2022-09-07T14:53:14-05:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STREET SUITE 1000 PEORIA IL 61602 990 2021-01-01 370999878 PEORIA HOSPITALS MOBILE MEDICAL SERVICES D/B/A ADV MEDICAL TRANS OF CENTRAL IL PEOR 3094946200 1718 NORTH STERLING AVE PEORIA IL 61604 JOHN STENSON BOARD CHAIRPERSON 3094946200 2022-08-17 1 JOHN STENSON XXX-XX-XXXX JENNIFER ADDIS P01890345 3096714500 2022-08-15 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JOHN STENSON 1718 NORTH STERLING AVE PEORIA IL 61604 35732641 0 X WWW.AMTCI.ORG X 1975 IL THE ORGANIZATION PROVIDES EMERGENCY AMBULANCE CARE, TREATMENT AND TRANSPORTATION TO MULTIPLE JURISDICTIONS IN ILLINOIS. IN ADDITION TO EMERGENCY AMBULANCE SERVICES, THE ENTITY PROVIDES SCHEDULED AMBULANCE, BEHAVIORAL HEALTH (IPT) AND WHEELCHAIR TRANSPORTATION BETWEEN HOSPITALS AND OTHER HEALTHCARE FACILITIES. 9 8 438 8 0 0 0 3366703 27373092 32028441 192320 -942879 849362 25394 28414774 34477659 300193 1934355 0 0 17195775 20051562 0 0 0 7650519 8144674 25146487 30130591 3268287 4347068 36748087 37264106 7220343 2977549 29527744 34286557 X THE ORGANIZATION PROVIDES EMERGENCY AMBULANCE CARE, TREATMENT AND TRANSPORTATION TO MULTIPLE JURISDICTIONS IN ILLINOIS. IN ADDITION TO EMERGENCY AMBULANCE SERVICES, THE ENTITY PROVIDES SCHEDULED AMBULANCE, BEHAVIORAL HEALTH (IPT) AND WHEELCHAIR TRANSPORTATION BETWEEN HOSPITALS AND OTHER HEALTHCARE FACILITIES. 0 0 24142839 1934355 31993353 THE ORGANIZATION PROVIDES EMERGENCY AMBULANCE CARE, TREATMENT AND TRANSPORTATION TO MULTIPLE JURISDICTIONS IN ILLINOIS. IN ADDITION, THE ENTITY PROVIDES SCHEDULED AMBULANCE, BEHAVIORAL HEALTH (IPT) AND WHEELCHAIR TRANSPORTATION BETWEEN HOSPITALS AND OTHER HEALTHCARE FACILITIES. THE ORGANIZATION PROVIDED 45,717 AMBULANCE, 3,614 IPT AND 6,472 WHEELCHAIR TRANSPORTS IN 2021. THE ORGANIZATION PROVIDED $1,523,720 IN CHARITABLE SERVICES TO QUALIFIED INDIVIDUALS AT NO CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE ORGANIZATION ALSO PROVIDED CARE TO MEDICARE AND MEDICAID PATIENTS AT RATES BELOW THE COST OF PROVIDING SERVICES. FOR 2021 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY $6,223,503. THE ORGANIZATION ALSO PROVIDED $2,116,098 IN SUPPORT OF OTHER COMMUNITY BENEFITS. 503415 60482 THE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 24646254 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 438 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X ANDREW RAND 3094946200 1718 N STERLING AVE PEORIA IL 61604 JEANINE SPAIN BOARD CHAIRPERSON 1.00 0.00 X X 0 0 0 JOHN STENSON BOARD VICE-CHAIRPERSON 1.00 0.00 X X 0 0 0 SALLY SNYDER BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 ANDREW RAND CEO/BOARD MEMBER 20.00 20.00 X X 630162 0 18636 MELISSA WOODS BOARD MEMBER 1.00 0.00 X 0 0 0 JAMES ADAMS BOARD MEMBER 1.00 0.00 X 0 0 0 BILL FLEMING BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT ANDERSON BOARD MEMBER 1.00 0.00 X 0 0 0 DAVE STENERSON BOARD MEMBER 1.00 0.00 X 0 0 0 TIM BECCUE VP OF FINANCE 20.00 20.00 X X 293076 0 25440 THOMAS GERACI VP OF OPERATIONS 35.00 5.00 X X 261793 0 3127 TODD BAKER VP BUSINESS DEVELOPMENT 20.00 20.00 X X 246497 0 24645 GREG CHANCE VP OF STRATEGY/CEO OF AMTSI 1.00 39.00 X X 13000 233853 17103 DERRICK HAHN VP OF FLEET 25.00 15.00 X X 206724 0 18555 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 20.00 20.00 X X 151673 0 9750 CHAD CRAIG CRITICAL CARE PARAMEDIC 40.00 0.00 X 158068 0 19792 DENISE DURRELL PHRN 40.00 0.00 X 146959 0 18636 BRUCE RETHERFORD CRITICAL CARE PARAMEDIC 40.00 0.00 X 144865 0 5555 MELISSA STOKES PHRN 40.00 0.00 X 130585 0 16725 2383402 233853 177964 10 0 1 0 PEARL TECHNOLOGY 1003 E TOLEDO AVE PEORIA HEIGHTS IL 61616 SOFTWARE SUPPORT 203000 1 3366703 3366703 TRANSPORT REVENUE 621990 30078711 30078711 SUBSIDY REVENUE 621990 962255 962255 CONTRACT REVENUE 621990 926993 926993 TUITION REVENUE 611600 60482 60482 32028441 283627 283627 28476 1254982 -1226506 -1226506 -1226506 MISCELLANEOUS 900099 25394 25394 25394 34477659 32053835 0 -942879 X 1934355 1934355 1802926 1467232 335694 15335792 12480366 2855426 552714 450046 102668 1113673 899227 214446 1246457 1057064 189393 120519 120519 64274 64274 79294 65000 14294 22706 22706 166165 149436 16729 526173 158892 367281 308554 211263 97291 49783 49783 -578056 -578056 1589975 1258969 331006 1685706 1511949 173757 SUPPLIES 1503061 1339307 163754 FUEL 822234 815122 7112 REPAIRS & MAINTENANCE 472665 376314 96351 RECRUITING 415929 415929 895692 584056 311636 30130591 24646254 5484337 0 9428011 8417447 4024918 5581466 180364 79796 930582 811167 25643365 16361953 9011623 9281412 5595373 6092484 36000 36000 7541216 6964334 36748087 37264106 2139559 2529885 3254000 0 1826784 447664 7220343 2977549 X 29527744 34286557 29527744 34286557 36748087 37264106 4347068 411745 0 X X 0 1 X 1 0 X 3366703 3366703 22711497 23745380 23909156 27373092 32037864 129776989 22711497 23745380 23909156 27373092 35404567 133143692 0 0 0 133143692 70643 92652 255226 76126 283627 778274 70643 92652 255226 76126 283627 778274 224087 89612 44160 965556 -1210535 112880 23006227 23927644 24208542 28414774 34477659 134034846 0.99340 0.98420 0.00580 0.00460 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS GAIN LOSS ON SALE OF ASSETS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1306232 1306232 7905559 2686369 5219190 16431574 13675584 2755990 9281412 RELATED PARTY RECEIVABLE 6964334 6964334 OTHER LIABILITIES 447664 447664 X 34889404 411745 411745 34477659 0 34477659 30131616 1025 1025 30130591 0 30130591 PART X, LINE 2: ADVANCED MEDICAL TRANSPORT, INC., PEORIA HOSPITALS' MOBILE MEDICAL SERVICES, ADVANCED MEDICAL TRANSPORT OF IOWA, ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD, INC. AND ADVANCED MEDICAL TRANSPORT EAST, INC. ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER THE INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). ADVANCED MEDICAL TRANSPORT, INC., PEORIA HOSPITALS' MOBILE MEDICAL SERVICES, ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD, INC. AND ADVANCED MEDICAL TRANSPORT EAST, INC. ARE EXEMPT FROM ILLINOIS INCOME TAXES. ADVANCED MEDICAL TRANSPORT OF IOWA IS EXEMPT FROM IOWA INCOME TAXES. FOR 2021 AND 2020, NO ASPECTS OF THE BUSINESS OF THESE ORGANIZATIONS ARE DEFINED BY THE IRC AS UNRELATED TO THE PURPOSE FOR WHICH THE TAX EXEMPTION IS GRANTED. PART XII, LINE 2D - OTHER ADJUSTMENTS: ADVANCED MEDICAL TRANSPORT, INC. EXPENSES 1,025. 0 ADVANCED MEDICAL TRANSPORT EAST INC 1718 N STERLING AVE PEORIA IL 61615 862146583 501(C)(3) 642660 0 SUPPORT FOR EMS CARE. CREIGHTON UNIVERSITY PO BOX 30282 OMAHA NE 68103 470376583 501(C)(3) 25000 0 SUPPORT FOR EMS EDUCATION. EASTER SEALS 1014 W PIONEER PKWY STE 110 PEORIA IL 61615 455123895 501(C)(3) 25000 0 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS. EPC 1913 W TOWNLINE ROAD PEORIA IL 61615 370794792 501(C)(3) 15000 0 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS. HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 100000 0 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS ICC 1 COLLEGE DR EAST PEORIA IL 61635 371207827 501(C)(3) 26000 0 SUPPORT FOR EMS EDUCATION. OSF HEALTHCARE FOUNDATION 530 NE GLEN OAK AVE PEORIA IL 61603 371259284 501(C)(3) 500000 0 SUPPORT FOR CANCER CENTER. SOUTH SIDE MISSION 1127 S LARAMIE ST PEORIA IL 61605 370663572 501(C)(3) 7500 0 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS. STREATOR FIRE DEPARTMENT 108 N WASSON ST STREATOR IL 61364 STREATOR FIRE DEPT 5996 0 IMPROVE LOCAL COMMUNITY CARDIAC ARREST SURVIVABILITY INIATIVES. UNITY POINT HEALTH - CENTRAL IL FOUNDATION 5409 N KNOXVILLE AVE PEORIA IL 61614 370681540 501(C)(3) 500000 0 SUPPORT FOR MENTAL HEALTH SERVICES AND PROGAMS. WTVP PO BOX 1347 PEORIA IL 61654 237041401 501(C)(3) 31500 0 SUPPORT LOCAL EDUCATION PROGRAMS 14 1 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 563162 0 67000 0 0 0 13000 0 5636 0 648798 0 0 0 TIM BECCUE VP OF FINANCE 203183 0 89893 0 0 0 9750 0 15690 0 318516 0 0 0 TODD BAKER VP BUSINESS DEVELOPMENT 193197 0 53300 0 0 0 13000 0 11645 0 271142 0 0 0 THOMAS GERACI VP OF OPERATIONS 248488 0 13305 0 0 0 3127 0 0 0 264920 0 0 0 GREG CHANCE VP OF STRATEGY/CEO OF AMTSI 13000 174153 0 59700 0 0 0 9219 0 7884 13000 250956 0 0 DERRICK HAHN VP OF FLEET 154652 0 52072 0 0 0 13000 0 5555 0 225279 0 0 0 CHAD CRAIG CRITICAL CARE PARAMEDIC 140875 0 17193 0 0 0 4311 0 15481 0 177860 0 0 0 DENISE DURRELL PHRN 134474 0 12485 0 0 0 13000 0 5636 0 165595 0 0 0 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 130686 0 20987 0 0 0 9750 0 0 0 161423 0 0 0 BRUCE RETHERFORD CRITICAL CARE PARAMEDIC 138696 0 6169 0 0 0 0 0 5555 0 150420 0 0 0 PART I, LINE 7 BASED ON EMPLOYEE PERFORMANCE FORM 990, PART VI, SECTION A, LINE 7A ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF UNITYPOINT HEALTH TRINITY, ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF UNITYPOINT HEALTH METHODIST/PROCTOR, ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF OSF HEALTHCARE SYSTEMS, AND ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF OSF SAINT FRANCIS MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION PROVIDES A COPY OF FORM 990 TO THE BOARD FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE OF THE CONFLICT OF INTEREST POLICY. EACH BOARD MEMBER ANNUALLY COMPLETES A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD REVIEWS COMPARABLE DATA AND THE SPECIFIC PERFORMANCE OF THE EXECUTIVE DIRECTOR IN DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 24E BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 132,285. MANAGEMENT AND GENERAL EXPENSES 141,099. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 273,384. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 170,573. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 170,573. EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 116,711. MANAGEMENT AND GENERAL EXPENSES 28,813. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 145,524. UNIFORMS: PROGRAM SERVICE EXPENSES 82,822. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 82,822. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 81,665. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,665. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 70,560. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,560. SURVEY & DUES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 40,114. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,114. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 31,050. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,050. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSEEING THE AUDIT AND SELECTING AN INDEPENDENT AUDITOR HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART IV, LINE 12 AND PART XII, LINE 2C THE ORGANIZATION HAS AUDITED FINANCIAL STATEMENTS THAT ARE PREPARED ON A CONSOLIDATED BASIS. FORM 5471, SCHEDULE O, PART I THE OFFICERS AND/OR DIRECTORS OF THE FOREIGN CORPORATION FILE FORM 5471 AS CATEGORY 2 FILERS IN ACCORDANCE WITH TREASURY REGULATION SECTION 1.6046-1(A)(2)(I)(C). THERE WERE NO 10% ACQUISITIONS BY UNITED STATES PERSONS DURING THE CURRENT YEAR. EACH SHAREHOLDER WITH RESPECT TO WHOM THE CATEGORY 2 FORMS ARE FILED IS A UNITED STATES SHAREHOLDER UNDER SECTION 953(C) AND HAS PROVIDED THE INFORMATION REQUIRED BY TREASURY REGULATION SECTION 1.6046-1(A)(2)(II)(A) TO THE IRS ON FORM 5471 ATTACHED TO THEIR RESPECTIVE INCOME TAX RETURN. FORM 5471, SCHEDULE B NO U.S. PERSON OWNED (AT ANY TIME DURING THE ACCOUNTING PERIOD), DIRECTLY OR INDIRECTLY, 10% OR MORE IN VALUE OR VOTE OF ANY CLASS OF THE CORPORATION'S OUTSTANDING STOCK. FORM 5471, SCHEDULE O, PART II, SECTION C & D THE FILER IS A CATEGORY 3 FILER FOR FORM 5471 PURPOSES BECAUSE IT IS A UNITED STATES SHAREHOLDER OF THE FOREIGN CORPORATION UNDER IRC SECTION 953(C). THEREFORE, THE FILER IS REQUIRED TO COMPLETE SCHEDULE O EVEN IF IT NEITHER ACQUIRED NOR DISPOSED OF STOCK IN THE FOREIGN CORPORATION. FORM 5471, SCHEDULE O, PART II, SECTION F THE FOREIGN CORPORATION FILED FORM 1120-F, U.S. INCOME TAX RETURN OF A FOREIGN CORPORATION, FOR ITS TAX YEARS ENDED MAY 31, 2020, 2019, AND 2018. THE FOREIGN CORPORATION HAD NO TAXABLE INCOME AND NO TAX DUE ON THE RETURN. ADDITIONAL FILING REQUIREMENTS FOR CATEGORY 3 FILERS: 1. THE AMOUNT AND TYPE OF ANY INDEBTEDNESS THE FOREIGN CORPORATION HAS WITH THE RELATED PERSONS DESCRIBED IN REGULATION SEC. 1.6046-1(B)(11). N/A - THERE IS NO INDEBTEDNESS BETWEEN CATALYST INSURANCE, LTD. AND RELATED PARTIES. 2. THE NAME, ADDRESS, INDENTIFYING NUMBER AND NUMBER OF SHARES SUBSCRIBED TO BY EACH SUBSCRIBER TO THE FOREIGN CORPORATION'S STOCK. N/A - THERE ARE CURRENTLY NO SUBSCRIPTIONS FOR ANY OF CATALYST INSURANCE, LTD.'S STOCK. FORM 5471, SCHEDULE E, PART I THROUGH III; AND SCHEDULE E-1 THE CONTROLLED FOREIGN CORPORATION FOR WHICH THIS INFORMATIONAL RETURN IS BEING FILED IS A TAX RESIDENT IN THE CAYMAN ISLANDS AND AS A CORPORATION ORGANIZED UNDER THE LAWS OF THE CAYMAN ISLANDS, THE CONTROLLED FOREIGN CORPORATION IS NOT SUBJECT TO TAXATION AS THE CAYMAN ISLANDS DOES NOT IMPOSE ANY FORM OF TAXATION ON RECEIPTS, DIVIDENDS, CAPITAL GAINS, GIFTS OR NET INCOME. SCHEDULE E, WHICH REPORTS FOREIGN TAXES PAID OR ACCRUED AND IS REQUIRED TO BE ATTACHED TO THIS RETURN, IS BEING FILED BUT DOES NOT HAVE ANY AMOUNTS SHOWN BECAUSE NO FOREIGN TAXES WERE PAID OR ACCRUED. ADVANCED MEDICAL TRANSPORT INC 1718 N STERLING AVE PEORIA IL 61604 260312211 CHARITABLE, SCIENTIFIC, & EDUCATION TO PHMMS, AMT IA, AMT EAST, & AMT SPRFLD IL 501(C)(3) LINE 10 0 ADVANCED MEDICAL TRANSPORT OF IOWA 1718 N STERLING AVE PEORIA IL 61604 274133957 PROVIDES AMBULANCE AND PARAMEDIC SERVICES IA 501(C)(3) LINE 10 ADVANCED MEDICAL TRANSPORT INC 0 ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD 1718 N STERLING AVE PEORIA IL 61604 320596837 PROVIDES AMBULANCE AND PARAMEDIC SERVICES IL 501(C)(3) LINE 10 ADVANCED MEDICAL TRANSPORT INC 0 ADVANCED MEDICAL TRANSPORT EAST INC 1718 N STERLING AVE PEORIA IL 61604 862146583 PROVIDES AMBULANCE AND PARAMEDIC SERVICES IL 501(C)(3) LINE 10 ADVANCED MEDICAL TRANSPORT INC 0 MIDWEST EMERGENCY MEDICAL SERVICES 1718 N STERLING AVE PEORIA IL 61604 263021862 BILLING AND MANAGEMENT IL ADVANCED MEDICAL TRANSPORT INC C 0 1 1 0 0 1 0 1 0 0 0 0 1 1 0 1 1 1 0 0 ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC A 888 AMTSI INTEREST PAID TO PHMMS ADVANCED MEDICAL TRANSPORT EAST INC B 642660 DONATION OF ASSETS TO AMTE ADVANCED MEDICAL TRANSPORT OF IOWA E 220038 NOTE PAYABLE FROM AMTI ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC E 5609406 NOTE PAYABLE FROM AMTSI ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC G 5000 SALE OF ASSETS TO AMTSI ADVANCED MEDICAL TRANSPORT OF IOWA L 54473 AMTI CONTRACTED SERVICES PAID TO ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC L 652200 AMTSI CONTRACTED SERVICES PAID TO ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC M 259429 PHMMS SERVICES PAID TO AMTSI ADVANCED MEDICAL TRANSPORT OF IOWA O 209084 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA P 77117 AMT IOWA EXPENSES PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES P 56989 MEMSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC P 336820 AMTSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC Q 912 PHMMS EXPENSES PAID BY AMTSI