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 222566964 NORTH COUNTRY HEALTH SYSTEMS INC NORT 8023343210 189 PROUTY DRIVE NEWPORT VT 05855 ANDRE BISSONNETTE 2011-07-15 true Brian D Todd 4178658701 2009 2016-02-24 21:20:13Z ANDRE BISSONNETTE 189 PROUTY DRIVE NEWPORT VT 05855 119563 false X WWW.NCHSI.ORG X 1984 VT TO ORGANIZE FUNDRAISING EFFORTS TO PROVIDE AFFILIATED ORGANIZATIONS WITH RESOURCES NEEDED TO CARRY OUT THEIR EXEMPT FUNCTIONS. 16 11 0 15 0 0 119566 119417 0 0 102 146 0 0 119668 119563 34160 82683 0 0 0 0 0 0 0 11051 13747 45211 96430 74457 23133 222471 245604 0 0 222471 245604 TO ORGANIZE FUNDRAISING EFFORTS TO PROVIDE AFFILIATED ORGANIZATIONS WITH RESOURCES NEEDED TO CARRY OUT THEIR EXEMPT FUNCTIONS. false false 88838 82683 TO ORGANIZE FUNDRAISING EFFORTS TO PROVIDE AFFILIATED ORGANIZATIONS WITH RESOURCES NEEDED TO CARRY OUT THEIR EXEMPT FUNCTIONS. 88838 true true false false false false false false false true false true false false false false false false false false false true false true false false false false false false false false false false false false false true true false false true 0 0 true 0 false false false false false false false false false 16 11 false false false false true true true true true false false true true true true true true false X ANDRE BISSONNETTE 8023347331 189 PROUTY DRIVE NEWPORT VT 05855 CLAUDIO D FORT 1.0 X X 0 268702 29885 DAVID BOUFFARD 1.0 X X 0 0 0 BOB WILSON 1.0 X 0 0 0 THOMAS MOSELEY MD 1.0 X 0 15031 0 SCOTT PERRY 1.0 X 0 0 0 CHRISTOPHER RICKMAN MD 1.0 X 0 218038 31245 SUSAN PENHARLOW 1.0 X 0 0 0 KATHRYN AUSTIN 1.0 X X 0 0 0 MELISSA PETTERSSON 1.0 X X 0 0 0 RICHARD BARAW 1.0 X 0 0 0 ALAN WING 1.0 X X 0 0 0 BILL STENGER 1.0 X 0 0 0 BONNIE NASH 1.0 X X 0 0 0 JEANE KADMIRI 1.0 X 0 0 0 DAVE LAFORCE 1.0 X 0 0 0 MARC BOUCHARD MD 1.0 X 0 274155 40961 PETER STUART MD 1.0 X 0 282912 17749 ANDRE BISSONNETTE 1.0 X 0 181791 27453 0 1240629 147293 0 false true false 0 28000 91417 119417 0 146 146 0 0 0 0 0 0 0 119563 146 82683 82683 0 0 0 0 0 0 0 0 0 0 0 7505 7505 0 0 0 0 0 5288 5276 12 0 0 0 0 0 0 0 0 0 0 MISC 954 879 75 96430 88838 7592 0 7489 4986 214982 240618 222471 245604 0 0 0 0 0 0 X 7489 4986 214982 240618 222471 245604 222471 245604 X false true true X false X X X false false false N CO HOSP 030185556 03 true 82683 N CO HLTH 222570334 03 true 0 2 82683 THE FULL NAMES OF THE SUPPORTED ORGANIZATIONS ARE: NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. NORTH COUNTRY HEALTH SERVICES, INC. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 119563 96430 23133 23133 36880 -82683 -82683 119563 119563 13747 13747 82683 82683 96430 OTHER AMOUNTS INCLUDED ON LINE BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D CONTRIBUTIONS PAID (82,683) OTHER AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1 SCHEDULE D, PART XIII, LINE 4B CONTRIBUTIONS PAID 82,683 UNCERTAIN TAX POSITIONS PART XIV 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. true NORTH COUNTRY HOSPITAL & HEALTH CENTER INC 189 PROUTY DRIVE NEWPORT VT 05855 030185556 501(C)(3) 82683 SUPPORT 1 MONITORING USE OF FUNDS PART I, LINE 2 NORTH YOUNTRY HEALTH SYSTEMS IS THE PARENT ORGANIZATION OF NORTH COUNTRY HOSPITAL & HEALTH CENTER AND SHARES CONSOLIDATED FINANCIALS WITH THE HOSPITAL; THEREFORE, THE ORGANIZATION HAS ACCESS TO THE HOSPITAL FINANCIALS AND IS ABLE TO MONITOR THE USE OF THE FUNDS. false false false false false false false false false 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 COMPENSATION DETERMINATION SCHEDULE J, PART I, LINE 3 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. MEMBERS/STOCKHOLDERS/OTHER PERSONS FORM 990, PART VI, SECTION A, LINES 6, 7A & 7B THE MEMBERSHIP OF THE CORPORATION SHALL CONSIST OF ALL PERSONS REFERRED TO IN THE ARTICLES OF ASSOCIATION AS THE INITIAL MEMBERS OF THE CORPORATION, ALL PERSONS WHO SHALL THEREAFTER BE ELECTED MEMBERS IN CONFORMITY WITH THE BYLAWS, DEPARTMENT DIRECTORS AND ALL APPOINTEES OF THE ACTIVE MEDICAL STAFF OF NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. THE MEMBERS SHALL BE REFERRED TO AS "NORTH COUNTRY MEMBERS". AS LISTED IN THE ARTICLES OF ASSOCIATION, THE SOLE MEMBER OF THE CORPORATION IS NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. NORTH COUNTRY MEMBERS SHALL BE ELECTED AT THE ANNUAL MEETING BY A MAJORITY VOTE OF THE EXISTING NORTH COUNTRY MEMBERS PRESENT AND VOTING AT SAID MEETING. THE CORPORATION SHALL CONDUCT AN ANNUAL ENROLLMENT OF MEMBERS BUT PERSONS MAY BE ADMITTED TO MEMBERSHIP AT ANY TIME. THE OFFICER OR AGENT HAVING CHARGE OF THE BOOKS OF THE CORPORATION SHALL MAKE A COMPLETE RECORD OF THE MEMBERS ENTITLED TO VOTE AT EACH MEETING OF MEMBERS THEREOF, ARRANGED IN ALPHABETICAL ORDER. THE MEMBER LIST MUST BE AVAILABLE FOR INSPECTION BY ANY MEMBER, BEGINNING TWO (2) BUSINESS DAYS AFTER NOTICE OF THE MEETING IS GIVEN FOR WHICH THE LIST WAS PREPARED AND CONTINUING THROUGH THE MEETING DATE. THE LIST SHALL BE AVAILABLE AT THE PRINCIPLE OFFICE OF NORTH COUNTRY HOSPITAL. A MEMBER, HIS AGENT OR ATTORNEY IS ENTITLED, ON WRITTEN DEMAND, TO INSPECT AND TO COPY THE LIST DURING REGULAR BUSINESS HOURS AT HIS OR HER EXPENSE, DURING THE PERIOD IT IS AVAILABLE FOR INSPECTION. THE MEMBER LIST SHALL BE MAINTAINED IN WRITTEN FORM OR IN ANOTHER FORM CAPABLE OF CONVERSION TO WRITTEN FORM WITHIN A REASONABLE TIME. AT EACH ANNUAL MEETING, THE NORTH COUNTRY MEMBERS SHALL FIX, WITHIN THE LIMITS SPECIFIED ABOVE, THE SIZE OF THE BOARD OF TRUSTEES FOR THE ENSUING YEAR AND SHALL ELECT THE NUMBER OF TRUSTEES NECESSARY TO COMPLETE THE SIZE SO FIXED; PROVIDED, HOWEVER, THAT THE SIZE OF THE BOARD OF TRUSTEES MAY BE DECREASED ONLY TO ELIMINATE VACANCIES EXISTING BY REASONS OF THE DEATH, RESIGNATION, REMOVAL OR NATURAL EXPIRATION OF THE TERM OF ONE OR MORE TRUSTEES. THE BYLAWS MAY BE ALTERED, AMENDED OR REPEALED BY NORTH COUNTRY MEMBERS AT ANY REGULAR OR SPECIAL MEETING, PROVIDED THE NOTICE OF SUCH MEETING SHALL HAVE CONTAINED A COPY OF THE PROPOSED ALTERATION, AMENDMENT OR REPEAL AND PROVIDED A QUORUM IS PRESENT, SUBJECT TO RATIFICATION BY THE NORTH COUNTRY BOARD. 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. 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 VIEW ON-SITE OR BY WRITTEN REQUEST. NORTH COUNTRY HOSPITAL & HEALTH CENTER 189 PROUTY DRIVE NEWPORT VT 05855 030185556 HOSPITAL VT 501(C)(3) 3 NA NORTH COUNTRY HLTH SRVCS DBA DERBY GREEN 189 PROUTY DRIVE NEWPORT VT 05855 222570334 SKILLED NRSG VT 501(C)(3) 9 NA MEDICAL ARTS BUILDING INC 189 PROUTY DRIVE NEWPORT VT 05855 030275720 TITLE HOLDING VT 501(C)(2) NA false true true false false false false false false false true false true true false false false false NORTH COUNTRY HOSPITAL & HEALTH CENTER INC B 82683