SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
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OMB No. 1545-0047
2020
Open to Public
Inspection
Name of the organization
North Country Health Consortium Inc
 
Employer identification number

02-0503184
Return Reference Explanation
Form 990, Part III, line 2 The North Country Public Health Network (NC PHN) began the process of acquiring and delivering vaccines to populations as they became eligible in December 2020. In the spirit of "the North Country takes care of each other," the NC PHN addressed the equity issues of rurality and poverty to deliver vaccines early to homebound individuals, low-income and age-restricted properties, and frontline workers. The NC PHN team administered approximately 4,755 doses of the COVID-19 Vaccine primary and booster series in Coos and Northern Grafton Counties.
Form 990, Part III, line 3 In December 2020, NCHC ceased clinical substance use disorder (SUD) services, including Friendship House.
Form 990, Part VI, Section A, line 6 The Organization has a class of members. Please refer to the Form 990, Part VI, line 7a narrative response on Schedule O for further details.
Form 990, Part VI, Section A, line 7a Membership in the corporation is open to any individual, organization, professional association, government body, business, or foundation demonstrating support for the corporation and its purposes and upon paying the annual membership fee. Membership will continue so long as payment of the annual membership fee is current. Each member has one vote in corporate matters and one vote on all matters to be considered by the members, and the vote of a majority of the members present at any properly constituted meeting shall be necessary to adopt proposals. An annual meeting of the members is held on a date during November as designated by the Board of Directors, at which members shall elect the Board of Directors.
Form 990, Part VI, Section A, line 8b No committees may act on behalf of the governing body. The Organization does maintain committees that report to the Board, including the Nominating Committee, Ad Hoc Membership Committee, Finance Committee, and Strategic Planning Committee.
Form 990, Part VI, Section B, line 11b Executive management engages a public accounting firm to prepare the annual 990. Once the 990 is completed, it is reviewed by management and provided to the Board of Directors for approval prior to filing with the IRS.
Form 990, Part VI, Section B, line 12c All Board members and key employees are required to complete a conflict of interest statement at time of appointment/hire. The statement is then re-signed annually, for review by the Board Chair and Executive Director for any potential conflicts. The completed forms are held in the Human Resources/Administrative Assistant's offfice (and in Board e-files). If the perception of a conflict of interest arises with a member of the Board during any meeting, that member recuses him/herself from all discussion and voting by leaving the room/zoom meeting.
Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available upon request.
Form 990, Part X, Line 10: Land, Buildings, and Equipment Section 1.263(a)-3(n) Election: North Country Health Consortium, Inc. 262 Cottage St., Suite 230 Littleton, NH 03561 EIN: 02-0503184 North Country Health Consortium, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).
Form 990, Part XI, Line 8: Prior Period Adjustment During 2021, the Organization identified a misstatement in previously reported September 30, 2020 consolidated financial statements related to the amounts included in total assets - discontinued operations and loss from discontinued operations. The September 30, 2020 consolidated financial statements have been restated to correct an error related to the timing of revenue recognition. Accordingly, these amounts have been restated in the September 30, 2020 consolidated financial statements.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2020


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