2016-08-15T10:52:07-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-10-01 410785161 MILLE LACS HEALTH SYSTEM MILL 3205322580 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 WILLIAM NELSON CEO 3205322580 2016-08-08 1 KOREY BOELTER P00775161 6123764500 2014 2016-09-27 15:27:22Z WILLIAM NELSON 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 38833315 0 X WWW.MLHEALTH.ORG X 1953 MN TO PROVIDE QUALITY HEALTH SERVICES TO RESIDENTS OF ONAMIA, MN AND THE SURROUNDING AREA. 11 9 627 20 0 0 92437 191265 35958037 37436010 18685 -87599 1064020 1190855 37133179 38730531 0 9231 0 0 23811045 24470360 0 0 0 14209366 14329678 38020411 38809269 -887232 -78738 27577899 27076729 12785946 12363514 14791953 14713215 X TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MANTAINING OPTIMAL HEALTH. 1 0 32710168 9231 37436010 MILLE LACS HEALTH SYSTEM (MLHS) IS A RURAL HEALTH SYSTEM LOCATED IN ONAMIA, MN, 80 MILES NORTH OF THE TWIN CITIES NEAR LAKE MILLE LACS. OUR SYSTEM INCLUDES A 25-BED ACUTE CARE HOSPITAL, A 57-BED LONG-TERM CARE FACILITY, A 10-BED SENIOR CARE FACILITY, HOME CARE, HOSPICE, A BLS AND ALS AMBULANCE SERVICE, AS WELL AS AN ATTACHED MEDICAL CLINIC. MLHS ALSO OPERATES MEDICAL CLINICS IN THE TOWNS OF ISLE, HILLMAN, GARRISON AND MILACA. OUR MEDICAL STAFF ALSO PROVIDES COVERAGE TO THE NE-IA-SHING CLINIC ON THE NEARBY MILLE LACS RESERVATION. THE HEALTH SYSTEM IS ORGANIZED AS A 501(C)(3) NONPROFIT CORPORATION. DUE TO THE LACK OF AVAILABLE HEALTHCARE OPTIONS IN THIS CENTRAL MINNESOTA REGION, THE FEDERAL GOVERNMENT HAS DESIGNATED THIS COMMUNITY AS A MEDICALLY UNDERSERVED AREA IN TERMS OF PRIMARY CARE CLINICS. THE REMOTENESS OF HEALTHCARE SERVICES TO THE MILLE LACS COMMUNITIES IN THE 1950'S PROMPTED AN AREA-WIDE COMMUNITY EFFORT TO BUILD A HOSPITAL. THE HOSPITAL WAS COMPLETED IN 1956 AND, FIVE YEARS LATER A NURSING HOME WAS BUILT ADJACENT TO IT. OVER THE YEARS, THE FACILITIES HAVE BEEN EXPANDED AND MODERNIZED AND RENAMED SEVERAL TIMES. IN 1995, AN AMBITIOUS BUILDING PROJECT AND INTEGRATION EFFORT, WHICH INCLUDED A NEW HOSPITAL EMERGENCY ROOM, REHABILITATION CENTER, AND CLINIC SPACE WERE COMPLETED. THIS BUILDING PROJECT WAS MADE POSSIBLE THROUGH NEARLY A HALF MILLION DOLLARS WHICH WERE RAISED LOCALLY. IN 2001, A MULTI-MILLION DOLLAR EXPANSION AND RENOVATION PROJECT WAS STARTED TO FURTHER UPGRADE THE HOSPITAL AND LONG-TERM CARE SERVICES AND POSITION US TO MEET THE GROWING HEALTHCARE NEEDS OF THE AREA.MILLE LACS HEALTH SYSTEM SERVES A PERMANENT POPULATION OF BETWEEN 12,000 AND 15,000, INCLUDING RESIDENTS OF THE MILLE LACS RESERVATION. BECAUSE OF THE RECREATIONAL FEATURES OF THE MILLE LACS AREA, MLHS ALSO SERVES A NUMBER OF SEASONAL RESIDENTS. IT IS ESTIMATED THAT DURING THE BUSY SUMMER AND HOLIDAY WEEKENDS THERE ARE UP TO AN ADDITIONAL 25,000 PEOPLE IN THE AREA. THIS NUMBER IS BASED ON STATISTICS FROM LOCAL RESORTS, MOTELS, AND CAMPGROUNDS. THE CLOSEST ACUTE CARE FACILITY IS 28 MILES AWAY IN PRINCETON. THE CLOSEST TERTIARY CARE FACILITY IS 55 MILES AWAY IN ST. CLOUD. THE CLOSEST SECONDARY LEVEL IS 50 MILES AWAY IN BRAINERD. MLHS IS THE ONLY PROVIDER OF ACUTE CARE WITHIN OUR PRIMARY SERVICE AREA OF ONAMIA, HILLMAN, ISLE, GARRISON AND WAHKON, WHICH INCLUDES THE MILLE LACS RESERVATION. MILLE LACS HEALTH SYSTEM ALSO SERVES PATIENTS OUTSIDE THE PRIMARY SERVICE AREA. THE SECONDARY SERVICE AREA INCLUDES MORA, BOCK, MILACA, AND OGILVIE. 32710168 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 115 0 627 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X JOHN UNZEN CFO 3205322581 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 MARK TADYCH CHAIR 8.00 X X 4800 0 0 FR KERMIT HOLL VICE-CHAIR 2.00 X X 720 0 0 BECKY HOULE TREASURER 2.00 X X 900 0 0 DIANE GIBAS SECRETARY 2.00 X X 750 0 0 DENNIS BURR BOARD MEMBER 2.00 X 0 0 0 DR CATHY DONOVAN BOARD MEMBER/PHYSICIAN 40.00 X 202396 0 41752 ROB DUBBS BOARD MEMBER 2.00 X 0 0 0 PHIL GRAVEL BOARD MEMBER 2.00 X 780 0 0 WENDY KAFKA BOARD MEMBER 2.00 X 780 0 0 BETSY LUNDQUIST BOARD MEMBER 2.00 X 960 0 0 DR ARDEN VIRNIG BOARD MEMBER/PHYSICIAN 40.00 X 196028 0 16651 WILLIAM NELSON CEO 40.00 X 320862 0 64865 JOHN UNZEN CFO 40.00 X 147318 0 17579 KIM KUCERA COO 40.00 X 145793 0 36245 JULIE SCHMIDT VP HUMAN RESOURCES 40.00 X 0 0 0 PATTI HOOK-VIRNIG CHIEF OF STAFF 40.00 X 152558 0 41741 DR TOM BRACKEN VP MEDICAL AFFAIRS 40.00 X 228123 0 49542 CATHERINE STEINER PHYSICIAN ASSISTANT 40.00 X 125042 0 40429 MARK MARSHALL PHYSICIAN ASSISTANT 40.00 X 120492 0 18210 DAVID STROBEL PHYSICIAN 40.00 X 189845 0 23966 ROGER BOETTCHER PHYSICIAN 40.00 X 186491 0 34591 PETER LINDBLOOM PHYSICIAN ASSISTANT 40.00 X 141995 0 41743 2166633 0 427314 19 0 1 0 CENTRAL MN ANESTHESIA SERVICES INC 9527 330TH ST ONAMIA MN 56359 ANESTHESIA 496125 CLIFTONLARSONALLEN LLP 220 S 6TH ST STE 300 MINNEAPOLIS MN 55402 ACCOUNTING 150583 WMG LYFJABERG LLC 107 FLYNN DR STE 600 MILBANK SD 57252 HOSPITAL STAFFING 131319 WILLIAM ORR CONSULTING 3537 GREAT OAKS PL EAGAN MN 55123 SENIOR CARE CONSULTING 105000 4 99270 91995 191265 PATIENT REVENUE 621110 31187219 31187219 CLINIC REVENUE 900099 5256192 5256192 ASSISTED LIVING 623000 611695 611695 JOINT VENTURE INCOME 900099 318787 318787 THERAPY REVENUE 900099 62117 62117 37436010 15185 15185 75615 0 75615 75615 75615 102784 -102784 -102784 -102784 78345 0 78345 78345 MISCELLANEOUS 900099 660744 660744 MEALS REVENUE 900099 326006 326006 JOINT VENTURE INCOME - OTHER 900099 44814 44814 5331 5331 1036895 38730531 37436010 0 1103256 X 9231 9231 1733310 809399 923911 17132800 15672737 1460063 468866 433528 35338 3839298 3480825 358473 1296086 1152872 143214 43503 43503 85879 85879 4680992 3605948 1075044 182554 135173 47381 1248596 904647 343949 184093 55102 128991 651026 630157 20869 206539 157667 48872 467125 375884 91241 1776744 1162131 614613 296876 179248 117628 MEDICAL SUPPLIES 1936179 1936179 BAD DEBT EXPENSE 1204919 1204919 FOOD 408771 408771 MEDICAID ASSESSMENT 367647 160455 207192 588235 235295 352940 38809269 32710168 6099101 0 1459506 1427981 4764390 4781411 5613435 6352347 40000 200000 395102 422945 593355 488517 41401307 29091461 13612031 12309846 27448 72262 1021819 985924 50813 35496 27577899 27076729 2100293 1980488 8729675 8267880 6317 8772 1723565 1384891 226096 721483 12785946 12363514 X 14791953 14713215 14791953 14713215 27577899 27076729 -78738 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1158795 1158795 24377798 16225151 8152647 1185616 817151 368465 14508355 12049159 2459196 170743 170743 12309846 DUE TO THIRD PARTY PAYERS 721483 721483 X 37393673 102784 102784 37290889 1439642 1439642 38730531 37604350 0 37604350 1204919 1204919 38809269 PART IV, LINE 2B: THE HOSPITAL HOLDS FUNDS ON BEHALF OF THE NURSING HOME RESIDENTS IN A SEPARATE BANK ACCOUNT. PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF EQUIPMENT 102,784. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,204,919. UNRESTRICTED CONTRIBUTIONS 33,307. INTEREST INCOME 12,682. GRANT INCOME 99,270. RENTAL INCOME 27,964. CAPITAL GRANTS AND CONTRIBUTIONS 61,500. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,204,919. 1 1 X 1 X 1 X 1 1 1 0 0 107533 107533 0.00290 5849798 3769042 2080756 0.05530 5957331 3769042 2188289 0.05820 19605 19605 0.00050 132428 10115 122313 0.00330 9231 9231 0.00020 161264 10115 151149 0.00400 6118595 3779157 2339438 0.06220 1 1204919 0 10564911 10752009 -187098 X 1 1 1 1 MILLE LACS HEALTH SYSTEM 200 NORTH ELM STREET ONAMIA MN 563590800 WWW.MLHEALTH.ORG 8557484 X X X X MILLE LACS HEALTH SYSTEM 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X HTTP://WWW.MLHEALTH.ORG/CONTENT/QUALITY-CARE X 1 12 1 HTTP://WWW.MLHEALTH.ORG/CONTENT/QUALITY-CARE 0 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X 1 X X X 1 X 0 X X 1 X 0 0 MILLE LACS HEALTH SYSTEM PART V, SECTION B, LINE 5: NINE COMMUNITY AND COUNTY REPS WERE INTERVIEWED AND FIVE COMMUNITY FORUMS WERE CONDUCTED. THE PERSONS CONSULTED WERE 1.) COMMUNITY HEALTH UNIT SUPERVISOR, MILLE LACS COUNTY COMMUNITY AND VETERANS SERVICES. 2.) DISABILITIES UNIT SUPERVISOR, MILLE LACS COUNTY COMMUNITY AND VETERAN SERVICES. 3,) MAYOR, CITY OF ONAMIA, MN. 4.) COMMISSIONER OF HEALTH AND HUMAN SERVICES, THE MILLE LACS BAND OF OJIBWE TRIBE. 5.) SHERIFF, MILLE LACS COUNTY, 6.) NURSE, ONAMIA SCHOOL DISTRICT. 7.) DIRECTOR OF EMERGENCY SERVICES, MILLE LACS HEALTH SYSTEM. 8.) DIRECTOR OF COMMUNITY-BASED SERVICES, ASSISTED LIVING, HOME CARE AND HOSPICE, MILLE LACS HEALTH SYSTEM. 9.) PATIENT ACCOUNTS REPRESENTATIVE, MILLE LACS HEALTH SYSTEM. MILLE LACS HEALTH SYSTEM PART V, SECTION B, LINE 11: BECAUSE OF LIMITED RESOURCES, WE CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED HEALH NEED. WE HAVE CHOSEN OUR RESPONSES BASED ON ANALYSES OF OUR RESOURCES, OUR MISSION, OUR EXISTING SPECIALTIES, COMMUNITY PRIORITIES, AND EXISTING COMMUNITY RESOURCES.MILLE LACS HEALTH SYSTEM HAS EXPANDED ITS CLINIC HOURS TO SATURDAYS AND HAS IMPROVED ITS CARE FOR OBESE AND DIABETIC PATIENTS FOLLOWING CLINICALLY ACCEPTED TESTS AND PROTOCOLS. WE CONTINUE TO ASSIST THE MILLE LACS BAND OF THE OJIBWE TRIBE BY SENDING FAMILY PRACTICE PROVIDERS TO THE TRIBAL CLINIC. MILLE LACS HEALTH SYSTEM PART V, SECTION B, LINE 22D: WE CALCULATE AMOUNTS GENERALLY BILLED IN ACCORDANCE WITH OUR AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL. AMOUNTS GENERALLY BILLED ARE BASED ON THE DISCOUNTED CHARGES TO OUR LARGEST INSURANCE PAYER, BY VOLUME. THE DISCOUNT GIVEN TO OUR LARGEST INSURANCE PAYER IS LESS THAN 10% WHILE THE SMALLEST DISCOUNT AVAILABLE UNDER OUR FINANCIAL ASSISTANCE POLICY IS 10%. 5 MHLS FAMILY CLINIC - ONAMIA 200 NORTH ELM ST ONAMIA MN 56359 MEDICAL CLINIC MHLS FAMILY CLINIC - ISLE 375 WEST ISLE ST ISLE MN 56342 MEDICAL CLINIC MHLS FAMILY CLINIC - GARRISON 27378 STATE HIGHWAY 18 GARRISION MN 56450 MEDICAL CLINIC MHLS FAMILY CLINIC - HILLMAN 26362 370TH AVE HILLMAN MN 56338 MEDICAL CLINIC MHLS FAMILY CLINIC - MILACA 1010 5TH ST SE MILACA MN 56353 MEDICAL CLINIC PART I, LINE 3C: THE FEDERAL POVERTY INCOME GUIDELINES PROVIDE THE INITIAL FRAMEWORK TO DETERMINE THE INDIVIDUAL'S ABILITY TO PAY. INDIVIDUALS WITH INCOME AND ASSETS EQUAL TO OR LESS THAN THE FEDERAL POVERTY INCOME GUIDELINES, WITH NO OTHER AVAILABLE ASSETS MUST BE EVALUATED TO SEE IF THE PATIENT FIRST QUALIFIES FOR ASSISTANCE FROM ANY FEDERAL, STATE, OR LOCAL COUNTY PROGRAMS SUCH AS MA. A REASONABLE PAYMENT SCHEDULE OVER A ONE OR TWO YEAR PERIOD WILL BE DETERMINED IN THE INTERVIEW PROCESS. THE PORTION THAT WILL BE WRITTEN OFF SHOULD THEN BE CLASSIFED AS A CHARITY DISCOUNT. INDIVIDUALS WITHIN TWO (2) TIMES THE FEDERAL POVERTY GUIDELINES MAY ALSO HAVE SOME MEDICAL INSURANCE COVERAGE. THE PATIENT DEDUCTABLE AND NONCOVERED SERVICES MAY BE LARGE ENOUGH THAT THE INDIVIDUAL IN INCAPABLE OF PAYING OFF WITHIN A 1-2 YEAR PERIOD. THEREFORE, THIS UNPAYABLE AMOUNT BY THE PATIENT MAY BE CLASSIFED AS CHARITY DISCOUNT. PART I, LINE 7: THE COSTS INCLUDED IN PART 1, LINES 7A AND 7B WERE DERIVED BY USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 AND THEN APPLIED AGAINST INTERNALLY DEVELOPED NUMBERS. THE COSTS INCLUDED IN PART 1, LINES 7E, 7F AND 7I WERE ACTUAL COSTS TRACKED BY THE HEALTH SYSTEM IN THEIR FINANCIAL PROCESS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,204,919. PART III, LINE 2: SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" PARAGRAPHS ON PAGES 8 AND 9 OF THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT OUR BAD DEBT EXPENSE CALCULATION. PART III, LINE 3: MILLE LACS HEALTH SYSTEM IS REPORTING $0 BECAUSE WE DO NOT HAVE A METHOD TO REASONABLY ESTIMATE THE PORTION OF BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DIDN'T APPLY. PART III, LINE 4: SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" PARAGRAPHS ON PAGES 8 AND 9 OF THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT OUR BAD DEBT EXPENSE CALCULATION. PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS AND REVENUES WERE CALCULATED USING THE 9/30/2015 COST REPORT. THE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT AS IT REPRESENTS A FINANCIAL SACRIFICE BY MILLE LACS HEALTH SYSTEM IN SERVING THE ELDERLY MEMBERS OF OUR COMMUNITY WHO MAY OTHERWISE STRUGGLE TO AFFORD HEALTH CARE. PART III, LINE 9B: ONCE SOMEONE IS APPROVED FOR FINANCIAL ASSISTANCE OUR BUSINESS OFFICE WILL REMOVE THE AMOUNT SENT PREVIOUSLY TO THE COLLECTION AGENCIES. WE CONTACT THE COLLECTION AGENCY TO STOP PURSUING PAYMENT FROM THE PATIENT AND WORK WITH THE PATIENT BALANCES IN HOUSE. PART VI, LINE 2: MILLE LACS HEALTH SYSTEM ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITY THROUGH THE ORGANIZATION OF COMMUNITY MEETINGS - FEEDBACK FORUMS. THE ORGANIZERS PROVIDE CONSTANT FEEDBACK OF COMMUNITY NEEDS. THERE ARE COMMUNITY FOCUS GROUPS AND HOSPITAL STAFF ATTENDANCE AT VARIOUS CLUB MEETINGS TO PROVIDE HEALTH INFORMATION AND GUIDANCE ON HOW TO ACCESS TO THE HOSPITALS SERVICES. PART VI, LINE 3: ELIGIBILITY FOR ASSISTANCE INFORMATION IS ON THE BILLING STATEMENTS. THE HEALTH SYSTEM PROVIDES ARTICLE NEWSLETTERS AND COMMUNITY OUTREACH PROGRAMS ON SUCH PROGRAMS AVAILABLE TO THE PUBLIC. AN ASSISTANCE INFORMATION SHEET IS PROVIDED TO THE PATIENT OR REPRESENTATIVE AT THE TIME OF THE SERVICE OR AT A SCHEDULED MEETING FOR ELIGIBILITY. PART VI, LINE 4: MILLE LACS HEALTH SYSTEM IS LOCATED 80 MILES NORTH OF THE MINNEAPOLIS MN AREA IN CENTRAL MINNESOTA. THE HEALTH SYSTEM SERVES THE PREDOMINATELY RURAL AREA OF MILLE LACS COUNTY AND PORTIONS OF MORRISON, AITKIN, CROW WING AND KANABEC COUNTIES, PLUS THE MILLE LACS OJIBWE INDIAN RESERVATION. THE MILLE LACS PRIMARY SERVICE AREA INCLUDES 15,000 TO 18,000 YEAR ROUND RESIDENTS WITH THE POPULATION DOUBLING DURING THE PEAK TOURIST SEASON. PERSONS LIVING BELOW THE POVERTY LEVEL IS IN MILLE LACS COUNTY IS 13.4% FROM THE US CENSUS. THE DEMOGRAPHIC AND SOCIOECONOMIC PROFILE COMMON TO OUR RURAL COMMUNITY ALSO INFLUENCES THE DEMANDS ON OUR HEALTHCARE SYSTEM. RURAL AREAS IN GENERAL HAVE GREATER CONCENTRATIONS OF ELDERLY PEOPLE THAN DO URBAN AREAS. AN OLDER POPLULATION IS MORE LIKELY TO HAVE CHRONIC HEALTHCARE NEEDS, WHICH CAN PLACE A HEAVY BURDEN ON COMMUNITIES THAT ALREADY FACE PROVIDER SHORTAGES. PART VI, LINE 5: MILLE LACS HEALTH SYSTEM PROVIDES EDUCATIONAL HEALTH FAIRS, COMMUNITY MEETINGS ON HEALTH PROBLEMS, DIAGNOSIS AND PREVENTION METHODS. PART OF OUR MISSION STATEMENT IS TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MAINTAINING OPTIMAL HEALTH. THE HEALTH SYSTEM PROVIDES PASTORAL CARE TO PATIENTS UPON REQUEST-FROM OUR AREA CHURCHES CLERGY. WE SEND OUT QUARTERLY COMMUNITY HEALTH INFORMATION NEWS LETTERS. WE PROVIDE FREE BLOOD PRESSURE TESTING PROGRAMS. 1 PART I, LINE 2: MILLE LACS HEALTH SYSTEM GIVES SMALL CONTRIBUTIONS TO SUPPORT VARIOUS LOCAL CHARITIES. THE ORGANIZATION DOES NOT MONITOR HOW THOSE CONTRIBUTIONS ARE SPENT, TRUSTING THAT THE RECIPIENT ORGANIZATION WILL SPEND IT APPROPRIATELY ACCORDING TO ITS CHARITABLE MISSION AND PURPOSE. X X X X X 0 0 0 0 0 0 0 0 0 DR CATHY DONOVAN BOARD MEMBER/PHYSICIAN 197841 0 25 0 4530 0 6522 0 35230 0 244148 0 0 0 DR ARDEN VIRNIG BOARD MEMBER/PHYSICIAN 190394 0 25 0 5609 0 7854 0 8797 0 212679 0 0 0 WILLIAM NELSON CEO 253314 0 56275 0 11273 0 9800 0 55065 0 385727 0 0 0 JOHN UNZEN CFO 142569 0 25 0 4724 0 5993 0 11586 0 164897 0 0 0 KIM KUCERA COO 141456 0 25 0 4312 0 6140 0 30105 0 182038 0 0 0 PATTI HOOK-VIRNIG CHIEF OF STAFF 147646 0 25 0 4887 0 6685 0 35056 0 194299 0 0 0 DR TOM BRACKEN VP MEDICAL AFFAIRS 221595 0 25 0 6503 0 7427 0 42115 0 277665 0 0 0 CATHERINE STEINER PHYSICIAN ASSISTANT 122096 0 25 0 2921 0 5266 0 35163 0 165471 0 0 0 DAVID STROBEL PHYSICIAN 184166 0 25 0 5654 0 0 0 23966 0 213811 0 0 0 ROGER BOETTCHER PHYSICIAN 180739 0 25 0 5727 0 7738 0 26853 0 221082 0 0 0 PETER LINDBLOOM PHYSICIAN ASSISTANT 138656 0 25 0 3314 0 6215 0 35528 0 183738 0 0 0 A CITY OF ONAMIA 416005437 2003-06-24 4500000 NURSING HOME FACILITY 0 0 0 A 1688136 4500000 40431 4459569 2005 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF ONAMIA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/01/2009 PATTI HOOK-VIRNIG FAMILY MEMBER OF DR. ARDEN VIRNIG, BOARD MEMBER AND PHYSICIAN OF MLHS 194299 COMPENSATION PAID BY MLHS AS AN EMPLOYED PHYSICIAN. HER COMPENSATION IS ALSO REPORTED ON PART VII, SECTION A AND SCHEDULE J, PART II. 0 FORM 990, PART III, LINE 2 THE ORGANIZATION CONTRACTED A FULL-TIME SURGEON. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS COMPRISED OF THE ELECTED OFFICERS OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS OF THE ORGANIZATION IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS AND IS AT ALL TIMES SUBJECT TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A TWO MEMBERS OF THE BOARD OF DIRECTORS ARE PHYSICIANS OF MILLE LACS HEALTH SYSTEM. THESE DIRECTORS ARE ELECTED BY THE MEDICAL STAFF ANNUALLY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS PRESENTED TO THE BOARD MEMBERS FOR REVIEW AND APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR/OFFICER OF MLHS SHALL COMPLETE AND SIGN A CONFLICT OF INTEREST QUESTIONNARIE UPON APPOINTMENT AND THEREAFTER AT THE TIME OF EACH ANNUAL MEETING. THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE CEO AND COMPLIANCE OFFICER. EACH DIRECTOR/OFFICER OF MLHS SHALL FULLY DISCLOSE ANY CONFLICTS OF INTERESTS. IF A CONFLICT OF INTEREST EXISTS, THE BOARD MEMBER/OFFICER MAY BE ASKED TO STEP DOWN. FORM 990, PART VI, SECTION B, LINE 15 THE CEO AND OTHER OFFICERS' COMPENSATION IS EVALUATED BY THE BOARD OF DIRECTORS. COMPARABILITY DATA FROM OTHER AREA FACILITIES IS USED ALONG WITH AN EXECUTIVE SALARY SURVEY TO DETERMINE COMPENSATION FOR TOP MANAGEMENT OFFICIALS. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2015. FORM 990, PART VI, SECTION C, LINE 19 THE HEALTH SYSTEM'S GOVERNING DOCUMENTS, CONFLICT OF INTERET POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 3,605,948. MANAGEMENT AND GENERAL EXPENSES 1,075,044. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,680,992.