PEORIA HOSPITALS MOBILE MEDICAL SERVICES: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
PEORIA HOSPITALS MOBILE MEDICAL SERVICES (EIN 37-0999878)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-13
IRS object ID
202013189349311956
Schema version
2019v5.1
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)
Return2020-11-13T16:14:38-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

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 Begin2019-01-01TaxPeriodBeginDt

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
Signature2020-11-09SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonSAMUEL A CIGELNIKPreparerPersonNm
PTINP00324762PTIN
Phone3096714500PhoneNum
Preparation2020-11-09PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.137.57.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-11-09IPDt
IP Tm13:42:59IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdFB4F3F4AA475E49A9B1F4615434F66DD4B304750AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

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$24,278,231GrossReceiptsAmt
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 Body10VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee440TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$23,745,380PYProgramServiceRevenueAmt
CY Program Service Revenue$23,909,156CYProgramServiceRevenueAmt
PY Investment Income$107,139PYInvestmentIncomeAmt
CY Investment Income$274,676CYInvestmentIncomeAmt
PY Other Revenue$75,125PYOtherRevenueAmt
CY Other Revenue$24,710CYOtherRevenueAmt
PY Total Revenue$23,927,644PYTotalRevenueAmt
CY Total Revenue$24,208,542CYTotalRevenueAmt
PY Grants And Similar Paid$228,038PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$212,095CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$14,449,435PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$14,677,922CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$7,160,354PYOtherExpensesAmt
CY Other Expenses$7,006,311CYOtherExpensesAmt
PY Total Expenses$21,837,827PYTotalExpensesAmt
CY Total Expenses$21,896,328CYTotalExpensesAmt
PY Revenues Less Expenses$2,089,817PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,312,214CYRevenuesLessExpensesAmt
Total Assets BOY$25,794,644TotalAssetsBOYAmt
Total Assets EOY$28,665,373TotalAssetsEOYAmt
Total Liabilities BOY$2,522,820TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,677,248TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$23,271,824NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$25,988,125NetAssetsOrFundBalancesEOYAmt
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$17,261,024ExpenseAmt
Grant$212,095GrantAmt
Revenue$23,899,289RevenueAmt
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 43,447 AMBULANCE, 2,734 IPT AND 6,004 WHEELCHAIR TRANSPORTS IN 2019. THE ORGANIZATION PROVIDED $709,715 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 2019 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY $3,178,396. THE ORGANIZATION ALSO PROVIDED $394,684 IN SUPPORT OF OTHER COMMUNITY BENEFITS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$449,444ExpenseAmt
Revenue$34,577RevenueAmt
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$17,710,468TotalProgramServiceExpensesAmt
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 Document14IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee440EmployeeCnt
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 Members10GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
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 Line1ANDREW RANDBusinessNameLine1Txt
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 (20 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
ROBERT ANDERSON
BOARD CHAIRPERSON1.000.00Yes (X)Yes (X)$0$0$0
JEANINE SPAIN
BOARD VICE-CHAIRPERSON1.000.00Yes (X)Yes (X)$0$0$0
SALLY SNYDER
BOARD TREASURER/SECRETARY1.000.00Yes (X)Yes (X)$0$0$0
JAMES BROWN
BOARD MEMBER1.000.00Yes (X)$0$0$0
ANDREW RAND
CEO/BOARD MEMBER20.0030.00Yes (X)Yes (X)$391,933$0$17,099
TAMMY PAUWELS
BOARD MEMBER1.001.00Yes (X)$0$0$0
JAMES ADAMS
BOARD MEMBER1.000.00Yes (X)$0$0$0
BILL FLEMING
BOARD MEMBER1.000.00Yes (X)$0$0$0
TODD BAKER
BOARD MEMBER1.000.00Yes (X)$0$0$0
JOHN STENSON
BOARD MEMBER1.000.00Yes (X)$0$0$0
TIM BECCUE
VP OF FINANCE20.0030.00Yes (X)Yes (X)$209,612$0$19,438
GREG CHANCE
VP OF STRATEGY25.0015.00Yes (X)Yes (X)$173,586$0$9,233
THOMAS GERACI
VP OF OPERATIONS25.0015.00Yes (X)Yes (X)$132,189$0$3,296
DERRICK HAHN
VP OF FLEET25.0015.00Yes (X)Yes (X)$131,201$0$16,039
CHELSEY TALLEY
DIRECTOR OF ACCOUNTING20.0030.00Yes (X)Yes (X)$144,598$0$9,500
JENNIFER FLEMING
DIRECTOR OF OPERATIONS40.000.00$101,189$0$5,592Yes (X)
LAUREN EMANUELSON
DIRECTOR OF QUALITY IMPROVEMENT AND COMPLIANCE34.006.00$133,778$0$8,986Yes (X)
EVAN INEICHEN
CRITICAL CARE PARAMEDIC40.000.00$119,768$0$2,270Yes (X)
MARK GILLES
CRITICAL CARE PARAMEDIC40.000.00$103,844$0$8,088Yes (X)
CHAD CRAIG
CRITICAL CARE PARAMEDIC40.000.00$139,903$0$16,962Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,781,601TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$116,503TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K11IndivRcvdGreaterThan100KCnt
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$23,527,276$23,527,276
SUBSIDY REVENUE621990$347,303$347,303
TUITION REVENUE611600$34,577$34,577
FieldValueIRS element (for citing)
Total Program Service Revenue$23,909,156TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$255,226TotalRevenueColumnAmt
Exclusion$255,226ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$89,139OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$69,689OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$19,450OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,450TotalRevenueColumnAmt
Exclusion$19,450ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUSDesc
Business900099BusinessCd
Total Revenue Column$24,710TotalRevenueColumnAmt
Related Or Exempt Func Income$24,710RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$24,710OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,208,542TotalRevenueColumnAmt
Related Or Exempt Func Income$23,933,866RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$274,676ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$212,095TotalAmt
Program Services$212,095ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,418,086TotalAmt
Program Services$1,160,327ProgramServicesAmt
Management And General$257,759ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,715,452TotalAmt
Program Services$8,767,747ProgramServicesAmt
Management And General$1,947,705ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$350,506TotalAmt
Program Services$287,298ProgramServicesAmt
Management And General$63,208ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,282,620TotalAmt
Program Services$1,066,493ProgramServicesAmt
Management And General$216,127ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$911,258TotalAmt
Program Services$769,396ProgramServicesAmt
Management And General$141,862ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$62,053TotalAmt
Management And General$62,053ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$58,900TotalAmt
Management And General$58,900ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$54,247TotalAmt
Program Services$45,466ProgramServicesAmt
Management And General$8,781ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$156,225TotalAmt
Program Services$130,703ProgramServicesAmt
Management And General$25,522ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$437,160TotalAmt
Program Services$135,426ProgramServicesAmt
Management And General$301,734ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$286,906TotalAmt
Program Services$191,517ProgramServicesAmt
Management And General$95,389ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total-$358,075TotalAmt
Program Services-$358,075ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,989,213TotalAmt
Program Services$1,658,264ProgramServicesAmt
Management And General$330,949ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$1,098,972TotalAmt
Program Services$977,631ProgramServicesAmt
Management And General$121,341ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$960,356$792,966$167,390
FUEL$628,627$625,827$2,800
REPAIRS & MAINTENANCE$438,690$360,507$78,183
RECRUITING$295,055$295,055

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$897,982TotalAmt
Program Services$591,825ProgramServicesAmt
Management And General$306,157ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$21,896,328TotalAmt
Program Services$17,710,468ProgramServicesAmt
Management And General$4,185,860ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$6,735,436BOYAmt
EOY$3,119,815EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,799,065BOYAmt
EOY$5,286,454EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,146,110BOYAmt
EOY$3,316,581EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$1,176,567BOYAmt
EOY$7,758,118EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$500,477BOYAmt
EOY$647,998EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$22,539,012LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$14,038,605LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,400,989BOYAmt
EOY$8,500,407EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

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

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$25,794,644BOYAmt
EOY$28,665,373EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$644,233BOYAmt
EOY$620,655EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,878,587BOYAmt
EOY$2,056,593EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,522,820BOYAmt
EOY$2,677,248EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$23,271,824BOYAmt
EOY$25,988,125EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$23,271,824BOYAmt
EOY$25,988,125EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$25,794,644BOYAmt
EOY$28,665,373EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$2,312,214ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$404,087NetUnrlzdGainsLossesInvstAmt
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$21,341,729CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,169,307CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$22,711,497CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,745,380CurrentTaxYearMinus1YearAmt
Current Tax Year$23,909,156CurrentTaxYearAmt
Total$113,877,069TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,341,729CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,169,307CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$22,711,497CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,745,380CurrentTaxYearMinus1YearAmt
Current Tax Year$23,909,156CurrentTaxYearAmt
Total$113,877,069TotalAmt

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$113,877,069PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$68,591CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$65,310CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$70,643CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$92,652CurrentTaxYearMinus1YearAmt
Current Tax Year$255,226CurrentTaxYearAmt
Total$552,422TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$68,591CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$65,310CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$70,643CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$92,652CurrentTaxYearMinus1YearAmt
Current Tax Year$255,226CurrentTaxYearAmt
Total$552,422TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$309,584CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$37,727CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$224,087CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$89,612CurrentTaxYearMinus1YearAmt
Current Tax Year$44,160CurrentTaxYearAmt
Total$705,170TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$21,719,904CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$22,272,344CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$23,006,227CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$23,927,644CurrentTaxYearMinus1YearAmt
Current Tax Year$24,208,542CurrentTaxYearAmt
Total$115,134,661TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98910PublicSupportCY509Pct
Public Support PY5090.98800PublicSupportPY509Pct
Investment Income CY0.00480InvestmentIncomeCYPct
Investment Income PY0.00350InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,207,823OtherCostOrOtherBasisAmt
Book Value$1,207,823BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,601,195OtherCostOrOtherBasisAmt
Depreciation$1,607,763DepreciationAmt
Book Value$4,993,432BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,729,994OtherCostOrOtherBasisAmt
Depreciation$12,430,842DepreciationAmt
Book Value$2,299,152BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$8,500,407TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
ACCRUED WAGES, TAXES, AND WITHHOLDINGS$744,386
OTHER LIABILITIES$470,209
NOTE PAYABLE TO MEMSI$841,998
FieldValueIRS element (for citing)
Total Liability$2,056,593TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$24,612,629TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$404,087NetUnrealizedGainsInvstAmt
Revenue Not Reported$404,087RevenueNotReportedAmt
Revenue Subtotal$24,208,542RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$24,208,542TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$21,896,328TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$21,896,328ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$21,896,328TotalExpensesPerForm990Amt

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
HEART OF ILLINOIS UNITED WAY
509 W HIGH STPEORIAIL61606370661504501(C)(3)$89,000SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS
CEO COUNCIL - ALIGNMENT PEORIA
100 SW WATER STREETPEORIAIL61602371271212501(C)(3)$10,000SUPPORT ECONOMIC GROWTH
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
PEORIA AREA CHAMBER OF COMMERCE
403 NE JEFFERSON AVEPEORIAIL61603370459010501(C)(6)$5,000SUPPORT LOCAL EDUCATION PROGRAMS
CENTRAL ILLINOIS BUSINESS PUBLISHERS
4736 N UNIVERSITYPEORIAIL61614$5,000SUPPORT LOCAL NON-FOR-PROFITS
PEORIA AREA FOOD BANK
721 W MCBEAN STPEORIAIL61605376058636501(C)(3)$5,000SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS
WTVP
PO BOX 1347PEORIAIL61654237041401501(C)(3)$5,000SUPPORT LOCAL EDUCATION PROGRAMS
PEORIA RIVERFRONT MUSEUM
222 SW WASHINGTON STPEORIAIL61602272920016501(C)(3)$20,000SUPPORT LOCAL EDUCATION PROGRAMS
FieldValueIRS element (for citing)
Total501c3 Org8Total501c3OrgCnt
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 (5 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$291,933$0$100,000$0$0$0$12,500$0$4,599$0$409,032$0$0$0
TIM BECCUE
VP OF FINANCE$170,207$0$39,405$0$0$0$9,500$0$9,938$0$229,050$0$0$0
GREG CHANCE
VP OF STRATEGY$149,586$0$24,000$0$0$0$2,251$0$6,982$0$182,819$0$0$0
CHELSEY TALLEY
DIRECTOR OF ACCOUNTING$123,240$0$21,358$0$0$0$9,500$0$0$0$154,098$0$0$0
CHAD CRAIG
CRITICAL CARE PARAMEDIC$136,148$0$3,755$0$0$0$3,807$0$13,155$0$156,865$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 107,280. MANAGEMENT AND GENERAL EXPENSES 111,779. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 219,059. EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 183,000. MANAGEMENT AND GENERAL EXPENSES 31,093. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 214,093. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 165,142. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,142. UNIFORMS: PROGRAM SERVICE EXPENSES 81,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,660. SUBCONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 58,750. MANAGEMENT AND GENERAL EXPENSES 20,425. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,175. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 68,562. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,562. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 51,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,394. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 22,904. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,904. COMMUNICATIONS: PROGRAM SERVICE EXPENSES -4,007. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -4,007.
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, 2016, 2017, 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-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 Rylts0ReceiptOfIntAnntsRntsRyltsInd
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 OrgYes (1)AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (10 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
MIDWEST EMERGENCY MEDICAL SERVICES
D$842,000NOTE PAYABLE TO MEMSI
ADVANCED MEDICAL TRANSPORT OF IOWA
P$482,064AMT IOWA EXPENSES PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF IOWA
O$573,808AMT IOWA PAYROLL PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF IOWA
H$194,960PURCHASE OF ASSETS FROM AMT IOWA
ADVANCED MEDICAL TRANSPORT OF IOWA
E$220,038NOTE PAYABLE FROM AMTI
MIDWEST EMERGENCY MEDICAL SERVICES
O$1,477MEMSI PAYROLL PAID BY PHMMS
MIDWEST EMERGENCY MEDICAL SERVICES
P$195,625MEMSI EXPENSES PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
E$4,794,026NOTE PAYABLE FROM AMTSI
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
P$2,116,606AMTSI EXPENSES PAID BY PHMMS
ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC
G$90,168SALE OF ASSETS TO AMTSI

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