2021-11-10T11:37:42-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STREET SUITE 1000 PEORIA IL 61602 990 2020-01-01 370999878 PEORIA HOSPITALS MOBILE MEDICAL SERVICES D/B/A ADV MEDICAL TRANS OF CENTRAL IL PEOR 3094946200 1718 NORTH STERLING AVE PEORIA IL 61604 JEANINE SPAIN BOARD CHAIRPERSON 3094946200 2021-11-02 1 JEANINE SPAIN XXX-XX-XXXX STEPHANIE J PETRI CPA P01238917 3096714500 2021-11-02 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z JEANINE SPAIN 1718 NORTH STERLING AVE PEORIA IL 61604 28436856 0 X WWW.ADVANCEDMEDICALTRANSPORT.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. 8 7 429 0 0 0 0 0 23909156 27373092 274676 192320 24710 849362 24208542 28414774 212095 300193 0 0 14677922 17195775 0 0 0 7006311 7650519 21896328 25146487 2312214 3268287 28665373 36748087 2677248 7220343 25988125 29527744 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 19838320 300193 28179829 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 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. 532271 42625 THE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 20370591 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 13 0 1 429 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X GREG CHANCE 3094946200 1718 N STERLING AVE PEORIA IL 61604 ROBERT ANDERSON BOARD MEMBER 1.00 0.00 X 0 0 0 JEANINE SPAIN BOARD CHAIRPERSON 1.00 0.00 X X 0 0 0 SALLY SNYDER BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 MELISSA WOODS BOARD MEMBER 1.00 0.00 X 0 0 0 ANDREW RAND CEO/BOARD MEMBER 20.00 20.00 X X 401987 0 18351 JAMES ADAMS BOARD MEMBER 1.00 0.00 X 0 0 0 BILL FLEMING BOARD MEMBER 1.00 0.00 X 0 0 0 TODD BAKER VP BUSINESS DEVELOPMENT 20.00 20.00 X X 141547 0 17986 JOHN STENSON BOARD VICE-CHAIRPERSON 1.00 0.00 X X 0 0 0 TIM BECCUE VP OF FINANCE 20.00 20.00 X X 189869 0 25738 GREG CHANCE VP OF STRATEGY/CEO OF AMTSI 0.00 40.00 X X 8848 153042 10610 THOMAS GERACI VP OF OPERATIONS 35.00 5.00 X X 133605 0 3340 DERRICK HAHN VP OF FLEET 25.00 15.00 X X 136576 0 18722 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 20.00 20.00 X X 143721 0 9750 BRET WHELAN-RAMP EMS ACADEMY DIRECTOR 40.00 0.00 X 144366 0 18541 JENNIFER FLEMING DIRECTOR OF OPERATIONS 40.00 0.00 X 142471 0 7905 LAUREN EMANUELSON DIRECTOR OF QUALITY 40.00 0.00 X 109137 0 11268 MARK GILLES CRITICAL CARE PARAMEDIC 40.00 0.00 X 136936 0 20265 CHAD CRAIG CRITICAL CARE PARAMEDIC 40.00 0.00 X 143022 0 22510 DENISE DURRELL PHRN 40.00 0.00 X 122989 0 18882 STEPHANIE SINN PAYROLL ADMINISTRATOR 40.00 0.00 X 102971 0 13780 DAKOTA ZIMMERMAN PHRN 40.00 0.00 X 101348 0 13045 2159393 153042 230693 14 0 1 0 0 TRANSPORT REVENUE 621990 26947266 26947266 SUBSIDY REVENUE 621990 383201 383201 TUITION REVENUE 611600 42625 42625 27373092 76126 76126 138276 22082 116194 116194 116194 CARES GRANT 900099 759108 759108 MISCELLANEOUS 900099 90254 90254 849362 28414774 28222454 0 192320 X 300193 300193 1552127 1266414 285713 12799771 10443630 2356141 450807 365053 85754 1349945 1127939 222006 1043125 871990 171135 75405 75405 59310 59310 -30770 -36453 5683 167922 151422 16500 511522 163970 347552 288143 195717 92426 3974 3974 -621591 -621591 1957403 1564509 392894 1333176 1185352 147824 SUPPLIES 1547616 1390606 157010 FUEL 551458 548035 3423 REPAIRS & MAINTENANCE 523856 439672 84184 RECRUITING 317776 317776 965319 692383 272936 25146487 20370591 4775896 0 3119815 9428011 5286454 5595373 3316581 4024918 7758118 7721580 647998 930582 23967025 14955402 8500407 9011623 36000 36000 28665373 36748087 620655 888788 0 3254000 2056593 3077555 2677248 7220343 X 25988125 29527744 25988125 29527744 28665373 36748087 3268287 271332 0 X X 0 1 X 1 0 X 22169307 22711497 23745380 23909156 27373092 119908432 22169307 22711497 23745380 23909156 27373092 119908432 0 0 0 119908432 65310 70643 92652 255226 76126 559957 65310 70643 92652 255226 76126 559957 37727 224087 89612 44160 965556 1361142 22272344 23006227 23927644 24208542 28414774 121829531 0.98420 0.98910 0.00460 0.00480 X 1227639 1227639 6777613 1970955 4806658 15961773 12984447 2977326 9011623 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 1250771 OTHER LIABILITIES 984784 NOTE PAYABLE TO MEMSI 842000 3077555 28686106 271332 271332 28414774 0 28414774 25146487 0 25146487 0 25146487 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 90000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS JUNIOR ACHIEVEMENT OF CENTRAL ILLINOIS 508 HIGH POINT LANE EAST PEORIA IL 61611 370657600 501(C)(3) 5000 SUPPORT LOCAL EDUCATION PROGRAMS INVICTUS WOODS ENDOWMENT CENTER 29240 N COUNTY HIGHWAY 28 GLASFORD IL 61533 461323458 501(C)(3) 5000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS CENTRAL ILLINOIS BUSINESS PUBLISHERS 4736 N UNIVERSITY PEORIA IL 61614 5000 SUPPORT LOCAL NON-FOR-PROFITS WTVP PO BOX 1347 PEORIA IL 61654 237041401 501(C)(3) 25000 SUPPORT LOCAL EDUCATION PROGRAMS PEORIA RIVERFRONT MUSEUM 222 SW WASHINGTON ST PEORIA IL 61602 272920016 501(C)(3) 25000 SUPPORT LOCAL EDUCATION PROGRAMS APPSCO NFP 4606B N PROSPECT RD PEORIA HEIGHTS IL 61616 814829268 501(C)(3) 5000 SUPPORT LOCAL EDUCATION PROGRAMS GEORGE WASHINGTON CARVER CENTER 710 W PERCY BAKER AVE PEORIA IL 61605 370802842 501(C)(3) 5000 SUPPORT LOCAL EDUCATION PROGRAMS CATHOLIC CHARITIES DIOCESE OF PEORIA 2900 WEST HEADING AVE WEST PEORIA IL 61604 370661190 501(C)(3) 5000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS CITY OF CHILLICOTHE 908 N SECOND ST CHILLICOTHE IL 61523 6110 SUPPORT LOCAL EDUCATION PROGRAMS PEKIN FIRE DEPARTMENT 3232 COURT STREET PEKIN IL 61554 11992 IMPROVE LOCAL COMMUNITY CARDIAC ARREST SURVIVABILITY INIATIVES PEORIA FIRE DEPARTMENT 505 NE MONROE PEORIA IL 61603 65956 IMPROVE LOCAL COMMUNITY CARDIAC ARREST SURVIVABILITY INIATIVES 11 1 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 297950 0 104037 0 0 0 12500 0 5851 0 420338 0 0 0 TIM BECCUE VP OF FINANCE 189869 0 0 0 0 0 9750 0 15988 0 215607 0 0 0 GREG CHANCE VP OF STRATEGY/CEO OF AMTSI 8848 153042 0 0 0 0 111 1960 0 8539 8959 163541 0 0 CHAD CRAIG CRITICAL CARE PARAMEDIC 140775 0 2247 0 0 0 3935 0 18575 0 165532 0 0 0 BRET WHELAN-RAMP EMS ACADEMY DIRECTOR 137566 0 6800 0 0 0 2727 0 15814 0 162907 0 0 0 TODD BAKER VP BUSINESS DEVELOPMENT 121547 0 20000 0 0 0 13000 0 4986 0 159533 0 0 0 MARK GILLES CRITICAL CARE PARAMEDIC 133365 0 3571 0 0 0 6757 0 13508 0 157201 0 0 0 DERRICK HAHN VP OF FLEET 136576 0 0 0 0 0 13000 0 5722 0 155298 0 0 0 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 126906 0 16815 0 0 0 9750 0 0 0 153471 0 0 0 JENNIFER FLEMING DIRECTOR OF OPERATIONS 132110 0 10361 0 0 0 2183 0 5722 0 150376 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 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 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, 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-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, AND EDUCATIONAL TO FUTHER PHMMS AND AMT OF IOWA IL 501(C)(3) 9 0 ADVANCED MEDICAL TRANSPORT OF IOWA 1718 N STERLING AVE PEORIA IL 61604 274133957 PROVIDES AMBULANCE AND PARAMEDIC SERVICES IA 501(C)(3) 9 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) 9 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 0 0 1 1 0 1 0 0 0 0 1 1 0 1 1 1 0 0 MIDWEST EMERGENCY MEDICAL SERVICES D 842000 NOTE PAYABLE TO MEMSI ADVANCED MEDICAL TRANSPORT OF IOWA P 133954 AMT IOWA EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 171828 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA E 220038 NOTE PAYABLE FROM AMTI MIDWEST EMERGENCY MEDICAL SERVICES P 15877 MEMSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC E 4794026 NOTE PAYABLE FROM AMTSI ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC P 153220 AMTSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC G 622500 SALE OF ASSETS TO AMTSI ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC A 21787 AMTSI INTEREST PAID TO PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC L 643166 AMTSI CONTRACTED SERVICES PAID TO ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC M 43004 PHMMS SERVICES PAID TO AMTSI ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC Q 6776 PHMMS EXPENSES PAID BY AMTSI