2025-08-11T14:35:38-05:00 2024-09-30 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2023-10-01 141727048 CVPH FOUNDATION INC CVPH 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 1709647 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. 19 18 0 80 0 0 987678 960560 0 0 -69975 213298 59636 29546 977339 1203404 129778 95968 0 0 201008 212591 0 0 0 1218670 1240152 1549456 1548711 -572117 -345307 9024419 10817311 378117 1069308 8646302 9748003 THE GENEROSITY OF OUR CARING COMMUNITY ENABLES US TO ADVANCE INITIATIVES THAT ARE IMPORTANT TO THE HEALTH OF THE NORTH COUNTRY. 0 0 1410492 95968 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 224 FAMILIES MEETING THEIR TRAVEL EXPENSES INCURRED WHILE OBTAINING SPECIALIZED HEALTHCARE COVERED TRAVEL EXPENSES TO INCLUDE FUEL, FERRY TICKETS, FLIGHT COSTS, LODGING, AND FOOD. 3376 SUPPORT SERVICES RELATED TO TREATMENT AND CARE FOR PATIENTS UNDERGOING BREAST CANCER TREATMENT. 1413868 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 0 1 1 0 0 0 0 0 0 0 0 0 0 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 19 18 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 1 1 0 NY X MATEJ KOLLAR VPCFO 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 JULIE HUTTIG PRESIDENT 1.00 X X 0 0 0 JULIE KRAMER TREASURER 1.00 X X 0 0 0 PAIGE BOUYEA-RAVILLE VICE PRESIDENT 1.00 X X 0 0 0 RYAN BENNETT BOARD MEMBER 1.00 X 0 0 0 JUSTIN MEYER BOARD MEMBER 1.00 X 0 0 0 ELIZABETH MURRAY BOARD MEMBER 1.00 X 0 0 0 DANIELLE KING BOARD MEMBER 1.00 X 0 0 0 MICHAEL MCMAHON MD BOARD MEMBER 1.00 X 0 367626 35684 TAMAR WEERTS BOARD MEMBER 1.00 X 0 0 0 CHRIS AKEY BOARD MEMBER 1.00 X 0 0 0 TODD MCCARTHY BOARD MEMBER 1.00 X 0 0 0 TED SILL SECRETARY 1.00 X X 0 0 0 KRISTA JOCK BOULE BOARD MEMBER 1.00 X 0 0 0 JODY CARPENTER BOARD MEMBER 1.00 X 0 0 0 ADAM CROSLEY BOARD MEMBER 1.00 X 0 0 0 JUDY GUGLIELMO BOARD MEMBER 1.00 X 0 0 0 PAT LEARY BOARD MEMBER 1.00 X 0 0 0 VICKI MARKING 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 168605 0 43986 MICHELLE LEBEAU PRESIDENT & COO 2.00 48.00 X 0 610683 113166 MATEJ KOLLAR VP/CFO 2.00 48.00 X 0 323937 53305 CHRISTOPHER HICKEY FORMER SVP/CFO 0.00 X 0 212356 36772 168605 1514602 282913 1 1 1 0 0 960560 6153 960560 182511 182511 471222 440435 30787 30787 30787 95354 65808 29546 29546 1203404 0 0 242844 X 95968 95968 212591 212591 18743 18743 4816 4816 321033 318386 2647 20984 20984 29990 29990 125359 110105 15254 96064 96064 OTHER EXPENSES 401857 376540 25317 SUPPLIES 210101 203285 6816 BANK CHARGES 8799 8799 CATERING 2406 929 1477 1548711 1413868 134843 0 139687 100354 164235 813496 553351 18001 17365 452567 550489 3372877 9430653 4227791 864 9024419 10817311 7427 378117 1061881 378117 1069308 X 3874571 4915021 4771731 4832982 8646302 9748003 9024419 10817311 X -345307 1626737 -179729 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 4771739 530517 496586 965860 4832982 4755066 317723 578637 879687 4771739 4586863 1581240 -1139636 273401 4755066 4036100 682721 1012398 1144356 4586863 3674866 697228 439171 775165 4036100 0.09286 0.90714 0 1 1 0 BENEFICIAL INTEREST IN HEALTH NETWORK INVESTMENT POOL 9430653 F 9430653 GIFT ANNUITY PAYABLE 110052 OTHER LIABILITIES 274267 DEFERRED COMPENSATION 24436 DUE TO AFFILIATES 653126 1061881 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 18 OF THE CONSOLIDATED FINANCIAL STATEMENTS CONTAIN A FOOTNOTE INDICATING THAT NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED. SUMMER EVENT 95354 95354 16519 12296 27086 5090 4817 95354 95354 16519 12296 27086 5090 4817 65808 29546 1 TRAVEL SERVICES FOR HEALTHCARE OUT OF AREA 164 53586 ACTUAL COST METHOD ASSISTANCE TO EMPLOYEES IN FINANCIAL CRISIS 43 42382 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 X X X X X 0 1 1 0 0 0 0 0 1 1 MICHELLE LEBEAU PRESIDENT & COO 0 503752 0 64499 0 42432 0 84670 0 28496 0 723849 0 0 MICHAEL MCMAHON MD BOARD MEMBER 0 366948 0 0 0 678 0 19800 0 15884 0 403310 0 0 MATEJ KOLLAR VP/CFO 0 277133 0 23695 0 23109 0 19737 0 33568 0 377242 0 0 CHRISTOPHER HICKEY FORMER SVP/CFO 0 201211 0 0 0 11145 0 11124 0 25648 0 249128 0 0 KERRY HALEY ASSOCIATE VP OF PHILANTHRO 159057 0 9058 0 490 0 13620 0 30366 0 212591 0 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 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 FEES OR SERVICES: PROGRAM SERVICE EXPENSES 318,386. MANAGEMENT AND GENERAL EXPENSES 2,647. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 321,033. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS -179,729. 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