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
Regional Emergency Medical Services Authority
Employer identification number
27-3923442
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.") .
0
0
0
0
0
0
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......
1,320,044
3,634,101
3,237,689
3,142,229
11,334,063
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
0
1,320,044
3,634,101
3,237,689
3,142,229
11,334,063
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.
105,771
105,771
c
Add lines 7a and 7b..
105,771
105,771
8
Public support (Subtract line 7c from line 6.)
11,228,292
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...
0
1,320,044
3,634,101
3,237,689
3,142,229
11,334,063
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
0
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
0
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
11,147
640
11,008
18,179
40,974
13
Total support. (Add lines 9, 10c, 11, and 12.)..
0
1,331,191
3,634,741
3,248,697
3,160,408
11,375,037
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
0 %
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
Regional Emergency Medical Services Authority
Employer identification number
27-3923442
Return Reference
Explanation
FORM 990, PART III, LINE 4A
THE MISSION OF REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY (REMSA) IS TO PROVIDE AN EFFECTIVE GROUND AMBULANCE SERVICE WHICH FUNCTIONS AS A PART OF A COORDINATED EMERGENCY MEDICAL SERVICE SYSTEM FOR THE HEALTH AND SAFETY OF THE COMMUNITY AND ITS CITIZENS. THE ORGANIZATION IS THE ONLY EMERGENCY MEDICAL TRANSPORT COMPANY IN THE CITY OF ST. JOSEPH, WHICH HAS A POPULATION OF APPROXIMATELY 70,000 PEOPLE. THE ORGANIZATION SERVED 9,061 CLIENTS, 18.1% OF WHICH WERE UNINSURED, 66.1% COVERED BY MEDICARE AND MEDICAID AND 15.8% COMMERCIALLY INSURED. THE ORGANIZATION PROVIDED FINANCIAL ASSISTANCE OF $405,528 AND INCURRED $1,515,146 IN LOSSES FOR NON-PAYMENT OF AMOUNTS OWED. THE ORGANIZATION DID NOT RECEIVE ANY GRANTS OR SUPPORT FROM OUTSIDE SOURCES OTHER THAN CLIENT PAYMENTS. The board of directors of the organization adopted an amendment, effective July 1, 2014, that changes the articles of incorporation to make Buchanan County, Missouri the sole member. By adopting the amendment, the board transferred ownership and operation of the entity to Buchanan County. By doing so, the provision of ambulance services can be more easily aligned with other governmental programs provided by the county and the city of St. Joseph, in order to better serve the community.
FORM 990, PART VI, SECTION A, LINE 2
CAROL ROEVER, CURT KRETZINGER, JANIE SCHUMAKER AND JOHN WILSON HAVE A BUSINESS RELATIONSHIP.
fORM 990, PART VI, SECTION A, LINE 3
DAY-TO-DAY OPERATIONS ARE MANAGED BY PERSONNEL PROVIDED BY MEDSERV INTERNATIONAL LLC AKA FITCH & ASSOCIATES.
FORM 990, PART VI, SECTION A, LINE 6
THROUGH JUNE 30, 2014 HEARTLAND HEALTH, A MISSOURI NONPROFIT CORPORATION, WAS THE SOLE MEMBER OF REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY. HEARTLAND HEALTH HAD THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY. HEARTLAND HEALTH WAS NOT ENTITLED TO RECEIVE A SHARE OF REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY'S PROFITS, EXCESS DUES, OR ASSETS UPON DISSOLUTION.
FORM 990, PART VI, SECTION A, LINE 7A
THROUGH JUNE 30, 2014 HEARTLAND HEALTH, AS THE SOLE MEMBER OF REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY, HAD THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B
THE CORPORATE BYLAWS OF REGIONAL EMERGENCY MEDICAL SERVICES AUTHORITY IDENTIFY CERTAIN RIGHTS AND POWERS WHICH WERE RESERVED TO HEARTLAND HEALTH, AS THE SOLE MEMBER. IN EACH INSTANCE, THE RIGHTS AND POWERS RESERVED TO THE SOLE MEMBER MAY BE SUMMARIZED AS FOLLOWS: A. APPROVE THE FORMATION OR ACQUISTION OF LEGAL ENTITIES BY THE COMPANY, AND APPROVE THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR THE DIVESTURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP OR CORPORATE REORGANIZATION OF THE CORPORATION. B. APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE DIRECTORS SERVING ON THE BOARD OF DIRECTORS, THE OFFICERS OF THE CORPORATION AND THE AUDITORS AND LEGAL COUNSEL OF THE CORPORATION. C. APPROVE THE TRANSFER OF ASSETS AND THE REALLOCATION OF DEBT AMONG THE CORPORATION, THE MEMBER, AND OTHER AFFILIATES OF THE MEMBER IN CONSULTATION WITH THE CORPORATION'S BOARD OF DIRECTORS. D. APPROVE THE CAPITAL AND OPERATING BUDGETS AND PLANS, AND STRATEGIC PLANS, STRATEGIC DIRECTION AND LONG-RANGE PLANNING OF THE CORPORATION. E. APPROVE THE ESTABLISHMENT OF BANKING RELATIONSHIPS AND THE TERMS THEREOF, AND MANAGEMENT OF ALL CASH AND OTHER ASSETS OF, AND INCURRENCE OF DEBT AND ENCUMBERANCE OF ASSETS BY, THE CORPORATION. F. APPROVE ALL CHANGES AND AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 11B
AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE TAX DEPARTMENT, CONTROLLER AND TREASURER, ALL REVIEW THE RETURN. THE COMPLETE 990 IS THEN EMAILED TO ALL MEMBERS OF THE BOARD FOR REVIEW BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C
UPON AGREEING TO FILL A BOARD POSITION, THE PROSPECTIVE MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST DOCUMENT WHICH DISCLOSES FAMILY AND BUSINESS RELATIONSHIPS THAT COULD BE CONSIDERED IN CONFLICT WITH THEIR POSITION ON THE BOARD. IN THIS DOCUMENT, THEY AGREE THAT THEY WILL DISCLOSE ANY ACTIVITIES IN WHICH THEY MAY NOT BE INDEPENDENT IN REGARDS TO A TRANSACTION. THIS DOCUMENT IS DISTRIBUTED AND HELD BY LEGAL COUNSEL. THE MEMBER ALSO SIGNS HEARTLAND'S CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO ETHICAL BEHAVIOR AND ADHERING TO CONFIDENTIALITY POLICIES. THIS DOCUMENT IS HELD BY THE CORPORATE COMPLIANCE OFFICE. ANNUALLY, THE CORPORATE COMPLIANCE OFFICER DISTRIBUTES A SURVEY TO EACH BOARD MEMBER TO FACILITATE DISCLOSURE OF ANY REPORTABLE ACTIVITIES. DURING THE COURSE OF BOARD MEETINGS, BOARD MEMBERS WILL DISMISS THEMSELVES FROM MEETINGS AND/OR ABSTAIN FROM VOTING DURING DISCUSSIONS OF ISSUES THAT RELATE TO THOSE SPECIFIC MEMBERS OR THE COMPANIES THAT THEY REPRESENT. ALL DISMISSALS AND ABSTENTIONS ARE RECORDED IN THE MINUTES OF THE BOARD MEETING. ANNUALLY, BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO ETHICAL BEHAVIOR AND ADHERING TO CONFIDENTIALITY POLICIES. THEY ALSO RECIEVE A QUESTIONNAIRE WHICH FACILITATES THE DISCLOSURE OF ANY REPORTABLE ACTIVITIES TO THE CORPORATE COMPLIANCE OFFICER.
FORM 990, PART VI, SECTION B, LINES 15A & 15B
TOP MANAGEMENT OFFICIALS ARE EMPLOYED BY AN AFFILIATE, HEARTLAND REGIONAL MEDICAL CENTER, AND RECEIVE NO SPECIFIC COMPENSATION FOR SERVICES TO THE FILING ORGANIZATION. THE AFFILIATE ORGANIZATION PERFORMS A COMPENSATION REVIEW EACH YEAR. MARKET DATA IS PROVIDED BY AN INDEPENDENT CONSULTING FIRM THAT SPECIALIZES IN MARKET SALARY DATA. A COMPENSATION COMMITTEE COMPRISED OF THE HEARTLAND HEALTH BOARD CHAIR, HEARTLAND HEALTH BOARD VICE-CHAIR AND THREE ADDITIONAL HEARTLAND HEALTH BOARD MEMBERS AND INDEPENDENT LEGAL COUNSEL, AS SCRIBE, OVERSEE AN ANNUAL SALARY REVIEW PROCESS FOR OFFICERS, ADMINISTRATORS AND KEY EMPLOYEES. FOR EACH POSITION TO BE REVIEWED, THE FULL SCOPE OF DUTIES AND RESPONSIBILITIES, NUMBERS OF STAFF MANAGED, PROCESSES MANAGED, APPROXIMATE REVENUE, EXPENSE, OR CAPITAL DOLLARS MANAGED ARE PROVIDED TO THE THIRD PARTY CONSULTANT. THE FACILITY SIZE, NOT-FOR-PROFIT STATUS AND THE SCOPE OF EACH JOB POSITION IS COMPARED TO LIKE FACILITIES TO DETERMINE BASE COMPENSATION AND INCENTIVE COMPENSATION FOR EACH POSITION. THE DATA GATHERED BY THE MARKET RESEARCH FIRM IS REVIEWED BY THE COMPENSATION COMMITTEE, OUTLIER ISSUES ARE RESOLVED AND BASED UPON PRESENT FINANCIAL INDICATORS, THE COMMITTEE MAKES THEIR DETERMINATION OF COMPENSATION LEVELS FOR THE NEXT PAY YEAR.
FORM 990, PART VI, SECTION C, LINE 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990, PART VII, LINE 2
DAVE CARTER AND CRAIG DIERINGER ARE EMPLOYED BY MEDSERV INTERNATIONAL AND CONTRACTED TO REMSA TO PROVIDE MANAGEMENT SERVICES. PAYMENTS TO MEDSERV INTERNATIONAL FOR THEIR SERVICES SURPASS $100,000.
FORM 990, PART XI, LINE 9
INTERCOMPANY TRANSFER $ 2,117,004
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.