CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization: CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER (EIN 14-1338471)
Tax period: 2018-10-01 to 2019-09-30
Filed: 2020-08-17
IRS object ID: 202002309349301720
Schema version: 2018v3.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2020-08-17T11:07:08-05:00	ReturnTs
Tax Period End	2019-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	161226221	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	FUST CHARLES CHAMBERS LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	5784 WIDEWATERS PARKWAY	AddressLine1Txt
City	SYRACUSE	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	13214	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2018-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	141338471	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CHAMPLAIN VALLEY PHYSICIANS HOSPITAL	BusinessNameLine1Txt
Business Name Line2	MEDICAL CENTER	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	CHAM	BusinessNameControlTxt
Phone	5185612000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 BEEKMAN STREET	AddressLine1Txt
City	PLATTSBURGH	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12901	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CHRISTOPHER HICKEY	PersonNm
Person Title	VICE PRESIDENT OF FINANCE	PersonTitleTxt
Phone	5185612000	PhoneNum
Signature	2020-08-17	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	THOMAS J GIUFRE	PreparerPersonNm
PTIN	P00841958	PTIN
Phone	3154463600	PhoneNum
Preparation	2020-08-17	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	45.47.55.42	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2020-08-17	IPDt
IP Tm	06:43:39	IPTm
IP Timezone	ED	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	DA39A3EE5E6B4B0D3255BFEF95601890AFD80709	AtSubmissionCreationDeviceId
At Submission Filing Device Id	6C6D92B252C939303AFEF40D396F39D1F437D1B1	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2018	TaxYr
Build TS	2020-09-23 17:36:50Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	CHRISTOPHER HICKEY	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 BEEKMAN STREET	AddressLine1Txt
City	PLATTSBURGH	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12901	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$370,724,124	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.CVPH.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1903	FormationYr
Legal Domicile State	NY	LegalDomicileStateCd
Activity Or Mission	CVPH MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTH CARE FOR THE NORTH COUNTRY REGION IN UPSTATE NEW YORK.	ActivityOrMissionDesc
Voting Members Governing Body	13	VotingMembersGoverningBodyCnt
Voting Members Independent	13	VotingMembersIndependentCnt
Total Employee	2749	TotalEmployeeCnt
Total Volunteers	334	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,970,499	PYContributionsGrantsAmt
CY Contributions Grants	$3,689,903	CYContributionsGrantsAmt
PY Program Service Revenue	$345,657,501	PYProgramServiceRevenueAmt
CY Program Service Revenue	$359,656,410	CYProgramServiceRevenueAmt
PY Investment Income	$1,817,087	PYInvestmentIncomeAmt
CY Investment Income	$61,023	CYInvestmentIncomeAmt
PY Other Revenue	$6,518,782	PYOtherRevenueAmt
CY Other Revenue	$6,688,906	CYOtherRevenueAmt
PY Total Revenue	$355,963,869	PYTotalRevenueAmt
CY Total Revenue	$370,096,242	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$218,518,693	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$230,681,100	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$143,345,874	PYOtherExpensesAmt
CY Other Expenses	$142,912,956	CYOtherExpensesAmt
PY Total Expenses	$361,864,567	PYTotalExpensesAmt
CY Total Expenses	$373,594,056	CYTotalExpensesAmt
PY Revenues Less Expenses	-$5,900,698	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$3,497,814	CYRevenuesLessExpensesAmt
Total Assets BOY	$217,442,781	TotalAssetsBOYAmt
Total Assets EOY	$225,721,877	TotalAssetsEOYAmt
Total Liabilities BOY	$158,364,583	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$189,423,030	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$59,078,198	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$36,298,847	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	CVPH MEDICAL CENTER'S MISSION IS TO PROVIDE QUALITY HEALTHCARE FOR THE NORTH COUNTRY REGION IN UPSTATE NEW YORK.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$275,598,144	ExpenseAmt
Revenue	$366,435,550	RevenueAmt
Desc	CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER (CVPH)IS A 300 BED ACUTE CARE HOSPITAL AND 54 BED SKILLED NURSING FACILITY. CVPH PROVIDES COMPREHENSIVE MEDICAL AND SURGICAL SERVICES TO THE NORTHERN NEW YORK STATE REGION, REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. DURING 2019, CVPH PROVIDED 66,350 PATIENT DAYS OF CARE TO ITS 9,631 ADMISSIONS, AND 44,807 EMERGENCY CARE CENTER VISITS. DURING THE YEAR, 18,134 SURGICAL PROCEDURES WERE PERFORMED. 753 BIRTHS OCCURRED IN CVPH FACILITIES. CVPH EMPLOYS MORE THAN 2,700 INDIVIDUALS. IN ADDITION, THE HOSPITAL HAS 179 MEMBERS OF ITS MEDICAL STAFF, 94% OF WHICH ARE BOARD CERTIFIED. THE HOSPITAL IS JOINT COMMISSION ACCREDITED AND LICENSED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. IN ADDITION TO ITS MAIN CAMPUS, CVPH OPERATES SEVERAL OUTPATIENT FACILITIES WHERE SERVICES ARE PROVIDED TO ITS PATIENTS INCLUDING: AMBULATORY SURGERY, PHYSICAL AND OCCUPATIONAL THERAPY, REHABILITATION, RENAL DIALYSIS, AND DIAGNOSTIC IMAGING. CVPH ALSO OPERATES HEALTH CLINICS LOCATED IN OUTLYING GEOGRAPHIC AREAS, TO BETTER SERVE THE HEALTH NEEDS OF CVPH'S RURAL COMMUNITY SERVICE AREA. THROUGH ITS VARIOUS LOCATIONS, OUTREACH ACTIVITIES, AND SUPPORT GROUPS, CVPH IS ACTIVE IN THE COMMUNITY IN PROMOTING HEALTH AND WELLNESS OF THE BODY, MIND, AND SPIRIT. CVPH PROVIDES ONGOING MEDICAL EDUCATION TO ITS MEDICAL STAFF, IN ADDITION TO OFFERING AN X-RAY TECHNOLOGY PROGRAM FOR ENROLLED STUDENTS. CVPH MAINTAINS A COMPREHENSIVE MEDICAL LIBRARY AND HAVE MADE AVAILABLE WEB-BASED LINKS FOR THE COMMUNITY TO EASILY ACCESS HEALTH AND WELLNESS INFORMATION AND EDUCATIONAL MATERIALS. CVPH ACCEPTS NUMEROUS INSURANCE PLANS, AND IS MEDICARE AND MEDICAID APPROVED. ADDITIONALLY, CVPH HAS A CHARITY CARE POLICY TO ACCOMMODATE PATIENTS WHOSE FINANCIAL MEANS ARE WITHIN SPECIFIED GUIDELINES.	Desc
Total Program Service Expenses	$275,598,144	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (1)	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	0	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	135	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	2749	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	13	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	NY	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	CHRISTOPHER HICKEY VICE PRESIDENT	PersonNm
Phone	5185612000	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 BEEKMAN STREET	AddressLine1Txt
City	PLATTSBURGH	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12901	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
ROBERT BENAK MD
EX-OFFICIO	1.00	Yes (X)	$0	$0	$0
JOHN BERNARDI
CHAIR	1.00	Yes (X)	$0	$0	$0	Yes (X)
ALEXANDER EDWARDS
TREASURER	1.00	Yes (X)	$0	$0	$0	Yes (X)
BETSY VINCENCIO
VICE CHAIR	1.00	Yes (X)	$0	$0	$0	Yes (X)
DAVID ANDERSON MD
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
JOANN GLEESON-KREIG PHD
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
JOSEPH DONNERY DPM
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
VICTORIA ZINSER DULEY
SECRETARY	1.00	Yes (X)	$0	$0	$0	Yes (X)
PAOLO FEDI MD
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
NEIL FESSETTE
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
PAUL GRASSO
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
VICKI MARKING
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
THOMAS RECNY
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
AMY SENECAL
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
WOUTER RIETSEMAMD
CHIEF QUALITY AND INFOR.	48.00		$638,918	$0	$45,472	Yes (X)	2.00
KENT HALL
CHIEF MEDICAL OFFICER	48.00		$698,861	$0	$33,361	Yes (X)	2.00
MICHELLE LEBEAU
PRESIDENT/COO	48.00		$758,620	$0	$39,374	Yes (X)	2.00
SCOTT ST GEORGE
FORMER VICE PRESIDENT OF FINANCE	30.00		$339,582	$0	$11,421	Yes (X)	20.00
CHRISTOPHER HICKEY
VICE PRESIDENT OF FINANCE	30.00		$0	$0	$0	Yes (X)	20.00
STEPHANE MULLIGAN
ORTHOPEDIC SURGEON	45.00		$124,950	$0	$8,893			Yes (X)
CHARLES VOLK
ORTHOPEDIC SURGEON	45.00		$153,652	$0	$7,308			Yes (X)
FRANKLIN BERTUCH
ANESTHESIOLOGIST	40.00		$331,800	$0	$26,872			Yes (X)
VIVIAN MEJIAS
ANESTHESIOLOGIST	40.00		$260,745	$0	$10,708			Yes (X)
LOIUS-PHILIPPE CHARETTE
PHYSICIAN	40.00		$253,541	$0	$6,375			Yes (X)
STEPHENS MUNDY
FORMER PRESIDENT/CEO	30.00		$2,254,418	$0	$43,625		20.00		Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$5,815,087	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$233,409	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	251	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
MAYO COLLABORATIVE SERVICES
200 FIRST STREET SOUTHWEST	ROCHESTER	MN	55905	LABORATORY	$1,110,971
E4H - ENVIRONMENTS FOR HEALTH
185 TOLCOTT RD	WILLISTON	VT	05495	ARCHITECTURAL SERVICES	$440,094
HUDSON HEADWATERS HEALTH NETWORK
9 CAREY RD	QUEENSBURY	NY	12804	THIRD PARTY ADMINISTRATOR	$369,177
NIXON PEABODY LLP
PO BOX 28012	NEW YORK	NY	100878012	LEGAL	$296,866
SUNY PLATTSBURGH SPEECH AND HEARING
101 BROAD STREET	PLATTSBURGH	NY	12901	SPEECH PATHOLOGY	$210,414

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	21	CntrctRcvdGreaterThan100KCnt
Related Organizations	$200,000	RelatedOrganizationsAmt
Government Grants	$3,489,903	GovernmentGrantsAmt
Total Contributions	$3,689,903	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE	621990	$347,556,182	$347,556,182
340B REVENUE	611430	$10,467,400	$10,467,400
LABORATORY DIAGNOSTIC & CLINICAL	621500	$797,506	$797,506
BLOOD BANK	621500	$566,728	$566,728
DIALYSIS	621500	$268,594	$268,594

Field	Value	IRS element (for citing)
Total Program Service Revenue	$359,656,410	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$40,296	TotalRevenueColumnAmt
Exclusion	$40,296	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$44,374	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$134,608	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	-$90,234	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$90,234	TotalRevenueColumnAmt
Exclusion	-$90,234	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$514,001	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$493,274	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$20,727	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$20,727	TotalRevenueColumnAmt
Exclusion	$20,727	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CAFETERIA SALES	900099	$1,760,998	$1,760,998
WELLNESS CENTER	900099	$889,250	$889,250
MED SURG SUPPLIES	900099	$173,211	$173,211

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,955,681	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,955,681	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$6,779,140	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$370,096,242	TotalRevenueColumnAmt
Related Or Exempt Func Income	$366,435,550	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	-$29,211	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$2,565,610	TotalAmt
Program Services	$2,047,419	ProgramServicesAmt
Management And General	$518,191	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$173,079,997	TotalAmt
Program Services	$136,808,901	ProgramServicesAmt
Management And General	$36,271,096	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$12,497,533	TotalAmt
Program Services	$10,997,829	ProgramServicesAmt
Management And General	$1,499,704	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$31,887,441	TotalAmt
Program Services	$30,016,771	ProgramServicesAmt
Management And General	$1,870,670	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$10,650,519	TotalAmt
Management And General	$10,650,519	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$12,479,250	TotalAmt
Program Services	$12,088,377	ProgramServicesAmt
Management And General	$390,873	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$654,539	TotalAmt
Management And General	$654,539	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$236,110	TotalAmt
Management And General	$236,110	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$12,545	TotalAmt
Management And General	$12,545	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$17,409,201	TotalAmt
Program Services	$6,131,710	ProgramServicesAmt
Management And General	$11,277,491	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$594,799	TotalAmt
Program Services	$88,668	ProgramServicesAmt
Management And General	$506,131	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$602,645	TotalAmt
Program Services	$437,129	ProgramServicesAmt
Management And General	$165,516	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$1,944,887	TotalAmt
Program Services	$1,186,495	ProgramServicesAmt
Management And General	$758,392	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$1,173,345	TotalAmt
Program Services	$654,819	ProgramServicesAmt
Management And General	$518,526	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$2,370,067	TotalAmt
Management And General	$2,370,067	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$15,438,138	TotalAmt
Management And General	$15,438,138	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$3,190,930	TotalAmt
Management And General	$3,190,930	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
SUPPLIES	$58,097,657	$56,625,341	$1,472,316
BAD DEBTS	$8,599,644	$8,599,644
MAINTENANCE & REPAIRS	$7,570,161	$4,536,132	$3,034,029
UTILITIES	$2,249,694	$265,101	$1,984,593

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$10,289,344	TotalAmt
Program Services	$5,113,808	ProgramServicesAmt
Management And General	$5,175,536	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$373,594,056	TotalAmt
Program Services	$275,598,144	ProgramServicesAmt
Management And General	$97,995,912	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$4,867,229	BOYAmt
EOY	$2,540,774	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$42,888,793	BOYAmt
EOY	$50,304,741	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$6,245,337	BOYAmt
EOY	$6,864,715	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$1,736,663	BOYAmt
EOY	$2,892,542	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$211,720,955	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$106,607,210	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$102,821,564	BOYAmt
EOY	$105,113,745	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$50,267,182	BOYAmt
EOY	$49,842,413	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$8,616,013	BOYAmt
EOY	$8,162,947	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$217,442,781	BOYAmt
EOY	$225,721,877	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$24,246,773	BOYAmt
EOY	$29,165,602	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$29,470,000	BOYAmt
EOY	$27,975,308	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$25,393,152	BOYAmt
EOY	$29,892,985	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$79,254,658	BOYAmt
EOY	$102,389,135	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$158,364,583	BOYAmt
EOY	$189,423,030	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$55,815,361	BOYAmt
EOY	$33,105,335	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,918,894	BOYAmt
EOY	$1,849,569	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,343,943	BOYAmt
EOY	$1,343,943	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$59,078,198	BOYAmt
EOY	$36,298,847	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$217,442,781	BOYAmt
EOY	$225,721,877	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$3,497,814	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$14,120	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	-$19,295,657	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$37,078,542	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,095,690	InvestmentEarningsOrLossesAmt
Other Expenditures	$2,237,948	OtherExpendituresAmt
Administrative Expenses	$4,084	AdministrativeExpensesAmt
End Year Balance	$35,932,200	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$34,780,589	BeginningYearBalanceAmt
Contributions	$2,271,004	ContributionsAmt
Investment Earnings Or Losses	$33,273	InvestmentEarningsOrLossesAmt
Administrative Expenses	$6,324	AdministrativeExpensesAmt
End Year Balance	$37,078,542	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$33,237,051	BeginningYearBalanceAmt
Investment Earnings Or Losses	$3,475,138	InvestmentEarningsOrLossesAmt
Administrative Expenses	$1,931,600	AdministrativeExpensesAmt
End Year Balance	$34,780,589	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$30,409,963	BeginningYearBalanceAmt
Investment Earnings Or Losses	$2,998,228	InvestmentEarningsOrLossesAmt
Other Expenditures	$108,488	OtherExpendituresAmt
Administrative Expenses	$62,652	AdministrativeExpensesAmt
End Year Balance	$33,237,051	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$30,540,658	BeginningYearBalanceAmt
Contributions	$722,012	ContributionsAmt
Investment Earnings Or Losses	-$760,034	InvestmentEarningsOrLossesAmt
Administrative Expenses	$92,673	AdministrativeExpensesAmt
End Year Balance	$30,409,963	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.91110	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	0.03740	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.05150	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	Yes (1)	EndowmentsHeldRelatedOrgInd
Related Org List Sch R	Yes (1)	RelatedOrgListSchRInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$3,280,000	OtherCostOrOtherBasisAmt
Book Value	$3,280,000	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$89,293,780	OtherCostOrOtherBasisAmt
Depreciation	$35,021,979	DepreciationAmt
Book Value	$54,271,801	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,933,678	OtherCostOrOtherBasisAmt
Depreciation	$1,019,914	DepreciationAmt
Book Value	$1,913,764	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$106,801,450	OtherCostOrOtherBasisAmt
Depreciation	$69,039,816	DepreciationAmt
Book Value	$37,761,634	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$9,412,047	OtherCostOrOtherBasisAmt
Depreciation	$1,525,501	DepreciationAmt
Book Value	$7,886,546	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$105,113,745	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (7 entries)

DescDesc	AmtAmt
DEFERRED COMPENSATION PLAN	$6,017,119
ACCRUED PENSION COSTS	$54,061,290
DUE TO RELATED PARTIES	$23,837,492
SWAP AGREEMENT LIABILITY	$9,567,661
L-T COMPENSATION RELATED	$5,939,156
ESTIMATED THIRD PARTY SETTLEMENTS	$2,792,500
OTHER LIABILITIES	$173,917

Field	Value	IRS element (for citing)
Total Liability	$102,389,135	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART V, LINE 4:

CERTAIN BOARD-DESIGNATED FUNDS HAVE BEEN ESTABLISHED TO MEET SPECIFIC CURRENT AND FUTURE NEEDS OF THE HOSPITAL OR TO ADEQUATELY DISCHARGE FUTURE LIABILITES. THESE FUNDS INCLUDE THE PLANT AND CAPITAL IMPROVEMENT FUNDS, WHICH ARE DESIGNATED FOR SPECIFIC PROJECTS SUCH AS THE SURGICAL CENTER CONSTRUCTION, AND DESIGNATED FUNDS FOR BOTH SELF-INSURANCE AND FOR CVPH'S VARIOUS EMPLOYEE BENEFIT PLANS. TEMPORARILY RESTRICTED NET ASSETS ARE INTENDED FOR THE PURCHASE OF PROPERTY AND EQUIPMENT. PERMANENTLY RESTRICTED NET ASSETS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES, INCLUDING MEDICAL SERVICES PROVIDED TO CHILDREN, AND PROVIDING FOR CHARITY CARE.

PART X, LINE 2:

THE SYSTEM IS INCORPORATED AND RECOGNIZED BY THE INTERNAL REVENUE SERVICE ("IRS") AS TAX-EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). ACCORDINGLY, THE IRS HAS DETERMINED THAT THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS OF SEPTEMBER 30, 2019 AND 2018, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR THE SYSTEM. THE SYSTEM ACCOUNTS FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH ACCOUNTING STANDARDS CODIFICATION (ASC) 740 INCOME TAXES, WHICH ADDRESSES HOW TO ACCOUNT FOR AND REPORT THE EFFECTS OF TAXES BASED ON INCOME. NO PROVISION FOR UNCERTAIN TAX POSITIONS IS RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE TAX YEARS OPEN TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES ARE 2016 THROUGH 2019.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,203,965	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,203,965	NetCommunityBenefitExpnsAmt
Total Expense	0.00330	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$53,350,635	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$25,247,145	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$28,103,490	NetCommunityBenefitExpnsAmt
Total Expense	0.07700	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$54,554,600	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$25,247,145	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$29,307,455	NetCommunityBenefitExpnsAmt
Total Expense	0.08030	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$5,033,075	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,952,380	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,080,695	NetCommunityBenefitExpnsAmt
Total Expense	0.00570	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,415,442	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,415,442	NetCommunityBenefitExpnsAmt
Total Expense	0.00660	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$36,302,707	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$20,157,046	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$16,145,661	NetCommunityBenefitExpnsAmt
Total Expense	0.04420	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$43,751,224	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$23,109,426	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$20,641,798	NetCommunityBenefitExpnsAmt
Total Expense	0.05650	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$98,305,824	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$48,356,571	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$49,949,253	NetCommunityBenefitExpnsAmt
Total Expense	0.13680	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$3,008,155	BadDebtExpenseAmt
Bad Debt Expense Attributable	$1,203,262	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$98,113,771	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$117,733,631	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$19,619,860	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

Field	Value	IRS element (for citing)
Business Name Line1	1 PET SCAN LLC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Primary Activities	IMAGING SERVICES	PrimaryActivitiesTxt
Org Profit Or Ownership	0.49000	OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership	0.00000	OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership	0.51000	PhysiciansProfitOrOwnershipPct

Field	Value	IRS element (for citing)
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	75 BEEKMAN ST	AddressLine1Txt
City	PLATTSBURGH	CityNm
State Abbreviation	NY	StateAbbreviationCd
ZIP	12901	ZIPCd

Field	Value	IRS element (for citing)
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Teaching Hospital	Yes (X)	TeachingHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	Yes (1)	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	Yes (1)	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	HTTPS://WWW.CVPH.ORG/DATA/FILES/CHNA%20FILES/CHA-COMPRESSED%2012%2030%2019.	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	HTTP://WWW.CLINTONHEALTH.ORG/PDF%20FILES/CHA.PDF	OtherWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTPS://WWW.CVPH.ORG/DATA/FILES/CHNA%20FILES/CSP-COMPRESSED%2012%2030%2019.	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	150.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	HTTP://WWW.CVPH.ORG	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	HTTP://WWW.CVPH.ORG	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	HTTP://WWW.CVPH.ORG	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare	Yes (X)	LookBackMedicareInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED	PART V, SECTION B, LINE 5: TO REACH THIS CONCLUSION, THE UNIVERSITY OF VERMONT HEALTH NETWORK- CHAMPLAIN VALLEY PHYSICIANS HOSPITAL (CVPH) AND CLINTON COUNTY HEALTH DEPARTMENT (CCHD), LEAD ENTITIES IN THE PROCESS, FACILITATED/ COMPLETED THE FOLLOWING ACTIVITIES WITH THE CLINTON COUNTY COMMUNITY: TWO COMMUNITY BASED, HEALTH FOCUSED SURVEYS; A REVIEW OF OVER 300 HEALTH INDICATORS AND A SECONDARY DATA ANALYSIS; A COMMUNITY HEALTH PRIORITY SETTING SESSION; A PRIORITY AND FOCUS AREA FINALIZATION PROCESS; AND CREATION OF SHARED ACTION PLANS.HEALTH INDICATORS FROM SCORES OF RESOURCES WERE CONSIDERED IN THE PROCESS, INCLUDING DATA FROM THE NYS PREVENTION AGENDA DASHBOARD, COMMUNITY HEALTH INDICATOR REPORTS, NYS OFFICE OF MENTAL HEALTH, DIVISION OF CRIMINAL JUSTICE SERVICES, NYS EXPANDED BEHAVIORAL RISK FACTOR SURVEY, USDA ECONOMIC RESEARCH SERVICE, AMERICAN COMMUNITY SURVEY, HEALTH RESOURCES AND SERVICES ADMINISTRATION, CENTER FOR HEALTH WORKFORCE STUDIES AND OTHERS. LOCALLY GENERATED AND/ OR COLLECTED DATA WERE ALSO CONSIDERED, WHEN AVAILABLE. PRIMARY DATA INCLUDED FEEDBACK FROM RESIDENT SURVEYS RELATED TO HEALTH, SOCIAL AND ENVIRONMENTAL CONCERNS AS WELL AS QUALITATIVE PROGRAM DATA FROM VARIOUS COMMUNITY BASED ORGANIZATIONS AND CCHD. PARTICIPATION IN HEALTH PRIORITY SELECTION REPRESENTED AT LEAST ELEVEN DISTINCT COMMUNITY SECTORS INCLUDING HEALTHCARE (CLINICAL, POPULATION AND PUBLIC HEALTH), BUSINESS, COMMUNITY BASED ORGANIZATION/SERVICE, HOUSING, HUMAN SERVICES, AND MENTAL/BEHAVIORAL HEALTH. THESE VERY PARTNERS CONTRIBUTE ACTIVITIES AND RESOURCES TO CREATE LOCAL ACTION PLANS. THE RESULTING ACTION PLANS FEATURE IN-PROGRESS AND PLANNED WORK RELATED TO THE SELECTED HEALTH PRIORITIES AND INTENDED TO ALTER HEALTH OUTCOMES FOR THE BETTER OF ALL RESIDENTS. FEATURED INTERVENTIONS REFLECT A RANGE OF ACTIVITIES AND APPROACHES THAT FALL ACROSS THE HEALTH IMPACT PYRAMID AND INCLUDE SERVICE INFRASTRUCTURE, PROGRAM DEVELOPMENT, EDUCATION AND CROSS-SECTOR COLLABORATIONS.
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED	PART V, SECTION B, LINE 6A: CVPH IS PART OF THE ADIRONDACK RURAL HEALTH NETWORK. ADIRONDACK RURAL HEALTH NETWORK: THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) IS A PROGRAM OF THE ADIRONDACK HEALTH INSTITUTE, INC. (AHI). AHI IS A JOINT VENTURE OF ADIRONDACK HEALTH (ADIRONDACK MEDICAL CENTER), UNIVERSITY OF VERMONT HEALTH NETWORK - CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, GLENS FALLS HOSPITAL AND HUDSON HEADWATERS HEALTH NETWORK. THE MISSION OF AHI IS TO PROMOTE, SPONSOR, AND COORDINATE INITIATIVES AND PROGRAMS THAT IMPROVE HEALTHCARE QUALITY, ACCESS, AND SERVICE DELIVERY IN THE ADIRONDACK REGION.THE ADIRONDACK RURAL HEALTH NETWORK (ARHN) PROVIDES A FORUM FOR LOCAL PUBLIC HEALTH SERVICES, COMMUNITY HEALTH CENTERS, HOSPITALS, COMMUNITY MENTAL HEALTH PROGRAMS, EMERGENCY MEDICAL SERVICES, AND OTHER COMMUNITY-BASED ORGANIZATIONS TO ADDRESS RURAL HEALTHCARE DELIVERY BARRIERS, IDENTIFY REGIONAL HEALTH NEEDS AND SUPPORT THE NYS PREVENTION AGENDA TO IMPROVE HEALTH CARE IN THE REGION. THE ARHN REGION INCLUDES NEW YORK'S CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, AND WASHINGTON COUNTIES.SINCE 2002, ARHN HAS BEEN RECOGNIZED AS THE LEADING SPONSOR OF FORMAL COMMUNITY HEALTH PLANNING IN THE REGION WORKING WITH SEVERAL LOCAL HEALTH DEPARTMENTS. THE COMMUNITY HEALTH ASSESSMENT (CHA) COMMITTEE, FACILITATED BY ARHN, IS MADE UP OF HOSPITALS AND COUNTY HEALTH DEPARTMENTS WORKING TOGETHER UTILIZING A SYSTEMATIC APPROACH TO COMMUNITY HEALTH PLANNING. THE CHA COMMITTEE IS MADE UP OF MEMBERS FROM ADIRONDACK HEALTH, ALICE HYDE MEDICAL CENTER, ELIZABETHTOWN COMMUNITY HOSPITAL, ESSEX COUNTY PUBLIC HEALTH, FRANKLIN COUNTY PUBLIC HEALTH, FULTON COUNTY PUBLIC HEALTH, GLENS FALLS HOSPITAL, HAMILTON COUNTY PUBLIC HEALTH SERVICES, MOSES LUDINGTON HOSPITAL & INTER-LAKES HEALTH, NATHAN LITTAUER HOSPITAL, UVM HEALTH NETWORK - CVPH, WARREN COUNTY HEALTH SERVICES, AND WASHINGTON COUNTY PUBLIC HEALTH SERVICES.
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED	PART V, SECTION B, LINE 6B: THE CHNA IS A JOINT EFFORT WITH THE CLINTON COUNTY HEALTH DEPARTMENT. IN ADDITION, CLINTON COUNTY ACTION FOR HEALTH CONSORTIUM IS A KEY PART OF THE PROCESS, AND THEIR PURPOSE IS DESCRIBED BELOW.CLINTON COUNTY ACTION FOR HEALTH CONSORTIUM: THE CLINTON COUNTY ACTION FOR HEALTH (AFH) CONSORTIUM IS A MULTI-SECTOR, MULTI-DISCIPLINARY COLLECTION OF LOCAL HEALTH SYSTEM PARTNERS WORKING TOWARDS COMMUNITY HEALTH IMPROVEMENT AND FACILITATED BY CCHD. THE PRIMARY WORK OF THE GROUP HAS BEEN BUILT AROUND DATA DRIVEN IDENTIFIED NEEDS (NYS PREVENTION AGENDA) AND AVAILABLE COMMUNITY RESOURCES. PARTNERS IN THE EFFORT INCLUDE: MUNICIPALITIES, BUSINESSES, GRASSROOTS COMMUNITY GROUPS, HEALTH CARE PROVIDERS, THE LOCAL HOSPITAL, CHAMBER OF COMMERCE, HUMAN SERVICE AGENCIES, SCHOOLS AND LOCAL NOT-FOR-PROFITS. THE GROUP HAS EXISTED FOR OVER A DECADE AND PRESENTLY HAS APPROXIMATELY FORTY MEMBERS THAT HAVE FORMALLY COMMITTED TO ITS PURPOSE BY SIGNING AFH PARTNERSHIP LETTERS. RECRUITMENT OF NEW MEMBERS IS ONGOING. THE AFH CONSORTIUM HAS INCREASED COMMUNITY OWNERSHIP AND COMMITMENT TO THE SHARED HEALTH IMPROVEMENT GOALS AND TO THE WORK CAPTURED IN THE CHIP. IN FACILITATING THESE EFFORTS, THE CCHD HAS STRENGTHENED ITS ABILITY TO LEVERAGE RESOURCES FROM PUBLIC HEALTH PARTNERS AND PRIVATE ENTITIES ALIKE. SIGNIFICANT PROGRESS ON THE COUNTY'S CHIP HAS BEEN MADE CAPITALIZING ON THIS SYSTEM OF PARTNERSHIP CREATED THROUGH THE CONSORTIUM. THE AFH CONSORTIUM MEETS PERIODICALLY FOR UPDATES, ISSUE DISCUSSION, AND INFORMATION SHARING. A MINIMUM OF SIX MEETING ARE SCHEDULED EACH YEAR, WITH ADDITIONAL GATHERINGS SCHEDULED AS NEEDED. SUBCOMMITTEES OF MEMBERS WITH EXPERTISE RELATED TO SELECTED PRIORITY AREAS MEET MORE FREQUENTLY AND KEEP THE GROUP APPRISED OF THEIR WORK. CCHD TRACKS PROGRESS ON THE CHIP CONTINUALLY AND PREPARES A YEAR-END REPORT WHICH INCLUDES UPDATES ON WORK RELATED TO THE TWO FEATURED PRIORITY AREAS AND A SUMMARY OF ACCOMPLISHMENTS BY LOCAL PARTNERS RELATED TO EACH OF THE NYSDOH PREVENTION PLAN PRIORITY AREAS. CAPTURED ACTIVITIES DEMONSTRATE WORK ON ALL TIERS OF THE PUBLIC HEALTH IMPACT PYRAMID. MORE INFORMATION ON THE PUBLIC HEALTH PYRAMID IS INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN.CVPH IS PART OF THE ADIRONDACK RURAL HEALTH NETWORK (ARHN). ARHN IS A PROGRAM OF THE ADIRONDACK HEALTH INSTITUTE, INC. (AHI). AHI IS A JOINT VENTURE OF ADIRONDACK MEDICAL CENTER, UVMHN-CVPH, GLENS FALLS HOSPITAL, AND HUDSON HEADWATERS HEALTH NETWORK. THE MISSION OF AHI IS TO PROMOTE, SPONSOR, AND COORDINATE INITIATIVES AND PROGRAMS THAT IMPROVE HEALTHCARE QUALITY, ACCESS, AND SERVICE DELIVERY IN THE ADIRONDACK REGION. ARHN PROVIDES A FORUM FOR LOCAL PUBLIC HEALTH SERVICES, COMMUNITY HEALTH CENTERS, COMMUNITY MENTAL HEALTH PROGRAMS, EMERGENCY MEDICAL SERVICES, AND OTHER COMMUNITY-BASED ORGANIZATIONS TO ADDRESS RURAL HEALTHCARE DELIVERY BARRIERS, IDENTIFY REGIONAL HEALTH NEEDS AND SUPPORT THE NYS PREVENTION AGENDA TO IMPROVE CARE IN THE REGION. THE ARHN REGION INCLUDES NEW YORK'S CLINTON, ESSEX, FRANKLIN, FULTON, HAMILTON, WARREN, AND WASHINGTON COUNTIES. CLINTON COUNTY HEALTH DEPARTMENT (ALONG WITH OTHER COUNTIES) PLAYS AN ACTIVE ROLE IN ARHN AS WELL.
CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MED	PART V, SECTION B, LINE 11: THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY WERE IDENTIFIED AS FOLLOWS, MODELED AFTER THE NEW YORK STATE PREVENTION AGENDA:1. PREVENT CHRONIC DISEASESA. FOCUS AREA 1: HEALTHY EATING AND FOOD SECURITYB. FOCUS AREA 3: TOBACCO PREVENTIONC. FOCUS AREA 4: CHRONIC DISEASE PREVENTIVE CARE AND MANAGEMENT2. PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE USE DISORDERSA. FOCUS AREA 1: WELL-BEINGB. FOCUS AREA 2: MENTAL AND SUBSTANCE USE DISORDERS AND PREVENTION3. DISPARITY TO FOCUS ON: LOW INCOME POPULATION

Field	Value	IRS element (for citing)
Facility	8	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (8 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - CVPH AMBULATORY SURGERY CENTER
77 PLAZA BLVD	PLATTSBURGH	NY	12901	AMBULATORY SURGERY
3 - CVPH DIAGNOSTIC CENTER
89 PLAZA BLVD	PLATTSBURGH	NY	12901	LAB & IMAGING SERVICES
4 - CVPH REHABILITATION - DEGRANDPRE WAY
16 DEGRANDPRE WAY	PLATTSBURGH	NY	12901	PHYSICAL THERAPY
5 - CVPH REHABILITATION - TOM MILLER RD
TOM MILLER RD	PLATTSBURGH	NY	12901	PHYSICAL THERAPY
6 - NORTH COUNTRY REGIONAL BLOOD DONOR CENTE
85 PLAZA BOULEVARD	PLATTSBURGH	NY	12901	BLOOD DONATION CENTER
7 - CVPH SPORTS MEDICAL AND REHABILITATION
295 NEW YORK RD	PLATTSBURGH	NY	12901	PHYSICAL AND OCCUPATIONAL THERAPY, EXERCISE AND WELLNESS
8 - FAMILY MEDICINE CENTER
159 MARGARET STREET SUITE 100	PLATTSBURGH	NY	12901	PRIMARY CARE
9 - MOBILE HEALTH SCREENING VAN
75 BEEKMAN ST	PLATTSBURGH	NY	12901	LAB AND DIAGNOSTIC IMAGING

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 7:	IN ACCORDANCE WITH THE IRS INSTRUCTIONS, CVPH USED THE RATIO OF COST TO CHARGES TO CALCULATE COSTS. SPECIFICALLY, THE FACILITY'S TOTAL EXPENSES FROM PART IX LINE 25 OF $373,594,056 LESS COMMUNITY BENEFIT EXPENSES OF $5,033,075 WAS USED TO DETERMINE THE 2019 RCC PERCENTAGE. THE GROSS CHARITY CARE WRITE OFFS WAS OBTAINED FROM OUR REVENUE REPORTS AND TO WHICH THE CALCULATED RCC APPLIED. LINE 7(E): CLINTON COUNTY NY IS DESIGNATED AS A HEALTHCARE PROFESSIONAL SHORTAGE AREA (HPSA) FOR PRIMARY CARE. TO HELP ALLEVIATE THE LACK OF ACCESS TO PRIMARY CARE IN THE COUNTY AND SURROUNDING AREA, CVPH HAS BEEN OPERATING A HEALTH CENTER CLINIC TO PROVIDE MEDICAL TREATMENT FOR THIS AT RISK POPULATION. DURING 2019, THE CLINIC HAD IN EXCESS OF 20,000 PATIENT ENCOUNTERS WITH A PAYER MIX OF 81% MEDICAID AND MEDICARE, 16% COMMERCIAL, 1% SELF PAY AND 2% OTHER. PART 1 LINE 7, COLUMN F: AMOUNT OF BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX LINE 25 COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR PURPOSES OF CALCULATING THE RCC PERCENTAGE WAS $8,599,644 AS REFLECTED ON PART IX LINE 24(B)
PART I, LN 7 COL(F):	AMOUNT OF BAD DEBT EXPENSE INCLUDED IN FORM 990 PART IX LINE 25 COLUMN (A), BUT REMOVED FROM THIS FIGURE FOR PURPOSES OF CALCULATING THE RCC PERCENTAGE WAS $3,008,155 AS REFLECTED ON PART IX LINE 24(E)PART III, LINE 3:IN ACCORDANCE WITH IRS 990 INSTRUCTIONS, CVPH APPLIED THE CALCULATED RATIO OF COST TO CHARGES TO THE FACILITY'S 2019 BAD DEBT EXPENSE OF $8,599,644 IN ORDER TO CALCULATE THE BAD DEBT EXPENSE (AT COST) AS REPORTED ON PART III LINE 2. THE RCC USED WAS 34.98%. THEREFORE, THE BAD DEBT EXPENSE (AT COST) FOR 2019 WAS $3,008,155. WE ATTRIBUTE APPROXIMATELY 40% OF THIS AMOUNT TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY, CAUSING THE PORTION OF BAD DEBT AS A COMMUNITY BENEFIT TO BE $1,203,262.
PART III, LINE 4:	THE BAD DEBT EXPENSE FOOTNOTE IS DISCLOSED IN ATTACHED AUDITED FINANCIAL STATEMENTS ON PAGE 14.
PART III, LINE 8:	USED MEDICARE ONLY TOTAL CHARGES FROM INSTITUTIONAL COST REPORT FOR 2019 AND APPLIED THE RATIO OF COST TO CHARGES FROM THE 2019 COST REPORT DATA. APPROXIMATELY 44% OF OUR REVENUE IS DERIVED FROM MEDICARE PATIENTS. WE FEEL THE SHORTFALL FROM THIS PROGRAM IS DIRECTLY A COMMUNITY BENEFIT IN THAT WE ARE A SOLE COMMUNITY HOSPITAL.
PART III, LINE 9B:	CVPH HAS A FORMAL CREDIT AND COLLECTION POLICY. ALL PATIENT ACCOUNTS WILL BE BILLED AND FOLLOWED UP ON IN A TIMELY FASHION. ALL DISCOUNTS WILL BE APPLIED AND OFFERED PER POLICY, UNIFORMLY AND WITHOUT PREJUDICE OR DISCRIMINATION. THE POLICY CONSISTS OF DOCUMENTED PROCEDURES FOR INSURANCE, CREDIT BALANCES, SELF PAY OUTPATIENT, AND SELF PAY INPATIENT (NO INSURANCE & AFTER INSURANCE). THERE ARE SPECIFIED PAYMENT ARRANGEMENTS THAT ARE OFFERED AND THE TIME FRAME ALLOTTED FOR REPAYMENT IS GRADUATED BASED ON THE AMOUNT OWED, RANGING FROM 30 DAYS TO 36 MONTHS. CUSTOMER SERVICE REPRESENTATIVES PLACE PHONE CALLS TO PATIENTS TO RESOLVE ACCOUNTS OR ESTABLISH PAYMENT ARRANGEMENTS. AFTER ACCOUNTS HAVE BEEN AT THE PRIMARY BAD DEBT AGENCY FOR A PERIOD OF 6 MONTHS WITHOUT PAYMENTS, THE ACCOUNTS ARE FORWARDED TO A SECOND PLACEMENT AGENCY FOR ATTEMPTED RECOVERY.
PART VI, LINE 2:	CVPH WORKS COLLABORATIVELY TO ASSESS HEALTH NEEDS AND THEN IMPLEMENT STRATEGIES TO ADDRESS THE HEALTH PRIORITIES OF THE COMMUNITY IT SERVES. CVPH HAS WORKED WITH OTHER HOSPITALS, HEALTH DEPARTMENTS, AND AGENCIES IN CLINTON, ESSEX, AND FRANKLIN COUNTIES THROUGH PARTICIPATION IN THE MAPPING OUR WAY TO A HEALTHIER COMMUNITY PROCESS WHICH IS COORDINATED BY THE NEW YORK STATE DEPARTMENT OF HEALTH. THE GOAL OF THIS GROUP IS TO ANALYZE DATA AND SEEK OPINIONS FROM THE PUBLIC TO DETERMINE THE MAJOR CHALLENGES, NEEDS AND BARRIERS TO PROVIDING SERVICES. BY BRINGING THE VARIOUS PROVIDERS TOGETHER FROM A THREE-COUNTY AREA, IT IS BELIEVED THAT THIS PROVIDES A BROADER, MORE REPRESENTATIVE DETERMINATION OF THE NEEDS THAT EXIST. A FOUR-STEP PROCESS IS USED TO ESTABLISH PRIORITIES AS PART OF THE FORMALIZED COMMUNITY HEALTH ASSESSMENT. DATA IS COMPILED AND ANALYZED, PRIORITIES ARE DETERMINED, FOCUS GROUPS SEEK CONSENSUS AND REPORT OUT, DATA IS FURTHER WEIGHTED AND A FINAL SELECTION OF PRIORITIES FOCUSING ON ACCESS TO CARE AND THE NEED TO DIRECT RESOURCES TO TREATMENT OF CHRONIC DISEASE WERE ADOPTED AS KEY NEEDS. TO THAT END, CVPH HAS DIRECTED RESOURCES TO SUPPORT OF THE ADIRONDACK REGION MEDICAL HOME, PHYSICIAN RECRUITMENT, ITS DIABETES EDUCATION CENTER AND COMMUNITY EFFORT RELATED TO THE IMPORTANCE OF PROPER NUTRITION AND EXERCISE. WORKING INDEPENDENTLY, CVPH ASSESSES NEEDS BY ENCOURAGING AN OPEN DIALOGUE WITH ITS VARIOUS COMMUNITY CONSTITUENCIES. THE MEDICAL CENTER HOSTS MEETINGS, VISITS CLUBS AND ORGANIZATIONS, SURVEYS ITS PATIENTS, ENCOURAGES FEEDBACK THROUGH ITS WEB SITE AND INVITES FORMER PATIENTS FOR LUNCH AND TO SHARE OBSERVATIONS ABOUT UNMET NEEDS AND WAYS TO IMPROVE SERVICES WITH EMPHASIS ON FILLING EXISTING GAPS IN SERVICE. AS PART OF ITS STRATEGIC PLANNING PROCESS A COORDINATED AND FORMALIZED APPROACH IS TAKEN TO ASSESS PERCEIVED NEEDS FROM THE COMMUNITY, MEDICAL STAFF, EMPLOYEES AND BOARD MEMBERS UTILIZING FULL AND HALF- DAY MEETING SESSIONS.CVPH IS A VOLUNTARY, NOT-FOR-PROFIT, ARTICLE 28 ORGANIZATION THAT IS GOVERNED BY A VOLUNTARY BOARD OF DIRECTORS AND IS LICENSED FOR 300 BEDS. CVPH IS LOCATED AT 75 BEEKMAN STREET IN PLATTSBURGH, NEW YORK WITH SATELLITE SERVICES AT A NUMBER OF OTHER AUTHORIZED LOCATIONS WITHIN THE PLATTSBURGH AREA. CVPH IS PART OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS COMPRISED OF SIX HOSPITALS, A HOME HEALTH AND HOSPICE AGENCY, AND AN EMPLOYED MEDICAL GROUP. IT IS AFFILIATED WITH AN ACADEMIC MEDICAL CENTER IN BURLINGTON, VERMONT. CVPH OFFERS A VARIETY OF SERVICES INCLUDING CARDIOVASCULAR, ORTHOPEDICS, OBSTETRICS, PSYCHIATRY, LONG TERM CARE, AND PRIMARY CARE. IT HAS A FAMILY MEDICINE RESIDENCY PROGRAM TO HELP ADDRESS PRIMARY CARE SHORTAGES IN THE COMMUNITY. CVPH PROVIDES CANCER SERVICES THROUGH THE FITZPATRICK CANCER CENTER. IN ADDITION, CVPH HAS A ROBUST MEDICAL HOME AS WELL AS THE ADIRONDACK REGION ACO WHICH ARE KEY PARTNERS IN ADDRESSING COMMUNITY HEALTH NEEDS.
PART VI, LINE 3:	THE FOLLOWING INFORMATION IS LISTED ON EVERY PATIENT STATEMENT: "FINANCIAL AID MAY BE AVAILABLE TO QUALIFIED PATIENTS. PLEASE CALL OUR OFFICE AT 562-7074 TO SEE IF YOU QUALIFY." WE ALSO HAVE INFORMATIONAL FLYERS AT THE CASHIERS DESK AND SEVERAL OTHER AREAS IN THE HOSPITAL. AT TIME OF REGISTRATION FOR EVERY SELF PAY PATIENT, WE ASK PERMISSION TO HAVE THE PATIENT CONTACTED TO SEE IF THEY QUALIFY FOR MEDICAID. ALSO WHEN MAKING A CALL TO COLLECT ON PATIENT ACCOUNTS, THE PATIENT IS OFFERED TO TAKE PART IN CVPH'S CARES PROGRAM WHERE APPROPRIATE TO DO SO.
PART VI, LINE 4:	THE PRIMARY SERVICE AREA FOR CVPH IS DEFINED AS CLINTON COUNTY. CVPH'S SECONDARY SERVICE AREA FOR TERTIARY SERVICES NOT AVAILABLE IN THOSE COMMUNITIES ARE ESSEX, FRANKLIN, AND EASTERN ST. LAWRENCE COUNTIES. THE DEMOGRAPHIC CHARACTERISTICS AND HEALTH NEEDS OF THESE COUNTIES REFLECT THOSE IN CLINTON COUNTY. OUR PAYER MIX CONSINSTS OF APPROXIMATELY 53% MEDICARE AND MEDICAID PROGRAMS. CVPH IS THE ONLY HOSPITAL IN CLINTON COUNTY. CLINTON COUNTY'S POPULATION IS 81,224. SIMILAR TO THE REST OF UPSTATE NEW YORK, CLINTON COUNTY'S POPULATION IS LIMITED IN ITS ETHNIC AND RACIAL DIVERSITY; OVER 90% OF RESIDENTS ARE WHITE/NON-HISPANICS, FOLLOWED BY 4.2% BLACK/AFRICAN AMERICAN, NON-HISPANICS AND 2.8% HISPANIC/LATINOS. WHILE THERE ARE NO SIGNIFICANT HEALTH DISPARITIES BASED ON RACE AND ETHNICITY IN CLINTON COUNTY, THERE ARE ACCESS TO CARE ISSUES. IN FACT, IN A RECENT RESIDENT SURVEY, OVER HALF OF THE RESPONDENTS (50.3%) REPORTED EXPERIENCING AT LEAST ONE BARRIER TO MEDICAL CARE FOR THEMSELVES OR THEIR FAMILY IN THE PAST YEAR. THE MOST COMMONLY REPORTED BARRIERS, IDENTIFIED BY ALMOST 1 IN 3 RESPONDENTS, INCLUDED: NOT HAVING DENTAL OR VISION INSURANCE (32.8%), CO-PAYS OR DEDUCTIBLES THAT WERE TOO HIGH (31.9%), NO SPECIALIST WAS AVAILABLE LOCALLY (30.4%) AND COULD NOT AFFORD (29.9%). THE PERCENTAGE OF ADULTS WITH HEALTH INSURANCE IN CLINTON COUNTY IS AT 94.0%, WITH 88.5% OF THE POPULATION HAVING A REGULAR HEALTH CARE PROVIDER. THE RATE OF AGE-ADJUSTED PREVENTABLE HOSPITALIZATIONS PER 10,000 POPULATION AMONG THOSE 18 YEARS OF AGE AND OLDER (129.5) IS HIGHER THAN THE RATE FOR UPSTATE NEW YORK (116.8), AND THE PREVENTION AGENDA BENCHMARK (122.0) RATE. THE RATE OF ED VISITS PER 10,000 POPULATION IN CLINTON COUNTY (5164.5) IS HIGHER THAN THE ARHN REGION (4,866.3) AND SIGNIFICANTLY HIGHER THAN UPSTATE NEW YORK (3,865.6). OVER 16% OF THE POPULATION IS 65 YEARS OF AGE AND OLDER. THE PERCENTAGE OF ADULTS 18 YEARS OF AGE AND OLDER IN CLINTON COUNTY WITH A DISABILITY (25.7%) IS HIGHER THAN THE ARHN REGION (25.6%), UPSTATE NEW YORK (22.8%), AND THE STATE AS A WHOLE (22.9%).HOUSEHOLD INCOME ON AVERAGE IS $65,435, WITH PER CAPITA INCOME AT $25,833. THE PERCENTAGE OF INDIVIDUALS IN CLINTON COUNTY LIVING BELOW THE FEDERAL POVERTY LEVEL HAS REMAINED STABLE AT 15.2%. IN TOTAL, THERE ARE 30,624 HOUSEHOLDS IN CLINTON COUNTY. THE PERCENTAGE OF INDIVIDUALS ENROLLED IN MEDICAID IS 24.4%.OF THE TOTAL POPULATION IN CLINTON COUNTY, APPROXIMATELY 37% OF INDIVIDUALS 25 YEARS OF AGE AND OLDER HAVE A HIGH SCHOOL DIPLOMA OR EQUIVALENT. ANOTHER 30.8% HAVE AN ASSOCIATE'S OR BACHELOR'S DEGREE OR HIGHER. FIFTY SIX PERCENT OF THE POPULATION 16 YEARS AND OLDER IS IN THE WORKFORCE, WITH THE HIGHEST PERCENTAGE OF INDIVIDUALS IN THE FIELD OF EDUCATION (26.7%), FOLLOWED BY RETAIL TRADE (13.3%), MANUFACTURING (12.3%), AND ARTS, ENTERTAINMENT, RECREATION, HOTEL AND FOOD SERVICES (10.8%).
PART VI, LINE 5:	CVPH MEDICAL CENTER PLAYS AN IMPORTANT ROLE IN PROMOTING HEALTH IN THE COMMUNITY BY, FOR INSTANCE, HOSTING FREE COMMUNITY LECTURES, SUPPORT GROUPS, AND SCREENINGS. A FREE MONTHLY COMMUNITY LECTURE SERIES OFFERS A WIDE RANGE OF TOPICS FROM DIABETES AND CANCER TO RHEUMATOLOGY AND MACULAR DEGENERATION. CVPH SPONSORS A NUMBER OF FREE SUPPORT GROUPS INCLUDING PROGRAMS ON DIABETES, MULTIPLE CANCER GROUPS, AND BEREAVEMENT. AN ARRAY OF FOCUSED CLASSES ARE HELD FOR EXPECTANT MOTHERS AS PART OF AN OVERALL CHILDBIRTH EDUCATION INITIATIVE. REGULAR CAR-SEAT SAFETY CHECKS ARE HELD TO ENSURE THAT INFANTS AND TODDLERS ARE APPROPRIATELY SECURED IN THEIR VEHICLES. CVPH WORKS IN CONJUNTION WITH THE ADIRONDACK SAFE KIDS NETWORK FOR AN ANNUAL BIKE AND SKATEBOARD SAFETY FAIR THAT DISTRIBUTES HUNDREDS OF FREE SAFETY HELMETS. CVPH IS A REGULAR PARTICIPANT AT VARIOUS HEALTH FAIRS IN THE REGION DISPENSING EDUCATION INFORMATION AND PROVIDING FREE HEALTH SCREENINGS. CVPH ALSO WORKS WITH OTHER AGENCIES TO FACILITATE INSURANCE COVERAGE FOR ELIGIBLE INDIVIDUALS AND FAMILIES. CVPH MEDICAL CENTER OVERSEES THE NEW YORK STATE GRANT-FUNDED CANCER SERVICES PROGRAM (CSP) OF CLINTON COUNTY. THE PROGRAM PROVIDES CLINTON COUNTY RESIDENTS WHO HAVE NO INSURANCE OR WHO ARE UNDERINSURED WITH FREE SCREENINGS FOR BREAST, CERVICAL AND COLORECTAL CANCERS. THE SERVICES ARE PROVIDED VIA LOCAL PROVIDERS AND CLINICS. CVPH ALSO PARTICIPATES IN THE ACTION FOR HEALTH COALITION WHICH WAS CREATED AS PART OF THE MAPP/CHNA PROCESS. THIS GROUP HAS AN ACTIVE ROLE IN TRACKING PROGRESS MADE IN IMPLEMENTING CHANGES TO IMPACT THE HEALTH OF THE COMMUNITY AS WELL AS MAKING ADJUSTMENTS TO THE STRATEGIES IDENTIFIED TO ADDRESS THESE NEEDS. SOME OF THE ACCOMPLISHMENTS OF THE ACTION FOR HEALTH COALITION INCLUDE CVPH HOSTING NEW VISIONS PROGRAM FOR SELECTED COLLEGE BOUND HIGH SCHOOL SENIORS PLANNING TO MAJOR IN A HEALTH RELATED FIELD OF STUDY, MOVING TOBACCO PRODUCTS OUT OF SIGHT IN MANY RETAIL ESTABLISHMENTS, IMPROVING NUTRITION IN SCHOOLS, AND FOCUSING ON POSITIVELY IMPACTING CHRONIC DISEASE MANAGEMENT IN CLINTON COUNTY.
PART VI, LINE 6:	CVPH MEDICAL CENTER, IS A MEMBER OF THE UNIVERSITY OF VERMONT HEALTH NETWORK (FORMERLY FLETCHER ALLEN PARTNERS, INC.), ALSO COVERING THE BURLINGTON AND BERLIN, VERMONT AREAS.CVPH IS A VOLUNTARY, NOT-FOR-PROFIT, ARTICLE 28 ORGANIZATION THAT IS GOVERNED BY A VOLUNTARY BOARD OF DIRECTORS AND IS LICENSED FOR 300 BEDS. CVPH IS LOCATED AT 75 BEEKMAN STREET IN PLATTSBURGH, NEW YORK WITH SATELLITE SERVICES AT A NUMBER OF OTHER AUTHORIZED LOCATIONS WITHIN THE PLATTSBURGH AREA. CVPH IS PART OF THE UNIVERSITY OF VERMONT HEALTH NETWORK, WHICH IS COMPRISED OF SIX HOSPITALS, A HOME HEALTH AND HOSPICE AGENCY, AND AN EMPLOYED MEDICAL GROUP. IT IS AFFILIATED WITH AN ACADEMIC MEDICAL CENTER IN BURLINGTON, VERMONT. CVPH OFFERS A VARIETY OF SERVICES INCLUDING CARDIOVASCULAR, ORTHOPEDICS, OBSTETRICS, PSYCHIATRY, LONG TERM CARE, AND PRIMARY CARE. IT HAS A FAMILY MEDICINE RESIDENCY PROGRAM TO HELP ADDRESS PRIMARY CARE SHORTAGES IN THE COMMUNITY. CVPH PROVIDES CANCER SERVICES THROUGH THE FITZPATRICK CANCER CENTER. IN ADDITION, CVPH HAS A ROBUST MEDICAL HOME AS WELL AS THE ADIRONDACK REGION ACO WHICH ARE KEY PARTNERS IN ADDRESSING COMMUNITY HEALTH NEEDS.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Travel For Companions	Yes (X)	TravelForCompanionsInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (1)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	Yes (1)	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	Yes (1)	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
WOUTER RIETSEMAMD
CHIEF QUALITY AND INFOR.	$476,532	$0	$144,170	$0	$18,216	$0	$0	$0	$45,472	$0	$684,390	$0	$0	$0
KENT HALL
CHIEF MEDICAL OFFICER	$526,394	$0	$153,455	$0	$19,012	$0	$0	$0	$33,361	$0	$732,222	$0	$0	$0
MICHELLE LEBEAU
PRESIDENT/COO	$523,830	$0	$193,297	$0	$41,493	$0	$0	$0	$39,374	$0	$797,994	$0	$0	$0
SCOTT ST GEORGE
FORMER VICE PRESIDENT OF FINANCE	$292,319	$0	$47,263	$0	$0	$0	$0	$0	$11,421	$0	$351,003	$0	$0	$0
CHARLES VOLK
ORTHOPEDIC SURGEON	$153,652	$0	$0	$0	$0	$0	$0	$0	$7,308	$0	$160,960	$0	$0	$0
FRANKLIN BERTUCH
ANESTHESIOLOGIST	$331,800	$0	$0	$0	$0	$0	$0	$0	$26,872	$0	$358,672	$0	$0	$0
VIVIAN MEJIAS
ANESTHESIOLOGIST	$260,745	$0	$0	$0	$0	$0	$0	$0	$10,708	$0	$271,453	$0	$0	$0
LOIUS-PHILIPPE CHARETTE
PHYSICIAN	$253,541	$0	$0	$0	$0	$0	$0	$0	$6,375	$0	$259,916	$0	$0	$0
STEPHENS MUNDY
FORMER PRESIDENT/CEO	$402,105	$0	$283,122	$0	$1,569,191	$0	$0	$0	$43,625	$0	$2,298,043	$0	$706,487	$0

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 1A	TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF THE CEO OF LESS THAN $1,000 IS ALLOWED TO BE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLOYEE RECEIVES THIS BENEFIT.
PART I, LINE 1B	TRAVEL FOR COMPANIONS: TOTAL TRAVEL COSTS FOR COMPANION OF THE CEO OF LESS THAN $1,000 IS ALLOWED TO BE INCURRED AND REIMBURSED BY CVPH MEDICAL CENTER. NO OTHER BOARD MEMBER, OFFICER, DIRECTOR, OR KEY EMPLOYEE RECEIVES THIS BENEFIT.
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, LINES 4A-B	STEPHENS MUNDY, PRESIDENT & CFO OF CHAMPLAIN VALLEY PHYSICIANS HOSPITAL MEDICAL CENTER, SEPARATED FROM SERVICE ON JULY 1, 2018. IN ACCORDANCE WITH THE SEPARATION AGREEMENT, HE IS ENTITLED TO 18 MONTHS CONTINUATION OF SALARY AND CONTINUATION OF CERTAIN BENEFITS. IN 2018 HE RECEIVED PAYMENTS IN LIEU OF BENEFIT CONTINUATION PLUS SALARY CONTINUATION PAYMENTS TOTALLING $409,487. DURING CALENDAR YEAR 2018, CHAMPLAIN VALLEY PHYSICIANS HOSPITAL, A SUBSIDIARY OF THE UVM HEALTH NETWORK, PAID OFFICER MUNDY FOR AMOUNTS VESTED IN 2018 UNDER A LONG TERM SUPPLEMENTAL RETIREMENT BENEFIT PLAN SRP) WHICH WAS ENTERED INTO DURING 2012. THE AMOUNT VESTED AND PAID FOR CALENDAR YEAR 2018 OF $988,459 IS REPORTED IN SCHEDULE J, PART II, COLUMN BIII. A DISTRIBUTION TO STEPHENS MUNDY, CEO,IN THE AMOUNT OF $1,569,191 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. MUNDY'S TAXABLE COMPENSATION. A DISTRIBUTION TO WOUTER RIETSEMA IN THE AMOUNT OF $18,216 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. RIETSEMA'S TAXABLE COMPENSATION. A DISTRIBUTION TO MICHELLE LEBEAU IN THE AMOUNT OF $41,494 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MS. LEBEAU'S TAXABLE COMPENSATION. A DISTRIBUTION TO KENT HALL IN THE AMOUNT OF $19,012 WAS MADE FROM A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE AMOUNT WAS INCLUDED IN MR. HALL'S TAXABLE COMPENSATION.
PART I, LINE 6	DURING 2019, 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 2019 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.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)

Bond ReferenceBondReferenceCd	Bond Issuer EINBondIssuerEIN	CUSIPCUSIPNum	Bond IssuedBondIssuedDt	Issue PriceIssuePriceAmt	PurposePurposeDesc	DefeasedDefeasedInd	On Behalf Of IssuerOnBehalfOfIssuerInd	Pool FinancingPoolFinancingInd
COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY
A	146035154	187476AD8	2007-06-07	$19,565,000	CONSTRUCTION OF SURGICAL SVC WING	0	0	0
COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY
B	146035154	187476AB2	2006-12-19	$12,650,000	REFINANCE SERIES 1997 BONDS	0	0	0
COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY
C	146035154	187476AE6	2007-06-25	$12,505,000	RENOVATION OF SURGICAL AREA	0	0	0

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)

Bond ReferenceBondReferenceCd	Total ProceedsTotalProceedsAmt	In Reserve FundInReserveFundAmt	Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt	Capital ExpendituresCapitalExpendituresAmt	Substantial CompletionSubstantialCompletionYr	Refunding Taxable BondsRefundingTaxableBondsInd	Final Allocation MadeFinalAllocationMadeInd	Adequate Books And Rec MaintAdequateBooksAndRecMaintInd	Refunding EscrowRefundingEscrowAmt
A	$19,565,000	$1,172,250	$1,340,812	$17,051,938	2009	0	Yes (1)	Yes (1)
B	$12,650,000		$138,395		1998	Yes (1)	Yes (1)	Yes (1)	$12,511,605
C	$12,505,000	$727,569	$811,805	$10,965,626	2009	0	Yes (1)	Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)

Bond ReferenceBondReferenceCd	Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd	Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A	Yes (1)	Yes (1)
B	Yes (1)	Yes (1)
C	Yes (1)	Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiledInd	Rebate Not Due YetRebateNotDueYetInd	Exception To RebateExceptionToRebateInd	No Rebate DueNoRebateDueInd	Variable Rate IssueVariableRateIssueInd	Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd	Term Of HedgeTermOfHedgePct	Superintegrated HedgeSuperintegratedHedgeInd	Hedge TerminatedHedgeTerminatedInd	Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd	Gross Proceeds InvestedGrossProceedsInvestedInd	Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd
KEY BANK
A	0	0	0	Yes (1)	Yes (1)	Yes (1)	35.000000000000	0	0	0	0	Yes (1)
KEY BANK
B	0	0	0	Yes (1)	Yes (1)	Yes (1)	11.000000000000	0	0	0	0	Yes (1)
KEY BANK
C	0	0	0	Yes (1)	Yes (1)	Yes (1)	35.000000000000	0	0	0	0	Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)

Bond ReferenceBondReferenceCd	Procedures Corrective ActionProceduresCorrectiveActionInd
A	0
B	0
C	0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	DATE REBATE COMPUTATION PERFORMED	FormAndLineReferenceDesc
Explanation	ISSUER NAME: COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/16/2010 ISSUER NAME: COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2011 ISSUER NAME: COUNTY OF CLINTON INDUSTRIAL DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/25/2012	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	THE UNIVERSITY OF VERMONT HEALTH NETWORK, INC. (UVMHN) IS THE VOTING MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE UNIVERSITY OF VERMONT HEALTH NETWORK 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	CVPH 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	CVPH 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 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 ORGANIZATION'S 990 FORMS, AND APPROVAL BY THE BOARD OF 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. PART B: THE SAME FORMAL PROCESS NOTED IN QUESTION 15(A) ABOVE 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	CVPH 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 CVPH OR BY SENDING A REQUEST IN WRITING TO CVPH ADMINISTRATIVE OFFICES. THE ORGANIZATION HAS INSTRUCTIONS POSTED ON ITS WEBSITE FOR THOSE SEEKING COPIES OF DOCUMENTS.
FORM 990, PART XI, LINE 9:	CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -3,447,434. PENSION RELATED CHANGES OTHER THAN NET PERIODIC PENSION COSTS -22,296,801. CHANGE IN NET INTEREST OF FOUNDATION -69,325. TRANSFERS FROM PARENT/RELATED PARTY 4,537,124. CHANGE IN INTEREST IN INVESTMENT POOL 1,980,779.
FORM 990, PART XII, LINE 2C:	THERE IS AN AUDIT COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
SCHEDULE H, PART V, SECTION B, LINE 11	EACH PRIORITY-SPECIFIC ACTION PLAN INCLUDES FOCUS AREAS, GOALS, OBJECTIVES, AND MEASURES FOR EVIDENCE-BASED INTERVENTIONS TO TRACK THEIR IMPACTS INCLUDING REDUCTIONS IN HEALTH DISPARITIES AMONG RACIAL, ETHNIC, AND SOCIOECONOMIC GROUPS, AGE GROUPS, AND PERSONS WITH DISABILITIES. CCHD AND CVPH USE THE PREVENTION AGENDA AS A FRAMEWORK FOR ASSESSING HEALTH, IDENTIFYING LOCAL HEALTH PRIORITIES AND PLANNING COLLABORATIVE HEALTH IMPROVEMENT EFFORTS WITHIN CLINTON COUNTY. CVPH AND CCHD UNDERSTAND THE KEY TO SUCCESSFULLY IMPACTING THE HEALTH OF CLINTON COUNTY IS PARTNERING WITH THE COMMUNITY AND ITS ORGANIZATIONS AND COMBINING RESOURCES. IT IS THE INTENT OF THE LEAD PARTNERS THAT ACTION PLANS CAPTURE THE PARTNERSHIP, CONTRIBUTIONS AND SUPPORT OF MANY COMMUNITY ORGANIZATIONS TO STRENGTHEN THE IMPACT OF THE PLANNED INTERVENTIONS AND ASSURE THE RESPONSIBLE USE OF LIMITED RESOURCES. CLINTON COUNTY IS FORTUNATE TO HAVE DEVELOPED A STRONG NETWORK OF PARTNERS REPRESENTING MANY DIFFERENT COMMUNITY SECTORS AND OFFERING A VARIETY OF ASSETS AND CAPACITIES FOR ACHIEVING ITS SHARED VISION FOR COMMUNITY HEALTH. LEAD STAFF FROM CCHD AND CVPH HAVE WORKED WITH PARTNERS TO COLLECT AND ORGANIZE ACTIVITIES AND INTERVENTIONS THAT WILL ADDRESS THE IDENTIFIED HEALTH PRIORITIES. THIS WAS DONE UTILIZING A VARIETY OF METHODS: REVIEW OF CURRENT CHIP/IS ACTIVITIES AND PROGRESS AS WELL AS THOSE OF OTHER SHARED WORK PLANS (IE. COMMUNITY SERVICES PLAN), INDIVIDUAL MEETINGS WITH KEY PARTNERS, EMAILS SOLICITING SUGGESTIONS AND CONTRIBUTIONS OF RELATED ACTIVITIES FROM AFH PARTICIPANTS, AND REVIEW OF INFORMATION COLLECTED FROM THE PRIORITY SETTING EVENT AND DIRECTLY FROM RESIDENTS THROUGH THE SURVEY PROCESS. INFORMATION WAS THEN ORGANIZED BY GOALS/ OBJECTIVES WITHIN EACH FOCUS AREA, RESULTING IN FIVE ACTION PLANS AND FORMATTED FOLLOWING NYSDOH GUIDANCE AND PROVIDED TOOLS. THESE ACTION PLANS BECOME CCHD'S CHIP AND CVPH'S IS FOR THE NEXT THREE YEARS. IT IS IMPOSSIBLE TO FEATURE ALL THE HEALTH IMPROVEMENT WORK THAT WILL OCCUR IN CLINTON COUNTY OVER THE NEXT THREE YEARS IN THE ACTION PLANS. MUCH THOUGHT IS GIVEN TO THE FEATURED INTERVENTIONS; OFTEN IT IS THE ITEMS THAT BEST DEMONSTRATE THE LOCAL COMMITMENT TO COLLECTIVE IMPACT WORK, INNOVATION, AND CROSS-SYSTEM COLLABORATION. THERE IS ALSO AN INTENTIONAL BLEND OF ACTIVITIES THAT WILL VARY IN DURATION. AS SUCH, THERE WILL BE PROGRESS TO ACKNOWLEDGE AND CELEBRATE PERPETUALLY. THIS ALSO ALLOWS NEW INTERVENTIONS TO BE CONSIDERED AND ADDED REGULARLY BASED ON EMERGING LOCAL NEEDS AND RESOURCES. TARGET PROGRAMS AND LOCATIONS FOR THE FEATURED INTERVENTIONS ARE DETERMINED BY A NUMBER OF FACTORS INCLUDING REVIEW OF HEALTH INDICATOR DATA, ESPECIALLY TO IDENTIFY HIGH NEEDS POPULATIONS AND AREAS WITHIN THE COUNTY, AND FEASIBILITY OF ACTIVITIES MEETING SUCCESS (EXISTENCE OF POTENTIAL SITES, ACCESSIBILITY, RECEPTIVENESS, ETC.). FEATURED INTERVENTIONS AND PROJECTED OUTCOMES ARE INFLUENCED BY PARTNER RESOURCES INCLUDING STAFF, FUNDING AND EXPERTISE. SOME INTERVENTIONS THAT THE HOSPITAL HAS A ROLE IN ARE AS FOLLOWS: - PROVIDING COMMUNITY EDUCATION ON HPV SCREENING - EXPANDING THE CVPH DIABETES PREVENTION PROGRAM (DPP) - COORDINATION OF REFERRALS TO DPP - OFFER TOBACCO CESSATION ASSISTANCE THROUGH CERTIFIED TOBACCO TREATMENT SPECIALISTS - EMBEDDING OUTPATIENT BEHAVIORAL HEALTH SERVICES INTO THE INPATIENT PSYCHIATRY UNITS TO ESTABLISH WARM HAND OFF OF CARE - ASSIST IN THE CREATION AND SUSTAINABILITY OF INCLUSIVE, HEALTHY PUBLIC SPACES (INDOOR WALKING TRAILS, RIVER SPUR TRAILS, ETC.)

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (20 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Controlled OrganizationControlledOrganizationInd	Direct Controlling NADirectControllingNACd
UVM HEALTH NETWORK MEDICAL GROUP INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	030225105	PHYSICIAN SERVICES	VT	501(C)(3)	LINE 12B, II	UVMHN	Yes (1)
UNIV OF VT MEDICAL GROUP-NEW YORK
183 PARK STREET	MALONE	NY	12953	203905216	PHYSICIAN SERVICES	NY	501(C)(3)	LINE 3	UVMHNMG	Yes (1)
UNIV OF VT MED CTR FOUNDATION INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	263159849	FUNDRAISING	VT	501(C)(3)	LINE 12B, II	UVMHNMG	Yes (1)
UNIV OF VT MED CTR AUXILLIARY INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	208022004	SERVICE	VT	501(C)(3)	LINE 12D, III-O		0	N/A
UNIV OF VT HEALTH NETWORK
111 COLCHESTER AVE	BURLINGTON	VT	05401	452880726	HOLDING COMPANY	VT	501(C)(3)	LINE 12B, II		0	N/A
CENTRAL VT MEDICAL CENTER
111 COLCHESTER AVE	BURLINGTON	VT	05401	222547186	HOSPITAL	VT	501(C)(3)	LINE 3	UVMHN	Yes (1)
UNIVERSITY HEALTH CENTER
111 COLCHESTER AVE	BURLINGTON	VT	05401	030229931	HOSPITAL	VT	501(C)(3)	LINE 12D, III-O	UVMHNMG	Yes (1)
COMMUNITY PROVIDERS INC
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	222544844	HLTH SVC COORD	NY	501(C)(3)	LINE 12B, II	UVMHN	Yes (1)
ELIZABETHTOWN COMMUNITY HOSPITAL
75 PARK STREET	ELIZABETHTOWN	NY	12901	141364513	HOSPITAL	NY	501(C)(3)	LINE 3	UVMHN	Yes (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	Yes (1)
CVPH MEDICAL CENTER FOUNDATION
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	141727048	HLTH SVC COORD	NY	501(C)(3)	LINE 12C, III-FI	CVPH	Yes (1)
LAKE CHAMPLAIN PHYSICIAN SERVICES PC
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	273785445	PHYSICIAN SERVICES	NY	501(C)(3)	LINE 12B, II	CVPH	Yes (1)
UNIVERSITY MEDICAL EDUCATION ASSOCIATES
89 BEAUMONT AVENUE	BURLINGTON	VT	05401	237107832	EDUCATIONAL	VT	501(C)(3)	LINE 11	UVMHNMG	Yes (1)
ALICE HYDE MEDICAL CENTER
133 PARK STREET	MALONE	NY	12953	150346515	HOSPITAL	NY	501(C)(3)	LINE 3	UVMHN	Yes (1)
PORTER MEDICAL CENTER INC
115 PORTER DRIVE	MIDDLEBURY	VT	05753	030310862	SUPPORTING ORGANIZATION	VT	501(C)(3)	LINE 12C, III-FI	UVMHN	Yes (1)
HELEN PORTER NURSING HOME
37 PORTER DRIVE	MIDDLEBURY	VT	05753	030306549	NURSING HOME	VT	501(C)(3)	LINE 3	PMC	Yes (1)
AUXILLARY OF PORTER MEDICAL CENTER
37 PORTER DRIVE	MIDDLEBURY	VT	05753	237363227	SUPPORTING ORGANIZATION	VT	501(C)(3)	LINE 12C, III-FI	PMC	Yes (1)
PORTER HOSPITAL
37 PORTER DRIVE	MIDDLEBURY	VT	05753	030181058	HOSPITAL	VT	501(C)(3)	LINE 3	PMC	Yes (1)
UVMHN HOME HEALTH AND HOSPICE
1110 PRIM ROAD	COLCHESTER	VT	05446	030179603	HOME HEALTHCARE	VT	501(C)(3)	LINE 12B, II	UVMHN	Yes (1)
VMC INDEMNITY COMPANY INC
95 ST PAUL ST	BURLINGTON	VT	05401	831102018	INSURANCE	VT	501(C)(3)	LINE 12B, II		Yes (1)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Direct Controlling NADirectControllingNACd	Predominant Income TypePredominantIncomeTypeTxt	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt
ONECARE VT ACCOUNTABLE CARE
111 COLCHESTER AVE	BURLINGTON	VT	05401	455399218	ACCOUNTABLE CARE	VT	N/A	RELATED	0	0
ADIRONDACK ACO LLC
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	462840926	ACCOUNTABLE CARE	NY	N/A	NA	0	0
YANKEE MEDICAL INC
276 NORTH AVENUE	BURLINGTON	VT	05401	030225363	HOME MEDICAL EQUIPMENT	VT			0	0	UVMHN

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (9 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Entity TypeEntityTypeTxt	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	CityForeignAddress/CityNm	CountryForeignAddress/CountryCd	Foreign PostalForeignAddress/ForeignPostalCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd	Direct Controlling NADirectControllingNACd
UVMHN VENTURES INC
111 COLCHESTER AVE	BURLINGTON	VT	05401	043380045	HOLDING COMPANY	VT	UVMHN	C	0
VMC INDEMNITY COMPANY LTD
					CAPTIVE INSURANCE		UVMMC	C	0	PO BOX HM 3103	HAMILTON	BD	HM 19	BD
UVMHN CREDENTIALING & ENROLLMENT
111 COLCHESTER AVE	BURLINGTON	VT	05401	030333056	ADMIN SVC	VT	UVMHN VENTURES	C	0
CHARITABLE REMAINDER TRUST (5)
111 COLCHESTER AVE	BURLINGTON	VT	05401		SUPPORT	VT	UVMMCCVMC	T	0
PERPETUAL TRUST (4)
111 COLCHESTER AVE	BURLINGTON	VT	05401		SUPPORT	VT	UVMMC	T	0
CHARITABLE IRREVOCABLE TRUST (7)
111 COLCHESTER AVE	BURLINGTON	VT	05401		SUPPORT	VT	UVMMCCVMC	T	0
CHAMPLAIN VALLEY HEALTH NETWORK
75 BEEKMAN STREET	PLATTSBURGH	NY	12901	161586102	ADMIN SVC	NY		C	0						N/A
MEDIQUEST INC
PO BOX 1656	PLATTSBURGH	NY	12901	141663061	MED OFFICE LEASE	NY	CPI	C	0
YANKEE MEDICAL INC
276 NORTH AVENUE	BURLINGTON	VT	05401	030225363	HOME MEDICAL EQUIPMENT	VT	UVMHN	C	0

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	0	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	0	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	0	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	0	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	0	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	0	DivRelatedOrganizationInd
Asset Sale To Other Org	0	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	0	AssetPurchaseFromOtherOrgInd
Asset Exchange	Yes (1)	AssetExchangeInd
Rental Of Facilities To Oth Org	0	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	0	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	Yes (1)	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (1)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	0	SharingOfFacilitiesInd
Paid Employees Sharing	Yes (1)	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	Yes (1)	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	Yes (1)	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	Yes (1)	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt	Method Of Amount DeterminationMethodOfAmountDeterminationTxt
THE UNIVERSITY OF VERMONT MEDICAL CENTER INC
Q	$1,145,282	FMV
UVMHN MG
O	$9,916,890	FMV
VMCIC
Q	$3,062,617	FMV