84354 DAVID H ELLENBOGEN SVP SEC & GENERAL COUNSEL 0 395550 0 261312 0 78879 0 74554 0 25079 0 835374 0 75880 MARY P QUIST SVP FIN & CORP CONTROLLER 0 329723 0 268265 0 65654 0 23638 0 31656 0 718936 0 58551 JAMES P JACOBSON FORMER SVP SEC & GEN COUNSEL 0 0 0 124339 0 471130 0 0 0 0 0 595469 0 150790 ESTHER TOMLJANOVICH FORMER DIRECTOR 0 0 0 0 0 11500 0 0 0 0 0 11500 0 0 PART I, LINE 3 MEDICA HOLDING COMPANY, THE FILING ORGANIZATION, DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY MEDICA SERVICES COMPANY, A RELATED ORGANIZATION. WHEN ESTABLISHING COMPENSATION, MEDICA SERVICES COMPANY USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 6 MANAGEMENT INCENTIVE COMPENSATION INCLUDES COMPONENTS RELATED TO THE ORGANIZATION'S OPERATING EARNINGS. PART-I LINE-4B THE FOLLOWING RECEIVED A SUPPLEMENT NONQUALIFIED RETIREMENT PLAN PAYMENT FROM MEDICA SERVICES COMPANY, A RELATED ORGANIZATION: MARK L. BAIRD - $84,354 JOHN W. NAYLOR - $250,332 DAVID H. ELLENBOGEN - $75,880 MARY P. QUIST - $58,551 JAMES P. JACOBSON - $150,790 FORM 990, PART VI, SECTION A, LINE 3 MEDICA HOLDING COMPANY HAS ENTERED INTO AN ADMINISTRATIVE SERVICE AGREEMENT WITH MEDICA SERVICES COMPANY (MSC), A RELATED TAXABLE ORGANIZATION. THROUGH THIS AGREEMENT, MSC LEASES ITS EMPLOYEES AND PROVIDES VARIOUS MANAGEMENT/ADMINISTRATIVE SERVICES TO MEDICA HOLDING COMPANY AND MEDICA HOLDING COMPANY PAYS FOR SUCH SERVICES THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION B, LINE 11B MEDICA'S TAX ADVISORS COMPLETE THE RETURN, FINANCE STAFF 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 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 HOLDING COMPANY, THE FILING ORGANIZATION, DOES NOT PAY COMPENSATION. ALL COMPENSATION IS PAID BY A RELATED ORGANIZATION, WHICH USES THE FOLLOWING TO DETERMINE COMPENSATION: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEY/STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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 MEDICA ENTITIES ARE REQUIRED TO FILE ANNUAL FINANCIAL STATEMENT 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 612(D). FORM 990, PART VII, SECTION B, LINE 1: CERTAIN INDIVIDUALS REPORTED ON FORM 990, PART VII SPLIT THEIR TIME BETWEEN ALL ENTITIES UNDER MEDICA HOLDING COMPANY. THE AVERAGE HOURS PER WEEK REPORTED IN PART VII ARE THE TOTAL HOURS PER WEEK FOR ALL MEDICA ORGANIZATIONS. FORM 990, PART VII JOHN STANOCH'S BOARD STIPEND WAS PAID TO STANOCH, LLC. FORM 990, PART XI, LINE 9: INVESTMENT IN SUBSIDIARY -20,479,636. MEDICA HEALTH PLANS 401 CARLSON PARKWAY MINNETONKA MN 55305 411242261 HEALTH COVERAGE MN 501(C)(4) N/A MHC 1 MEDICA FOUNDATION 401 CARLSON PARKWAY MINNETONKA MN 55305 411812461 FOUNDATION MN 501(C)(3) LINE 12B MHC 1 MEDICA COMMUNITY HEALTH PLAN 401 CARLSON PARKWAY MINNETONKA MN 55305 411843804 HEALTH COVERAGE MN 501(C)(4) N/A MHC 1 SSM HEALTH PLAN INC 10101 WOODFIELD LANE ST LOUIS MO 63132 831979548 HEALTH INSURANCE MO 501(C)(4) N/A MFCJVN 0 MS COMMUNITY NFP JV LLC (MFCJVN) 401 CARLSON PARKWAY MINNETONKA MN 55305 873268926 HOLDING COMPANY MN MHC RELATED 5114402 0 0 0.55000 MEDICA SERVICES COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 852902940 ADMIN. SERVICES MN MAS C 0 DEAN HEALTH SERVICES COMPANY LLC 1277 DEMING WAY MADISON WI 53717 842933639 ADMIN. SERVICES WI MSCJV C 0 DEAN HEALTH PLAN INC 1277 DEMING WAY MADISON WI 53717 391535024 HEALTH INSURANCE WI DHI C 0 DEAN HEALTH INSURANCE INC (DHI) PO BOX 56099 MADISON WI 53705 391830837 HEALTH INSURANCE WI MSCJV C 0 SSM HEALTH INSURANCE COMPANY 10101 WOODFIELD LANE ST LOUIS MO 63132 834718249 HEALTH INSURANCE MO MSCJV C 0 MEDICA REGIONAL INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 854111612 HEALTH INSURANCE MN MAS C 0 MEDICA INSURANCE COMPANY 401 CARLSON PARKWAY MINNETONKA MN 55305 411490988 HEALTH INSURANCE MN MAS C 0 MEDICA HEALTH MANAGEMENT 401 CARLSON PARKWAY MINNETONKA MN 55305 208005519 HEALTH MANAGEMENT MN MAS C 0 MEDICA AFFILIATED SERVICES (MAS) 401 CARLSON PARKWAY MINNETONKA MN 55305 411716415 HOLDING COMPANY MN MHC C 1 MS COMMUNITY JV LLC (MSCJV) 401 CARLSON PARKWAY MINNETONKA MN 55305 873240022 HOLDING COMPANY MN MHC C 0 MEDICA SELF-INSURED 401 CARLSON PARKWAY MINNETONKA MN 55305 411479417 THIRD PARTY ADMIN MN MAS C 0 MMSI INC 401 CARLSON PARKWAY MINNETONKA MN 55305 411547003 THIRD PARTY ADMIN MN MAS C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0