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Nonprofiteer
← TRI-STATE AMBULANCE INC

Form 990 for tax year 2022

Filed by TRI-STATE AMBULANCE INC.

Totals

Total revenue
$8,543,010
Total expenses
$7,870,421
Contributions and grants received
$171,305
Grants paid
$21,515
Program service revenue
$8,363,377
Investment income
$8,328
Other revenue
$0
Total assets, end of year
$7,298,962
Total liabilities, end of year
$706,483
Net assets or fund balances, end of year
$6,592,479
Program services expenses (Part IX)
$6,850,822
Management and general expenses
$1,019,599
Fundraising expenses
$0
Program service expenses (Part III)
$6,850,822

Program services were 87.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $171,305

  • 2a · Program service revenue: PRE-HOSPITAL EMERGENCY

    total $8,234,010 · related or exempt $8,234,010

  • 2b · Program service revenue: MEDICAL SUPPLIES SERVICES

    total $64,076 · related or exempt $64,076

  • 2c · Program service revenue: MISCELLANEOUS RENTAL INCOME

    total $65,291 · related or exempt $65,291

  • 2f · All other program service revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 3 · Investment income

    total $8,328 · excluded $8,328

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 7c · Gain or loss

    securities $0 · other assets $0

  • 11d · All other revenue

    total $0 · related or exempt $0 · unrelated business $0 · excluded $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $3,459 · program services $3,459

  • 2 · Grants to domestic individuals

    total $18,056 · program services $18,056

  • 4 · Benefits paid to or for members

    total $0 · program services $0

  • 7 · Other salaries and wages

    total $3,735,864 · program services $3,181,206 · management and general $554,658

  • 8 · Pension plan contributions

    total $70,655 · program services $60,165 · management and general $10,490

  • 9 · Other employee benefits

    total $600,911 · program services $511,695 · management and general $89,216

  • 10 · Payroll taxes

    total $261,387 · program services $222,579 · management and general $38,808

  • 11a · Fees: management

    total $173,908 · management and general $173,908

  • 11c · Fees: accounting

    total $1,500 · program services $1,500

  • 11g · Fees: other

    total $403,153 · program services $380,627 · management and general $22,526 · fundraising $0

  • 12 · Advertising and promotion

    total $9,354 · management and general $9,354

  • 13 · Office expenses

    total $100,406 · program services $41,970 · management and general $58,436

  • 14 · Information technology

    total $31,656 · program services $6,327 · management and general $25,329

  • 16 · Occupancy

    total $211,870 · program services $180,414 · management and general $31,456

  • 17 · Travel

    total $37,742 · program services $37,742

  • 19 · Conferences, conventions and meetings

    total $59,900 · program services $59,900

  • 22 · Depreciation, depletion and amortization

    total $564,388 · program services $564,388

  • 23 · Insurance

    total $28,284 · program services $24,085 · management and general $4,199

  • 24a · Other expenses: BAD DEBT EXPENSE

    total $888,615 · program services $888,615

  • 24b · Other expenses: RENT, REPAIRS AND MAINTENANCE

    total $358,455 · program services $358,455

  • 24c · Other expenses: SUPPLIES

    total $286,339 · program services $286,339

  • 24d · Other expenses: MISCELLANEOUS OTHER EXPENSES

    total $24,519 · program services $23,300 · management and general $1,219

  • 24e · All other expenses

    total $0 · program services $0 · management and general $0 · fundraising $0

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $300 · end of year $300

  • 2 · Savings and temporary cash investments

    beginning of year $2,226,425 · end of year $3,161,502

  • 3 · Pledges and grants receivable

    beginning of year $0 · end of year $0

  • 4 · Accounts receivable

    beginning of year $1,510,572 · end of year $1,621,761

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 7 · Other notes and loans receivable

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $0 · end of year $0

  • 9 · Prepaid expenses and deferred charges

    beginning of year $114,941 · end of year $58,411

  • 10a · Land, buildings and equipment: cost or other basis

    $6,516,508

  • 10b · Land, buildings and equipment: accumulated depreciation

    $4,059,520

  • 10c · Land, buildings and equipment, net

    beginning of year $2,901,269 · end of year $2,456,988

  • 12 · Investments: other securities

    beginning of year $0

  • 13 · Investments: program-related

    beginning of year $0

  • 15 · Other assets

    beginning of year $25,934 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $581,678 · end of year $495,106

  • 19 · Deferred revenue

    beginning of year $247,122 · end of year $196,066

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $25,934 · end of year $0

  • 25 · Other liabilities

    beginning of year $4,817 · end of year $15,311

  • 27 · Net assets without donor restrictions

    beginning of year $5,919,890 · end of year $6,592,479

Mission and programs · 2022

Mission

SEE SCHEDULE O.

  • SEE SCHEDULE O.

    Expenses $6,850,822 · Grants $21,515 · Revenue $8,363,377

As filed on the 2022 return.

Listed in Part VII

  • Bryan Erdmann

    SECRETARY/TREASURER

    Total calculated
    $388,769
    From this org
    $0
    From related orgs
    $316,306
    Other
    $72,463
    Hours/week
    1 + 47.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $312,047 related
    Bonus
    $0
    Other
    $0 + $4,259 related
    Deferred
    $0 + $44,225 related
    Nontaxable benefits
    $0 + $28,238 related
    Filer's total
    $0 + $388,769 related

  • Michael McKee

    PRESIDENT

    Total calculated
    $338,716
    From this org
    $0
    From related orgs
    $270,756
    Other
    $67,960
    Hours/week
    1 + 47 related

    Schedule J breakdown matched by us

    Base
    $0 + $270,131 related
    Bonus
    $0
    Other
    $0 + $625 related
    Deferred
    $0 + $40,054 related
    Nontaxable benefits
    $0 + $27,906 related
    Filer's total
    $0 + $338,716 related

  • Michael Poellinger

    VICE PRESIDENT

    Total calculated
    $0
    Hours/week
    1 + 0.5 related

  • Kyle Bakkum

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 0.5 related

  • Michael Kittelson

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 0.5 related

  • Therese Binfet

    BOARD MEMBER

    Total calculated
    $209,562
    From this org
    $0
    From related orgs
    $163,779
    Other
    $45,783
    Hours/week
    1 + 40.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $162,354 related
    Bonus
    $0
    Other
    $0 + $1,425 related
    Deferred
    $0 + $24,049 related
    Nontaxable benefits
    $0 + $21,734 related
    Filer's total
    $0 + $209,562 related

  • Tom Tornstrom

    ADMINISTRATIVE DIRECTOR

    Total calculated
    $186,023
    From this org
    $0
    From related orgs
    $146,760
    Other
    $39,263
    Hours/week
    1 + 40.5 related

    Schedule J breakdown matched by us

    Base
    $0 + $145,795 related
    Bonus
    $0
    Other
    $0 + $965 related
    Deferred
    $0 + $21,537 related
    Nontaxable benefits
    $0 + $17,726 related
    Filer's total
    $0 + $186,023 related

  • Callie Revels

    OPERATIONS SUPERVISOR

    Total calculated
    $117,531
    From this org
    $104,790
    From related orgs
    $0
    Other
    $12,741
    Hours/week
    40

  • Gregg Bulman

    PARAMEDIC

    Total calculated
    $123,920
    From this org
    $93,815
    From related orgs
    $0
    Other
    $30,105
    Hours/week
    40

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 3 EXECUTIVE COMPENSATION
COMPENSATION FOR EXECUTIVES IS ESTABLISHED BY GUNDERSEN LUTHERAN HEALTH SYSTEM, INC., A RELATED PARTY. GUNDERSEN LUTHERAN HEALTH SYSTEM, INC. USED A COMPENSATION COMMITTEE, COMPENSATION SURVEY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION FOR EXECUTIVES.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • GUNDERSEN LUTHERAN ENVISION LLC

    C Corporation · RENEWABLE ENERGY · WI

    Directly controlled by GLHS

  • BEL-REGIONAL HOME MEDICAL INC

    C Corporation · DURABLE MEDICAL EQUIPMENT, RETAIL · WI

    Directly controlled by NA

  • BELLIN INVESTMENTS INC

    C Corporation · OTHER · WI

    Directly controlled by NA

Provenance

Return type
form_990
Tax year
2022
Filed
27 October 2023
IRS schema version
2022v5.0
Source object
202303009349300420

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