PEORIA HOSPITALS MOBILE MEDICAL SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PEORIA HOSPITALS MOBILE MEDICAL SERVICES (EIN 37-0999878)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-13
IRS object ID
201332259349302623
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-13T16:45:30-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1301 SW ADAMS STE 900 BOX 1835AddressLine1
CityPEORIACity
StateILState
ZIP Code616561835ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN370999878EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PEORIA HOSPITALS MOBILE MEDICAL SERVICESBusinessNameLine1
Business Name Line2D/B/A ADV MEDICAL TRANS OF CENTRAL ILBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlPEORNameControl
Phone3094946200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11718 NORTH STERLING AVEAddressLine1
CityPEORIACity
StateILState
ZIP Code61604ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGREG SOWARDSName
TitleBOARD CHAIRPERSONTitle
Phone3094946200Phone
Date Signed2013-08-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLINDA MARTINName
PTINP00255069PTIN
Phone3096714500Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGREG SOWARDSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11718 NORTH STERLING AVEAddressLine1
CityPEORIACity
StateILState
ZIP Code61604ZIPCode
FieldValueIRS element (for citing)
Gross Receipts15129848GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.ADVANCEDMEDICALTRANSPORT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1975YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTHE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees351TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year15322500ProgramServiceRevenuePriorYear
Program Service Revenue CY14994888ProgramServiceRevenueCY
Investment Income Prior Year25651InvestmentIncomePriorYear
Investment Income Current Year49618InvestmentIncomeCurrentYear
Other Revenue Prior Year47025OtherRevenuePriorYear
Other Revenue Current Year75975OtherRevenueCurrentYear
Total Revenue Prior Year15395176TotalRevenuePriorYear
Total Revenue Current Year15120481TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year86247GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY80035GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9513458SalariesEtcPriorYear
Salaries Etc Current Year9091081SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4606322OtherExpensePriorYear
Other Expenses Current Year4455204OtherExpensesCurrentYear
Total Expenses Prior Year14206027TotalExpensesPriorYear
Total Expenses Current Year13626320TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1189149RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1494161RevenuesLessExpensesCY
Total Assets BOY13993276TotalAssetsBOY
Total Assets EOY14751270TotalAssetsEOY
Total Liabilities BOY3775852TotalLiabilitiesBOY
Total Liabilities EOY2998213TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10217424NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY11753057NetAssetsOrFundBalancesEOY
Mission DescriptionTHE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10956817Expense
Grants80035Grants
Revenue14994888Revenue
DescriptionTHE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS (34,049 AMBULANCE TRANSPORTS IN 2012 AND 1,566 WHEELCHAIR TRANSPORTS IN 2012).Description
Total Program Service Expense10956817TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees351NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ANDREW RANDBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3094946200TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11718 N STERLING AVEAddressLine1
CityPEORIACity
StateILState
ZIP Code61604ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
SHERRY THOMPSON
BOARD MEMBER1.00X000
ANDREW BLAND
BOARD MEMBER1.00X000
JEANINE SPAIN
BOARD MEMBER1.00X000
JEFF FICK
BOARD CHAIRPERSON1.00000X
ROBERT ANDERSON
BOARD TREASURER/SECRETARY1.00000X
GREG SOWARDS
BOARD VICE CHAIRPERSON1.00000X
ANDREW RAND
EXECUTIVE DIRECTOR/BOARD M40.00281437010797X
SHEROLYN TOLLIVER
ASST. EXECUTIVE DIRECTOR40.00116398010034X
JERRY KOLB
CONTROLLER40.0012579900X
FieldValueIRS element (for citing)
Total Reportable Comp From Org523634TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation20831TotalOtherCompensation
Number Individuals GT100 K3NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
TRANSPORT REVENUE6219901441323314413233
SUBSIDY REVENUE621990581655581655
FieldValueIRS element (for citing)
Total Program Service Revenue14994888TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column51420TotalRevenueColumn
Exclusion$51,420ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other7565Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other9367Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-1802Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1802TotalRevenueColumn
Exclusion-$1,802ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column75975TotalRevenueColumn
Exclusion$75,975ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue75975TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column15120481TotalRevenueColumn
Related Or Exempt Function Income14994888RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$125,593ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total80035Total
Program Services80035ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total523634Total
Management And General523634ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7172643Total
Program Services6349596ProgramServices
Management And General823047ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total210623Total
Management And General210623ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total574375Total
Program Services501898ProgramServices
Management And General72477ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total609806Total
Program Services500986ProgramServices
Management And General108820ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total41525Total
Management And General41525ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total82244Total
Management And General82244ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total52951Total
Management And General52951ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total137962Total
Program Services106421ProgramServices
Management And General31541ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total138227Total
Program Services71926ProgramServices
Management And General66301ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total125954Total
Program Services49731ProgramServices
Management And General76223ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total40781Total
Management And General40781ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1315250Total
Program Services974092ProgramServices
Management And General341158ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total547280Total
Program Services430398ProgramServices
Management And General116882ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FUEL624362624362
SUPPLIES596587596587
REPAIR & MAINTENANCE40421235350950703
RECRUITING102201102201

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total245668Total
Program Services215075ProgramServices
Management And General30593ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total13626320Total
Program Services10956817ProgramServices
Management And General2669503ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY450BOY
EOY1316382EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY594530BOY
EOY1115431EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2926925BOY
EOY2461643EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1454850BOY
EOY1357258EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY306345BOY
EOY623334EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis17863343LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10022121LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8674176BOY
EOY7841222EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY36000BOY
EOY36000EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY13993276BOY
EOY14751270EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY795679BOY
EOY531721EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2104144BOY
EOY1533333EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY876029BOY
EOY933159EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3775852BOY
EOY2998213EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10217424BOY
EOY11753057EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10217424BOY
EOY11753057EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13993276BOY
EOY14751270EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses1494161ReconcilationRevenueExpenses
Reconciliation Unrealized Invest41472ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10534120CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11643491CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14367597CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15322500CurrentTaxYearMinus1Year
Current Tax Year14994888CurrentTaxYear
Total66862596Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10534120CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11643491CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14367597CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15322500CurrentTaxYearMinus1Year
Current Tax Year14994888CurrentTaxYear
Total66862596Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50966862596PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years46980CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7778CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18930CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25086CurrentTaxYearMinus1Year
Current Tax Year51420CurrentTaxYear
Total150194Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years46980CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7778CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18930CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25086CurrentTaxYearMinus1Year
Current Tax Year51420CurrentTaxYear
Total150194Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years299532CurrentTaxYearMinus4Years
Total299532Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years76553CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years45526CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years36821CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year47590CurrentTaxYearMinus1Year
Current Tax Year74173CurrentTaxYear
Total280663Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10957185CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11696795CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14423348CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year15395176CurrentTaxYearMinus1Year
Current Tax Year15120481CurrentTaxYear
Total67592985Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98920PublicSupportPercentage509
Prior Year Support Percentage0.97990PriorYearSupportPercentage
Investment Income Percentage0.00220InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00270PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis231389OtherCostOrOtherBasis
Book Value231389BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4928722OtherCostOrOtherBasis
Depreciation891887Depreciation
Book Value4036835BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12703232OtherCostOrOtherBasis
Depreciation9130234Depreciation
Book Value3572998BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7841222TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ACCRUED WAGES, TAXES, AND WITHHOLDINGS$617,099
OTHER LIABILITIES$316,060
FieldValueIRS element (for citing)
Total Of Amounts933159TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt15161953TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments41472NetUnrealizedGainsInvestments
Revenue Not Rptd F99041472RevenueNotRptdF990
Revenue Subtotal15120481RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99015120481TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt13626320TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal13626320ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99013626320TotalExpensesPerForm990

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
HEART OF ILLINOIS UNITED WAY
509 W HIGH STPEORIAIL6160637066150434000CHARITABLE CONTRIBUTION
EASTER SEALS UCP
507 E ARMSTRONG AVEPEORIAIL616033706862505000CHARITABLE CONTRIBUTION
OSF ST FRANCIS MEDICAL CENTER
530 NE GLEN OAK AVEPEORIAIL616373706625695000CHARITABLE CONTRIBUTION
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants3TotalNbrOf501C3AndGovtGrants

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonANDREW RANDNamePerson
TitleEXECUTIVE DIRECTOR/BOARD MTitle
Base Compensation Filing Org221437BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org60000BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org8250DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org2547NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org292234TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 7ReturnReference
ExplanationBASED ON EMPLOYEE PERFORMANCEExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 7ATWO MEMBERS ARE ELECTED BY THE COMMUNITY ADVISORY BOARD OF THE SAINT FRANCIS MEDICAL CENTER, TWO MEMBERS ARE ELECTED BY THE BOARD OF DIRECTORS OF THE METHODIST MEDICAL CENTER OF ILLINOIS, AND TWO MEMBERS ARE ELECTED BY THE BOARD OF TRUSTEES OF PROCTOR COMMUNITY HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION PROVIDES A COPY OF FORM 990 TO THE BOARD FOR REVIEW PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 15ATHE BOARD REVIEWS COMPARABLE DATA AND THE SPECIFIC PERFORMANCE OF THE EXECUTIVE DIRECTOR IN DETERMINING COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2CTHE 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 2CTHE ORGANIZATION HAS AUDITED FINANCIAL STATEMENTS THAT ARE PREPARED ON A CONSOLIDATED BASIS.
FORM 5471, SCHEDULE BNO U.S. PERSONS OWNED (AT ANY TIME DURING THE ANNUAL ACCOUNTING PERIOD) DIRECTLY OR INDIRECTLY, 10% OR MORE IN VALUE OF ANY CLASS OF THE CORPORATION'S OUTSTANDING STOCK.
FORM 5471, SCHEDULE O, PART II, SECTION C & DTHE TAXPAYER NEITHER ACQUIRED NOR DISPOSED OF STOCK IN THE FOREIGN CORPORATION, CATALYST INSURANCE, LTD., DURING THE YEAR ENDED MAY 31, 2012. 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.ACQUISITIONS AND DISPOSITIONS
FORM 5471, SCHEDULE O, PART II, SECTION FCATALYST INSURANCE, LTD. FILED FORM 1120-F, U.S. INCOME TAX RETURN OF A FOREIGN CORPORATION, FOR ITS TAX YEARS ENDED MAY 31, 2009, 2010, AND 2011. 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.ADDITIONAL INFORMATION

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrg
ADVANCED MEDICAL TRANSPORT INC
1718 N STERLING AVEPEORIAIL61604260312211CHARITABLE, SCIENTIFIC, AND EDUCATIONAL TO FUTHER PHMMSIL501(C)(3)90
ADVANCED MEDICAL TRANSPORT OF IOWA
1718 N STERLING AVEPEORIAIL61604274133957PROVIDES AMBULANCE AND PARAMEDIC SERVICESIA501(C)(3)90

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1MIDWEST EMERGENCY MEDICAL SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11718 N STERLING AVEAddressLine1
CityPEORIACity
StateILState
ZIP Code61604ZIPCode
FieldValueIRS element (for citing)
EIN263021862EIN
Primary ActivityBILLING AND MANAGEMENTPrimaryActivity
Legal Domicile StateILLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1ADVANCED MEDICAL TRANSPORTBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
MEMSI
O207792SHARED EXPENSES REPORTED ON 1120
MEMSI
Q367022SHARED EXPENSES REPORTED ON 1120
ADVANCED MEDICAL TRANSPORT OF IOWA
D440076NOTE DOCUMENT
ADVANCED MEDICAL TRANSPORT OF IOWA
O454319EXPENSE REPORT ANALYSIS
ADVANCED MEDICAL TRANSPORT OF IOWA
Q651420SALARY REPORT ANALYSIS
ADVANCED MEDICAL TRANSPORT OF IOWA AND ADVANCED MEDICAL TRANSPORT INC
E0GUARANTEE OF $5,000,000 LOAN

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