2019-08-13T11:13:49-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-10-01 410785161 MILLE LACS HEALTH SYSTEM MILL 3205322580 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 WILLIAM NELSON CEO 3205322580 2019-08-09 1 KOREY BOELTER P00775161 6123764500 67.137.57.251 2019-08-09 10:46:47 CD P 9E4ACA9A3A5583693B49D79FC84C6D308F7C5743 E9B0F9A18C8000C04B4B0CC56389FCB9464530FE 2017 2019-02-21 02:37:17Z WILLIAM NELSON 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 44264598 0 X WWW.MLHEALTH.ORG X 1953 MN TO PROVIDE QUALITY HEALTH SERVICES TO RESIDENTS OF ONAMIA, MN AND THE SURROUNDING AREA. 10 8 572 80 0 0 162901 169752 39980583 42039254 30719 44304 1638039 2011288 41812242 44264598 0 0 0 0 25531975 26712686 0 0 0 15870031 15881680 41402006 42594366 410236 1670232 26057876 28390762 11290333 11952987 14767543 16437775 X TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MANTAINING OPTIMAL HEALTH. 0 0 35724374 0 42039254 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. 35724374 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 108 0 1 572 1 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JOHN UNZEN CFO 3205322580 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 KEVIN ANDERSON CHAIR 8.00 0.00 X X 510 0 0 MARK TADYCH CHAIR (THRU DECEMBER 2017) 8.00 0.00 X X 4800 0 0 PHIL GRAVEL VICE CHAIR 2.00 0.00 X X 690 0 0 BECKY HOULE TREASURER 2.00 0.00 X X 660 0 0 WENDY KAFKA SECRETARY 2.00 0.00 X X 870 0 0 DENNIS BURR BOARD MEMBER 2.00 0.00 X 570 0 0 ROB DUBBS BOARD MEMBER 2.00 0.00 X 660 0 0 FR KERMIT HOLL BOARD MEMBER 2.00 0.00 X 390 0 0 BETSY LUNDQUIST BOARD MEMBER 2.00 0.00 X 780 0 0 DR LYNNE STEINER BOARD MEMBER/PHYSICIAN 2.00 0.00 X 217279 0 41990 DR ARDEN VIRNIG BOARD MEMBER/PHYSICIAN 2.00 0.00 X 201190 0 22455 WILLIAM NELSON CEO 40.00 0.00 X 360716 0 61251 JOHN UNZEN CFO 40.00 0.00 X 180069 0 37945 KIM KUCERA COO 40.00 0.00 X 176486 0 32938 DR PATTI HOOK CHIEF OF STAFF 40.00 0.00 X 162129 0 33911 DR MOHAN KARKI CHIEF OF STAFF (THRU DECEMBER 2017) 40.00 0.00 X 225719 0 61316 BECKY FOSSAND VP HUMAN RESOURCES 40.00 0.00 X 150395 0 28380 DR TOM BRACKEN VP MEDICAL AFFAIRS 40.00 0.00 X 191668 0 47279 RANJITA ADHIKARI PHYSICIAN 40.00 0.00 X 206411 0 42560 CATHY DONOVAN PHYSICIAN 40.00 0.00 X 198744 0 43874 ROGER BOETTCHER PHYSICIAN 40.00 0.00 X 194903 0 31992 CATHERINE STEINER PHYSICIAN ASSISTANT 36.00 0.00 X 173239 0 46106 MARK MARSHALL PHYSICIAN ASSISTANT 36.00 0.00 X 163827 0 21262 2812705 0 553259 20 0 1 0 CENTRAL MN ANESTHESIA SERVICES INC 9527 330TH ST ONAMIA MN 56359 ANESTHESIA SERVICES 506051 FOCUSONE SOLUTIONS INC PO BOX 3037 OMAHA NE 68103 TEMPORARY STAFFING 248573 CLIFTONLARSONALLEN LLP PO BOX 776376 CHICAGO IL 60677 AUDIT/TAX/ACCOUNTING 171915 PREMIER STAFFING 243 WINKLER TRAIL COLOGNE MN 55322 TEMPORARY STAFFING 154106 FAIRVIEW HEALTH SERVICES PO BOX 9459 MINNEAPOLIS MN 55440 DIAGNOSTIC SERVICES 118128 8 169752 169752 PATIENT REVENUE 621110 36513892 36513892 CLINIC REVENUE 900099 4435922 4435922 ASSISTED LIVING 623000 730387 730387 JOINT VENTURE INCOME 900099 335183 335183 THERAPY REVENUE 900099 23870 23870 42039254 43904 43904 76886 0 76886 76886 76886 400 0 400 400 400 74688 0 74688 74688 340(B) REVENUE 900099 1269951 1269951 MEALS REVENUE 900099 374317 374317 MISCELLANEOUS 900099 144160 144160 71286 71286 1859714 44264598 42039254 0 2055592 X 2438657 1093467 1345190 19065369 17647158 1418211 581001 511635 69366 3163658 2785945 377713 1464001 1305403 158598 24523 24523 156757 156757 5210915 3945121 1265794 167705 151621 16084 1393068 776120 616948 281140 54593 226547 638412 616225 22187 242293 202839 39454 367617 303273 64344 1321590 1037311 284279 321395 209367 112028 MEDICAL SUPPLIES 2587107 2587107 BAD DEBT EXPENSE 1623788 1623788 FOOD 492547 492547 MEDICAID ASSESSMENT 362079 160455 201624 690744 220399 470345 42594366 35724374 6869992 0 2384639 4873444 4827872 4857876 6391225 6690716 120000 80000 464675 446673 374851 768089 42021667 32523800 10471452 9497867 72735 138120 950427 1037977 26057876 28390762 2441428 2897520 7186008 6629711 8524 7763 1365404 1264255 288969 1153738 11290333 11952987 X 14767543 16396817 0 40958 14767543 16437775 26057876 28390762 1670232 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 2493 2493 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL DUES TO AHA/MHA/MHCA, OF WHICH, A PORTION IS SPENT ON LOBBYING. 0 1 X 1187310 1187310 24476648 18489910 5986738 1185616 930189 255427 14956053 13103701 1852352 216040 216040 9497867 DUE TO THIRD PARTY PAYERS 1153738 1153738 X 42398669 -1623788 -1623788 44022457 242141 242141 44264598 40970578 0 40970578 1623788 1623788 42594366 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 NONPROFIT 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: PROVISION FOR UNCOLLECTIBLE ACCOUNTS -1,623,788. PART XI, LINE 4B - OTHER ADJUSTMENTS: UNRESTRICTED CONTRIBUTIONS 21,666. INTEREST INCOME 34,740. GRANT INCOME 24,924. RENTAL INCOME 27,964. GAIN ON DISPOSAL OF EQUIPMENT 400. CAPITAL GRANTS AND CONTRIBUTIONS 91,489. TEMPORARILY RESTRICTED CONTRIBUTIONS 40,958. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,623,788. 1 1 X 1 X 1 X 1 1 1 0 1 1 85668 85668 0.00210 6411094 4247166 2163928 0.05280 6496762 4247166 2249596 0.05490 59386 59386 0.00140 130465 130465 0.00320 3889 3889 0.00010 193740 193740 0.00470 6690502 4247166 2443336 0.05960 1 1623788 0 5584004 8836593 -3252589 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 15 1 0 0 1 X WWW.MLHEALTH.ORG/CONTENT/QUALITY-CARE X 1 15 0 1 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X HTTPS://WWW.MLHEALTH.ORG/SUBMIT_BILL_PAY X HTTPS://WWW.MLHEALTH.ORG/SUBMIT_BILL_PAY X HTTPS://WWW.MLHEALTH.ORG/SUBMIT_BILL_PAY X X X X X X 1 X 0 X X X 1 X 0 0 MILLE LACS HEALTH SYSTEM PART V, SECTION B, LINE 5: WE GATHERED QUALITATIVE INFORMATION AND PERSPECTIVES ON COMMUNITY HEALTH NEEDS THROUGH ONE-ON-ONE AND SMALL GROUP INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS. THESE INTERVIEWS WERE CONDUCTED IN MAY 2016. THE PRIMARY GOAL OF THESE INTERVIEWS WAS TO ASCERTAIN A RANGE OF PERSPECTIVES ON THE COMMUNITY'S HEALTH NEEDS. WE GATHERED INFORMATION FROM THE FOLLOWING SPECIFIED GROUPS WITHIN OUR COMMUNITY: - PEOPLE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH; - GOVERNMENT HEALTH DEPARTMENTS AND OTHER GOVERNMENT AGENCIES; - LEADERS, REPRESENTATIVES OR MEMBERS OF MEDICALLY UNDERSERVED POPULATIONS; - LEADERS, REPRESENTATIVES OR MEMBERS OF LOW-INCOME POPULATIONS; AND - LEADERS, REPRESENTATIVES OR MEMBERS OF MINORITY POPULATIONS.THE FOLLOWING AGENCIES, ORGANIZATIONS AND BUSINESSES PARTICIPATED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS BY CONTRIBUTING THEIR PERSPECTIVES, OPINIONS AND OBSERVATIONS. - MILLE LACS COUNTY DEPARTMENT OF COMMUNITY & VETERAN SERVICES - MILLE LACS BAND OF THE OJIBWE TRIBE - ONAMIA SCHOOL DISTRICT - MILLE LACS COUNTY SHERIFF'S DEPARTMENT - CITY OF ONAMIA - CITY OF MILACA - CITY OF ISLE - CITY OF GARRISON - MILLE LACS HEALTH SYSTEM - HOLY CROSS CATHOLIC CHURCHWE BELIEVE EACH OF THESE ORGANIZATIONS IS A QUALIFIED REPRESENTATIVE OF THE IDENTIFIED GROUPS BECAUSE THE NATURE OF THEIR WORK BRINGS THEM INTO CONTACT WITH THOSE GROUPS ON A REGULAR BASIS. FOR MANY OF THE ORGANIZATIONS LISTED, THE NATURE OF THEIR MISSION AND PURPOSE REQUIRES THEM TO CONSIDER THE SPECIAL NEEDS OF THE GROUPS IDENTIFIED.COMMUNITY FORUMSIN ADDITION TO THE INTERVIEWS LISTED ABOVE, WE ALSO CONDUCTED FIVE COMMUNITY FORUMS THROUGHOUT OUR COMMUNITY TO GET BROADER INPUT FROM THE GENERAL PUBLIC. THE FORUMS WERE HELD IN MAY 2016, IN THE FOLLOWING LOCATIONS. - ONAMIA - 18 INDIVIDUALS - ISLE - 13 INDIVIDUALS - GARRISON - 9 INDIVIDUALS - HILLMAN - 6 INDIVIDUALS - MILACA - 12 INDIVIDUALS IN TOTAL, 58 INDIVIDUALS PROVIDED INPUT THROUGH THE COMMUNITY FORUMS. MILLE LACS HEALTH SYSTEM PART V, SECTION B, LINE 11: THROUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT, MILLE LACS HEALTH SYSTEM IDENTIFIED THE FOLLOWING SIGNIFICANT COMMUNITY HEALTH NEEDS AND PRIORITIZED THEM IN THE GIVEN ORDER:1. BEHAVIORAL HEALTH 2. CHRONIC DISEASES3. OBESITYCONSISTENT WITH THE REQUIREMENTS OF SECTION 501(R)(3), THIS IMPLEMENTATION STRATEGY IDENTIFIES MLHS'S PLANNED RESPONSE TO EACH SIGNIFICANT COMMUNITY HEALTH NEED. IF MLHS DOES NOT PLAN TO ADDRESS A HEALTH NEED, THIS IMPLEMENTATION STRATEGY EXPLAINS WHY.BEHAVIORAL HEALTH: BEHAVIORAL HEALTH ENCOMPASSES BOTH SUBSTANCE ABUSE AND MENTAL HEALTH. MLHS CONSIDERS THESE TO BE THE COMMUNITY HEALTH NEED MOST IN NEED OF IMMEDIATE ATTENTION.SUBSTANCE ABUSEMLHS EXECUTIVES AND MEDICAL STAFF HAVE APPROVED IMPLEMENTATION OF THE CHRONIC OPIOID ANALGESIC THERAPY ("COAT") PROGRAM, A TREATMENT PROGRAM DESIGNED TO HELP PEOPLE WITH A HISTORY OF CHRONIC OPIOID USE REDUCE OR ELIMINATE THEIR DEPENDENCE ON THOSE MEDICATIONS FOR NONCANCER-RELATED PAIN. THE PROGRAM WORKS TO TARGET CHRONIC OPIOID USERS THROUGH CAREFUL MONITORING OF THEIR PRESCRIPTION HISTORY, EDUCATING THEM ABOUT THE DANGERS OF OVERUSE AND, WHEN APPROPRIATE, GUIDING THEM THROUGH A GRADUAL WEANING PROCESS TO A SAFER LEVEL OF USE. THE WEANING PROCESS INCLUDES GRADUAL REDUCTION AND CAREFUL COUNSELING AND GUIDANCE, HELPING THE INDIVIDUAL REALIZE THAT OTHER, HEALTHIER OPTIONS EXIST.THE COAT PROGRAM WAS ADOPTED AS A COLLABORATIVE EFFORT WITH SURROUNDING COMMUNITIES AND OTHER AREA HEALTH CARE PROVIDERS. THE COLLABORATIVE CONVERSATION WAS INITIATED BY CHI ST. GABRIEL'S HOSPITAL IN LITTLE FALLS.THE COAT PROGRAM REQUIRES A SERIOUS COMMITMENT FROM PATIENTS AND PHYSICIANS, INCLUDING AN EXHAUSTIVE INITIAL ASSESSMENT WITH A PHYSICIAN, DRUG SCREENS, A TREATMENT PLAN, SUPERVISED REFILLS AND QUARTERLY DOCTOR VISITS. THEREFORE, THE PRIMARY RESOURCE COMMITTED TO THIS PROGRAM IS THE TIME OF OUR MEDICAL STAFF.THROUGH THE COAT PROGRAM, MLHS HOPES TO:- DECREASE THE QUANTITY OF PRESCRIPTION DRUGS DIVERTED AWAY FROM INTENDED USERS;- DECREASE THE NUMBER OF INDIVIDUALS ADDICTED TO OPIOIDS;- DECREASE THE FREQUENCY WITH WHICH INDIVIDUALS MOVE FROM PRESCRIPTION MEDICATIONS TO ILLICIT DRUGS, SUCH AS HEROIN; - DECREASE "PRESCRIPTION FISHING", IN WHICH INDIVIDUALS TRAVEL TO VARIOUS DISTANT EMERGENCY ROOMS CLAIMING INJURY OR PAIN TO OBTAIN ADDITIONAL OPIOIDS; AND- ENSURE EACH INDIVIDUAL IS PRESCRIBED APPROPRIATE MEDICATIONS TO EFFECTIVELY TREAT THEIR MEDICAL CONDITION(S).THROUGH THE ABOVE OUTCOMES, MLHS ALSO HOPES TO INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES ACROSS OUR COMMUNITY BY REDUCING THE AMOUNT OF TIME AND RESOURCES DEDICATED TO THESE LONG-TERM OPIOID ABUSERS, WHICH WOULD ALLOW ADDITIONAL INDIVIDUALS TO BE TREATED WITH MINIMAL CHANGES IN STAFFING.MENTAL HEALTHMLHS EXECUTIVES AND MEDICAL STAFF HAVE INITIATED A PARTNERSHIP WITH BEHAVIORAL HEALTH PROVIDERS ("BHP"), A SUBSIDIARY OF FAIRVIEW HEALTH SERVICES, TO PROVIDE TELEMEDICINE SERVICES FOR MLHS EMERGENCY ROOM PATIENTS WITH MENTAL HEALTH NEEDS. THROUGH THIS PARTNERSHIP, BHP WILL PROVIDE A MENTAL/BEHAVIORAL HEALTH ASSESSMENT AND ASSIST MLHS STAFF IN PLAN DEVELOPMENT. SOME PATIENTS WILL BE DISCHARGED WITH OUTPATIENT MENTAL HEALTH OPTIONS, WHILE OTHERS MAY REQUIRE INPATIENT THERAPY. BHP WILL ASSIST MLHS IN IDENTIFYING THE APPROPRIATE SETTING FOR THESE PATIENTS. MLHS HAS COMMITTED SPACE WITHIN OUR EMERGENCY DEPARTMENT, ALONG WITH ACQUISITION OF THE NECESSARY EQUIPMENT, TO PROVIDE THIS TELEMEDICINE SERVICE TO OUR PATIENTS.MLHS HAS ALSO APPROVED A COLLABORATION WITH NORTHERN PINES MENTAL HEALTH CENTER ("NORTHERN PINES") IN WHICH NORTHERN PINES WILL PROVIDE SOCIAL SERVICE VISITS AT THE MLHS CLINIC IN ONAMIA TWO DAYS A WEEK. MLHS HAS COMMITTED SPACE WITHIN THE ONAMIA CLINIC TO PROVIDE THIS SERVICE TO OUR COMMUNITY.FINALLY, MLHS IS COMMITTED TO EXPANDING OUR BEHAVIORAL HEALTH SERVICES BY INCREASING THE NUMBER OF PSYCHIATRISTS AND PSYCHOLOGISTS ON OUR MEDICAL STAFF, ALTHOUGH THE DIFFICULTY OF RECRUITING PH.D.- LEVEL INDIVIDUALS MEANS WE CANNOT COMMIT TO A SPECIFIC TIME-FRAME WITHIN WHICH THESE ADDITIONS WILL OCCUR.THROUGH THESE PROGRAMS AND EFFORTS, MLHS AIMS TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES IN OUR COMMUNITY BY PROVIDING ADDITIONAL SERVICES, HIGHER QUALITY SERVICES, AND MORE FREQUENT SERVICES, IMPROVING THE LEVEL OF CARE FOR EACH PERSON WE SERVE.CHRONIC ILLNESSES & DISEASESCHRONIC ILLNESSES AND DISEASE ARE INCLUDED IN THE QUALITY MEASURES UPON WHICH MLHS IS EVALUATED BY THE U.S. CENTERS FOR MEDICARE & MEDICAID SERVICES ("CMS"). AS SUCH, MLHS IS COMMITTED TO ADDRESSING THESE NEEDS, ALTHOUGH WE HAVE NO SPECIFIC PLANS THAT ARE APPROPRIATE TO SHARE WITHIN THIS DOCUMENT.OBESITYOBESITY IS ALSO INCLUDED IN THE QUALITY MEASURES UPON WHICH MLHS IS EVALUATED BY CMS. AS SUCH, MLHS IS COMMITTED TO ADDRESSING THIS NEED, ALTHOUGH WE HAVE NO SPECIFIC PLANS THAT ARE APPROPRIATE TO SHARE WITHIN THIS DOCUMENT.ACCESS TO HEALTH CAREMLHS IS ATTEMPTING TO IMPROVE ACCESS TO HEALTH CARE THROUGH OUR EFFORTS TO IMPROVE ACCESS TO BEHAVIORAL HEALTH SERVICES, AS DISCUSSED ABOVE.MILLE LACS HEALTH SYSTEM CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2013 AND PUBLISHED THE RELATED REPORT IN SEPTEMBER 2013. IN THAT ASSESSMENT, THE FOLLOWING NEEDS WERE IDENTIFIED:1. ACCESS TO CARE2. OBESITY3. CHRONIC DISEASES4. HEALTH EDUCATION5. SUBSTANCE ABUSE6. HEALTH CARE FOR LOW-INCOME INDIVIDUALS7. HEALTH CARE FOR NATIVE AMERICANS8. HEALTH CARE FOR THE ELDERLY9. HEALTH CARE FOR CHILDRENBASED ON THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT, WE EXPANDED OUR CLINIC HOURS TO SATURDAYS AND IMPROVED OUR 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.BECAUSE OF LIMITED RESOURCES, WE CANNOT RESPOND EFFECTIVELY TO EVERY IDENTIFIED HEALTH NEED. WE HAVE CHOSEN OUR RESPONSES BASED ON ANALYSES OF OUR RESOURCES, OUR MISSION, OUR EXISTING SPECIALTIES, COMMUNITY PRIORITIES, AND EXISTING COMMUNITY RESOURCES. 5 1 - MHLS FAMILY CLINIC - ONAMIA 200 N ELM STREET ONAMIA MN 56359 MEDICAL CLINIC 2 - MHLS FAMILY CLINIC - ISLE 375 W ISLE STREET ISLE MN 56342 MEDICAL CLINIC 3 - MHLS FAMILY CLINIC - GARRISON 27378 STATE HIGHWAY 18 GARRISION MN 56450 MEDICAL CLINIC 4 - MHLS FAMILY CLINIC - HILLMAN 26362 370TH AVENUE HILLMAN MN 56338 MEDICAL CLINIC 5 - MHLS FAMILY CLINIC - MILACA 1010 5TH STREET 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 1- OR 2-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 IS INCAPABLE OF PAYING OFF WITHIN A 1-2 YEAR PERIOD. THEREFORE, THIS UNPAYABLE AMOUNT BY THE PATIENT MAY BE CLASSIFED AS A 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 $ 1,623,788. PART III, LINE 2: SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" PARAGRAPHS ON PAGES 7 AND 8 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 7 AND 8 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 9/30/2018 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: REASONABLE EFFORTS TO NOTIFY AN INDIVIDUAL ABOUT FINANCIAL ASSISTANCEAT LEAST 30 DAYS PRIOR TO TAKING ANY EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL, THE HEALTH SYSTEM WILL PROVIDE THE INDIVIDUAL WITH A WRITTEN NOTICE THAT INCLUDES THE FOLLOWING INFORMATION. - THE HEALTH SYSTEM OFFERS FINANCIAL ASSISTANCE TO ELIGIBLE INDIVIDUALS. - IDENTIFY THE EXTRAORDINARY COLLECTION ACTIONS THAT MAY BE INITIATED AGAINST THE INDIVIDUAL TO OBTAIN PAYMENT FOR THE CARE. - PROVIDE A DEADLINE AFTER WHICH SUCH EXTRAORDINARY COLLECTION ACTIONS MAY BE INITIATED.THE WRITTEN NOTICE WILL INCLUDE A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY. THE HEALTH SYSTEM WILL ALSO MAKE REASONABLE EFFORTS TO ORALLY NOTIFY THE RESPONSIBLE PARTY ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW THE INDIVIDUAL MAY OBTAIN ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS.BEFORE ENGAGING IN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL, THE BUSINESS OFFICE MANAGER WILL DETERMINE THAT REASONABLE EFFORTS HAVE BEEN MADE TO NOTIFY THE INDIVIDUAL ABOUT FINANCIAL ASSISTANCE.IF AN INDIVIDUAL SUBMITS A FINANCIAL ASSISTANCE APPLICATION, THE HEALTH SYSTEM WILL CEASE ALL COLLECTION EFFORTS UNTIL A DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY IS MADE. IF THE HEALTH SYSTEM OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION, THE EXTRAORDINARY COLLECTION ACTION WILL BE SUSPENDED. SUSPENDING AN ACTION MEANS THAT NO FURTHER STEPS ARE TAKEN ON THAT EXTRAORDINARY COLLECTION ACTION AND NO NEW EXTRAORDINARY COLLECTION ACTIONS ARE INITIATED. THIS SUSPENSION MAY BE LIFTED WHEN THE HEALTH SYSTEM DETERMINES THE INDIVIDUAL'S ELIGIBILITY FOR FINANCIAL ASSISTANCE AND NOTIFIES THE INDIVIDUAL OF THAT DECISION.IF THE HEALTH SYSTEM OR ANOTHER AUTHORIZED PARTY HAS ALREADY BEGUN AN EXTRAORDINARY COLLECTION ACTION AGAINST AN INDIVIDUAL WHEN THAT INDIVIDUAL IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, ALL REASONABLY AVAILABLE MEASURES WILL BE TAKEN TO REVERSE THE EXTRAORDINARY COLLECTION ACTION. SUCH STEPS INCLUDE, BUT ARE NOT LIMITED TO, VACATING A JUDGMENT AGAINST THE INDIVIDUAL, LIFTING A LEVY OR LIEN ON THE INDIVIDUAL'S PROPERTY, AND REMOVING FROM THE INDIVIDUAL'S CREDIT REPORT ANY ADVERSE INFORMATION THAT WAS REPORTED.IF AN INDIVIDUAL SUBMITS AN INCOMPLETE FINANCIAL ASSISTANCE APPLICATION, THE HEALTH SYSTEM WILL TAKE THE FOLLOWING STEPS TO ENCOURAGE THEM TO COMPLETE THE APPLICATION. - SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS TO OBTAIN PAYMENT FOR THE CARE. - PROVIDE A WRITTEN NOTICE TO THE RESPONSIBLE PARTY THAT INCLUDES THE ADDITIONAL INFORMATION AND/OR DOCUMENTATION THAT MUST BE SUBMITTED, AND THE PHYSICAL LOCATION AND PHONE NUMBER OF THE BUSINESS OFFICE MANAGER, WHO CAN ANSWER QUESTIONS ABOUT THE FINANCIAL ASSISTANCE POLICY AND/OR PROVIDE ASSISTANCE WITH THE FINANCIAL ASSISTANCE APPLICATION PROCESS. - ALLOW A REASONABLE AMOUNT OF TIME FOR THE RESPONSIBLE PARTY TO SUBMIT A COMPLETE FINANCIAL ASSISTANCE APPLICATION. SUCH PERIOD OF TIME WILL BE AT LEAST 30 DAYS FROM THE DATE THE WRITTEN NOTICE IS SENT TO THE RESPONSIBLE PARTY.IF THE INDIVIDUAL FAILS TO PROVIDE THE REQUESTED INFORMATION WITHIN THE STATED TIME, THE HEALTH SYSTEM MAY RENEW THE PREVIOUSLY INITIATED EXTRAORDINARY COLLECTION ACTIONS.IF AN INDIVIDUAL HAS MADE FULL OR PARTIAL PAYMENT, AND THE INDIVIDUAL IS SUBSEQUENTLY DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, ANY PAYMENTS IN EXCESS OF THEIR NEWLY CALCULATED REMAINING LIABILITY WILL BE REFUNDED TO THE PATIENT WITHIN 30 DAYS OF THE FINANCIAL ASSISTANCE ELIGIBILITY DETERMINATION. IF THE REFUNDABLE AMOUNT IS LESS THAN $5.00, IT WILL NOT BE REFUNDED. 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 HOSPITAL'S 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 NEWSLETTERS. WE PROVIDE FREE BLOOD PRESSURE TESTING PROGRAMS. PART VI, LINE 7, REPORTS FILED WITH STATES MN X X X X 0 0 0 0 0 0 0 0 0 DR LYNNE STEINER BOARD MEMBER/PHYSICIAN 194156 0 20040 0 3083 0 7478 0 34512 0 259269 0 0 0 DR ARDEN VIRNIG BOARD MEMBER/PHYSICIAN 198368 0 38 0 2784 0 6844 0 15611 0 223645 0 0 0 WILLIAM NELSON CEO 291979 0 66038 0 2699 0 9800 0 51451 0 421967 0 0 0 JOHN UNZEN CFO 178292 0 37 0 1740 0 6968 0 30977 0 218014 0 0 0 KIM KUCERA COO 174455 0 38 0 1993 0 7369 0 25569 0 209424 0 0 0 DR PATTI HOOK CHIEF OF STAFF 159862 0 38 0 2229 0 5795 0 28116 0 196040 0 0 0 DR MOHAN KARKI CHIEF OF STAFF (THRU DECEMBER 2017) 222677 0 37 0 3005 0 4492 0 56824 0 287035 0 0 0 BECKY FOSSAND VP HUMAN RESOURCES 148573 0 38 0 1784 0 6133 0 22247 0 178775 0 0 0 DR TOM BRACKEN VP MEDICAL AFFAIRS 189107 0 481 0 2080 0 6775 0 40504 0 238947 0 0 0 RANJITA ADHIKARI PHYSICIAN 203445 0 37 0 2929 0 3977 0 38583 0 248971 0 0 0 CATHY DONOVAN PHYSICIAN 196122 0 39 0 2583 0 6758 0 37116 0 242618 0 0 0 ROGER BOETTCHER PHYSICIAN 192617 0 38 0 2248 0 6749 0 25243 0 226895 0 0 0 CATHERINE STEINER PHYSICIAN ASSISTANT 171312 0 39 0 1888 0 7243 0 38863 0 219345 0 0 0 MARK MARSHALL PHYSICIAN ASSISTANT 162230 0 38 0 1559 0 6680 0 14582 0 185089 0 0 0 A CITY OF ONAMIA 416005437 2003-06-24 4500000 NURSING HOME FACILITY 0 0 0 A 2209614 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 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 11B PRIOR TO FILING THE 990 TAX FORM, IT IS PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. 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 2018. 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 3,945,121. MANAGEMENT AND GENERAL EXPENSES 1,265,794. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,210,915.