2019-08-09T11:35:22-05:00 2018-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STE 1000 PEORIA IL 61602 990 2018-01-01 370999878 PEORIA HOSPITALS MOBILE MEDICAL SERVICES D/B/A ADV MEDICAL TRANS OF CENTRAL IL PEOR 3094946200 1718 NORTH STERLING AVE PEORIA IL 61604 ROBERT ANDERSON BOARD CHAIRPERSON 3094946200 2019-07-24 1 SAMUEL A CIGELNIK CPA P00324762 3096714500 2019-07-24 67.137.57.251 2019-07-24 14:09:34 CD P DBA0DE0710B3CC388F2BEE46780927D00A68B01B 6536C806F53B74C078C7EC9B2427BCB239CA21E7 2018 2019-02-21 02:37:17Z ROBERT ANDERSON 1718 NORTH STERLING AVE PEORIA IL 61604 23943010 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 9 421 0 0 0 0 0 22711497 23745380 184484 107139 110246 75125 23006227 23927644 285809 228038 0 0 13859210 14449435 0 0 0 7292676 7160354 21437695 21837827 1568532 2089817 24023436 25794644 2597872 2522820 21425564 23271824 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 17515923 228038 23781331 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 43,920 AMBULANCE, 2,530 IPT AND 5,743 WHEELCHAIR TRANSPORTS IN 2018. THE ORGANIZATION PROVIDED $703,857 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 2018 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY $3,161,690. THE ORGANIZATION ALSO PROVIDED $331,770 IN SUPPORT OF OTHER COMMUNITY BENEFITS. 417838 39174 THE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 17933761 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 20 0 1 421 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 0 0 0 0 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 ANDREW RAND CEO/BOARD MEMBER 12.50 37.50 X X 369888 0 17505 SHERRY HOFFMAN BOARD VICE-CHAIRPERSON 1.00 0.00 X X 0 0 0 ROBERT ANDERSON BOARD CHAIRPERSON 1.00 0.00 X X 0 0 0 JAMES BROWN BOARD MEMBER 1.00 0.00 X 0 0 0 TODD BAKER BOARD MEMBER 1.00 0.00 X 0 0 0 JEANINE SPAIN BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 THOMAS GERACI VP OF OPERATIONS 12.50 37.50 X X 131787 0 3295 TIM BECCUE VP OF FINANCE 12.50 37.50 X X 187245 0 22375 JAMES ADAMS BOARD MEMBER 1.00 0.00 X 0 0 0 ASHLEY SPAIN BOARD MEMBER 1.00 0.00 X 0 0 0 GREG CHANCE VP OF STRATEGY 12.50 37.50 X X 147259 0 11529 DERRICK HAHN VP OF FLEET 12.50 37.50 X X 116466 0 9449 TAMMY PAUWELS BOARD MEMBER 1.00 1.00 X 0 0 0 SALLY SNYDER BOARD MEMBER 1.00 0.00 X 0 0 0 CHELSEY TALLEY DIRECTOR OF ACCOUNTING 12.50 37.50 X X 131804 0 6510 CHAD CRAIG CRITICAL CARE PARAMEDIC 50.00 0.00 X 116620 0 20264 1201069 0 90927 7 0 1 0 0 TRANSPORT REVENUE 621990 23396919 23396919 SUBSIDY REVENUE 621990 309287 309287 TUITION REVENUE 611600 39174 39174 23745380 92652 92652 29853 15366 14487 14487 14487 MISCELLANEOUS 900099 75125 75125 75125 23927644 23820505 0 107139 X 228038 228038 1084450 902287 182163 10885594 9057060 1828534 320127 266353 53774 1235865 1065427 170438 923399 789746 133653 38350 38350 60000 60000 14103 5814 8289 175316 148195 27121 388744 122269 266475 270628 185887 84741 1612 1612 -231739 -231739 1989561 1671079 318482 1095086 962224 132862 SUPPLIES 916804 789924 126880 FUEL 658422 656883 1539 REPAIRS & MAINTENANCE 420139 335396 84743 EDUCATION & TRAINING 245767 227287 18480 1117561 751631 365930 21837827 17933761 3904066 0 4067163 6735436 4984776 4799065 2785741 3146110 1290387 1176567 322822 500477 21615086 12214097 10536547 9400989 36000 36000 24023436 25794644 554676 644233 183334 0 1859862 1878587 2597872 2522820 X 21425564 23271824 21425564 23271824 24023436 25794644 2089817 -243557 0 X X 0 1 X 1 0 X 19752615 21341729 22169307 22711497 23745380 109720528 19752615 21341729 22169307 22711497 23745380 109720528 0 0 0 109720528 90260 68591 65310 70643 92652 387456 90260 68591 65310 70643 92652 387456 289286 309584 37727 224087 89612 950296 20132161 21719904 22272344 23006227 23927644 111058280 0.98800 0.98830 0.00350 0.00370 X 1200323 1200323 6350585 1316912 5033673 14064178 10897185 3166993 9400989 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 690641 OTHER LIABILITIES 457946 NOTE PAYABLE TO MEMSI 730000 1878587 23684087 -243557 -243557 23927644 0 23927644 21837827 0 21837827 0 21837827 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 73000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS CEO COUNCIL - ALIGNMENT PEORIA 100 SW WATER STREET PEORIA IL 61602 371271212 501(C)(3) 5000 SUPPORT ECONOMIC GROWTH AMERICAN HEART ASSOCIATION PO BOX 50035 PRESCOTT AZ 86304 135613797 501(C)(3) 10000 SUPPORT HEART HEALTH AND RESEARCH OSF HEALTHCARE FOUNDATION 530 NE GLEN OAK AVE PEORIA IL 61614 371259284 501(C)(3) 10000 SUPPORT CANCER CARE AND RESEARCH JUNIOR ACHIEVEMENT OF CENTRAL ILLINOIS 508 HIGH POINT LANE EAST PEORIA IL 61611 370657600 501(C)(3) 11000 SUPPORT LOCAL EDUCATION PROGRAMS EPC 1913 W TOWNLINE ROAD PEORIA IL 61615 370794792 501(C)(3) 15000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS INVICTUS WOODS ENDOWMENT CENTER 29240 N COUNTY HIGHWAY 28 GLASFORD IL 61533 5000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS. SALVATION ARMY 401 NE ADAMS PEORIA IL 61603 362167910 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 8 1 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 279888 0 90000 0 0 0 12250 0 5255 0 387393 0 0 0 TIM BECCUE VP OF FINANCE 161552 0 25693 0 0 0 9250 0 13125 0 209620 0 0 0 GREG CHANCE VP OF STRATEGY 130542 0 16717 0 0 0 1919 0 9610 0 158788 0 0 0 PART I, LINE 7 BASED ON EMPLOYEE PERFORMANCE 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 RECRUITING: PROGRAM SERVICE EXPENSES 226,896. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 226,896. BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 116,574. MANAGEMENT AND GENERAL EXPENSES 100,673. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 217,247. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 160,680. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 160,680. UNIFORMS: PROGRAM SERVICE EXPENSES 104,210. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 104,210. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 97,264. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,264. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 95,650. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,650. SUBCONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 47,621. MANAGEMENT AND GENERAL EXPENSES 38,099. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 85,720. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 67,214. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,214. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 62,680. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 62,680. 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. DUE TO SECURITY CONCERNS, THE INFORMATION IS AVAILABLE UPON REQUEST AND MAY BE OBTAINED FROM THE OFFICE OF THE FOREIGN CORPORATION. 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 CATALYST INSURANCE, LTD. FILED FORM 1120-F, U.S. INCOME TAX RETURN OF A FOREIGN CORPORATION, FOR ITS TAX YEARS ENDED MAY 31, 2015, 2016, AND 2017. CATALYST INSURANCE, LTD. 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. 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 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 730000 NOTE PAYABLE TO MEMSI ADVANCED MEDICAL TRANSPORT OF IOWA P 817566 AMT IOWA EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 873389 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA H 50585 PURCHASE OF ASSETS FROM AMT IOWA ADVANCED MEDICAL TRANSPORT OF IOWA E 220038 NOTE PAYABLE FROM AMTI MIDWEST EMERGENCY MEDICAL SERVICES O 28445 MEMSI PAYROLL PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES P 144816 MEMSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA G 115487 SALE OF ASSETS TO AMT IOWA