2014-08-14T14:04:53-05:00 2013-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-10-01 410785161 MILLE LACS HEALTH SYSTEM MILL 3205323154 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 WILLIAM NELSON 3205323154 2014-08-13 1 KOREY BOELTER P00775161 6123764500 2012 2015-11-30 17:44:51Z WILLIAM NELSON 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 37826779 0 X WWW.MLHEALTH.ORG X 1953 MN TO PROVIDE QUALITY HEALTH SERVICES TO RESIDENTS OF ONAMIA, MN AND THE SURROUNDING AREA. 10 7 569 20 0 0 32501 238007 37260554 37009715 41320 63764 495304 515293 37829679 37826779 60000 55000 0 0 22479032 23004345 0 0 2295 14867217 14458944 37406249 37518289 423430 308490 29933157 29831401 14562462 14152216 15370695 15679185 X TO ASSIST THOSE RESIDING IN AND VISITING THE MILLE LACS AREA IN ACHIEVING AND MANTAINING OPTIMAL HEALTH. 0 0 31699346 55000 37009715 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. 31699346 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 97 0 569 1 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X JOHN UNZEN CFO 3205322581 200 NORTH ELM STREET PO BOX A ONAMIA MN 563590800 MARK TADYCH 8.00 X X 4800 0 0 KEVIN ANDERSON 2.00 X X 780 0 0 BECKY HOULE 2.00 X X 840 0 0 DIANE GIBAS 2.00 X X 600 0 0 PHIL GRAVEL 2.00 X 660 0 0 FR KERMIT HOLL OSC 2.00 X 690 0 0 DR MAGGIE LARSON 40.00 X 169626 0 14022 STEVE LONG 2.00 X 940 0 0 BETSY LUNDQUIST 2.00 X 0 0 0 JUDY WAYTASHEK 2.00 X 960 0 0 DR ARDEN VIRNIG 40.00 X 185632 0 7718 WILLIAM NELSON 40.00 X 271156 0 11776 JOHN UNZEN 40.00 X 144280 0 8848 KIM KUCERA 40.00 X 146540 0 12768 FERN GERSHONE 40.00 X 134725 0 5671 TOM BRACKEN 40.00 X 222635 0 14741 SHARON GOSSETT 40.00 X 325555 0 18299 ROGER BOETTCHER 40.00 X 213052 0 16836 RODNEY HAYES 40.00 X 171296 0 17637 CATHY DONOVAN 40.00 X 216773 0 11887 PATTI HOOK-VIRNIG 40.00 X 135495 0 20858 2347035 0 161061 21 0 1 0 ANDERSON BUILDERS 4220 PARKK GLEN ROAD ST LOUIS PARK MN 55416 CONSTRUCTION 1891282 CENTRAL MN ANESTHESIA SERVICES INC 9527 330TH ST ONAMIA MN 56359 ANESTHESIA 496125 FAIRVIEW UNIVERSITY PO BOX 9459 MINNEAPOLIS MN 55440 DIAGNOSTICS 131511 CLIFTONLARSONALLEN LLP 220 S 6TH ST STE 300 MINNEAPOLIS MN 55402 ACCOUNTING 115754 WILLIAM ORR CONSULTING 3537 GREAT OAKS PLACE EAGAN MN 55123 SENIOR CARE CONSULTING 102000 5 16669 221338 238007 PATIENT REVENUE 621110 31197102 31197102 CLINIC REVENUE 900099 4949604 4949604 ASSISTED LIVING 623000 567699 567699 JOINT VENTURE INCOME 900099 219721 219721 THERAPY REVENUE 900099 75589 75589 37009715 29568 29568 73453 0 73453 73453 73453 34196 0 34196 34196 34196 90840 0 90840 90840 MEALS REVENUE 900099 314675 314675 MISCELLANEOUS 900099 28018 28018 DISCOUNTS & REBATES 900099 5171 5171 3136 3136 351000 37826779 37009715 0 579057 55000 55000 1476026 573412 900319 2295 16034926 14854163 1180763 402230 372611 29619 3876087 3445134 430953 1215076 1085285 129791 8801 8801 127444 127444 3641120 2755451 885669 169605 134040 35565 1330630 968713 361917 205721 39289 166432 642098 609385 32713 231562 184446 47116 544571 420840 123731 2090247 1370377 719870 318983 214199 104784 MEDICAL SUPPLIES 1979788 1979788 BAD DEBT EXPENSE 1788052 1788052 FOOD 403569 403569 MEDICAID ASSESSMENT 374626 160455 214171 602127 285137 316990 37518289 31699346 5816648 2295 17512 20604 8297828 6390889 5522938 6882628 348487 359361 468826 626401 39941663 25499337 13935033 14442326 54144 1206943 1043063 81446 66129 29933157 29831401 1758643 2081034 9661661 9208879 3022158 2341303 120000 521000 14562462 14152216 X 15370695 15679185 15370695 15679185 29933157 29831401 308490 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1158795 1158795 24057717 14560785 9496932 1185616 722897 462719 12960132 10215655 2744477 579403 579403 14442326 DUE TO THIRD PARTY PAYERS 521000 521000 X 35710629 0 35710629 2116150 2116150 37826779 35730237 0 35730237 1788052 1788052 37518289 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: UNRESTRICTED CONTRIBUTIONS 11,652. INTEREST INCOME 29,244. GRANT INCOME 16,669. RENTAL INCOME 28,610. GAIN ON DISPOSAL OF EQUIPMENT 34,196. CAPITAL GRANTS AND CONTRIBUTIONS 207,727. PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,788,052. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 1,788,052. 1 1 X 1 X 1 X 1 1 1 0 1 1 852277 0 852277 0.02390 6006680 2504604 3502076 0.09800 6858957 2504604 4354353 0.12190 58 7502 35226 0 35226 0.00100 179143 16188 162955 0.00460 21 11373 11373 0 11373 0.00030 79 18875 225742 16188 209554 0.00590 79 18875 7084699 2520792 4563907 0.12780 1 1788052 1341039 9507558 9285502 222056 X 1 1 1 1 MILLE LACS HEALTH SYSTEM

200 NORTH ELM STREET ONAMIA MN 563590800

X X X X MILLE LACS HEALTH SYSTEM 1 1 X X X X X X X X X 12 1 0 1 X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X X X 1 1 X X X X 1 0 X X 1 X 0 0 5 MHLS FAMILY CLINIC - ONAMIA

200 NORTH ELM ST ONAMIA MN 56359

MEDICAL CLINIC MHLS FAMILY CLINIC - ISLE

375 WEST ISLE ST ISLE MN 56342

MEDICAL CLINIC MHLS FAMILY CLINIC - GARRISON

27378 STATE HIGHWAY 18 GARRISION MN 56450

MEDICAL CLINIC MHLS FAMILY CLINIC - HILLMAN

26362 370TH AVE HILLMAN MN 56338

MEDICAL CLINIC MHLS FAMILY CLINIC - MILACA

1010 5TH ST SE MILACA MN 56353

MEDICAL CLINIC PART I, LINE 3C: THE FEDERAL POVERTY INCOME GUIDELINES PROVIDE THE INITIAL FRAMEWORK TO DETERMINE THE INDIVIDUAL'S ABILITY TO PAY. INDIVIDUALS WITH INCOME AND ASSETS EQUAL TO OR LESS THAN THE FEDERAL POVERTY INCOME GUIDELINES, WITH NO OTHER AVAILABLE ASSETS MUST BE EVALUATED TO SEE IF THE PATIENT FIRST QUALIFIES FOR ASSISTANCE FROM ANY FEDERAL, STATE, OR LOCAL COUNTY PROGRAMS SUCH AS MA. A REASONABLE PAYMENT SCHEDULE OVER A ONE OR TWO YEAR PERIOD WILL BE DETERMINED IN THE INTERVIEW PROCESS. THE PORTION THAT WILL BE WRITTEN OFF SHOULD THEN BE CLASSIFED AS A CHARITY DISCOUNT. INDIVIDUALS WITHIN TWO (2) TIMES THE FEDERAL POVERTY GUIDELINES MAY ALSO HAVE SOME MEDICAL INSURANCE COVERAGE. THE PATIENT DEDUCTABLE AND NONCOVERED SERVICES MAY BE LARGE ENOUGH THAT THE INDIVIDUAL IN INCAPABLE OF PAYING OFF WITHIN A 1-2 YEAR PERIOD. THEREFORE, THIS UNPAYABLE AMOUNT BY THE PATIENT MAY BE CLASSIFED AS CHARITY DISCOUNT. PART I, LINE 7: THE COSTS INCLUDED IN PART 1, LINES 7A AND 7B WERE DERIVED BY USING THE COST TO CHARGE RATIO CALCULATED USING WORKSHEET 2 AND THEN APPLIED AGAINST INTERNALLY DEVELOPED NUMBERS. THE COSTS INCLUDED IN PART 1, LINES 7E, 7F AND 7I WERE ACTUAL COSTS TRACKED BY THE HEALTH SYSTEM IN THEIR FINANCIAL PROCESS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1788052. 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.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 8: NO SHORTFALL WAS CALCULATED ON PART III, LINE 7, INSTEAD THERE WAS A SURPLUS OF $222,056. 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 2013 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. 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%. 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 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. REPORTS FILED WITH STATES PART VI, LINE 7 MN 1 MILLE LACS AREA HEALTH FOUNDATION INC 200 NORTH ELM STREET PO BOX A ONAMIA MN 56359 743155412 501(C)(3) 55000 GENERAL OPERATING SUPPORT. 1 0 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 MILLE LACS AREA FOUNDATION. THIS IS TRACKED INTERNALLY THROUGH THE FINANCIAL REPORTING PROCESS AS THE MILLE LACS HEALTH SYSTEM MAINTAINS THE FOUNDATION'S BOOKS AND RECORDS. X X X X X X 0 0 0 0 0 0 0 0 0 DR MAGGIE LARSON 165677 0 51 0 3898 0 7053 0 6969 0 183648 0 0 0 DR ARDEN VIRNIG 180545 0 51 0 5036 0 7413 0 305 0 193350 0 0 0 WILLIAM NELSON 203648 0 54456 0 13052 0 8656 0 3120 0 282932 0 0 0 JOHN UNZEN 139870 0 51 0 4359 0 5848 0 3000 0 153128 0 0 0 KIM KUCERA 137166 0 51 0 9323 0 6104 0 6664 0 159308 0 0 0 TOM BRACKEN 216835 0 401 0 5399 0 7063 0 7678 0 237376 0 0 0 SHARON GOSSETT 324702 0 0 0 853 0 9800 0 8499 0 343854 0 0 0 ROGER BOETTCHER 207637 0 51 0 5364 0 8800 0 8036 0 229888 0 0 0 RODNEY HAYES 164638 0 51 0 6607 0 7204 0 10433 0 188933 0 0 0 CATHY DONOVAN 212633 0 51 0 4089 0 8800 0 3087 0 228660 0 0 0 PATTI HOOK-VIRNIG 132030 0 51 0 3414 0 5996 0 14862 0 156353 0 0 0 A CITY OF ONAMIA 416005437 2003-06-24 4500000 NURSING HOME FACILITY 0 0 0 A 1376621 4500000 40431 4459569 2005 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 1 0 0 0 0 A 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C 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 6 ANY PERSON, GROUP OR ORGANIZATION CONTRIBUTING CASH, PROPERTY OR SERVICES TO THE HOSPITAL IN THE AMOUNT DESIGNATED BY THE BOARD OF DIRECTORS FROM TIME TO TIME IS RECOGNIZED AS A MEMBER. THESE MEMBERS HAVE NO VOTING RIGHTS OR POWERS. 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 2013. 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.