NORTH COUNTRY HEALTH SERVICES INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization: NORTH COUNTRY HEALTH SERVICES INC (EIN 22-2570334)
Tax period: 2009-10-01 to 2010-09-30
Filed: 2011-08-15
IRS object ID: 201122279349301962
Schema version: 2009v1.7
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 J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2011-08-15T10:29:51-04:00	Timestamp
Tax Period End Date	2010-09-30	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	2009-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	222570334	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	NORTH COUNTRY HEALTH SERVICES INC	BusinessNameLine1
Business Name Line2	D/B/A DERBY GREEN	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	NORT	NameControl
Phone	8027662201	Phone

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	ANDRE BISSONNETTE	Name
Title	VP OF FINANCE	Title
Date Signed	2011-07-15	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	2009	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

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

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	LISA BOHLMAN 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	1476650	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c	X	Organization501c
Web Site	WWW.NCHSI.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1984	YearFormation
State Legal Domicile	VT	StateLegalDomicile
Activity Or Mission Description	NORTH COUNTRY HEALTH SERVICES IS A PRIVATE, NOT-FOR-PROFIT CORPORATION COMMITTED TO THE IMPROVEMENT AND ATTAINMENT OF THE HEALTH OF FACILITY RESIDENTS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	16	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	37	TotalNbrEmployees
Total Nbr Volunteers	34	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	16853	ContributionsGrantsPriorYear
Contributions Grants Current Year	16485	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	1352992	ProgramServiceRevenuePriorYear
Program Service Revenue CY	1381291	ProgramServiceRevenueCY
Investment Income Prior Year	-29498	InvestmentIncomePriorYear
Investment Income Current Year	10975	InvestmentIncomeCurrentYear
Other Revenue Prior Year	0	OtherRevenuePriorYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	1340347	TotalRevenuePriorYear
Total Revenue Current Year	1408751	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	911620	SalariesEtcPriorYear
Salaries Etc Current Year	918124	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	403995	OtherExpensePriorYear
Other Expenses Current Year	423947	OtherExpensesCurrentYear
Total Expenses Prior Year	1315615	TotalExpensesPriorYear
Total Expenses Current Year	1342071	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	24732	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	66680	RevenuesLessExpensesCY
Total Assets BOY	785340	TotalAssetsBOY
Total Assets EOY	813303	TotalAssetsEOY
Total Liabilities BOY	136237	TotalLiabilitiesBOY
Total Liabilities EOY	89535	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	649103	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	723768	NetAssetsOrFundBalancesEOY
Mission Description	NORTH COUNTRY HEALTH SERVICES IS A PRIVATE, NOT-FOR-PROFIT CORPORATION COMMITTED TO THE IMPROVEMENT AND ATTAINMENT OF THE HEALTH OF FACILITY RESIDENTS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	935874	Expense
Revenue	1091220	Revenue
Description	THE ORGANIZATION PROVIDED SKILLED NURSING HEALTH CARE FOR RESIDENTS OF A CERTIFIED INTERMEDIATE CARE FACILITY. FOR FISCAL YEAR 2010, THE ORGANIZATION HAD 6,671 MEDICAID PATIENT DAYS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	225083	Expense
Revenue	262445	Revenue
Description	THE ORGANIZATION PROVIDES OTHER SERVICES TO ALL PATIENTS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	23693	Expense
Revenue	27626	Revenue
Description	THE ORGANIZATION PROVIDED SKILLED NURSING HEALTH CARE FOR RESIDENTS OF A CERTIFIED INTERMEDIATE CARE FACILITY. FOR FISCAL YEAR 2010, THE ORGANIZATION HAD 131 MEDICARE PATIENT DAYS. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.	Description

Field	Value	IRS element (for citing)
Total Program Service Expense	1184650	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	true	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Balance Sheet Amounts Reported	true	BalanceSheetAmountsReported
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	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
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	6	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	37	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
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
Nbr Voting Governing Body Members	16	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
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

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
CLAUDIO D FORT
CEO	1.0	X	X	0	268702	29885
DAVID BOUFFARD
CHAIR THROUGH 01/2010	1.0	X	X	0	0	0
KATHRYN AUSTIN
CHAIR BEGINNING 01/2010	1.0	X	X	0	0	0
SCOTT PERRY
TRUSTEE	1.0	X		0	0	0
SUSAN PENHARLOW
TRUSTEE	1.0	X		0	0	0
MELISSA PETTERSSON
SECRETARY/CLERK	1.0	X	X	0	0	0
RICHARD BARAW
TRUSTEE	1.0	X		0	0	0
ALAN WING
VICE CHAIR - BOARD	1.0	X	X	0	0	0
BILL STENGER
TRUSTEE	1.0	X		0	0	0
BONNIE NASH
VICE CHAIR - FINANCE	1.0	X	X	0	0	0
JEANE KADMIRI
TRUSTEE	1.0	X		0	0	0
DAVE LAFORCE
TRUSTEE	1.0	X		0	0	0
THOMAS MOSELEY MD
TRUSTEE	1.0	X		0	15031	0
BOB WILSON
TRUSTEE	1.0	X		0	0	0
CHRISTOPHER RICKMAN MD
PHYSICIAN/TRUSTEE	1.0	X		0	218038	31245
MARC BOUCHARD MD
MEDICAL STAFF VP	1.0	X		0	274155	40961
PETER STUART MD
MEDICAL STAFF PRESIDENT	1.0	X		0	282912	17749
ANDRE BISSONNETTE
VP OF FINANCE	1.0		X	0	181791	27453
LISA BOHLMAN
ADMINISTRATOR	40.0		X	75413	0	5319

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	75413	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1240629	TotalReportableCompFrmRltdOrgs
Total Other Compensation	152612	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Number Of Contractors GT100 K	0	NumberOfContractorsGT100K
Government Grants	16485	GovernmentGrants
Total Contributions	16485	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT REVENUE	623000	1380447	1380447
OTHER	623000	844	844

Field	Value	IRS element (for citing)
Total Program Service Revenue	1381291	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	6547	TotalRevenueColumn
Exclusion	$6,547	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 Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	72327	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	66658	Securities
Other	1241	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	5669	Securities
Other	-1241	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	4428	TotalRevenueColumn
Exclusion	$4,428	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

Field	Value	IRS element (for citing)
Total Other Revenue	0	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1408751	TotalRevenueColumn
Related Or Exempt Function Income	1381291	RelatedOrExemptFunctionIncome
Exclusion	$10,975	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total

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	80732	Total
Management And General	80732	ManagementAndGeneral

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	654352	Total
Program Services	635180	ProgramServices
Management And General	19172	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	22723	Total
Program Services	19778	ProgramServices
Management And General	2945	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	102815	Total
Program Services	94119	ProgramServices
Management And General	8696	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	57502	Total
Program Services	50049	ProgramServices
Management And General	7453	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	1000	Total
Management And General	1000	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1000	Total
Management And General	1000	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	16975	Total
Management And General	16975	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	3678	Total
Management And General	3678	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	70956	Total
Program Services	70795	ProgramServices
Management And General	161	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	0	Total

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	116339	Total
Program Services	111263	ProgramServices
Management And General	5076	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	746	Total
Program Services	746	ProgramServices

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	25733	Total
Program Services	25733	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	13937	Total
Program Services	9587	ProgramServices
Management And General	4350	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	0	Total

Interest Interest

Field	Value	IRS element (for citing)
Total	1266	Total
Program Services	1167	ProgramServices
Management And General	99	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	46116	Total
Program Services	42523	ProgramServices
Management And General	3593	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	8308	Total
Program Services	8308	ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
DUES AND SUBSCRIPTIONS	3109	618	2491
RECRUITING & RETENTION	2555	2555
MEDICAID TAXES	91141	91141
MEDICAL SUPPLIES & DRUGS	21088	21088

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	1342071	Total
Program Services	1184650	ProgramServices
Management And General	157421	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1100	BOY
EOY	1100	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	267117	BOY
EOY	275408	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	80180	BOY
EOY	96535	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	100	BOY
EOY	100	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	20375	BOY
EOY	19284	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	942536	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	744238	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	211032	BOY
EOY	198298	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	205436	BOY
EOY	222578	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	785340	BOY
EOY	813303	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	69530	BOY
EOY	43224	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	1324	BOY
EOY	1455	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	65383	BOY
EOY	44856	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	136237	BOY
EOY	89535	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	649103	BOY
EOY	723768	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	649103	BOY
EOY	723768	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	785340	BOY
EOY	813303	EOY

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus1 Year	16853	CurrentTaxYearMinus1Year
Current Tax Year	16485	CurrentTaxYear
Total	33338	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1154716	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1292325	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1306076	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1352992	CurrentTaxYearMinus1Year
Current Tax Year	1381291	CurrentTaxYear
Total	6487400	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1154716	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1292325	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1306076	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1369845	CurrentTaxYearMinus1Year
Current Tax Year	1397776	CurrentTaxYear
Total	6520738	Total

Field	Value	IRS element (for citing)
Public Support Total509	6520738	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	20578	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	14384	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4410	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	7701	CurrentTaxYearMinus1Year
Current Tax Year	6547	CurrentTaxYear
Total	53620	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	20578	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	14384	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4410	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	7701	CurrentTaxYearMinus1Year
Current Tax Year	6547	CurrentTaxYear
Total	53620	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1175294	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1306709	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1310486	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1377546	CurrentTaxYearMinus1Year
Current Tax Year	1404323	CurrentTaxYear
Total	6574358	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.99184	PublicSupportPercentage509
Prior Year Support Percentage	0.99203	PriorYearSupportPercentage
Investment Income Percentage	0.00816	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00797	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

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
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. A PORTION OF THESE DUES ARE ATTRIBUTABLE TO LOBBYING PURPOSES.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	true	IncludedOnFS

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	30000	OtherCostOrOtherBasis
Book Value	30000	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Book Value	0	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	603026	OtherCostOrOtherBasis
Depreciation	493712	Depreciation
Book Value	109314	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	280949	OtherCostOrOtherBasis
Depreciation	226405	Depreciation
Book Value	54544	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	28561	OtherCostOrOtherBasis
Depreciation	24121	Depreciation
Book Value	4440	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	198298	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DUE TO AFFILIATES	Description
Amount	$44,856	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	44856	TotalOfAmounts
Total Revenue	1408751	TotalRevenue
Total Expenses	1342071	TotalExpenses
Excess Or Deficit For Year	66680	ExcessOrDeficitForYear
Net Unrealized GL On Investments	7985	NetUnrealizedGLOnInvestments
Total Adjustments	7985	TotalAdjustments
Excess Or Deficit Per FS	74665	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	1399317	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	7985	NetUnrealizedGainsInvestments
Other Revenues	-17419	OtherRevenues
Revenue Not Rptd F990	-9434	RevenueNotRptdF990
Revenue Subtotal	1408751	RevenueSubtotal
Total Revenue Per Form990	1408751	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	1324652	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	1324652	ExpensesSubtotal
Other Expenses Not Included	17419	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	17419	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	1342071	TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
TRUST, ESCROW, AND CUSTODIAL ACCOUNTS	SCHEDULE D, PART IV, LINE 2B	THE ORGANIZATION MAINTAINS A "RESIDENT PERSONAL FUNDS PAYABLE" ACCOUNT. THIS ACCOUNT HOLDS PERSONAL FUNDS OF RESIDENTS IN AN INTEREST BEARING ACCOUNT AT A LOCAL BANK. IN ORDER TO ISSUE CHECKS FROM THE ACCOUNT, TWO SIGNATURES ARE REQUIRED.
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 RECONCILING ITEMS	SCHEDULE D, PART XII, LINE 2D AND PART XIII, LINE 4B	THE FOLLOWING EXPENSES WERE INCLUDED WITH REVENUES ON THE AUDIT REPORT; HOWEVER, WERE MOVED TO BE PROPERLY INCLUDED WITH EXPENSES ON THE AUDIT REPORT. $ 13,741 EXPENSES PAID OUT OF GRANT FUNDS 3,678 INVESTMENT FEES -------- $ 17,419

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	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	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

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
CLAUDIO D FORT
0	211444	0	32594	0	24664	0	5982	0	23903	0	298587
ANDRE BISSONNETTE
0	103585	0	50366	0	27840	0	3675	0	23778	0	209244
CHRISTOPHER RICKMAN MD
0	217641	0	0	0	397	0	13175	0	18070	0	249283
MARC BOUCHARD MD
0	273578	0	0	0	577	0	17150	0	23811	0	315116
PETER STUART MD
0	282078	0	0	0	834	0	14673	0	3076	0	300661

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	COMPENSATION DETERMINATION	Identifier
Return Reference	SCHEDULE J, PART I, LINE 3	ReturnReference
Explanation	NORTH COUNTRY HOSPITAL, A RELATED ORGANIZATION, USES AN INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD IN DETERMINING THE COMPENSATION OF THE CEO.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
ORGANIZATION'S MISSION	FORM 990, PART III, LINE 1	NORTH COUNTRY HEALTH SERVICES, INC., IS A PRIVATE, NOT-FOR-PROFIT CORPORATION COMMITTED TO THE IMPROVEMENT AND ATTAINMENT OF THE HEALTH OF OUR FACILITY RESIDENTS. THE CENTRAL PURPOSE OF THE CORPORATION IS TO SUPPORT AND OVERSEE THE OPERATION OF DERBY GREEN. DERBY GREEN IS A TWENTY-THREE BED FACILITY CERTIFIED BY MEDICARE/MEDICAID. NORTH COUNTRY HEALTH SERVICES, INC., HAS A FURTHER COMMITMENT TO ASSIST COMMUNITY MEMBERS IN THE MAINTENANCE AND IMPROVEMENT OF THEIR OWN HEALTH. DERBY GREEN WILL OFFER OTHER PROGRAMS THAT WILL BE BENEFICIAL TO THE COMMUNITY AND IN THE BEST INTERESTS OF DERBY GREEN. IN RECOGNITION OF THE BURDEN THAT THE COSTS OF HEALTH CARE PLACES ON THE COMMUNITY, NORTH COUNTRY HEALTH SERVICES, INC., WILL PROVIDE QUALITY HEALTH CARE WHILE EVERY EFFORT WILL BE MADE TO CONTAIN COSTS.
PROGRAM SERVICES	FORM 990, PART III, LINE 4	THE ORGANIZATION PROVIDES OTHER SERVICES TO ALL PATIENTS. DERBY GREEN PROVIDES A FULL RANGE OF HEALTH CARE SERVICES AND IS COMMITTED TO PROVIDING EXCELLENT HEALTHCARE IN A KIND AND CARING ENVIRONMENT. DERBY GREEN IS A PROGRESSIVE NURSING FACILITY WITH CARING STAFF WHO WILL STRIVE TO MEET THE INDIVIDUAL NEEDS OF EACH RESIDENT. SERVICES PROVIDED INCLUDE: - 24-HOUR NURSING CARE AND ON-CALL PHYSICIAN, - LAUNDRY, SOCIAL, PODIATRY, AND BEAUTICIAN SERVICES, - PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY IN ADDITION, RECREATIONAL, RELIGIOUS, AND SOCIAL EVENTS ARE AVAILABLE TO ALL RESIDENTS. INDIVIDUAL AND GROUP ACTIVITIES SUCH AS BINGO, CHURCH SERVICES, MOVIES, SEASONAL PARTIES, AND MUSICAL ENTERTAINMENT ARE ROUTINELY OFFERED. REALITY ORIENTATION AND STIMULATION IS DIRECTED THROUGH THE LIFE ENHANCEMENT PROGRAM. SPECIAL OUTINGS MAY INCLUDE PICNICS IN THE PARK, BARBEQUES, AND SCENIC RIDES IN THE WHEELCHAIR LIFT EQUIPPED VAN. IN-ROOM CABLE AND PHONE SERVICE IS AVAILABLE.
MEMBERS OF THE ORGANIZATION	FORM 990, PART VI, SECTION A, LINES 6, 7A, & 7B	THE SOLE MEMBER OF THE CORPORATION 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. THE MEMBER SHALL HAVE SUCH OTHER POWERS AS ARE SPECIFIED IN THE ARTICLES OF ASSOCIATION AND IN THE BY-LAWS, INCLUDING, WITHOUT LIMITATION, THE POWER TO ELECT AND REMOVE TRUSTEES AND TO AMEND AND RESTATE THE ARTICLES OF ASSOCIATION. THE AUTHORITY OF THE BOARD OF TRUSTEES TO EXERCISE THE POWERS LISTED IN THE BYLAWS IS CONDITIONED ON THE PRIOR APPROVAL OF THE MEMBER.
REVIEW OF THE FORM 990	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, LINE 15A	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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus
NORTH COUNTRY HOSPITAL & HEALTH CENTER
189 PROUTY DRIVE	NEWPORT	VT	05855	030185556	HOSPITAL	VT	501(C)(3)	3
NORTH COUNTRY HEALTH SYSTEMS
189 PROUTY DRIVE	NEWPORT	VT	05855	222566964	PARENT/FUNDRS	VT	501(C)(3)	11B II
MEDICAL ARTS BUILDING
189 PROUTY DRIVE	NEWPORT	VT	05855	030275720	TITLE HOLDING	VT	501(C)(2)

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	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
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	false	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	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg