2026-06-25T10:08:05-05:00 2025-09-30 161226221 FUSTCHARLES LLP 220 S WARREN STREET SYRACUSE NY 13202 990 2024-10-01 273785445 LAKE CHAMPLAIN PHYSICIAN SERVICES PC LAKE 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 DR LISA MARK PRESIDENT 5185612000 2026-06-18 1 1 THOMAS J GIUFRE P00841958 3154463600 2026-06-18 2024 2025-03-06 01:10:19Z DR LISA MARK 75 BEEKMAN STREET PLATTSBURGH NY 12901 0 0 X WWW.CVPH.ORG X 2010 NY 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. 1 0 0 0 0 0 0 0 444 0 0 0 0 0 444 0 0 0 0 0 0 0 0 0 0 37211 5846 37211 5846 -36767 -5846 20000 20184 229898 235928 -209898 -215744 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. 0 0 5846 LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. PROVIDES GENERAL MEDICAL SERVICES TO PATIENTS. 5846 1 0 0 0 0 0 0 0 0 0 0 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 1 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 5185612000 75 BEEKMAN STREET PLATTSBURGH NY 12901 MICHELLE LEBEAU PRESIDENT/COO 2.00 48.00 X 0 729287 133642 MATEJ KOLLAR VP/CFO 2.00 48.00 X 0 375258 53427 DR LISA MARK CHIEF MEDICAL OFFICER 2.00 48.00 X 0 525284 53254 0 1629829 240323 0 0 1 0 0 0 0 0 0 4830 4830 1016 1016 5846 5846 0 0 20000 20184 20000 20184 229898 235928 229898 235928 X -209898 -215744 -209898 -215744 20000 20184 -5846 0 X 0 1 X 1 0 X X 1 CHAMPLAIN VALLEY PHYSICIANS 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 DUE TO RELATED PARTIES 235928 235928 X PART X, LINE 2: LAKE CHAMPLAIN PHYSICIAN SERVICES, PC IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS FOR THE UNIVERSITY OF VERMONT HEALTH NETWORK. PAGE 17 OF THE CONSOLIDATED FINANCIAL STATEMENTS CONTAINS A FOOTNOTE INDICATING THAT NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED. 1 0 1 0 0 0 0 0 0 1 1 MICHELLE LEBEAU PRESIDENT/COO 0 537948 0 160216 0 31123 0 94579 0 39063 0 862929 0 0 DR LISA MARK CHIEF MEDICAL OFFICER 0 443184 0 79754 0 2346 0 20700 0 32554 0 578538 0 0 MATEJ KOLLAR VP/CFO 0 293227 0 58290 0 23741 0 17241 0 36186 0 428685 0 0 PART I, LINE 3 LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. RELIED ON THE UNIVERSITY OF VERMONT HEALTH NETWORK ("UVM HEALTH NETWORK"), THE PARENT ORGANIZATION OF CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, TO ESTABLISH SENIOR EXECTUIVE COMPENSATION. UVM HEALTH NETWORK UTILIZED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION: - COMPENSATION COMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMITTEE PART I, LINE 4B DURING 2024, 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 2024 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 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 DR. LISA MARK IS THE SOLE VOTING MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE SHAREHOLDERS AGREEMENT, DR. LISA MARK, THE SOLE SHAREHOLDER AND DIRECTOR OF LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C., IS REQUIRED TO VOTE ALL OF HIS/HER SHARES TO ELECT, OR REMOVE, AS DIRECTORS THOSE INDIVIDUALS DESIGNATED BY THE BOARD OF DIRECTORS OF THE MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. 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 LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. HAS A WRITTEN CONFLICT OF INTEREST POLICY AS A PART OF ITS GOVERNING DOCUMENTS. THE 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 INDIVIUALS (COMMITTEES AND/OR LEVELS OF REVIEW) TO ENSURE THE BEST INTEREST OF THE HOSPITAL. 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 INTEREST FOR EACH ANNUAL PERIOD. FORM 990, PART VI, SECTION C, LINE 19 LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. PARTIES DESIRING COPIES OF SUCH DOCUMENTS MUST PRESENT THEMSELVES AT THE ADMINISTRATIVE OFFICES OF LAKE CHAMPLAIN PHYSICIAN SERVICES, P.C. OR BY SENDING A REQUEST IN WRITING TO THE ADMINISTRATIVE OFFICES. THE ORGANIZATION HAS INSTRUCTIONS POSTED ON ITS WEBSITE FOR THOSE SEEKING COPIES OF DOCUMENTS. 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