2016-08-04T09:37:24-05:00 2015-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STE 1000 PEORIA IL 61602 990 2015-01-01 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 2016-07-19 1 SAMUEL A CIGELNIK P00324762 3096714500 2015 2016-12-15 16:53:06Z ROBERT ANDERSON 1718 NORTH STERLING AVE PEORIA IL 61604 21748726 0 X WWW.ADVANCEDMEDICALTRANSPORT.ORG X 1975 IL THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 10 9 402 0 0 0 0 0 19752615 21341729 313222 377975 66324 200 20132161 21719904 155709 152971 0 0 11538120 12159276 0 0 0 6553892 6944345 18247721 19256592 1884440 2463312 18913081 20752118 3506012 3036277 15407069 17715841 X THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 0 0 14869172 152971 20962482 THE ORGANIZATION PROVIDES EMERGENCY AMBULANCE CARE, TREATMENT AND TRANSPORTATION TO MULTIPLE JURISDICTIONS IN ILLINOIS. IN ADDITION TO EMERGENCY AMBULANCE SERVICE, THE ENTITY PROVIDES SCHEDULED AMBULANCE, BEHAVIORAL HEALTH (IPT) AND WHEELCHAIR TRANSPORTATION BETWEEN HOSPITALS AND OTHER HEALTHCARE FACILITIES. THE ORGANIZATION PROVIDED 42,229 AMBULANCE TRANSPORTS, 2,563 IPT TRANSPORTS AND 5,249 WHEELCHAIR TRANSPORTS IN 2015. THE ORGANIZATION PROVIDED $424,337 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 2015 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY APPROXIMATELY $3,067,496. IN ADDITION, THE ORGANIZATION PROVIDED OTHER COMMUNITY BENEFIT ACTIVITIES THROUGHOUT THE YEAR THAT WOULD HAVE COST $341,703. 316667 316667 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. 273372 62780 THE ORGANIZATION PROVIDES MULTIPLE PARAMEDIC AND OTHER EMS TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 15459211 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 18 0 1 402 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 320138 0 17532 SHERRY THOMPSON 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 JAY WILLSHER BOARD TREASURER/SECRETARY 1.00 1.00 X X 0 0 0 JEANINE SPAIN BOARD MEMBER 1.00 0.00 X 0 0 0 TOM GERACI VP OF OPERATIONS 12.50 37.50 X X 108868 0 5357 TIM BECCUE VP OF FINANCE 12.50 37.50 X X 154439 0 24035 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 BOARD MEMBER 1.00 0.00 X X 0 0 0 DERRICK HAHN VP OF FLEET 12.50 37.50 X X 99057 0 8482 CHAD CRAIG CRITICAL CARE PARAMEDIC 50.00 0.00 X 100032 0 12002 782534 0 67408 4 0 1 0 0 TRANSPORT REVENUE 621990 20108652 20108652 SUBSIDY REVENUE 621990 853630 853630 TRINITY REVENUE 621990 316667 316667 TUITION REVENUE 611600 62780 62780 21341729 68591 68591 338206 28822 309384 309384 309384 MISCELLANEOUS 900099 200 200 200 21719904 21341929 0 377975 X 152971 152971 682502 564423 118079 9642400 7974170 1668230 309548 255993 53555 685167 595045 90122 839659 717926 121733 59694 59694 56304 56304 11032 11032 227211 184561 42650 286923 116037 170886 230236 136638 93598 30513 30513 -431631 -431631 1575262 1237884 337378 1023356 861399 161957 REPAIRS & MAINTENANCE 965924 861904 104020 SUPPLIES 959116 773151 185965 FUEL 545868 540014 5854 RECRUITING 200723 200723 1203814 718003 485811 19256592 15459211 3797381 0 1469010 1051808 3471629 4379634 2829360 3246833 1025488 890042 790674 561485 19937851 9351535 9290920 10586316 36000 36000 18913081 20752118 369641 427977 343056 26389 733333 983334 2059982 1598577 3506012 3036277 X 15407069 17715841 15407069 17715841 18913081 20752118 2463312 -154540 0 X X 0 1 X 1 0 X 15322500 14994888 19286054 19752615 21341729 90697786 15322500 14994888 19286054 19752615 21341729 90697786 0 0 0 90697786 25086 51420 95546 90260 68591 330903 25086 51420 95546 90260 68591 330903 47590 74173 -816 289286 309584 719817 15395176 15120481 19380784 20132161 21719904 91748506 0.98850 0.99140 0.00360 0.00330 X 1189226 1189226 4820113 1109144 3710969 13928512 8242391 5686121 10586316 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 495247 OTHER LIABILITIES 553330 NOTE PAYABLE TO MEMSI 550000 1598577 21565364 -154540 -154540 21719904 0 21719904 19254592 -2000 -2000 19256592 0 19256592 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 55000 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS ST JUDE CHILDREN'S RESEARCH HOSPITAL 4722 N SHERIDAN ROAD PEORIA IL 61614 351044585 501(C)(3) 5000 SUPPORT CHILDREN'S MEDICAL INITIATIVES CHILDREN'S HOSPITAL OF IL 800 NE GLEN OAK AVE PEORIA IL 61603 320353954 501(C)(3) 5000 SUPPORT CHILDREN'S MEDICAL INITIATIVES AMERICAN HEART ASSOCIATION 2141 WEST WHITE OAKS DRIVE SUITE A SPRINGFIELD IL 62704 135613797 501(C)(3) 5000 SUPPORT HEART HEALTH AND RESEARCH GREATER PEORIA ECONOMIC DEVELOPMENT COUNCIL 100 SW WATER STREET PEORIA IL 61602 371104504 501(C)(6) 5000 SUPPORT ECONOMIC GROWTH CITY OF PEORIA 419 FULTON STREET SUITE 106 PEORIA IL 61602 376001761 50000 SUPPORT RESIDENTIAL POLICE OFFICER PROGRAM WILDLIFE PRAIRIE STATE PARK 3826 N TAYLOR RD HANNA CITY IL 61536 208064678 501(C)(3) 5000 SUPPORT PARK AND PARK ACTIVITIES MERCER COUNTY SHERIFF'S OFFICE 906 SW 3RD STREET ALEDO IL 61231 366006630 5000 SUPPORT POLICE OFFICER CANINE UNIT 5 3 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 241058 0 0 0 79080 0 12000 0 5532 0 337670 0 0 0 TIM BECCUE VP OF FINANCE 125254 0 0 0 29185 0 9000 0 15035 0 178474 0 0 0 PART I, LINE 7 BASED ON EMPLOYEE PERFORMANCE FORM 990, PART VI, SECTION B, LINE 11 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 EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 163,558. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 163,558. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 154,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,993. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 153,601. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 153,601. COMMUNICATIONS: PROGRAM SERVICE EXPENSES 134,434. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 134,434. FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 123,572. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 123,572. SPONSORSHIPS: PROGRAM SERVICE EXPENSES 112,197. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 112,197. BIOHAZARD DISPOSAL: PROGRAM SERVICE EXPENSES 93,125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,125. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 90,689. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,689. UNIFORMS: PROGRAM SERVICE EXPENSES 59,696. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,696. CORPORATE COMPLIANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 47,213. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,213. DUES & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 35,115. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,115. BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 34,621. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,621. CUSTOMER SURVEY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,000. 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, 2015. 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, 2012, 2013, AND 2014. 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 0 0 0 0 0 0 0 1 1 0 0 0 MIDWEST EMERGENCY MEDICAL SERVICES D 550000 NOTE PAYABLE TO MEMSI MIDWEST EMERGENCY MEDICAL SERVICES P 322590 MEMSI EXPENSES PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES O 265933 MEMSI PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA P 602223 AMT IOWA EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 474793 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA G 41904 SALE OF ASSETS TO AMT IOWA ADVANCED MEDICAL TRANSPORT OF IOWA E 806381 NOTE PAYABLE FROM AMTI