2024-08-15T12:32:15-05:00 2023-09-30 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2022-10-01 061718419 EMT OF CVPH INC EMTO 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 MATEJ KOLLAR VP/CFO 5185612000 2024-08-06 1 0 THOMAS J GIUFRE P00841958 3154463600 2024-08-06 2022 2024-08-08 14:25:15Z MATEJ KOLLAR 75 BEEKMAN ST PLATTSBURGH NY 12901 4015195 0 X WWW.CVPH.ORG X 2004 NY THE MISSION OF EMT OF CVPH IS TO PROVIDE COST EFFECTIVE EMERGENCY MEDICAL TRANSPORTATION SERVICES. 4 1 0 0 0 0 708442 724356 3238621 3290839 0 0 0 0 3947063 4015195 0 0 0 0 0 0 0 0 0 3811322 4136838 3811322 4136838 135741 -121643 1159575 1102603 402323 466994 757252 635609 THE MISSION OF EMT OF CVPH INC IS TO PROVIDE COST EFFECTIVE EMERGENCY TRANSPORTATION SERVICES. 0 0 3990486 3290839 THE ORGANIZATION SERVES THE LOCAL COMMUNITY'S NEEDS BY PROVIDING STAFFS 24 FULL-TIME, 12 PER-DIEM, AND 7 PART-TIME EMT'S. DURING 2023 AMBULATORY SERVICES PROVIDED BY THESE EMT'S AMOUNTED TO 4,587 TRANSPORTS, AND 317 NO TRANSPORTS (ASSISTANCE PROVIDED ON SITE). THE ORGANIZATION'S EMTS ALSO PROVIDE BACKUP TRANSPORT SERVICE AND ASSISTANCE TO AREA TOWNSHIPS WHEN OUTFLOW EXISTS, THEREBY FURTHER SERVING LOCAL COMMUNITIES. 3990486 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 1 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 1 1 0 NY X MATEJ KOLLAR 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 MICHELLE LEBEAU PRESIDENT/COO 1.00 49.00 X X 0 607301 51434 CHRISTOPHER HICKEY SVP/CFO 1.00 49.00 X X 0 440560 33055 MATEJ KOLLAR TREASURER 1.00 49.00 X X 0 212288 32115 BRENDAN OWENS SECRETARY 1.00 X X 0 0 0 0 1260149 116604 0 1 1 0 MULTIMED BILLING SERVICE INC 21 OSWEGO ST BALDWINSVILLE NY 13027 PATIENT CLAIM BILLING AND RECONCILING PA 195449 1 724356 724356 AMBULATORY TRANSPORTAT 621910 3290839 3290839 3290839 4015195 3290839 0 0 2171 2171 363628 363628 19494 19494 73475 73475 5704 5704 151318 151318 1865 1865 PURCHASED SERVICES 2834744 2690563 144181 BAD DEBT EXPENSE 524361 524361 MAINTENANCE AND REPAIRS 120601 120601 OTHER EXPENSES 39477 39477 4136838 3990486 146352 0 70191 89201 820225 896842 -1167 -2448 1202552 1083544 270326 119008 1159575 1102603 5489 48025 396834 418969 402323 466994 X 0 0 0 0 757252 635609 757252 635609 1159575 1102603 -121643 0 X X 0 1 X 1 0 X 645125 662875 688400 708442 724356 3429198 2986296 2848658 2682323 3238621 3290839 15046737 3631421 3511533 3370723 3947063 4015195 18475935 0 0 0 18475935 3631421 3511533 3370723 3947063 4015195 18475935 1.00000 1.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1202552 1083544 119008 119008 DUE TO CVPH MEDICAL CENTER - LONG TERM 278586 DUE TO CVPH MEDICAL CENTER - SHORT TERM 140383 418969 X PART X, LINE 2: EMT OF CVPH IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF VERMONT HEALTH NETWORK. PAGES 17 AND 18 OF THE CONSOLIDATED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE INDICATING THAT NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED. 1 X X X X X 0 1 0 0 0 0 0 1 1 1 MICHELLE LEBEAU PRESIDENT/COO 0 491886 0 89938 0 25477 0 32091 0 19343 0 658735 0 0 CHRISTOPHER HICKEY SVP/CFO 0 389094 0 51466 0 0 0 15250 0 17805 0 473615 0 0 MATEJ KOLLAR TREASURER 0 199031 0 13257 0 0 0 9996 0 22119 0 244403 0 0 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 7 EMT OF CVPH, INC. 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. FORM 990, PART VI, SECTION A, LINE 6 COMMUNITY PROVIDERS INC IS THE SOLE MEMBER OF EMT OF CVPH. CPI MAY ELECT THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EMT OF CVPH HAS AS ITS SOLE MEMBER COMMUNITY PROVIDERS INC (CPI). CPI MAY ELECT THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 WAS PROVIDED ELECTRONICALLY TO EACH BOARD MEMBER PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AS PART OF ITS GOVERNING DOCUMENTS. THIS 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 INDIVIDUALS (COMMITTEE 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 INTERESTS FOR EACH ANNUAL PERIOD. FORM 990, PART VI, SECTION B, LINE 15 CVPH 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 ORGANIZATIONS FORM 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 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. UVM HEALTH NETWORK MEDICAL GROUP 111 COLCHESTER AVE BURLINGTON VT 05401 030225105 PHYSICIAN SERVICES VT 501(C)(3) LINE 12A, I UVMHN 1 UNIV OF VT MED CTR FOUNDATION INC 111 COLCHESTER AVE BURLINGTON VT 05401 263159849 FUNDRAISING VT 501(C)(3) LINE 12A, I UVMMC 1 UNIV OF VT MED CTR AUXILLIARY INC 111 COLCHESTER AVE BURLINGTON VT 05401 208022004 SERVICE VT 501(C)(3) LINE 12C, III-FI N/A 0 UNIV OF VT HEALTH NETWORK 111 COLCHESTER AVE BURLINGTON VT 05401 452880726 HOLDING COMPANY VT 501(C)(3) LINE 12A, I N/A 0 CENTRAL VT MEDICAL CENTER 111 COLCHESTER AVE BURLINGTON VT 05401 222547186 HOSPITAL VT 501(C)(3) LINE 3 UVM HLTH NET 1 UNIV OF HEALTH CENTER 111 COLCHESTER AVE BURLINGTON VT 05401 030229931 HOSPITAL VT 501(C)(3) LINE 12C, III-FI UVMHNMG 1 COMMUNITY PROVIDERS INC 75 BEEKMAN STREET PLATTSBURGH NY 12901 222544844 HLTH SVC COORD NY 501(C)(3) LINE 12A, I UVM HLTH NET 1 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL 75 BEEKMAN STREET PLATTSBURGH NY 12901 141338471 HOSPITAL NY 501(C)(3) LINE 3 CPI 1 ELIZABETHTOWN COMMUNITY HOSPITAL 75 PARK STREET ELIZABETHTOWN NY 12932 141727048 HOSPITAL NY 501(C)(3) LINE 3 UVMHN 1 CVPH MEDICAL CENTER FOUNDATION 75 BEEKMAN STREET PLATTSBURGH NY 12901 141727078 HLTH SVC COORD NY 501(C)(3) LINE 12B, II CVPH 1 LAKE CHAMPLAIN PHYSICIAN SERVICES PC 75 BEEKMAN STREET PLATTSBURGH NY 12901 273785445 PHYSICIAN SERVICES NY 501(C)(3) LINE 12A, I CVPH 1 UNIVERSITY MEDICAL EDUCATION ASSOCIATES 89 BEAUMONT AVENUE BURLINGTON VT 05401 237107832 EDUCATIONAL VT 501(C)(3) LINE 10 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 UVM HLTH NET 1 HELEN PORTER NURSING HOME 37 PORTER DRIVE MIDDLEBURY VT 05753 030306549 NURSING HOME VT 501(C)(3) LINE 3 PCM 0 AUXILLARY OF PORTER MEDICAL CENTER 37 PORTER DRIVE MIDDLEBURY VT 05753 237363227 SUPPORTING ORGANIZATION VT 501(C)(3) LINE 12C, III-FI PCM 0 PORTER HOSPITAL 37 PORTER DRIVE MIDDLEBURY VT 05753 030181058 HOSPITAL VT 501(C)(3) LINE 3 PCM 0 UVMHN HOME HEALTH AND HOSPICE 1110 PRIM RD COLCHESTER VT 05446 SERVICE VT 501(C)(3) LINE 3 UVMHN 0 VMC INDEMNITY COMPANY INC 95 ST PAUL ST BURLINGTON VT 05401 831102018 INSURANCE VT 501(C)(3) LINE 12A, I UVMHN 0 CHAMPLAIN VALLEY HEALTH NETWORK 75 BEEKMAN STREET PLATTSBURGH NY 12901 161586102 ADMINISTRATIVE SERVICES NY COMMUNITY PROVIDERS INC C 0 MEDIQUEST INC PO BOX 1656 PLATTSBURGH NY 12901 141663061 MEDICAL OFFICE LEASE NY COMMUNITY PROVIDERS INC C 0 UVMHN VENTURES INC 111 COLCHESTER AVE BURLINGTON VT 05401 043380045 HOLDING COMPANY VT UVMHN C 0 UVM HEALTH NETWORK CREDENTIALING & ENROLLMENT 111 COLCHESTER AVE BURLINGTON VT 05401 030333056 ADMINISTRATIVE SERVICES VT UVMHN VENTURES 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 YANKEE MEDICAL 276 NORTH AVE BURLINGTON VT 05401 030225363 HOME MEDICAL EQUIPMENT VT UVMHN C 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0