2020-11-13T16:14:38-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STREET SUITE 1000 PEORIA IL 61602 990 2019-01-01 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 2020-11-09 1 SAMUEL A CIGELNIK P00324762 3096714500 2020-11-09 67.137.57.251 2020-11-09 13:42:59 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 FB4F3F4AA475E49A9B1F4615434F66DD4B304750 2019 2021-01-29 14:40:06Z JEANINE SPAIN 1718 NORTH STERLING AVE PEORIA IL 61604 24278231 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. 10 9 440 0 0 0 0 0 23745380 23909156 107139 274676 75125 24710 23927644 24208542 228038 212095 0 0 14449435 14677922 0 0 0 7160354 7006311 21837827 21896328 2089817 2312214 25794644 28665373 2522820 2677248 23271824 25988125 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 17261024 212095 23899289 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 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. 449444 34577 THE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 17710468 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 14 0 1 440 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X ANDREW RAND 3094946200 1718 N STERLING AVE PEORIA IL 61604 ROBERT ANDERSON BOARD CHAIRPERSON 1.00 0.00 X X 0 0 0 JEANINE SPAIN BOARD VICE-CHAIRPERSON 1.00 0.00 X X 0 0 0 SALLY SNYDER BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 JAMES BROWN BOARD MEMBER 1.00 0.00 X 0 0 0 ANDREW RAND CEO/BOARD MEMBER 20.00 30.00 X X 391933 0 17099 TAMMY PAUWELS BOARD MEMBER 1.00 1.00 X 0 0 0 JAMES ADAMS BOARD MEMBER 1.00 0.00 X 0 0 0 BILL FLEMING BOARD MEMBER 1.00 0.00 X 0 0 0 TODD BAKER BOARD MEMBER 1.00 0.00 X 0 0 0 JOHN STENSON BOARD MEMBER 1.00 0.00 X 0 0 0 TIM BECCUE VP OF FINANCE 20.00 30.00 X X 209612 0 19438 GREG CHANCE VP OF STRATEGY 25.00 15.00 X X 173586 0 9233 THOMAS GERACI VP OF OPERATIONS 25.00 15.00 X X 132189 0 3296 DERRICK HAHN VP OF FLEET 25.00 15.00 X X 131201 0 16039 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 20.00 30.00 X X 144598 0 9500 JENNIFER FLEMING DIRECTOR OF OPERATIONS 40.00 0.00 X 101189 0 5592 LAUREN EMANUELSON DIRECTOR OF QUALITY IMPROVEMENT AND COMPLIANCE 34.00 6.00 X 133778 0 8986 EVAN INEICHEN CRITICAL CARE PARAMEDIC 40.00 0.00 X 119768 0 2270 MARK GILLES CRITICAL CARE PARAMEDIC 40.00 0.00 X 103844 0 8088 CHAD CRAIG CRITICAL CARE PARAMEDIC 40.00 0.00 X 139903 0 16962 1781601 0 116503 11 0 1 0 0 TRANSPORT REVENUE 621990 23527276 23527276 SUBSIDY REVENUE 621990 347303 347303 TUITION REVENUE 611600 34577 34577 23909156 255226 255226 89139 69689 19450 19450 19450 MISCELLANEOUS 900099 24710 24710 24710 24208542 23933866 0 274676 X 212095 212095 1418086 1160327 257759 10715452 8767747 1947705 350506 287298 63208 1282620 1066493 216127 911258 769396 141862 62053 62053 58900 58900 54247 45466 8781 156225 130703 25522 437160 135426 301734 286906 191517 95389 -358075 -358075 1989213 1658264 330949 1098972 977631 121341 SUPPLIES 960356 792966 167390 FUEL 628627 625827 2800 REPAIRS & MAINTENANCE 438690 360507 78183 RECRUITING 295055 295055 897982 591825 306157 21896328 17710468 4185860 0 6735436 3119815 4799065 5286454 3146110 3316581 1176567 7758118 500477 647998 22539012 14038605 9400989 8500407 36000 36000 25794644 28665373 644233 620655 1878587 2056593 2522820 2677248 X 23271824 25988125 23271824 25988125 25794644 28665373 2312214 404087 0 X X 0 1 X 1 0 X 21341729 22169307 22711497 23745380 23909156 113877069 21341729 22169307 22711497 23745380 23909156 113877069 0 0 0 113877069 68591 65310 70643 92652 255226 552422 68591 65310 70643 92652 255226 552422 309584 37727 224087 89612 44160 705170 21719904 22272344 23006227 23927644 24208542 115134661 0.98910 0.98800 0.00480 0.00350 X 1207823 1207823 6601195 1607763 4993432 14729994 12430842 2299152 8500407 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 744386 OTHER LIABILITIES 470209 NOTE PAYABLE TO MEMSI 841998 2056593 24612629 404087 404087 24208542 0 24208542 21896328 0 21896328 0 21896328 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 89000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS CEO COUNCIL - ALIGNMENT PEORIA 100 SW WATER STREET PEORIA IL 61602 371271212 501(C)(3) 10000 SUPPORT ECONOMIC GROWTH 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 PEORIA AREA CHAMBER OF COMMERCE 403 NE JEFFERSON AVE PEORIA IL 61603 370459010 501(C)(6) 5000 SUPPORT LOCAL EDUCATION PROGRAMS CENTRAL ILLINOIS BUSINESS PUBLISHERS 4736 N UNIVERSITY PEORIA IL 61614 5000 SUPPORT LOCAL NON-FOR-PROFITS PEORIA AREA FOOD BANK 721 W MCBEAN ST PEORIA IL 61605 376058636 501(C)(3) 5000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS WTVP PO BOX 1347 PEORIA IL 61654 237041401 501(C)(3) 5000 SUPPORT LOCAL EDUCATION PROGRAMS PEORIA RIVERFRONT MUSEUM 222 SW WASHINGTON ST PEORIA IL 61602 272920016 501(C)(3) 20000 SUPPORT LOCAL EDUCATION PROGRAMS 8 1 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 291933 0 100000 0 0 0 12500 0 4599 0 409032 0 0 0 TIM BECCUE VP OF FINANCE 170207 0 39405 0 0 0 9500 0 9938 0 229050 0 0 0 GREG CHANCE VP OF STRATEGY 149586 0 24000 0 0 0 2251 0 6982 0 182819 0 0 0 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 123240 0 21358 0 0 0 9500 0 0 0 154098 0 0 0 CHAD CRAIG CRITICAL CARE PARAMEDIC 136148 0 3755 0 0 0 3807 0 13155 0 156865 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 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 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, 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-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 0 0 0 1 1 0 1 1 0 0 0 0 0 0 1 1 0 0 0 MIDWEST EMERGENCY MEDICAL SERVICES D 842000 NOTE PAYABLE TO MEMSI ADVANCED MEDICAL TRANSPORT OF IOWA P 482064 AMT IOWA EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 573808 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA H 194960 PURCHASE OF ASSETS FROM AMT IOWA ADVANCED MEDICAL TRANSPORT OF IOWA E 220038 NOTE PAYABLE FROM AMTI MIDWEST EMERGENCY MEDICAL SERVICES O 1477 MEMSI PAYROLL PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES P 195625 MEMSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC E 4794026 NOTE PAYABLE FROM AMTSI ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC P 2116606 AMTSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF SPRINGFIELD INC G 90168 SALE OF ASSETS TO AMTSI