2011-08-12T10:10:07-05:00 2010-09-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-10-01 410785161 MILLE LACS HEALTH SYSTEM MILL 3205323154 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 William Nelson 3205323154 2011-08-01 1 6123764500 2009 2016-02-24 21:20:13Z William Nelson 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 35370373 0 X www.mlhealth.org X 1953 MN TO PROVIDE QUALITY HEALTH SERVICES TO RESIDENTS OF ONAMIA, MN AND THE SURROUNDING AREA. 10 8 522 45 0 0 131190 166453 32351364 34713877 6491 59254 1032137 430789 33521182 35370373 60000 60000 0 18725702 19419413 0 0 14198575 14224526 32984277 33703939 536905 1666434 27342222 28768186 16031880 15823667 11310342 12944519 To assist those residing in and visiting the Mille Lacs area in achieving and mantaining optimal health. 0 0 28826229 60000 34713877 Mille Lacs Health System (MLHS) is a rural health system located in Onamia, MN, 80 miles north of the Twin Cities on the south shore of 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 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-La-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. 28826229 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 63 0 522 1 0 0 0 0 0 0 0 0 0 0 0 10 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X X John Unzen CFO 3205323154 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 Mark Tadych 8.00 X X 6050 0 0 Kevin Anderson 2.00 X X 1010 0 0 Judy Waytashek 2.00 X X 930 0 0 Diane Gibas 2.00 X X 630 0 0 Steve Long 2.00 X 660 0 0 Becky Houle 2.00 X 872 0 0 Fr Kermit Holl OSC 2.00 X 675 0 0 Gail Kulick 2.00 X 265 0 0 Arden Virnig 2.00 X 155426 0 6187 Eric Enberg 2.00 X 159851 0 23208 William Nelson 40.00 X 198135 0 15783 John Unzen 40.00 X 121400 0 4815 Kim Kucera 40.00 X 108887 0 21909 Tom Bracken 40.00 X 172017 0 24751 Roger Boettcher 40.00 X 156546 0 22837 Cathy Donovan 40.00 X 145498 0 18043 Rodney Hayes 40.00 X 139703 0 22781 Peter Lindbloom 40.00 X 140910 0 22914 Sharon Gossett 40.00 X 633124 0 9800 2142589 0 193028 15 0 1 0 CMDI 150 10th Street NW Milaca MN 56353 MRI/RADIOLGY 1263123 Behavioral Health Concepts Inc 305 Calle Villario San Clemente CA 92672 COUNSELING SENIOR CARE 410316 Experienced Resources LLC PO Box 201005 Bloomington MN 55420 CONTRACT SERVICES IT/HR 339946 Russ Hauge 4864 Crown Land Woodbury MN 55129 CRNA 279058 Justin Towne central MN Anesthesia 9527 330th Onamia MN 56359 CRNA 261883 9 105635 6601 54217 166453 Patient Revenue 621110 33621203 33621203 JOINT VENTURE INCOME 900099 547016 547016 ASSISTED LIVING 623000 463904 463904 CLINIC REVENUE 900099 47777 47777 Therapy Revenue 900099 33977 33977 34713877 56779 56779 43791 43791 43791 43791 2475 2475 2475 2475 85924 85924 85924 Meals Revenue 900099 259784 259784 Miscellaneous 900099 24045 24045 PENSION REVENUE 900099 11013 11013 6232 6232 301074 35370373 34713877 0 490043 60000 60000 1057303 475916 581387 12513933 11643211 870722 361996 339639 22357 4422151 4173996 248155 1064030 949321 114709 22313 22313 419302 419302 4103228 3272067 831161 113811 1604 112207 969273 629858 339415 513592 492538 21054 155548 111799 43749 1855 1855 671703 649068 22635 2077101 1575632 501469 286634 222259 64375 MEDICAL SUPPLIES 1862829 1862829 BAD DEBT EXPENSE 1536879 1536879 TAXES 609624 274095 335529 FOOD 332681 332681 LICENSES & PERMITS 209410 33929 175481 338743 188908 149835 33703939 28826229 4877710 0 4436055 7164814 238000 238000 6636057 6138589 73776 204968 322422 296657 321089 642706 31831456 19137788 13999723 12693668 1213516 1293269 101584 95515 27342222 28768186 2480738 2522912 10797623 10446453 2203519 2399302 550000 455000 16031880 15823667 X 11310342 12886775 57744 11310342 12944519 27342222 28768186 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 365798 365798 20778622 11384603 9394019 895019 556715 338304 9750017 7196470 2553547 42000 42000 12693668 Due To Third Party Payors 455000 455000 35370373 33703939 1666434 -32257 -32257 1634177 35133653 0 35133653 236720 236720 35370373 33703939 0 33703939 0 33703939 Part X: Description of Uncertain Tax Positions Under FIN 48: Income Taxes 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 guidance clarifies the accounting for uncertainty in income taxes recognized in an entity's financial statements. The guidance further prescribes recognition and measurement of tax provisions taken or expected to be taken on a tax return that are not certain to be realized. The Organization's income tax returns are subject to review and examination by federal, state, and local authorities. The Organization is not aware of any activities that would jeopardize its tax-exempt status. The tax returns for the tax years 2007 to 2009 are open to examination by federl, local, and state authorities. Part XI, Line 8 - Other Adjustments: Net Assets Released from Restrictions: -32257. Part XII, Line 4b - Other Adjustments: Unrestricted Contributions: 83340. Interest Income: 56779. Grant Income: 6601. Restricted Contributions: 90000. 1 1 X 1 X 1 X 1 1 1 0 1 1 692049 692049 0.02150 6140356 5232078 908278 0.02820 6832405 5232078 1600327 0.04970 39 355 7044 7044 0.00020 132179 26099 106080 0.00330 2548486 2313074 235412 0.00730 2762 2762 0.00010 39 355 2690471 2339173 351298 0.01090 39 355 9522876 7571251 1951625 0.06060 0 809208 309648 4219123 5848150 -1629027 X 1 0 Mille Lacs Health System Hospital

200 North Elm Street Onamia MN 563590800

X X X X 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 III, Line 4: A cost-to-charge ratio was used to report bad debt figures. The cost to charge ratio was derived from the irs instructions for scheudle H, Worksheet 2. Amounts on line 3 were calculated manually by reviewing all bad debt charges for patients that had any Medical Assistance or PMAP/MNCARE coverage and Guarantor Notes regarding Charity Care. Most of the visits included in the total were for patients that may have qualified for Charity Care, but they choose not to apply or complete the application. MLHS does offer assistance in the preparation of the charity care forms.Financial Statement Disclosure: Patient accounts receivable, where a 3rd party is responsible for paying the amount, are carried at a net amount determined by the original charge for the services provided less an estimate made for contractual adjustments or discounts to 3rd party payors. Patient accounts due directly from the patients are carried at the original charge for the services less amounts covered by 3rd party payors and less an estimated allowance for doubtful accounts based on a review of outstanding amounts on a monthly basis. Patient accounts receiveable are written off when deemed uncollectible. Part III, Line 8: THE mEDICARE SHORT-FALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE: (1) IT PROVIDES SERVICES TO A SIGNIFICANT PORTION OF OUR SERVICE POPULATION AT A NEGATIVE MARGIN (2) THE HOSPITAL WOULD DISCONTINUE PROVIDING SERVICES TO MEDICARE PATIENTS IF THE DECISION WERE SOLEY FINANCIAL (3) THERE iS A COMMUNITY NEED TO PROVIDE THESE SERVICES AND (4) IF THE HOSPITAL DID NOT PROVIDE THESE SERVICES, THEY WOULD BECOME THE OBLIGATION OF THE GOVERNMENT. Part V: As the clinics are not required to be seperatly registered with the state, they will be included in Part VI as a seperate disclosure:(1) Name: Onamia Family Practice ClinicAddress: 200 North Elm Street Onamia, MN 56359Description: Outpatient Physician Clinic(2) Name: Isle Family Practice ClinicAddress: 375 West Isle Street Isle, MN 56342Description: Outpatient Physician Clinic(3) Name: Hillman Family Practice ClinicAddress: County Road 8 Hillman, MN 56338Description: Outpatient Physician Clinic(4) Name: Garrison Family Practice ClinicAddress: 27378 State Hwy 18 Garrison, MN 56450Description: Outpatient Physician Clinic(5) Name: Mille Lacs Health System Chiropractic/Rehab ClinicAddress: 1000 5th Street, Suite 1010 Milaca, MN 56353Description: Outpatient Chiropractic and Physical Therapy(6) Name: Mille Lacs Health System Home Care & HospiceAddress: 200 North Elm Street, PO Box A Onamia, MN 56359Description: At-home care and care for the terminally ill(7) Name: Mille Lacs Health System Long-Term CareAddress: 200 North Elm Street, PO Box A Onamia, MN 56359Description: Skilled Nursing Facility Part I, Line 7Costs associated with physician clinics as subsidized health services have been included in Part I, Line 7g. 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 an 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 6: 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. MN 1 MILLE LACS AREA HEALTH FOUNDATION INC 200 NORTH ELM STREET PO BOX A ONAMIA MN 56359 743155412 501(C)(3) 60000 GENERAL OPERATING SUPPORT. 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE HEALTH SYSTEM'S ONLY GRANT WAS TO A RELATED FOUNDATION UNDER COMMON MANAGEMENT. X X X X X X 0 0 0 0 0 0 0 0 0 Arden Virnig 155426 0 0 0 0 0 5657 0 530 0 161613 0 0 0 Eric Enberg 159851 0 0 0 0 0 5667 0 17541 0 183059 0 0 0 William Nelson 160635 0 37500 0 0 0 8257 0 7526 0 213918 0 0 0 Tom Bracken 172017 0 0 0 0 0 8257 0 16494 0 196768 0 0 0 Roger Boettcher 156546 0 0 0 0 0 6343 0 16494 0 179383 0 0 0 Cathy Donovan 145498 0 0 0 0 0 5671 0 12372 0 163541 0 0 0 Rodney Hayes 139703 0 0 0 0 0 5672 0 17109 0 162484 0 0 0 Peter Lindbloom 140910 0 0 0 0 0 5805 0 17109 0 163824 0 0 0 Sharon Gossett 633124 0 0 0 0 0 9800 0 0 0 642924 0 0 0 Supplemental Information Part III . City of Onamia 410785161 noneavail 2003-06-24 4500000 Nursing Home Facility 0 0 4500000 40431 4459569 2005 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 Form 990, Part VI, Section B, line 11 The Form 990 will be presented at a board meeting for approval before filing the tax return. Form 990, Part VI, Section B, line 12c Each director/officer of MLHS shall complete and sign a conlfict of interest questionnarie upon appointment and thereafter at the time of each annual meeting. Each director/officer of MLHS shall fully disclose any conflicts of interests. Form 990, Part VI, Section B, line 15 CEO 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. 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. Mille Lacs Area HEALTH Foundation INC 200 North Elm Street PO Box A Onamia MN 56359 743155412 Fundraising MN 501(c)(3) 7 N/A 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0