MILLE LACS HEALTH SYSTEM: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- MILLE LACS HEALTH SYSTEM (EIN 41-0785161)
- Tax period
- 2013-10-01 to 2014-09-30
- Filed
- 2015-08-13
- IRS object ID
- 201502259349301550
- Schema version
- 2013v4.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-08-13T09:31:09-05:00 | ReturnTs |
| Tax Period End | 2014-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410785161 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLE LACS HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MILL | BusinessNameControlTxt |
| Phone | 3205322580 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 NORTH ELM STREET PO BOX A | AddressLine1 |
| City | ONAMIA | City |
| State | MN | State |
| ZIP Code | 563590800 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | WILLIAM NELSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 3205322580 | PhoneNum |
| Signature | 2015-08-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KACIE MCEWEN | PreparerPersonNm |
| PTIN | P01599614 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | WILLIAM NELSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 NORTH ELM STREET PO BOX A | AddressLine1 |
| City | ONAMIA | City |
| State | MN | State |
| ZIP Code | 563590800 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $37,133,179 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MLHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1953 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTH SERVICES TO RESIDENTS OF ONAMIA, MN AND THE SURROUNDING AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 556 | TotalEmployeeCnt |
| Total Volunteers | 20 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $238,007 | PYContributionsGrantsAmt |
| CY Contributions Grants | $92,437 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $37,009,715 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,958,037 | CYProgramServiceRevenueAmt |
| PY Investment Income | $63,764 | PYInvestmentIncomeAmt |
| CY Investment Income | $18,685 | CYInvestmentIncomeAmt |
| PY Other Revenue | $515,293 | PYOtherRevenueAmt |
| CY Other Revenue | $1,064,020 | CYOtherRevenueAmt |
| PY Total Revenue | $37,826,779 | PYTotalRevenueAmt |
| CY Total Revenue | $37,133,179 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $55,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $23,004,345 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,811,045 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $14,458,944 | PYOtherExpensesAmt |
| CY Other Expenses | $14,209,366 | CYOtherExpensesAmt |
| PY Total Expenses | $37,518,289 | PYTotalExpensesAmt |
| CY Total Expenses | $38,020,411 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $308,490 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$887,232 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,831,401 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,577,899 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,152,216 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,785,946 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $15,679,185 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,791,953 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MANTAINING OPTIMAL HEALTH. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $31,804,043 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $35,958,037 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $31,804,043 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 102 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 556 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN UNZEN CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3205322581 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 NORTH ELM STREET PO BOX A | AddressLine1 |
| City | ONAMIA | City |
| State | MN | State |
| ZIP Code | 563590800 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MARK TADYCH | ||||||||
| CHAIR | 8.00 | Yes (X) | Yes (X) | $4,800 | $0 | $0 | ||
| FR KERMIT HOLL | ||||||||
| VICE-CHAIR | 2.00 | Yes (X) | Yes (X) | $630 | $0 | $0 | ||
| BECKY HOULE | ||||||||
| TREASURER | 2.00 | Yes (X) | Yes (X) | $690 | $0 | $0 | ||
| DIANE GIBAS | ||||||||
| SECRETARY | 2.00 | Yes (X) | Yes (X) | $600 | $0 | $0 | ||
| BETSY LUNDQUIST | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $840 | $0 | $0 | |||
| WENDY KAFKA | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $60 | $0 | $0 | |||
| PHIL GRAVEL | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $570 | $0 | $0 | |||
| DR ARDEN VIRNIG | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | Yes (X) | $188,018 | $0 | $15,990 | |||
| DR CATHY DONOVAN | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | Yes (X) | $189,460 | $0 | $41,186 | |||
| JUDY WAYTASHEK | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $90 | $0 | $0 | |||
| STEVE LONG | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| WILLIAM NELSON | ||||||||
| CEO | 40.00 | Yes (X) | $300,592 | $0 | $61,422 | |||
| JOHN UNZEN | ||||||||
| CFO | 40.00 | Yes (X) | $151,372 | $0 | $17,372 | |||
| KIM KUCERA | ||||||||
| COO | 40.00 | Yes (X) | $146,101 | $0 | $37,847 | |||
| FERN GERSHONE | ||||||||
| VP HUMAN RESOURCES | 40.00 | Yes (X) | $137,489 | $0 | $21,641 | |||
| TOM BRACKEN | ||||||||
| VP MEDICAL AFFAIRS | 40.00 | $209,691 | $0 | $50,012 | Yes (X) | |||
| ROGER BOETTCHER | ||||||||
| PHYSICIAN | 40.00 | $179,524 | $0 | $33,591 | Yes (X) | |||
| DAVID STROEBEL | ||||||||
| PHYSICIAN | 40.00 | $179,230 | $0 | $24,762 | Yes (X) | |||
| RODNEY HAYES | ||||||||
| PHYSICIAN | 40.00 | $159,466 | $0 | $44,710 | Yes (X) | |||
| PETER LINDBLOOM | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | $134,154 | $0 | $41,044 | Yes (X) | |||
| PATTI HOOK-VIRNIG | ||||||||
| PHYSICIAN | 40.00 | $128,586 | $0 | $39,813 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,111,963 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $429,390 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 22 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CENTRAL MN ANESTHESIA SERVICES INC | |||||
| 9527 330TH ST | ONAMIA | MN | 56359 | ANESTHESIA | $537,469 |
| ANDERSON BUILDERS | |||||
| 4220 PARKK GLEN ROAD | ST LOUIS PARK | MN | 55416 | CONSTRUCTION | $176,971 |
| CLIFTONLARSONALLEN LLP | |||||
| 220 S 6TH ST STE 300 | MINNEAPOLIS | MN | 55402 | ACCOUNTING | $132,645 |
| WILLIAM ORR CONSULTING | |||||
| 3537 GREAT OAKS PLACE | EAGAN | MN | 55123 | SENIOR CARE CONSULTING | $102,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $67,484 | GovernmentGrantsAmt |
| All Other Contributions | $24,953 | AllOtherContributionsAmt |
| Total Contributions | $92,437 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621110 | $30,728,282 | $30,728,282 |
| CLINIC REVENUE | 900099 | $4,305,028 | $4,305,028 |
| ASSISTED LIVING | 623000 | $590,547 | $590,547 |
| JOINT VENTURE INCOME | 900099 | $265,553 | $265,553 |
| THERAPY REVENUE | 900099 | $68,627 | $68,627 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,958,037 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,784 | TotalRevenueColumnAmt |
| Exclusion | $17,784 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $74,811 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $74,811 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $74,811 | TotalRevenueColumnAmt |
| Exclusion | $74,811 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $901 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $901 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $901 | TotalRevenueColumnAmt |
| Exclusion | $901 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $85,064 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,064 | TotalRevenueColumnAmt |
| Exclusion | $85,064 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS | 900099 | $555,153 | $555,153 |
| MEALS REVENUE | 900099 | $312,469 | $312,469 |
| JOINT VENTURE INCOME - OTHER | 900099 | $27,448 | $27,448 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,075 | TotalRevenueColumnAmt |
| Exclusion | $9,075 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $904,145 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,133,179 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $35,958,037 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,082,705 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,448,569 | TotalAmt |
| Program Services | $596,069 | ProgramServicesAmt |
| Management And General | $852,500 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,916,008 | TotalAmt |
| Program Services | $15,416,620 | ProgramServicesAmt |
| Management And General | $1,499,388 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,396 | TotalAmt |
| Program Services | $363,083 | ProgramServicesAmt |
| Management And General | $35,313 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,774,832 | TotalAmt |
| Program Services | $3,371,574 | ProgramServicesAmt |
| Management And General | $403,258 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,273,240 | TotalAmt |
| Program Services | $1,131,405 | ProgramServicesAmt |
| Management And General | $141,835 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,799 | TotalAmt |
| Management And General | $6,799 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,171 | TotalAmt |
| Management And General | $123,171 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,072,326 | TotalAmt |
| Program Services | $2,909,514 | ProgramServicesAmt |
| Management And General | $1,162,812 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $204,169 | TotalAmt |
| Program Services | $163,675 | ProgramServicesAmt |
| Management And General | $40,494 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,237,409 | TotalAmt |
| Program Services | $855,391 | ProgramServicesAmt |
| Management And General | $382,018 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $209,712 | TotalAmt |
| Program Services | $46,086 | ProgramServicesAmt |
| Management And General | $163,626 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $702,558 | TotalAmt |
| Program Services | $672,783 | ProgramServicesAmt |
| Management And General | $29,775 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $209,276 | TotalAmt |
| Program Services | $175,703 | ProgramServicesAmt |
| Management And General | $33,573 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $502,277 | TotalAmt |
| Program Services | $398,242 | ProgramServicesAmt |
| Management And General | $104,035 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,884,150 | TotalAmt |
| Program Services | $1,263,672 | ProgramServicesAmt |
| Management And General | $620,478 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $308,444 | TotalAmt |
| Program Services | $197,330 | ProgramServicesAmt |
| Management And General | $111,114 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,906,350 | $1,906,350 | |
| BAD DEBT EXPENSE | $1,478,715 | $1,478,715 | |
| FOOD | $428,942 | $428,942 | |
| MEDICAID ASSESSMENT | $362,120 | $160,455 | $201,665 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $572,948 | TotalAmt |
| Program Services | $268,434 | ProgramServicesAmt |
| Management And General | $304,514 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,020,411 | TotalAmt |
| Program Services | $31,804,043 | ProgramServicesAmt |
| Management And General | $6,216,368 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,604 | BOYAmt |
| EOY | $1,459,506 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,390,889 | BOYAmt |
| EOY | $4,764,390 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,882,628 | BOYAmt |
| EOY | $5,613,435 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $40,000 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $359,361 | BOYAmt |
| EOY | $395,102 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $626,401 | BOYAmt |
| EOY | $593,355 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $40,980,204 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $27,368,173 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,442,326 | BOYAmt |
| EOY | $13,612,031 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $27,448 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,043,063 | BOYAmt |
| EOY | $1,021,819 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,129 | BOYAmt |
| EOY | $50,813 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,831,401 | BOYAmt |
| EOY | $27,577,899 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,957 | BOYAmt |
| EOY | $2,100,293 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,208,879 | BOYAmt |
| EOY | $8,729,675 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,077 | BOYAmt |
| EOY | $6,317 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,341,303 | BOYAmt |
| EOY | $1,723,565 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $521,000 | BOYAmt |
| EOY | $226,096 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,152,216 | BOYAmt |
| EOY | $12,785,946 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,679,185 | BOYAmt |
| EOY | $14,791,953 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,679,185 | BOYAmt |
| EOY | $14,791,953 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,831,401 | BOYAmt |
| EOY | $27,577,899 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$887,232 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,158,795 | OtherCostOrOtherBasisAmt |
| Book Value | $1,158,795 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,267,306 | OtherCostOrOtherBasisAmt |
| Depreciation | $15,434,064 | DepreciationAmt |
| Book Value | $8,833,242 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,185,616 | OtherCostOrOtherBasisAmt |
| Depreciation | $774,558 | DepreciationAmt |
| Book Value | $411,058 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,867,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,159,551 | DepreciationAmt |
| Book Value | $2,707,614 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $501,322 | OtherCostOrOtherBasisAmt |
| Book Value | $501,322 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,612,031 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO THIRD PARTY PAYERS | Desc |
| Amt | $226,096 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $226,096 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $35,512,719 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,478,715 | OtherRevenueAmt |
| Revenue Not Reported | -$1,478,715 | RevenueNotReportedAmt |
| Revenue Subtotal | $36,991,434 | RevenueSubtotalAmt |
| Other Revenues Not Included | $141,745 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $141,745 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $37,133,179 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $36,541,752 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $56 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $56 | ExpensesNotReportedAmt |
| Expenses Subtotal | $36,541,696 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,478,715 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,478,715 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $38,020,411 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS -1,478,715. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | UNRESTRICTED CONTRIBUTIONS 26,631. INTEREST INCOME 16,490. GRANT INCOME 67,484. RENTAL INCOME 30,295. GAIN ON DISPOSAL OF EQUIPMENT 901. ROUNDING -56. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | ROUNDING 56. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,478,715. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $216,157 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $216,157 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,745,595 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,365,246 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,380,349 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,961,752 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,365,246 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,596,506 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09460 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,262 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $17,262 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $156,921 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,030 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $144,891 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00380 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,113 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,113 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $179,296 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,030 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $167,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00440 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,141,048 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,377,276 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,763,772 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09900 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,478,715 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $982,708 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,896,002 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,880,746 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $15,256 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLE LACS HEALTH SYSTEM | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 NORTH ELM STREET | AddressLine1 |
| City | ONAMIA | City |
| State | MN | State |
| ZIP Code | 563590800 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | 8557484 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MILLE LACS HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.MLHEALTH.ORG/CONTENT/QUALITY-C | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | 0 | AllNeedsAddressedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (1) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (1) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| State Regulation | Yes (X) | StateRegulationInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | 0 | IncludesPublicityMeasuresInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MILLE LACS HEALTH SYSTEM | PART V, SECTION B, LINE 3: 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 7: 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 | PART V, SECTION B, LINE 20D: 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%. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, LN 7 COL(F): | THE AMOUNT OF BAD DEBT THAT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE WAS $1,478,715 |
| PART III, LINE 2: | SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" PARAGRAPHS ON PAGES 8 AND 9 IN THE FINANCIAL STATEMENTS FOR INFORMATION ABOUT OUR BAD DEBT EXPENSE CALCULATION. |
| PART III, LINE 3: | THE AMOUNT 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. |
| PART III, LINE 8: | NO SHORTFALL WAS CALCULATED ON PART III, LINE 7, INSTEAD THERE WAS A SURPLUS OF $15,256. THIS IS REASONABLE BECAUSE MLHS IS A CRITICAL ACCESS HOSPITAL WHICH MEDICARE REIMBURSES AT 101% OF COST. THE MEDICARE ALLOWABLE COSTS INCLUDED ON PART III, LINE 6 WAS DERIVED USING THE 2014 FILED MEDICARE COST REPORT. |
| 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. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR ARDEN VIRNIG | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $182,608 | $0 | $50 | $0 | $5,360 | $0 | $7,530 | $0 | $8,460 | $0 | $204,008 | $0 | $0 | $0 |
| DR CATHY DONOVAN | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $184,641 | $0 | $50 | $0 | $4,769 | $0 | $6,373 | $0 | $34,813 | $0 | $230,646 | $0 | $0 | $0 |
| WILLIAM NELSON | ||||||||||||||
| CEO | $232,692 | $0 | $56,750 | $0 | $11,150 | $0 | $9,800 | $0 | $51,622 | $0 | $362,014 | $0 | $0 | $0 |
| JOHN UNZEN | ||||||||||||||
| CFO | $141,286 | $0 | $50 | $0 | $10,036 | $0 | $6,149 | $0 | $11,223 | $0 | $168,744 | $0 | $0 | $0 |
| KIM KUCERA | ||||||||||||||
| COO | $141,722 | $0 | $50 | $0 | $4,329 | $0 | $6,119 | $0 | $31,728 | $0 | $183,948 | $0 | $0 | $0 |
| FERN GERSHONE | ||||||||||||||
| VP HUMAN RESOURCES | $131,570 | $0 | $50 | $0 | $5,869 | $0 | $5,503 | $0 | $16,138 | $0 | $159,130 | $0 | $0 | $0 |
| TOM BRACKEN | ||||||||||||||
| VP MEDICAL AFFAIRS | $202,544 | $0 | $50 | $0 | $7,097 | $0 | $7,183 | $0 | $42,829 | $0 | $259,703 | $0 | $0 | $0 |
| ROGER BOETTCHER | ||||||||||||||
| PHYSICIAN | $173,347 | $0 | $50 | $0 | $6,127 | $0 | $7,466 | $0 | $26,125 | $0 | $213,115 | $0 | $0 | $0 |
| DAVID STROEBEL | ||||||||||||||
| PHYSICIAN | $173,129 | $0 | $50 | $0 | $6,051 | $0 | $693 | $0 | $24,069 | $0 | $203,992 | $0 | $0 | $0 |
| RODNEY HAYES | ||||||||||||||
| PHYSICIAN | $150,551 | $0 | $0 | $0 | $8,915 | $0 | $6,722 | $0 | $37,988 | $0 | $204,176 | $0 | $0 | $0 |
| PETER LINDBLOOM | ||||||||||||||
| PHYSICIAN ASSISTANT | $125,470 | $0 | $50 | $0 | $8,634 | $0 | $5,893 | $0 | $35,151 | $0 | $175,198 | $0 | $0 | $0 |
| PATTI HOOK-VIRNIG | ||||||||||||||
| PHYSICIAN | $124,424 | $0 | $50 | $0 | $4,112 | $0 | $5,742 | $0 | $34,071 | $0 | $168,399 | $0 | $0 | $0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF ONAMIA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 416005437 | BondIssuerEIN |
| Bond Issued | 2003-06-24 | BondIssuedDt |
| Issue Price | $4,500,000 | IssuePriceAmt |
| Purpose | NURSING HOME FACILITY | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,528,950 | RetiredAmt |
| Total Proceeds | $4,500,000 | TotalProceedsAmt |
| Issuance Costs From Proceeds | $40,431 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $4,459,569 | CapitalExpendituresAmt |
| Substantial Completion | 2005 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | DATE REBATE COMPUTATION PERFORMED | FormAndLineReferenceDesc |
| Explanation | ISSUER NAME: CITY OF ONAMIA DATE THE REBATE COMPUTATION WAS PERFORMED: 01/01/2009 | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PATTI HOOK-VIRNIG | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | FAMILY MEMBER OF DR. ARDEN VIRNIG, BOARD MEMBER AND PHYSICIAN OF MLHS | RelationshipDescriptionTxt |
| Transaction | $168,339 | TransactionAmt |
| Transaction | COMPENSATION PAID BY MLHS AS AN EMPLOYED PHYSICIAN. HER COMPENSTION IS ALSO REPORTED ON PART VII, SECTION A AND SCHEDULE J, PART II. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2014. |
| 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 2,909,514. MANAGEMENT AND GENERAL EXPENSES 1,162,812. TOTAL EXPENSES 4,072,326. |