NORTH COUNTRY HEALTHCARE INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- NORTH COUNTRY HEALTHCARE INC (EIN 81-2225283)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-06-26
- IRS object ID
- 201921779349300107
- Schema version
- 2017v2.3
- 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 | 2019-06-26T07:53:49-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010523282 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Berry Dunn McNeil & Parker LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1100 | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 041041100 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 812225283 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | North Country Healthcare Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 6033265639 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 Clover Lane | AddressLine1Txt |
| City | Whitefield | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03598 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James Hamblin | PersonNm |
| Person Title | Board Chair | PersonTitleTxt |
| Phone | 6033265639 | PhoneNum |
| Signature | 2019-06-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Barbara J McGuan CPA | PreparerPersonNm |
| PTIN | P00219457 | PTIN |
| Phone | 2077752387 | PhoneNum |
| Preparation | 2019-06-24 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 69.49.157.66 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-06-24 | IPDt |
| IP Tm | 15:34:10 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BCE379EC6B2F882893C3F02DE0A5A3D951B1B2ED | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | James Hamblin | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 Clover Lane | AddressLine1Txt |
| City | Whitefield | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03598 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,269,030 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.northcountryhealth.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2016 | FormationYr |
| Legal Domicile State | NH | LegalDomicileStateCd |
| Activity Or Mission | Healthcare Management | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 13 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $2,944,230 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,269,030 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $2,944,230 | PYTotalRevenueAmt |
| CY Total Revenue | $4,269,030 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $1,011,546 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,002,733 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,918,034 | PYOtherExpensesAmt |
| CY Other Expenses | $3,263,578 | CYOtherExpensesAmt |
| PY Total Expenses | $2,929,580 | PYTotalExpensesAmt |
| CY Total Expenses | $4,266,311 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $14,650 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,719 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $377,723 | TotalAssetsBOYAmt |
| Total Assets EOY | $785,835 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $327,723 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $733,116 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $50,000 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $52,719 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | As small, rural hospitals in a rapidly changing healthcare environment, joining together will keep us strong enough to maintain all of our hospitals as viable entities. Affiliation will allow our community hospitals to keep their own identities within a larger health system and will preserve access to high-quality, personal health care for people in the North Country. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,104,186 | ExpenseAmt |
| Revenue | $4,269,030 | RevenueAmt |
| Desc | The main focus of NCH is management oversight and development of common administrative and clinical processes and practices between the four Hospitals. It is the intent to develop synergies and shared services to increase efficiency, lower cost and increase quality and patient satisfaction for the entire region. | Desc |
| Total Program Service Expenses | $4,104,186 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | 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 | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | 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 | Yes (1) | 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 | 5 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| 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 | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | 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 | Yes (1) | 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 | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Celeste Pitts | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6037885321 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8 Clover Lane | AddressLine1Txt |
| City | Whitefield | CityNm |
| State Abbreviation | NH | StateAbbreviationCd |
| ZIP | 03598 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Mark Kelley | |||||||
| Chair | 1.00 | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| James Hamblin | |||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Greg Placy | |||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Donald Crane | |||||||
| Treasurer | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Edward Duffy MD | |||||||
| Interim CEO | 20.00 | 20.00 | Yes (X) | Yes (X) | $0 | $362,920 | $37,219 |
| Bill Bedor | |||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Alta Chase | |||||||
| Director | 1.00 | 10.00 | Yes (X) | $0 | $0 | $0 | |
| Donna Goodrich | |||||||
| Director | 1.00 | 2.00 | Yes (X) | $0 | $0 | $0 | |
| Pat Kelly | |||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Lars Nielson MD | |||||||
| Director | 1.00 | 40.00 | Yes (X) | $0 | $312,627 | $27,226 | |
| James Nohl | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| David Ruble | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Mark Russell | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| John Sauter MD | |||||||
| Director | 1.00 | 40.00 | Yes (X) | $0 | $322,046 | $5,400 | |
| John Starr | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| James Tibbetts | |||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| John McDowell MD | |||||||
| Past Director | 1.00 | 40.00 | Yes (X) | $0 | $6,699 | $0 | |
| Russell Keene | |||||||
| Past President/CFO | 40.00 | 0.00 | Yes (X) | $538,975 | $0 | $18,931 | |
| Warren West | |||||||
| Past CEO | 40.00 | 0.00 | Yes (X) | $407,521 | $250,000 | $37,306 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $946,496 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,254,292 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $126,082 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | 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/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Androscoggin Valley Hospital Inc | |||||
| 59 Page Hill Road | Berlin | NH | 03570 | Management Services | $877,389 |
| Sean Tracey Associates | |||||
| 401 State Street Suite 3 | Portsmouth | NH | 03801 | Marketing | $604,839 |
| Littleton Hospital Association | |||||
| 600 St Johnsbury Road | Littleton | NH | 03561 | Management Services | $525,379 |
| Quorum Health Resources | |||||
| 1573 Mallory Lane Suite 200 | Brentwood | TN | 37027 | GPO & Consulting | $200,839 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Management Fees | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $4,269,030 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,269,030 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,269,030 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,269,030 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,269,030 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,002,733 | TotalAmt |
| Program Services | $1,002,733 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $735,354 | TotalAmt |
| Program Services | $735,354 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,156 | TotalAmt |
| Management And General | $130,156 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,969 | TotalAmt |
| Management And General | $31,969 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,548 | TotalAmt |
| Program Services | $63,548 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,009 | TotalAmt |
| Program Services | $13,009 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,055 | TotalAmt |
| Program Services | $10,055 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,888 | TotalAmt |
| Program Services | $19,888 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Supplies & Services | $1,668,648 | $1,668,648 |
| Education Center | $427,752 | $427,752 |
| Recruitment Expense | $136,390 | $136,390 |
| Miscellaneous Expense | $26,809 | $26,809 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,266,311 | TotalAmt |
| Program Services | $4,104,186 | ProgramServicesAmt |
| Management And General | $162,125 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,331 | BOYAmt |
| EOY | $101,342 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $159,392 | BOYAmt |
| EOY | $628,418 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $56,075 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,723 | BOYAmt |
| EOY | $785,835 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $327,723 | BOYAmt |
| EOY | $733,116 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $327,723 | BOYAmt |
| EOY | $733,116 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $52,719 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $52,719 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,723 | BOYAmt |
| EOY | $785,835 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,719 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 5 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (5 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| Androscoggin Valley Hospital Inc | ||||
| 020280367 | 3 | Yes (1) | $998,613 | $0 |
| Weeks Medical Center | ||||
| 020222242 | 3 | Yes (1) | $934,473 | $0 |
| Upper Connecticut Valley Hospital | ||||
| 020276210 | 3 | Yes (1) | $306,412 | $0 |
| Littleton Hospital Association | ||||
| 020222152 | 3 | Yes (1) | $1,574,396 | $0 |
| North Country Home Health & Hospice Agency Inc | ||||
| 020300637 | 10 | Yes (1) | $49,248 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 5 | SupportedOrganizationsTotalCnt |
| Support Sum | $3,863,142 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part I, Line 12g | FormAndLineReferenceDesc |
| Explanation | Androscoggin Valley Hospital, Inc., Weeks Medical Center, Upper Connecticut Valley Hospital, and Littleton Hospital Association are all listed in the Organization's governing documents. Effective January 2017, the Organization became the sole member of North Country Home Health & Hospice Agency, Inc.; however, the Organization's governing documents currently do not directly reference the Agency. | ExplanationTxt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,000 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,000 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The Organization pays dues to various organizations, a portion of which is attributable to lobbying expenses. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Edward Duffy MD | ||||||||||||||
| Interim CEO | $0 | $362,869 | $0 | $0 | $0 | $51 | $0 | $3,152 | $0 | $34,067 | $0 | $400,139 | $0 | $0 |
| Lars Nielson MD | ||||||||||||||
| Director | $0 | $289,459 | $0 | $0 | $0 | $23,168 | $0 | $5,632 | $0 | $21,594 | $0 | $339,853 | $0 | $0 |
| John Sauter MD | ||||||||||||||
| Director | $0 | $265,049 | $0 | $36,838 | $0 | $20,159 | $0 | $5,400 | $0 | $0 | $0 | $327,446 | $0 | $0 |
| Russell Keene | ||||||||||||||
| Past President/CFO | $329,119 | $0 | $0 | $0 | $209,856 | $0 | $0 | $0 | $18,931 | $0 | $557,906 | $0 | $0 | $0 |
| Warren West | ||||||||||||||
| Past CEO | $407,521 | $0 | $0 | $0 | $0 | $250,000 | $5,400 | $0 | $31,906 | $0 | $444,827 | $250,000 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 4b | Russell Keene participated in a supplemental nonqualified retirement plan. Amounts related to this plan, reported on Page 2 of Schedule J, include $181,064 in column B(iii). Warren West also participated in a supplemental nonqualified retirement plan. Amounts related to this plan, reported on Page 2 of Schedule J, include $250,000 in column B(iii). |
| Schedule J, Part I, Line 3 | The Organization is the sole member of Androscoggin Valley Hospital ("AVH"), Littleton Hospital Association d/b/a Littleton Regional Healthcare ("LRH"), Weeks Medical Center ("WMC"), Upper Connecticut Valley Hospital ("UCVH"), and North Country Home Health & Hospice Agency, Inc. ("NCHH&H"). The Organization retained the services of its interim and past Chief Executive Officer and its past President/Chief Financial Officer pursuant to Employee Leasing Agreements (the "Agreements") between the Organization and LRH and AVH. These agreements provided for LRH and AVH to lease the services of the Organization's intermin and past CEO and past President/CFO, respectively, and for the Organization to pay LRH and AVH an amount equal to the salaries of such individuals as set forth in the Agreements. The Organization obtained an opinion from the firm of Arthur J. Gallagher & Co. dated March 1, 2016 as to the reasonableness of the compensation to be paid to the past CEO and past President/CFO pursuant to the Agreements, which opinion was based on a comparison of market data for similarly situated executives. AVH, LRH, WMC and UCVH - as the original constituent parties to the Affiliation Agreement that resulted in the creation of the Organization - approved the Agreements for the past CEO and past President/CFO, of which there is contemporaneous substantiation. The current interim CEO's compensation is based on the compensation determined for the past CEO. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 7a | Subsequent to the Initial Board, each member of the Corporation Board shall be nominated by action of a Hospital board of directors, or by the Corporation Board, as the case may be, in accordance with the nomination powers indicated in the Corporation's Bylaws. |
| Form 990, Part VI, Section A, line 7b | Any action to amend the Articles of Agreement or Bylaws of a particular Hospital or any affiliate of such Hospital may be initiated by action of either the Corporation Board or such Hospital Board, and shall be authorized by a two-thirds vot of the Corporation Boaard and each of the Hospital Boards. Any action to amend the Articles of Agreement or Bylaws of the Corporation must be initiated by the Corporation Board, and shall be authorized by a two-thirds vote of each of the Corporation Board and each of the Hospital Boards. |
| Form 990, Part VI, Section B, line 11b | Management conducts an initial review of the draft 990. Once the initial review is complete the 990 will be made available electronically to the North Country Healthcare Board Members. |
| Form 990, Part VI, Section B, line 12c | Conflict of Interest Process: - Conflict of Interest Disclosure completed via BoardPaq (electronic means) - Results compiled into Conflict Matrix which is reviewed and approved by the Board - Conflicts that meet the Pecuniary Benefit criteria are identified, shared with the Board and approved. - Disclosure notices are placed in local papers. - The Division of Charitable Trust is notified of the PB and copies of the public notices are attached. All employees are required to sign the NCH Code of Conduct. |
| Form 990, Part VI, Section B, line 15 | The Organization is the sole member of Androscoggin Valley Hospital ("AVH"), Littleton Hospital Association d/b/a Littleton Regional Healthcare ("LRH"), Weeks Medical Center ("WMC"), Upper Connecticut Valley Hospital ("UCVH"), and North Country Home Health & Hospice Agency, Inc. ("NCHH&H"). The Organization retained the services of its interim and past Chief Executive Officer and its past President/Chief Financial Officer pursuant to Employee Leasing Agreements (the "Agreements") between the Organization and LRH and AVH. These agreements provided for LRH and AVH to lease the services of the Organization's interim and past CEO and past President/CFO, respectively, and for the Organization to pay LRH and AVH an amount equal to the salaries of such individuals as set forth in the Agreements. The Organization obtained an opinion from the firm of Arthur J. Gallagher & Co. dated March 1, 2016 as to the reasonableness of the compensation to be paid to the interim and past CEO and past President/CFO pursuant to the Agreements, which opinion was based on a comparison of market data for similarly situated executives. AVH, LRH, WMC and UCVH - as the original constituent parties to the Affiliation Agreement that resulted in the creation of the Organization - approved the Agreements for the interim and past CEO and past President/CFO, of which there is contemporaneous substantiation. The current interim CEO's compensation is based on the compensation determined for the past CEO. |
| Form 990, Part VI, Section C, line 19 | The Organization formed in April of 2016. The Organization has implemented some of their policies, and is currently in the process of developing the remaining policies and procedures. The governing documents and financial statements are available to the public upon request. |
| Part VII, Section A, Line 1 | North Country Healthcare, Inc. did not pay compensation to its officers, directors, or highly compensated employees. Certain individuals who were employees of related organizations (Androscoggin Valley Hospital, Little Regional Healthcare, Upper Connecticut Valley Hospital, and Weeks Medical Center) performed services for North Country Healthcare Inc. North Country Healthcare, Inc. reimbursed this compensation at cost and has reported it as management fee expense. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Androscoggin Valley Hospital Inc | |||||||||||
| 59 Page Hill Road | Berlin | NH | 03570 | 020280367 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 | |
| Weeks Medical Center | |||||||||||
| 173 Middle Street | Lancaster | NH | 03584 | 020222242 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 | |
| Upper Connecticut Valley Hospital | |||||||||||
| Corliss lane | Colebrook | NH | 03576 | 020276210 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 | |
| Littleton Hospital Association | |||||||||||
| 600 St Johnsbury Road | Littleton | NH | 03561 | 020222152 | Critical Access Hospital | NH | 501(c)(3) | Line 3 | N/A | 0 | |
| North Country Home Health & Hospice Agency Inc | |||||||||||
| 536 Cottage Street | Littleton | NH | 03561 | 020300637 | Home Health Agency | NH | 501(c)(3) | Line 10 | Yes (1) | North Country Healthcare Inc | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments