2017-08-11T13:44:54-05:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STE 1000 PEORIA IL 61602 990 2016-01-01 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 2017-07-07 1 SAMUEL A CIGELNIK CPA P00324762 3096714500 2017-07-05 67.137.57.251 2017-07-07 10:08:10 CD P A37B929B3C4A007685C3DE6C1AE4373EFC622F4E 540938B99006520E32A311382CBF49BE445FAAD6 2016 2021-01-29 14:40:06Z ROBERT ANDERSON 1718 NORTH STERLING AVE PEORIA IL 61604 22310626 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 9 428 0 0 0 0 0 21341729 22169307 377975 43294 200 59743 21719904 22272344 152971 183223 0 0 12159276 13648264 0 0 0 6944345 6786799 19256592 20618286 2463312 1654058 20752118 22343619 3036277 2817405 17715841 19526214 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 16494914 183223 22175621 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 43,266 AMBULANCE, 2,615 IPT AND 4,289 WHEELCHAIR TRANSPORTS IN 2016. THE ORGANIZATION PROVIDED $681,549 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 2016 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY $3,018,173. THE ORGANIZATION ALSO PROVIDED $301,450 IN SUPPORT OF OTHER COMMUNITY BENEFITS. 26389 26389 THE ORGANIZATION TOOK OVER THE TRINITY AMBULANCE SERVICE IN THE QUAD CITIES IN 2013. TRINITY HOSPITAL PROVIDED A CONTRIBUTION TO THE ORGANIZATION IN ORDER TO GET OPERATIONS UP AND RUNNING IN THE QUAD CITIES AREA. 365180 27040 THE ORGANIZATION PROVIDES PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 16886483 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 17 0 1 428 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 358436 0 18488 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 123022 0 3075 TIM BECCUE VP OF FINANCE 12.50 37.50 X X 173752 0 28564 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 149619 0 9783 DERRICK HAHN VP OF FLEET 12.50 37.50 X X 109304 0 10115 TAMMY PAUWELS BOARD MEMBER 1.00 0.00 X 0 0 0 SALLY SNYDER BOARD MEMBER 1.00 0.00 X 0 0 0 THERESA FINDERTY DIRECTOR OF QUALITY 12.50 37.50 X X 100310 0 20924 CHAD CRAIG CRITICAL CARE PARAMEDIC 50.00 0.00 X 119698 0 22374 1134141 0 113323 7 0 1 0 0 TRANSPORT REVENUE 621990 21589982 21589982 SUBSIDY REVENUE 621990 525896 525896 TUITION REVENUE 611600 27040 27040 TRINITY REVENUE 621990 26389 26389 22169307 65310 65310 16266 38282 -22016 -22016 -22016 MISCELLANEOUS 900099 59743 59743 59743 22272344 22229050 0 43294 X 183223 183223 1014441 847279 167162 10506324 8775062 1731262 302836 252934 49902 909925 794093 115832 914738 781774 132964 73956 73956 53400 53400 37272 37272 215784 182979 32805 266948 115418 151530 212088 122332 89756 27418 27418 -427336 -427336 2152339 1823158 329181 991387 863848 127539 SUPPLIES 937436 787938 149498 FUEL 505343 500188 5155 REPAIRS & MAINTENANCE 465939 387287 78652 RECRUITING 288948 288948 985877 607358 378519 20618286 16886483 3731803 0 1051808 1194570 4379634 4596539 3246833 3701295 890042 1747363 561485 428614 20747463 10108225 10586316 10639238 36000 36000 20752118 22343619 427977 465549 26389 983334 616667 1598577 1735189 3036277 2817405 X 17715841 19526214 17715841 19526214 20752118 22343619 1654058 156315 0 X X 0 1 X 1 0 X 14994888 19286054 19752615 21341729 22169307 97544593 14994888 19286054 19752615 21341729 22169307 97544593 0 0 0 97544593 51420 95546 90260 68591 65310 371127 51420 95546 90260 68591 65310 371127 74173 -816 289286 309584 37727 709954 15120481 19380784 20132161 21719904 22272344 98625674 0.98900 0.98850 0.00380 0.00360 X 1189226 1189226 4833105 1216630 3616475 14725132 8891595 5833537 10639238 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 593814 OTHER LIABILITIES 411375 NOTE PAYABLE TO MEMSI 730000 1735189 22428659 156315 156315 22272344 0 22272344 20618286 0 20618286 0 20618286 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 76279 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS GREATER PEORIA ECONOMIC DEVELOPMENT COUNCIL 100 SW WATER STREET PEORIA IL 61602 371104504 501(C)(6) 5000 SUPPORT ECONOMIC GROWTH PEORIA PROMISE FOUNDATION 620 W GLEN AVENUE PEORIA IL 61614 134353454 501(C)(3) 10000 TUITION ASSISTANCE TO QUALIFIED PEORIA AREA STUDENTS EPC INC PO BOX 3418 PEORIA IL 61612 370794792 501(C)(3) 10000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS. CENTRAL ILLINOIS BUSINESS PUBLISHERS INC 4736 N UNIVERSITY PEORIA IL 61614 364171073 7500 PROMOTE VOLUNTEERISM, CORPORATE RESPONSIBILITY AND COMMUNITY ENGAGEMENT. AMERICAN HEART ASSOCIATION 2141 WEST WHITE OAKS DRIVE SUITE A SPRINGFIELD IL 62704 135613797 501(C)(3) 7500 SUPPORT HEART HEALTH AND RESEARCH. 4 2 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 256436 0 102000 0 0 0 12000 0 6488 0 376924 0 0 0 TIM BECCUE VP OF FINANCE 149416 0 24336 0 0 0 10454 0 18110 0 202316 0 0 0 GREG CHANCE VP OF STRATEGY 126019 0 23600 0 0 0 1913 0 7870 0 159402 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 BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 99,951. MANAGEMENT AND GENERAL EXPENSES 104,983. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 204,934. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 156,019. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 156,019. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 114,197. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,197. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 110,959. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110,959. EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 109,113. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 109,113. BIOHAZARD DISPOSAL: PROGRAM SERVICE EXPENSES 81,087. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,087. UNIFORMS: PROGRAM SERVICE EXPENSES 71,216. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 71,216. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 46,891. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,891. SUBCONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 45,878. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,878. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 30,420. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,420. CORPORATE COMPLIANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,863. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,863. CUSTOMER SURVEY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,300. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,300. 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 B NO U.S. PERSONS OWNED (AT ANY TIME DURING THE ANNUAL 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 TAXPAYER NEITHER ACQUIRED NOR DISPOSED OF STOCK IN THE FOREIGN CORPORATION, CATALYST INSURANCE, LTD., DURING THE YEAR ENDED MAY 31, 2016. THE TAXPAYER IS CLASSIFIED AS A CATEGORY 3 FILER FOR FORM 5471 PURPOSES BECAUSE THE TAXPAYER IS TREATED AS A U.S. SHAREHOLDER OF CATALYST INSURANCE, LTD. UNDER INTERNAL REVENUE CODE SEC. 953(C), AND IS THEREFORE REQUIRED TO COMPLETE SCHEDULE O. 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, 2013, 2014, AND 2015. 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 0 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 751740 AMT IOWA EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 827108 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA H 21676 PURCHASE OF ASSETS FROM AMT IOWA ADVANCED MEDICAL TRANSPORT OF IOWA E 1366664 NOTE PAYABLE FROM AMTI MIDWEST EMERGENCY MEDICAL SERVICES O 304074 MEMSI PAYROLL PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES P 293024 MEMSI EXPENSES PAID BY PHMMS