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Nonprofiteer
← LAKE CHAMPLAIN PHYSICIAN SERVICES PC

Form 990 for tax year 2022

Filed by LAKE CHAMPLAIN PHYSICIAN SERVICES PC.

Totals

Total revenue
$2,550
Total expenses
$1,258
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$2,550
Investment income
$0
Other revenue
$0
Total assets, end of year
$90,284
Total liabilities, end of year
$263,415
Net assets or fund balances, end of year
-$173,131
Program services expenses (Part IX)
$1,258
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$1,258

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: MEDICAL SERVICES

    total $2,550 · related or exempt $2,550

Functional expenses

Part IX, the statement of functional expenses.

  • 23 · Insurance

    total $1,101 · program services $1,101

  • 24a · Other expenses: LICENSES AND TAXES

    total $157 · program services $157

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $62,631 · end of year $64,467

  • 4 · Accounts receivable

    beginning of year $27,573 · end of year $25,745

  • 15 · Other assets

    beginning of year $72 · end of year $72

  • 25 · Other liabilities

    beginning of year $264,699 · end of year $263,415

  • 27 · Net assets without donor restrictions

    beginning of year -$174,423 · end of year -$173,131

Mission and programs · 2022

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.

  • LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PROVIDES GENERAL MEDICAL SERVICES TO PATIENTS.

    Expenses $1,258 · Revenue $2,550

As filed on the 2022 return.

Listed in Part VII

  • Wouter Jan Rietsema MD

    SHAREHOLDER/MEMBER

    Total calculated
    $506,690
    From this org
    $0
    From related orgs
    $454,136
    Other
    $52,554
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $371,044 related
    Bonus
    $0 + $50,643 related
    Other
    $0 + $32,449 related
    Deferred
    $0 + $33,550 related
    Nontaxable benefits
    $0 + $19,004 related
    Filer's total
    $0 + $506,690 related

  • Christopher Hickey

    SVP/CFO

    Total calculated
    $473,615
    From this org
    $0
    From related orgs
    $440,560
    Other
    $33,055
    Hours/week
    20 + 30 related

    Schedule J breakdown matched by us

    Base
    $0 + $389,094 related
    Bonus
    $0 + $51,466 related
    Other
    $0
    Deferred
    $0 + $15,250 related
    Nontaxable benefits
    $0 + $17,805 related
    Filer's total
    $0 + $473,615 related

  • Michelle Lebeau

    PRESIDENT/COO

    Total calculated
    $658,735
    From this org
    $0
    From related orgs
    $607,301
    Other
    $51,434
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $491,886 related
    Bonus
    $0 + $89,938 related
    Other
    $0 + $25,477 related
    Deferred
    $0 + $32,091 related
    Nontaxable benefits
    $0 + $19,343 related
    Filer's total
    $0 + $658,735 related

  • Matej Kollar

    VP/CFO

    Total calculated
    $244,403
    From this org
    $0
    From related orgs
    $212,288
    Other
    $32,115
    Hours/week
    2 + 48 related

    Schedule J breakdown matched by us

    Base
    $0 + $199,031 related
    Bonus
    $0 + $13,257 related
    Other
    $0
    Deferred
    $0 + $9,996 related
    Nontaxable benefits
    $0 + $22,119 related
    Filer's total
    $0 + $244,403 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 2 · Substantiation required before reimbursing expenses
  • 3 · Compensation committee
  • 3 · Independent compensation consultant
  • 3 · Written employment contract
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception
  • 9 · Followed the rebuttable-presumption procedure

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings

The filer's explanations (Part III)

PART I, LINE 3
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
PART I, LINE 4B
DURING 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.
PART I, LINE 7
LAKE 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.
PART I, LINE 8
SALARIES AND OTHER FIXED AMOUNTS PAYABLE TO EXECUTIVES SUCH AS OFFICERS AND CERTAIN KEY EMPLOYEES ARE SET BY CONTRACTS THAT ARE NEGOTIATED AND ENTERED INTO PRIOR TO THE COMMENCEMENT OF EACH EXECUTIVES' EMPLOYMENT. THE TERMS OF SUCH CONTRACTS ARE APPROVED IN ADVANCE BY THE APPROPRIATE COMPENSATION COMMITTEE OR OTHER BOARD-AUTHORIZED BODY, WHICH OBTAINS AND RELIES ON APPROPRIATE DATA AS TO COMPARABILITY PRIOR TO MAKING SUCH OFFER, AND CONCURRENTLY DOCUMENTS ITS BASIS FOR DETERMINATION.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • UVMHN VENTURES INC

    C · HOLDING COMPANY · VT

    Directly controlled by UVMHN

  • UVM HEALTH NETWORK CREDENTIALING & ENROLLMENT

    C · ADMIN SVC · VT

    Directly controlled by UVMHN VENTURES

  • CHARITABLE REMAINDER TRUST (6)

    T · SUPPORT · VT

    Directly controlled by UVMMCCVMC

  • PERPETUAL TRUST (10)

    T · SUPPORT · VT

    Directly controlled by UVMMC

  • CHARITABLE IRREVOCABLE TRUST (8)

    T · SUPPORT · VT

    Directly controlled by UVMMCCVMC

  • CHAMPLAIN VALLEY HEALTH NETWORK

    C · ADMIN SVC · NY

  • MEDIQUEST INC

    C · MED OFFICE LEASE · NY

  • YANKEE MEDICAL INC

    C · HOME MEDICAL EQUIPMENT · VT

    Directly controlled by UVMHN

Provenance

Return type
form_990
Tax year
2022
Filed
6 August 2024
IRS schema version
2022v5.0
Source object
202442289349302099

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