2025-11-10T13:31:54-06:00 2024-12-31 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2024-01-01 411384358 Warren Community Hospital Inc WARR 2187454211 300 West Good Samaritan Drive Warren MN 56762 Jon Linnell CEO 2187454211 2025-11-07 1 1 Lisa Chaffee CPA P00193453 7012551091 2025-11-07 2024 2025-03-06 01:10:19Z North Valley Health Center Jon Linnell 300 West Good Samaritan Drive Warren MN 56762 17868088 0 X www.northvalleyhealth.org X 1980 MN Provide compassionate, quality care, focusing on the needs of our patients and their families. 8 8 133 9 0 0 672946 1160451 15123684 16531891 82183 152859 16218 15814 15895031 17861015 875 500 0 0 8171758 8711056 0 0 78005 8184863 9062616 16357496 17774172 -462465 86843 14769542 14648812 13211636 12936768 1557906 1712044 X We provide compassionate, quality care, focusing on the unique needs of our patients and their families. 1 0 14101471 500 16531891 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 manages public health services for Marshall County. During 2024, North Valley Health Center experienced an overall decrease in patient days. Acute inpatient days increased by 28 days, but acute (Continued on Schedule O)swing-bed days decreased 133 days for a total decrease of 105 days. Our full-time emergency room provided care to 1,382 patients, which was an increase of 113 patients over the prior year.Our Rural Health Clinic experienced another year of an increase in total visits. 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 6,770 patients in 2024 compared to 6,747 patients in 2023, which was an increase of 23 visits. There were no Telemedicine visits in 2024.In 2024, North Valley Health Center provided $26,078 worth of charity care based on established rates of charges foregone. Total direct and indirect costs related to these foregone charges was approximately $18,000 based on an average of ratio of cost to gross charges.NVHC completed its fourth Community Health Needs Assessment in 2022 which complemented the strategic plans established in previous years. As in previous years, NVHC continues to work on the goals identified in the assessment. These goals are described further in Schedule H, part V, line 11 14101471 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 15 0 1 133 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 0 0 0 0 MN X Mitchell Kotrba 2187453261 300 West Good Samaritan Drive Warren MN 56762 Shari Swanson President 1.00 X X 0 0 0 James Widner Vice President 1.00 X X 0 0 0 Ron Leverington Secretary 1.00 X X 0 0 0 Jason Boman Director 1.00 X 0 0 0 Mark Yutrzenka Director 1.00 X 0 0 0 Darlene Dvorak Director 1.00 X 0 0 0 Jeff Hanson Director 1.00 X 0 0 0 Mallory Craik Director 1.00 X 0 0 0 Jon Linnell CEO 40.00 X 341639 0 9879 Mitchell Kotrba CFO 40.00 X 166342 0 20541 Michelle Woinarowicz Nurse Practitioner 40.00 X 302126 0 48272 Shane Skeim Nurse Practitioner 40.00 X 285865 0 21963 Jill Smith Nurse Practitioner 40.00 X 237359 0 1483 Nicole Steien Nurse Practitioner 40.00 X 214195 0 34709 Jeremy Houser Physician Assistant 40.00 X 147349 0 2947 1694875 0 139794 14 0 1 0 Francis LeBlanc MD 1622 Valley Golf Way East Grand Forks MN 56721 Contracted Physician 339502 Mirza Baig MD 815 Memorial Drive Crookston MN 56716 Contracted Physician 222750 AJ Anesthesia LLC PO Box 244 Drayton ND 58225 Contracted CRNA 144000 3 24092 677533 458826 1160451 Program Service Revenue 621110 15393180 15393180 340b Pharmacy Revenue 456110 878055 878055 Miscellaneous 900099 260656 260656 16531891 152859 152859 9350 0 9350 9350 9350 13537 24092 7073 6464 6464 17861015 16531891 0 168673 X 500 500 538401 538401 60898 60898 6688091 5870885 749357 67849 88278 80676 7602 829112 600745 228367 506276 416719 84459 5098 1032 1032 96058 96058 3179530 2992511 183922 3097 72308 930 71378 737070 350877 384232 1961 859802 859802 322425 264468 57957 28409 27897 512 16556 13820 2736 407157 351233 55924 1160924 1001467 159457 92756 80016 12740 Medical Supplies 1810851 1810851 MN care tax 169990 169990 107748 6988 100760 17774172 14101471 3594696 78005 608122 685913 29214 315650 2843357 3046530 100000 161999 173365 269174 601634 20689723 13649380 7755404 7040343 2719583 2251884 135120 135120 247569 298373 14769542 14648812 1197353 1292089 201786 11631714 11442893 382569 0 13211636 12936768 X 1110787 1197831 447119 514213 1557906 1712044 14769542 14648812 86843 67295 0 X 0 1 X 0 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 421320 75 840 840 421395 421320 8411 8411 421320 421285 35 1499 1499 421320 421215 70 1613 1613 421285 421190 25 2408 2408 421215 0.32060 0.67940 0.00000 1 0 44882 44882 13863210 8294151 5569059 6612635 5355229 1257406 168996 168996 7040343 X 17928310 67295 67295 17861015 0 17861015 17774172 0 17774172 0 17774172 Part V, Line 4: There are two endowment funds at North Valley Health Center. One is for capital purchases and the other is for Physician costs (recruiting, salary, etc). Part X, Line 2: The Health Center believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Golf Tournament 37629 24092 13537 362 2100 2747 1864 37629 24092 13537 362 2100 2747 1864 7073 6464 1 1 X 1 X 1 X 1 1 0 0 18000 18000 0.00100 1392851 629359 763492 0.04300 1410851 629359 781492 0.04400 3163 3163 0.00020 2768910 1880202 888708 0.05000 2772073 1880202 891871 0.05020 4182924 2509561 1673363 0.09420 500 500 0.00000 500 500 0.00000 1 132532 99399 4432196 4465488 -33292 X 1 1 1 1 Warren Community Hospital Inc DBA North Valley Health Center W Good Samaritan MN 56762 www.northvalleyhealth.org 00871 X X X One Provider Based Rural Health Clinic Warren Community Hospital Inc 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X See Part V, Section C X 1 22 1 See Part V, Section C 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Warren Community Hospital, Inc. Part V, Section B, Line 5: The 2022 CHNA report incorporated the expertise of the director of North Valley Public Health, Francis Tougas, Quin County Community Health Services Public Health Director for Marshall County. NVHC identified current and unmet community health care needs in the community by reviewing archival data. A wide range of available archival data and reports were reviewed to identify health care needs. Key data points included, but were not limited to:1) 2017 Northwest Regional Adult Behavioral Health Survey (NRABS). The NRABS survey was a randomized household survey that captured a broad snapshot of the health of adults in the region. This survey was conducted in partnership with Quin County Community Health Services (QCHS), a partnership of five local public health departments in NWMN.2) Minnesota All Payer Claims Database (MN APCD). The MN APCD is a state repository of health care claims data that is derived from medical providers' billing records sent to insurance companies, plan administrators and public payers. Because of the completeness of data and its geographic richness for the state, this data offered an unprecedented opportunity to learn more about what types of services are provided across the state, how much they cost, and what outcomes are being achieved.3) 2020 Census Data Warren Community Hospital, Inc. Part V, Section B, Line 6b: Quinn Community Health Services Warren Community Hospital, Inc. Part V, Section B, Line 11: In the most recent CHNA conducted, the following priority area needs were identified:1) Access to Care2) Mental HealthNVHC feels both priority area needs are important to the communities we serve and will be addressing both of them as financially reasonably as possible.In the current tax year, NVHC has taken the following actions to address the priority need areas detailed in the CHNA:1) Access to Carea. NVHC continued to work on getting the nurses properly trained and certified to provide new chemo and chemo-like treatments at our facility. Cost and finding eligible trainers for this service have been difficult due to rural location have held up progress. b. Continued to recruit and retain staff in all areas of need. NVHC contracted with Integrated Telehealth Partners to provide a Mental Health Nurse Practitioner to see patients in our community. This area does continue to be an ongoing item due to our rural location.c. NVHC and the Public Health department that NVHC manages for Marshall County have access to a Syndromic Surveillance system called CDC Essence. This system has allowed NVHC to monitor for spikes in influenza like illness (flu, covid, other respiratory illnesses) and provide education to the public and other community partners about the increase and preventing the spread (staying home, washing hands, covering cough, etc.). The system was also used to monitor mental health signs and symptoms within the community to track suicides, suicide attempts, crisis calls from our other partners so we can see what the needs are during the past year.2) Mental Healtha. NVHC contracted with a mental health nurse practitioner to provide mental health services in our rural health clinic three days a week. This nurse practitioner also sees residents at the local nursing home through our organization.b. NVHC identified dedicated space for its Senior Life Solutions Geriatric Mental Health program. This space was being remodeled in 2024 to properly provide the service and will need State approval prior to being used. NVHC hopes to begin this service to the community in fiscal year 2025. 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/_files/ugd/2d546d_d4218805eb014fa6ac44013261bff5dd.pdf Part V, Section B, Line 10a: Implementation Strategy:https://www.northvalleyhealth.org/_files/ugd/2d546d_d4218805eb014fa6ac44013261bff5dd.pdf Part V, Section B, Line 16a-c Line 16a - Financial Assistance Policy:https://www.northvalleyhealth.org/_files/ugd/0b415a_8c8fc190947f4d9c9ef3cf7d5b328798.pdf URL Line 16b - FAP Application:https://www.northvalleyhealth.org/_files/ugd/0b415a_801254878aa34daa8c3dcafbc990e83f.pdf URLLine 16c - Plain Language Summary:https://www.northvalleyhealth.org/_files/ugd/2d546d_fca73add5fd9416fa2f3fd82baa15c73.pdf URL Part I, Line 3c: In addition 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 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 2024, the NVHC gave $100 to the Warren/Alvarado/Oslo High School to support after after-prom parties to discourage students from partaking in any illegal or unsafe activities along with giving $400 to the Marshall County Sheriff's department in their efforts in creating a child safety and drug prevention education program for children and adults in the community. 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: North Valley Health Center reports amounts as bad debt once they are 120 days overdue and have been turned over to a collection agency. Historically, almost all of these amounts remain 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 bad debt amount is considered charity care. 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 as in most prior years has shown a Medicare shortfall due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.Medicare allowable costs were obtained from the 2024 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, 28% are Medicare, 28% are Medicare Advantage, 17% are Blue Cross Blue Shield, 11% are commercial, 14% 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, one from Viking, 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. X X X 0 0 0 0 0 0 0 0 0 Jon Linnell CEO 331218 0 0 0 10421 0 5200 0 4679 0 351518 0 0 0 Michelle Woinarowicz Nurse Practitioner 302126 0 0 0 0 0 5200 0 43072 0 350398 0 0 0 Shane Skeim Nurse Practitioner 285865 0 0 0 0 0 5200 0 16763 0 307828 0 0 0 Nicole Steien Nurse Practitioner 214195 0 0 0 0 0 4552 0 30157 0 248904 0 0 0 Jill Smith Nurse Practitioner 237359 0 0 0 0 0 0 0 1483 0 238842 0 0 0 Mitchell Kotrba CFO 166342 0 0 0 0 0 3387 0 17154 0 186883 0 0 0 Jeremy Houser Physician Assistant 147349 0 0 0 0 0 2947 0 0 0 150296 0 0 0 Jon Linnell CEO Advance for Services X 100000 100000 0 1 1 100000 Tasha Kotrba Family relationship to current Officer 60898 Wages and benefits paid for performance of services 0 Form 990, Part III, line 2 The organization provided a new program service in 2024, Senior Life Solutions, which provided group and individual mental health therapy sessions for geriatric seniors in our community. Form 990, Part VI, Section A, line 1a The bylaws allow for an Executive Committee. The Executive Committee shall consist of the President, Vice President, Secretary, and Treasurer. The Executive Committee shall have the power to transact all regular business of the corporation during the period between the meetings of the Board of Directors, subject to any limitation imposed upon the Executive Committee by the Board of Directors. Form 990, Part VI, Section A, line 6 All residents, who are 18 years or older, living within the radius of 25 miles of the organization's service area served by members of the Board of Directors shall be eligible to vote at the annual meetings. Form 990, Part VI, Section A, line 7a Any community member is allowed to attend our annual meeting to vote on matters at hand which include, but are not limited to, appointing board members, approving the administrators, and financial reports, etc. Board members are selected/appointed at the annual meeting. Community members present at the annual meeting can approve any nomination and vote on board members. Form 990, Part VI, Section A, line 8b The bylaws allow for an Executive Committee. The Executive Committee did not meet during the year and there are no other committees that act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The CFO will email out a draft copy of the Form 990 to all of the board members. Board members will be able to look over the Form 990, and if they see any changes will report them to the CFO. The CFO and CEO will also review the 990. If there are any changes, the board will receive a final draft to review (which includes the changes) and approve before it is filed with the IRS. Form 990, Part VI, Section B, line 12c The board of directors and members of management look at the policy annually and report if there are any potential conflicts. Potential conflicts are reviewed by the CEO to determine if a conflict exists. Board members with a conflict must abstain from voting. A member of management with a conflict of interest would abstain from the decision making process related to the conflicting decision if a conflict of interest were present and the final decision would rest with the other members of management. Form 990, Part VI, Section B, line 15 When any of these positions open up for employment, it is brought to the attention of Board of Directors. The Board has the facility advertise the position by any means possible. Once applications are received, the Board reviews and holds a discussion on the applications to determine who to hire. Once an individual is chosen, compensation is determined using historical salary amounts at the facility comparable with the individual's experience. The Board determines the salary and submits it to the applicant for approval. If the applicant does not feel the compensation is appropriate, then the Board would reconsider and try to compromise with the individual. This process goes on until an individual is hired. Once hired, compensation for these positions is reviewed annually with the Board to determine whether, or not, pay increases will occur in the given year based on the work performance of the individual in correlation with the financial performance of the facility. Form 990, Part VI, Section C, line 19 These documents are not made available to the public. If someone were to request the documents, they could make a formal request to our Administrator, who could then provide the document. Form 990, Part IX, line 11g Professional Fees: Program service expenses 2,258,727. Management and general expenses 105,144. Fundraising expenses 0. Total expenses 2,363,871. Purchased Services: Program service expenses 561,807. Management and general expenses 77,022. Fundraising expenses 3,097. Total expenses 641,926. Other Fees: Program service expenses 171,977. Management and general expenses 1,756. Fundraising expenses 0. Total expenses 173,733.