NORTH COUNTRY HOSPITAL & HEALTH CENTER,INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- NORTH COUNTRY HOSPITAL & HEALTH CENTER,INC (EIN 03-0185556)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-12
- IRS object ID
- 201432249349301438
- Schema version
- 2012v2.3
- 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
- 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) |
|---|---|---|
| Timestamp | 2014-08-12T12:07:34-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 030185556 | EIN |
Name Name
| 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 Name | % ANDRE BISSONNETTE | InCareOfName |
| Name Control | NORT | NameControl |
| Phone | 8023347331 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANDRE BISSONNETTE | Name |
| Title | VICE PRESIDENT OF FINANCE | Title |
| Phone | 8023347331 | Phone |
| Date Signed | 2014-08-06 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Brian D Todd | Name |
| Phone | 4178658701 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CLAUDIO FORT | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| 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 | 91650173 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NCHSI.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1919 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS OF ORLEANS AND ESSEX COUNTIES, ENSURING THAT HEALTH CARE IS AVAILABLE TO ALL PEOPLE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 668 | TotalNbrEmployees |
| Total Nbr Volunteers | 50 | TotalNbrVolunteers |
| Total Gross UBI | 7594 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 5518 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 299191 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 316739 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 79113354 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 78995838 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 680060 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1346042 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 45037 | OtherRevenuePriorYear |
| Other Revenue Current Year | -12441 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 80137642 | TotalRevenuePriorYear |
| Total Revenue Current Year | 80646178 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 9450 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 47058082 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 47168685 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 33888208 | OtherExpensePriorYear |
| Other Expenses Current Year | 33053274 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 80946290 | TotalExpensesPriorYear |
| Total Expenses Current Year | 80231409 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -808648 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 414769 | RevenuesLessExpensesCY |
| Total Assets BOY | 73717207 | TotalAssetsBOY |
| Total Assets EOY | 74170231 | TotalAssetsEOY |
| Total Liabilities BOY | 36182392 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 33893618 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 37534815 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 40276613 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 35113196 | Expense |
| Revenue | 48198800 | Revenue |
| Description | 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 73,765 REGISTRATIONS FOR THE YEAR. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 21770181 | Expense |
| Revenue | 15483725 | Revenue |
| Description | 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 91,213 PATIENTS VISITS FOR THE YEAR. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 13343014 | Expense |
| Grants | 9450 | Grants |
| Revenue | 15313313 | Revenue |
| Description | INPATIENT HOSPITAL CARE WAS PROVIDED AT A CRITICAL ACCESS HOSPITAL TOTALING 5,890 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 70226391 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 59 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 668 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | ANDRE BISSONNETTE | NamePerson |
| Telephone Number | 8023347331 | TelephoneNumber |
Address US AddressUS
| 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 | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| KATHRYN AUSTIN | ||||||||
| CHAIR | 10.0 | 2.0 | X | X | 0 | 0 | 0 | |
| SCOTT PERRY | ||||||||
| TRUSTEE | 5.0 | 2.0 | X | 0 | 0 | 0 | ||
| GARY GILLESPIE | ||||||||
| VICE CHAIR FINANCE | 5.0 | 2.0 | X | X | 0 | 0 | 0 | |
| MELISSA PETTERSSON | ||||||||
| SECRETARY/CLERK | 5.0 | 2.0 | X | X | 0 | 0 | 0 | |
| RICHARD BARAW | ||||||||
| TRUSTEE | 5.0 | 6.0 | X | 0 | 0 | 0 | ||
| ALAN WING | ||||||||
| VICE CHAIR - BOARD | 5.0 | 2.0 | X | X | 0 | 0 | 0 | |
| BILL STENGER | ||||||||
| TRUSTEE | 5.0 | 2.0 | X | 0 | 0 | 0 | ||
| JENNIFER LADD MD | ||||||||
| VP MEDICAL STAFF BEG 01/13 | 40.0 | 2.0 | X | 389788 | 0 | 32767 | ||
| JEANE KADMIRI | ||||||||
| TRUSTEE | 5.0 | 2.0 | X | 0 | 0 | 0 | ||
| FRANK KNOLL | ||||||||
| TRUSTEE BEG 01/13 | 5.0 | 2.0 | X | 0 | 0 | 0 | ||
| MARK BEAMS | ||||||||
| TRUSTEE | 5.0 | 2.0 | X | 0 | 0 | 0 | ||
| BOB WILSON | ||||||||
| TRUSTEE | 5.0 | 2.0 | X | 0 | 0 | 0 | ||
| CHRISTOPHER RICKMAN MD | ||||||||
| TRUSTEE/PHYSICIAN | 40.0 | 2.0 | X | 236042 | 0 | 38418 | ||
| CLAUDIO D FORT | ||||||||
| CEO | 40.0 | 2.0 | X | X | 267789 | 0 | 56865 | |
| ROBERT PRIMEAU | ||||||||
| PRESIDENT MEDICAL STAFF | 5.0 | 2.0 | X | 46500 | 0 | 0 | ||
| MARC BOUCHARD | ||||||||
| MED STAFF VP ENDING 01/13 | 5.0 | 2.0 | X | 294512 | 0 | 55146 | ||
| DAVE LAFORCE | ||||||||
| VICE CHAIR FINANCE END 01/13 | 5.0 | 2.0 | X | X | 0 | 0 | 0 | |
| ANDRE BISSONNETTE | ||||||||
| VP OF FINANCE | 40.0 | 2.0 | X | 142851 | 0 | 37682 | ||
| GREGORY WALKER | ||||||||
| PHYSICIAN | 40.0 | 518927 | 0 | 48015 | X | |||
| SG NEALE | ||||||||
| PHYSICIAN | 40.0 | 647984 | 0 | 36985 | X | |||
| VERONIKA JEDLOWVSZKY | ||||||||
| PHYSICIAN | 40.0 | 431419 | 0 | 47955 | X | |||
| THOMAS VARNEY | ||||||||
| PHYSICIAN | 40.0 | 430865 | 0 | 27749 | X | |||
| LARRY SISSON | ||||||||
| PHYSICIAN | 40.0 | 487550 | 0 | 49371 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3894227 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 430953 | TotalOtherCompensation |
| Number Individuals GT100 K | 51 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| NORTH COUNTRY RADIOLOGY PC | |
| PHYSICIAN | 901945 |
| MORRISON MANAGEMENT SPECIALISTS | |
| CAF MGMT | 559145 |
| MEDICUS HOSPITALISTS SERVICES LLC | |
| TEMP PHYSICIAN | 626137 |
| CPS INC | |
| PHARMACY MGMT | 367474 |
| BKD LLP | |
| AUDIT/CONSULTING/TAX | 184328 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Related Organizations | 1999 | RelatedOrganizations |
| Government Grants | 185077 | GovernmentGrants |
| All Other Contributions | 129663 | AllOtherContributions |
| Total Contributions | 316739 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 624100 | 71536574 | 71536574 |
| OTHER PATIENT SERVICE REVENUE | 624100 | 3581620 | 3581620 |
| EHR REVENUE | 624100 | 682500 | 682500 |
| 340B PHARMACY | 446110 | 2970097 | 2970097 |
| CAFETERIA | 722514 | 225047 | 225047 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 78995838 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 571307 | TotalRevenueColumn |
| Exclusion | $571,307 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1800 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1800 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1800 | TotalRevenueColumn |
| Exclusion | $1,800 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 11747066 | Securities |
| Other | 31664 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 10895240 | Securities |
| Other | 108755 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 851826 | Securities |
| Other | -77091 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 774735 | TotalRevenueColumn |
| Exclusion | $774,735 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|
| HOUSEKEEPING SERVICES | 812900 | 809 | 809 | |
| ADMINISTRATIVE SERVICES | 561000 | 6785 | 6785 | |
| LOSS ON INVEST IN EQUITY INVESTEE | 900099 | -21835 | -$21,835 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | -14241 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 80646178 | TotalRevenueColumn |
| Related Or Exempt Function Income | 78995838 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 7594 | UnrelatedBusinessRevenue |
| Exclusion | $1,326,007 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9450 | Total |
| Program Services | 9450 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1598360 | Total |
| Program Services | 1093173 | ProgramServices |
| Management And General | 505187 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34405259 | Total |
| Program Services | 30485994 | ProgramServices |
| Management And General | 3919265 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1515862 | Total |
| Program Services | 1369792 | ProgramServices |
| Management And General | 146070 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7372229 | Total |
| Program Services | 6592736 | ProgramServices |
| Management And General | 779493 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2276975 | Total |
| Program Services | 2021977 | ProgramServices |
| Management And General | 254998 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 631435 | Total |
| Management And General | 631435 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103587 | Total |
| Management And General | 103587 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60645 | Total |
| Management And General | 60645 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 217953 | Total |
| Management And General | 217953 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5565277 | Total |
| Program Services | 4471577 | ProgramServices |
| Management And General | 1093700 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259331 | Total |
| Program Services | 3068 | ProgramServices |
| Management And General | 256263 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2265204 | Total |
| Program Services | 1913770 | ProgramServices |
| Management And General | 351434 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66885 | Total |
| Program Services | 55886 | ProgramServices |
| Management And General | 10999 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1154320 | Total |
| Program Services | 993322 | ProgramServices |
| Management And General | 160998 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 164850 | Total |
| Program Services | 107164 | ProgramServices |
| Management And General | 57686 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 242590 | Total |
| Program Services | 191427 | ProgramServices |
| Management And General | 51163 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 652119 | Total |
| Program Services | 588619 | ProgramServices |
| Management And General | 63500 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4614061 | Total |
| Program Services | 4163294 | ProgramServices |
| Management And General | 450767 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 801544 | Total |
| Program Services | 612822 | ProgramServices |
| Management And General | 188722 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | 6728307 | 6728307 | |
| PROVIDER TAX | 4335683 | 4335683 | |
| BAD DEBT | 2705004 | 2705004 | |
| REPAIRS & MAINTENANCE | 1710387 | 1621527 | 88860 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 774092 | Total |
| Program Services | 161799 | ProgramServices |
| Management And General | 612293 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80231409 | Total |
| Program Services | 70226391 | ProgramServices |
| Management And General | 10005018 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4086513 | BOY |
| EOY | 6211819 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37919 | BOY |
| EOY | 77881 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9581334 | BOY |
| EOY | 7476183 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1453455 | BOY |
| EOY | 1610986 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 825095 | BOY |
| EOY | 799491 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 67801281 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 39982980 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 30627625 | BOY |
| EOY | 27818301 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24873728 | BOY |
| EOY | 27428937 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95875 | BOY |
| EOY | 74041 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 383366 | BOY |
| EOY | 441537 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1752297 | BOY |
| EOY | 2231055 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73717207 | BOY |
| EOY | 74170231 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9611330 | BOY |
| EOY | 8617112 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44115 | BOY |
| EOY | 11379 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21655000 | BOY |
| EOY | 21025000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 770233 | BOY |
| EOY | 700005 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4101714 | BOY |
| EOY | 3540122 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36182392 | BOY |
| EOY | 33893618 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34399282 | BOY |
| EOY | 36999364 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2340824 | BOY |
| EOY | 2482540 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 794709 | BOY |
| EOY | 794709 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37534815 | BOY |
| EOY | 40276613 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73717207 | BOY |
| EOY | 74170231 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 414769 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1155038 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 1171991 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | true | OtherActivities |
| Other Activities | $21,809 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 21809 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER LOBBYING ACTIVITIES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1(I) | ReturnReference |
| Explanation | THE ORGANIZATION PAYS DUES TO THE VERMONT HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 18.9% OF DUES SUPPORT LOBBYING EFFORTS. IN ADDITION, THE ORGANIZATION PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 23.98% OF DUES SUPPORT LOBBYING EFFORTS. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2731541 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 104171 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2835712 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2652555 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 78986 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2731541 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2531933 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 120622 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2652555 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2413853 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 118080 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2531933 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2604676 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -190823 | InvestmentEarningsOrLosses |
| End Of Year Balance | 2413853 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.28025 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.71975 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 405921 | OtherCostOrOtherBasis |
| Book Value | 405921 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19133280 | OtherCostOrOtherBasis |
| Depreciation | 9495881 | Depreciation |
| Book Value | 9637399 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 19430002 | OtherCostOrOtherBasis |
| Depreciation | 11068274 | Depreciation |
| Book Value | 8361728 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 27457853 | OtherCostOrOtherBasis |
| Depreciation | 18601170 | Depreciation |
| Book Value | 8856683 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1374225 | OtherCostOrOtherBasis |
| Depreciation | 817655 | Depreciation |
| Book Value | 556570 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 27818301 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| EST AMTS DUE TO 3RD PARTY PAYER | $1,827,596 |
| INTEREST RATE SWAP | $1,712,526 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3540122 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 80050250 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1155038 | NetUnrealizedGainsInvestments |
| Other Revenues | -1750966 | OtherRevenues |
| Revenue Not Rptd F990 | -595928 | RevenueNotRptdF990 |
| Revenue Subtotal | 80646178 | RevenueSubtotal |
| Total Revenue Per Form990 | 80646178 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 77308452 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 77308452 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 217953 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 2705004 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 2922957 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 80231409 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ENDOWMENT FUNDS | SCHEDULE D, PART V, LINE 4 | 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. |
| UNCERTAIN TAX POSITIONS | SCHEDULE D, PART X, LINE 2 | 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. |
| OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12 | SCHEDULE D, PART XI, LINE 2D | $ 1,113,820 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 58,171 CHANGE IN INTEREST IN NET ASSETS OF NCHS (217,953) INVESTMENT MANAGEMENT FEES (2,705,004) BAD DEBT EXPENSE -------------- $ (1,750,966) |
| OTHER EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 | SCHEDULE D, PART XII, LINE 4B | $ 2,705,004 BAD DEBT EXPENSE |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | false | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 909897 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 909897 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01170 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21762508 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11155547 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10606961 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13680 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22672405 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11155547 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11516858 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.14850 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6987 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 6987 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 127807 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 127807 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17334288 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11583849 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5750439 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07420 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22382 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 22382 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17491464 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11583849 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5907615 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07620 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40163869 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 22739396 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 17424473 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.22470 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2821 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2821 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1980 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1980 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4801 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4801 | NetCommunityBuildingExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $2,705,004 | BadDebtExpenseAmount |
| Amount Attributable To | 421981 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 25943663 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 26578889 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -635226 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH COUNTRY HOSPITAL | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH COUNTRY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 10 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (10 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| 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 CARE, 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 |
| NORTH COUNTRY HOSPITAL OCCUPATIONAL HLTH | ||||
| 1734 CRAWFORD FARM ROAD | NEWPORT | VT | 05855 | OCCUPATIONAL HEALTH |
| COMMUNITY MEDICAL ASSOCIATES | ||||
| 41 MEDICAL VILLAGE DRIVE | NEWPORT | VT | 05855 | FAMILY MED, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC |
| NORTHERN VT COUNSELING & PSYCH SERVICES | ||||
| 212 PROUTY DRIVE STE 4 | NEWPORT | VT | 05855 | COUNSELING & PSYCHIATRIC SERVICES |
| 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 |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PERCENT OF TOTAL EXPENSE | SCHEDULE H, PART I, LINE 7, COLUMN F | 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 $2,705,004. |
| COSTING METHODOLOGY | SCHEDULE H, PART I, LINE 7 | THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6. |
| SUBSIDIZED SERVICES | SCHEDULE H, PART I, LINE 7G | 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 $5,632,416. |
| COMMUNITY BUILDING ACTIVITIES | SCHEDULE H, PART II | 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. |
| BAD DEBT EXPENSE | SCHEDULE H, PART III, SECTION A, LINE 4 | 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. 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. |
| MEDICARE SHORTFALL | SCHEDULE H, PART III, SECTION B, LINES 5-7 | 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. |
| COMMUNITY BENEFIT | SCHEDULE H, PART III, SECTION B, LINE 8 | 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. |
| COLLECTION POLICY | SCHEDULE H, PART III, SECTION C, LINE 9B | 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. |
| COMMUNITY INPUT | SCHEDULE H, PART V, SECTION B, LINE 3 | 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. |
| IMPLEMENTATION STRATEGY | SCHEDULE H, PART V, SECTION B, LINE 6 | 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: HTTP://WWW.NCHSI.ORG/GETPAGE.PHP?NAME=REPORT_CARDS&SUB=ABOUT+NCH |
| 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. | |
| 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. | |
| 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. | |
| 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. | |
| 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 | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | false | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | true | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JENNIFER LADD MD | ||||||||||||||
| VP MEDICAL STAFF BEG 01/13 | 370466 | 0 | 19322 | 0 | 0 | 0 | 13625 | 0 | 19142 | 0 | 422555 | 0 | 0 | 0 |
| CHRISTOPHER RICKMAN MD | ||||||||||||||
| TRUSTEE/PHYSICIAN | 224181 | 0 | 11861 | 0 | 0 | 0 | 14838 | 0 | 23580 | 0 | 274460 | 0 | 0 | 0 |
| CLAUDIO D FORT | ||||||||||||||
| CEO | 265220 | 0 | 0 | 0 | 2569 | 0 | 25746 | 0 | 31119 | 0 | 324654 | 0 | 0 | 0 |
| ANDRE BISSONNETTE | ||||||||||||||
| VP OF FINANCE | 141474 | 0 | 0 | 0 | 1377 | 0 | 7975 | 0 | 29707 | 0 | 180533 | 0 | 0 | 0 |
| GREGORY WALKER | ||||||||||||||
| PHYSICIAN | 388276 | 0 | 110450 | 0 | 20201 | 0 | 17375 | 0 | 30640 | 0 | 566942 | 0 | 0 | 0 |
| SG NEALE | ||||||||||||||
| PHYSICIAN | 540949 | 0 | 107035 | 0 | 0 | 0 | 6125 | 0 | 30860 | 0 | 684969 | 0 | 0 | 0 |
| VERONIKA JEDLOWVSZKY | ||||||||||||||
| PHYSICIAN | 346134 | 0 | 85285 | 0 | 0 | 0 | 17375 | 0 | 30580 | 0 | 479374 | 0 | 0 | 0 |
| THOMAS VARNEY | ||||||||||||||
| PHYSICIAN | 323762 | 0 | 107103 | 0 | 0 | 0 | 6125 | 0 | 21624 | 0 | 458614 | 0 | 0 | 0 |
| LARRY SISSON | ||||||||||||||
| PHYSICIAN | 461345 | 0 | 0 | 0 | 26204 | 0 | 18625 | 0 | 30746 | 0 | 536921 | 0 | 0 | 0 |
| MARC BOUCHARD | ||||||||||||||
| MED STAFF VP ENDING 01/13 | 294512 | 0 | 0 | 0 | 0 | 0 | 27378 | 0 | 27768 | 0 | 349658 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| HEALTH CLUB BENEFITS | SCHEDULE J, PART I, LINE 1B | ALL EMPLOYEES OF THE ORGANIZATION RECEIVE THE BENEFIT OF A LOCAL HEALTH CLUB'S MEMBERSHIP. |
| SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B | THE FOLLOWING INDIVIDUALS LISTED ON FORM 990, PART VII, RECEIVED 457(F) EMPLOYER CONTRIBUTIONS IN THE FOLLOWING AMOUNTS: $ 15,871 CLAUDIO FORT 10,000 MARC BOUCHARD |
| COMPENSATION CONTINGENT ON THE REVENUES OF THE ORGANIZATION | SCHEDULE J, PART I, LINE 5A | PHYSICIANS EARN COMPENSATION BASED UPON THEIR PRODUCTIVITY AGAINST ESTABLISHED TARGETS. INCREASED PRODUCTIVITY IS DIRECTLY RELATED TO INCREASED REVENUES FOR THE ORGANIZATION. |
| NON FIXED PAYMENTS | SCHEDULE J, PART I, LINE 7 | THE SENIOR TEAM AND CERTAIN DOCTORS ARE GIVEN BONUSES BASED ON SPECIFIC PROGRAM PERFORMANCE. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| 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) |
|---|---|---|
| Issuer EIN | 030292808 | IssuerEIN |
| CUSIP Number | 924166AR2 | CUSIPNumber |
| Date Issued | 2007-06-01 | DateIssued |
| Issue Price | 23795000 | IssuePrice |
| Description Of Purpose | REFUND 04 BONDS, CAP IMPROV | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 0 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 24215685 | TotalProceeds |
| Amount In Reserve Fund | 0 | AmountInReserveFund |
| Capitalized Interest | 0 | CapitalizedInterest |
| Refunding Escrow | 16900515 | RefundingEscrow |
| Issuance Costs From Proceeds | 171170 | IssuanceCostsFromProceeds |
| Credit Enhancement | 9000 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 7135000 | CapitalExpenditures |
| Other Spent Proceeds | 0 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | true | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Bond Iss Meet Prvt Security Pay Test | false | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedProp |
| Remedial Action Taken | false | RemedialActionTaken |
| Non Qualified Bond Remed Procdrs | true | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiled |
| Rebate Not Due Yet | false | RebateNotDueYet |
| Exception To Rebate | false | ExceptionToRebate |
| No Rebate Due | true | NoRebateDue |
| Variable Rate Issue | true | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
Name Of Hedge Provider NameOfHedgeProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
Name Of GIC Provider NameOfGICProvider
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Written Proc To Monitor Reqs | false | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | false | ProcToUndertkCorrectiveAction |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DATE OF REBATE COMPUTATION | Identifier |
| Return Reference | SCHEDULE K, PART IV, LINE 2C | ReturnReference |
| Explanation | A REBATE CALCULATION IS BEING PERFORMED FOR THE BONDS AS OF 6/1/12. NO REBATE IS EXPECTED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | 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. |
| MEMBERS/STOCKHOLDERS/OTHER PERSONS | FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B | 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 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | 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. |
| MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | 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. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE BOARD ANNUALLY REVIEWS THE CEO AND SENIOR TEAM SALARIES USING COMPARABILITY DATA. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MINUTES. |
| DOCUMENT DISCLOSURE | FORM 990, PART VI, SECTION C, LINE 19 | 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. |
| BOARD OF DIRECTORS | FORM 990, PART VII, SECTION A | 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, 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, MARC BOUCHARD 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. ROBERT PRIMEAU IS COMPENSATED AS AN INDEPENDENT CONTRACTOR FOR HIS SERVICES AS A PEDIATRIC HOSPITALIST. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 9 | $ 1,113,820 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 58,171 CHANGE IN INTEREST IN NET ASSETS OF NCHS ------------ $ 1,171,991 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHEAST KINGDOM HLTHCARE COL | BusinessNameLine1 |
Address US AddressUS
| 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 Activity | SLEEP LAB SVC | PrimaryActivity |
| Legal Domicile State | VT | LegalDomicileState |
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 | PredominantIncomeType |
| Share Of Total Income | 56624 | ShareOfTotalIncome |
| Share Of EOY Assets | 445650 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| Code V | $0 | CodeVAmount |
| General Or Managing Partner | true | GeneralOrManagingPartner |
| Percentage Ownership | 0.60000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |