2020-08-17T10:27:35-05:00 2019-09-30 BKD LLP 910 E ST LOUIS 200/PO BOX 1190 SPRINGFIELD MO 658062523 990 2018-10-01 030185556 NORTH COUNTRY HOSPITAL & HEALTH CENTER INC % TRACEY PAUL NORT 8023347331 189 PROUTY DR NEWPORT VT 05855 TRACEY PAUL CFO 8023347331 2020-06-16 true Brian D Todd P00422601 4178658701 167.68.126.162 43032920202305000002 2020-08-17 P 74C51B083D6172D3D43AC87F1A33B4712A418457 EADA8263F67F30EEC173F90D1C5FD4FB3EC213FF 2018 2020-11-06 18:47:13Z D BRIAN NALL 189 PROUTY DR NEWPORT VT 05855 108387726 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. 15 10 658 40 17803 14159 181559 331527 84634595 91057538 2019176 1262303 11439 -16066 86846769 92635302 0 0 0 0 50815978 51925393 0 0 0 36012174 37872762 86828152 89798155 18617 2837147 86415286 86819379 32562799 30993344 53852487 55826035 X 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. false false 44400993 64653721 THE HOSPITAL OFFERS OUTPATIENT SERVICES INCLUDING EMERGENCY ROOM, LAB WORK, DIAGNOSTIC IMAGING (X-RAY, CT SCAN, MRI, MAMMOGRAMS, NUCLEAR IMAGING ULTRASOUND), OUTPATIENT SURGERIES, PULMONARY, CARDIAC CARE AND THERAPY SERVICES (PHYSICAL, SPEECH AND REHABILITATIVE). 9837811 14325155 INPATIENT HOSPITAL CARE WAS PROVIDED AT A CRITICAL ACCESS HOSPITAL TOTALING 6,287 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. 21620161 12078662 THE HOSPITAL'S PHYSICIAN PRACTICE CLINICS PROVIDE INTERNAL MEDICINE RADIOLOGY PROGRAM, PSYCHIATRIC, OB/GYN, NEUROLOGY, ORTHOPEDICS, OCCUPATIONAL HEALTH, PULMONARY-SLEEP, AND SURGICAL SERVICES. 75858965 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true 74 0 true 658 true true true false false false false false false false false false false false X 15 10 false false false false true true true true true false false true true true true true true true true false VT X TRACEY PAUL 8023347331 189 PROUTY DRIVE NEWPORT VT 05855 X DWIGHT NALL CEO BEG 10/2018 40.0 2.0 X X 68987 0 3127 THOMAS FRANK TRUSTEE/COO/INTERIM CEO 40.0 2.0 X 311668 0 16698 FRANK KNOLL CHAIR 10.0 2.0 X X 0 0 0 THOMAS MILNAMOW VICE CHAIR - BOARD 5.0 2.0 X X 0 0 0 HEIDI BROWN 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 UMAIR MALIK MD MEDICAL STAFF PRESIDENT 40.0 2.0 X X 293721 0 38238 CHARLES LAGOY MD MEDICAL STAFF VP 40.0 2.0 X X 283182 0 38320 CHRISTOPHER RICKMAN MD TRUSTEE 40.0 2.0 X 329697 0 40718 GARY GILLESPIE TRUSTEE 5.0 2.0 X 0 0 0 BOB WILSON TRUSTEE 5.0 2.0 X 0 0 0 JANET OSBORNE TRUSTEE 5.0 2.0 X 0 0 0 JIM BIERNAT TRUSTEE 5.0 2.0 X 0 0 0 STEVE WRIGHT TRUSTEE 5.0 2.0 X 0 0 0 TERRIE MCQUILLEN TRUSTEE 5.0 2.0 X 0 0 0 ANDRE BISSONNETTE CHIEF FINANCIAL OFFICER 40.0 2.0 X 219076 0 43566 AVRIL COCHRAN VP PATIENT CARE SERVICES 40.0 2.0 X 178258 0 27564 STEPHANE MULLIGAN MD PHYSICIAN 40.0 0.0 X 609556 0 35359 LARRY SISSON MD PHYSICIAN 40.0 0.0 X 564289 0 24187 PETER STUART MD PHYSICIAN 40.0 0.0 X 526156 0 23085 GREG WALKER MD PHYSICIAN 40.0 0.0 X 523965 0 57638 VERONIKA JEDLOVSZKY MD PHYSICIAN 40.0 0.0 X 432847 0 51399 CLAUDIO FORT FORMER CEO 0.0 0.0 X 102923 0 20084 4444325 0 419983 78 true true false NORTH COUNTRY RADIOLOGY PC 189 PROUTY DRIVE NEWPORT VT 05855 PHYSICIAN 1077957 BKD LLP 910 E ST LOUIS STREET SPRINGFIELD MO 65806 AUDIT/TAX/COST REPOR 376776 CLAUDE PAUL CONSTRUCTION 635 SHATTUCK HILL ROAD NEWPORT VT 05855 CONSTRUCTION 262972 GOLDFISH LOCUM TENENS 6865 WINDCREST DRIVE SUITE 300 PLANO TX 75024 LOCUM STAFF 225386 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM STAFF 183864 6 101787 229740 331527 PATIENT SERVICE REVENUE 624100 77659719 77659719 FIXED PROSPECTIVE REVENUE 624100 6049992 6049992 340B PHARMACY 624100 4673248 4673248 OTHER PATIENT SERVICE REVENUE 722514 2389359 2389359 CAFETERIA 446110 285220 285220 91057538 1011502 1011502 0 0 0 0 0 15957199 46026 15688967 63457 268232 -17431 250801 250801 0 0 0 0 0 0 0 0 0 LOSS ON INVEST IN EQUITY INVESTEE 812900 -33869 -33869 ADMIN SERVICES 561000 11975 11975 HOUSEKEEPING 900099 5828 5828 -16066 92635302 91057538 17803 1228434 X 0 0 0 0 1820676 1558064 262612 123007 123007 38652799 28910768 9742031 1581649 1392203 189446 7076560 6217300 859260 2670702 2341578 329124 97010 97010 63105 63105 92493 92493 0 0 358459 358459 8742020 8670259 71761 248833 248833 2107261 1960245 147016 50424 50424 0 1477153 1415297 61856 147796 143574 4222 0 227176 227176 667291 595456 71835 0 4113752 3670901 442851 734099 734099 MEDICAL SUPPLIES & DRUGS 5696003 5696003 PROVIDER TAX 4555652 4555652 REPAIRS & MAINTENANCE 4274376 4234206 40170 BAD DEBT 3422797 3422797 797062 797062 89798155 75858965 13939190 0 498403 205116 2476694 4559804 31142 24875 8588342 7428223 0 0 0 0 0 0 2628596 2519168 887834 758426 80072775 57792051 23403358 22280724 43306575 44471720 262532 618663 950085 763172 0 0 3381725 3189488 86415286 86819379 11310983 11079637 0 0 0 0 17027790 16221604 0 0 0 0 1673839 729913 0 0 2550187 2962190 32562799 30993344 X 49444068 51553180 3613560 3477996 794859 794859 53852487 55826035 86415286 86819379 X 2837147 252692 -1116291 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 13869 13869 false SCHEDULE C, PART II-B, LINE 1(I) OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS DUES TO THE VERMONT HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 11.63% OF DUES SUPPORT LOBBYING EFFORTS. IN ADDITION, THE ORGANIZATION PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION, WHICH HAS REPORTED THAT APPROXIMATELY 21.78% OF DUES SUPPORT LOBBYING EFFORTS. 3458184 51349 3509533 3247829 210355 3458184 2855688 392141 3247829 2647384 208304 2855688 2745606 -98222 2647384 0.22980 0.77020 false false 405921 405921 19765302 14338176 5427126 24874457 18044467 6829990 32701953 23722700 8979253 2325142 1686708 638434 22280724 0 EST AMTS DUE TO 3RD PARTY PAYER 1399537 INTEREST RATE SWAP 1562653 2962190 88382740 -232156 -3661947 -3894103 92276843 358459 358459 92635302 85997749 85997749 358459 3441947 3800406 89798155 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS: NORTH COUNTRY HEALTH SYSTEMS (NCHS), A RELATED ORGANIZATION, HAS ADOPTED INVESTMENT AND SPENDING POLICIES FOR ENDOWMENT ASSETS THAT ATTEMPT TO PROVIDE A PREDICTABLE STREAM OF FUNDING TO PROGRAMS AND OTHER ITEMS SUPPORTED BY ITS ENDOWMENT WHILE SEEKING TO MAINTAIN THE PURCHASING POWER OF THE ENDOWMENT. UNDER NCHS'S POLICIES, THE PRIMARY INVESTMENT GOAL IS GROWTH IN THE ENDOWMENT ACCOUNTS. NCHS EXPECTS ITS ENDOWMENT FUNDS TO PROVIDE AN AVERAGE RATE OF RETURN THAT EXCEEDS BENCH MARK RETURNS INDICATED FOR VARIOUS ASSET CLASSES. SCHEDULE D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D AMOUNTS INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12: $(3,422,797) BAD DEBT EXPENSE (220,000) NET ASSETS RELEASED FROM RESTRICTION (19,150) OTHER EXPENSES INCLUDED IN REVENUE ----------- $(3,661,947) SCHEDULE D, PART XII, LINE 4B AMOUNTS INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1: $ 3,422,797 BAD DEBT EXPENSE 19,150 OTHER EXPENSES INCLUDED IN REVENUE ----------- $ 3,441,947 true true X true X 300. false false true true false true true 741126 741126 0.00860 26194678 9729155 16465523 0.19060 26935804 9729155 17206649 0.19920 14056 14056 0.00020 85973 85973 0.00100 51196 6780 44416 0.00050 66217 66217 0.00080 217442 6780 210662 0.00250 27153246 9735935 17417311 0.20170 false 3422797 554910 24800355 25047745 -247390 X true true 1 1 NORTH COUNTRY HOSPITAL 189 PROUTY DRIVE NEWPORT VT 05855 NCHSI.ORG 832 X X X X NORTH COUNTRY HOSPITAL 1 false false true X X X X X X X X X 18 true false false true X SEE PART V, SECTION C true 18 true SEE PART V, SECTION C false true X 300. 0. X X X X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT: IN KEEPING WITH THE GUIDELINES FOR A COMPREHENSIVE CHNA, A NUMBER OF KEY COMMUNITY STAKEHOLDERS WHO REPRESENT THE BROAD INTEREST OF THE NEWPORT HOSPITAL SERVICE AREA, INCLUDING LEADERS AND REPRESENTATIVES OF ORGANIZATIONS THAT SERVE VARIOUS SEGMENTS OF THE POPULATION IN THE NCH SERVICE AREA WERE INVITED TO PARTICIPATE ON THE CHNA ADVISORY TEAM. WITH THE NCH CORE TEAM AS A SUBGROUP OF THE CHNA ADVISORY TEAM, THE ADVISORY TEAM WAS LEAD AND DISCUSSION WAS FACILITATED BY J. RIFFON. SCHEDULE H, PART V, SECTION B, LINE 7A & 10 WEBSITE URL FOR CHNA REPORT/IMPLEMENTATION STRATEGY: HTTPS://WWW.NORTHCOUNTRYHOSPITAL.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ SCHEDULE H, PART V, SECTION B, LINE 11 ADDRESSING IDENTIFIED NEEDS: AFTER REVIEW OF THE COMBINATION OF DATA AND THE RESULTS OF THE COMMUNITY SURVEY AND FOCUS GROUP PROCESSES, THE ADVISORY TEAM PRIORITIZED THE FOLLOWING AS KEY HEALTH CONCERNS RECOMMENDED FOR DEVELOPMENT OF IMPLEMENTATION STRATEGIES FOR THE 2018 NCH COMMUNITY HEALTH NEEDS ASSESSMENT: - SUPPORTING SUBSTANCE FREE LIFE STYLE AND MENTAL WELLNESS - SUPPORTING OLDER VERMONTERS AGING IN PLACE - SUPPORTING TOBACCO FREE LIFE STYLES - SUPPORTING HEALTHY EATING AND PHYSICAL ACTIVITY - SUPPORTING ACCESS TO MEDICAL AND ORAL HEALTH RESOURCES ADDITIONALLY, THE ADVISORY TEAM ACKNOWLEDGES THERE ARE RELATED KEY CONCERNS WHICH WERE IDENTIFIED THROUGH THE ASSESSMENT PROCESS THAT IMPACT THE HEALTH OF THE NCH SERVICE AREA BUT WHICH NCH'S IMPLEMENTATION STRATEGY DOES NOT INTEND TO DIRECTLY ADDRESS WITH SPECIFIC MEASURES OR ACTIVITIES TO ASSESS PROGRESS. THESE RELATED KEY CONCERNS INCLUDE: - HIGHER RATES OF UNEMPLOYMENT AND POVERTY - LOWER RATE OF HIGH SCHOOL EDUCATION AMONG ADULTS - TRANSPORTATION CHALLENGES - REDUCED ACCESS TO POST HIGH SCHOOL EDUCATION FOR SOME COMMUNITY MEMBERS DUE TO FINANCIAL BARRIERS HOWEVER, NCH'S IMPLEMENTATION STRATEGY CONTAINS A RECOMMENDATION TO ADDRESS THE RELATED HEALTH CONCERNS LISTED ABOVE BY A COMMITMENT TO ASSESS THE NEED AND COMMUNITY CAPACITY TO IMPLEMENT THE BRIDGES OUT OF POVERTY INITIATIVE IN THE NCH SERVICE AREA. THIS IS A NATIONALLY RECOGNIZED COMMUNITY SUPPORT PROGRAM WHICH HELPS A COMMUNITY MOVE INDEPENDENTLY FROM POVERTY TO SELF-SUFFICIENCY. SCHEDULE H, PART V, SECTION B, LINE 16A WEBSITE URL FOR FAP: HTTPS://WWW.NORTHCOUNTRYHOSPITAL.ORG/FINANCIAL-SERVICES/ SCHEDULE H, PART V, SECTION B, LINE 16B WEBSITE URL FOR FAP APPLICATION: https://www.northcountryhospital.org/financial-services/ SCHEDULE H, PART V, SECTION B, LINE 16C WEBSITE URL FOR PLAIN LANGUAGE FAP SUMMARY: HTTPS://WWW.NORTHCOUNTRYHOSPITAL.ORG/FINANCIAL-SERVICES/ SCHEDULE H, PART V, SECTION B, LINE 20E EFFORTS INITIATED BY THE HOSPITAL: EVERY PATIENT THAT IS FLAGGED FOR COLLECTION IS INVITED TO A FINANCIAL AID APPOINTMENT. 7 NORTH COUNTRY PRIMARY CARE BARTON 488 ELM ST BARTON VT 05822 FAMILY MED, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC NORTH COUNTRY PRIMARY CARE NEWPORT 186 MEDICAL VILLAGE DRIVE NEWPORT VT 05855 FAMILY CARE, NEWBORN CARE, PEDIATRICS, GERIATRICS, ETC. NORTH COUNTRY HOSPITAL OBGYN SERVICES 81 MEDICAL VILLAGE DRIVE SUITE 2 NEWPORT VT 05855 OB/GYN SERVICES NORTH COUNTRY SURGICAL ASSOCIATES 41 MEDICAL VILLAGE DR NEWPORT VT 05855 SURGERY NORTH COUNTRY ORTHOPEDICS 81 MEDICAL VILLAGE DR SUITE 1 NEWPORT VT 05855 ORTHOPEDICS NORTH COUNTRY NEUROLOGY SERVICES MEDICAL ARTS BLDG 2ND FLOOR 189 P NEWPORT VT 05855 NEUROLOGY NORTH COUNTRY PEDIATRICS 121 MEDICAL VILLAGE DR NEWPORT VT 05855 NEWBORN CARE, PEDIATRICS SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: TO ARRIVE AT THE PERCENT OF TOTAL EXPENSES, THE DENOMINATOR WHICH EQUALS TOTAL OPERATING EXPENSES PER PART IX, LINE 25, OF THE FORM 990 WAS REDUCED BY BAD DEBT EXPENSE OT $3,422,797. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1, 3, AND 6. SCHEDULE H, PART I, LINE 7G SUBSIDIZED SERVICES: AMOUNTS USED IN THE CALCULATION OF SUBSIDIZED SERVICES ON LINE 7G PRIMARILY CAME FROM COSTS ASSOCIATED WITH RURAL HEALTH CENTERS (RHCS). 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. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: OUR ORGANIZATION'S COMMUNITY-BUILDING ACTIVITIES INCLUDE ACTIVE PARTICIPATION BY HOSPITAL STAFF ON A NUMBER OF ECONOMIC-BUILDING COLLABORATIONS SUCH AS THE LOCAL ROTARY AND CHAMBER OF COMMERCE AS WELL AS ON LOCAL PARTNERSHIPS SUCH AS THOSE THAT FOCUS ON PREVENTION AND REDUCTION OF DOMESTIC VIOLENCE, PREVENTION/REDUCTION OF ALCOHOL, DRUGS AND TOBACCO, PROMOTION OF PHYSICAL ACTIVITY AND HEALTHY LIFESTYLE CHOICES. THE HOSPITAL ALSO PROVIDES MEETING SPACE AT NO CHARGE FOR NUMEROUS AGENCIES AND GROUPS THAT TARGET VARIOUS ASPECTS OF COMMUNITY HEALTH SUCH AS ALCOHOLICS ANONYMOUS, EARLY CHILDHOOD DEVELOPMENT, GRIEVING SUPPORT GROUPS, DRIVING SAFETY COURSES, YOUTH BEHAVIOR SUPPORT TEAMS AND YOUTH COURT DIVERSION TEAMS. SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT EXPENSE: BAD DEBT EXPENSE REPORTED ON LINE 2 IS THE AMOUNT PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT EXPENSE ATTRIBUTABLE TO FINANCIAL ASSISTANCE: THE ORGANIZATION HAS ESTIMATED THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY FOR LINE 3 BY UTILIZING DATA FROM THE U.S. CENSUS BUREAU. THE ORGANIZATION ESTIMATED THE PERCENTAGE BY OBTAINING THE PERCENT OF THE POPULATION IN ITS SERVICE AREA FALLING BELOW THE FEDERAL POVERTY GUIDELINES. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT EXPENSE FOOTNOTE: THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. THEY DO, HOWEVER, CONTAIN A FOOTNOTE THAT DESCRIBES PATIENT ACCOUNTS RECEIVABLE, THAT NOTE CAN BE FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 COMMUNITY BENEFIT: THE COMMUNITY IS BETTER SERVED WITH PROVIDERS AVAILABLE IN THE ORGANIZATION'S REMOTE REGION. THE ENTIRETY OF ANY SHORTFALL REPORTED SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE WILL LIKELY BE SHORTFALLS. ADDITIONALLY, TREATING MEDICARE PATIENTS IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD THAT TAX-EXEMPT HOSPITALS ARE HELD TO. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY: WHEN IDENTIFIED AS A POSSIBLE WRITE OFF TO MEDICARE BAD DEBT, AN ACCOUNT MUST MEET MEDICARE'S CRITERIA FOR REPORTING ON THE COST REPORT. AN ACCOUNT FOR A MEDICARE PATIENT MUST UNDERGO HOSPITAL COLLECTION EFFORTS FOR AT LEAST 120 DAYS FROM THE INITIAL DATE OF BILLING TO THE PATIENT BEFORE BEING CONSIDERED FOR WRITE-OFF TO A THIRD PARTY AGENCY. THESE MEDICARE ACCOUNTS WILL BE CLOSED AND RETURNED BY THE AGENCIES AFTER 120 DAYS FROM PLACEMENT IF COLLECTION EFFORTS FAIL AND THEY ARE DEEMED UNCOLLECTIBLE. IF A MEDICARE PATIENT IS DECEASED AND NO ESTATE CAN BE IDENTIFIED, IT WILL BE DEEMED UNCOLLECTIBLE AND MAY BE DIRECTLY CONSIDERED FOR WRITE-OFF RATHER THAN TURNED OVER TO A THIRD PARTY AGENCY. IF A MEDICARE PATIENT FILES FOR BANKRUPTCY, THE ACCOUNTS WILL BE DEEMED UNCOLLECTIBLE AND WILL BE DIRECTLY CONSIDERED FOR WRITE-OFF. IF A MEDICARE PATIENT QUALIFIES FOR FREE CARE UNDER THE HOSPITAL'S GUIDELINES, THE ACCOUNT(S) WILL BE DEEMED UNCOLLECTIBLE AND WILL BE WRITTEN OFF TO THE APPROPRIATE PAT CODE(S). WHEN A MEDICARE ACCOUNT IS DEEMED UNCOLLECTIBLE, THE DEDUCTIBLE AND/OR COINSURANCE AMOUNTS WILL BE WRITTEN OFF USING THE APPROPRIATE PAT CODE(S). NON COVERED AMOUNTS DO NOT QUALIFY FOR MEDICARE BAD DEBT. ALL SUPPORTING DOCUMENTATION REGARDING DEDUCTIBLE AND COINSURANCE AMOUNTS WILL BE COLLECTED AND FILED FOR COST REPORTING PURPOSES. THE HOSPITAL ALSO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT TO COMPLY WITH IRS 501(R) REQUIREMENTS. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: 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. THE VT DEPARTMENT OF HEALTH REMAINS AN 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 AND TOBACCO USE, OBESITY, LIFESTYLE CHOICES. DATA REGARDING SOCIOECONOMIC STATUS AND EDUCATION LEVEL IS ALSO READILY AVAILABLE, AGAIN FOR THE STATE AS WELL AS BY COUNTY AND SCHOOL DISTRICT. ALL DATA IS EASILY ACCESSIBLE ONLINE AT WWW.HEALTHVERMONT.GOV AND AT HUMANSERVICES.VERMONT.GOV. THE HOSPITAL ALSO COMPLETED A COMMUNITY HEALTH NEEDS ASSESSMENT TO COMPLY WITH NEW IRS 501(R) REQUIREMENTS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: FOR BALANCES OVER $500.00 A HELP IS AVAILABLE LETTER IS MAILED WITH THE INITIAL BILL, REGARDLESS OF WHETHER THE BALANCE IS SELF-PAY, PRIMARY OR AFTER INSURANCE. IN ADDITION, OUR COLLECTION LETTERS ALL REFER TO OUR FREE CARE PROGRAM ASKING THE PATIENT TO CALL TO DISCUSS THIS AND OTHER OPTIONS. WHEN FREE CARE IS DISCUSSED WITH THE PATIENT, IT IS EXPLAINED THAT THEY ARE REQUIRED TO APPLY FOR OTHER ASSISTANCE AND WE OFFER OUR HELP IN THE APPLICATION PROCESS. FOR SELF-PAY PATIENTS THAT ARE IP, ONE OF THE FINANCIAL COUNSELORS ATTEMPTS TO DISCUSS MEDICAID AS WELL AS FREE CARE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: WE SERVE TWO OF THE MOST ECONOMICALLY CHALLENGED COUNTIES IN VERMONT. WITH A TOTAL OF APPROXIMATELY 30,000 RESIDENTS IN OUR SERVICE AREA, OUR POPULATION, AS COMPARED TO VT AND THE US, HAS A SIGNIFICANTLY HIGHER PERCENTAGE OF PERSONS LIVING UNDER THE FEDERAL POVERTY LEVEL AND A VERY HIGH RATE OF ADULTS AGE 25+ WITHOUT A HIGH SCHOOL EDUCATION, WHILE THE MEDIAN HOUSEHOLD INCOME IS SIGNIFICANTLY LOWER, AGAIN AS COMPARED TO VT AND THE US. OUR REGION CONSISTENTLY HAS ONE OF THE HIGHEST RATES OF UNEMPLOYMENT IN THE STATE. THIS PRIMARILY WHITE POPULATION IS FOUND IN VERY SMALL COMMUNITIES SCATTERED OVER A RURAL, MOUNTAINOUS, AND LAKE-DOTTED AREA, MAKING TRAVELING AND NETWORKING A CHALLENGE, PARTICULARLY IN THE HARSH WINTER MONTHS. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: IN ADDITION TO THE COMMUNITY BUILDING ACTIVITIES LISTED ON PART II, 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 NO COST TO THEM. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM ROLES: NORTH COUNTRY HEALTH SYSTEMS, INC. AND ITS SUBSIDIARIES COLLECTIVELY DO BUSINESS AS NORTH COUNTRY HEALTH SYSTEM (NCHS). NORTH COUNTRY HEALTH SYSTEMS, INC. (HEALTH SYSTEM) IS THE PARENT HOLDING COMPANY FOR ITS WHOLLY OWNED SUBSIDIARIES, WHICH INCLUDE NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. (HOSPITAL) AND NORTH COUNTRY HEALTH SERVICES, INC., D/B/A DERBY GREEN (DERBY GREEN). NORTH COUNTRY HOSPITAL AND HEALTH CENTER, INC. OPERATES A 25-BED ACUTE ARE 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. X true true X X X X false false false true false false false true false ANDRE BISSONNETTE CHIEF FINANCIAL OFFICER 183797 0 30529 0 4750 0 14387 0 29179 0 262642 0 0 0 THOMAS FRANK TRUSTEE/COO/INTERIM CEO 244168 0 51000 0 16500 0 14549 0 2149 0 328366 0 0 0 AVRIL COCHRAN VP PATIENT CARE SERVICES 155815 0 22443 0 0 0 6490 0 21074 0 205822 0 0 0 UMAIR MALIK MD MEDICAL STAFF PRESIDENT 276039 0 3584 0 14098 0 8829 0 29409 0 331959 0 0 0 CHARLES LAGOY MD MEDICAL STAFF VP 255303 0 12559 0 15320 0 8944 0 29376 0 321502 0 0 0 CHRISTOPHER RICKMAN MD TRUSTEE 290197 0 12500 0 27000 0 19166 0 21552 0 370415 0 0 0 STEPHANE MULLIGAN MD PHYSICIAN 573565 0 25000 0 10991 0 3909 0 31450 0 644915 0 0 0 LARRY SISSON MD PHYSICIAN 494361 0 38466 0 31462 0 20625 0 3562 0 588476 0 0 0 PETER STUART MD PHYSICIAN 344046 0 148881 0 33229 0 19250 0 3835 0 549241 0 0 0 GREG WALKER MD PHYSICIAN 425092 0 67929 0 30944 0 20625 0 37013 0 581603 0 0 0 VERONIKA JEDLOVSZKY MD PHYSICIAN 359510 0 64150 0 9187 0 19247 0 32152 0 484246 0 0 0 CLAUDIO FORT FORMER CEO 89916 0 13007 6315 13769 123007 0 SCHEDULE J, PART I, LINE 1A HEALTH CLUB BENEFITS: ALL EMPLOYEES OF THE ORGANIZATION RECEIVE THE BENEFIT OF A LOCAL HEALTH CLUB'S MEMBERSHIP. SCHEDULE J, PART I, LINE 5A COMPENSATION CONTINGENT ON THE REVENUES OF THE ORGANIZATION: PHYSICIANS EARN COMPENSATION BASED UPON THEIR PRODUCTIVITY AGAINST ESTABLISHED TARGETS. INCREASED PRODUCTIVITY IS DIRECTLY RELATED TO INCREASED REVENUES FOR THE ORGANIZATION. VP/DIRECTOR INCENTIVES ARE ALSO BASED ON REVENUES AND PERFORMANCE. SCHEDULE J, PART I, LINE 7 NON FIXED PAYMENTS: THE SENIOR TEAM AND CERTAIN DOCTORS ARE GIVEN BONUSES BASED ON SPECIFIC PROGRAM PERFORMANCE. A VERMONT EDUCATIONAL AND HLTH BLDGS FINANCING AGNCY 030292808 924166AR2 2007-06-01 23795000 REFUND 04 BONDS, CAP IMPROV false false false B VERMONT EDUCATIONAL AND HLTH BLDGS FINANCING AGNCY 237154467 2016-06-01 18743131 BOND REFUNDING- NORTH COUNTRY HOSP false false false A 0 0 24215685 0 0 16900515 171170 9000 0 7135000 0 0 2010 true false true true B 0 0 18743131 0 0 0 222402 0 0 0 0 0 true false true true A false false false 0 false false false true B false false false 0 false false false true A false false false true true false 0 false 0 false false B true true true PEOPLES false false false 0 false false A false B false SCHEDULE K, PART IV, LINE 2C A REBATE CALCULATION IS BEING PERFORMED FOR THE BONDS AS OF 6/1/12. NO REBATE IS EXPECTED. FORM 990, PART III, LINE 1 ORGANIZATION'S MISSION: OUR MISSION: OUR MISSION IS TO PROVIDE EXCEPTIONAL CARE THAT MAKES A DIFFERENCE IN THE LIVES OF OUR PATIENTS AND COMMUNITY. VISION: WE WILL BE REGARDED AS AN EXCEPTIONAL COMMUNITY RESOURCE THAT HAS SIGNIFICANTLY IMPROVED THE HEALTH OF THE COMMUNITY. OUR VALUES: - QUALITY PATIENT CARE IS OUR GREATEST COMMITMENT - EMPLOYEES ARE OUR GREATEST ASSETS - EXCELLENT PATIENT EXPERIENCE IS OUR GREATEST ACCOMPLISHMENT - THE HEALTH OF THE COMMUNITY IS OUR GREATEST RESPONSIBILITY FORM 990, PART VI, SECTION A, LINE 6, 7A, & 7B MEMBERS/STOCKHOLDERS/OTHER PERSONS: THE SOLE MEMBER OF THE HOSPITAL SHALL BE NORTH COUNTRY HEALTH SYSTEMS, INC., A VERMONT NOT-FOR-PROFIT CORPORATION, ACTING THROUGH ITS BOARD OF TRUSTEES AND HEREINAFTER REFERRED TO AS THE MEMBER WHEN ACTING IN ITS CAPACITY AS SUCH. THE MEMBER SHALL HAVE THE EXCLUSIVE RIGHT TO ENJOY AND EXERCISE ALL RIGHTS AND POWERS CONFERRED ON MEMBERS OF NON-PROFIT CORPORATIONS UNDER THE LAWS OF THE STATE OF VERMONT, SUBJECT TO THE TERMS AND CONDITIONS OF THE AFFILIATION. THE MEMBER SHALL HAVE SUCH OTHER POWERS AS ARE SPECIFIED IN THE ARTICLES OF ASSOCIATION AND IN THESE BYLAWS, INCLUDING, WITHOUT THE POWER TO ELECT AND REMOVE TRUSTEES AND TO AMEND AND RESTATE THE ARTICLES OF ASSOCIATION. TWELVE OF THE TRUSTEES SHALL BE ELECTED BY THE MEMBER. THE AUTHORITY OF THE BOARD OF TRUSTEES TO EXERCISE THE FOLLOWING POWERS IS CONDITIONED ON THE PRIOR APPROVAL OF THE MEMBER: (1) THE ADOPTION OF ANNUAL OPERATING BUDGETS; (2) THE ADOPTION OF CAPITAL BUDGETS; (3) ANY VOLUNTARY DISSOLUTION, MERGER, OR CONSOLIDATION OF THE HOSPITAL OR THE SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE HOSPITAL'S ASSETS, OR THE CREATION OR ACQUISITION OF ANY SUBSIDIARY OR AFFILIATE CORPORATION OF THE HOSPITAL; (4) ANY AGREEMENT OR TRANSACTION, EITHER OF WHICH IS OF A MATERIAL NATURE, WITH ANOTHER CORPORATION CONTROLLED DIRECTLY BY OR AFFILIATED WITH THE MEMBER; AND (5) THE BORROWING OF ANY SUM IN EXCESS OF $100,000 WHICH HAS A STATED TERM GREATER THAN ONE YEAR OR WHICH IS SECURED BY A MORTGAGE OF ALL OR ANY PORTION OF THE HOSPITAL'S REAL PROPERTY OR BY A SECURITY INTEREST IN THE HOSPITAL'S ASSETS OR REVENUES, BUT NOT INCLUDING ANY BORROWING OF LESS THAN $ 100,000 TO PURCHASE OR LEASE EQUIPMENT OR OTHER PERSONAL PROPERTY THAT IS SECURED SOLELY BY A PURCHASE MONEY TITLE RETENTION OR OTHER FORM OF SECURITY INSTRUMENT OR AGREEMENT IN THE EQUIPMENT OR PERSONAL PROPERTY BEING ACQUIRED. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S MANAGEMENT AND FINANCE TEAM IN DETAIL. AFTER IT HAS BEEN REVIEWED, IT IS THEN PROVIDED TO THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD, COMMITTEE, OR OTHER INDIVIDUALS WHO, ON BEHALF OF THE CORPORATION, ARE CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. IN THE EVENT THAT A TRUSTEE, OFFICER, COMMITTEE MEMBER OR MEMBER OF THE CORPORATION'S LEADERSHIP GROUP BECOMES CONCERNED THAT ANOTHER INTERESTED PERSON HAS AN UNDISCLOSED FINANCIAL INTEREST OR IS EXERTING INAPPROPRIATE INFLUENCE RELATED TO A FINANCIAL INTEREST, THIS CONCERN SHOULD BE RAISED WITH THE CHAIR OF THE APPROPRIATE BOARD OR COMMITTEE OR, IF INVOLVING THE LEADERSHIP GROUP, AN APPROPRIATE CORPORATE OFFICER. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON BY THE REMAINING BOARD OR COMMITTEE MEMBERS. IT SHALL BE THE RESPONSIBILITY OF THE CHAIR OF THE BOARD OR COMMITTEE TO INSTRUCT AN INTERESTED PERSON ON THE RESTRICTIONS ON HIS OR HER PARTICIPATION PURSUANT TO THIS POLICY IN ANY FURTHER CONSIDERATION OF THE SUBJECT MATTER OF THE CONFLICT OF INTEREST AND TO ENFORCE THESE RESTRICTIONS. AWARENESS/COMPLIANCE WITH POLICY EACH INTERESTED PERSON SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. EACH INTERESTED PERSON SHALL DISCLOSE ON AN ANNUAL SURVEY FORM POTENTIAL CONFLICTS OF INTEREST AND FINANCIAL INTERESTS RELEVANT TO THIS POLICY. EACH INTERESTED PERSON SHALL ALSO PROVIDE ON AN ANNUAL SURVEY FORM A LIST OF IMMEDIATE FAMILY MEMBERS, INCLUDING SPOUSE, CHILDREN, GRANDCHILDREN, PARENTS, SIBLINGS AND ANY OTHER PERSON WHO LIVES IN HIS/HER HOUSEHOLD, IN ORDER THAT THE CORPORATION MAY HAVE A RECORD OF ALL INDIVIDUALS WHO MAY BE CONSIDERED DISQUALIFIED PERSONS UNDER INTERNAL REVENUE SERVICE REGULATIONS FOR THE PURPOSE OF ENSURING COMPLIANCE WITH TAX EXEMPT STATUS REQUIREMENTS FOR CHARITABLE ORGANIZATIONS. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT INVOLVES THE CONFLICT OF INTEREST. THE CHAIR OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, INCLUDING A CONSIDERATION OF INDEPENDENT COMPARABILITY DATA, VALUATIONS OR APPRAISALS, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE (OR QUORUM) OF ALL OF THE DISINTERESTED TRUSTEES OR COMMITTEE MEMBERS (REGARDLESS OF THE NUMBER PRESENT AT A MEETING): (I) WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTEREST AND FOR ITS OWN BENEFIT, (II) WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, AND (III) WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATIONS. FORM 990, PART VI, SECTION B, LINE 15A & 15B COMPENSATION REVIEW: THE BOARD ANNUALLY REVIEWS THE CEO AND SENIOR TEAM SALARIES USING COMPARABILITY DATA. THE REVIEW PROCESS IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO BE VIEWED BY THE PUBLIC UPON AN APPOINTMENT WITH THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER OR ASSISTANT. FORM 990, PART VII, SECTION A BOARD OF DIRECTORS: NORTH COUNTRY HOSPITAL AND HEALTH CENTER, NORTH COUNTRY HEALTH SERVICES, AND NORTH COUNTRY HEALTH SYSTEMS SHARE A BOARD OF DIRECTORS. NO BOARD MEMBERS RECEIVE COMPENSATION FOR THEIR DUTIES AS DIRECTORS. DWIGHT NALL, CEO, AND ANDRE BISSONNETTE, CHIEF FINANCIAL OFFICER, 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, CHARLES LAGOY, THOMAS FRANK AND UMAIR MALIK ARE COMPENSATED AS EMPLOYEES OF NORTH COUNTRY HOSPITAL. THEY DO NOT RECEIVE ANY COMPENSATION FOR THEIR DUTIES AS BOARD OF DIRECTORS MEMBERS. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS: $ 929,378 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 186,913 CHANGE IN INTEREST IN NET ASSETS OF NCHS ---------- $1,116,291 NORTH COUNTRY HEALTH SYSTEMS 189 PROUTY DRIVE NEWPORT VT 05829 222566964 PARENT/FUNDRS VT 501(C)(3) 12B II NA false NORTH COUNTRY HLTH SRVCS DBA DERBY GREEN 2853 US-5 DERBY VT 05829 222570334 SKILLED NURSG VT 501(C)(3) 10 NCHS false NORTHEAST KINGDOM HLTHCARE COL 55 SHERMAN DRIVE ST JOHNSBURY VT 05819 452787538 SLEEP LAB SVC VT NA RELATED 10310 663893 false 0 true 0.60000 false false false false false false false false false false false false true true true false true false false