Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
BEAUMONT MEDICAL TRANSPORTATION SERVICE
Employer identification number
26-0203703
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3,953,827
4,837,622
5,182,157
5,637,081
5,709,470
25,320,157
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
3,953,827
4,837,622
5,182,157
5,637,081
5,709,470
25,320,157
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
25,320,157
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
3,953,827
4,837,622
5,182,157
5,637,081
5,709,470
25,320,157
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
25
20,322
20,347
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
25
20,322
20,347
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
3,953,827
4,837,622
5,182,182
5,637,081
5,729,792
25,340,504
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.920 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.080 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
BEAUMONT MEDICAL TRANSPORTATION SERVICE
Employer identification number
26-0203703
Return Reference
Explanation
FORM 990, PART III, LINE 3
THE ORGANIZATION CEASED NON-EMERGENCY VAN SERVICE TRANSPORTATION IN MAY 2013.
FORM 990, PART VI, SECTION A, LINE 2
BUSINESS RELATIONSHIP-GREG BEAUCHEMIN, PAUL LACASSE, AND GERSON COOPER.
FORM 990, PART VI, SECTION A, LINE 3
THE ORGANIZATION CONTRACTS WITH PARASTAR, INC., A SUBSIDIARY OF COMMUNITY EMERGENCY MEDICAL SERVICES, INC., TO PROVIDE ON-SITE MANAGEMENT AND EXECUTIVE OVERSIGHT.
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION IS A JOINT VENTURE MADE UP OF TWO 501(C)(3) MEMBERS WITH THE FOLLOWING OWNERSHIP PERCENTAGE: COMMUNITY EMERGENCY MEDICAL SERVICE, INC. 40% WILLIAM BEAUMONT HOSPITAL 60%
FORM 990, PART VI, SECTION A, LINE 7A
THE ELECTION AND/OR REMOVAL OF THE PRESIDENT AND THE CHAIR OF THE CORPORATION'S BOARD OF DIRECTORS SHALL NOT BE DEEMED AUTHORIZED UNLESS AND UNTIL UNANIMOUSLY APPROVED BY BOTH MEMBERS ACCORDING TO ARTICLE III, SECTION 3.5.2 OF THE BYLAWS.
FORM 990, PART VI, SECTION A, LINE 7B
THE GOVERNING BODY OF THIS ENTITY HAVE FULL AUTHORITY TO GOVERN THE AFFAIRS EXCEPT FOR POWERS WHICH ARE RESERVED TO COMMUNITY EMERGENCY MEDICAL SERVICE, INC. AND WILLIAM BEAUMONT HOSPITAL, ITS MEMBERS, PER ARTICLE III, SECTION 3.4 OF THE BYLAWS. THESE RESERVED POWERS INCLUDE AMENDMENT OF THE ARTICLES OF INCORPORATION, BYLAWS OF THE CORPORATION OR THE CORPORATE OPERATING AGREEMENT OR MAKING ANY MATERIAL CHANGE TO THE PURPOSES OF THE CORPORATION; ELECTION AND/OR REMOVAL OF THE PRESIDENT AND THE CHAIR OF THE CORPORATION'S BOARD OF DIRECTORS; CHANGE IN THE VOTING RIGHTS OF THE MEMBERS; ADOPTION OF THE CORPORATION'S STRATEGIC PLANS; REMOVAL OF A BOARD OF DIRECTOR OR THE TERMINATION OF THE MANAGER; ADOPTION OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS, AND ANY AMENDMENTS TO SUCH BUDGETS; MAKING DISTRIBUTIONS TO A MEMBER; ALL CAPITAL EXPENDITURES BY THE CORPORATION IN EXCESS OF TEN THOUSAND AND 00/100 ($10,000.00) DOLLARS; ALL BORROWINGS OR GUARANTEES OF INDEBTEDNESS BY THE CORPORATION (OR ANY ENTITY CONTROLLED BY THE CORPORATION); ALL LENDING BY THE CORPORATION; ANY DECISION TO PURSUE CERTAIN ADVOCACY INITIATIVES OR POSITIONS AT THE STATE OR FEDERAL LEVEL, TO THE EXTENT PERMITTED UNDER THE CODE; THE CORPORATION'S INVESTMENTS OF CASH AND/OR RESERVES, WHETHER ON AN INDIVIDUAL BASIS OR AS PART OF A POOLED INVESTMENT STRATEGY; ANY MERGER OR CONSOLIDATION OF THE CORPORATION (OR ANY ENTITY CONTROLLED BY THE CORPORATION), OR ANY OTHER CHANGE IN OWNERSHIP PERCENTAGES, CONTROL, OR CAPITAL STRUCTURE OF THE CORPORATION (OR ANY ENTITY CONTROLLED BY THE CORPORATION) OR ANY LEASE, SALE, TRANSFER, EXCHANGE, ENCUMBRANCE, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE CORPORATION, IN A SINGLE TRANSACTION OR A SERIES OF TRANSACTIONS; THE CREATION OF ANY ENTITY CONTROLLED, DIRECTLY OR INDIRECTLY, BY THE CORPORATION; THE SALE OR TRANSFER OF MORE THAN TEN PERCENT (10%) OF THE ASSETS OF THE CORPORATION (OR ANY ENTITY CONTROLLED BY THE CORPORATION) TO ANY PERSON OR ENTITY; DISSOLUTION OF THE CORPORATION;
FORM 990, PART VI, SECTION A, LINE 8B
THERE ARE NO COMMITTEES.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 AND ALL RELATED SCHEDULES WERE PREPARED BY THE ORGANIZATION'S FINANCE DEPARTMENT AND REVIEWED BY AN OUTSIDE TAX FIRM. A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE OF THE CONFLICT OF INTEREST POLICY BY REVIEW OF THE POLICY ANNUALLY AT THE BOARD MEETING AND REQUESTING SUBMISSION OF CONFLICTS TO THE SECRETARY OF THE ORGANIZATION PER THE POLICY. THE CONFLICT OF INTEREST POLICY COVERS ANY DIRECTOR, OFFICER, NON-DIRECTOR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWER OR OTHER PERSON IN A SIMILAR POSITION OF AUTHORITY OVER THE CORPORATION. THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS [OR APPROPRIATE COMMITTEE] MAY, IN THEIR DISCRETION, REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM WHILE THE PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT IS DISCUSSED. THE COVERED PERSON SHALL LEAVE THE ROOM WHILE THE MATTER IS VOTED ON AND ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER TO APPROVE THE TRANSACTION OR ARRANGEMENT.
FORM 990, PART VI, SECTION B, LINE 15
THE TOP MANAGEMENT OFFICIAL AND KEY EMPLOYEES ARE PAID BY COMMUNITY EMS AND BILLED TO PARASTAR, INC, THE MANAGEMENT COMPANY. THEREFORE, A COMPENSATION PROCESS IS NOT APPLICABLE FOR THIS ORGANIZATION. THE DIRECTORS OF BEAUMONT MEDICAL TRANSPORTATION SERVICES, INC. DO NOT RECEIVE ANY FORM OF REMUNERATION FROM THE ORGANIZATION. THE DIRECTORS ARE COMPENSATED FROM A RELATED ENTITY. THE COMPENSATION RECEIVED IS REASONABLE AND IS BASED ON A PERCENTILE OF NATIONAL DATA WITH CONSIDERATION FOR LOCAL AND REGIONAL PAY PRACTICES.
FORM 990, PART VI, SECTION C, LINE 19
DOCUMENTS THAT ARE REQUIRED TO BE MADE AVAILABLE TO THE PUBLIC WILL BE MADE AVAILABLE UPON REQUEST.
FORM 990, PART VII, LINE 1A
S. COLLARD, D. DALBEC, M. MCPHERSON, R. GAGLIO, R. SWAINE, AND J. ZIADEH PROVIDE SERVICES TO BEAUMONT MEDICAL TRANSPORTATION SERVICE, INC. AND RELATED ENTITIES. HOURS WORKED ARE NOT TRACKED SEPARATELY FOR EACH ENTITY. THEREFORE, HOURS FOR THESE INDIVIDUALS REPORTED ON FORM 990, PART VII, REPRESENT THE AGGREGATE HOURS WORKED PER WEEK FOR ALL ENTITIES.
FORM 990, PART XI, LINE 9:
DISTRIBUTIONS TO MEMBERS -1,033,000.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.