2018-08-01T07:50:34-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STE 1000 PEORIA IL 61602 990 2017-01-01 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 2018-07-19 1 SAMUEL A CIGELNIK CPA P00324762 3096714500 2018-07-17 2017 2022-09-23 18:48:47Z ROBERT ANDERSON 1718 NORTH STERLING AVE PEORIA IL 61604 23112501 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 9 418 0 0 0 0 0 22169307 22711497 43294 184484 59743 110246 22272344 23006227 183223 285809 0 0 13648264 13859210 0 0 0 6786799 7292676 20618286 21437695 1654058 1568532 22343619 24023436 2817405 2597872 19526214 21425564 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 17009609 285809 22810245 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 44,054 AMBULANCE, 2,385 IPT AND 4,898 WHEELCHAIR TRANSPORTS IN 2017. THE ORGANIZATION PROVIDED $746,545 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 2017 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY $3,523,174. THE ORGANIZATION ALSO PROVIDED $467,550 IN SUPPORT OF OTHER COMMUNITY BENEFITS. 428261 11498 THE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 17437870 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 10 0 1 418 1 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 361764 0 16704 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 GREG SOWARDS BOARD MEMBER 1.00 0.00 X 0 0 0 JEANINE SPAIN BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 TOM GERACI VP OF OPERATIONS 12.50 37.50 X X 125208 0 17248 TIM BECCUE VP OF FINANCE 12.50 37.50 X X 180058 0 20069 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 143474 0 9757 DERRICK HAHN VP OF FLEET 12.50 37.50 X X 111867 0 8457 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 112689 0 6761 CHAD CRAIG CRITICAL CARE PARAMEDIC 50.00 0.00 X 116036 0 27 DONALD KEITH LIPPERT CRITICAL CARE PARAMEDIC 50.00 0.00 X 105395 0 3979 1256491 0 83002 8 0 1 0 0 TRANSPORT REVENUE 621990 22438849 22438849 SUBSIDY REVENUE 621990 261150 261150 TUITION REVENUE 611600 11498 11498 22711497 70643 70643 220115 106274 113841 113841 113841 MISCELLANEOUS 900099 110246 110246 110246 23006227 22821743 0 184484 X 285809 285809 1035060 869311 165749 10612160 8912784 1699376 277198 232809 44389 1041006 897736 143270 893786 771013 122773 70900 70900 60100 60100 205999 165855 40144 179047 151893 27154 418647 203933 214714 273958 189314 84644 13910 13910 -433644 -433644 2011270 1700483 310787 1103112 973407 129705 SUPPLIES 932457 779987 152470 FUEL 573274 571613 1661 REPAIRS & MAINTENANCE 437689 379625 58064 RECRUITING 234524 234524 1211433 551418 660015 21437695 17437870 3999825 0 1194570 4067163 4596539 4984776 3701295 2785741 1747363 1290387 428614 322822 21482345 10945798 10639238 10536547 36000 36000 22343619 24023436 465549 554676 616667 183334 1735189 1859862 2817405 2597872 X 19526214 21425564 19526214 21425564 22343619 24023436 1568532 330818 0 X X 0 1 X 1 0 X 19286054 19752615 21341729 22169307 22711497 105261202 19286054 19752615 21341729 22169307 22711497 105261202 0 0 0 105261202 95546 90260 68591 65310 70643 390350 95546 90260 68591 65310 70643 390350 -816 289286 309584 37727 224087 859868 19380784 20132161 21719904 22272344 23006227 106511420 0.98830 0.98900 0.00370 0.00380 X 1191268 1191268 6337487 1190033 5147454 13953590 9755765 4197825 10536547 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 657661 OTHER LIABILITIES 472201 NOTE PAYABLE TO MEMSI 730000 1859862 23344045 330818 7000 337818 23006227 0 23006227 21444695 7000 7000 21437695 0 21437695 PART XI, LINE 2D - OTHER ADJUSTMENTS: FMV OF DONATED PROPERTY 7,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: FMV OF DONATED PROPERTY 7,000. 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 93770 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) 80000 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 5 0 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 271764 0 90000 0 0 0 12000 0 4704 0 378468 0 0 0 TIM BECCUE VP OF FINANCE 157499 0 22559 0 0 0 9000 0 11069 0 200127 0 0 0 GREG CHANCE VP OF STRATEGY 127164 0 16310 0 0 0 1866 0 7891 0 153231 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 LOAN FORGIVENESS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 220,038. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 220,038. BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 112,013. MANAGEMENT AND GENERAL EXPENSES 101,951. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 213,964. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 169,466. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 169,466. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 157,869. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 157,869. EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 126,899. MANAGEMENT AND GENERAL EXPENSES 26,261. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,160. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 72,883. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,883. SUBCONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 41,680. MANAGEMENT AND GENERAL EXPENSES 25,958. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,638. UNIFORMS: PROGRAM SERVICE EXPENSES 65,901. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,901. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 47,056. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,056. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 43,458. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,458. 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, 2014, 2015, AND 2016. 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 715055 AMT IOWA EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 945487 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA H 9321 PURCHASE OF ASSETS FROM AMT IOWA ADVANCED MEDICAL TRANSPORT OF IOWA E 220038 NOTE PAYABLE FROM AMTI MIDWEST EMERGENCY MEDICAL SERVICES O 304684 MEMSI PAYROLL PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES P 321530 MEMSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA G 15883 SALE OF ASSETS TO AMT IOWA