2026-08-13T07:13:20-05:00 2025-09-30 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2024-10-01 141727048 CVPH FOUNDATION INC CVPH 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 MATEJ KOLLAR VP/CFO 5185612000 2026-08-06 1 1 THOMAS J GIUFRE P00841958 3154463600 2026-08-06 2024 2025-03-06 01:10:19Z MATEJ KOLLAR 75 BEEKMAN STREET PLATTSBURGH NY 12901 3736877 0 X WWW.CVPH.ORG X 1989 NY THE GENEROSITY OF OUR CARING COMMUNITY ENABLES US TO ADVANCE INITIATIVES THAT ARE IMPORTANT TO THE HEALTH OF THE NORTH COUNTRY. 21 20 0 121 0 0 960560 1524036 0 0 213298 962600 29546 34359 1203404 2520995 95968 196688 0 0 212591 303728 0 0 0 1240152 1348031 1548711 1848447 -345307 672548 10817311 11681672 1069308 857423 9748003 10824249 THE GENEROSITY OF OUR CARING COMMUNITY ENABLES US TO ADVANCE INITIATIVES THAT ARE IMPORTANT TO THE HEALTH OF THE NORTH COUNTRY. 0 0 1169474 196688 CVPH MEDICAL CENTER FOUNDATION (THE FOUNDATION) PROVIDES FINANCIAL SUPPORT TO CVPH MEDICAL CENTER TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. THIS SUPPORT INCLUDES REIMBURSEMENT OF THE HOSPITAL'S COST FOR THE PURCHASE OF NEW DIAGNOSTIC EQUIPMENT, PROVIDE FUNDING FOR HEALTHCARE SERVICES FOR CHILDREN, COORDINATE SUPPORT GROUPS FOR PATIENTS LIVING WITH ILLNESS, PROVIDE CHARITY CARE FOR THOSE IN NEED, AND COORDINATE PROGRAMS THAT PROMOTE HEALTH AND WELLNESS. IN ADDITION, THE FOUNDATION PROVIDES FINANCIAL ASSISTANCE TO 245 FAMILIES MEETING THEIR TRAVEL EXPENSES INCURRED WHILE OBTAINING SPECIALIZED HEALTHCARE COVERED TRAVEL EXPENSES TO INCLUDE FUEL, FERRY TICKETS, FLIGHT COSTS, LODGING, AND FOOD. 6105 SUPPORT SERVICES RELATED TO TREATMENT AND CARE FOR PATIENTS UNDERGOING BREAST CANCER TREATMENT. 1175579 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 21 20 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NY X MATEJ KOLLAR VPCFO 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 JULIE KRAMER TREASURER 1.00 X X 0 0 0 RYAN BRIENZA BOARD MEMBER 1.00 X 0 0 0 REGINALD CARTER BOARD MEMBER 1.00 X 0 0 0 KATHLEEN INSLEY BOARD MEMBER 1.00 X 0 0 0 DANIELLE KING VICE PRESIDENT 1.00 X X 0 0 0 MICHAEL MCMAHON MD BOARD MEMBER 1.00 44.00 X 0 323939 35460 TAMAR WEERTS BOARD MEMBER 1.00 X 0 0 0 CHRIS MCLEAR BOARD MEMBER 1.00 X 0 0 0 TODD MCCARTHY BOARD MEMBER 1.00 X 0 0 0 KRISTA JOCK BOULE BOARD MEMBER 1.00 X 0 0 0 JODY CARPENTER SECRETARY 1.00 X X 0 0 0 ADAM CROSLEY BOARD MEMBER 1.00 X 0 0 0 BRANNOIN SAMPLE BOARD MEMBER 1.00 X 0 0 0 LINDA BOURGEOIS BOARD MEMBER 1.00 X 0 0 0 VICKI MARKING PRESIDENT 1.00 X X 0 0 0 DENISE CALKINS RYDER BOARD MEMBER 1.00 X 0 0 0 NATHAN BULL BOARD MEMBER 1.00 X 0 0 0 WOUTER RIETSAMA MD BOARD MEMBER 1.00 X 0 0 0 SEAN LUCAS BOARD MEMBER 1.00 X 0 0 0 CHRISTINA UBL BOARD MEMBER 1.00 X 0 0 0 ANGELA POWELL MD BOARD MEMBER 1.00 X 0 0 0 KERRY HALEY ASSOCIATE VP OF PHILANTHRO 50.00 X 209418 0 51427 MICHELLE LEBEAU PRESIDENT & CEO 2.00 48.00 X 0 729287 133642 MATEJ KOLLAR VICE PRESIDENT OF FINANCE & CFO 2.00 48.00 X 0 375259 53427 209418 1428485 273956 1 0 1 0 0 41986 1482050 32971 1524036 296437 296437 1795679 1129516 666163 666163 666163 120725 41986 86366 34359 34359 2520995 0 0 996959 X 67226 67226 129462 129462 303728 303728 20449 2277 18172 11733 11733 342473 73008 269465 16885 16885 4215 4215 12748 12748 100396 94700 5696 61212 61212 SMALL EQUIPMENT 550884 547823 3061 OTHER EXPENSES 183525 145999 37526 MEDICAL SUPPLIES 40566 40007 559 BOOKS, DUES & SUBSCRIPT 2945 1117 1828 1848447 1175579 672868 0 100354 163253 164235 91230 553351 328328 17365 18816 550489 609558 9430653 10470244 864 243 10817311 11681672 7427 42717 1061881 814706 1069308 857423 X 4915021 5482636 4832982 5341613 9748003 10824249 10817311 11681672 X 672548 -18384 422082 X 0 1 X 1 0 X X 1 CHAMPLAIN VALLEY PHYSICIAN HOSPITAL MEDICAL CENTER 141338471 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4832982 1067115 245392 803876 5341613 4771739 530517 496586 965860 4832982 4755066 317723 578637 879687 4771739 4586863 1581240 -1139636 273401 4755066 4036100 682721 1012398 1144356 4586863 0.08945 0.91055 0 1 1 0 BENEFICIAL INTEREST IN HEALTH NETWORK INVESTMENT POOL 10470244 F 10470244 OTHER LIABILITIES 366501 DUE TO AFFILIATES 448205 814706 X PART III, LINE 4: THE PURPOSE OF THE ARTWORK COLLECTION IS TO PROVIDE ART THERAPY TO OUR PATIENTS AND THEIR VISITORS. PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE INTENDED FOR AND CONSISTS OF CHARITABLE REMAINDER TRUST FOR PROPERTY HELD FOR RENTAL PURPOSES, CVPH MEDICAL CENTER CAPITAL CAMPAIGN, GENERAL HEALTH CARE NEEDS OF THE COMMUNITY, AND CHILDREN'S MEDICAL EXPENSES. PERMANENTLY RESTRICTED NET ASSESTS INCLUDE AMOUNTS WHOSE INCOME IS TEMPORARILY RESTRICTED FOR TRAVEL ASSISTANCE FOR MEDICAL PURPOSES AND STAFF EDUCATION IN THE CANCER UNITS. PART X, LINE 2: CVPH FOUNDATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF VERMONT HEALTH NETWORK. PAGE 17 OF THE CONSOLIDATED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE INDICATING THAT NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED. SUMMER EVENT 140221 35916 104305 32971 31310 5900 6890 GOLF TOURNAMENT 22490 6070 16420 175 4112 5008 162711 41986 120725 32971 175 35422 5900 11898 86366 34359 1 BEHAVIORAL HEALTH SERVICES NETWORK 22 US OVAL SUITE 218 PLATTSBURGH NY 12901 141338346 501C(3) 8763 0 TO ESTABLISH A FULLY STOCKED BASIC NEEDS PANTRY TO GIVE ESSENTIAL PERSONAL CARE ITEMS TO INDIVIDUALS IN CRISIS. CHAMPLAIN VALLEY FAMILY CENTER 20 AMPERSAND DRIVE PLATTSBURGH NY 12901 141638308 501C(3) 8763 0 TO FACILITATE EVIDENCE-BASED PRACTICES AND OR PROMISING PRACTICES TO INCREASE SKILLS IN THE AREAS OF EMOTIONAL INTELLIGENCE, CONFLICT RESOLUTION AND SKILL. BE A HERO LLC 38 N MAIN STREET SUITE 233 ST ALBANS NY 05478 474516769 501C(3) 49700 0 TO PROVIDE PROGRAMS TO SCHOOLS THAT DEVELOP AND IMPROVE PERSONAL AND LEADERSHIP SKILLS. TRAVEL SERVICES FOR HEALTHCARE OUT OF AREA 186 63901 ACTUAL COST METHOD ASSISTANCE TO INDIVIDUALS IN FINANCIAL CRISIS 59 65561 ACTUAL COST METHOD PART I, LINE 2: PROCESS FOR GRANTS; THE FOUNDATION OBTAINS FROM EACH PROSPECTIVE RECIPIENT AN APPLICATION FORM AND COLLECTS PERSONAL FINANCIAL DATA. THE FOUNDATION DETERMINES FINANCIAL NEEDS BASED ON FINANCIAL INFORMATION SUPPLIED. RECIPIENTS OF GRANTS OR ASSISTANCE ARE REQUIRED TO PROVIDE DOCUMENTATION OF ALL EXPENSES INCURRED FOR WHICH THE RECIPIENT SEEKS ASSISTANCE. 1 0 1 0 0 0 0 0 0 1 1 MICHELLE LEBEAU PRESIDENT & CEO 0 537948 0 160216 0 31123 0 94579 0 39063 0 862929 0 0 MATEJ KOLLAR VICE PRESIDENT OF FINANCE & CFO 0 293228 0 58290 0 23741 0 17241 0 36186 0 428686 0 0 MICHAEL MCMAHON MD BOARD MEMBER 0 317681 0 0 0 6258 0 19611 0 15849 0 359399 0 0 KERRY HALEY ASSOCIATE VP OF PHILANTHRO 158727 0 25489 0 25202 0 20361 0 31066 0 260845 0 0 0 PART I, LINE 3 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, INC. ("CVPH") RELIED ON THE UNIVERSITY OF VERMONT HEALTH NETWORK ("UVM HEALTH NETWORK"), THE PARENT ORGANIZATION OF CVPH, TO ESTABLISH SENIOR EXECUTIVE COMPENSATION. UVM HEALTH NETWORK UTILIZED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE UNIVERSITY OF VERMONT HEALTH NETWORK, BY AND THROUGH ITS AFFILIATED SUBSIDIARIES, MAINTAINS A SUPPLEMENTAL RETIREMENT BENEFIT PLAN (SRP) UNDER CONTRACTUAL ARRANGEMENTS WITH SEVERAL PERSONS LISTED ON FORM 990, PART VII, SECTION A, LINE 1A. PURSUANT TO THE TERMS OF THE SRP, ANNUAL CREDITS WERE MADE EQUAL TO A FIXED PERCENTAGE OF BASE SALARY. THE FOLLOWING PERSONS PARTICIPATED IN THE SRP IN CALENDAR YEAR 2024, AND THEIR RESPECTIVE FIXED PERCENTAGE IS DESIGNATED IN PARENTHESES: MICHELLE LEBEAU (10.04%). DEFERRED AMOUNTS VEST ON THE EARLIER OF: (I) JANUARY 1 OF THE THIRD PLAN YEAR AFTER THE PLAN YEAR FOR WHICH THE ACCOUNT WAS CREATED; OR (II) THE PARTICIPANT'S 65TH BIRTHDAY. FOR THE PLANS NOTED ABOVE, AMOUNTS DEFERRED DURING CALENDAR YEAR 2024 ARE INCLUDED ON SCHEDULE J, PART II, COLUMN C. AMOUNTS DEFERRED REMAIN SUBJECT TO FORFEITURE IF CERTAIN CONDITIONS ARE NOT MET. 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. X 7 2510 FMV X 7209 FMV X 1 5000 FMV X 12 6165 FMV X RECREATIONAL ACTIVITIES 16 5081 FMV X WELLNESS PACKAGES 13 3370 FMV X GIFT CARDS 23 2935 FMV X VEHICLE SERVICES 3 702 FMV 0 0 0 PART I, COLUMN (B): THE NUMBER REPORTED IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION A, LINE 6 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER IS THE SOLE VOTING MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A CVPH FOUNDATION SHALL ELECT THE DIRECTORS TO HOLD OFFICE ANNUALLY, EACH DIRECTOR SHALL HOLD OFFICE UNTIL THE EXPIRATION OF THE TERM AND UNTIL A SUCCESSOR HAS BEEN ELECTED AND SHALL HAVE QUALIFIED OR UNTIL THE DIRECTOR'S PRIOR RESIGNATION OR REMOVAL. FORM 990, PART VI, SECTION B, LINE 11B THE FOUNDATION 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 THE CONFLICT OF INTEREST POLICY IS APPLICABLE TO MEMBERS OF THE GOVERNING BODY, OFFICERS, AND KEY EMPLOYEES. THE ORGAINIZATION REQUIRES THAT EACH BOARD MEMBER WILL AVOID CONFLICT OF INTEREST AND WILL NOT USE HIS OR HER MEMBERSHIP ON THE BOARD TO PROFIT HIS OR HER OWN INTERESTS. IF ANY ACTION OF THE BOARD MIGHT PRESENT A REAL OR PERCEIVED CONFLICT OF INTEREST, THE BOARD MEMBER WILL EXPLAIN THE REASONS, AND NOT VOTE OR PARTICIPATE IN DISCUSSION OF THE MATTER. THIS CONFLICT SHOULD IDEALLY BE COMMUNICATED TO THE PRESIDENT OR ANNOUNCE TO THE FULL BOARD IF THE ISSUE ARISES UNEXPECTEDLY. EACH BOARD MEMBER WILL BE ASKED ANNUALLY TO SIGN AN ACKNOWLEDGEMENT OF THE CONFLICT OF INTEREST RESPONSIBILITY FORM. FORM 990, PART VI, SECTION B, LINE 15 CVPH MEDICAL CENTER HAS A FORMAL PROCESS THAT IS USED TO DETERMINE THE COMPENSATION OF THE CEO ON AN ANNUAL BASIS. THIS PROCESS INCLUDED A COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES ENGAGING AN INDEPENDENT CONSULTANT, PERFORMANCE OF A COMPENSATION STUDY OR SURVEY, REVIEW, OR OTHER ORGANIZATIONS 990 AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. A WRITTEN EMPLOYMENT AGREEMENT IS ESTABLISHED SETTING FORTH THE COMPENSATION AND BENEFITS OF THE CEO. CVPH PAYS NON-FIXED EARNINGS BASED ON THE SUCCESS IN MEETING PERFORMANCE CRITERIA THAT ARE PROSPECTIVELY AGREED UPON AS GOALS FOR THE CEO. THE SAME FORMAL PROCESS IS USED TO DETERMINE THE BASE COMPENSATION OF THE 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 PARTIES DESIRING A COPY OF THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS MUST PRESENT THEMSELVES AT THE ADMINISTRATIVE OFFICES OR MAKE A REQUEST IN WRITING. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 73,008. MANAGEMENT AND GENERAL EXPENSES 269,465. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 342,473. FORM 990, PART XI, LINE 9: TRANSFER OF AFFILIATE 422,082. UVM HEALTH NETWORK MEDICAL GROUP INC 111 COLCHESTER AVE BURLINGTON VT 05401 030225105 PHYSICIAN SERVICES VT 501(C)(3) LINE 12B, II UVMHN 1 UNIV OF VT MED CTR FOUNDATION INC 111 COLCHESTER AVE BURLINGTON VT 05401 263159849 FUNDRAISING VT 501(C)(3) LINE 12B, II UVMHNMG 1 UNIV OF VT MED CTR AUXILLIARY INC 111 COLCHESTER AVE BURLINGTON VT 05401 208022004 SERVICE VT 501(C)(3) LINE 12D, III-O N/A 0 UNIV OF VT HEALTH NETWORK 111 COLCHESTER AVE BURLINGTON VT 05401 452880726 HOLDING COMPANY VT 501(C)(3) LINE 12B, II N/A 0 CENTRAL VT MEDICAL CENTER 111 COLCHESTER AVE BURLINGTON VT 05401 222547186 HOSPITAL VT 501(C)(3) LINE 3 UVMHN 1 UNIVERSITY HEALTH CENTER 111 COLCHESTER AVE BURLINGTON VT 05401 030229931 HOSPITAL VT 501(C)(3) LINE 12A, I UVMMC 1 COMMUNITY PROVIDERS INC 75 BEEKMAN STREET PLATTSBURGH NY 12901 222544844 HLTH SVC COORD NY 501(C)(3) LINE 12B, II UVMHN 1 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL 75 BEEKMAN STREET PLATTSBURGH NY 12901 141338471 HOSPITAL NY 501(C)(3) LINE 3 UVMHN 1 ELIZABETHTOWN COMMUNITY HOSPITAL 75 PARK STREET ELIZABETHTOWN NY 12932 141364513 HOSPITAL NY 501(C)(3) LINE 3 UVMHN 1 EMERGENCY MEDICAL TRANSPORT OF CVPH INC 75 BEEKMAN STREET PLATTSBURGH NY 12901 061718419 AMBULANCE SVC NY 501(C)(3) LINE 12C, III-FI CPI 1 LAKE CHAMPLAIN PHYSICIAN SERVICES PC 75 BEEKMAN STREET PLATTSBURGH NY 12901 273785445 PHYSICIAN SERVICES NY 501(C)(3) LINE 12B, II CVPH 1 UNIVERSITY MEDICAL EDUCATION ASSOCIATES 89 BEAUMONT AVENUE BURLINGTON VT 05401 237107832 EDUCATIONAL VT 501(C)(3) LINE 11 UVMHNMG 1 ALICE HYDE MEDICAL CENTER 133 PARK STREET MALONE NY 12953 150346515 HOSPITAL NY 501(C)(3) LINE 3 UVMHN 1 PORTER MEDICAL CENTER INC 115 PORTER DRIVE MIDDLEBURY VT 05753 030310862 SUPPORTING ORGANIZATION VT 501(C)(3) LINE 12C, III-FI UVMHN 1 HELEN PORTER NURSING HOME 37 PORTER DRIVE MIDDLEBURY VT 05753 030306549 NURSING HOME VT 501(C)(3) LINE 3 PMC 1 AUXILLARY OF PORTER MEDICAL CENTER 37 PORTER DRIVE MIDDLEBURY VT 05753 237363227 SUPPORTING ORGANIZATION VT 501(C)(3) LINE 12C, III-FI PMC 1 PORTER HOSPITAL 37 PORTER DRIVE MIDDLEBURY VT 05753 030181058 HOSPITAL VT 501(C)(3) LINE 3 PMC 1 UVMHN HOME HEALTH AND HOSPICE 1110 PRIM ROAD COLCHESTER VT 05446 030179603 HOME HEALTHCARE VT 501(C)(3) LINE 10 UVMHN 1 VMC INDEMNITY COMPANY INC 95 ST PAUL ST BURLINGTON VT 05401 831102018 INSURANCE VT 501(C)(3) LINE 12A, I UVMHN 1 UVMHN VENTURES INC 111 COLCHESTER AVE BURLINGTON VT 05401 043380045 HOLDING COMPANY VT UVMHN C 0 UVMHN CREDENTIALING & ENROLLMENT 111 COLCHESTER AVE BURLINGTON VT 05401 030333056 ADMIN SVC VT UVMHN VENTURES INC C 0 CHARITABLE REMAINDER TRUST (6) SUPPORT VT UVMMCCVMC T 0 PERPETUAL TRUST (10) SUPPORT VT UVMMC T 0 CHARITABLE IRREVOCABLE TRUST (8) SUPPORT VT UVMMCCVMC T 0 CHAMPLAIN VALLEY HEALTH NETWORK 75 BEEKMAN STREET PLATTSBURGH NY 12901 161586102 ADMIN SVC NY N/A C 0 MEDIQUEST INC PO BOX 1656 PLATTSBURGH NY 12901 141663061 MED OFFICE LEASE NY CPI C 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL S 422079