2013-08-13T16:45:30-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STE 900 BOX 1835 PEORIA IL 616561835 990 2012-01-01 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 3094946200 2013-08-08 1 LINDA MARTIN P00255069 3096714500 2012 2016-02-24 21:20:13Z GREG SOWARDS 1718 NORTH STERLING AVE PEORIA IL 61604 15129848 0 X WWW.ADVANCEDMEDICALTRANSPORT.ORG X 1975 IL THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 7 6 351 0 0 0 0 0 15322500 14994888 25651 49618 47025 75975 15395176 15120481 86247 80035 0 0 9513458 9091081 0 0 0 4606322 4455204 14206027 13626320 1189149 1494161 13993276 14751270 3775852 2998213 10217424 11753057 THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 0 0 10956817 80035 14994888 THE 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). 10956817 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 1 351 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 SHERRY THOMPSON 1.00 X 0 0 0 ANDREW BLAND 1.00 X 0 0 0 JEANINE SPAIN 1.00 X 0 0 0 JEFF FICK 1.00 X 0 0 0 ROBERT ANDERSON 1.00 X 0 0 0 GREG SOWARDS 1.00 X 0 0 0 ANDREW RAND 40.00 X 281437 0 10797 SHEROLYN TOLLIVER 40.00 X 116398 0 10034 JERRY KOLB 40.00 X 125799 0 0 523634 0 20831 3 0 1 0 0 TRANSPORT REVENUE 621990 14413233 14413233 SUBSIDY REVENUE 621990 581655 581655 14994888 51420 51420 7565 9367 -1802 -1802 -1802 MISCELLANEOUS 900099 75975 75975 75975 15120481 14994888 0 125593 80035 80035 523634 523634 7172643 6349596 823047 210623 210623 574375 501898 72477 609806 500986 108820 41525 41525 82244 82244 52951 52951 137962 106421 31541 138227 71926 66301 125954 49731 76223 40781 40781 1315250 974092 341158 547280 430398 116882 FUEL 624362 624362 SUPPLIES 596587 596587 REPAIR & MAINTENANCE 404212 353509 50703 RECRUITING 102201 102201 245668 215075 30593 13626320 10956817 2669503 0 450 1316382 594530 1115431 2926925 2461643 1454850 1357258 306345 623334 17863343 10022121 8674176 7841222 36000 36000 13993276 14751270 795679 531721 2104144 1533333 876029 933159 3775852 2998213 X 10217424 11753057 10217424 11753057 13993276 14751270 1494161 41472 0 X X 0 1 X 1 0 X 10534120 11643491 14367597 15322500 14994888 66862596 10534120 11643491 14367597 15322500 14994888 66862596 0 0 0 66862596 46980 7778 18930 25086 51420 150194 46980 7778 18930 25086 51420 150194 299532 299532 76553 45526 36821 47590 74173 280663 10957185 11696795 14423348 15395176 15120481 67592985 0.98920 0.97990 0.00220 0.00270 X 231389 231389 4928722 891887 4036835 12703232 9130234 3572998 7841222 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 617099 OTHER LIABILITIES 316060 933159 15161953 41472 41472 15120481 0 15120481 13626320 0 13626320 0 13626320 1 HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 34000 CHARITABLE CONTRIBUTION EASTER SEALS UCP 507 E ARMSTRONG AVE PEORIA IL 61603 370686250 5000 CHARITABLE CONTRIBUTION OSF ST FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVE PEORIA IL 61637 370662569 5000 CHARITABLE CONTRIBUTION 3 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND 221437 0 60000 0 0 0 8250 0 2547 0 292234 0 0 0 PART I, LINE 7 BASED ON EMPLOYEE PERFORMANCE FORM 990, PART VI, SECTION A, LINE 7A TWO 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 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 OF ANY CLASS OF THE CORPORATION'S OUTSTANDING STOCK. ACQUISITIONS AND DISPOSITIONS 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, 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. ADDITIONAL INFORMATION 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, 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. ADVANCED MEDICAL TRANSPORT INC 1718 N STERLING AVE PEORIA IL 61604 260312211 CHARITABLE, SCIENTIFIC, AND EDUCATIONAL TO FUTHER PHMMS 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 0 MIDWEST EMERGENCY MEDICAL SERVICES 1718 N STERLING AVE PEORIA IL 61604 263021862 BILLING AND MANAGEMENT IL ADVANCED MEDICAL TRANSPORT C 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 MEMSI O 207792 SHARED EXPENSES REPORTED ON 1120 MEMSI Q 367022 SHARED EXPENSES REPORTED ON 1120 ADVANCED MEDICAL TRANSPORT OF IOWA D 440076 NOTE DOCUMENT ADVANCED MEDICAL TRANSPORT OF IOWA O 454319 EXPENSE REPORT ANALYSIS ADVANCED MEDICAL TRANSPORT OF IOWA Q 651420 SALARY REPORT ANALYSIS ADVANCED MEDICAL TRANSPORT OF IOWA AND ADVANCED MEDICAL TRANSPORT INC E 0 GUARANTEE OF $5,000,000 LOAN