4A (Expenses $ 12237611 including grants of $ 475) (Revenue $ 13935121)
North Valley Health Center (NVHC) is a 12-bed acute care health center located in Warren, MN. Our major program service is to provide quality medical services that are accessible to all communities we service. Included in the program services are inpatient and swing bed care, a full-time emergency room, various outpatient services, and family practice clinic where care is provided regardless of a patient's ability to pay for the services provided. North Valley Health Center also provides public health services for Marshall County. The COVID-19 pandemic continued into Fiscal Year 2021 and NVHC and its' staff continued to step up to the plate to keep our facility and community as safe as possible from the virus. Thanks to the much needed financial support provided by the Federal and State governments, NVHC was able to purchase the necessary equipment and supplies to combat the pandemic and provide vital healthcare services to our community members. During 2021, North Valley Health Center experienced an overall increase in patient days. Acute inpatient days increased 166 days, but acute swing-bed days decreased 68 days for a total increase of 98 days. Our full-time emergency room provided care to 1,364 patients, which was an increase of 206 patients over the prior year.Our Rural Health Clinic experienced an increase in visits as it worked back to normal operating schedule towards the end of the fiscal year. NVHC operated with one half-time Physician, a Physician Assistant, and four Nurse Practitioners throughout most of the fiscal year. Our family practice clinic saw 6,131 patients in 2021 compared to 5,578 patients in 2020, which was an increase of 8.1%. The practitioners also saw 40 patients via Telemedicine in 2021 compared to 263 patients in 2020.In 2021, North Valley Health Center provided $63,463 worth of charity care based on established rates of charges foregone. Total direct and indirect costs related to these foregone charges was approximately $50,000 based on an average of ratio of cost to gross charges.NVHC completed its third Community Health Needs Assessment in 2019 which complemented the strategic plans established in 2013 and 2016. The goals identified in the Assessment were put on hold again due to the COVID-19 Pandemic.

Warren Community Hospital, Inc.
Part V, Section B, Line 5: In 2019, NVHC CEO worked to complete the 2019 CHNA. The NVHC CEO utilized the expertise of the North Valley Public Health Director along with Dr. Garth Kruger of EvaluationGroup, LLC. Dr. Kruger's role was to gather demographic and health statistics data via a survey where the Public Health Director provided direction, feedback, and guidance on the data collected to assist in identifying health priorities.

Warren Community Hospital, Inc.
Part V, Section B, Line 6b: EvaluationGroup LLC

Warren Community Hospital, Inc.
Part V, Section B, Line 11: The most recently completed CHNA identified access to care, weight issues, physical activity, cholesterol, blood pressure, heart failure, diabetes, tobacco use, alcohol use, medical care costs, and mental health as needs and concerns. Weight issues, physical activity, cholesterol, blood pressure, and diabetes can be lumped together in one category as obesity. Due to the COVID-19 Pandemic these community issues were put on hold for one more year as the facility continued to address the needs to respond to the pandemic.The pandemic, however, did create additional mental health issues within our community so various meetings, both internal and with community members, were held throughout the year to address the issue. NVHC continues to look for ways to provide services to these patients and is currently looking to add a part-time practitioner either on site or remotely that could visit with patients that have mental health needs.

Warren Community Hospital, Inc.
Part V, Section B, Line 13h: In additional to the Federal Poverty Guidelines, State Regulations are considered. Also special cases involving medically indigent patient accounts will be considered by NVHC administration on a case by case basis. The discounts to be applied will be based on a determination of what the household could reasonably be expected to pay, based on a review of assets, liabilities, and current disposable income and expenses.

Warren Community Hospital, Inc.
Part V, Section B, Line 16j: Brochure copies of the Financial Assistance Policy are available in the main lobby of the facility. Invoices sent after the initial invoice contain information about the Community Care Policy. The organization has a weekly ad in the community newspaper which mentions the Community Care Policy.

Part V, Section B, Line 7a:
CHNA:https://www.northvalleyhealth.org/about/2019-needs-assessment/

Part V, Section B, Line 10a:
Implementation Strategy:https://www.northvalleyhealth.org/about/2019-needs-assessment/

Part I, Line 3c:
In additional to the Federal Poverty Guidelines, special cases involving medically indigent patient accounts will be considered by NVHC administration on a case by case basis. The discounts to be applied will be based on a determination of what the household could reasonably be expected to pay, based on a review of assets, liabilities, and current disposable income and expenses.

Part I, Line 7:
An average ratio of cost to gross charges was used to determine the amount on Part I, line 7a. The organization used Worksheet 2 to determine the cost for Part I, Line 7b. Part I, line 7e was calculated based on actual costs of community events held. Part I, line 7g was calculated using the Medicare Cost report in determining the community benefit for the Rural Health Clinic, the Emergency Room, and Public Health.

Part II, Community Building Activities:
North Valley Health Center also supports other non-profit organizations within the community by making donations to these facilities. In 2021, the NVHC gave $200 to the Warren/Alvarado/Oslo High School, $100 to the Stephen/Argyle Central High School, and $100 to Marshall County Central High School to support after after-prom parties to discourage students from partaking in any illegal or unsafe activities along with giving $75 to the Warren Chapter of Bio-Girls which is a program that works to end the self-esteem crisis in adolescent girls.

Part III, Line 2:
The amount on line 2 represents implicit price concessions. The Health Center determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
Historically, almost all of the implicit price concessions amount remains unpaid as the patient does not have sufficient resources and likely would qualify for the Community Care program. To be conservative, NVHC has discounted this by 25% to account for unknown circumstances and concludes that 75% of the implicit price concessions amount is attributable to patients who would be eligible for financial assistance.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on pages 11 and 12 of the attached audited financial statements.

Part III, Line 8:
North Valley Health Center is a critical access hospital and in prior years has shown a Medicare shortfall due to sequestration. There is a surplus shown in 2021 as Sequestration went away for the fiscal year due to the COVID-19 Pandemic.Medicare allowable costs were obtained from the 2021 Medicare Cost Report. The cost to charge ratio indicated on that report was used to determine the amount of community care derived from subsidized health services. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.

Part III, Line 9b:
It is the patient's responsibility to inquire and apply for the Community Care Program (Program) at NVHC. Once an inquiry or application is received from a patient regarding the Program, all collection efforts cease until a determination can be made on whether, or not, the patient is accepted into the Program. Business office staff assist patients with all inquiries and/or incomplete applications until the proper information is obtained to make an informed decision on acceptance into the Program. After determination is made, patients are sent letters indicating whether, or not, they were accepted into the Program. Program policy allows for up to two months prior to the date of the application for eligible charges to be written off to the program. Patients remain responsible for the charges prior to the two month window if they are accepted into the Program and normal collection efforts would follow those charges. For those charges within the two month window along with any new charges, there are no collection practices for those patients accepted into the Program receiving a 100% discount as their entire balance is properly written off to charity care. Patients accepted in the Program with an outstanding balance after any sliding fee discount follow normal collection procedures stated within the policy. These patients under the sliding fee discount have 120 days to make a payment in full, or set up a payment plan. This time begins immediately for those patients without insurance and begins immediately for any remaining balance after all insurance payments have been exhausted for those patients with insurance. After 120 days, the gross remaining balance is sent to a collection agency to begin the collection process. Proper notices are sent to the patient on their monthly statement prior to this occurring. Adverse effects of collection are reversed if a patient is determined to be eligible for financial assistance. If a patient is not accepted into the program, they are instructed to set up a payment plan, or make payment in full and normal collection procedures would begin again from the date of the determination letter.

Part VI, Line 2:
North Valley Health Center (NVHC) currently assesses the health care needs of the community through informal meetings with all department heads of the organization. Community needs are discussed and determinations are made based on what the organization can provide and afford. NVHC also manages public health on behalf of Marshall County and utilizes their input greatly during these meetings. Finally, NVHC continues to get more involved in the community and meets with various members of the community during these social events to determine first hand needs of the people the organization serves.

Part VI, Line 3:
North Valley Health Center (NVHC) has brochure copies of both federal assistance and our Community Care Policy in the main lobby of the facility. The full Community Care Policy is available for those patients that request it and the full policy is available on the website at www.northvalleyhealth.org. NVHC also includes other information regarding the Community Care Program on our website and under the NVHC section within the Warren Economic Development Authority book detailing the city of Warren and its businesses. Information regarding the Community Care Program can also be found at Marshall County Social Services for patients that utilize that service. Patients without any insurance are informed about their options at the time of admission. North Valley Health Center happily meets with any patient concerned about their bill and works with the patient to determine eligibility for either federal assistance or our Community Care Program to help alleviate their concern.

Part VI, Line 4:
North Valley Health Center is the only medical facility located in Marshall County and is located 30 miles from other similar medical facilities to the east and south. A secondary facility is located 35 miles west and a similar care facility is located 42 miles north. Designations include Critical Access Hospital (CAH), Rural Health Clinic (RHC), Medically Underserved Area (MUA), and Health Professional Shortage Area (HPSA). Marshall County is considered by HRSA as one of the poorest counties in the nation. The rural service area includes 3,800 people in the western half of Marshall County and/or part of three townships in northern Polk County. Municipalities included in the service area include Oslo, Alvarado, Stephen, Argyle, and Warren plus the nineteen townships located near those municipalities. NVHC accepts all individuals who desire medical care regardless of the individual's ability to pay. Of those people who use the health center, 31% are Medicare, 25% are Medicare Advantage, 18% are Blue Cross Blue Shield, 11% are commercial, 13% are Medicaid, and 2% are private pay.

Part VI, Line 5:
North Valley Health Center (NVHC) is truly a community non-profit organization as it is controlled by the community. Any individual in the NVHC service area is considered a member of the organization. These members vote individuals within the service area to the community Board of Directors each year at the annual meeting of the Organization. The community board consists of at least one member from all areas within the service area (i.e. one from Stephen, one from Oslo, one from Argyle, one from Alvarado, one from Warren, etc). Any surplus funds are put back into the Organization to upgrade facilities and medical equipment to assure that the proper quality of care is provided to the community. NVHC also has an open medical staff where the facility extends medical staff privileges to all qualified physicians in the community who want to provide services at our facility. NVHC does operate an emergency room that is available 24 hours a day, seven days a week that is available to all regardless of the ability to pay. The emergency room is the only one available within a 30 mile radius of Warren, MN.