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        <ManagementAndGeneral>38287</ManagementAndGeneral>
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        <ManagementAndGeneral>14305</ManagementAndGeneral>
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        <ProgramServices>257618</ProgramServices>
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      <Occupancy>
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        <ProgramServices>386080</ProgramServices>
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        <ProgramServices>2329</ProgramServices>
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      <Interest>
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        <ProgramServices>474685</ProgramServices>
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      <OtherExpenses>
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      <OtherExpenses>
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        <ProgramServices>592904</ProgramServices>
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        <ContributorNameBusiness>
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          <AddressLine2>RESTRICTED</AddressLine2>
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          <State>RESTRICTED</State>
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      <DirectContactLegislators>1</DirectContactLegislators>
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        <BookValue>23634</BookValue>
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      <OtherAssets>
        <Description>CONSTRUCTION IN PROGRESS</Description>
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      <OtherAssets>
        <Description>RESTRICTED CASH FOR DEFERRED COMPENSATION</Description>
        <BookValue>702980</BookValue>
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      <OtherAssets>
        <Description>INVESTMENT IN REGIONAL AMBULANCE SERVICES, INC</Description>
        <BookValue>1119241</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>DUE FROM SIERRA MEDICAL SERVICES ALLIANCE</Description>
        <BookValue>430514</BookValue>
      </OtherAssets>
      <OtherAssets>
        <Description>DUE FROM REGIONAL AMBULANCE SERVICES, INC.</Description>
        <BookValue>138129</BookValue>
      </OtherAssets>
      <OtherAssets>
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      <TotalBookValueOtherAssets>2440047</TotalBookValueOtherAssets>
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        <Description>DEFERRED COMPENSATION</Description>
        <Amount>702979</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>DUE TO REGIONAL AMBULANCE SERVICES, INC.</Description>
        <Amount>2337373</Amount>
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      <OtherLiabilities>
        <Description>DUE TO SIERRA MEDICAL SERVICE ALLIANCE</Description>
        <Amount>33500</Amount>
      </OtherLiabilities>
      <OtherLiabilities>
        <Description>DUE TO MED-EXPRESS TRANSPORT, INC</Description>
        <Amount>79966</Amount>
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      <InitialContractException>0</InitialContractException>
      <Form990ScheduleJPartII>
        <NamePerson>PATRICK SMITH - REMSA</NamePerson>
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        <BonusFilingOrg>19000</BonusFilingOrg>
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        <NameOfInterestedPerson>
          <NamePerson>J RICHARD BARNARD</NamePerson>
        </NameOfInterestedPerson>
        <Relationship>REMSA OBTAINS SERVICES FROM A FIRM THAT EMPLOYS CHAIRMAN J. RICHARD BARNARD</Relationship>
        <AmountOfTransaction>43826</AmountOfTransaction>
        <DescriptionOfTransaction>REMSA OBTAINS PROFESSIONAL ACCOUNTING AND CONSULTING SERVICES FROM THE FIRM BARNARD VOGLER &amp; CO CPA'S. THE CHAIRMAN OF REMSA'S BOARD, J. RICHARD BARNARD, IS AN EMPLOYEE OF THE FIRM.</DescriptionOfTransaction>
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    </IRS990ScheduleL>
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      <GeneralExplanation>
        <Identifier>FORM 990, PART VI, SECTION B, LINE 11</Identifier>
        <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, TOP MANAGEMENT AND OTHER KEY EMPLOYEES IS REVIEWED BY THE BOARD ANNUALLY WITH THE APPROVAL OF THE BUDGET.</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>
    </IRS990ScheduleO>
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        </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>
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        </NameOfRelatedOrg>
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          <City>RENO</City>
          <State>NV</State>
          <ZIPCode>89502</ZIPCode>
        </AddressUS>
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        <PrimaryActivity>PROVIDES EMPLOYEE SERVICES TO REMSA</PrimaryActivity>
        <LegalDomicileState>NV</LegalDomicileState>
        <TypeOfEntity>C</TypeOfEntity>
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        <ShareOfEOYAssets>2531219</ShareOfEOYAssets>
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    </IRS990ScheduleR>
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</Return>