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
EDWARD AMBULANCE SERVICES LLC
Employer identification number
45-2389060
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......
2,366,292
3,892,709
4,752,490
11,011,491
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.
2,366,292
3,892,709
4,752,490
11,011,491
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.)
11,011,491
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...
2,366,292
3,892,709
4,752,490
11,011,491
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)..
2,366,292
3,892,709
4,752,490
11,011,491
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
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
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
EDWARD AMBULANCE SERVICES LLC
Employer identification number
45-2389060
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
GREG BEAUCHEMIN AND STEPHEN JAMEY BAKER HAVE A BUSINESS RELATIONSHIP. WILLIAM KOTTMANN, VINCENT PRYOR, MARIANNE SPENCER AND PAULA ALBRIGHT HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 3
THE ORGANIZATION CONTRACTS WITH PARASTAR EMERGENCY SYSTEMS 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. 45% EDWARD HOSPITAL 55%
FORM 990, PART VI, SECTION A, LINE 7A
BOARD IS COMPOSED OF 7 MANAGERS. CLASS A MEMBER (EDWARD HOSPITAL)IS ENTITLED TO NOMINATE 4 MANAGERS AND CLASS B MEMBER (COMMUNITY EMS)IS ENTITLED TO NOMINATE 3 MANAGERS. EACH MEMBER VOTES FOR THE ELECTION OF ALL MANAGERS. ONLY THE MEMBER THAT NOMINATED THE MANAGER MAY DIRECT THE REMOVAL OF THAT MANAGER. ACCORDING TO ARTICLE VII, SECTION 7.2 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 EDWARD HOSPITAL, ITS MEMBERS, PER ARTICLE VII, SECTION 7.4 OF THE BYLAWS. THESE RESERVED POWERS INCLUDE AMENDMENT, MODIFICATION OR REPEAL OF THIS AGREEMENT OR THE ARTICLES OF ORGANIZATION; MERGER, CONSOLIDATION OR AFFILIATION OF THE COMPANY WITH ANOTHER ENTITY; VOLUNTARY DISSOLUTION OF THE COMPANY; ADDITION OF NEW OR ADDITIONAL MEMBERS TO THE COMPANY; SALE, EXCHANGE, LEASE OR OTHER TRANSFER OF, OR MORTGAGE OF OR GRANT OF ANY SECURITY INTEREST IN, ANY REAL PROPERTY OF THE COMPANY INVOLVING AN AMOUNT IN EXCESS OF TWO HUNDRED THOUSAND DOLLARS ($200,000) IN ANY ONE TRANSACTION (OR SERIES OF RELATED TRANSACTIONS); SALE OF GREATER THAN TEN PERCENT (10%) OF THE ASSETS OF THE COMPANY; REMOVAL OF A MANAGER OF THE COMPANY OTHER THAN AS DIRECTED BY THE MEMBER THAT NOMINATED SUCH MANAGER; ANY BORROWING OR LENDING OF MONEY BY THE COMPANY IN ANY ONE TRANSACTION OR SERIES OF RELATED TRANSACTIONS (FOR ANY PURPOSE OTHER THAN TRADE OBLIGATIONS INCURRED IN THE ORDINARY COURSE OF BUSINESS), OR INCURRING ANY NEW OR INCREASING THE AMOUNT OF ANY EXISTING COMPANY INDEBTEDNESS, OR TAKING ANY ACTION TO MORTGAGE, PLEDGE, HYPOTHECATE OR GRANT A SECURITY INTEREST IN ANY ASSETS OF THE COMPANY OR THE ASSUMPTION OF ANY LOAN OR OBLIGATION OR GUARANTEE OF ANY LOAN OR OBLIGATION OF ANY PARTY OTHER THAN THE COMPANY BECOMING A SURETY WITH RESPECT TO A THIRD PARTY LOAN OR OBLIGATION; THE MAKING OF UNBUDGETED CAPITAL EXPENDITURES IN EXCESS OF TEN THOUSAND DOLLARS ($10,000) IN ANY ONE TRANSACTION (OR SERIES OF RELATED TRANSACTIONS); ANY CALL FOR CAPITAL CONTRIBUTIONS TO THE COMPANY IN ADDITION TO THE INITIAL CAPITAL CONTRIBUTIONS SET FORTH IN SECTION 3.1 OF ARTICLE III OR THE ISSUANCE OF ADDITIONAL MEMBERSHIP INTERESTS; THE APPROVAL, TERMINATION, AMENDMENT, MODIFICATION OR EXTENSION OF THE MANAGEMENT AGREEMENT AUTHORIZED PURSUANT TO SECTIONS 7.6 OF THIS AGREEMENT; MAKING ANY MATERIAL OR SUBSTANTIAL CHANGE IN THE CAPITAL OR MANAGERIAL STRUCTURE OF THE COMPANY OR THE PURPOSES OF THE COMPANY OR THE CHARACTER OF ITS BUSINESS, FOR EXAMPLE, A CHANGE SUCH THAT THE COMPANY'S PRINCIPAL ACTIVITY CEASES TO BE OPERATING MEDICAL TRANSPORTATION SERVICES; MAKING, EXECUTING OR DELIVERING, ON BEHALF OF THE COMPANY, AN ASSIGNMENT FOR THE BENEFIT OF CREDITORS; ADOPTION OR AMENDMENT OF THE COMPANY'S POLICY FOR THE DISTRIBUTIONS TO MEMBERS AND APPROVAL OF ANY DISTRIBUTION BY THE COMPANY TO A MEMBER OR THE MEMBERS REGARDLESS OF WHETHER THE DISTRIBUTION IS PURSUANT TO THE THEN CURRENT DISTRIBUTION POLICY; ANY OTHER MATTER REQUIRING ACTION OR APPROVAL BY BOTH OF THE MEMBERS UNDER THE LAWS OF THE STATE OF ILLINOIS; CREATION OF A NEW LEGAL ENTITY OWNED IN WHOLE OR IN PART BY THE COMPANY OR ANY MEMBER OR AN AFFILIATE OF ANY MEMBER THAT SHALL VIOLATE SECTION 10.1 OF THIS AGREEMENT; DOING ANY ACT WHICH WOULD MAKE IT IMPOSSIBLE OR IMPRACTICAL TO CARRY ON THE BUSINESS OF THE COMPANY; TAKING ANY ACTION ON BEHALF OF THE COMPANY WITH RESPECT TO MATTERS OUTSIDE THE ORDINARY COURSE OF BUSINESS OF THE COMPANY; SELECTING THE LEGAL COUNSEL AND THE ACCOUNTANTS OF THE COMPANY; APPROVAL OF THE LEASE, SALE, TRANSFER, EXCHANGE, ENCUMBRANCE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY AND ASSETS OF THE COMPANY IN A SINGLE TRANSACTION OR A SERIES OF TRANSACTIONS; ADOPTION OF AMENDMENT TO ANY INVESTMENT POLICY FOR THE COMPANY'S CASH OR RESERVES AND ANY INVESTMENT OF THE COMPANY'S CASH OR RESERVES NOT IN ACCORDANCE WITH THE APPROVED INVESTMENT POLICY; THE INSTITUTION OF ANY LEGAL PROCEEDINGS, INCLUDING THE COMMENCEMENT OF ANY LITIGATION OR ARBITRATION AGAINST A THIRD PARTY, BY THE COMPANY (OTHER THAN ROUTINE PROCEEDINGS FOR THE COLLECTION OF TRADE DEBT), THE DEFENSE OF ANY CLAIMS AGAINST THE COMPANY, THE NEGOTIATION OR EXECUTION OF ANY SETTLEMENT AGREEMENT, INCLUDING WITHOUT LIMITATION ANY ACTIONS OR CONTROVERSIES ARISING UNDER THE CODE, THE FRAUD AND ABUSE STATUTE OR THE STARK ACT OR ANY SUCH AGREEMENTS WITH ANY TAXING, LICENSING OR ACCREDITING AUTHORITY OR AGENCY; AND ANY GUARANTEE OF DEBT OF THE COMPANY BY A MEMBER TO THE MEMBERS.
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 BEFORE THE RETURN WAS FILED.
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 EDWARD AMBULANCE SERVICES LLC 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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.