Civic Intelligence

Lake Champlain Physician Services PC

990 • Fiscal year 2011 • EIN 27-3785445

Jan 01, 2011 to Dec 31, 2011 • Filed on Oct 28, 2014

75 Beekman Street12901
Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

97th percentile

2.01x

Higher debt load relative to assets than 97% of similar nonprofits.

2011 filings • NTEE E • $500k-$1M nonprofits • Source year 2011

Liabilities / Revenue

Score unavailable

No value available

Liabilities-to-revenue requires both liabilities and revenue on this filing.

Source year 2011

Net Margin

Score unavailable

No value available

Net margin requires both revenue and expenses on this filing.

Source year 2011

Top Officer Pay

Score unavailable

No value available

This filing does not contain officer compensation rows.

Source year 2011

Asset Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2011

Revenue Growth

Score unavailable

No value available

No valid filing value is available for this score.

Assets

$160,404

No earlier filing loaded for comparison.

Net Assets

-$162,712

No earlier filing loaded for comparison.

Liabilities

$323,116

No earlier filing loaded for comparison.

Revenue

-

No earlier filing loaded for comparison.

Expenses

$570,776

No earlier filing loaded for comparison.

Net Income

-

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$2.0M$1.0M$0-$1.0M-$2.0MAssets 2011: $160,404Liabilities 2011: $323,116Net Assets 2011: -$162,7122011Assets 2012: $473,365Liabilities 2012: $748,478Net Assets 2012: -$275,1132012Assets 2013: $168,639Liabilities 2013: $1,266,224Net Assets 2013: -$1,097,5852013Assets 2014: $343,880Liabilities 2014: $648,164Net Assets 2014: -$304,2842014Assets 2017: $121,226Liabilities 2017: $0Net Assets 2017: $121,2262017Assets 2018: $310,445Liabilities 2018: $263,935Net Assets 2018: $46,5102018Assets 2019: $240,082Liabilities 2019: $186,750Net Assets 2019: $53,3322019Assets 2020: $28,921Liabilities 2020: $86,429Net Assets 2020: -$57,5082020Assets 2021: $248,126Liabilities 2021: $358,516Net Assets 2021: -$110,3902021Assets 2022: $90,276Liabilities 2022: $264,699Net Assets 2022: -$174,4232022Assets 2023: $90,284Liabilities 2023: $263,415Net Assets 2023: -$173,1312023Assets 2024: $20,000Liabilities 2024: $229,898Net Assets 2024: -$209,8982024

Highlighted filing

2011

Assets$160,404
Liabilities$323,116
Net Assets-$162,712

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$1.5M$1.0M$500K$0-$500K-$1.0MExpenses 2011: $570,7762011Expenses 2012: $685,3462012Revenue 2013: $330,255Expenses 2013: $861,473Net Income 2013: -$531,2182013Revenue 2014: $689,498Expenses 2014: $633,103Net Income 2014: $56,3952014Revenue 2017: $682,458Expenses 2017: $777,010Net Income 2017: -$94,5522017Revenue 2018: $861,953Expenses 2018: $936,669Net Income 2018: -$74,7162018Revenue 2019: $1,264,413Expenses 2019: $1,257,591Net Income 2019: $6,8222019Revenue 2020: $24,555Expenses 2020: $135,395Net Income 2020: -$110,8402020Revenue 2021: $235,741Expenses 2021: $288,623Net Income 2021: -$52,8822021Revenue 2022: $22,264Expenses 2022: $86,297Net Income 2022: -$64,0332022Revenue 2023: $2,550Expenses 2023: $1,258Net Income 2023: $1,2922023Revenue 2024: $444Expenses 2024: $37,211Net Income 2024: -$36,7672024

Highlighted filing

2011

Revenue-
Expenses$570,776
Net Income-
Jump To
Filing Snapshot
Filing Period
Jan 1, 2011 to Dec 31, 2011
Signed
Oct 28, 2014
Return Version
2011v1.5
Gross Receipts
$524,350
Mission and Program Overview

Mission

Lake champlain physician services, p.c. Is a professional services company formed to further the charitable purposes of champlain valley physicians' hospital medical center through providing medical services to the community.

Filing and Contact Details

Filer

EIN
27-3785445
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IRS990/ActivityOrMissionDescription0LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. IS A PROFESSIONAL SERVICES COMPANY FORMED TO FURTHER THE CHARITABLE PURPOSES OF CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER THROUGH PROVIDING MEDICAL SERVICES TO THE COMMUNITY.
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IRS990ScheduleJ/Form990ScheduleJPartIII/Explanation0TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF STEPHENS MUNDY, CEO, OF LESS THAN $1,000 WERE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLYEE RECEIVED THIS BENEFIT.
IRS990ScheduleJ/Form990ScheduleJPartIII/Explanation1TOTAL TRAVEL COSTS FOR COMPANION OF STEPHENS MUNDY, CEO, OF LESS THAN $1,000 WERE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTIOR, OR KEY EMPLOYEE RECEIVED THIS BENEFIT.
IRS990ScheduleJ/Form990ScheduleJPartIII/Explanation2A DISTRIBUTION TO STEPHENS MUNDY, CEO, IN THE AMOUNT OF $145,772 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. MUNDY'S TAXABLE COMPENSATION. MR. MUNDY'S DISTRIBUTION OCCURRED AS A RESULT OF MEETING PRIOR YEAR VESTING AND FULL VESTING IN THE 2011 CONTRIBUTION OF $130,762. EACH OF THE FOLLOWING EMPLOYEES ALSO FULLY VESTED IN SERP CONTRIBUTIONS MADE BY THE ORGANIZATION DURING 2011 AND IN PROPR YEARS. FULLY VESTED AMOUNTS WERE INCLUDED IN EACH EMPLOYEE'S TAXABLE WAGES, AND ARE REPORTED ON SCH. J, PART II, COLUMN B (III). SERP CONTRIBUTIONS DURING 2011 WERE: WOUTER RIETSEMA $14,741, JOYCE RAFFERTY $13,744.
IRS990ScheduleJ/Form990ScheduleJPartIII/Explanation3DURING 2011, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER CONTINUED A COMPENSATION INCENTIVE PLAN FOR MANAGEMENT OF THE ORGANIZATION. THE PLAN SETS FORTH NUMEROUS OBJECTIVES AND GOALS TO BE MET IN ORDER TO EARN AN INCENTIVE AWARD. EACH OF THE GOALS ARE AIMED AT IMPROVING THE EXPANSE OF CVPH'S SERVICE OFFERINGS, QUALITY OF SERVICE AND OPERATION, AND MEETING COMMUNITY NEEDS. UNDER THE PLAN, THESE GOALS AND OBJECTIVES ARE ASSIGNED POINT VALUES, TOWARD A TOTAL 100 POSSIBLE POINTS. SPECIFIC MEASURES ARE SET TO DETERMINE WHETHER THE STATED OBJECTIVE HAS BEEN MET. ONE OF THE OBJECTIVES INCLUDED IN THE 2011 PLAN IS KEYED TO NET MARGIN OF THE ORGANIZATION. THIS OBJECTIVE MEASURE, HOWEVER, HAS NO MORE THAN 10 POTENTIAL POINTS THAT MAY BE ACHIEVED IF THE ORGANIZATION MAINTAINS THE STATED BUDGETED MARGIN, AND IS INTENDED TO MEET THE OVERALL GOAL OF MAINTAINING THE FINANCIAL HEALTH OF THE ORGANIZATION. OTHER GOALS IN THE PLAN ARE TO IMPROVE QUALITY OF SERVICES, EXPANSE OF SERVICE OFFERINGS, ORGANIZATIONAL DEVELOPMENT, AND REACH COMMUNITY NEEDS.
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IRS990ScheduleO/GeneralExplanation/Explanation0WOUTER JAN RIETSEMA, MD IS THE SOLE VOTING MEMBER OF THE ORGANIZATION.
IRS990ScheduleO/GeneralExplanation/Explanation1ACCORDING TO THE SHAREHOLDERS AGREEMENT DR. RIETSEMA, THE SOLE SHAREHOLDER AND DIRECTOR OF LAKE CHAMPLAIN P.C., IS REQUIRED TO VOTE ALL OF HIS SHARES TO ELECT, OR REMOVE, AS DIRECTORS THOSE INDIVIDUALS DESIGNATED BY THE BOARD OF DIRECTORS OF THE CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER.
IRS990ScheduleO/GeneralExplanation/Explanation2LAKE CHAMPLAIN PHYSICIAN SERVICES PROVIDES AN ELECTRONIC COPY OF FORM 990 TO EACH BOARD MEMBER PRIOR TO THE FORM BEING FILED.
IRS990ScheduleO/GeneralExplanation/Explanation3CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER HAS A WRITTEN CONFLICT OF INTEREST POLICY AS A PART OF ITS GOVERNING DOCUMENTS. THE POLICY IS APPLICABLE TO MEMBERS OF THE GOVERNING BODY, OFFICERS AND KEY EMPLOYEES. THE ORGANIZATION REQUIRES THAT MEMBERS HAVING A CONFLICT OF INTEREST IN A TRANSACTION RECUSE THEMSELVES OF VOTING ON THE MATTER. PROPOSED AND ONGOING TRANSACTIONS ARE REVIEWED BY APPROPRIATE GROUPS OF INDIVIUALS (COMMITTEES AND/OR LEVELS OF REVIEW) TO ENSURE THE BEST INTEREST OF THE ORGANIZATION. THE ORGANIZATION SOLICITS FROM EACH MEMBER OF THE GOVERNING BODY, OFFICERS, AND KEY EMPLOYEES AN ANNUAL SIGNED STATEMENT CERTIFYING COMPLIANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND SELF-DISCLOSURE OF CERTAIN INTEREST FOR EACH ANNUAL PERIOD.
IRS990ScheduleO/GeneralExplanation/Explanation4CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER HAS A FORMAL PROCESS THAT IS USED TO DETERMINE THE COMPENSATION OF THE CEO ON AN ANNUAL BASIS. THIS PROCESS INCLUDES A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES, ENGAGING AN INDEPENDENT CONSULTANT, PERFORMANCE OF A COMPENSATION SURVEY OR STUDY, REVIEW OF OTHER ORGANIZATION'S 990 FORMS, AND APPROVAL BY THE BOARD OF COMPENSATION COMMITTEE. A WRITTEN EMPLOYMENT AGREEMENT IS ESTABLISHED SETTING FORTH THE COMPENSATION AND BENEFITS OF THE SHAREHOLDERS. CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER PAYS NON-FIXED EARNINGS BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE CEO. PART B: THE SAME FORMAL PROCESS NOTED IN 15(A) ABOVE IS USED TO DETERMINE THE BASE COMPENSATION OF OTHER OFFICERS. NON-FIXED EARNINGS OF OTHER OFFICERS ARE BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA AND COMPARATIVE MARKET DATA.
IRS990ScheduleO/GeneralExplanation/Explanation5CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PARTIES DESIRING COPIES OF SUCH DOCUMENTS MUST PRESENT THEMSELVES AT THE ADMINISTRATIVE OFFICES OF LAKE CHAMPLAIN PHYSICIAN SERVICES OR BY SENDING A REQUEST IN WRITING TO THE ADMINISTRATIVE OFFICES. THE ORGANIZATION HAS INSTRUCTIONS POSTED ON ITS WEBSITE FOR THOSE SEEKING COPIES OF DOCUMENTS.
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IRS990ScheduleO/GeneralExplanation/ReturnReference1FORM 990, PART VI, SECTION A, LINE 7A
IRS990ScheduleO/GeneralExplanation/ReturnReference2FORM 990, PART VI, SECTION B, LINE 11
IRS990ScheduleO/GeneralExplanation/ReturnReference3FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/GeneralExplanation/ReturnReference4FORM 990, PART VI, SECTION B, LINE 15
IRS990ScheduleO/GeneralExplanation/ReturnReference5FORM 990, PART VI, SECTION C, LINE 19
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IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine10COMMUNITY PROVIDERS INC
IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine11COMMUNITY PROVIDERS INC
IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine12PARENT
IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine13COMMUNITY PROVIDERS INC
IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine14COMMUNITY PROVIDERS INC
IRS990ScheduleR/Form990ScheduleRPartII/EIN0141338471
IRS990ScheduleR/Form990ScheduleRPartII/EIN1141727048
IRS990ScheduleR/Form990ScheduleRPartII/EIN2222544844
IRS990ScheduleR/Form990ScheduleRPartII/EIN3141364513
IRS990ScheduleR/Form990ScheduleRPartII/EIN4061718419
IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection0501(C)(3)
IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection1501(C)(3)
IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection2501(C)(3)
IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection3501(C)(3)
IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection4501(C)(3)
IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/AddressLine1016 DEGRANDPRE WAY
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IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/State0NY
IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/ZIPCode012901
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IRS990ScheduleR/Form990ScheduleRPartIII/NameOfRelatedOrg/BusinessNameLine10VALCOUR IMAGING
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IRS990ScheduleR/Form990ScheduleRPartIII/PredominantIncomeType0RELATED
IRS990ScheduleR/Form990ScheduleRPartIII/PrimaryActivity0DIAGNOSTIC IMAGING
IRS990ScheduleR/Form990ScheduleRPartIII/ShareOfEOYAssets0477239
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IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState0NY
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IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState4NY
IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine10CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER
IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine11CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER FOUNDATION
IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine12COMMUNITY PROVIDERS INC (CPI)
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IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities2HLTH SVC COOR
IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities3HOSPITAL
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IRS990ScheduleR/Form990ScheduleRPartII/PublicCharityStatus0LINE 3
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IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/ZIPCode012901
IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/ZIPCode112901
IRS990ScheduleR/Form990ScheduleRPartIV/DirectControllingEntityName/BusinessNameLine10CPI
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IRS990ScheduleR/Form990ScheduleRPartIV/NameOfRelatedOrg/BusinessNameLine10CHAMPLAIN VALLEY HEALTH NETWORK
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IRS990ScheduleR/Form990ScheduleRPartIV/PrimaryActivity0ADMINISTRATIVE SERVICES
IRS990ScheduleR/Form990ScheduleRPartIV/PrimaryActivity1MED OFFICE LEASE
IRS990ScheduleR/Form990ScheduleRPartIV/ShareOfEOYAssets01776269
IRS990ScheduleR/Form990ScheduleRPartIV/ShareOfTotalIncome060657
IRS990ScheduleR/Form990ScheduleRPartIV/TypeOfEntity0C
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IRS990ScheduleR/GiftGrantOrCapContrFrOtherOrg00
IRS990ScheduleR/GiftGrantOrCapContrToOtherOrg00
IRS990ScheduleR/LoansOrGuaranteesFromOtherOrg01
IRS990ScheduleR/LoansOrGuaranteesToOtherOrg00
IRS990ScheduleR/OtherTransferFromOtherOrg00
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IRS990ScheduleR/PerformOfServicesByOtherOrgs00
IRS990ScheduleR/PerformOfServicesForOtherOrgs00
IRS990ScheduleR/PurchaseOfAssetsFromOtherOrg00
IRS990ScheduleR/ReceiptOfIntAnnRentsRoyalties00
IRS990ScheduleR/ReimbursementPaidByOtherOrg00
IRS990ScheduleR/ReimbursementPaidToOtherOrg01
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IRS990ScheduleR/RentalOfFacilitiesToOtherOrgs00
IRS990ScheduleR/SaleOfAssetsToOtherOrg00
IRS990ScheduleR/SharingOfFacilities00
IRS990ScheduleR/SharingOfPaidEmployees01
IRS990/School00
IRS990/SignificantChange00

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