Civic Intelligence

Lake Champlain Physician Services PC

990 • Fiscal year 2022 • EIN 27-3785445

Oct 01, 2021 to Sep 30, 2022 • Filed on Aug 07, 2023

75 Beekman StreetPlattsburgh, NY 12901

(518) 561-2000

Siviq Scores

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

Liabilities / Assets

99th percentile

2.93x

Higher debt load relative to assets than 99% of similar nonprofits.

2022 filings • NTEE E60 • <$500k nonprofits • Source year 2022

Liabilities / Revenue

100th percentile

11.89x

Higher debt load relative to revenue than 100% of similar nonprofits.

2022 filings • NTEE E60 • <$500k nonprofits • Source year 2022

Net Margin

6th percentile

-288%

Higher net margin than 6% of similar nonprofits.

2022 filings • NTEE E60 • <$500k nonprofits • Source year 2022

Top Officer Pay

100th percentile

$648,260

Higher top officer pay than 100% of similar nonprofits.

Top officer pay equals 2911.7% of source-year revenue.

2022 filings • NTEE E60 • <$500k nonprofits • Source year 2022

Asset Growth

10th percentile

-64%

Faster asset growth than 10% of similar nonprofits.

2022 filings • NTEE E60 • <$500k nonprofits • Annualized from 2021 to 2022

Revenue Growth

10th percentile

-91%

Faster revenue growth than 10% of similar nonprofits.

2022 filings • NTEE E60 • <$500k nonprofits • Annualized from 2021 to 2022

Assets

Down

$90,276

Down $157,850 (-64%) from 2021

Net Assets

Down

-$174,423

Down $64,033 (-58%) from 2021

Liabilities

Down

$264,699

Down $93,817 (-26%) from 2021

Revenue

Down

$22,264

Down $213,477 (-91%) from 2021

Expenses

Down

$86,297

Down $202,326 (-70%) from 2021

Net Income

Down

-$64,033

Down $11,151 (-21%) from 2021

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

2022

Assets$90,276
Liabilities$264,699
Net Assets-$174,423

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

2022

Revenue$22,264
Expenses$86,297
Net Income-$64,033
Jump To
Filing Snapshot
Filing Period
Oct 1, 2021 to Sep 30, 2022
Signed
Aug 7, 2023
Return Version
2021v4.2
Gross Receipts
$22,264
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.

Balance Sheet Detail
LineBeginningEndChange
Assets
Cash and Non-Interest-Bearing Accounts$10,312$62,631▲ $52,319
Accounts Receivable$237,742$27,573▼ $210,169
Pd in Cap Srpls Land Bldg Eqp Fund$0$0→ $0
Cap Stk Tr Prin Current Funds$0$0→ $0
Rtn Earn Endowment Incm Other Fnds$-110,390$-174,423▼ $64,033
Total Assets$248,126$90,276▼ $157,850
Other Assets Total$72$72→ $0
Liabilities
Other Liabilities$358,516$264,699▼ $93,817
Total Liabilities$358,516$264,699▼ $93,817
Net Assets / Fund Balance
Total Net Assets Fund Balance$-110,390$-174,423▼ $64,033
Total Liabilities and Net Assets / Fund Balance$248,126$90,276▼ $157,850
Compensation and Service Providers

Board Members and Trustees

NameTitle
Michelle LebeauPresident/COO
Wouter Jan Rietsema MdShareholder/member
Christopher HickeySVP/CFO
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$22,264
Investment Income
$0
Other Revenue
$0
Change in Net Assets
$-64,033
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$86,297
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Insurance$7,269--$7,269
Occupancy$2,778--$2,778
Other Expenses$977--$977
All Other Expenses$157--$157
Total Functional Expenses$86,297$0$0$86,297
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Due to Related Parties$264,699
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
No
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, Line 6

Wouter jan rietsema, md is the sole voting member of the organization.

Form 990, Part VI, Section A, Line 7A

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.

Form 990, Part VI, Section B, Line 11B

Lake champlain physician services, p.c. Provides an electronic copy of form 990 to each board member prior to the form being filed.

Form 990, Part VI, Section B, Line 12C

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.

Form 990, Part VI, Section B, Line 15

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

Form 990, Part VI, Section C, Line 19

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.

Filing and Contact Details

Filer

Filer Name
Lake Champlain Physician Services Pc
EIN
27-3785445
Phone
5185612000
Address
75 BEEKMAN STREET, PLATTSBURGH, NY 12901

Signing Officer

Name
Wouter Rietsema
Title
President
Phone
5185612000
Signed
2023-08-07
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Wouter Rietsema
Formed
2010
Legal Domicile
Ny
Voting Board Members
1
Independent Board Members
1
Employees
0
Volunteers
0

Preparer

Firm
Fustcharles Llp
Address
220 S WARREN STREET, SYRACUSE, NY 13202
Preparer
Thomas J Giufre
Phone
3154463600
Supplemental Narrative

Additional Explanations

FORM 990, PART XII, LINE 2C:

The process has not changed from the prior year.

Financial Statement Notes

PART X, LINE 2:

Entities within uvm health network, with the exception of entities specifically named below, are incorporated and recognized by the internal revenue service (irs) as tax-exempt under section 501(c)(3) of the internal revenue code (the code). Accordingly, the irs has determined that these organizations are exempt from federal income taxes on related income pursuant to section 501(a) of the code. Health network ventures holding, llc, university of vermont health network specialty care transport, llc, university of vermont medical center skilled nursing, llc, university of vermont medical center executive services, llc, valcour imaging, inc., and porter real estate holdings, llc, are single-member limited liability corporations. As such, for tax purposes, these organizations are treated as divisions of their sole member. Earnings and losses are passed through to the owners, which are tax-exempt, and are treated in the same manner for tax purposes. No provision for federal income taxes has been recorded in the accompanying consolidated financial statements for these organizations. Uvm health network health ventures, inc., medical education center condominium association, inc., mediquest corp., emergency medical transport of cvph, inc., and champlain valley health network, inc. Are taxable corporations for which the provision for income taxes is immaterial to the accompanying consolidated financial statements.

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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0ENTITIES WITHIN UVM HEALTH NETWORK, WITH THE EXCEPTION OF ENTITIES SPECIFICALLY NAMED BELOW, ARE INCORPORATED AND RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE). ACCORDINGLY, THE IRS HAS DETERMINED THAT THESE ORGANIZATIONS ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. HEALTH NETWORK VENTURES HOLDING, LLC, UNIVERSITY OF VERMONT HEALTH NETWORK SPECIALTY CARE TRANSPORT, LLC, UNIVERSITY OF VERMONT MEDICAL CENTER SKILLED NURSING, LLC, UNIVERSITY OF VERMONT MEDICAL CENTER EXECUTIVE SERVICES, LLC, VALCOUR IMAGING, INC., AND PORTER REAL ESTATE HOLDINGS, LLC, ARE SINGLE-MEMBER LIMITED LIABILITY CORPORATIONS. AS SUCH, FOR TAX PURPOSES, THESE ORGANIZATIONS ARE TREATED AS DIVISIONS OF THEIR SOLE MEMBER. EARNINGS AND LOSSES ARE PASSED THROUGH TO THE OWNERS, WHICH ARE TAX-EXEMPT, AND ARE TREATED IN THE SAME MANNER FOR TAX PURPOSES. NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THESE ORGANIZATIONS. UVM HEALTH NETWORK HEALTH VENTURES, INC., MEDICAL EDUCATION CENTER CONDOMINIUM ASSOCIATION, INC., MEDIQUEST CORP., EMERGENCY MEDICAL TRANSPORT OF CVPH, INC., AND CHAMPLAIN VALLEY HEALTH NETWORK, INC. ARE TAXABLE CORPORATIONS FOR WHICH THE PROVISION FOR INCOME TAXES IS IMMATERIAL TO THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS.
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0MICHELLE LEBEAU
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2CHRISTOPHER HICKEY
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0PRESIDENT/COO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1SHAREHOLDER/MEMBER
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2SVP/CFO
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IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0TRAVEL 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/ExplanationTxt1TRAVEL 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/ExplanationTxt2IN 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/ExplanationTxt3DURING 2022, 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 2022 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/ExplanationTxt4LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PAID AWARDS TO CERTAIN MEMBERS OF UPPER MANAGEMENT (DIRECTORS, VICE PRESIDENTS, PHYSICIAN CHAIRS AND SENIOR EXECUTIVES) THROUGH ITS ANNUAL VARIABLE PAY PLAN AS THE PLAN'S PERFORMANCE MEASURES WERE MET. THE MEASURES WERE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THESE MEASURES INCLUDED FINANCIAL, POPULATION HEALTH & QUALITY, AND OPERATIONAL RELATED METRICS.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 1A
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1PART I, LINE 1B
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc2PART I, LINE 3
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc3PART I, LINE 4B
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc4PART I, LINE 7
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IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0WOUTER JAN RIETSEMA, MD IS THE SOLE VOTING MEMBER OF THE ORGANIZATION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1ACCORDING 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/ExplanationTxt2LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PROVIDES AN ELECTRONIC COPY OF FORM 990 TO EACH BOARD MEMBER PRIOR TO THE FORM BEING FILED.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3LAKE 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/ExplanationTxt4LAKE 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/ExplanationTxt5LAKE 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/ExplanationTxt6THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc0FORM 990, PART VI, SECTION A, LINE 6
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc1FORM 990, PART VI, SECTION A, LINE 7A
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc2FORM 990, PART VI, SECTION B, LINE 11B
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc3FORM 990, PART VI, SECTION B, LINE 12C
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc4FORM 990, PART VI, SECTION B, LINE 15
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc5FORM 990, PART VI, SECTION C, LINE 19
IRS990ScheduleO/SupplementalInformationDetail/FormAndLineReferenceDesc6FORM 990, PART XII, LINE 2C:
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt2UVMHN VENTURES
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt3UVMMCCVMC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt4UVMMC
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/DirectControllingEntityName/BusinessNameLine1Txt6UVMHN
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/AddressLine1Txt0PO BOX HM 3103
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/ForeignAddress/CityNm0HAMILTON
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt0HOLDING COMPANY
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt1CAPTIVE INSURANCE
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt2ADMIN SVC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt3SUPPORT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt4SUPPORT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt5SUPPORT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt6ADMIN SVC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt7MED OFFICE LEASE
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/PrimaryActivitiesTxt8HOME MEDICAL EQUIPMENT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt0UVMHN VENTURES INC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt1VMC INDEMNITY COMPANY LTD
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt2UVM HEALTH NETWORK CREDENTIALING & ENROLLMENT
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt3CHARITABLE REMAINDER TRUST (5)
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt4PERPETUAL TRUST (4)
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt5CHARITABLE IRREVOCABLE TRUST (7)
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt6CHAMPLAIN VALLEY HEALTH NETWORK
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt7MEDIQUEST INC
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/RelatedOrganizationName/BusinessNameLine1Txt8YANKEE MEDICAL INC
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt3PO BOX 1656
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/AddressLine1Txt4276 NORTH AVENUE
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm3PLATTSBURGH
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/CityNm4BURLINGTON
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/StateAbbreviationCd0VT
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IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd005401
IRS990ScheduleR/IdRelatedOrgTxblCorpTrGrp/USAddress/ZIPCd105401

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