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        <TotalRevenueColumn>29673</TotalRevenueColumn>
        <UnrelatedBusinessRevenue>29673</UnrelatedBusinessRevenue>
      </OtherRevenueMisc>
      <TotalOtherRevenue>29673</TotalOtherRevenue>
      <TotalRevenue>
        <TotalRevenueColumn>33337378</TotalRevenueColumn>
        <RelatedOrExemptFunctionIncome>31564847</RelatedOrExemptFunctionIncome>
        <UnrelatedBusinessRevenue>29673</UnrelatedBusinessRevenue>
        <ExclusionAmount>7015</ExclusionAmount>
      </TotalRevenue>
      <InfoInScheduleOPartIX>X</InfoInScheduleOPartIX>
      <CompCurrentOfficersDirectors>
        <Total>702605</Total>
        <ProgramServices>305634</ProgramServices>
        <ManagementAndGeneral>396971</ManagementAndGeneral>
      </CompCurrentOfficersDirectors>
      <OtherSalariesAndWages>
        <Total>2602646</Total>
        <ProgramServices>1132151</ProgramServices>
        <ManagementAndGeneral>1470495</ManagementAndGeneral>
      </OtherSalariesAndWages>
      <PensionPlanContributions>
        <Total>228925</Total>
        <ProgramServices>99582</ProgramServices>
        <ManagementAndGeneral>129343</ManagementAndGeneral>
      </PensionPlanContributions>
      <OtherEmployeeBenefits>
        <Total>484011</Total>
        <ProgramServices>210545</ProgramServices>
        <ManagementAndGeneral>273466</ManagementAndGeneral>
      </OtherEmployeeBenefits>
      <PayrollTaxes>
        <Total>257814</Total>
        <ProgramServices>112149</ProgramServices>
        <ManagementAndGeneral>145665</ManagementAndGeneral>
      </PayrollTaxes>
      <FeesForServicesLegal>
        <Total>148549</Total>
        <ProgramServices>68927</ProgramServices>
        <ManagementAndGeneral>79622</ManagementAndGeneral>
      </FeesForServicesLegal>
      <FeesForServicesAccounting>
        <Total>95707</Total>
        <ProgramServices>44408</ProgramServices>
        <ManagementAndGeneral>51299</ManagementAndGeneral>
      </FeesForServicesAccounting>
      <FeesForServicesOther>
        <Total>174985</Total>
        <ProgramServices>81193</ProgramServices>
        <ManagementAndGeneral>93792</ManagementAndGeneral>
      </FeesForServicesOther>
      <OfficeExpenses>
        <Total>286705</Total>
        <ProgramServices>286705</ProgramServices>
      </OfficeExpenses>
      <Occupancy>
        <Total>172823</Total>
        <ProgramServices>172823</ProgramServices>
      </Occupancy>
      <Travel>
        <Total>168699</Total>
        <ProgramServices>168699</ProgramServices>
      </Travel>
      <Interest>
        <Total>504975</Total>
        <ProgramServices>504975</ProgramServices>
      </Interest>
      <DepreciationDepletion>
        <Total>2115444</Total>
        <ProgramServices>1882745</ProgramServices>
        <ManagementAndGeneral>232699</ManagementAndGeneral>
      </DepreciationDepletion>
      <OtherExpenses>
        <Description>CONTRACT MEDICAL SERVIC</Description>
        <Total>16651213</Total>
        <ProgramServices>16651213</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>AIRCRAFT AND VEHICLE LE</Description>
        <Total>2932714</Total>
        <ProgramServices>2932714</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>MEDICAL SUPPLIES</Description>
        <Total>1103595</Total>
        <ProgramServices>1103595</ProgramServices>
      </OtherExpenses>
      <OtherExpenses>
        <Description>AIRCRAFT &amp; VEHICLE MAIN</Description>
        <Total>1103162</Total>
        <ProgramServices>1103162</ProgramServices>
      </OtherExpenses>
      <AllOtherExpenses>
        <Total>3767488</Total>
        <ProgramServices>3767488</ProgramServices>
      </AllOtherExpenses>
      <TotalFunctionalExpenses>
        <Total>33502060</Total>
        <ProgramServices>30628708</ProgramServices>
        <ManagementAndGeneral>2873352</ManagementAndGeneral>
        <Fundraising>0</Fundraising>
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      <CashNonInterestBearing>
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        <EOY>850</EOY>
      </CashNonInterestBearing>
      <SavingsAndTempCashInvestments>
        <BOY>3840907</BOY>
        <EOY>2625547</EOY>
      </SavingsAndTempCashInvestments>
      <AccountsReceivable>
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        <EOY>15068190</EOY>
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      <PrepaidExpensesDeferredCharges>
        <BOY>183648</BOY>
        <EOY>555590</EOY>
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      <LandBuildingsEquipmentBasis>34653625</LandBuildingsEquipmentBasis>
      <LandBldgEquipmentAccumDeprec>18234625</LandBldgEquipmentAccumDeprec>
      <LandBuildingsEquipmentBasisNet>
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      </LandBuildingsEquipmentBasisNet>
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        <EOY>2825987</EOY>
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      <TotalAssets>
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        <EOY>37495164</EOY>
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      <AccountsPayableAccruedExpenses>
        <BOY>4659957</BOY>
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      <DeferredRevenue>
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        <EOY>163521</EOY>
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      <MortNotesPyblSecuredInvestProp>
        <BOY>9290268</BOY>
        <EOY>13731813</EOY>
      </MortNotesPyblSecuredInvestProp>
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        <BOY>753346</BOY>
        <EOY>2990936</EOY>
      </OtherLiabilities>
      <TotalLiabilities>
        <BOY>14848267</BOY>
        <EOY>19000706</EOY>
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      <FollowSFAS117>X</FollowSFAS117>
      <UnrestrictedNetAssets>
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        <EOY>18494458</EOY>
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      <TotalNetAssetsFundBalances>
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        <EOY>18494458</EOY>
      </TotalNetAssetsFundBalances>
      <TotalLiabNetAssetsFundBalances>
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        <EOY>37495164</EOY>
      </TotalLiabNetAssetsFundBalances>
      <ReconcilationRevenueExpenses>-164682</ReconcilationRevenueExpenses>
      <ReconcilationOtherChanges>0</ReconcilationOtherChanges>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>0</AccountantCompileOrReview>
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      <FSAuditedBasis>
        <FinancialStatementConsolidated>X</FinancialStatementConsolidated>
      </FSAuditedBasis>
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      <FederalGrantAuditRequired>1</FederalGrantAuditRequired>
      <FederalGrantAuditPerformed>1</FederalGrantAuditPerformed>
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        <CurrentTaxYearMinus1Year>226586</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>1735843</CurrentTaxYear>
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      <AmtsRecdFromDisqualPersons>
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      <AmtsFromSubstContributors>
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        <CurrentTaxYearMinus1Year>2839</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>6986</CurrentTaxYear>
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        <CurrentTaxYear>6986</CurrentTaxYear>
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        <CurrentTaxYearMinus1Year>-3122</CurrentTaxYearMinus1Year>
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        <CurrentTaxYearMinus3Years>29721940</CurrentTaxYearMinus3Years>
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        <CurrentTaxYearMinus1Year>30109845</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>32754766</CurrentTaxYear>
        <Total>153140290</Total>
      </TotalSupportTotal>
      <PublicSupportPercentage509>0.99920</PublicSupportPercentage509>
      <PriorYearSupportPercentage>0.99800</PriorYearSupportPercentage>
      <InvestmentIncomePercentage>0.00090</InvestmentIncomePercentage>
      <PriorYrInvestIncomePercentage>0.00220</PriorYrInvestIncomePercentage>
      <ThirtyThreePercntTestsCY509>X</ThirtyThreePercntTestsCY509>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInfo>
        <ContributorNumber>RESTRICTED</ContributorNumber>
        <ContributorNameBusiness>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorNameBusiness>
        <ContributorAddressUS>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorAddressUS>
        <AggregateContributions>RESTRICTED</AggregateContributions>
      </ContributorInfo>
    </IRS990ScheduleB>
    <IRS990ScheduleC documentId="RetDoc1039700001">
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      <PaidStaffOrManagement>0</PaidStaffOrManagement>
      <MediaAdvertisements>0</MediaAdvertisements>
      <MailingsMembers>0</MailingsMembers>
      <PublicationsOrBroadcast>0</PublicationsOrBroadcast>
      <GrantsOtherOrganizations>0</GrantsOtherOrganizations>
      <DirectContactLegislators>1</DirectContactLegislators>
      <DirectContactLegislatorsAmount>14438</DirectContactLegislatorsAmount>
      <RalliesDemonstrations>0</RalliesDemonstrations>
      <OtherActivities>0</OtherActivities>
      <TotalLobbyingExpendituresIIB>14438</TotalLobbyingExpendituresIIB>
      <NotDescribedIn501c3>0</NotDescribedIn501c3>
      <Form990ScheduleCPartIV>
        <Identifier>EXPLANATION OF LOBBYING ACTIVITIES:</Identifier>
        <ReturnReference>PART II-B, LINE 1:</ReturnReference>
        <Explanation>ACTIVITIES CONDUCTED DURING PERIOD INCLUDED ADVICE AND COUNSEL ON LOCAL, REGIONAL AND STATE ISSUES INVOLVING THE OPERATION OF REMSA AND ASSISTANCE IN THE DEVELOPMENT OF STRATEGIES ADVANCING REMSA'S INTEREST IN THESE AREAS. ALSO MONITORING OF ACTIVITIES DURING BIENNIAL LEGISLATIVE SESSION.</Explanation>
      </Form990ScheduleCPartIV>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
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        <BookValue>1821106</BookValue>
      </Land>
      <Buildings>
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        <Depreciation>1053532</Depreciation>
        <BookValue>6711088</BookValue>
      </Buildings>
      <Equipment>
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        <BookValue>7471323</BookValue>
      </Equipment>
      <OtherLandBuildings>
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        <Depreciation>1790424</Depreciation>
        <BookValue>415483</BookValue>
      </OtherLandBuildings>
      <TotalOfBookValueLandBuildings>16419000</TotalOfBookValueLandBuildings>
      <OtherAssets>
        <Description>DEPOSITS</Description>
        <BookValue>947950</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>CONSTRUCTION IN PROGRESS</Description>
        <BookValue>512399</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>INVESTMENT IN REGIONAL AMBULANCE SERVICES, INC</Description>
        <BookValue>1363765</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>MISCELLANEOUS</Description>
        <BookValue>1873</BookValue>
      </OtherAssets>
      <TotalBookValueOtherAssets>2825987</TotalBookValueOtherAssets>
      <OtherLiabilities>
        <Description>DUE TO SIERRA MEDICAL SERVICE ALLIANCE</Description>
        <Amount>266882</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>DUE TO REGIONAL AMBULANCE SERVICES INC</Description>
        <Amount>2724054</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>2990936</TotalOfAmounts>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="RetDoc1041300001">
      <EventsInformation>
        <NameOfEvent1>GOLF TOURNAMENT</NameOfEvent1>
        <GrossReceiptsEvent1>17029</GrossReceiptsEvent1>
        <CharitableContributionsEvent1>12943</CharitableContributionsEvent1>
        <GrossRevenueEvent1>4086</GrossRevenueEvent1>
        <OtherDirectExpensesEvent1>10209</OtherDirectExpensesEvent1>
        <NameOfEvent2>CARE FLIGHT HELICOPTER FUNDRAISER</NameOfEvent2>
        <GrossReceiptsEvent2>12150</GrossReceiptsEvent2>
        <GrossRevenueEvent2>12150</GrossRevenueEvent2>
        <OtherDirectExpensesEvent2>5998</OtherDirectExpensesEvent2>
        <GrossReceiptsTotal>29179</GrossReceiptsTotal>
        <CharitableContributionsTotal>12943</CharitableContributionsTotal>
        <GrossRevenueTotalEvents>16236</GrossRevenueTotalEvents>
        <OtherDirectExpensesTotalEvents>16207</OtherDirectExpensesTotalEvents>
        <DirectExpenseSummaryEvents>16207</DirectExpenseSummaryEvents>
        <NetIncomeSummary>29</NetIncomeSummary>
      </EventsInformation>
    </IRS990ScheduleG>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
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      <SeverancePayment>0</SeverancePayment>
      <SupplementalNonqualRetirePlan>0</SupplementalNonqualRetirePlan>
      <EquityBasedCompArrangement>0</EquityBasedCompArrangement>
      <CompBasedOnRevenueOfFilingOrg>0</CompBasedOnRevenueOfFilingOrg>
      <CompBasedOnRevenueRelatedOrgs>0</CompBasedOnRevenueRelatedOrgs>
      <CompBasedNetEarningsFilingOrg>0</CompBasedNetEarningsFilingOrg>
      <CompBasedNetEarningsRelateOrgs>0</CompBasedNetEarningsRelateOrgs>
      <AnyNonFixedPayments>0</AnyNonFixedPayments>
      <InitialContractException>0</InitialContractException>
      <Form990ScheduleJPartII>
        <NamePerson>JAMES GUBBELS - REMSA</NamePerson>
        <Title>PRESIDENT</Title>
        <BaseCompensationFilingOrg>193741</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>7500</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>35923</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>237164</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>KLARK STAFFAN</NamePerson>
        <Title>CAO</Title>
        <BaseCompensationFilingOrg>153827</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>5300</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>25660</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
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        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>JOSEPH L RYAN</NamePerson>
        <Title>MEDICAL DIRECTOR</Title>
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        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
        <NontaxableBenefitsFilingOrg>37879</NontaxableBenefitsFilingOrg>
        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>251442</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>NANCY L TOY</NamePerson>
        <Title>GRANT FINANCE OFFICER</Title>
        <BaseCompensationFilingOrg>126921</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>3250</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
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        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>153050</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
      <Form990ScheduleJPartII>
        <NamePerson>PATRICK SMITH</NamePerson>
        <Title>FORMER PRESIDENT/RETIRED</Title>
        <BaseCompensationFilingOrg>332153</BaseCompensationFilingOrg>
        <CompBasedOnRelatedOrgs>0</CompBasedOnRelatedOrgs>
        <BonusFilingOrg>9500</BonusFilingOrg>
        <BonusRelatedOrgs>0</BonusRelatedOrgs>
        <OtherCompensationFilingOrg>0</OtherCompensationFilingOrg>
        <OtherCompensationRelatedOrgs>0</OtherCompensationRelatedOrgs>
        <DeferredCompFilingOrg>0</DeferredCompFilingOrg>
        <DeferredCompRelatedOrgs>0</DeferredCompRelatedOrgs>
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        <NontaxableBenefitsRelatedOrgs>0</NontaxableBenefitsRelatedOrgs>
        <TotalCompensationFilingOrg>380612</TotalCompensationFilingOrg>
        <TotalCompensationRelatedOrgs>0</TotalCompensationRelatedOrgs>
        <CompReportPrior990FilingOrg>0</CompReportPrior990FilingOrg>
        <CompReportPrior990RelatedOrgs>0</CompReportPrior990RelatedOrgs>
      </Form990ScheduleJPartII>
    </IRS990ScheduleJ>
    <IRS990ScheduleL documentId="RetDoc1042800001">
      <Form990ScheduleLPartIV>
        <NameOfInterestedPerson>
          <NamePerson>J RICHARD BARNARD</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>REMSA OBTAINS SERVICES FROM A FIRM THAT EMPLOYS PAST CHAIRMAN MR. BARNARD.</Relationship>
        <AmountOfTransaction>51525</AmountOfTransaction>
        <DescriptionOfTransaction>REMSA OBTAINS PROFESSIONAL ACCOUNTING AND CONSULTING SERVICES FROM THE FIRM BARNARD VOGLER &amp; CO CPA'S. THE PAST CHAIRMAN OF REMSA'S BOARD, J. RICHARD BARNARD, IS AN EMPLOYEE OF THE FIRM.</DescriptionOfTransaction>
        <SharingOfRevenues>0</SharingOfRevenues>
      </Form990ScheduleLPartIV>
    </IRS990ScheduleL>
    <IRS990ScheduleM documentId="RetDoc1042900001">
      <CarsAndOtherVehicles>
        <NonCashCheckbox>X</NonCashCheckbox>
        <NumberOfContributions>1</NumberOfContributions>
        <NoncashContribsRptdF990>107000</NoncashContribsRptdF990>
        <MethodOfDeterminingRevenues>DONOR PROVIDED FMV</MethodOfDeterminingRevenues>
      </CarsAndOtherVehicles>
      <AnyPropertyThatMustBeHeld>0</AnyPropertyThatMustBeHeld>
      <ReviewProcessUnusualNCGifts>0</ReviewProcessUnusualNCGifts>
      <ThirdPartiesUsed>0</ThirdPartiesUsed>
    </IRS990ScheduleM>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <GeneralExplanation>
        <Identifier>NEW PROGRAM SERVICES</Identifier>
        <ReturnReference>FORM 990, PART III, LINE 2</ReturnReference>
        <Explanation>DUE TO A FEDERAL GRANT RECEIVED, THE NEW PROGRAM ALLOWS REMSA TO CREATE NEW CARE AND REFERRAL PATHWAYS TO ENSURE PATIENTS ENTERING THE EMERGENCY MEDICAL SERVICES SYSTEM RECEIVE THE SAFEST, MOST APPROPRIATE LEVEL OF QUALITY CARE.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 11</ReturnReference>
        <Explanation>THE 990 IS REVIEWED BY THE CEO AND CFO PRIOR TO BEING FILED. AT THIS TIME, THE 990 IS NOT REVIEWED BY THE BOARD.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 12C</ReturnReference>
        <Explanation>MANAGEMENT REGULARLY REVIEWS ANY ISSUES THAT ARISE UNDER THE CONFLICT OF INTEREST POLICY.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 15</ReturnReference>
        <Explanation>COMPENSATION FOR THE CEO IS APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. ALL OTHER SALARIES ARE REVIEWED BY THE BOARD ANNUALLY AS PART OF THE BUDGET APPROVAL PROCESS.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 18</ReturnReference>
        <Explanation>REMSA'S 990 IS LOCATED ON GUIDESTAR AS WELL AS MADE AVAILABLE UPON REQUEST.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 19</ReturnReference>
        <Explanation>REMSA'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>ALL OTHER FUNCTIONAL EXPENSES</Identifier>
        <ReturnReference>FORM 990, PART IX, LINE 24E</ReturnReference>
        <Explanation>AIRCRAFT AND VEHICLE FUEL: PROGRAM SERVICE EXPENSES 980,338. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 980,338. EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 604,284. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 604,284. INSURANCE: PROGRAM SERVICE EXPENSES 575,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 575,993. TELEPHONE: PROGRAM SERVICE EXPENSES 310,105. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 310,105. EDUCATION: PROGRAM SERVICE EXPENSES 216,367. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 216,367. FACILITY MAINT./JANITORIAL: PROGRAM SERVICE EXPENSES 199,141. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 199,141. UTILITIES: PROGRAM SERVICE EXPENSES 174,876. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,876. AIRCRAFT FLIGHT TIME: PROGRAM SERVICE EXPENSES 158,614. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 158,614. EMPLOYEE UNIFORMS: PROGRAM SERVICE EXPENSES 138,006. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,006. PUBLIC RELATIONS: PROGRAM SERVICE EXPENSES 133,111. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,111. POSTAGE AND PRINTING: PROGRAM SERVICE EXPENSES 130,265. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 130,265. CHILD SAFETY SEAT PROGRAM: PROGRAM SERVICE EXPENSES 97,060. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,060. TAXES/LICENSES/FEES: PROGRAM SERVICE EXPENSES 85,368. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 85,368. LDT COORDINATION SERVICES: PROGRAM SERVICE EXPENSES 67,896. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,896. MEALS AND ENTERTAINMENT: PROGRAM SERVICE EXPENSES 41,592. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,592. EMPLOYEE WELFARE: PROGRAM SERVICE EXPENSES 39,143. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,143. SILVER SAVER SUBSCRIPTION: PROGRAM SERVICE EXPENSES 38,187. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,187. COLLECTION: PROGRAM SERVICE EXPENSES 34,925. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,925. DUES/SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 31,581. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,581. AIRCRAFT/MISC.: PROGRAM SERVICE EXPENSES 7,772. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,772. RECRUITING: PROGRAM SERVICE EXPENSES 1,718. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,718. COST REIMBURSEMENT FROM RELATED PARTIES: PROGRAM SERVICE EXPENSES -298,854. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -298,854.</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>SIERRA MEDICAL SERVICES ALLIANCE</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>450 EDISON WAY</AddressLine1>
          <City>RENO</City>
          <State>NV</State>
          <ZIPCode>89502</ZIPCode>
        </AddressUS>
        <EIN>680459931</EIN>
        <PrimaryActivities>SEMSA IS AN INDEPENDENT, NONPROFIT ORG THAT EXPANDS HEALTHCARE SERVICES</PrimaryActivities>
        <LegalDomicileState>NV</LegalDomicileState>
        <PublicCharityStatus>509(A)(2) 33 1/3%</PublicCharityStatus>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartIV>
        <NameOfRelatedOrg>
          <BusinessNameLine1>REGIONAL AMBULANCE SERVICES INC</BusinessNameLine1>
        </NameOfRelatedOrg>
        <AddressUS>
          <AddressLine1>450 EDISON WAY</AddressLine1>
          <City>RENO</City>
          <State>NV</State>
          <ZIPCode>89502</ZIPCode>
        </AddressUS>
        <EIN>880355913</EIN>
        <PrimaryActivity>PROVIDES EMPLOYEE SERVICES TO REMSA</PrimaryActivity>
        <LegalDomicileState>NV</LegalDomicileState>
        <TypeOfEntity>C</TypeOfEntity>
        <ShareOfTotalIncome>18695269</ShareOfTotalIncome>
        <ShareOfEOYAssets>3916043</ShareOfEOYAssets>
        <PercentageOwnership>1.00000</PercentageOwnership>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartIV>
      <ReceiptOfIntAnnRentsRoyalties>0</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>0</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>0</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>0</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>0</LoansOrGuaranteesFromOtherOrg>
      <DividendsRelatedOrganization>0</DividendsRelatedOrganization>
      <SaleOfAssetsToOtherOrg>0</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>0</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>0</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>0</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>0</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>0</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>0</SharingOfFacilities>
      <SharingOfPaidEmployees>0</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>0</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>0</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>0</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>0</OtherTransferFromOtherOrg>
    </IRS990ScheduleR>
  </ReturnData>
</Return>