Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 118,329 | 217,458 | 459,921 | 795,708 | ||
| 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 | 5,936,668 | 6,377,807 | 4,107,227 | 8,427,139 | 8,952,623 | 33,801,464 |
| 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 | 6,054,997 | 6,595,265 | 4,107,227 | 8,427,139 | 9,412,544 | 34,597,172 |
| 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.) | 34,597,172 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 6,054,997 | 6,595,265 | 4,107,227 | 8,427,139 | 9,412,544 | 34,597,172 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,756 | 375 | 3,131 | |||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 2,756 | 375 | 3,131 | |||
| 11 | Net income from unrelated business activities not included on 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 6,057,753 | 6,595,265 | 4,107,602 | 8,427,139 | 9,412,544 | 34,600,303 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART III, SHORT YEAR EXPLANATION: | AS OF MARCH 2022, THE BOARD VOTED TO CHANGE THE ACCOUNTING PERIOD FROM 6/30/21 TO 12/31/21. AS A RESULT, THE COLUMNS IN SCHEDULE A, PART III CORRESPOND TO THE FOLLOWING TAX YEARS: 2019 = FYE 6/30/20 2020 = FYE 6/30/21 2021 = SHORT YEAR-END 12/31/21 2022 = FYE 12/31/22 2023 = FYE 12/31/23 |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | TOM SCALETTA, JASON OGDEN, ANDREW BROOKS, ELLEN TURNBULL AND DARYL WILSON HAVE A BUSINESS RELATIONSHIP. DAVID CLAEYS, LEEANN ODOM, MICHAEL KING, CHRIS FLORES AND NANCY SUSICK HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 3 | IN DECEMBER 2020, EDWARD ENTERED INTO AN ON-SITE MANAGEMENT AND EXECUTIVE OVERSIGHT AGREEMENT WITH SUPERIOR AIR-GROUND AMBULANCE. |
| 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 11B | 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 SUPERIOR AMBULANCE, 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. |
| FORM 990, PART IX, LINE 11G | DISPATCH FEES: PROGRAM SERVICE EXPENSES 291,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 291,600. LEASED EMPLOYEES: PROGRAM SERVICE EXPENSES 4,351,212. MANAGEMENT AND GENERAL EXPENSES 87,563. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,438,775. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 221,927. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 221,927. |
| Software ID: | |
| Software Version: |