2014-07-25T15:14:04-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STE 900 BOX 1835 PEORIA IL 616561835 990 2013-01-01 370999878 PEORIA HOSPITALS MOBILE MEDICAL SERVICES D/B/A ADV MEDICAL TRANS OF CENTRAL IL PEOR 3094946200 1718 NORTH STERLING AVE PEORIA IL 61604 GREG SOWARDS BOARD CHAIRPERSON 3094946200 2014-07-16 1 SAMUEL A CIGELNIK P00324762 3096714500 2013 2015-11-30 17:44:51Z GREG SOWARDS 1718 NORTH STERLING AVE PEORIA IL 61604 19663089 0 X WWW.ADVANCEDMEDICALTRANSPORT.ORG X 1975 IL THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 7 6 398 0 0 0 0 0 14994888 19286054 49618 91595 75975 3135 15120481 19380784 80035 169524 0 0 9091081 11105901 0 0 0 4455204 6273555 13626320 17548980 1494161 1831804 14751270 17804522 2998213 4219661 11753057 13584861 X THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 0 0 13839560 169524 18819301 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 AND WHEELCHAIR TRANSPORTATION BETWEEN HOSPITALS AND OTHER HEALTHCARE FACILITIES. THE ORGANIZATION PROVIDED 39,563 AMBULANCE TRANSPORTS AND 5,203 WHEELCHAIR TRANSPORTS IN 2013. THE ORGANIZATION PROVIDED $669,564 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 2013 PAYMENTS WERE LESS THAN ESTIMATED COSTS BY APPROXIMATELY $2,115,920. IN ADDITION, THE ORGANIZATION PROVIDED OTHER COMMUNITY BENEFIT ACTIVITIES THROUGHOUT THE YEAR THAT WOULD HAVE COST $287,064. 404278 404278 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. 156216 65610 THE ORGANIZATION PROVIDES MULTIPLE PARAMEDIC AND EMT BASIC TRAINING PROGRAMS EACH YEAR. THESE PROGRAMS ARE AVAILABLE TO EXTERNAL AGENCIES AND EMPLOYEES OF THE ORGANIZATION. 14400054 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 8 0 1 398 1 0 0 0 0 0 0 0 0 0 0 X 7 6 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 ANDREW RAND CEO/BOARD MEMBER 12.50 37.50 X X 293153 0 14194 SHERRY THOMPSON BOARD VICE-CHAIRPERSON 1.00 0.00 X X 0 0 0 ROBERT ANDERSON BOARD TREASURER/SECRETARY 1.00 0.00 X X 0 0 0 JAMES BROWN BOARD MEMBER 1.00 0.00 X 0 0 0 GREG SOWARDS BOARD CHAIRPERSON 1.00 0.00 X X 0 0 0 JAY WILLSHER BOARD MEMBER 1.00 1.00 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 81102 0 4557 JERRY KOLB FORMER CFO 12.50 37.50 X X 76583 0 0 TIM BECCUE CFO 12.50 37.50 X X 32433 0 1622 483271 0 20373 1 0 1 0 0 TRANSPORT REVENUE 621990 17818956 17818956 SUBSIDY REVENUE 621990 997210 997210 TRINITY REVENUE 621990 404278 404278 TUITION REVENUE 611600 65610 65610 19286054 95546 95546 278354 282305 -3951 -3951 -3951 MISCELLANEOUS 900099 3135 3135 3135 19380784 19289189 0 91595 169524 169524 483271 416007 67264 8895130 7657038 1238092 267579 230335 37244 666278 578706 87572 793643 680282 113361 143510 143510 61450 61450 97514 97514 39604 39604 182489 144762 37727 195168 122576 72592 158344 71965 86379 32128 32128 -346547 -346547 1401580 1053583 347997 848736 692923 155813 SUPPLIES 1034609 845838 188771 FUEL 780553 780553 REPAIRS & MAINTENANCE 650458 585942 64516 RECRUITING, EDUCATION & 259087 259087 734872 457480 277392 17548980 14400054 3148926 0 1316382 1559562 1115431 2354192 2461643 3030040 1357258 1553017 623334 808541 19757652 11294482 7841222 8463170 36000 36000 14751270 17804522 281721 543366 0 714290 1533333 1433333 1183159 1528672 2998213 4219661 X 11753057 13584861 11753057 13584861 14751270 17804522 1831804 0 X X 0 1 X 1 0 X 11643491 14367597 15322500 14994888 19286054 75614530 11643491 14367597 15322500 14994888 19286054 75614530 0 0 0 75614530 7778 18930 25086 51420 95546 198760 7778 18930 25086 51420 95546 198760 45526 36821 47590 74173 -816 203294 11696795 14423348 15395176 15120481 19380784 76016584 0.99470 0.98920 0.00260 0.00220 X 233789 233789 4993910 1043128 3950782 14529953 10251354 4278599 8463170 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 786847 OTHER LIABILITIES 391825 RELATED PARTY PAYABLE 350000 1528672 19380784 0 19380784 0 19380784 17548980 0 17548980 0 17548980 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 501(C)(3) 48437 SUPPORT LOCAL HEALTH AND HUMAN CARE PROGRAMS PEORIA PROMISE FOUNDATION 620 W GLEN AVE PEORIA IL 61614 134353454 501(C)(3) 22500 TUITION ASSISTANCE TO QUALIFIED PEORIA AREA STUDENTS OSF ST FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVE PEORIA IL 61637 370662569 501(C)(3) 50000 MEMORIAL TO OSF CANCER CENTER PEORIA RIVERFRONT MUSEUM 222 SW WASHINGTON ST PEORIA IL 61602 272920016 501(C)(3) 10625 SUPPORT MUSEUM AND MUSEUM ACTIVITIES ISAA PO BOX 464 CANTON IL 61520 232881612 501(C)(3) 8250 SUPPORT EDUCATION AND ADVOCACY OF ILLINOIS EMS BOYS & GIRLS CLUB 806 E KANSAS PEORIA IL 61603 370800010 501(C)(3) 7500 SUPPORT UNDERPRIVILEGED BOYS AND GIRLS 7 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND CEO/BOARD MEMBER 229153 0 64000 0 0 0 11500 0 2694 0 307347 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 COMMUNITY ADVISORY BOARD OF THE SAINT FRANCIS MEDICAL CENTER, ONE MEMBER IS ELECTED BY THE BOARD OF TRUSTEES OF THE UNITYPOINT HEALTH METHODIST HOSPITAL, AND ONE MEMBER IS ELECTED BY THE BOARD OF TRUSTEES OF UNITYPOINT HEALTH PROCTOR HOSPITAL. 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 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, 2013. 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, 2010, 2011, AND 2012. THE COMPANY 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 1 0 0 1 1 0 1 1 0 0 0 0 0 0 1 1 0 1 0 ADVANCED MEDICAL TRANSPORT OF IOWA A 1408 INTEREST ON NOTE PAYABLE MIDWEST EMERGENCY MEDICAL SERVICES R 783 INTEREST ON NOTE PAYABLE ADVANCED MEDICAL TRANSPORT OF IOWA D 0 NOTE PAYABLE TO AMT IOWA MIDWEST EMERGENCY MEDICAL SERVICES E 350000 NOTE PAYABLE FROM MEMSI MIDWEST EMERGENCY MEDICAL SERVICES P 289354 MEMSI EXPENSES PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA P 606939 AMT IOWA EXPENSES PAID BY PHMMS MIDWEST EMERGENCY MEDICAL SERVICES O 221684 MEMSI PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA O 426739 AMT IOWA PAYROLL PAID BY PHMMS ADVANCED MEDICAL TRANSPORT OF IOWA H 161323 PURCHASE OF ASSETS FROM AMT IOWA ADVANCED MEDICAL TRANSPORT OF IOWA G 111220 SALE OF ASSETS TO AMT IOWA SCHEDULE R, PART V, LINE 2 A NOTE PAYABLE TO ADVANCED MEDICAL TRANSPORT OF IOWA IS SHOWN ON SCHEDULE R WITH A ZERO BALANCE. THE LOAN BALANCE AT THE BEGINNING OF THE YEAR WAS $440,076. THE LOAN BALANCE AT THE END OF THE YEAR WAS $0, AS THE BALANCE WAS PAID IN FULL DURING THE YEAR.