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← MEDICA ONE HEALTH PLAN

Form 990 for tax year 2022

Filed by MEDICA ONE HEALTH PLAN.

Totals

Total revenue
$20,471
Total expenses
$78,912
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$0
Investment income
$20,471
Other revenue
$0
Total assets, end of year
$2,579,868
Total liabilities, end of year
$1,478,433
Net assets or fund balances, end of year
$1,101,435
Program services expenses (Part IX)
$78,912
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$78,912

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $20,471 · excluded $20,471

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7c · Gain or loss

    securities $0 · other assets $0

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 11g · Fees: other

    total $0 · program services $0 · management and general $0 · fundraising $0

  • 24a · Other expenses: Claims run off

    total $59,090 · program services $59,090

  • 24b · Other expenses: Bank Service Charges

    total $18,394 · program services $18,394

  • 24c · Other expenses: Taxes - Other

    total $1,428 · program services $1,428

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $198,138 · end of year $579,955

  • 2 · Savings and temporary cash investments

    beginning of year $3,162 · end of year $3,189

  • 4 · Accounts receivable

    beginning of year $128,969

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 10a · Land, buildings and equipment: cost or other basis

    $0

  • 10b · Land, buildings and equipment: accumulated depreciation

    $0

  • 10c · Land, buildings and equipment, net

    beginning of year $0 · end of year $0

  • 12 · Investments: other securities

    beginning of year $2,491,501 · end of year $1,996,724

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $4,933 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $80,654 · end of year $849

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $1,504,297 · end of year $1,477,584

  • 27 · Net assets without donor restrictions

    beginning of year $1,241,752 · end of year $1,101,435

Mission and programs · 2022

Mission

The mission of PreferredOne Community Health Plan (PCHP) is to make available to the residents of the state of Minnesota comprehensive health maintenance services that are accessible, acceptable, and delivered in a manner congruent with the economic and social needs of the community. The health plan will advocate for improvements in the delivery, quality and coverage of health care services and pursue health care programs to meet community needs.

  • PREFERREDONE COMMUNITY HEALTH PLAN MADE AVAILABLE TO THE RESIDENTS OF THE STATE OF MINNESOTA COMPREHENSIVE HEALTH MAINTENANCE SERVICES THAT WERE ACCESSIBLE, ACCEPTABLE, AND DELIVERED IN A MANNER CONGRUENT WITH THE ECONOMIC AND SOCIAL NEEDS OF THE COMMUNITY. THE HEALTH PLAN ADVOCATED FOR IMPROVEMENTS IN THE DELIVERY, QUALITY AND COVERAGE OF HEALTH CARE SERVICES AND PURSUE HEALTH CARE PROGRAMS TO MEET COMMUNITY NEEDS. THESE EXPENSES REPRESENT THE RUN DOWN OF ACTIVITIES FOR THE ORGANIZATION. THE ORGANIZATION ENDED SERVICES IN 2021.

    Expenses $78,912

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • John Batson

    Chair

    Total calculated
    $1,087,917
    From this org
    $0
    From related orgs
    $1,077,616
    Other
    $10,301
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $646,045 related
    Bonus
    $0 + $431,486 related
    Other
    $0 + $85 related
    Deferred
    $0 + $9,150 related
    Nontaxable benefits
    $0 + $1,151 related
    Filer's total
    $0 + $1,087,917 related

  • Kimberly DeRoche MD

    Director

    Total calculated
    $707,732
    From this org
    $0
    From related orgs
    $601,139
    Other
    $106,593
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $467,287 related
    Bonus
    $0 + $129,405 related
    Other
    $0 + $4,446 related
    Deferred
    $0 + $85,490 related
    Nontaxable benefits
    $0 + $21,103 related
    Filer's total
    $0 + $707,732 related

  • Rebecca Hilley

    Director

    Total calculated
    $0
    Hours/week
    0

  • Trudi Trysla

    Director

    Total calculated
    $1,048,997
    From this org
    $0
    From related orgs
    $931,521
    Other
    $117,476
    Hours/week
    0 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $598,239 related
    Bonus
    $0 + $233,318 related
    Other
    $0 + $99,964 related
    Deferred
    $0 + $102,593 related
    Nontaxable benefits
    $0 + $14,883 related
    Filer's total
    $0 + $1,048,997 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
The following individuals participated in a nonqualified retirement plan: Trudi Trysla John Batson Kimberly DeRoche, MD Due to a vesting event, the following individuals had income in Part VII and Schedule J related to a nonqualified retirement plan: Trudi Trysla, $97,069
Schedule J, Part I, Line 7 Non-fixed payments
FAIRVIEW HEALTH SERVICES PROVIDES LUMP SUM FINANCIAL AWARDS BASED ON SYSTEM-WIDE, BUSINESS UNIT AND/OR DEPARTMENTS FINANCIAL AND QUALITY MEASURES. ANNUAL GOALS, SPECIFICALLY TIED TO PRODUCTIVITY AND QUALITY INDICATORS, ARE SET FOR THE YEAR AND AN INCENTIVE PAID OUT ANNUALLY IF KEY GOALS AND MEASURES ARE ACHIEVED.
Schedule J, Part I, Line 4b
Fairview Health Services' plan is only open to a select group of highly compensated employees. The plan contributes the difference of that 403(b) employer contributions were missed for participant who earn more than the IRS limit on eligible compensation for qualified retirement plans. The contribution is unfunded. The plan complies with Section 457(f) of the code.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • Ridges Surgery Center LLC

    N/A · Surg Cntr · MN

    Directly controlled by NA

  • Crosstown Surgery Center LLC

    N/A · Surgery Center · MN

    Directly controlled by NA

  • SouthHealth ASC LLC

    N/A · Surgery Center · MN

    Directly controlled by NA

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • Fairview Clinics

    C Corporation · Physician · MN

    Directly controlled by NA

  • Fairview Physician and Clinic Services

    C Corporation · Physician · MN

    Directly controlled by NA

  • Fairview Development Company

    C Corporation · Leasehold · MN

    Directly controlled by NA

  • Fairview Express Care

    C Corporation · Physician · MN

    Directly controlled by NA

  • FHS Assurance Limited

    C Corporation · Self insur · MN

    Directly controlled by NA

  • HealthEast Diversified Services Inc

    C Corporation · Reference · MN

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2022
Filed
23 June 2023
IRS schema version
2022v5.0
Source object
202341749349300019

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