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        <RelatedOrExemptFuncIncomeAmt>8087121</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>317529</ExclusionAmt>
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      <CompCurrentOfcrDirectorsGrp>
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        <ProgramServicesAmt>98704</ProgramServicesAmt>
        <ManagementAndGeneralAmt>308721</ManagementAndGeneralAmt>
        <FundraisingAmt>10967</FundraisingAmt>
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      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>4153462</ProgramServicesAmt>
        <ManagementAndGeneralAmt>419197</ManagementAndGeneralAmt>
        <FundraisingAmt>15094</FundraisingAmt>
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      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>167878</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15853</ManagementAndGeneralAmt>
        <FundraisingAmt>524</FundraisingAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>267397</ProgramServicesAmt>
        <ManagementAndGeneralAmt>12203</ManagementAndGeneralAmt>
        <FundraisingAmt>520</FundraisingAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>392755</TotalAmt>
        <ProgramServicesAmt>336534</ProgramServicesAmt>
        <ManagementAndGeneralAmt>54275</ManagementAndGeneralAmt>
        <FundraisingAmt>1946</FundraisingAmt>
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      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>1884</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>59655</TotalAmt>
        <ManagementAndGeneralAmt>59655</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>209101</TotalAmt>
        <ProgramServicesAmt>50400</ProgramServicesAmt>
        <ManagementAndGeneralAmt>158701</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
        <TotalAmt>141224</TotalAmt>
        <ProgramServicesAmt>32512</ProgramServicesAmt>
        <ManagementAndGeneralAmt>94952</ManagementAndGeneralAmt>
        <FundraisingAmt>13760</FundraisingAmt>
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      <InformationTechnologyGrp>
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        <ProgramServicesAmt>122235</ProgramServicesAmt>
        <ManagementAndGeneralAmt>80422</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>55207</TotalAmt>
        <ProgramServicesAmt>50886</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4321</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>68420</TotalAmt>
        <ProgramServicesAmt>68420</ProgramServicesAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>12614</TotalAmt>
        <ManagementAndGeneralAmt>12614</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>614661</TotalAmt>
        <ProgramServicesAmt>553195</ProgramServicesAmt>
        <ManagementAndGeneralAmt>61466</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>277349</TotalAmt>
        <ProgramServicesAmt>185037</ProgramServicesAmt>
        <ManagementAndGeneralAmt>92010</ManagementAndGeneralAmt>
        <FundraisingAmt>302</FundraisingAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Vehicle Expense</Desc>
        <TotalAmt>337536</TotalAmt>
        <ProgramServicesAmt>337536</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>283590</TotalAmt>
        <ProgramServicesAmt>283590</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Building and Grounds</Desc>
        <TotalAmt>242182</TotalAmt>
        <ProgramServicesAmt>234620</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7562</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Uniforms</Desc>
        <TotalAmt>37452</TotalAmt>
        <ProgramServicesAmt>37452</ProgramServicesAmt>
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      <AllOtherExpensesGrp>
        <TotalAmt>45872</TotalAmt>
        <ProgramServicesAmt>18340</ProgramServicesAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>6998198</ProgramServicesAmt>
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        <FundraisingAmt>43113</FundraisingAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>519781</EOYAmt>
      </CashNonInterestBearingGrp>
      <LandBldgEquipCostOrOtherBssAmt>7960068</LandBldgEquipCostOrOtherBssAmt>
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      <LandBldgEquipBasisNetGrp>
        <BOYAmt>3741502</BOYAmt>
        <EOYAmt>4252557</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>5723555</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>9143899</BOYAmt>
        <EOYAmt>10495893</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>70045</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
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        <EOYAmt>448437</EOYAmt>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>518482</EOYAmt>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>8627760</BOYAmt>
        <EOYAmt>9977411</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>8627760</BOYAmt>
        <EOYAmt>9977411</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>9143899</BOYAmt>
        <EOYAmt>10495893</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>1206772</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>142879</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingOtherInd methodOfAccountingOtherDesc="Modified Cash">X</MethodOfAccountingOtherInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
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    <IRS990ScheduleA documentId="RetDoc1039100001">
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      <GiftsGrantsContrisRcvd509Grp>
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        <CurrentTaxYearMinus3YearsAmt>946419</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>487513</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>438947</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>133624</CurrentTaxYearAmt>
        <TotalAmt>3472236</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
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        <CurrentTaxYearMinus3YearsAmt>5534080</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>6641713</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>6716564</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>8069220</CurrentTaxYearAmt>
        <TotalAmt>31773388</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <TaxRevLeviedOrgnztnlBnft509Grp>
        <CurrentTaxYearMinus4YearsAmt>962018</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>1020905</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>1027904</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1142265</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1121177</CurrentTaxYearAmt>
        <TotalAmt>5274269</TotalAmt>
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      <Total509Grp>
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        <CurrentTaxYearMinus3YearsAmt>7501404</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>8157130</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>8297776</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>9324021</CurrentTaxYearAmt>
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      <AmountsRcvdDsqlfyPersonGrp>
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      <SubstantialContributorsAmtGrp>
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      </SubstantialContributorsAmtGrp>
      <SubstAndDsqlfyPrsnsTotGrp>
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      <PublicSupportTotal509Amt>40519893</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
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      <InvestmentIncomeAndUBTIGrp>
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      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
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      <TotalSupportCalendarYearGrp>
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      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12, Explanation of Other Income:</FormAndLineReferenceDesc>
        <ExplanationTxt>Other Income</ExplanationTxt>
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    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
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        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
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        <BookValueAmt>181142</BookValueAmt>
      </LandGrp>
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      <OtherLandBuildingsGrp>
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      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>4252557</TotalBookValueLandBuildingsAmt>
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      <NetUnrealizedGainsInvstAmt>142879</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>142879</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>9659451</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>9659451</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>8452679</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>8452679</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>8452679</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
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      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Francis Manzo</PersonNm>
        <TitleTxt>CEO/Chief</TitleTxt>
        <BaseCompensationFilingOrgAmt>158244</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>30021</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>219341</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Heather Lenhardt</PersonNm>
        <TitleTxt>Chief Financial Officer</TitleTxt>
        <BaseCompensationFilingOrgAmt>142579</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>27609</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
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        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Gabrielle Hergert - Director of</PersonNm>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>24270</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>6969</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14385</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>158538</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>There are no other committees that can act on behalf of the board.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The CFO reviews the 990 and presents it to the Chief and Treasurer who then presents it to the Board of Directors at which time the Board resolves any and all open issues and gives their approval to file.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board annually reviews conflict of interest questionnaires completed by the Board members, employees, and volunteers and addresses any conflicts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board annually reviews compensation packages and compares them to packages awarded at ambulance services of similar size and demographics. Final compensation packages are voted on by the Board.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>All policies, financial statements, and governing documents are available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>