2011-08-15T10:29:51-04:00 2010-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2009-10-01 030185556 NORTH COUNTRY HOSPITAL & HEALTH CENTER INC NORT 8023347331 189 PROUTY DRIVE NEWPORT VT 05855 ANDRE BISSONNETTE 2011-08-02 true Brian D Todd 4178658701 2009 2016-02-24 21:20:13Z CLAUDIO FORT 189 PROUTY DRIVE NEWPORT VT 05855 87471296 false X WWW.NCHSI.ORG X 1919 VT TO PROVIDE HEALTH CARE SERVICES TO THE RESIDENTS OF ORLEANS AND ESSEX COUNTIES, ENSURING THAT HEALTH CARE IS AVAILABLE TO ALL PEOPLE. 16 11 624 67 1108 197686 516593 66724712 71518042 -957780 1009914 21310 11407 65985928 73055956 38000 36500 0 0 38939141 41892370 0 0 0 26261695 28437112 65238836 70365982 747092 2689974 70343862 72835053 35979787 35672650 34364075 37162403 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. false false 41414679 47364289 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, & REHABILITATIVE) TOTALING 79,423 REGISTRATIONS FOR THE YEAR. 11294913 12474905 INPATIENT HOSPITAL CARE PROVIDED AT A CRITICAL ACCESS HOSPITAL TOTALING 6,297 DAYS FOR THE YEAR. 10039922 11678848 PHYSICIAN PRACTICES - INTERNAL MEDICINE, RADIOLOGY PROGRAM, PSYCHIATRIC, OB/GYN, NEUROLOGY, ORTHOPEDICS, OCCUPATIONAL HEALTH, PULMONARY-SLEEP, SURGICAL SERVICES AND HEMATOLOGY ONCOLOGY PRACTICES. SERVICING 126,089 PATIENT VISITS FOR THE YEAR. 36500 36500 62786014 true true false true false false false false true true false true false false false false false false true false true true true true true false false false false false false false false false false true false false false false true false true false true 60 0 true 624 true true true false false false false true true false false false 16 11 false false false false true true true true true false false true true true true true true true true false X ANDRE BISSONNETTE 8023347331 189 PROUTY DRIVE NEWPORT VT 05855 DAVID BOUFFARD 10.0 X X 0 0 0 KATHRYN AUSTIN 10.0 X X 0 0 0 SCOTT PERRY 5.0 X 0 0 0 SUSAN PENHARLOW 5.0 X 0 0 0 MELISSA PETTERSSON 5.0 X X 0 0 0 RICHARD BARAW 5.0 X 0 0 0 ALAN WING 5.0 X X 0 0 0 BILL STENGER 5.0 X 0 0 0 BONNIE NASH 5.0 X X 0 0 0 MARC BOUCHARD MD 40.0 X 274155 0 40961 JEANE KADMIRI 5.0 X 0 0 0 DAVE LAFORCE 5.0 X 0 0 0 PETER STUART MD 40.0 X 282912 0 17749 THOMAS MOSELEY MD 40.0 X 15031 0 0 BOB WILSON 5.0 X 0 0 0 CHRISTOPHER RICKMAN MD 40.0 X 218038 0 31245 CLAUDIO D FORT 40.0 X X 268702 0 29885 ANDRE BISSONNETTE 40.0 X 181791 0 27453 KIM CAMPBELL 40.0 X 215908 0 35075 WILLIAM PERKET 40.0 X 167462 0 22458 JOE FALWORTH 40.0 X 172177 0 18528 SHERYL WASHBURN 40.0 X 188465 0 6028 CHRISTOPHER PEER MD 40.0 X 573069 0 34142 GREG WALKER MD 40.0 X 611802 0 41547 JENNIFER LADD MD 40.0 X 381883 0 20975 LARRY SISSON MD 40.0 X 425680 0 42504 MARK MEREDITH MD 40.0 X 326894 0 23987 4303969 0 392537 35 false true false HP CUMMINGS CONSTRUCTION CO CONSTRUCTION 2868657 NORTH COUNTRY RADIOLOGY PC RADIOLOGY 806775 MORRISON MGMT SPECIALIST DIETARY CONTRACTOR 514769 AMERICAN HEATH CENTERS MRI CONTRACT 457142 FLETCHER ALLEN MGMT ACCT LAB SERVICES 266665 51 7789 82683 173758 252363 249156 516593 PATIENT SERVICE REVENUE 900099 69132913 69132913 PHARMACY REVENUE 446110 37381 37381 OTHER PATIENT SERVICE REVENUE 900099 2347748 2347748 71518042 520689 520689 0 0 4984 4984 4984 4984 14892306 3921 14316373 90629 575933 -86708 489225 489225 13653 7789 8338 5315 5315 0 0 HOUSEKEEPING SERVICES 812900 1108 1108 1108 73055956 71518042 1108 1020213 25000 25000 11500 11500 0 0 2214024 1325567 888457 0 29715920 26628295 3087625 1118686 991036 127650 6773305 6030633 742672 2070435 1823492 246943 616115 616115 36392 36392 98290 98290 0 0 156926 156926 3114831 2881070 233761 105012 27312 77700 3086619 3024173 62446 239841 40856 198985 0 1402545 1216742 185803 114844 89528 25316 0 185337 172662 12675 566763 525290 41473 0 3895225 3610189 285036 903401 721577 181824 BAD DEBT 2765861 2765861 REPAIRS & MAINTENANCE 1360081 1273369 86712 PROVIDER TAX 2909922 2909922 MEDICAL SUPPLIES & DRUGS 6573270 6573270 DUES & SUBSCRIPTIONS 305837 118670 187167 70365982 62786014 7579968 0 11373525 7548370 40675 7176363 7730981 1305882 1413455 874203 834222 65739150 34774233 27371007 30964917 18952024 20568702 214982 240618 3075876 3493113 70343862 72835053 8879225 8123132 16675 0 23410000 22845000 885138 816157 2788749 3888361 35979787 35672650 X 31634108 34312970 1935258 2054724 794709 794709 34364075 37162403 70343862 72835053 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 25306 25306 false OTHER LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1(I) THE ORGANIZATION PAYS DUES TO THE VERMONT HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 23.83% OF DUES SUPPORT LOBBYING EFFORTS. IN ADDITION, THE ORGANIZATION PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 23.76% OF DUES SUPPORT LOBBYING EFFORTS. 2413853 118080 2531933 2604676 -190823 2413853 0.31387 0.68613 false false 405921 405921 18497150 7667986 10829164 18918785 8340611 10578174 26228350 18169234 8059116 1688944 596402 1092542 30964917 LIFE INSURANCE POLICY 2687021 DUE FROM AFFILIATES 87992 CSV-WHOLE LF IN 4 718100 3493113 0 EST AMOUNTS DUE TO 3RD PARTY PAYER 1700948 INTEREST RATE SWAP 2187413 3888361 73055956 70365982 2689974 541471 -433117 108354 2798328 72970884 541471 -469617 71854 72899030 156926 156926 73055956 70172556 70172556 156926 36500 193426 70365982 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. FIN 48 DISCLOSURE 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 CHANGES IN NET ASSETS SCHEDULE D, PART XI, LINE 8 AND PART XII, LINE 2D $ 363,846 TRANSFER FROM AFFILIATE (822,599) CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 25,636 CHANGE IN INTEREST IN NET ASSETS OF NORTH COUNTRY HEALTH SYSTEMS ----------- $(433,117) SCHEDULE D, PART XI, LINE 8 ( 11,500) SCHOLARSHIPS PAID RECLASSED ( 25,000) GRANTS PAID RECLASSED ----------- $(469,617) SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSES SCHEDULE D, PART XIII, LINE 4B $( 11,500) SCHOLARSHIPS PAID RECLASSED ( 25,000) GRANTS PAID RECLASSED ----------- $( 36,500) GOLF TOURNAMENT 21442 7789 13653 3964 2466 1800 108 0 21442 7789 13653 3964 2466 1800 108 8338 5315 true true X true X true X false true false false 838805 838805 0.01190 15169190 11677214 3491976 0.04960 16007995 11677214 4330781 0.06150 8 1619 167253 167253 0.00240 5 518 94174 94174 0.00130 12292588 8179316 4113272 0.05850 5 104 61031 61031 0.00090 18 2241 12615046 8179316 4435730 0.06310 18 2241 28623041 19856530 8766511 0.12460 1 20 5146 5146 0.00010 2 3038 3038 2 1086 2775 2775 5 1106 10959 10959 0.00010 false 1639326 234424 26603726 32363009 -5759283 X true true NORTH COUNTRY HOSPITAL

189 PROUTY DRIVE NEWPORT VT 05855

X X X X 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

INTERNAL MEDICINE, PEDIATRICS, NRSG HOM CARE,GERIATRICS, ETC NORTHERN VT COUNSELING & PSYCH SERVICES

212 PROUTY DRIVE STE 4 NEWPORT VT 05855

COUNSELING & PSYCHIATRIC SERVICES ROW G - SEVERAL RURAL HEALTH CLINICS AND OTHER SPECIALTY CLINICS ARE INCLUDED ON LINE 7G. THE HOSPITAL PROVIDES THESE SERVICES IN RURAL AREAS WHERE THERE WOULD BE A SHORTAGE OR LACK OF CARE WITHOUT THE SERVICES. THE HOSPITAL CONTINUES TO PROVIDE THESE SERVICES AS A BENEFIT TO THE COMMUNITY DESPITE KNOWING THAT FINANCIAL SHORTFALLS WILL BE SUSTAINED. 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 PATIENT WHEN THE PATIENTS LIABILITY IS DETERMINED. PATIENT ACCOUNTS 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. LINE 2 WAS CALCULATED USING THE COST TO CHARGE RATIO TIMES BAD DEBT EXPENSE. 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. 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. 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. 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. 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. 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. 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. OTHER 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 NOT COST TO THEM. 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), NORTH COUNTRY HEALTH SERVICES, INC., D/B/A DERBY GREEN (DERBY GREEN), AND MEDICAL ARTS BUILDING, INC., D/B/A BARTON CLINIC BUILDING (MED ARTS). 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. MED ARTS MANAGED THE PHYSICIANS' OFFICE BUILDING IN BARTON, VERMONT, AND WAS CONSOLIDATED INTO THE HOSPITAL DURING 2010. true INDOOR RECREATION OF ORLEANS COUNTY 400 QUARRY RD DERBY VT 058290558 030316525 501(C)(3) 25000 HEALTHY CHANGES INITIATIVE 1 0 HEALTH CARE EDUCATION SCHOLARSHIP 23 11500 PROCEDURES FOR MONITORING FUNDS SCHEDULE I, PART I, LINE 2 THE ORGANIZATION MONITORS THE USE OF THE FUNDS BY REQUESTING A FOLLOW UP REPORT FROM THE RECIPIENT DESCRIBING HOW THE FUNDS WERE USED AND THE NUMBER OF PEOPLE ASSISTED. THE RECIPIENTS OF SCHOLARSHIP FUNDS ARE REQUIRED TO COMPLETE THE SEMESTER IN WHICH THEY RECEIVE THE SCHOLARSHIP FUNDS. X false true X X X X false false false true false false false true false MARC BOUCHARD MD 273578 0 0 577 17150 23811 315116 0 PETER STUART MD 282078 0 0 834 14673 3076 300661 0 CHRISTOPHER RICKMAN MD 217641 0 0 397 13175 18070 249283 0 ANDRE BISSONNETTE 103585 0 50366 27840 3675 23778 209244 0 KIM CAMPBELL 138404 0 50997 26507 11248 23827 250983 0 WILLIAM PERKET 99275 0 46843 21344 4461 17997 189920 0 JOE FALWORTH 102421 0 46204 23552 524 18004 190705 0 SHERYL WASHBURN 132983 0 52581 2901 3438 2590 194493 0 CHRISTOPHER PEER MD 527731 0 21490 23848 9800 24342 607211 0 GREG WALKER MD 343568 0 239838 28396 17150 24397 653349 0 JENNIFER LADD MD 300853 0 70129 10901 9800 11175 402858 0 LARRY SISSON MD 387747 0 11372 26561 18375 24129 468184 0 MARK MEREDITH MD 196583 0 5412 124899 0 23987 350881 0 CLAUDIO D FORT 211444 0 32594 24664 5982 23903 298587 0 HEALTH CLUB BENEFITS SCHEDULE J, PART I, LINE 1B ALL EMPLOYEES OF THE ORGANIZATION RECEIVE THE BENEFIT OF A LOCAL HEALTH CLUB'S MEMBERSHIP. 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. VERMONT EDUCATIONAL & HLTH BLDGS FINANCING AGENCY 030292808 924166AR2 2007-06-01 23795000 REFUND 04 BONDS, CAP IMPROV false false 24215685 0 16900515 0 180170 0 7135000 2010 true false true true false false false false false 0.00000 0.00000 0.00000 true false true false false false false X 1 219156 FMV X 1 30000 FMV 0 false false true NUMBER OF CONTRIBUTIONS SCHEDULE M, PART I, COLUMN B THE NUMBER OF CONTRIBUTIONS WAS DETERMINED BY THE NUMBER OF CONTRIBUTORS. THIRD PARTIES HIRED TO SOLICIT NONCASH CONTRIBUTIONS SCHEDULE M, PART I, LINE 32B THE ORGANIZATION USED A STOCK BROKER TO SELL THE DONATED SECURITIES. 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. PROGRAM SERVICES FORM 990, PART III, LINE 4D THE ORGANIZATION PAID $36,500 OF GRANTS AND SCHOLARSHIPS DURING THE FISCAL YEAR INCLUDING: $25,000 GRANT TO THE INDOOR RECREATION OF ORLEANS COUNTY AS PART OF THE HEALTHY CHANGES INITIATIVE AND $11,500 OF HEALTH CARE EDUCATION SCHOLARSHIPS. 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 11A 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. 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. NORTH COUNTRY HEALTH SYSTEMS INC 189 PROUTY DRIVE NEWPORT VT 05855 222566964 PARENT/FUNDRS VT 501(C)(3) 11B II NORTH COUNTRY HLTH SRVCS DBA DERBY GREEN 189 PROUTY DRIVE NEWPORT VT 05855 222570334 SKILLED NURSG VT 501(C)(3) 9 MEDICAL ARTS BUILDING INC 189 PROUTY DRIVE NEWPORT VT 05855 030275720 TITLE HOLDING VT 501(C)(2) false false true false false false false false false true false true true true false true false true