NORTH COUNTRY HOSPITAL & HEALTH CENTER,INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization: NORTH COUNTRY HOSPITAL & HEALTH CENTER,INC (EIN 03-0185556)
Tax period: 2013-10-01 to 2014-09-30
Filed: 2015-08-17
IRS object ID: 201502299349301430
Schema version: 2013v4.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2015-08-17T13:49:57-05:00	ReturnTs
Tax Period End	2014-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	BKD LLP	BusinessNameLine1

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	910 E ST LOUIS 200/PO BOX 1190	AddressLine1
City	SPRINGFIELD	City
State	MO	State
ZIP Code	658062523	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2013-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	030185556	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	NORTH COUNTRY HOSPITAL & HEALTH CENTER INC	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of	% ANDRE BISSONNETTE	InCareOfNm
Business Name Control	NORT	BusinessNameControlTxt
Phone	8023347331	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	189 PROUTY DRIVE	AddressLine1
Address Line2	Suite	AddressLine2
City	NEWPORT	City
State	VT	State
ZIP Code	05855	ZIPCode

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ANDRE BISSONNETTE	PersonNm
Person Title	VICE PRESIDENT OF FINANCE	PersonTitleTxt
Phone	8023347331	PhoneNum
Signature	2015-04-02	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Brian D Todd	PreparerPersonNm
PTIN	P00422601	PTIN
Phone	8023347331	PhoneNum

Field	Value	IRS element (for citing)
Tax	2013	TaxYr
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	CLAUDIO FORT	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	189 PROUTY DRIVE	AddressLine1
City	NEWPORT	City
State	VT	State
ZIP Code	05855	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	$92,044,017	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.NCHSI.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1919	FormationYr
Legal Domicile State	VT	LegalDomicileStateCd
Activity Or Mission	TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS OF ORLEANS AND ESSEX COUNTIES, ENSURING THAT HEALTH CARE IS AVAILABLE TO ALL PEOPLE.	ActivityOrMissionDesc
Voting Members Governing Body	15	VotingMembersGoverningBodyCnt
Voting Members Independent	11	VotingMembersIndependentCnt
Total Employee	644	TotalEmployeeCnt
Total Volunteers	55	TotalVolunteersCnt
Total Gross UBI	$8,202	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$6,035	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$316,739	PYContributionsGrantsAmt
CY Contributions Grants	$326,895	CYContributionsGrantsAmt
PY Program Service Revenue	$78,995,838	PYProgramServiceRevenueAmt
CY Program Service Revenue	$80,646,404	CYProgramServiceRevenueAmt
PY Investment Income	$1,346,042	PYInvestmentIncomeAmt
CY Investment Income	$1,529,509	CYInvestmentIncomeAmt
PY Other Revenue	-$12,441	PYOtherRevenueAmt
CY Other Revenue	$103,307	CYOtherRevenueAmt
PY Total Revenue	$80,646,178	PYTotalRevenueAmt
CY Total Revenue	$82,606,115	CYTotalRevenueAmt
PY Grants And Similar Paid	$9,450	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$8,081	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$47,168,685	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$44,975,055	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$33,053,274	PYOtherExpensesAmt
CY Other Expenses	$34,119,429	CYOtherExpensesAmt
PY Total Expenses	$80,231,409	PYTotalExpensesAmt
CY Total Expenses	$79,102,565	CYTotalExpensesAmt
PY Revenues Less Expenses	$414,769	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,503,550	CYRevenuesLessExpensesAmt
Total Assets BOY	$74,170,231	TotalAssetsBOYAmt
Total Assets EOY	$78,814,597	TotalAssetsEOYAmt
Total Liabilities BOY	$33,893,618	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$33,696,166	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$40,276,613	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$45,118,431	NetAssetsOrFundBalancesEOYAmt
Mission	QUALITY PATIENT CARE IS OUR GREATEST COMMITMENT, EMPLOYEES ARE OUR GREATEST ASSET, EXCELLENT PATIENT EXPERIENCE IS OUR GREATEST ACCOMP- LISHMENT, & THE HLTH OF OUR COMMUNITY IS OUR GREATEST RESPONSIBILITY.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$47,103,993	ExpenseAmt
Revenue	$55,162,221	RevenueAmt
Desc	THE HOSPITAL OFFERS OUTPATIENT SERVICES INCLUDING EMERGENCY ROOM, LAB WORK, DIAGNOSTIC IMAGING (X-RAY, CT SCAN, MRI, MAMMOGRAMS, NUCLEAR IMAGING ULTRASOUND), OUTPATIENT SURGERIES, ONCOLOGY TREATMENTS, PULMONARY, CARDIAC CARE AND THERAPY SERVICES (PHYSICAL, SPEECH AND REHABILITATIVE) TOTALING 69,862 REGISTRATIONS FOR THE YEAR.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$11,225,074	ExpenseAmt
Grant	$8,081	GrantAmt
Revenue	$13,149,579	RevenueAmt
Desc	INPATIENT HOSPITAL CARE WAS PROVIDED AT A CRITICAL ACCESS HOSPITAL TOTALING 5,582 PATIENT DAYS FOR THE YEAR. THE HOSPITAL'S INPATIENT CARE SERVICES INCLUDE A 24 HOUR EMERGENCY DEPARTMENT, MEDICAL AND SURGICAL SERVICES, INTENSIVE CARE UNITS, BIRTHING CENTER, CLINICAL LABORATORY, MRI AND ULTRASOUND, NEUROLOGY, ORTHOPEDICS, PHARMACY, REHABILITATION SERVICES, OCCUPATIONAL AND PHYSICAL THERAPY AMONG OTHERS. THE HOSPITAL ALSO PROVIDED COMMUNITY GRANTS.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$10,536,419	ExpenseAmt
Revenue	$12,334,604	RevenueAmt
Desc	THE HOSPITAL'S PHYSICIAN PRACTICE CLINICS PROVIDE INTERNAL MEDICINE, RADIOLOGY PROGRAM, PSYCHIATRIC, OB/GYN, NEUROLOGY, ORTHOPEDICS, OCCUPATIONAL HEALTH, PULMONARY-SLEEP, SURGICAL SERVICES AND HEMATOLOGY/ONCOLOGY PRACTICES. THE PHYSICIAN PRACTICE CLINICS OF THE HOSPITAL SERVICED 83,973 PATIENTS VISITS FOR THE YEAR.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$68,865,486	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	Yes (true)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	69	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	644	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	15	GoverningBodyVotingMembersCnt
Independent Voting Member	11	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (true)	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (true)	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	ANDRE BISSONNETTE	PersonNm
Phone	8023347331	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	189 PROUTY DRIVE	AddressLine1
City	NEWPORT	City
State	VT	State
ZIP Code	05855	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (21 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	Highest Compensated EmployeeHighestCompensatedEmployeeInd
KATHRYN AUSTIN
CHAIR	10.0	2.0	Yes (X)	Yes (X)	$0	$0	$0
SCOTT PERRY
TRUSTEE	5.0	2.0	Yes (X)		$0	$0	$0
GARY GILLESPIE
VICE CHAIR FINANCE	5.0	2.0	Yes (X)	Yes (X)	$0	$0	$0
MELISSA PETTERSSON
SECRETARY/CLERK	5.0	2.0	Yes (X)	Yes (X)	$0	$0	$0
RICHARD BARAW
TRUSTEE	5.0	2.0	Yes (X)		$0	$0	$0
ALAN WING
VICE CHAIR - BOARD	5.0	2.0	Yes (X)	Yes (X)	$0	$0	$0
BILL STENGER
TRUSTEE	5.0	2.0	Yes (X)		$0	$0	$0
JENNIFER LADD MD
VP MEDICAL STAFF	40.0	2.0	Yes (X)		$339,103	$0	$52,374
RACHEL DISANTO MD
PRESIDENT MEDICAL STAFF	40.0	2.0	Yes (X)		$208,319	$0	$35,069
FRANK KNOLL
TRUSTEE	5.0	2.0	Yes (X)		$0	$0	$0
MARK BEAMS
TRUSTEE	5.0	2.0	Yes (X)		$0	$0	$0
BOB WILSON
TRUSTEE	5.0	2.0	Yes (X)		$0	$0	$0
CHRISTOPHER RICKMAN MD
TRUSTEE/PHYSICIAN	40.0	2.0	Yes (X)		$300,652	$0	$46,989
CLAUDIO D FORT
CEO	40.0	2.0	Yes (X)	Yes (X)	$276,286	$0	$57,468
THOMAS MILNAMOW
TRUSTEE BEG 1/14	5.0	2.0	Yes (X)		$0	$0	$0
ANDRE BISSONNETTE
VP OF FINANCE	40.0	2.0		Yes (X)	$156,565	$0	$33,425
GREGORY WALKER MD
PHYSICIAN	40.0				$530,859	$0	$45,230	Yes (X)
SG NEALE MD
PHYSICIAN	40.0				$616,526	$0	$38,033	Yes (X)
MARK C MEREDITH MD
PHYSICIAN	40.0				$421,459	$0	$38,887	Yes (X)
THOMAS VARNEY MD
PHYSICIAN	40.0				$584,525	$0	$33,792	Yes (X)
LARRY SISSON MD
PHYSICIAN	40.0				$496,122	$0	$46,722	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$3,930,416	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$427,989	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	48	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

ServicesServicesDesc	CompensationCompensationAmt
NORTH COUNTRY RADIOLOGY PC
PHYSICIAN	$901,281
MORRISON MANAGEMENT SPECIALISTS
CAF MGMT	$555,979
MORRIS SWITZER ASSOCIATES
ARCHITECTURE	$177,101
CPS INC
PHARMACY MGMT	$401,826
BKD LLP
AUDIT/CONSULTING/TAX	$166,897

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	8	CntrctRcvdGreaterThan100KCnt
Government Grants	$282,319	GovernmentGrantsAmt
All Other Contributions	$44,576	AllOtherContributionsAmt
Total Contributions	$326,895	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENUE	624100	$72,096,241	$72,096,241
OTHER PATIENT SERVICE REVENUE	624100	$3,709,028	$3,709,028
EHR REVENUE	624100	$868,068	$868,068
340B PHARMACY	446110	$3,752,987	$3,752,987
CAFETERIA	722514	$220,080	$220,080

Field	Value	IRS element (for citing)
Total Program Service Revenue	$80,646,404	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$587,596	TotalRevenueColumnAmt
Exclusion	$587,596	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,400	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$1,400	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,400	TotalRevenueColumnAmt
Exclusion	$1,400	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$10,325,487	SecuritiesAmt
Other	$54,328	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$9,345,002	SecuritiesAmt
Other	$92,900	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$980,485	SecuritiesAmt
Other	-$38,572	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$941,913	TotalRevenueColumnAmt
Exclusion	$941,913	ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
GAIN ON INVEST IN EQUITY INVESTEE	900099	$93,705	$93,705
ADMINISTRATIVE SERVICES	561000	$7,532		$7,532
HOUSEKEEPING SERVICES	812900	$670		$670

Field	Value	IRS element (for citing)
Other Revenue Total	$101,907	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$82,606,115	TotalRevenueColumnAmt
Related Or Exempt Func Income	$80,646,404	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$8,202	UnrelatedBusinessRevenueAmt
Exclusion	$1,624,614	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$8,081	TotalAmt
Program Services	$8,081	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$1,503,117	TotalAmt
Program Services	$979,374	ProgramServicesAmt
Management And General	$523,743	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$32,514,326	TotalAmt
Program Services	$28,217,147	ProgramServicesAmt
Management And General	$4,297,179	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$1,491,181	TotalAmt
Program Services	$1,373,182	ProgramServicesAmt
Management And General	$117,999	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$7,229,596	TotalAmt
Program Services	$6,544,739	ProgramServicesAmt
Management And General	$684,857	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$2,236,835	TotalAmt
Program Services	$2,012,051	ProgramServicesAmt
Management And General	$224,784	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$670,150	TotalAmt
Management And General	$670,150	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$56,200	TotalAmt
Management And General	$56,200	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$56,269	TotalAmt
Management And General	$56,269	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$247,627	TotalAmt
Management And General	$247,627	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$5,908,327	TotalAmt
Program Services	$4,778,689	ProgramServicesAmt
Management And General	$1,129,638	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$206,633	TotalAmt
Program Services	$109	ProgramServicesAmt
Management And General	$206,524	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,724,049	TotalAmt
Program Services	$2,404,894	ProgramServicesAmt
Management And General	$319,155	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$49,803	TotalAmt
Program Services	$42,126	ProgramServicesAmt
Management And General	$7,677	ManagementAndGeneralAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,145,035	TotalAmt
Program Services	$988,494	ProgramServicesAmt
Management And General	$156,541	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$151,563	TotalAmt
Program Services	$117,878	ProgramServicesAmt
Management And General	$33,685	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$280,365	TotalAmt
Program Services	$243,992	ProgramServicesAmt
Management And General	$36,373	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$702,169	TotalAmt
Program Services	$633,117	ProgramServicesAmt
Management And General	$69,052	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$4,580,565	TotalAmt
Program Services	$4,129,828	ProgramServicesAmt
Management And General	$450,737	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$792,466	TotalAmt
Program Services	$595,200	ProgramServicesAmt
Management And General	$197,266	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES & DRUGS	$6,524,648	$6,524,648
PROVIDER TAX	$4,221,188	$4,221,188
BAD DEBT	$3,147,280	$3,147,280
REPAIRS & MAINTENANCE	$2,309,518	$1,759,189	$550,329

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$345,574	TotalAmt
Program Services	$144,280	ProgramServicesAmt
Management And General	$201,294	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$79,102,565	TotalAmt
Program Services	$68,865,486	ProgramServicesAmt
Management And General	$10,237,079	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$6,211,819	BOYAmt
EOY	$9,014,417	EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$77,881	BOYAmt
EOY	$56,780	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$7,476,183	BOYAmt
EOY	$6,872,144	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$1,610,986	BOYAmt
EOY	$1,677,199	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$799,491	BOYAmt
EOY	$1,206,031	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$65,096,183	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$38,822,102	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$27,818,301	BOYAmt
EOY	$26,274,081	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$27,428,937	BOYAmt
EOY	$30,303,538	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$74,041	BOYAmt
EOY	$165,745	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$441,537	BOYAmt
EOY	$711,296	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$2,231,055	BOYAmt
EOY	$2,533,366	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$74,170,231	BOYAmt
EOY	$78,814,597	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$8,617,112	BOYAmt
EOY	$9,278,204	EOYAmt

Grants Payable GrantsPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$11,379	BOYAmt
EOY	$0	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$21,025,000	BOYAmt
EOY	$20,370,000	EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$700,005	BOYAmt
EOY	$614,245	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$3,540,122	BOYAmt
EOY	$3,433,717	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$33,893,618	BOYAmt
EOY	$33,696,166	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$36,999,364	BOYAmt
EOY	$41,661,530	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,482,540	BOYAmt
EOY	$2,662,192	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$794,709	BOYAmt
EOY	$794,709	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$40,276,613	BOYAmt
EOY	$45,118,431	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$74,170,231	BOYAmt
EOY	$78,814,597	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$3,503,550	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$1,410,635	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$72,367	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	false	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbyingGrp
Total Direct Lobbying		TotalDirectLobbyingGrp
Total Lobbying Expend		TotalLobbyingExpendGrp
Other Exempt Purpose Expend		OtherExemptPurposeExpendGrp
Total Exempt Purpose Expend		TotalExemptPurposeExpendGrp
Lobbying Nontaxable Amount		LobbyingNontaxableAmountGrp
Grassroots Nontaxable		GrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non Tx		TotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non Tx		TotLbbyExpendMnsLbbyngNonTxGrp
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	false	GrantsOtherOrganizationsInd
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	Yes (true)	OtherActivitiesInd
Other Activities	$14,722	OtherActivitiesAmt
Total Lobbying Expenditures	$14,722	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE C, PART II-B, LINE 1(I)	FormAndLineReferenceDesc
Explanation	OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE VERMONT HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 11.55% OF DUES SUPPORT LOBBYING EFFORTS. IN ADDITION, THE ORGANIZATION PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 23.65% OF DUES SUPPORT LOBBYING EFFORTS.	ExplanationTxt

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amounts		ArtPublicExhibitionAmountsGrp
Held Works Art		HeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,835,712	BeginningYearBalanceAmt
Investment Earnings Or Losses	$366,855	InvestmentEarningsOrLossesAmt
Other Expenditures	$5,820	OtherExpendituresAmt
End Year Balance	$3,196,747	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,731,541	BeginningYearBalanceAmt
Investment Earnings Or Losses	$104,171	InvestmentEarningsOrLossesAmt
End Year Balance	$2,835,712	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,652,555	BeginningYearBalanceAmt
Investment Earnings Or Losses	$78,986	InvestmentEarningsOrLossesAmt
End Year Balance	$2,731,541	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,531,933	BeginningYearBalanceAmt
Investment Earnings Or Losses	$120,622	InvestmentEarningsOrLossesAmt
End Year Balance	$2,652,555	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$2,413,853	BeginningYearBalanceAmt
Investment Earnings Or Losses	$118,080	InvestmentEarningsOrLossesAmt
End Year Balance	$2,531,933	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	0.24860	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.75140	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	false	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$405,921	OtherCostOrOtherBasisAmt
Book Value	$405,921	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$19,146,176	OtherCostOrOtherBasisAmt
Depreciation	$10,363,122	DepreciationAmt
Book Value	$8,783,054	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$19,702,525	OtherCostOrOtherBasisAmt
Depreciation	$11,962,773	DepreciationAmt
Book Value	$7,739,752	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$23,661,936	OtherCostOrOtherBasisAmt
Depreciation	$15,592,989	DepreciationAmt
Book Value	$8,068,947	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,179,625	OtherCostOrOtherBasisAmt
Depreciation	$903,218	DepreciationAmt
Book Value	$1,276,407	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$26,274,081	TotalBookValueLandBuildingsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
EST AMTS DUE TO 3RD PARTY PAYER	$1,661,633
INTEREST RATE SWAP	$1,772,084

Field	Value	IRS element (for citing)
Total Liability	$3,433,717	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$79,447,402	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$236,194	NetUnrealizedGainsInvstAmt
Other Revenue	-$3,394,907	OtherRevenueAmt
Revenue Not Reported	-$3,158,713	RevenueNotReportedAmt
Revenue Subtotal	$82,606,115	RevenueSubtotalAmt
Total Revenue Per Form990	$82,606,115	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$75,707,658	TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal	$75,707,658	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$247,627	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$3,147,280	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$3,394,907	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$79,102,565	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUNDS: NORTH COUNTRY HEALTH SYSTEMS (NCHS), A RELATED ORGANIZATION, HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER NCHS'S POLICIES, THE PRIMARY INVESTMENT GOAL IS GROWTH IN THE ENDOWMENT ACCOUNTS. NCHS EXPECTS ITS ENDOWMENT FUNDS TO PROVIDE AN AVERAGE RATE OF RETURN THAT EXCEEDS BENCH MARK RETURNS INDICATED FOR VARIOUS ASSET CLASSES.
SCHEDULE D, PART X, LINE 2	UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
SCHEDULE D, PART XI, LINE 2D	AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $ (3,147,280) BAD DEBT EXPENSE (247,627) INVESTMENT MANAGEMENT FEES -------------- $ (3,394,907)
SCHEDULE D, PART XII, LINE 4B	AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 3,147,280 BAD DEBT EXPENSE

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (true)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	false	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$563,299	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$563,299	NetCommunityBenefitExpnsAmt
Total Expense	0.00740	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$23,209,002	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,418,983	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$11,790,019	NetCommunityBenefitExpnsAmt
Total Expense	0.15520	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$23,772,301	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,418,983	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$12,353,318	NetCommunityBenefitExpnsAmt
Total Expense	0.16260	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$13,264	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$13,264	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$153,235	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$153,235	NetCommunityBenefitExpnsAmt
Total Expense	0.00200	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,362,583	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,133,984	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,228,599	NetCommunityBenefitExpnsAmt
Total Expense	0.06880	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$19,270	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$19,270	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,548,352	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$11,133,984	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$5,414,368	NetCommunityBenefitExpnsAmt
Total Expense	0.07130	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$40,320,653	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$22,552,967	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$17,767,686	NetCommunityBenefitExpnsAmt
Total Expense	0.23390	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,733	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$2,733	NetCommunityBenefitExpnsAmt

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,111	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$4,111	NetCommunityBenefitExpnsAmt

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$835	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$835	NetCommunityBenefitExpnsAmt

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,679	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$7,679	NetCommunityBenefitExpnsAmt

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReportedInd
Bad Debt Expense	$3,147,280	BadDebtExpenseAmt
Bad Debt Expense Attributable	$484,681	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$25,293,646	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$24,856,205	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	$437,441	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	NORTH COUNTRY HOSPITAL	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	189 PROUTY DRIVE	AddressLine1
City	NEWPORT	City
State	VT	State
ZIP Code	05855	ZIPCode

Field	Value	IRS element (for citing)
Website Address	nchsi.org	WebsiteAddressTxt
State License	832	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	NORTH COUNTRY HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	12	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	false	CHNAConductedWithOtherFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	https://www.northcountryhospital.org	OwnWebsiteURLTxt
Rpt Available Upon Request	Yes (X)	RptAvailableUponRequestInd
Adopt Implementation Strategy	Yes (X)	AdoptImplementationStrategyInd
Exec Implementation Strategy	Yes (X)	ExecImplementationStrategyInd
Develop Community Wide Plan	Yes (X)	DevelopCommunityWidePlanInd
Exec Community Wide Plan	Yes (X)	ExecCommunityWidePlanInd
Include Operational Plan	Yes (X)	IncludeOperationalPlanInd
Adopt Budget	Yes (X)	AdoptBudgetInd
Prioritize Health Needs	Yes (X)	PrioritizeHealthNeedsInd
Prioritize Services	Yes (X)	PrioritizeServicesInd
All Needs Addressed	Yes (true)	AllNeedsAddressedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Used Deter Elig Free Care	Yes (true)	FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care	200.	FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt Care	Yes (true)	FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care	300.	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (true)	ExplainedBasisInd
Income Level	Yes (X)	IncomeLevelInd
Asset Level	Yes (X)	AssetLevelInd
Medical Indigency	Yes (X)	MedicalIndigencyInd
Insurance Status	Yes (X)	InsuranceStatusInd
Uninsured Discount	Yes (X)	UninsuredDiscountInd
Medicaid Medicare	Yes (X)	MedicaidMedicareInd
State Regulation	Yes (X)	StateRegulationInd
Residency	Yes (X)	ResidencyInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
Posted On Website	Yes (X)	PostedOnWebsiteInd
Attached To Invoice	Yes (X)	AttachedToInvoiceInd
Posted In Emergency Room	Yes (X)	PostedInEmergencyRoomInd
Posted In Admission Office	Yes (X)	PostedInAdmissionOfficeInd
Provided On Admission	Yes (X)	ProvidedOnAdmissionInd
Available On Request	Yes (X)	AvailableOnRequestInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Collection Activities	false	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Average Negotiated Rates	Yes (X)	AverageNegotiatedRatesInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

SCHEDULE H, PART V, SECTION B, LINE 3

COMMUNITY INPUT: THE HOSPITAL ENGAGED A GROUP OF COMMUNITY MEMBERS AND LOCAL AND STATE AGENCIES AS PART OF ITS ASSESSMENT TEAM FOR THE PURPOSE OF DEFINING THE MEDICAL NEEDS OF THE COMMUNITY.

SCHEDULE H, PART V, SECTION B, LINE 6

IMPLEMENTATION STRATEGY: IN RESPONSE TO THE RESULTS OF NORTH COUNTRY HOSPITAL & HEALTH CENTER'S MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION ADOPTED AN IMPLEMENTATION STRATEGY. THE IMPLEMENTATION STRATEGY CAN BE FOUND AT THE FOLLOWING URL: HTTPS://WWW.NORTHCOUNTRYHOSPITAL.ORG/COMMUNITY-NEEDS-ASSESSMENT THE ORGANIZATION HAS MADE PROGRESS TOWARDS THE IMPLEMENTATION STRATEGIES USED TO ADDRESS THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT. A REPORT DETAILING THIS PROGRESS IS ATTACHED.

Field	Value	IRS element (for citing)
Facility	8	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	FacilityFacilityTxt
ORLEANS FAMILY MEDICINE
30 EAST ST	ORLEANS	VT	05860	FAMILY MED, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC
FAMILY PRACTICE OF NEWPORT
81 MEDICAL VILLAGE DRIVE	NEWPORT	VT	05855	FAMILY MED, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC
THE BARTON CLINIC
488 ELM ST	BARTON	VT	05822	FAMILY MED, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC
NORTH COUNTRY HOSPITAL OBGYN SERVICES
81 MEDICAL VILLAGE DRIVE	NEWPORT	VT	05855	OB/GYN SERVICES
COMMUNITY MEDICAL ASSOCIATES
41 MEDICAL VILLAGE DRIVE	NEWPORT	VT	05855	FAMILY MED, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC
NORTH COUNTRY SURGICAL ASSOCIATES
41 MEDICAL VILLAGE DR	NEWPORT	VT	05855	SURGERY
NORTH COUNTRY ORTHOPEDICS
81 MEDICAL VILLAGE DR	NEWPORT	VT	05855	ORTHOPEDICS
NORTH COUNTRY NEUROLOGICAL
MEDICAL ARTS BLDG 2ND FLOOR 189 P	NEWPORT	VT	05855	NEUROLOGICAL

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7, COLUMN F	PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OF $3,147,280.
SCHEDULE H, PART I, LINE 7	COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6.
SCHEDULE H, PART I, LINE 7G	SUBSIDIZED SERVICES: AMOUNTS USED IN THE CALCULATION OF SUBSIDIZED SERVICES ON LINE 7G PRIMARILY CAME FROM COSTS ASSOCIATED WITH RURAL HEALTH CENTERS (RHC). NORTH COUNTRY HOSPITAL PROVIDES PRIMARY CARE SERVICES TO THE SURROUNDING COMMUNITIES AT THE CENTERS. THESE SERVICES ARE PROVIDED IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OF QUALITY MEDICAL CARE WITHOUT THE SERVICES. NORTH COUNTRY HOSPITAL CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED. THE NET AMOUNT OF SUBSIDIZED SERVICES ATTRIBUTABLE TO RHC'S IS $5,073,189.
SCHEDULE H, PART II	COMMUNITY BUILDING ACTIVITIES: OUR ORGANIZATION'S COMMUNITY-BUILDING ACTIVITIES INCLUDE ACTIVE PARTICIPATION BY HOSPITAL STAFF ON A NUMBER OF ECONOMIC-BUILDING COLLABORATIONS SUCH AS THE LOCAL ROTARY AND CHAMBER OF COMMERCE AS WELL AS ON LOCAL PARTNERSHIPS SUCH AS THOSE THAT FOCUS ON PREVENTION AND REDUCTION OF DOMESTIC VIOLENCE, PREVENTION/REDUCTION OF ALCOHOL, DRUGS AND TOBACCO, PROMOTION OF PHYSICAL ACTIVITY AND HEALTHY LIFESTYLE CHOICES. THE HOSPITAL ALSO PROVIDES MEETING SPACE AT NO CHARGE FOR NUMEROUS AGENCIES AND GROUPS THAT TARGET VARIOUS ASPECTS OF COMMUNITY HEALTH SUCH AS ALCOHOLICS ANONYMOUS, EARLY CHILDHOOD DEVELOPMENT, GRIEVING SUPPORT GROUPS, DRIVING SAFETY COURSES, YOUTH BEHAVIOR SUPPORT TEAMS AND YOUTH COURT DIVERSION TEAMS.
SCHEDULE H, PART III, SECTION A, LINE 2	BAD DEBT EXPENSE: BAD DEBT EXPENSE REPORTED ON LINE 2 IS THE AMOUNT PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO FINANCIAL ASSISTANCE: THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY FOR LINE 3 BY UTILIZING DATA FROM THE U.S. CENSUS BUREAU. THE ORGANIZATION ESTIMATED THE PERCENTAGE BY OBTAINING THE PERCENT OF THE POPULATION IN ITS SERVICE AREA FALLING BELOW THE FEDERAL POVERTY GUIDELINES. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE. THAT FOOTNOTE READS AS FOLLOWS: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.
SCHEDULE H, PART III, SECTION B, LINES 5-7	MEDICARE CALCULATION: THE AMOUNTS SHOWN ON LINES 5, 6, AND 7 DO NOT INCLUDE THE MEDICARE REVENUES AND COSTS ASSOCIATED WITH THE RURAL HEALTH CLINICS AND OTHER PHYSICIAN CLINICS. THESE MEDICARE REVENUES AND COSTS COMPRISE A PORTION OF THE TOTAL SUBSIDIES INCLUDED IN SUBSIDIZED SERVICES ON PART I, LINE 7G. AS THESE FIGURES DO NOT INCLUDE CERTAIN MEDICARE PROGRAM REVENUES AND COSTS, IT THUS CANNOT REFLECT ALL OF THE ORGANIZATION'S REVENUES AND COSTS ASSOCIATED WITH ITS PARTICIPATION IN MEDICARE PROGRAMS.
SCHEDULE H, PART III, SECTION B, LINE 8	COMMUNITY BENEFIT: THE COMMUNITY IS BETTER SERVED WITH PROVIDERS AVAILABLE IN THE ORGANIZATION'S REMOTE REGION. THE ENTIRETY OF THE SHORTFALL REPORTED ON LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE WILL LIKELY BE SHORTFALLS. ADDITIONALLY, TREATING MEDICARE PATIENTS IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO.
SCHEDULE H, PART III, SECTION C, LINE 9B	COLLECTION POLICY: WHEN IDENTIFIED AS A POSSIBLE WRITE OFF TO MEDICARE BAD DEBT, AN ACCOUNT MUST MEET MEDICARE'S CRITERIA FOR REPORTING ON THE COST REPORT. AN ACCOUNT FOR A MEDICARE PATIENT MUST UNDERGO HOSPITAL COLLECTION EFFORTS FOR AT LEAST 120 DAYS FROM THE INITIAL DATE OF BILLING TO THE PATIENT BEFORE BEING CONSIDERED FOR WRITE-OFF TO A THIRD PARTY AGENCY. THESE MEDICARE ACCOUNTS WILL BE CLOSED AND RETURNED BY THE AGENCIES AFTER 120 DAYS FROM PLACEMENT IF COLLECTION EFFORTS FAIL AND THEY ARE DEEMED UNCOLLECTIBLE. IF A MEDICARE PATIENT IS DECEASED AND NO ESTATE CAN BE IDENTIFIED, IT WILL BE DEEMED UNCOLLECTIBLE AND MAY BE DIRECTLY CONSIDERED FOR WRITE-OFF RATHER THAN TURNED OVER TO A THIRD PARTY AGENCY. IF A MEDICARE PATIENT FILES FOR BANKRUPTCY, THE ACCOUNTS WILL BE DEEMED UNCOLLECTIBLE AND WILL BE DIRECTLY CONSIDERED FOR WRITE-OFF. IF A MEDICARE PATIENT QUALIFIES FOR FREE CARE UNDER THE HOSPITAL'S GUIDELINES, THE ACCOUNT(S) WILL BE DEEMED UNCOLLECTIBLE AND WILL BE WRITTEN OFF TO THE APPROPRIATE PAT CODE(S). WHEN A MEDICARE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE DEDUCTIBLE AND/OR COINSURANCE AMOUNTS WILL BE WRITTEN OFF USING THE APPROPRIATE PAT CODE(S). NON COVERED AMOUNTS DO NOT QUALIFY FOR MEDICARE BAD DEBT. ALL SUPPORTING DOCUMENTATION REGARDING DEDUCTIBLE AND COINSURANCE AMOUNTS WILL BE COLLECTED AND FILES FOR COST REPORTING PURPOSES.
SCHEDULE H, PART VI, LINE 2	NEEDS ASSESSMENT: WHILE THE HOSPITAL ACTIVELY PARTICIPATES IN A NUMBER OF COMMUNITY PARTNERSHIPS THAT FOCUS ON VARIOUS ASPECTS OF LOCAL HEALTH NEEDS - INCLUDING, FOR EXAMPLE, HEALTH DISPARITIES, ALCOHOL, DRUG AND TOBACCO PREVENTION, PROMOTING HEALTHY EATING AND PHYSICAL ACTIVITY. VT DEPARTMENT OF HEALTH REMAINS AND EXCELLENT AND VERY THOROUGH DATA SOURCE, WITH DATA AVAILABLE STATEWIDE, BY COUNTY AND BY SCHOOL SUPERVISORY DISTRICTS. DATA IS AVAILABLE ACROSS THE LIFESPAN AND INCLUDES, FOR EXAMPLE TOPICS SUCH AS COMMUNICABLE DISEASE, CHRONIC DISEASE, OCCUPATIONAL HEALTH DATA, RISK FACTORS SUCH AS ALCOHOL, DRUG & TOBACCO USE, OBESITY, LIFESTYLE CHOICES. DATA REGARDING SOCIOECONOMIC STATUS AND EDUCATION LEVEL IS ALSO READILY AVAILABLE, AGAIN FOR THE STATE AS WELL AS BY COUNTY AND SCHOOL DISTRICT. ALL DATA IS EASILY ACCESSIBLE ONLINE AT WWW.HEALTHVERMONT.GOV AND AT HUMANSERVICES.VERMONT.GOV. THE HOSPITAL ALSO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT TO COMPLY WITH NEW IRS 501(R) REQUIREMENTS.
SCHEDULE H, PART VI, LINE 3	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: FOR BALANCES OVER $500.00 A "HELP IS AVAILABLE" LETTER IS MAILED WITH THE INITIAL BILL, REGARDLESS OF WHETHER THE BALANCE IS SELF-PAY, PRIMARY OR AFTER INSURANCE. IN ADDITION, OUR COLLECTION LETTERS ALL REFER TO OUR FREE CARE PROGRAM ASKING THE PATIENT TO CALL TO DISCUSS THIS AND OTHER OPTIONS. WHEN FREE CARE IS DISCUSSED WITH THE PATIENT, IT IS EXPLAINED THAT THEY ARE REQUIRED TO APPLY FOR OTHER ASSISTANCE AND WE OFFER OUR HELP IN THE APPLICATION PROCESS. FOR SELF-PAY PATIENTS THAT ARE IP, ONE OF THE FINANCIAL COUNSELORS ATTEMPTS TO DISCUSS MEDICAID AS WELL AS FREE CARE.
SCHEDULE H, PART VI, LINE 4	COMMUNITY INFORMATION: WE SERVE TWO OF THE MOST ECONOMICALLY CHALLENGED COUNTIES IN VERMONT. WITH A TOTAL OF APPROXIMATELY 30,000 RESIDENTS IN OUR SERVICE AREA, OUR POPULATION, AS COMPARED TO VT AND THE US, HAS A SIGNIFICANTLY HIGHER PERCENTAGE OF PERSONS LIVING UNDER THE FEDERAL POVERTY LEVEL AND A VERY HIGH RATE OF ADULTS AGE 25+ WITHOUT A HIGH SCHOOL EDUCATION, WHILE THE MEDIAN HOUSEHOLD INCOME IS SIGNIFICANTLY LOWER, AGAIN AS COMPARED TO VT AND THE US. OUR REGION CONSISTENTLY HAS ONE OF THE HIGHEST RATES OF UNEMPLOYMENT IN THE STATE. THIS PRIMARILY WHITE POPULATION IS FOUND IN VERY SMALL COMMUNITIES SCATTERED OVER A RURAL, MOUNTAINOUS, AND LAKE-DOTTED AREA, MAKING TRAVELING AND NETWORKING A CHALLENGE, PARTICULARLY IN THE HARSH WINTER MONTHS.
SCHEDULE H, PART VI, LINE 5	PROMOTION OF COMMUNITY HEALTH: IN ADDITION TO THE COMMUNITY BUILDING ACTIVITIES LISTED ON POTHER COMMUNITY BENEFITS INCLUDE ACTIVITIES SUCH AS PROVIDING SKILLED NURSING SERVICES WHILE ACUTELY ILL PATIENTS ARE TRANSFERRED BY AMBULANCE TO A TERTIARY CARE CENTER, PROVIDING SUPPORT AND SUPERVISION IN THE EDUCATION OF STUDENT NURSES AND MEDICAL STUDENTS, DONATING SUPPLIES AND EQUIPMENT TO OTHER NON-PROFIT ORGANIZATIONS FOR THEIR CONTINUED USE, ACTIVE PARTICIPATION ON THE BOARDS OF SEVERAL HEALTH-RELATED AGENCIES SUCH AS THE VISITING NURSE ASSOCIATION, THE DOMESTIC VIOLENCE TASK FORCE, AND THE AREA AGENCY ON AGING. THE ORGANIZATION ALSO IMPLEMENTS A HELP LINE FOR THE HOMEBOUND OR FRAIL INDIVIDUALS WHO LIVE ALONE. A NUMBER OF LOCAL RESIDENTS RECEIVE THIS SERVICE AT NO COST TO THEM.
SCHEDULE H, PART VI, LINE 6	AFFILIATED HEALTH CARE SYSTEM ROLES: NORTH COUNTRY HEALTH SYSTEMS, INC. AND ITS SUBSIDIARIES COLLECTIVELY DO BUSINESS AS NORTH COUNTRY HEALTH SYSTEM (NCHS). NORTH COUNTRY HEALTH SYSTEMS, INC. (HEALTH SYSTEM) IS THE PARENT HOLDING COMPANY FOR ITS WHOLLY OWNED SUBSIDIARIES, WHICH INCLUDE NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. (HOSPITAL) AND NORTH COUNTRY HEALTH SERVICES, INC., D/B/A DERBY GREEN (DERBY GREEN). NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. OPERATES A 25-BED ACUTE CARE HOSPITAL FACILITY IN NEWPORT, VERMONT. THE HOSPITAL PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES TO PATIENTS IN NEWPORT, VERMONT, AND THE SURROUNDING AREA. THE HOSPITAL ALSO OPERATES A NUMBER OF PHYSICIAN CLINICS IN THE SAME GEOGRAPHIC AREA. DERBY GREEN OPERATES A 23-BED NURSING HOME LOCATED IN DERBY, VERMONT.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	false	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	Yes (true)	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (true)	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 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
JENNIFER LADD MD
VP MEDICAL STAFF	$339,103	$0	$0	$0	$0	$0	$31,003	$0	$21,371	$0	$391,477	$0	$0	$0
RACHEL DISANTO MD
PRESIDENT MEDICAL STAFF	$190,719	$0	$17,600	$0	$0	$0	$8,543	$0	$26,526	$0	$243,388	$0	$0	$0
CHRISTOPHER RICKMAN MD
TRUSTEE/PHYSICIAN	$276,565	$0	$24,087	$0	$0	$0	$26,729	$0	$20,260	$0	$347,641	$0	$0	$0
CLAUDIO D FORT
CEO	$276,286	$0	$0	$0	$0	$0	$30,945	$0	$26,523	$0	$333,754	$0	$0	$0
ANDRE BISSONNETTE
VP OF FINANCE	$149,957	$0	$3,635	$0	$2,973	$0	$8,407	$0	$25,018	$0	$189,990	$0	$0	$0
GREGORY WALKER MD
PHYSICIAN	$382,681	$0	$139,788	$0	$8,390	$0	$17,850	$0	$27,380	$0	$576,089	$0	$0	$0
SG NEALE MD
PHYSICIAN	$562,110	$0	$36,400	$0	$18,016	$0	$10,200	$0	$27,833	$0	$654,559	$0	$0	$0
MARK C MEREDITH MD
PHYSICIAN	$398,372	$0	$11,495	$0	$11,592	$0	$11,475	$0	$27,412	$0	$460,346	$0	$0	$0
THOMAS VARNEY MD
PHYSICIAN	$516,254	$0	$68,271	$0	$0	$0	$6,375	$0	$27,417	$0	$618,317	$0	$0	$0
LARRY SISSON MD
PHYSICIAN	$468,401	$0	$16,200	$0	$11,521	$0	$19,125	$0	$27,597	$0	$542,844	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE J, PART I, LINE 1B	HEALTH CLUB BENEFITS: ALL EMPLOYEES OF THE ORGANIZATION RECEIVE THE BENEFIT OF A LOCAL HEALTH CLUB'S MEMBERSHIP.
SCHEDULE J, PART I, LINE 4B	SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, RECEIVED 457(F) EMPLOYER CONTRIBUTIONS IN THE FOLLOWING AMOUNTS: $ 16,920 CLAUDIO FORT 10,000 CHRISTOPHER RICKMAN
SCHEDULE J, PART I, LINE 5A	COMPENSATION CONTINGENT ON THE REVENUES OF THE ORGANIZATION: PHYSICIANS EARN COMPENSATION BASED UPON THEIR PRODUCTIVITY AGAINST ESTABLISHED TARGETS. INCREASED PRODUCTIVITY IS DIRECTLY RELATED TO INCREASED REVENUES FOR THE ORGANIZATION.
SCHEDULE J, PART I, LINE 7	NON FIXED PAYMENTS: THE SENIOR TEAM AND CERTAIN DOCTORS ARE GIVEN BONUSES BASED ON SPECIFIC PROGRAM PERFORMANCE.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	VERMONT EDUCATIONAL & HLTH BLDGS FINANCING AGENCY	BusinessNameLine1

Field	Value	IRS element (for citing)
Bond Issuer EIN	030292808	BondIssuerEIN
CUSIP	924166AR2	CUSIPNum
Bond Issued	2007-06-01	BondIssuedDt
Issue Price	$23,795,000	IssuePriceAmt
Purpose	REFUND 04 BONDS, CAP IMPROV	PurposeDesc
Defeased	false	DefeasedInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Pool Financing	false	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$0	RetiredAmt
Bond Defeased	$0	BondDefeasedAmt
Total Proceeds	$24,215,685	TotalProceedsAmt
In Reserve Fund	$0	InReserveFundAmt
Capitalized Interest	$0	CapitalizedInterestAmt
Refunding Escrow	$16,900,515	RefundingEscrowAmt
Issuance Costs From Proceeds	$171,170	IssuanceCostsFromProceedsAmt
Credit Enhancement	$9,000	CreditEnhancementAmt
Working Capital Expenditures	$0	WorkingCapitalExpendituresAmt
Capital Expenditures	$7,135,000	CapitalExpendituresAmt
Other Spent Proceeds	$0	OtherSpentProceedsAmt
Unspent	$0	UnspentAmt
Substantial Completion	2010	SubstantialCompletionYr
Current Refunding	Yes (true)	CurrentRefundingInd
Advance Refunding	false	AdvanceRefundingInd
Final Allocation Made	Yes (true)	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (true)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedPropertyInd
Any Lease Arrangements	false	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	false	MgmtContractBondFincdPropInd
Any Research Agreements	false	AnyResearchAgreementsInd
Private Bus Use By Others	0	PrivateBusUseByOthersPct
Bond Iss Meet Prvt Sec Pymt Test	false	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedPropInd
Remedial Action Taken	false	RemedialActionTakenInd
Procs Nonqualified Bond Remdtd	Yes (true)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiledInd
Rebate Not Due Yet	false	RebateNotDueYetInd
Exception To Rebate	false	ExceptionToRebateInd
No Rebate Due	Yes (true)	NoRebateDueInd
Variable Rate Issue	Yes (true)	VariableRateIssueInd
Hedge Identified In Bks And Rec	false	HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1

Field	Value	IRS element (for citing)
Gross Proceeds Invested	false	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	false	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	false	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE K, PART IV, LINE 2C	FormAndLineReferenceDesc
Explanation	DATE OF REBATE COMPUTATION: A REBATE CALCULATION IS BEING PERFORMED FOR THE BONDS AS OF 6/1/12. NO REBATE IS EXPECTED.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 1	ORGANIZATION'S MISSION: MISSION: AT NORTH COUNTRY HEALTH SYSTEM QUALITY PATIENT CARE IS OUR GREATEST COMMITMENT, EMPLOYEES ARE OUR GREATEST ASSET, EXCELLENT PATIENT EXPERIENCE IS OUR GREATEST ACCOMPLISHMENT, AND THE HEALTH OF OUR COMMUNITY IS OUR GREATEST RESPONSIBILITY. VISION: NORTH COUNTRY HEALTH SYSTEM WILL PROVIDE PRIMARY AND SECONDARY HEALTH CARE THAT IS SAFE, EFFECTIVE, PATIENT-CENTERED, TIMELY, EFFICIENT AND EQUITABLE TO THE RESIDENTS OF ORLEANS AND ESSEX COUNTIES. SIGNIFICANT CHANGES TO BYLAWS: FORM 990, PART VI, LINE 4 DURING THE FISCAL YEAR, THE ORGANIZATION MADE THE FOLLOWING SIGNIFICANT CHANGES TO ITS BYLAWS: -ARTICLE II, PART A WAS EXPANDED TO INCLUDE SECTION 7 ON CRIMINAL RECORDS DISCLOSURE: ALL MEDICAL STAFF MUST IMMEDIATELY DISCLOSE IN WRITING ANY CONVICTIONS, GUILTY OR NO CONTEST PLEAS TO ANY CIVIL OR CRIMINAL VIOLATION(S) EXCLUDING MINOR TRAFFIC VIOLATIONS. ALL DISCLOSURES ARE TO BE SUBMITTED IN WRITING TO THE MEDICAL STAFF COORDINATOR WHO WILL FORWARD THE INFORMATION TO THE MEDICAL EXECUTIVE COMMITTEE. EACH VIOLATION WILL BE REVIEWED BY THE COMMITTEE ON A CASE BY CASE BASIS. -THE DEFINITION OF QUORUM SECTIONS WAS UPDATED IN SECTION 4 OF THE MEDICAL STAFF BYLAWS: THOSE ACTIVE STAFF PRESENT AT ANY REGULAR OR SPECIAL MEETING OF THE MEDICAL STAFF SHALL CONSTITUTE A QUORUM SO LONG AS THERE IS A MINIMUM NUMBER OF 10 ACTIVE STAFF PRESENT. ONCE A QUORUM IS ESTABLISHED, THE BUSINESS OF THE MEETING MAY CONTINUE, AND ALL ACTIONS TAKEN SHALL BE BINDING EVEN THOUGH LESS THAN A QUORUM EXISTS AT A LATER TIME IN THE MEETING. THE PRESIDENT MAY SERVE AS A PROXY VOTING MEMBER ONLY IF NECESSARY TO OBTAIN A QUORUM. THE PRESENCE OF ONE-HALF OF THE TOTAL MEMBERSHIP OF THE COMMITTEE OR SERVICES ELIGIBLE TO VOTE AT ANY OR SPECIAL MEETING, WHICH MUST INCLUDE ONE-HALF OF THE REQUIRED PHYSICIAN MEMBERSHIP, SHALL CONSTITUTE A QUORUM FOR ALL ACTIONS. ONCE A QUORUM IS ESTABLISHED, THE BUSINESS OF THE MEETING MAY CONTINUE, AND ALL ACTIONS TAKEN SHALL BE BINDING EVEN THOUGH LESS THAN A QUORUM EXISTS AT A LATER TIME IN THE MEETING. THE PRESIDENT MAY SERVE AS A PROXY VOTING MEMBER ONLY IF NECESSARY TO OBTAIN A QUORUM. -ARTICLE V, SECTION 1 OF THE MEDICAL STAFF BYLAWS WAS UPDATED: THE JOINT CONFERENCE COMMITTEE SHALL CONSIST OF THE MEDICAL EXECUTIVE COMMITTEE, THE BOARD EXECUTIVE COMMITTEE AND THE CHIEF EXECUTIVE OFFICER. THE CHAIRPERSON OF THE COMMITTEE SHALL ALTERNATE BETWEEN A BOARD MEMBER AND A MEDICAL STAFF MEMBER EVERY TWO YEARS.
FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B	MEMBERS/STOCKHOLDERS/OTHER PERSONS: THE SOLE MEMBER OF THE HOSPITAL SHALL BE NORTH COUNTRY HEALTH SYSTEMS, INC., A VERMONT NOT-FOR-PROFIT CORPORATION, ACTING THROUGH ITS BOARD OF TRUSTEES AND HEREINAFTER REFERRED TO AS THE "MEMBER" WHEN ACTING IN ITS CAPACITY AS SUCH. THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO ENJOY AND EXERCISE ALL RIGHTS AND POWERS CONFERRED ON MEMBERS OF NON-PROFIT CORPORATIONS UNDER THE LAWS OF THE STATE OF VERMONT, SUBJECT TO THE TERMS AND CONDITIONS OF THE AFFILIATION. THE MEMBER SHALL HAVE SUCH OTHER POWERS AS ARE SPECIFIED IN THE ARTICLES OF ASSOCIATION AND IN THESE BYLAWS, INCLUDING, WITHOUT THE POWER TO ELECT AND REMOVE TRUSTEES AND TO AMEND AND RESTATE THE ARTICLES OF ASSOCIATION. TWELVE OF THE TRUSTEES SHALL BE ELECTED BY THE MEMBER. THE AUTHORITY OF THE BOARD OF TRUSTEES TO EXERCISE THE FOLLOWING POWERS IS CONDITIONED ON THE PRIOR APPROVAL OF THE MEMBER: (1) THE ADOPTION OF ANNUAL OPERATING BUDGETS; (2) THE ADOPTION OF CAPITAL BUDGETS; (3) ANY VOLUNTARY DISSOLUTION, MERGER, OR CONSOLIDATION OF THE HOSPITAL OR THE SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE HOSPITAL'S ASSETS, OR THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE CORPORATION OF THE HOSPITAL; (4) ANY AGREEMENT OR TRANSACTION, EITHER OF WHICH IS OF A MATERIAL NATURE, WITH ANOTHER CORPORATION CONTROLLED DIRECTLY BY OR AFFILIATED WITH THE MEMBER; AND (5) THE BORROWING OF ANY SUM IN EXCESS OF $100,000 WHICH HAS A STATED TERM GREATER THAN ONE YEAR OR WHICH IS SECURED BY A MORTGAGE OF ALL OR ANY PORTION OF THE HOSPITAL'S REAL PROPERTY OR BY A SECURITY INTEREST IN THE HOSPITAL'S ASSETS OR REVENUES, BUT NOT INCLUDING ANY BORROWING OF LESS THAN $ 100,000 TO PURCHASE OR LEASE EQUIPMENT OR OTHER PERSONAL PROPERTY THAT IS SECURED SOLELY BY A PURCHASE MONEY TITLE RETENTION OR OTHER FORM OF SECURITY INSTRUMENT OR AGREEMENT IN THE EQUIPMENT OR PERSONAL PROPERTY BEING ACQUIRED.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S MANAGEMENT AND FINANCE TEAM IN DETAIL. AFTER IT HAS BEEN REVIEWED, IT IS THEN PROVIDED TO THE FULL BOARD.
FORM 990, PART VI, SECTION B, LINE 12C	MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD, COMMITTEE, OR OTHER INDIVIDUALS WHO, ON BEHALF OF THE CORPORATION, ARE CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. IN THE EVENT THAT A TRUSTEE, OFFICER, COMMITTEE MEMBER OR MEMBER OF THE CORPORATION'S LEADERSHIP GROUP BECOMES CONCERNED THAT ANOTHER INTERESTED PERSON HAS AN UNDISCLOSED FINANCIAL INTEREST OR IS EXERTING INAPPROPRIATE INFLUENCE RELATED TO A FINANCIAL INTEREST, THIS CONCERN SHOULD BE RAISED WITH THE CHAIR OF THE APPROPRIATE BOARD OR COMMITTEE OR, IF INVOLVING THE LEADERSHIP GROUP, AN APPROPRIATE CORPORATE OFFICER. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON BY THE REMAINING BOARD OR COMMITTEE MEMBERS. IT SHALL BE THE RESPONSIBILITY OF THE CHAIR OF THE BOARD OR COMMITTEE TO INSTRUCT AN INTERESTED PERSON ON THE RESTRICTIONS ON HIS OR HER PARTICIPATION PURSUANT TO THIS POLICY IN ANY FURTHER CONSIDERATION OF THE SUBJECT MATTER OF THE CONFLICT OF INTEREST AND TO ENFORCE THESE RESTRICTIONS. AWARENESS/COMPLIANCE WITH POLICY EACH INTERESTED PERSON SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH INTERESTED PERSON SHALL DISCLOSE ON AN ANNUAL SURVEY FORM POTENTIAL CONFLICTS OF INTEREST AND FINANCIAL INTERESTS RELEVANT TO THIS POLICY. EACH INTERESTED PERSON SHALL ALSO PROVIDE ON AN ANNUAL SURVEY FORM A LIST OF IMMEDIATE FAMILY MEMBERS, INCLUDING SPOUSE, CHILDREN, GRANDCHILDREN, PARENTS, SIBLINGS AND ANY OTHER PERSON WHO LIVES IN HIS/HER HOUSEHOLD, IN ORDER THAT THE CORPORATION MAY HAVE A RECORD OF ALL INDIVIDUALS WHO MAY BE CONSIDERED DISQUALIFIED PERSONS UNDER INTERNAL REVENUE SERVICE REGULATIONS FOR THE PURPOSE OF ENSURING COMPLIANCE WITH TAX EXEMPT STATUS REQUIREMENTS FOR CHARITABLE ORGANIZATIONS. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT INVOLVES THE CONFLICT OF INTEREST. THE CHAIR OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, INCLUDING A CONSIDERATION OF INDEPENDENT COMPARABILITY DATA, VALUATIONS OR APPRAISALS, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE (OR QUORUM) OF ALL OF THE DISINTERESTED TRUSTEES OR COMMITTEE MEMBERS (REGARDLESS OF THE NUMBER PRESENT AT A MEETING): (I) WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT, (II) WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, AND (III) WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATIONS.
FORM 990, PART VI, SECTION B, LINES 15A & 15B	COMPENSATION REVIEW: THE BOARD ANNUALLY REVIEWS THE CEO AND SENIOR TEAM SALARIES USING COMPARABILITY DATA. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MINUTES.
FORM 990, PART VI, SECTION C, LINE 19	DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO BE VIEWED BY THE PUBLIC UPON AN APPOINTMENT WITH THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER OR ASSISTANT.
FORM 990, PART VII, SECTION A	BOARD OF DIRECTORS: NORTH COUNTRY HOSPITAL AND HEALTH CENTER, NORTH COUNTRY HEALTH SERVICES, AND NORTH COUNTRY HEALTH SYSTEMS SHARE A BOARD OF DIRECTORS. NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. CLAUDIO FORT, CEO, RACHEL DISANTO, PRESIDENT OF MEDICAL STAFF AND ANDRE BISSONNETTE, VP OF FINANCE, EACH WORK APPROXIMATELY 40 HOURS PER WEEK BETWEEN NORTH COUNTRY HOSPITAL AND HEALTH CENTER, NORTH COUNTRY HEALTH SERVICES, AND NORTH COUNTRY HEALTH SYSTEMS. THEY ARE COMPENSATED FOR THEIR DUTIES IN THAT CAPACITY. CHRISTOPHER RICKMAN AND JENNIFER LADD ARE COMPENSATED AS EMPLOYEES OF NORTH COUNTRY HOSPITAL. THEY DO NOT RECEIVE ANY COMPENSATION FOR THEIR DUTIES AS BOARD OF DIRECTORS MEMBERS.
FORM 990, PART XI, LINE 9	OTHER CHANGES IN NET ASSETS: $ (59,558) CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 269,759 CHANGE IN INTEREST IN NET ASSETS OF NCHS (282,568) TRANSFER TO AFFILIATE ------------ $ (72,367)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrganizationControlledOrganizationInd
NORTH COUNTRY HEALTH SYSTEMS INC
189 PROUTY DRIVE	NEWPORT	VT	05855	222566964	PARENT/FUNDRS	VT	501(C)(3)	11B II	NA	false
NORTH COUNTRY HLTH SRVCS DBA DERBY GREEN
189 PROUTY DRIVE	NEWPORT	VT	05855	222570334	SKILLED NURSG	VT	501(C)(3)	9	NCHS	false

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	NORTHEAST KINGDOM HLTHCARE COL	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	55 SHERMAN DRIVE	AddressLine1
City	ST JOHNSBURY	City
State	VT	State
ZIP Code	05819	ZIPCode

Field	Value	IRS element (for citing)
EIN	452787538	EIN
Primary Activities	SLEEP LAB SVC	PrimaryActivitiesTxt
Legal Domicile State	VT	LegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Predominant Income Type	RELATED	PredominantIncomeTypeTxt
Share Of Total Income	$4,483	ShareOfTotalIncomeAmt
Share Of EOY Assets	$278,670	ShareOfEOYAssetsAmt
Disproportionate Allocations	false	DisproportionateAllocationsInd
UBI Code V	$0	UBICodeVAmt
General Or Managing Partner	Yes (true)	GeneralOrManagingPartnerInd
Ownership	0.60000	OwnershipPct

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	false	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	false	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	false	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	false	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	Yes (true)	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	Yes (true)	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (true)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (true)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd