2012-10-23T13:32:23-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 301 SW ADAMS STREET BOX 1835 PEORIA IL 616561835 990 2011-01-01 370999878 PEORIA HOSPITALS MOBILE MEDICAL SERVICES D/B/A ADV MEDICAL TRANS OF CENTRAL IL PEOR 3094946200 1718 NORTH STERLING AVE PEORIA IL 61604 JEFF FICK 3094946200 2012-10-19 1 LINDA MARTIN P00255069 3096714500 2011 2016-02-24 21:20:13Z JEFF FICK 1718 NORTH STERLING AVE PEORIA IL 61604 15395176 0 X WWW.ADVANCEDMEDICALTRANSPORT.ORG X 1975 IL THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 11 11 352 0 0 0 0 0 14367597 15322500 21575 25651 34176 47025 14423348 15395176 194945 86247 0 0 8629950 9513458 0 0 0 4547220 4606322 13372115 14206027 1051233 1189149 11617252 13993276 2341753 3775852 9275499 10217424 THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS. 0 0 11542933 86247 15322500 THE ORGANIZATION PROVIDES AMBULANCE AND PARAMEDIC SERVICES AS WELL AS TRANSPORTATION FOR WHEELCHAIR BOUND INDIVIDUALS (34,232 AMBULANCE TRANSPORTS IN 2011 AND 1,714 WHEELCHAIR TRANSPORTS IN 2011). 11542933 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 0 1 8 0 1 352 1 0 0 0 0 0 0 0 0 0 0 X 11 11 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 40.00 X 260415 0 10818 ROBERT KLAUS 1.00 X 0 0 0 DEBBIE SIMON 1.00 X 0 0 0 CAROL SHIELDS 1.00 X 0 0 0 CAROL LINETT 1.00 X 0 0 0 HOA COOPER 1.00 X 0 0 0 ROBERT ANDERSON 1.00 X 0 0 0 SHERRY THOMPSON 1.00 X 0 0 0 JEFF FICK 1.00 X 0 0 0 LARRY CLORE 1.00 X 0 0 0 DON WHITE 1.00 X 0 0 0 SHEROLYN TOLLIVER 40.00 X 114747 0 9604 JERRY KOLB 40.00 X 119424 0 0 494586 0 20422 3 0 1 0 0 TRANSPORT REVENUE 621990 14945695 14945695 SUBSIDY REVENUE 621990 376805 376805 15322500 25086 25086 565 0 565 565 565 MISCELLANEOUS 900099 47025 47025 47025 15395176 15322500 0 72676 86247 86247 260415 260415 7774832 6644824 1130008 186625 186625 662675 600606 62069 628911 535028 93883 59681 59681 53313 53313 13316 13316 133868 107792 26076 156416 110537 45879 142767 68457 74310 37084 37084 1268782 996357 272425 553259 444064 109195 FUEL 696575 696575 SUPPLIES 649274 547529 101745 REPAIR & MAINTENANCE 448644 392093 56551 RECRUITING 121154 95957 25197 272189 216867 55322 14206027 11542933 2663094 0 450 450 837049 594530 2773384 2926925 681539 1454850 187605 306345 17450174 8775998 7101225 8674176 36000 36000 11617252 13993276 691035 795679 623471 2104144 1027247 876029 2341753 3775852 X 9275499 10217424 9275499 10217424 11617252 13993276 X 1189149 -247224 X X 0 1 1 X 0 X 9492020 10534120 11643491 14367597 15322500 61359728 9492020 10534120 11643491 14367597 15322500 61359728 0 0 0 61359728 68867 46980 7778 18930 25086 167641 68867 46980 7778 18930 25086 167641 497023 299532 796555 85872 76553 45526 36821 47590 292362 10143782 10957185 11696795 14423348 15395176 62616286 0.97990 0.97230 0.00270 0.00330 X 150000 150000 4911817 749199 4162618 81389 80498 891 12306968 7946301 4360667 8674176 ACCRUED WAGES, TAXES, AND WITHHOLDINGS 552957 OTHER LIABILITIES 323072 876029 15395176 14206027 1189149 -18551 -228673 -247224 941925 15376625 0 15376625 18551 18551 15395176 14206027 0 14206027 0 14206027 PART XII, LINE 4B - OTHER ADJUSTMENTS: NET UNREALIZED LOSS 18,551. 1 HEARTLAND COMMUNITY HEALTH CLINIC 1701 W GARDEN ST PEORIA IL 61605 371270794 25000 CHARITABLE CONTRIBUTION QUEST CHARTER ACADEMY 2503 N UNIVERSITY PEORIA IL 61604 376001759 5000 CHARITABLE CONTRIBUTION HEART OF ILLINOIS UNITED WAY 509 W HIGH ST PEORIA IL 61606 370661504 31500 CHARITABLE CONTRIBUTION PEORIA PROMISE 110 SW JEFFERSON AVE 600 PEORIA IL 61602 134353454 10000 CHARITABLE CONTRIBUTION MERCY HEALTH FOUNDATION 250 MERCY DR DUBUQUE IA 52001 262227941 5000 CHARITABLE CONTRIBUTION 5 X X X X 0 0 0 0 0 0 0 1 0 ANDREW RAND 260415 0 0 0 0 0 8250 0 2568 0 271233 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -18,551. PRIOR PERIOD ADJUSTMENTS: -228,673. TOTAL TO FORM 990, PART XI, LINE 5: -247,224. 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. 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 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 MEMSI M 51353 SHARED EXPENSES REPORTED ON 1120 MEMSI N 210882 SHARED EXPENSES REPORTED ON 1120 ADVANCED MEDICAL TRANSPORT OF IOWA D 440076 NOTE DOCUMENT ADVANCED MEDICAL TRANSPORT OF IOWA F 788979 FMV OF ASSETS SOLD ADVANCED MEDICAL TRANSPORT OF IOWA M 617541 ACCOUNTS PAYABLE ADJUSTMENT ADVANCED MEDICAL TRANSPORT OF IOWA N 497652 ACCOUNTS PAYABLE ADJUSTMENT ADVANCED MEDICAL TRANSPORT INC & ADVANCED MEDICAL TRANSPORT OF IOWA E 0 GUARANTEE OF $5,000,000 LOAN