Liabilities / Assets
96th percentile
Higher debt load relative to assets than 96% of similar nonprofits.
990 • Fiscal year 2020 • EIN 27-3785445
Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.
Liabilities / Assets
96th percentile
Higher debt load relative to assets than 96% of similar nonprofits.
Liabilities / Revenue
96th percentile
Higher debt load relative to revenue than 96% of similar nonprofits.
Net Margin
4th percentile
Higher net margin than 4% of similar nonprofits.
Top Officer Pay
100th percentile
Higher top officer pay than 100% of similar nonprofits.
Top officer pay equals 3080.6% of source-year revenue.
Asset Growth
3rd percentile
Faster asset growth than 3% of similar nonprofits.
Revenue Growth
6th percentile
Faster revenue growth than 6% of similar nonprofits.
Assets
Down$28,921
Down $211,161 (-88%) from 2019
Net Assets
Down-$57,508
Down $110,840 (-208%) from 2019
Liabilities
Down$86,429
Down $100,321 (-54%) from 2019
Revenue
Down$24,555
Down $1,239,858 (-98%) from 2019
Expenses
Down$135,395
Down $1,122,196 (-89%) from 2019
Net Income
Down-$110,840
Down $117,662 (-1725%) from 2019
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.
| Line | Beginning | End | Change |
|---|---|---|---|
| Assets | |||
| Cash and Non-Interest-Bearing Accounts | $90,196 | $27,573 | ▼ $62,623 |
| Accounts Receivable | $26,777 | $1,276 | ▼ $25,501 |
| Pd in Cap Srpls Land Bldg Eqp Fund | $0 | $0 | → $0 |
| Cap Stk Tr Prin Current Funds | $0 | $0 | → $0 |
| Rtn Earn Endowment Incm Other Fnds | $53,332 | $-57,508 | ▼ $110,840 |
| Total Assets | $240,082 | $28,921 | ▼ $211,161 |
| Other Assets Total | $123,109 | $72 | ▼ $123,037 |
| Liabilities | |||
| Other Liabilities | $186,750 | $86,429 | ▼ $100,321 |
| Total Liabilities | $186,750 | $86,429 | ▼ $100,321 |
| Net Assets / Fund Balance | |||
| Total Net Assets Fund Balance | $53,332 | $-57,508 | ▼ $110,840 |
| Total Liabilities and Net Assets / Fund Balance | $240,082 | $28,921 | ▼ $211,161 |
| Name | Title |
|---|---|
| Stephens Mundy | Former President & CEO |
| Michelle Lebeau | President/COO |
| Wouter Jan Rietsema Md | Shareholder/member |
| Christopher Hickey | VP of Finance |
| Line Item | Amount |
|---|---|
| Other Expenses | $135,395 |
| Grants and Similar Amounts Paid | $0 |
| Professional Fundraising Fees | $0 |
| Salaries, Compensation, and Employee Benefits | $0 |
| Total Fundraising Expense | $0 |
| Line Item | Program | Management | Fundraising | Total |
|---|---|---|---|---|
| All Other Expenses | $8,865 | - | - | $8,865 |
| Travel | $7,220 | - | - | $7,220 |
| Fees for Services Management | $3,751 | - | - | $3,751 |
| Fees for Services Accounting | $3,504 | - | - | $3,504 |
| Occupancy | $3,354 | - | - | $3,354 |
| Other Expenses | $2,068 | - | - | $2,068 |
| Insurance | $1,101 | - | - | $1,101 |
| Total Functional Expenses | $135,395 | $0 | $0 | $135,395 |
| Line Item | Amount |
|---|---|
| Professional Fundraising Fees | $0 |
| Liability | Amount |
|---|---|
| Due to Related Parties | $86,429 |
“Wouter jan rietsema, md is the sole voting member of the organization.”
“According to the shareholders agreement, dr. Rietsema, the sole shareholder and director of lake champlain physician services, 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 medical center.”
“Lake champlain physician services, p.c. Provides an electronic copy of form 990 to each board member prior to the form being filed.”
“Lake champlain physician services, p.c. 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 hospital. 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.”
“Lake champlain physician services, p.c. 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 ceo. Lake champlain physician services, p.c. 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. In addition to the tools and processes identified in schedule j, part i, champlain valley physicians hospital receives guidance regarding its president's compensation from the compensation committee of the board of trustees of the university of vermont health network, which is the sole member of the hospital. That network compensation committee utilizes the following methods to establish that guidance: -compensation committee -independent compensation consultant -compensation survey or study -approval by the board or compensation committee”
“Lake champlain physician services, p.c. 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, p.c. 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.”
“The process has not changed from the prior year.”
“The system consists of not-for-profit corporations under section 501(c)(3) of the internal revenue code (the code) and are exempt from federal income taxes on related income pursuant to section 501(a) of the code. As of september 30, 2020, the system did not have any unrecognized tax benefits or any related accrued interest or penalties. The tax years open to examination by federal and state taxing authorities are 2017 through 2020.”
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/AccountantCompileOrReviewInd | 0 | 0 |
| IRS990/AccountsReceivableGrp/BOYAmt | 0 | 26777 |
| IRS990/AccountsReceivableGrp/EOYAmt | 0 | 1276 |
| IRS990/ActivitiesConductedPrtshpInd | 0 | 0 |
| IRS990/ActivityOrMissionDesc | 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/AllOtherContributionsAmt | 0 | 3161 |
| IRS990/AllOtherExpensesGrp/ProgramServicesAmt | 0 | 8865 |
| IRS990/AllOtherExpensesGrp/TotalAmt | 0 | 8865 |
| IRS990/AnnualDisclosureCoveredPrsnInd | 0 | 1 |
| IRS990/AuditCommitteeInd | 0 | 1 |
| IRS990/BooksInCareOfDetail/BusinessName/BusinessNameLine1Txt | 0 | THE ORGANIZATION |
| IRS990/BooksInCareOfDetail/PhoneNum | 0 | 5185612000 |
| IRS990/BooksInCareOfDetail/USAddress/AddressLine1Txt | 0 | 75 BEEKMAN STREET |
| IRS990/BooksInCareOfDetail/USAddress/CityNm | 0 | PLATTSBURGH |
| IRS990/BooksInCareOfDetail/USAddress/StateAbbreviationCd | 0 | NY |
| IRS990/BooksInCareOfDetail/USAddress/ZIPCd | 0 | 12901 |
| IRS990/BusinessRlnWith35CtrlEntInd | 0 | 0 |
| IRS990/BusinessRlnWithFamMemInd | 0 | 0 |
| IRS990/BusinessRlnWithOrgMemInd | 0 | 0 |
| IRS990/CapStkTrPrinCurrentFundsGrp/BOYAmt | 0 | 0 |
| IRS990/CapStkTrPrinCurrentFundsGrp/EOYAmt | 0 | 0 |
| IRS990/CashNonInterestBearingGrp/BOYAmt | 0 | 90196 |
| IRS990/CashNonInterestBearingGrp/EOYAmt | 0 | 27573 |
| IRS990/ChangeToOrgDocumentsInd | 0 | 0 |
| IRS990/CntrctRcvdGreaterThan100KCnt | 0 | 0 |
| IRS990/CollectionsOfArtInd | 0 | 0 |
| IRS990/CompensationFromOtherSrcsInd | 0 | 0 |
| IRS990/CompensationProcessCEOInd | 0 | 1 |
| IRS990/CompensationProcessOtherInd | 0 | 1 |
| IRS990/ConflictOfInterestPolicyInd | 0 | 1 |
| IRS990/ConservationEasementsInd | 0 | 0 |
| IRS990/ConsolidatedAuditFinclStmtInd | 0 | 1 |
| IRS990/CreditCounselingInd | 0 | 0 |
| IRS990/CYBenefitsPaidToMembersAmt | 0 | 0 |
| IRS990/CYContributionsGrantsAmt | 0 | 3161 |
| IRS990/CYGrantsAndSimilarPaidAmt | 0 | 0 |
| IRS990/CYInvestmentIncomeAmt | 0 | 0 |
| IRS990/CYOtherExpensesAmt | 0 | 135395 |
| IRS990/CYOtherRevenueAmt | 0 | 0 |
| IRS990/CYProgramServiceRevenueAmt | 0 | 21394 |
| IRS990/CYRevenuesLessExpensesAmt | 0 | -110840 |
| IRS990/CYSalariesCompEmpBnftPaidAmt | 0 | 0 |
| IRS990/CYTotalExpensesAmt | 0 | 135395 |
| IRS990/CYTotalFundraisingExpenseAmt | 0 | 0 |
| IRS990/CYTotalProfFndrsngExpnsAmt | 0 | 0 |
| IRS990/CYTotalRevenueAmt | 0 | 24555 |
| IRS990/DecisionsSubjectToApprovaInd | 0 | 0 |
| IRS990/DeductibleArtContributionInd | 0 | 0 |
| IRS990/DeductibleNonCashContriInd | 0 | 0 |
| IRS990/DelegationOfMgmtDutiesInd | 0 | 0 |
| IRS990/Desc | 0 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PROVIDES GENERAL MEDICAL SERVICES TO PATIENTS. |
| IRS990/DescribedInSection501c3Ind | 0 | 1 |
| IRS990/DisregardedEntityInd | 0 | 0 |
| IRS990/DocumentRetentionPolicyInd | 0 | 1 |
| IRS990/DonorAdvisedFundInd | 0 | 0 |
| IRS990/DonorRstrOrQuasiEndowmentsInd | 0 | 0 |
| IRS990/ElectionOfBoardMembersInd | 0 | 1 |
| IRS990/EmployeeCnt | 0 | 0 |
| IRS990/EngagedInExcessBenefitTransInd | 0 | 0 |
| IRS990/ExpenseAmt | 0 | 135395 |
| IRS990/FamilyOrBusinessRlnInd | 0 | 0 |
| IRS990/FederalGrantAuditRequiredInd | 0 | 0 |
| IRS990/FeesForServicesAccountingGrp/ProgramServicesAmt | 0 | 3504 |
| IRS990/FeesForServicesAccountingGrp/TotalAmt | 0 | 3504 |
| IRS990/FeesForServicesManagementGrp/ProgramServicesAmt | 0 | 3751 |
| IRS990/FeesForServicesManagementGrp/TotalAmt | 0 | 3751 |
| IRS990/ForeignActivitiesInd | 0 | 0 |
| IRS990/ForeignFinancialAccountInd | 0 | 0 |
| IRS990/ForeignOfficeInd | 0 | 0 |
| IRS990/Form8282PropertyDisposedOfInd | 0 | 0 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt | 0 | 48.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt | 1 | 30.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt | 2 | 48.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRltdOrgRt | 3 | 30.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt | 0 | 2.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt | 1 | 20.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt | 2 | 2.00 |
| IRS990/Form990PartVIISectionAGrp/AverageHoursPerWeekRt | 3 | 20.00 |
| IRS990/Form990PartVIISectionAGrp/FormerOfcrDirectorTrusteeInd | 0 | X |
| IRS990/Form990PartVIISectionAGrp/IndividualTrusteeOrDirectorInd | 0 | X |
| IRS990/Form990PartVIISectionAGrp/OfficerInd | 0 | X |
| IRS990/Form990PartVIISectionAGrp/OfficerInd | 1 | X |
| IRS990/Form990PartVIISectionAGrp/OfficerInd | 2 | X |
| IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt | 0 | 47930 |
| IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt | 1 | 10659 |
| IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt | 2 | 36530 |
| IRS990/Form990PartVIISectionAGrp/OtherCompensationAmt | 3 | 22413 |
| IRS990/Form990PartVIISectionAGrp/PersonNm | 0 | WOUTER JAN RIETSEMA MD |
| IRS990/Form990PartVIISectionAGrp/PersonNm | 1 | CHRISTOPHER HICKEY |
| IRS990/Form990PartVIISectionAGrp/PersonNm | 2 | MICHELLE LEBEAU |
| IRS990/Form990PartVIISectionAGrp/PersonNm | 3 | STEPHENS MUNDY |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt | 0 | 0 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt | 1 | 0 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt | 2 | 0 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromOrgAmt | 3 | 0 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt | 0 | 394261 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt | 1 | 270507 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt | 2 | 561815 |
| IRS990/Form990PartVIISectionAGrp/ReportableCompFromRltdOrgAmt | 3 | 734021 |
| IRS990/Form990PartVIISectionAGrp/TitleTxt | 0 | SHAREHOLDER/MEMBER |
| IRS990/Form990PartVIISectionAGrp/TitleTxt | 1 | VP OF FINANCE |
| IRS990/Form990PartVIISectionAGrp/TitleTxt | 2 | PRESIDENT/COO |
| IRS990/Form990PartVIISectionAGrp/TitleTxt | 3 | FORMER PRESIDENT & CEO |
| IRS990/Form990ProvidedToGvrnBodyInd | 0 | 1 |
| IRS990/FormationYr | 0 | 2010 |
| IRS990/FormerOfcrEmployeesListedInd | 0 | 1 |
| IRS990/FSAuditedBasisGrp/ConsolidatedBasisFinclStmtInd | 0 | X |
| IRS990/FSAuditedInd | 0 | 1 |
| IRS990/FundraisingActivitiesInd | 0 | 0 |
| IRS990/GamingActivitiesInd | 0 | 0 |
| IRS990/GoverningBodyVotingMembersCnt | 0 | 1 |
| IRS990/GrantsToIndividualsInd | 0 | 0 |
| IRS990/GrantsToOrganizationsInd | 0 | 0 |
| IRS990/GrantToRelatedPersonInd | 0 | 0 |
| IRS990/GrossReceiptsAmt | 0 | 24555 |
| IRS990/GroupReturnForAffiliatesInd | 0 | 0 |
| IRS990/IncludeFIN48FootnoteInd | 0 | 1 |
| IRS990/IndependentAuditFinclStmtInd | 0 | 0 |
| IRS990/IndependentVotingMemberCnt | 0 | 1 |
| IRS990/IndivRcvdGreaterThan100KCnt | 0 | 0 |
| IRS990/IndoorTanningServicesInd | 0 | 0 |
| IRS990/InfoInScheduleOPartVIInd | 0 | X |
| IRS990/InfoInScheduleOPartXIIInd | 0 | X |
| IRS990/InsuranceGrp/ProgramServicesAmt | 0 | 1101 |
| IRS990/InsuranceGrp/TotalAmt | 0 | 1101 |
| IRS990/InvestmentInJointVentureInd | 0 | 0 |
| IRS990/IRPDocumentCnt | 0 | 0 |
| IRS990/IRPDocumentW2GCnt | 0 | 0 |
| IRS990/LegalDomicileStateCd | 0 | NY |
| IRS990/LoanOutstandingInd | 0 | 0 |
| IRS990/LobbyingActivitiesInd | 0 | 0 |
| IRS990/LocalChaptersInd | 0 | 0 |
| IRS990/MaterialDiversionOrMisuseInd | 0 | 0 |
| IRS990/MembersOrStockholdersInd | 0 | 1 |
| IRS990/MethodOfAccountingAccrualInd | 0 | X |
| IRS990/MinutesOfCommitteesInd | 0 | 1 |
| IRS990/MinutesOfGoverningBodyInd | 0 | 1 |
| IRS990/MissionDesc | 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/MoreThan5000KToIndividualsInd | 0 | 0 |
| IRS990/MoreThan5000KToOrgInd | 0 | 0 |
| IRS990/NetAssetsOrFundBalancesBOYAmt | 0 | 53332 |
| IRS990/NetAssetsOrFundBalancesEOYAmt | 0 | -57508 |
| IRS990/NetUnrelatedBusTxblIncmAmt | 0 | 0 |
| IRS990/NondeductibleContributionsInd | 0 | 0 |
| IRS990/OccupancyGrp/ProgramServicesAmt | 0 | 3354 |
| IRS990/OccupancyGrp/TotalAmt | 0 | 3354 |
| IRS990/OfficerMailingAddressInd | 0 | 0 |
| IRS990/OperateHospitalInd | 0 | 0 |
| IRS990/Organization501c3Ind | 0 | X |
| IRS990/OrgDoesNotFollowFASB117Ind | 0 | X |
| IRS990/OtherAssetsTotalGrp/BOYAmt | 0 | 123109 |
| IRS990/OtherAssetsTotalGrp/EOYAmt | 0 | 72 |
| IRS990/OtherChangesInNetAssetsAmt | 0 | 0 |
| IRS990/OtherExpensesGrp/Desc | 0 | PURCHASED SERVICES |
| IRS990/OtherExpensesGrp/Desc | 1 | BAD DEBT EXPENSE |
| IRS990/OtherExpensesGrp/ProgramServicesAmt | 0 | 105532 |
| IRS990/OtherExpensesGrp/ProgramServicesAmt | 1 | 2068 |
| IRS990/OtherExpensesGrp/TotalAmt | 0 | 105532 |
| IRS990/OtherExpensesGrp/TotalAmt | 1 | 2068 |
| IRS990/OtherLiabilitiesGrp/BOYAmt | 0 | 186750 |
| IRS990/OtherLiabilitiesGrp/EOYAmt | 0 | 86429 |
| IRS990/PartialLiquidationInd | 0 | 0 |
| IRS990/PayPremiumsPrsnlBnftCntrctInd | 0 | 0 |
| IRS990/PdInCapSrplsLandBldgEqpFundGrp/BOYAmt | 0 | 0 |
| IRS990/PdInCapSrplsLandBldgEqpFundGrp/EOYAmt | 0 | 0 |
| IRS990/PoliticalCampaignActyInd | 0 | 0 |
| IRS990/PrincipalOfficerNm | 0 | WOUTER RIETSEMA |
| IRS990/ProfessionalFundraisingInd | 0 | 0 |
| IRS990/ProgramServiceRevenueGrp/BusinessCd | 0 | 621110 |
| IRS990/ProgramServiceRevenueGrp/Desc | 0 | MEDICAL SERVICES |
| IRS990/ProgramServiceRevenueGrp/RelatedOrExemptFuncIncomeAmt | 0 | 21394 |
| IRS990/ProgramServiceRevenueGrp/TotalRevenueColumnAmt | 0 | 21394 |
| IRS990/ProhibitedTaxShelterTransInd | 0 | 0 |
| IRS990/PYBenefitsPaidToMembersAmt | 0 | 0 |
| IRS990/PYContributionsGrantsAmt | 0 | 0 |
| IRS990/PYExcessBenefitTransInd | 0 | 0 |
| IRS990/PYGrantsAndSimilarPaidAmt | 0 | 0 |
| IRS990/PYInvestmentIncomeAmt | 0 | 0 |
| IRS990/PYOtherExpensesAmt | 0 | 1257591 |
| IRS990/PYOtherRevenueAmt | 0 | 0 |
| IRS990/PYProgramServiceRevenueAmt | 0 | 1264413 |
| IRS990/PYRevenuesLessExpensesAmt | 0 | 6822 |
| IRS990/PYSalariesCompEmpBnftPaidAmt | 0 | 0 |
| IRS990/PYTotalExpensesAmt | 0 | 1257591 |
| IRS990/PYTotalProfFndrsngExpnsAmt | 0 | 0 |
| IRS990/PYTotalRevenueAmt | 0 | 1264413 |
| IRS990/QuidProQuoContributionsInd | 0 | 0 |
| IRS990/RcvFndsToPayPrsnlBnftCntrctInd | 0 | 0 |
| IRS990/ReconcilationRevenueExpnssAmt | 0 | -110840 |
| IRS990/RegularMonitoringEnfrcInd | 0 | 1 |
| IRS990/RelatedEntityInd | 0 | 1 |
| IRS990/RelatedOrganizationCtrlEntInd | 0 | 0 |
| IRS990/ReportInvestmentsOtherSecInd | 0 | 0 |
| IRS990/ReportLandBuildingEquipmentInd | 0 | 0 |
| IRS990/ReportOtherAssetsInd | 0 | 0 |
| IRS990/ReportOtherLiabilitiesInd | 0 | 1 |
| IRS990/ReportProgramRelatedInvstInd | 0 | 0 |
| IRS990/RevenueAmt | 0 | 21394 |
| IRS990/RtnEarnEndowmentIncmOthFndsGrp/BOYAmt | 0 | 53332 |
| IRS990/RtnEarnEndowmentIncmOthFndsGrp/EOYAmt | 0 | -57508 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/Contribution35ControlledInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/ContributionControllerInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/ContributionFamilyInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/ControlledDisqualifiedPrsnInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/DisqualifiedPrsnControllIntInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/DisqualifiedPrsnOwnrIntInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/ExcessBusinessHoldingsRulesInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/ListedByNameGoverningDocInd | 0 | 1 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/LoanDisqualifiedPersonInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/OrganizationChangeSuprtOrgInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/PaymentSubstantialContribtrInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportedOrgNotOrganizedUSInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportedOrgSectionC456Ind | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/SupportNonSupportedOrgInd | 0 | 0 |
| IRS990ScheduleA/Form990SchASupportingOrgGrp/SuprtOrgNoIRSDeterminationInd | 0 | 0 |
| IRS990ScheduleA/Form990SchAType1SuprtOrgGrp/OperateBenefitNonSuprtOrgInd | 0 | 0 |
| IRS990ScheduleA/Form990SchAType1SuprtOrgGrp/PowerAppointMajorityDirTrstInd | 0 | 1 |
| IRS990ScheduleA/OtherSupportSumAmt | 0 | 0 |
| IRS990ScheduleA/SupportedOrganizationsCnt | 0 | 1 |
| IRS990ScheduleA/SupportedOrganizationsTotalCnt | 0 | 1 |
| IRS990ScheduleA/SupportedOrgInformationGrp/EIN | 0 | 141338471 |
| IRS990ScheduleA/SupportedOrgInformationGrp/GoverningDocumentListedInd | 0 | 1 |
| IRS990ScheduleA/SupportedOrgInformationGrp/OrganizationTypeCd | 0 | 3 |
| IRS990ScheduleA/SupportedOrgInformationGrp/OtherSupportAmt | 0 | 0 |
| IRS990ScheduleA/SupportedOrgInformationGrp/SupportAmt | 0 | 0 |
| IRS990ScheduleA/SupportedOrgInformationGrp/SupportedOrganizationName/BusinessNameLine1Txt | 0 | CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER |
| IRS990ScheduleA/SupportingOrganization509a3Ind | 0 | X |
| IRS990ScheduleA/SupportingOrgType1Ind | 0 | X |
| IRS990ScheduleA/SupportSumAmt | 0 | 0 |
| IRS990/ScheduleBRequiredInd | 0 | 0 |
| IRS990ScheduleD/FootnoteTextInd | 0 | X |
| IRS990ScheduleD/OtherLiabilitiesOrgGrp/Amt | 0 | 86429 |
| IRS990ScheduleD/OtherLiabilitiesOrgGrp/Desc | 0 | DUE TO RELATED PARTIES |
| IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt | 0 | THE SYSTEM CONSISTS OF NOT-FOR-PROFIT CORPORATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF SEPTEMBER 30, 2020, THE SYSTEM DID NOT HAVE ANY UNRECOGNIZED TAX BENEFITS OR ANY RELATED ACCRUED INTEREST OR PENALTIES. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2017 THROUGH 2020. |
| IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | PART X, LINE 2: |
| IRS990ScheduleD/TotalBookValueLandBuildingsAmt | 0 | 0 |
| IRS990ScheduleD/TotalLiabilityAmt | 0 | 86429 |
| IRS990ScheduleJ/AnyNonFixedPaymentsInd | 0 | 0 |
| IRS990ScheduleJ/BoardOrCommitteeApprovalInd | 0 | X |
| IRS990ScheduleJ/CompBasedOnRevenueOfFlngOrgInd | 0 | 0 |
| IRS990ScheduleJ/CompBsdNetEarnsFlngOrgInd | 0 | 0 |
| IRS990ScheduleJ/CompBsdNetEarnsRltdOrgsInd | 0 | 1 |
| IRS990ScheduleJ/CompBsdOnRevRelatedOrgsInd | 0 | 1 |
| IRS990ScheduleJ/CompensationCommitteeInd | 0 | X |
| IRS990ScheduleJ/CompensationSurveyInd | 0 | X |
| IRS990ScheduleJ/EquityBasedCompArrngmInd | 0 | 0 |
| IRS990ScheduleJ/IndependentConsultantInd | 0 | X |
| IRS990ScheduleJ/InitialContractExceptionInd | 0 | 0 |
| IRS990/ScheduleJRequiredInd | 0 | 1 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt | 0 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt | 1 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt | 2 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BaseCompensationFilingOrgAmt | 3 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount | 0 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount | 1 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount | 2 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusFilingOrganizationAmount | 3 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt | 0 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt | 1 | 24000 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt | 2 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/BonusRelatedOrganizationsAmt | 3 | 0 |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/CompensationBasedOnRltdOrgsAmt | 0 | 375430 |
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| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 1 | CHRISTOPHER HICKEY |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 2 | MICHELLE LEBEAU |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm | 3 | STEPHENS MUNDY |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 0 | SHAREHOLDER/MEMBER |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 1 | VP OF FINANCE |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 2 | PRESIDENT/COO |
| IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt | 3 | FORMER PRESIDENT & CEO |
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| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 0 | TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF THE CEO OF LESS THAN $1,000 IS ALLOWED TO BE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLOYEE RECEIVES THIS BENEFIT. |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 1 | TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF THE CEO OF LESS THAN $1,000 IS ALLOWED TO BE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLOYEE RECEIVES THIS BENEFIT. |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 2 | IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN PART I, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 3 | STEPHENS MUNDY, PRESIDENT & CFO OF CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, SEPARATED FROM SERVICE ON JULY 1, 2018. IN ACCORDANCE WITH THE SEPARATION AGREEMENT, HE IS ENTITLED TO 18 MONTHS CONTINUATION OF SALARY AND CONTINUATION OF CERTAIN BENEFITS. IN 2019 HE RECEIVED PAYMENTS IN LIEU OF BENEFIT CONTINUATION PLUS SALARY CONTINUATION PAYMENTS TOTALLING $734,021. A DISTRIBUTION TO WOUTER RIETSEMA IN THE AMOUNT OF $18,831 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. RIETSEMA'S TAXABLE COMPENSATION. A DISTRIBUTION TO MICHELLE LEBEAU IN THE AMOUNT OF $95,039 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MS. LEBEAU'S TAXABLE COMPENSATION. |
| IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt | 4 | DURING 2020, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER CONTINUED A COMPENSATION INCENTIVE PLAN FOR MANAGEMENT OF THE ORGANIZATION. THE PLAN SETS FORTH NUMEROUS OBJECTIVES AND GOALS (16) 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. ONLY ONE OF THE 16 OBJECTIVES INCLUDED IN THE 2020 PLAN IS KEYED TO NET MARGIN OF THE ORGANIZATION. THIS MEASURE IS INTENDED TO MEET THE OVERALL GOAL OF MAINTAINING THE FINANCIAL HEALTH OF THE ORGANIZATION. OTHER GOALS IN THE PLAN ARE TO IMPROVE PATIENT & EMPLOYEE SATISFACTION. |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | PART I, LINE 1A |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 1 | PART I, LINE 1B |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 2 | PART I, LINE 3 |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 3 | PART I, LINES 4A-B |
| IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc | 4 | PART I, LINE 6 |
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| IRS990ScheduleJ/TravelForCompanionsInd | 0 | X |
| IRS990ScheduleJ/WrittenEmploymentContractInd | 0 | X |
| IRS990ScheduleJ/WrittenPolicyRefTAndEExpnssInd | 0 | 1 |
| IRS990/ScheduleORequiredInd | 0 | 1 |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 0 | WOUTER JAN RIETSEMA, MD IS THE SOLE VOTING MEMBER OF THE ORGANIZATION. |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 1 | ACCORDING TO THE SHAREHOLDERS AGREEMENT, DR. RIETSEMA, THE SOLE SHAREHOLDER AND DIRECTOR OF LAKE CHAMPLAIN PHYSICIAN SERVICES, 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 MEDICAL CENTER. |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 2 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PROVIDES AN ELECTRONIC COPY OF FORM 990 TO EACH BOARD MEMBER PRIOR TO THE FORM BEING FILED. |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 3 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. 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 HOSPITAL. 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/SupplementalInformationDetail/ExplanationTxt | 4 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. 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 CEO. LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. 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. IN ADDITION TO THE TOOLS AND PROCESSES IDENTIFIED IN SCHEDULE J, PART I, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL RECEIVES GUIDANCE REGARDING ITS PRESIDENT'S COMPENSATION FROM THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS THE SOLE MEMBER OF THE HOSPITAL. THAT NETWORK COMPENSATION COMMITTEE UTILIZES THE FOLLOWING METHODS TO ESTABLISH THAT GUIDANCE: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt | 5 | LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. 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, P.C. 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/SupplementalInformationDetail/ExplanationTxt | 6 | THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 0 | FORM 990, PART VI, SECTION A, LINE 6 |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 1 | FORM 990, PART VI, SECTION A, LINE 7A |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 2 | FORM 990, PART VI, SECTION B, LINE 11B |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 3 | FORM 990, PART VI, SECTION B, LINE 12C |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 4 | FORM 990, PART VI, SECTION B, LINE 15 |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 5 | FORM 990, PART VI, SECTION C, LINE 19 |
| IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc | 6 | FORM 990, PART XII, LINE 2C: |
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| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt | 2 | UVMHN VENTURES |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt | 3 | UVMMCCVMC |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt | 4 | UVMMC |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt | 5 | UVMMCCVMC |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt | 6 | UVMHN |
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| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EIN | 4 | 030225363 |
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| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 1 | C |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 2 | C |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 3 | T |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 4 | T |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 5 | T |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 6 | C |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/EntityTypeTxt | 7 | C |
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| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 1 | VT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 2 | VT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 3 | VT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 4 | VT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 5 | NY |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 6 | NY |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/LegalDomicileStateCd | 7 | VT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt | 0 | HOLDING COMPANY |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt | 1 | CAPTIVE INSURANCE |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt | 2 | ADMIN SVC |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt | 3 | SUPPORT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt | 4 | SUPPORT |
| IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt | 5 | SUPPORT |
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Displayed year
2020 • Form 990Detailed filing. Detailed filing data is available for this year.