2025-08-11T14:35:38-05:00 2024-09-30 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2023-10-01 222544844 COMMUNITY PROVIDERS INC COMM 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 MATEJ KOLLAR VP & CFO 5185612000 2025-08-04 1 1 THOMAS J GIUFRE P00841958 3154463600 2025-08-04 2023 2025-03-06 01:10:19Z MATEJ KOLLAR 75 BEEKMAN STREET PLATTSBURGH NY 12901 0 0 X WWW.CVPH .ORG X 1984 NY THE MISSION OF CPI IS TO PROMOTE HEALTH IN THE REGION THROUGH COORDINATED COST-EFFECTIVE, HIGH QUALITY HEALTH CARE SERVICES. CPI WILL COORDINATE A CONTINUUM OF HEALTH CARE SERVICES THROUGH PARTNERING WITH EXISTING ORGANIZATIONS INITIATING SERVICES WHEN NEEDED AND GENERATING FUNDS TO MAINTAIN THESE SYSTEMS. 3 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1272781 557062 0 0 1272781 557062 X THE MISSION OF CPI IS TO PROMOTE HEALTH IN THE REGION THROUGH COORDINATED COST EFFECTIVE, HIGH QUALITY HEALTH CARE SERVICES. CPI WILL COORDINATE A CONTINUUM OF HEALTH CARE SERVICES THROUGH PARTNERING WITH EXISITING ORGANIZATIONS, INITIATING SERVICES WHERE NEEDED AND GENERATE FUNDS TO MAINTAIN THESE SYSTEMS. 0 0 THE ORGANIZATION PROVIDES COORDINATION OF HEALTH CARE OPERATIONS IN SERVING THE HEALTH NEEDS OF THE NORTHERN UPSTATE NEW YORK COMMUNITY. 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 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 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 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 1.00 49.00 X X 0 610683 113166 BRENDAN OWENS SECRETARY 2.00 X X 0 0 0 MATEJ KOLLAR VP/CFO 1.00 49.00 X X 0 323937 53305 CHRISTOPHER HICKEY FORMER VICE PRESIDENT 1.00 49.00 X 0 212356 36772 0 1146976 203243 0 1 1 0 0 0 0 0 0 0 0 0 0 1272781 557062 1272781 557062 0 0 X 0 0 0 0 1272781 557062 1272781 557062 1272781 557062 X 0 -715719 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 0 INVESTMENT IN MEDIQUEST 770498 C INVESTMENT IN EMT -213436 C 557062 X PART X, LINE 2: COMMUNITY PROVIDERS, INC. IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF VERMONT HEALTH NETWORK. PAGE 18 OF THE CONSOLIDATED FINANCIAL STATEMENTS CONTAINS 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 0 1 1 MICHELLE LEBEAU PRESIDENT 0 503752 0 64499 0 42432 0 84670 0 28496 0 723849 0 0 MATEJ KOLLAR VP/CFO 0 277133 0 23695 0 23109 0 19737 0 33568 0 377242 0 0 CHRISTOPHER HICKEY FORMER VICE PRESIDENT 0 201211 0 0 0 11145 0 11124 0 25648 0 249128 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 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 UNIVERSITY OF VERMONT HEALTH NETWORK IS THE SOLE MEMBER OF COMMUNITY PROVIDERS, INC.(CPI). FORM 990, PART VI, SECTION A, LINE 7A UNIVERSITY OF VERMONT HEALTH NETWORK MAY ELECT THE MEMBERS OF THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION PROVIDES AN ELECTRONIC COPY OF FORM 990 TO EACH BOARD MEMBER PRIOR TO 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 ORGANIZATION REQUIRES THAT MEMBERS HAVING A CONFLICT OF INTEREST WITH A TRANSACTION RECUSE THEMSELVES OF VOTING ON THE MATTER. PROPOSED AND ONGOING TRANSACTIONS ARE REVIEWED BY APPROPRIATE GROUPS OF INDIVIDUALS (COMMITTEES 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 ORGANIZATIONS 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 COMMITTTEE OF THE BOARD OF TRUSTEES, ENGAGING IN 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 FORMAT IS USED TO DETERMINE THE BASE COMPENSATION OF THE OTHER OFFICERS. NON-FIXED EARNINGS OF OTHER OFFICERS ARE BASED ON THE SUCCESS OF 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 XI, LINE 9: CHANGE IN INVESTMENT OF SUBSIDIARIES -715,719. 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 12D, III-O UVMHNMG 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 12901 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 CVPH MEDICAL CENTER FOUNDATION 75 BEEKMAN STREET PLATTSBURGH NY 12901 141727048 HLTH SVC COORD NY 501(C)(3) LINE 12C, III-FI CVPH 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 RD COLCHESTER VT 05446 030179603 HOME HEALTH CARE VT 501(C)(3) LINE 3 UVMHNMG 1 VMC INDEMNITY COMPANY INC 95 ST PAUL ST BURLINGTON VT 05401 831102018 INSURANCE VT 501(C)(3) LINE 3 1 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 ADMIN SVC 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 CHAMPLAIN VALLEY HEALTH NETWORK 75 BEEKMAN STREET PLATTSBURGH NY 12901 161586102 ADMIN SVC NY N/A C 1.00000 0 MEDIQUEST INC PO BOX 1656 PLATTSBURGH NY 12901 141663061 MED OFFICE LEASE NY N/A C 190435 1872475 1.00000 0 YANKEE MEDICAL INC 276 NORTH AVENUE BURLINGTON VT 05401 030225363 HOME MEDICAL EQUIPMENT VT N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0