PEORIA HOSPITALS MOBILE MEDICAL SERVICES: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
PEORIA HOSPITALS MOBILE MEDICAL SERVICES (EIN 37-0999878)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-10
IRS object ID
202113149349303191
Schema version
2020v4.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-11-10T11:37:42-06:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1301 SW ADAMS STREET SUITE 1000AddressLine1Txt
CityPEORIACityNm
State AbbreviationILStateAbbreviationCd
ZIP61602ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN370999878EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PEORIA HOSPITALS MOBILE MEDICAL SERVICESBusinessNameLine1Txt
Business Name Line2D/B/A ADV MEDICAL TRANS OF CENTRAL ILBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlPEORBusinessNameControlTxt
Phone3094946200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11718 NORTH STERLING AVEAddressLine1Txt
CityPEORIACityNm
State AbbreviationILStateAbbreviationCd
ZIP61604ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJEANINE SPAINPersonNm
Person TitleBOARD CHAIRPERSONPersonTitleTxt
Phone3094946200PhoneNum
Signature2021-11-02SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstJEANINEPersonFirstNm
Person LastSPAINPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSTEPHANIE J PETRI CPAPreparerPersonNm
PTINP01238917PTIN
Phone3096714500PhoneNum
Preparation2021-11-02PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJEANINE SPAINPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11718 NORTH STERLING AVEAddressLine1Txt
CityPEORIACityNm
State AbbreviationILStateAbbreviationCd
ZIP61604ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$28,436,856GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.ADVANCEDMEDICALTRANSPORT.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1975FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTHE 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.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee429TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$23,909,156PYProgramServiceRevenueAmt
CY Program Service Revenue$27,373,092CYProgramServiceRevenueAmt
PY Investment Income$274,676PYInvestmentIncomeAmt
CY Investment Income$192,320CYInvestmentIncomeAmt
PY Other Revenue$24,710PYOtherRevenueAmt
CY Other Revenue$849,362CYOtherRevenueAmt
PY Total Revenue$24,208,542PYTotalRevenueAmt
CY Total Revenue$28,414,774CYTotalRevenueAmt
PY Grants And Similar Paid$212,095PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$300,193CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$14,677,922PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$17,195,775CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$7,006,311PYOtherExpensesAmt
CY Other Expenses$7,650,519CYOtherExpensesAmt
PY Total Expenses$21,896,328PYTotalExpensesAmt
CY Total Expenses$25,146,487CYTotalExpensesAmt
PY Revenues Less Expenses$2,312,214PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$3,268,287CYRevenuesLessExpensesAmt
Total Assets BOY$28,665,373TotalAssetsBOYAmt
Total Assets EOY$36,748,087TotalAssetsEOYAmt
Total Liabilities BOY$2,677,248TotalLiabilitiesBOYAmt
Total Liabilities EOY$7,220,343TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$25,988,125NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$29,527,744NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$19,838,320ExpenseAmt
Grant$300,193GrantAmt
Revenue$28,179,829RevenueAmt
DescTHE 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 41,457 AMBULANCE, 2,710 IPT AND 5,852 WHEELCHAIR TRANSPORTS IN 2020. THE ORGANIZATION PROVIDED $753,942 IN CHARITABLE SERVICES TO QUALIFIED INDIVIDUALS AT NO CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. THE ORGANIZATION ALSO PROVIDED CARE TO MEDICAID PATIENTS AT RATES BELOW THE COST OF PROVIDING SERVICES. FOR 2020 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY $3,628,391. THE ORGANIZATION ALSO PROVIDED $519,645 IN SUPPORT OF OTHER COMMUNITY BENEFITS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$532,271ExpenseAmt
Revenue$42,625RevenueAmt
DescTHE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$20,370,591TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document13IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee429EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GREG CHANCEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone3094946200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11718 N STERLING AVEAddressLine1Txt
CityPEORIACityNm
State AbbreviationILStateAbbreviationCd
ZIP61604ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
ROBERT ANDERSON
BOARD MEMBER1.000.00Yes (X)$0$0$0
JEANINE SPAIN
BOARD CHAIRPERSON1.000.00Yes (X)$0$0$0Yes (X)
SALLY SNYDER
BOARD TREASURER/SECRETARY1.000.00Yes (X)$0$0$0Yes (X)
MELISSA WOODS
BOARD MEMBER1.000.00Yes (X)$0$0$0
ANDREW RAND
CEO/BOARD MEMBER20.0020.00Yes (X)$401,987$0$18,351Yes (X)
JAMES ADAMS
BOARD MEMBER1.000.00Yes (X)$0$0$0
BILL FLEMING
BOARD MEMBER1.000.00Yes (X)$0$0$0
TODD BAKER
VP BUSINESS DEVELOPMENT20.0020.00Yes (X)$141,547$0$17,986Yes (X)
JOHN STENSON
BOARD VICE-CHAIRPERSON1.000.00Yes (X)$0$0$0Yes (X)
TIM BECCUE
VP OF FINANCE20.0020.00Yes (X)$189,869$0$25,738Yes (X)
GREG CHANCE
VP OF STRATEGY/CEO OF AMTSI0.0040.00Yes (X)$8,848$153,042$10,610Yes (X)
THOMAS GERACI
VP OF OPERATIONS35.005.00Yes (X)$133,605$0$3,340Yes (X)
DERRICK HAHN
VP OF FLEET25.0015.00Yes (X)$136,576$0$18,722Yes (X)
CHELSEY TALLEY
DIRECTOR OF ACCOUNTING20.0020.00Yes (X)$143,721$0$9,750Yes (X)
BRET WHELAN-RAMP
EMS ACADEMY DIRECTOR40.000.00$144,366$0$18,541Yes (X)
JENNIFER FLEMING
DIRECTOR OF OPERATIONS40.000.00$142,471$0$7,905Yes (X)
LAUREN EMANUELSON
DIRECTOR OF QUALITY40.000.00$109,137$0$11,268Yes (X)
MARK GILLES
CRITICAL CARE PARAMEDIC40.000.00$136,936$0$20,265Yes (X)
CHAD CRAIG
CRITICAL CARE PARAMEDIC40.000.00$143,022$0$22,510Yes (X)
DENISE DURRELL
PHRN40.000.00$122,989$0$18,882Yes (X)
STEPHANIE SINN
PAYROLL ADMINISTRATOR40.000.00$102,971$0$13,780Yes (X)
DAKOTA ZIMMERMAN
PHRN40.000.00$101,348$0$13,045Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,159,393TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$153,042TotReportableCompRltdOrgAmt
Total Other Compensation$230,693TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K14IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
TRANSPORT REVENUE621990$26,947,266$26,947,266
SUBSIDY REVENUE621990$383,201$383,201
TUITION REVENUE611600$42,625$42,625
FieldValueIRS element (for citing)
Total Program Service Revenue$27,373,092TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$76,126TotalRevenueColumnAmt
Exclusion$76,126ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$138,276OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$22,082OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$116,194OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$116,194TotalRevenueColumnAmt
Exclusion$116,194ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
CARES GRANT900099$759,108$759,108
MISCELLANEOUS900099$90,254$90,254
FieldValueIRS element (for citing)
Other Revenue Total$849,362OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$28,414,774TotalRevenueColumnAmt
Related Or Exempt Func Income$28,222,454RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$192,320ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$300,193TotalAmt
Program Services$300,193ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,552,127TotalAmt
Program Services$1,266,414ProgramServicesAmt
Management And General$285,713ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$12,799,771TotalAmt
Program Services$10,443,630ProgramServicesAmt
Management And General$2,356,141ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$450,807TotalAmt
Program Services$365,053ProgramServicesAmt
Management And General$85,754ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,349,945TotalAmt
Program Services$1,127,939ProgramServicesAmt
Management And General$222,006ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$1,043,125TotalAmt
Program Services$871,990ProgramServicesAmt
Management And General$171,135ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$75,405TotalAmt
Management And General$75,405ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$59,310TotalAmt
Management And General$59,310ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total-$30,770TotalAmt
Program Services-$36,453ProgramServicesAmt
Management And General$5,683ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$167,922TotalAmt
Program Services$151,422ProgramServicesAmt
Management And General$16,500ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$511,522TotalAmt
Program Services$163,970ProgramServicesAmt
Management And General$347,552ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$288,143TotalAmt
Program Services$195,717ProgramServicesAmt
Management And General$92,426ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,974TotalAmt
Program Services$3,974ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total-$621,591TotalAmt
Program Services-$621,591ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,957,403TotalAmt
Program Services$1,564,509ProgramServicesAmt
Management And General$392,894ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,333,176TotalAmt
Program Services$1,185,352ProgramServicesAmt
Management And General$147,824ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$1,547,616$1,390,606$157,010
FUEL$551,458$548,035$3,423
REPAIRS & MAINTENANCE$523,856$439,672$84,184
RECRUITING$317,776$317,776

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$965,319TotalAmt
Program Services$692,383ProgramServicesAmt
Management And General$272,936ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$25,146,487TotalAmt
Program Services$20,370,591ProgramServicesAmt
Management And General$4,775,896ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,119,815BOYAmt
EOY$9,428,011EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$5,286,454BOYAmt
EOY$5,595,373EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,316,581BOYAmt
EOY$4,024,918EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$7,758,118BOYAmt
EOY$7,721,580EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$647,998BOYAmt
EOY$930,582EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$23,967,025LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$14,955,402LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$8,500,407BOYAmt
EOY$9,011,623EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$36,000BOYAmt
EOY$36,000EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$28,665,373BOYAmt
EOY$36,748,087EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$620,655BOYAmt
EOY$888,788EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,254,000EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,056,593BOYAmt
EOY$3,077,555EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,677,248BOYAmt
EOY$7,220,343EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$25,988,125BOYAmt
EOY$29,527,744EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$25,988,125BOYAmt
EOY$29,527,744EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$28,665,373BOYAmt
EOY$36,748,087EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$3,268,287ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$271,332NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,169,307CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,711,497CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,745,380CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,909,156CurrentTaxYearMinus1YearAmt
Current Tax Year$27,373,092CurrentTaxYearAmt
Total$119,908,432TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,169,307CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,711,497CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,745,380CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,909,156CurrentTaxYearMinus1YearAmt
Current Tax Year$27,373,092CurrentTaxYearAmt
Total$119,908,432TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$119,908,432PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$65,310CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$70,643CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$92,652CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$255,226CurrentTaxYearMinus1YearAmt
Current Tax Year$76,126CurrentTaxYearAmt
Total$559,957TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$65,310CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$70,643CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$92,652CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$255,226CurrentTaxYearMinus1YearAmt
Current Tax Year$76,126CurrentTaxYearAmt
Total$559,957TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$37,727CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$224,087CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$89,612CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$44,160CurrentTaxYearMinus1YearAmt
Current Tax Year$965,556CurrentTaxYearAmt
Total$1,361,142TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$22,272,344CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$23,006,227CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,927,644CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$24,208,542CurrentTaxYearMinus1YearAmt
Current Tax Year$28,414,774CurrentTaxYearAmt
Total$121,829,531TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98420PublicSupportCY509Pct
Public Support PY5090.98910PublicSupportPY509Pct
Investment Income CY0.00460InvestmentIncomeCYPct
Investment Income PY0.00480InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,227,639OtherCostOrOtherBasisAmt
Book Value$1,227,639BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,777,613OtherCostOrOtherBasisAmt
Depreciation$1,970,955DepreciationAmt
Book Value$4,806,658BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$15,961,773OtherCostOrOtherBasisAmt
Depreciation$12,984,447DepreciationAmt
Book Value$2,977,326BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,011,623TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
ACCRUED WAGES, TAXES, AND WITHHOLDINGS$1,250,771
OTHER LIABILITIES$984,784
NOTE PAYABLE TO MEMSI$842,000
FieldValueIRS element (for citing)
Total Liability$3,077,555TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$28,686,106TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$271,332NetUnrealizedGainsInvstAmt
Revenue Not Reported$271,332RevenueNotReportedAmt
Revenue Subtotal$28,414,774RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$28,414,774TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$25,146,487TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$25,146,487ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$25,146,487TotalExpensesPerForm990Amt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (12 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
HEART OF ILLINOIS UNITED WAY
509 W HIGH STPEORIAIL61606370661504501(C)(3)$90,000SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS
JUNIOR ACHIEVEMENT OF CENTRAL ILLINOIS
508 HIGH POINT LANEEAST PEORIAIL61611370657600501(C)(3)$5,000SUPPORT LOCAL EDUCATION PROGRAMS
INVICTUS WOODS ENDOWMENT CENTER
29240 N COUNTY HIGHWAY 28GLASFORDIL61533461323458501(C)(3)$5,000SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS
CENTRAL ILLINOIS BUSINESS PUBLISHERS
4736 N UNIVERSITYPEORIAIL61614$5,000SUPPORT LOCAL NON-FOR-PROFITS
WTVP
PO BOX 1347PEORIAIL61654237041401501(C)(3)$25,000SUPPORT LOCAL EDUCATION PROGRAMS
PEORIA RIVERFRONT MUSEUM
222 SW WASHINGTON STPEORIAIL61602272920016501(C)(3)$25,000SUPPORT LOCAL EDUCATION PROGRAMS
APPSCO NFP
4606B N PROSPECT RDPEORIA HEIGHTSIL61616814829268501(C)(3)$5,000SUPPORT LOCAL EDUCATION PROGRAMS
GEORGE WASHINGTON CARVER CENTER
710 W PERCY BAKER AVEPEORIAIL61605370802842501(C)(3)$5,000SUPPORT LOCAL EDUCATION PROGRAMS
CATHOLIC CHARITIES DIOCESE OF PEORIA
2900 WEST HEADING AVEWEST PEORIAIL61604370661190501(C)(3)$5,000SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS
CITY OF CHILLICOTHE
908 N SECOND STCHILLICOTHEIL61523$6,110SUPPORT LOCAL EDUCATION PROGRAMS
PEKIN FIRE DEPARTMENT
3232 COURT STREETPEKINIL61554$11,992IMPROVE LOCAL COMMUNITY CARDIAC ARREST SURVIVABILITY INIATIVES
PEORIA FIRE DEPARTMENT
505 NE MONROEPEORIAIL61603$65,956IMPROVE LOCAL COMMUNITY CARDIAC ARREST SURVIVABILITY INIATIVES
FieldValueIRS element (for citing)
Total501c3 Org11Total501c3OrgCnt
Total Other Org1TotalOtherOrgCnt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ANDREW RAND
CEO/BOARD MEMBER$297,950$0$104,037$0$0$0$12,500$0$5,851$0$420,338$0$0$0
TIM BECCUE
VP OF FINANCE$189,869$0$0$0$0$0$9,750$0$15,988$0$215,607$0$0$0
GREG CHANCE
VP OF STRATEGY/CEO OF AMTSI$8,848$153,042$0$0$0$0$111$1,960$0$8,539$8,959$163,541$0$0
CHAD CRAIG
CRITICAL CARE PARAMEDIC$140,775$0$2,247$0$0$0$3,935$0$18,575$0$165,532$0$0$0
BRET WHELAN-RAMP
EMS ACADEMY DIRECTOR$137,566$0$6,800$0$0$0$2,727$0$15,814$0$162,907$0$0$0
TODD BAKER
VP BUSINESS DEVELOPMENT$121,547$0$20,000$0$0$0$13,000$0$4,986$0$159,533$0$0$0
MARK GILLES
CRITICAL CARE PARAMEDIC$133,365$0$3,571$0$0$0$6,757$0$13,508$0$157,201$0$0$0
DERRICK HAHN
VP OF FLEET$136,576$0$0$0$0$0$13,000$0$5,722$0$155,298$0$0$0
CHELSEY TALLEY
DIRECTOR OF ACCOUNTING$126,906$0$16,815$0$0$0$9,750$0$0$0$153,471$0$0$0
JENNIFER FLEMING
DIRECTOR OF OPERATIONS$132,110$0$10,361$0$0$0$2,183$0$5,722$0$150,376$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 7FormAndLineReferenceDesc
ExplanationBASED ON EMPLOYEE PERFORMANCEExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 7AONE 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 11BTHE ORGANIZATION PROVIDES A COPY OF FORM 990 TO THE BOARD FOR REVIEW PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 15ATHE BOARD REVIEWS COMPARABLE DATA AND THE SPECIFIC PERFORMANCE OF THE EXECUTIVE DIRECTOR IN DETERMINING COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 24EBANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 120,682. MANAGEMENT AND GENERAL EXPENSES 116,173. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 236,855. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 168,151. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 168,151. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 155,337. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 155,337. EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 126,689. MANAGEMENT AND GENERAL EXPENSES 20,583. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 147,272. UNIFORMS: PROGRAM SERVICE EXPENSES 76,524. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,524. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 66,380. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 66,380. SUBCONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 45,000. MANAGEMENT AND GENERAL EXPENSES 526. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,526. SURVEY & DUES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 36,069. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,069. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 33,205. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,205.
FORM 990, PART XII, LINE 2CTHE 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 2CTHE ORGANIZATION HAS AUDITED FINANCIAL STATEMENTS THAT ARE PREPARED ON A CONSOLIDATED BASIS.
FORM 5471, SCHEDULE O, PART ITHE 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 BNO 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 & DTHE 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 FTHE FOREIGN CORPORATION FILED FORM 1120-F, U.S. INCOME TAX RETURN OF A FOREIGN CORPORATION, FOR ITS TAX YEARS ENDED MAY 31, 2017, 2018, AND 2019. 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-1THE 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
ADVANCED MEDICAL TRANSPORT INC
1718 N STERLING AVEPEORIAIL61604260312211CHARITABLE, SCIENTIFIC, AND EDUCATIONAL TO FUTHER PHMMS AND AMT OF IOWAIL501(C)(3)90
ADVANCED MEDICAL TRANSPORT OF IOWA
1718 N STERLING AVEPEORIAIL61604274133957PROVIDES AMBULANCE AND PARAMEDIC SERVICESIA501(C)(3)90ADVANCED MEDICAL TRANSPORT INC
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD
1718 N STERLING AVEPEORIAIL61604320596837PROVIDES AMBULANCE AND PARAMEDIC SERVICESIL501(C)(3)90ADVANCED MEDICAL TRANSPORT INC

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MIDWEST EMERGENCY MEDICAL SERVICESBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11718 N STERLING AVEAddressLine1Txt
CityPEORIACityNm
State AbbreviationILStateAbbreviationCd
ZIP61604ZIPCd
FieldValueIRS element (for citing)
EIN263021862EIN
Primary ActivitiesBILLING AND MANAGEMENTPrimaryActivitiesTxt
Legal Domicile StateILLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1ADVANCED MEDICAL TRANSPORT INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeCEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other OrgYes (1)AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (12 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
MIDWEST EMERGENCY MEDICAL SERVICES
D$842,000NOTE PAYABLE TO MEMSI
ADVANCED MEDICAL TRANSPORT OF IOWA
P$133,954AMT IOWA EXPENSES PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF IOWA
O$171,828AMT IOWA PAYROLL PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF IOWA
E$220,038NOTE PAYABLE FROM AMTI
MIDWEST EMERGENCY MEDICAL SERVICES
P$15,877MEMSI EXPENSES PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
E$4,794,026NOTE PAYABLE FROM AMTSI
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
P$153,220AMTSI EXPENSES PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
G$622,500SALE OF ASSETS TO AMTSI
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
A$21,787AMTSI INTEREST PAID TO PHMMS
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
L$643,166AMTSI CONTRACTED SERVICES PAID TO
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
M$43,004PHMMS SERVICES PAID TO AMTSI
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
Q$6,776PHMMS EXPENSES PAID BY AMTSI

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