Liabilities / Assets
97th percentile
Higher debt load relative to assets than 97% of similar nonprofits.
990 • Fiscal year 2011 • EIN 27-3785445
Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.
Liabilities / Assets
97th percentile
Higher debt load relative to assets than 97% of similar nonprofits.
Liabilities / Revenue
Score unavailable
Liabilities-to-revenue requires both liabilities and revenue on this filing.
Net Margin
Score unavailable
Net margin requires both revenue and expenses on this filing.
Top Officer Pay
Score unavailable
This filing does not contain officer compensation rows.
Asset Growth
Score unavailable
No earlier valid filing was available within the previous three public years.
Revenue Growth
Score unavailable
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.
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.
This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.
| Path | # | Value |
|---|---|---|
| IRS990/AccountantCompileOrReview | 0 | 0 |
| IRS990/ActivitiesConductedPartnership | 0 | 0 |
| IRS990/ActivityOrMissionDescription | 0 | 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. |
| IRS990/AddressPrincipalOfficerUS/AddressLine1 | 0 | 75 BEEKMAN ST |
| IRS990/AddressPrincipalOfficerUS/City | 0 | PLATTSBURGH |
| IRS990/AddressPrincipalOfficerUS/State | 0 | NY |
| IRS990/AddressPrincipalOfficerUS/ZIPCode | 0 | 12901 |
| IRS990/AnnualDisclosureCoveredPersons | 0 | 1 |
| IRS990/BenefitsPaidToMembersCY | 0 | 0 |
| IRS990/BenefitsPaidToMembersPriorYear | 0 | 0 |
| IRS990/BsnssRltnshpThruFamilyMember | 0 | 0 |
| IRS990/BsnssRltnshpWithOrganization | 0 | 0 |
| IRS990/CapStckTrstPrinCurrentFunds/BOY | 0 | 0 |
| IRS990/CapStckTrstPrinCurrentFunds/EOY | 0 | 0 |
| IRS990/CashNonInterestBearing/BOY | 0 | 250 |
| IRS990/CashNonInterestBearing/EOY | 0 | 160404 |
| IRS990/ChangesToOrganizingDocs | 0 | 0 |
| IRS990/CollectionsOfArt | 0 | 0 |
| IRS990/CompensationFromOtherSources | 0 | 0 |
| IRS990/CompensationProcessCEO | 0 | 1 |
| IRS990/CompensationProcessOther | 0 | 1 |
| IRS990/ConflictOfInterestPolicy | 0 | 1 |
| IRS990/ConservationEasements | 0 | 0 |
| IRS990/ConsolidatedAuditFinancialStmt | 0 | 1 |
| IRS990/ContributionsGrantsCurrentYear | 0 | 0 |
| IRS990/ContributionsGrantsPriorYear | 0 | 0 |
| IRS990/CreditCounseling | 0 | 0 |
| IRS990/DecisionsSubjectToApproval | 0 | 0 |
| IRS990/DeductibleContributionsOfArt | 0 | 0 |
| IRS990/DeductibleNonCashContributions | 0 | 0 |
| IRS990/DelegationOfManagementDuties | 0 | 0 |
| IRS990/DescribedIn501C3 | 0 | 1 |
| IRS990/Description | 0 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PROVIDES GENERAL MEDICAL SERVICES TO PATIENTS. |
| IRS990/DisregardedEntity | 0 | 0 |
| IRS990/DocumentRetentionPolicy | 0 | 1 |
| IRS990/DonorAdvisedFunds | 0 | 0 |
| IRS990/DoNotFollowSFAS117 | 0 | X |
| IRS990/ElectionOfBoardMembers | 0 | 1 |
| IRS990/ExcessBenefitTransaction | 0 | 0 |
| IRS990/Expense | 0 | 570776 |
| IRS990/FamilyOrBusinessRelationship | 0 | 0 |
| IRS990/FederalGrantAuditRequired | 0 | 0 |
| IRS990/ForeignActivities | 0 | 0 |
| IRS990/ForeignFinancialAccount | 0 | 0 |
| IRS990/ForeignOffice | 0 | 0 |
| IRS990/Form8282PropertyDisposedOf | 0 | 0 |
| IRS990/Form990PartVIISectionA/AverageHoursPerWeek | 0 | 5.00 |
| IRS990/Form990PartVIISectionA/AverageHoursPerWeek | 1 | 2.00 |
| IRS990/Form990PartVIISectionA/AverageHoursPerWeek | 2 | 2.00 |
| IRS990/Form990PartVIISectionA/IndividualTrusteeOrDirector | 0 | X |
| IRS990/Form990PartVIISectionA/NamePerson | 0 | WOUTER JAN RIETSEMA MD |
| IRS990/Form990PartVIISectionA/NamePerson | 1 | STEPHENS MUNDY |
| IRS990/Form990PartVIISectionA/NamePerson | 2 | JOYCE RAFFERTY |
| IRS990/Form990PartVIISectionA/Officer | 0 | X |
| IRS990/Form990PartVIISectionA/Officer | 1 | X |
| IRS990/Form990PartVIISectionA/Officer | 2 | X |
| IRS990/Form990PartVIISectionA/OtherCompensation | 0 | 49456 |
| IRS990/Form990PartVIISectionA/OtherCompensation | 1 | 52373 |
| IRS990/Form990PartVIISectionA/OtherCompensation | 2 | 51651 |
| IRS990/Form990PartVIISectionA/ReportableCompFromOrganization | 0 | 0 |
| IRS990/Form990PartVIISectionA/ReportableCompFromOrganization | 1 | 0 |
| IRS990/Form990PartVIISectionA/ReportableCompFromOrganization | 2 | 0 |
| IRS990/Form990PartVIISectionA/ReportableCompFromRelatedOrgs | 0 | 373256 |
| IRS990/Form990PartVIISectionA/ReportableCompFromRelatedOrgs | 1 | 791535 |
| IRS990/Form990PartVIISectionA/ReportableCompFromRelatedOrgs | 2 | 353279 |
| IRS990/Form990PartVIISectionA/Title | 0 | SHAREHOLDER/MEMBER |
| IRS990/Form990PartVIISectionA/Title | 1 | OFFICER |
| IRS990/Form990PartVIISectionA/Title | 2 | OFFICER |
| IRS990/Form990ProvidedToGoverningBody | 0 | 1 |
| IRS990/FormersListed | 0 | 0 |
| IRS990/FSAudited | 0 | 0 |
| IRS990/FundraisingActivities | 0 | 0 |
| IRS990/FundsToPayPremiums | 0 | 0 |
| IRS990/Gaming | 0 | 0 |
| IRS990/GrantsAndSimilarAmntsCY | 0 | 0 |
| IRS990/GrantsAndSimilarAmntsPriorYear | 0 | 0 |
| IRS990/GrantsToIndividuals | 0 | 0 |
| IRS990/GrantsToOrganizations | 0 | 0 |
| IRS990/GrantToRelatedPerson | 0 | 0 |
| IRS990/GrossReceipts | 0 | 524350 |
| IRS990/GroupReturnForAffiliates | 0 | 0 |
| IRS990/Hospital | 0 | 0 |
| IRS990/IndependentAuditFinancialStmt | 0 | 0 |
| IRS990/IndoorTanningServices | 0 | 0 |
| IRS990/InfoInScheduleOPartVI | 0 | X |
| IRS990/Insurance/ProgramServices | 0 | 13507 |
| IRS990/Insurance/Total | 0 | 13507 |
| IRS990/InvestmentIncomeCurrentYear | 0 | 0 |
| IRS990/InvestmentIncomePriorYear | 0 | 0 |
| IRS990/InvestmentInJointVenture | 0 | 0 |
| IRS990/LoanToOfficerOrDQP | 0 | 0 |
| IRS990/LobbyingActivities | 0 | 0 |
| IRS990/LocalChapters | 0 | 0 |
| IRS990/MaterialDiversionOrMisuse | 0 | 0 |
| IRS990/MembersOrStockholders | 0 | 1 |
| IRS990/MethodOfAccountingAccrual | 0 | X |
| IRS990/MinutesOfCommittees | 0 | 1 |
| IRS990/MinutesOfGoverningBody | 0 | 1 |
| IRS990/MissionDescription | 0 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. IS A PROFESSIONAL SERVICES COMPANY FORMED TO FURTHER THE CHARITABLE PURPOSES OF THE CHAMPLAIN VALLEY PHYSICIANS' HOSPITAL MEDICAL CENTER THROUGH PROVIDING MEDICAL SERVICES TO THE COMMUNITY. |
| IRS990/MoreThan5000KToIndividuals | 0 | 0 |
| IRS990/MoreThan5000KToOrganizations | 0 | 0 |
| IRS990/NameOfPrincipalOfficerPerson | 0 | JOYCE RAFFERTY |
| IRS990/NbrIndependentVotingMembers | 0 | 1 |
| IRS990/NbrVotingGoverningBodyMembers | 0 | 1 |
| IRS990/NbrVotingMembersGoverningBody | 0 | 1 |
| IRS990/NetAssetsOrFundBalancesBOY | 0 | -116286 |
| IRS990/NetAssetsOrFundBalancesEOY | 0 | -162712 |
| IRS990/NetUnrelatedBusinessTxblIncome | 0 | 0 |
| IRS990/NonDeductibleContributions | 0 | 0 |
| IRS990/NumberFormsTransmittedWith1096 | 0 | 0 |
| IRS990/NumberIndependentVotingMembers | 0 | 1 |
| IRS990/NumberIndividualsGT100K | 0 | 0 |
| IRS990/NumberOfContractorsGT100K | 0 | 0 |
| IRS990/NumberOfEmployees | 0 | 0 |
| IRS990/NumberW2GIncluded | 0 | 0 |
| IRS990/Occupancy/ProgramServices | 0 | 49810 |
| IRS990/Occupancy/Total | 0 | 49810 |
| IRS990/OfficeExpenses/ProgramServices | 0 | 5910 |
| IRS990/OfficeExpenses/Total | 0 | 5910 |
| IRS990/OfficerEntityWithBsnssRltnshp | 0 | 0 |
| IRS990/OfficerMailingAddress | 0 | 0 |
| IRS990/Organization501c3 | 0 | X |
| IRS990/OtherExpensePriorYear | 0 | 32624 |
| IRS990/OtherExpensesCurrentYear | 0 | 128391 |
| IRS990/OtherExpenses/Description | 0 | TAXES AND LICENSES |
| IRS990/OtherExpenses/Description | 1 | OTHER PURCHASED SERVICE |
| IRS990/OtherExpenses/Description | 2 | MISCELLANEOUS |
| IRS990/OtherExpenses/Description | 3 | TRANSCRIPTION |
| IRS990/OtherExpenses/ProgramServices | 0 | 17619 |
| IRS990/OtherExpenses/ProgramServices | 1 | 16229 |
| IRS990/OtherExpenses/ProgramServices | 2 | 11836 |
| IRS990/OtherExpenses/ProgramServices | 3 | 11108 |
| IRS990/OtherExpenses/Total | 0 | 17619 |
| IRS990/OtherExpenses/Total | 1 | 16229 |
| IRS990/OtherExpenses/Total | 2 | 11836 |
| IRS990/OtherExpenses/Total | 3 | 11108 |
| IRS990/OtherLiabilities/BOY | 0 | 116536 |
| IRS990/OtherLiabilities/EOY | 0 | 323116 |
| IRS990/OtherRevenueCurrentYear | 0 | 0 |
| IRS990/OtherRevenuePriorYear | 0 | 0 |
| IRS990/OtherSalariesAndWages/ProgramServices | 0 | 442385 |
| IRS990/OtherSalariesAndWages/Total | 0 | 442385 |
| IRS990/PaidInCapSrplsLandBldgEqpFund/BOY | 0 | 0 |
| IRS990/PaidInCapSrplsLandBldgEqpFund/EOY | 0 | 0 |
| IRS990/PartialLiquidation | 0 | 0 |
| IRS990/PoliticalActivities | 0 | 0 |
| IRS990/PremiumsPaid | 0 | 0 |
| IRS990/PriorExcessBenefitTransaction | 0 | 0 |
| IRS990/ProfessionalFundraising | 0 | 0 |
| IRS990/ProgramServiceRevenue/BusinessCode | 0 | 621110 |
| IRS990/ProgramServiceRevenueCY | 0 | 524350 |
| IRS990/ProgramServiceRevenue/Description | 0 | MEDICAL SERVICES |
| IRS990/ProgramServiceRevenuePriorYear | 0 | 0 |
| IRS990/ProgramServiceRevenue/RelatedOrExemptFunctionIncome | 0 | 524350 |
| IRS990/ProgramServiceRevenue/TotalRevenueColumn | 0 | 524350 |
| IRS990/ProhibitedTaxShelterTrans | 0 | 0 |
| IRS990/QuidProQuoContributions | 0 | 0 |
| IRS990/ReconcilationOtherChanges | 0 | 0 |
| IRS990/ReconcilationRevenueExpenses | 0 | -46426 |
| IRS990/RegularMonitoringEnforcement | 0 | 1 |
| IRS990/RelatedEntity | 0 | 1 |
| IRS990/RelatedOrgControlledEntity | 0 | 0 |
| IRS990/ReportFin48Footnote | 0 | 0 |
| IRS990/ReportInvestOthSecurities | 0 | 0 |
| IRS990/ReportLandBldgEquip | 0 | 0 |
| IRS990/ReportOtherAssets | 0 | 0 |
| IRS990/ReportOtherLiabilities | 0 | 1 |
| IRS990/ReportProgRelInvest | 0 | 0 |
| IRS990/RetainedEarningsEndowmentEtc/BOY | 0 | -116286 |
| IRS990/RetainedEarningsEndowmentEtc/EOY | 0 | -162712 |
| IRS990/Revenue | 0 | 524350 |
| IRS990/RevenuesLessExpensesCY | 0 | -46426 |
| IRS990/RevenuesLessExpensesPriorYear | 0 | -116286 |
| IRS990/SalariesEtcCurrentYear | 0 | 442385 |
| IRS990/SalariesEtcPriorYear | 0 | 83662 |
| IRS990ScheduleA/CertificationCheckbox | 0 | X |
| IRS990ScheduleA/ContribBy35ControlledEntity | 0 | 0 |
| IRS990ScheduleA/ContribByControllingIndividual | 0 | 0 |
| IRS990ScheduleA/ContributionByRelatedParty | 0 | 0 |
| IRS990ScheduleA/SumOfAmounts | 0 | 0 |
| IRS990ScheduleA/SupportedOrgInformation/Amount | 0 | 0 |
| IRS990ScheduleA/SupportedOrgInformation/EIN | 0 | 141338471 |
| IRS990ScheduleA/SupportedOrgInformation/ListedInGoverningDoc | 0 | 1 |
| IRS990ScheduleA/SupportedOrgInformation/Name/BusinessNameLine1 | 0 | CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER |
| IRS990ScheduleA/SupportedOrgInformation/OrganizedInUS | 0 | 0 |
| IRS990ScheduleA/SupportedOrgInformation/SupportedOrganizationNotified | 0 | 0 |
| IRS990ScheduleA/SupportedOrgInformation/TypeOfOrganization | 0 | 3 |
| IRS990ScheduleA/SupportingOrg509a3Type1 | 0 | X |
| IRS990ScheduleA/SupportingOrganization509a3 | 0 | X |
| IRS990ScheduleA/TotalNumberOfSupportedOrgs | 0 | 1 |
| IRS990/ScheduleBRequired | 0 | 0 |
| IRS990ScheduleD/OtherLiabilities/Amount | 0 | 192665 |
| IRS990ScheduleD/OtherLiabilities/Amount | 1 | 130451 |
| IRS990ScheduleD/OtherLiabilities/Description | 0 | DUE TO CVPH |
| IRS990ScheduleD/OtherLiabilities/Description | 1 | DUE TO CVHN |
| IRS990ScheduleD/TotalOfAmounts | 0 | 323116 |
| IRS990ScheduleD/TotalOfBookValueLandBuildings | 0 | 0 |
| IRS990ScheduleJ/AnyNonFixedPayments | 0 | 0 |
| IRS990ScheduleJ/BoardOrCommitteeApproval | 0 | X |
| IRS990ScheduleJ/CompBasedNetEarningsFilingOrg | 0 | 0 |
| IRS990ScheduleJ/CompBasedNetEarningsRelateOrgs | 0 | 1 |
| IRS990ScheduleJ/CompBasedOnRevenueOfFilingOrg | 0 | 0 |
| IRS990ScheduleJ/CompBasedOnRevenueRelatedOrgs | 0 | 0 |
| IRS990ScheduleJ/CompensationCommittee | 0 | X |
| IRS990ScheduleJ/CompensationSurvey | 0 | X |
| IRS990ScheduleJ/EquityBasedCompArrangement | 0 | 0 |
| IRS990ScheduleJ/Form990OfOtherOrganizations | 0 | X |
| IRS990ScheduleJ/Form990ScheduleJPartII/BaseCompensationFilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BaseCompensationFilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BaseCompensationFilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BonusFilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BonusFilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BonusFilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BonusRelatedOrgs | 0 | 57804 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BonusRelatedOrgs | 1 | 168397 |
| IRS990ScheduleJ/Form990ScheduleJPartII/BonusRelatedOrgs | 2 | 57278 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompBasedOnRelatedOrgs | 0 | 300608 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompBasedOnRelatedOrgs | 1 | 477366 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompBasedOnRelatedOrgs | 2 | 282242 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompReportPrior990FilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompReportPrior990FilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompReportPrior990FilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompReportPrior990RelatedOrgs | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompReportPrior990RelatedOrgs | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/CompReportPrior990RelatedOrgs | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/DeferredCompFilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/DeferredCompFilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/DeferredCompFilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/DeferredCompRelatedOrgs | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/DeferredCompRelatedOrgs | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/DeferredCompRelatedOrgs | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartIII/Explanation | 0 | TRAVEL 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/Explanation | 1 | 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, DIRECTIOR, OR KEY EMPLOYEE RECEIVED THIS BENEFIT. |
| IRS990ScheduleJ/Form990ScheduleJPartIII/Explanation | 2 | A 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/Explanation | 3 | DURING 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. |
| IRS990ScheduleJ/Form990ScheduleJPartIII/ReturnReference | 0 | PART I, LINE 1A |
| IRS990ScheduleJ/Form990ScheduleJPartIII/ReturnReference | 1 | PART I, LINE 1B |
| IRS990ScheduleJ/Form990ScheduleJPartIII/ReturnReference | 2 | PART I, LINE 4B |
| IRS990ScheduleJ/Form990ScheduleJPartIII/ReturnReference | 3 | PART I, LINE 6 |
| IRS990ScheduleJ/Form990ScheduleJPartII/NamePerson | 0 | WOUTER JAN RIETSEMA MD |
| IRS990ScheduleJ/Form990ScheduleJPartII/NamePerson | 1 | STEPHENS MUNDY |
| IRS990ScheduleJ/Form990ScheduleJPartII/NamePerson | 2 | JOYCE RAFFERTY |
| IRS990ScheduleJ/Form990ScheduleJPartII/NontaxableBenefitsFilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/NontaxableBenefitsFilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/NontaxableBenefitsFilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/NontaxableBenefitsRelatedOrgs | 0 | 49456 |
| IRS990ScheduleJ/Form990ScheduleJPartII/NontaxableBenefitsRelatedOrgs | 1 | 52373 |
| IRS990ScheduleJ/Form990ScheduleJPartII/NontaxableBenefitsRelatedOrgs | 2 | 51651 |
| IRS990ScheduleJ/Form990ScheduleJPartII/OtherCompensationFilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/OtherCompensationFilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/OtherCompensationFilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/OtherCompensationRelatedOrgs | 0 | 14844 |
| IRS990ScheduleJ/Form990ScheduleJPartII/OtherCompensationRelatedOrgs | 1 | 145772 |
| IRS990ScheduleJ/Form990ScheduleJPartII/OtherCompensationRelatedOrgs | 2 | 13759 |
| IRS990ScheduleJ/Form990ScheduleJPartII/TotalCompensationFilingOrg | 0 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/TotalCompensationFilingOrg | 1 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/TotalCompensationFilingOrg | 2 | 0 |
| IRS990ScheduleJ/Form990ScheduleJPartII/TotalCompensationRelatedOrgs | 0 | 422712 |
| IRS990ScheduleJ/Form990ScheduleJPartII/TotalCompensationRelatedOrgs | 1 | 843908 |
| IRS990ScheduleJ/Form990ScheduleJPartII/TotalCompensationRelatedOrgs | 2 | 404930 |
| IRS990ScheduleJ/IndependentConsultant | 0 | X |
| IRS990ScheduleJ/InitialContractException | 0 | 0 |
| IRS990/ScheduleJRequired | 0 | 1 |
| IRS990ScheduleJ/SeverancePayment | 0 | 0 |
| IRS990ScheduleJ/SubstantiationRequired | 0 | 1 |
| IRS990ScheduleJ/SupplementalNonqualRetirePlan | 0 | 1 |
| IRS990ScheduleJ/TravelForCompanions | 0 | X |
| IRS990ScheduleJ/WrittenEmploymentContract | 0 | X |
| IRS990ScheduleJ/WrittenPolicyReTAndEExpenses | 0 | 1 |
| IRS990ScheduleO/GeneralExplanation/Explanation | 0 | WOUTER JAN RIETSEMA, MD IS THE SOLE VOTING MEMBER OF THE ORGANIZATION. |
| IRS990ScheduleO/GeneralExplanation/Explanation | 1 | ACCORDING 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/Explanation | 2 | LAKE CHAMPLAIN PHYSICIAN SERVICES PROVIDES AN ELECTRONIC COPY OF FORM 990 TO EACH BOARD MEMBER PRIOR TO THE FORM BEING FILED. |
| IRS990ScheduleO/GeneralExplanation/Explanation | 3 | CHAMPLAIN 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/Explanation | 4 | CHAMPLAIN 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/Explanation | 5 | CHAMPLAIN 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. |
| IRS990ScheduleO/GeneralExplanation/ReturnReference | 0 | FORM 990, PART VI, SECTION A, LINE 6 |
| IRS990ScheduleO/GeneralExplanation/ReturnReference | 1 | FORM 990, PART VI, SECTION A, LINE 7A |
| IRS990ScheduleO/GeneralExplanation/ReturnReference | 2 | FORM 990, PART VI, SECTION B, LINE 11 |
| IRS990ScheduleO/GeneralExplanation/ReturnReference | 3 | FORM 990, PART VI, SECTION B, LINE 12C |
| IRS990ScheduleO/GeneralExplanation/ReturnReference | 4 | FORM 990, PART VI, SECTION B, LINE 15 |
| IRS990ScheduleO/GeneralExplanation/ReturnReference | 5 | FORM 990, PART VI, SECTION C, LINE 19 |
| IRS990/ScheduleORequired | 0 | 1 |
| IRS990ScheduleR/ExchangeOfAssets | 0 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/AddressLine1 | 0 | 75 BEEKMAN STREET |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/AddressLine1 | 1 | 75 BEEKMAN STREET |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/AddressLine1 | 2 | 75 BEEKMAN STREET |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/AddressLine1 | 3 | PARK STREET |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/AddressLine1 | 4 | 75 BEEKMAN STREET |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/City | 0 | PLATTSBURGH |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/City | 1 | PLATTSBURGH |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/City | 2 | PLATTSBURGH |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/City | 3 | ELIZABETHTOWN |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/City | 4 | PLATTSBURGH |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/State | 0 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/State | 1 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/State | 2 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/State | 3 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/State | 4 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/ZIPCode | 0 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/ZIPCode | 1 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/ZIPCode | 2 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/ZIPCode | 3 | 12932 |
| IRS990ScheduleR/Form990ScheduleRPartII/AddressUS/ZIPCode | 4 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartII/ControlledOrg | 0 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartII/ControlledOrg | 1 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartII/ControlledOrg | 2 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartII/ControlledOrg | 3 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartII/ControlledOrg | 4 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine1 | 0 | COMMUNITY PROVIDERS INC |
| IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine1 | 1 | COMMUNITY PROVIDERS INC |
| IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine1 | 2 | PARENT |
| IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine1 | 3 | COMMUNITY PROVIDERS INC |
| IRS990ScheduleR/Form990ScheduleRPartII/DirectControllingEntityName/BusinessNameLine1 | 4 | COMMUNITY PROVIDERS INC |
| IRS990ScheduleR/Form990ScheduleRPartII/EIN | 0 | 141338471 |
| IRS990ScheduleR/Form990ScheduleRPartII/EIN | 1 | 141727048 |
| IRS990ScheduleR/Form990ScheduleRPartII/EIN | 2 | 222544844 |
| IRS990ScheduleR/Form990ScheduleRPartII/EIN | 3 | 141364513 |
| IRS990ScheduleR/Form990ScheduleRPartII/EIN | 4 | 061718419 |
| IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection | 0 | 501(C)(3) |
| IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection | 1 | 501(C)(3) |
| IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection | 2 | 501(C)(3) |
| IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection | 3 | 501(C)(3) |
| IRS990ScheduleR/Form990ScheduleRPartII/ExemptCodeSection | 4 | 501(C)(3) |
| IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/AddressLine1 | 0 | 16 DEGRANDPRE WAY |
| IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/City | 0 | PLATTSBURGH |
| IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/State | 0 | NY |
| IRS990ScheduleR/Form990ScheduleRPartIII/AddressUS/ZIPCode | 0 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartIII/DirectControllingEntityName/BusinessNameLine1 | 0 | CPI |
| IRS990ScheduleR/Form990ScheduleRPartIII/DisproportionateAllocations | 0 | 0 |
| IRS990ScheduleR/Form990ScheduleRPartIII/GeneralOrManagingPartner | 0 | 1 |
| IRS990ScheduleR/Form990ScheduleRPartIII/LegalDomicileState | 0 | NY |
| IRS990ScheduleR/Form990ScheduleRPartIII/NameOfRelatedOrg/BusinessNameLine1 | 0 | VALCOUR IMAGING |
| IRS990ScheduleR/Form990ScheduleRPartIII/PercentageOwnership | 0 | 0.75000 |
| IRS990ScheduleR/Form990ScheduleRPartIII/PredominantIncomeType | 0 | RELATED |
| IRS990ScheduleR/Form990ScheduleRPartIII/PrimaryActivity | 0 | DIAGNOSTIC IMAGING |
| IRS990ScheduleR/Form990ScheduleRPartIII/ShareOfEOYAssets | 0 | 477239 |
| IRS990ScheduleR/Form990ScheduleRPartIII/ShareOfTotalIncome | 0 | 1465544 |
| IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState | 0 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState | 1 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState | 2 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState | 3 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/LegalDomicileState | 4 | NY |
| IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine1 | 0 | CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER |
| IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine1 | 1 | CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER FOUNDATION |
| IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine1 | 2 | COMMUNITY PROVIDERS INC (CPI) |
| IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine1 | 3 | ELIZABETHTOWN COMMUNITY HOSPITAL |
| IRS990ScheduleR/Form990ScheduleRPartII/NameOfDisregardedEntity/BusinessNameLine1 | 4 | EMT OF CVPH |
| IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities | 0 | HOSPITAL |
| IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities | 1 | HLTH SVC SUPP |
| IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities | 2 | HLTH SVC COOR |
| IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities | 3 | HOSPITAL |
| IRS990ScheduleR/Form990ScheduleRPartII/PrimaryActivities | 4 | AMBULANCE SVC |
| IRS990ScheduleR/Form990ScheduleRPartII/PublicCharityStatus | 0 | LINE 3 |
| IRS990ScheduleR/Form990ScheduleRPartII/PublicCharityStatus | 1 | LINE 11B, II |
| IRS990ScheduleR/Form990ScheduleRPartII/PublicCharityStatus | 2 | LINE 11B, II |
| IRS990ScheduleR/Form990ScheduleRPartII/PublicCharityStatus | 3 | LINE 3 |
| IRS990ScheduleR/Form990ScheduleRPartII/PublicCharityStatus | 4 | LINE 11B, II |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/AddressLine1 | 0 | 75 BEEKMAN ST |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/AddressLine1 | 1 | 75 BEEKMAN ST |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/City | 0 | PLATTSBURG |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/City | 1 | PLATTSBURG |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/State | 0 | NY |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/State | 1 | NY |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/ZIPCode | 0 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartIV/AddressUS/ZIPCode | 1 | 12901 |
| IRS990ScheduleR/Form990ScheduleRPartIV/DirectControllingEntityName/BusinessNameLine1 | 0 | CPI |
| IRS990ScheduleR/Form990ScheduleRPartIV/DirectControllingEntityName/BusinessNameLine1 | 1 | CPI |
| IRS990ScheduleR/Form990ScheduleRPartIV/EIN | 0 | 161586102 |
| IRS990ScheduleR/Form990ScheduleRPartIV/EIN | 1 | 141663061 |
| IRS990ScheduleR/Form990ScheduleRPartIV/LegalDomicileState | 0 | NY |
| IRS990ScheduleR/Form990ScheduleRPartIV/LegalDomicileState | 1 | NY |
| IRS990ScheduleR/Form990ScheduleRPartIV/NameOfRelatedOrg/BusinessNameLine1 | 0 | CHAMPLAIN VALLEY HEALTH NETWORK |
| IRS990ScheduleR/Form990ScheduleRPartIV/NameOfRelatedOrg/BusinessNameLine1 | 1 | MEDIQUEST INC |
| IRS990ScheduleR/Form990ScheduleRPartIV/PercentageOwnership | 0 | 1.00000 |
| IRS990ScheduleR/Form990ScheduleRPartIV/PercentageOwnership | 1 | 1.00000 |
| IRS990ScheduleR/Form990ScheduleRPartIV/PrimaryActivity | 0 | ADMINISTRATIVE SERVICES |
| IRS990ScheduleR/Form990ScheduleRPartIV/PrimaryActivity | 1 | MED OFFICE LEASE |
| IRS990ScheduleR/Form990ScheduleRPartIV/ShareOfEOYAssets | 0 | 1776269 |
| IRS990ScheduleR/Form990ScheduleRPartIV/ShareOfTotalIncome | 0 | 60657 |
| IRS990ScheduleR/Form990ScheduleRPartIV/TypeOfEntity | 0 | C |
| IRS990ScheduleR/Form990ScheduleRPartIV/TypeOfEntity | 1 | C |
| IRS990ScheduleR/GiftGrantOrCapContrFrOtherOrg | 0 | 0 |
| IRS990ScheduleR/GiftGrantOrCapContrToOtherOrg | 0 | 0 |
| IRS990ScheduleR/LoansOrGuaranteesFromOtherOrg | 0 | 1 |
| IRS990ScheduleR/LoansOrGuaranteesToOtherOrg | 0 | 0 |
| IRS990ScheduleR/OtherTransferFromOtherOrg | 0 | 0 |
| IRS990ScheduleR/OtherTransferToOtherOrg | 0 | 0 |
| IRS990ScheduleR/PerformOfServicesByOtherOrgs | 0 | 0 |
| IRS990ScheduleR/PerformOfServicesForOtherOrgs | 0 | 0 |
| IRS990ScheduleR/PurchaseOfAssetsFromOtherOrg | 0 | 0 |
| IRS990ScheduleR/ReceiptOfIntAnnRentsRoyalties | 0 | 0 |
| IRS990ScheduleR/ReimbursementPaidByOtherOrg | 0 | 0 |
| IRS990ScheduleR/ReimbursementPaidToOtherOrg | 0 | 1 |
| IRS990ScheduleR/RentalOfFacilitiesFrOtherOrgs | 0 | 1 |
| IRS990ScheduleR/RentalOfFacilitiesToOtherOrgs | 0 | 0 |
| IRS990ScheduleR/SaleOfAssetsToOtherOrg | 0 | 0 |
| IRS990ScheduleR/SharingOfFacilities | 0 | 0 |
| IRS990ScheduleR/SharingOfPaidEmployees | 0 | 1 |
| IRS990/School | 0 | 0 |
| IRS990/SignificantChange | 0 | 0 |
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Displayed year
2011 • Form 990Facts available. Structured filing facts are available, but richer extracted sections are limited.