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Case No.: 2019-EMS-T0004-DHS
(EMS No. 01116, 01117, 01118, 01119, 01120, 01121, 01123, 01125, 01127, 01128, 01129, 01130)


In the Matter of: Envision Healthcare Holdings, Inc., AMR HoldCo, Inc., American Medical Response (AMR) Proposed Transferor Global Medical
Response, Inc. Proposed
Transferee Joint Applicants PURSUANT TO applications filed on September 26, 2017,
Envision Healthcare Holdings, Inc., AMR HoldCo, Inc., Ranch Merger Sub, Inc., American Medical Response ("AMR" or "Proposed Transferor"), the holder of Certificates of
Necessity ("C.O.N.") Nos 54, 55, 58, 62, 63, 65, 71, 85, 87, 94, 109 and 136 (collectively, "the AMR C.O.N.s") proposes to transfer the A.M.R. C.O.N.s to Global Medical Response, Inc.
*("Global Medical" or
"Proposed Transferee"). PURSUANT TO A.R.S. §§ 36-2232(A)(4), 36-2236(B), and 36-2234(C), the Director of the
Arizona Department of Health Services ("Director") must approve requests to transfer a C.O.N. before such transfers may occur and may waive the hearing required by A.R.S. § 36-2234(A) for such actions. *The Transferee was originally identified as Air Medical Group Holdings, Inc., but on March 14, 2018, Envision Healthcare Corporation divested its interest in all Arizona AMR subsidiaries to Global Medical Response, Inc. Global Medical Response, Inc. (formerly Air Medical Group Holdings, Inc.) changed its name on the closing date to serve as the parent company of all Arizona AMR subsidiaries.
The Department, acting through the Bureau of Emergency Medical Services and Trauma Systems ("BEMSTS" or "Bureau"), is the agency within the State of Arizona empowered to
administer a statewide system of emergency medical services, which includes the certification and regulation of all levels of emergency medical care technicians and the certification and regulation of ambulance services in Arizona. The Department's authority to consider an application for transfer of a
C.O.N. is established under
A.R.S. Title 36, Chapter 21.1,
Article 2, specifically A.R.S.
§ 36-2236(B). That statute
requires the Director's written approval prior to any assignment or transfer of a C.O.N. Further, A.A.C. R9-25-901(49)(a) defines a "transfer" as "a change of ownership" or type of business entity." A.A.C. R9-25-901(9)(b) and (c) defines a "change of ownership" as the sale or transfer of "20% or more of the stock, interest, or beneficial interest," or when the "controlling influence changes to the extent that the
management and control of the ground ambulance service is significantly altered." Because the parties propose a transfer of the controlling interests in the ground ambulance companies that currently hold the AMR C.O.N.s the proposed change in ownership and controlling influence over these ground ambulance companies has been significantly altered, thereby triggering the Department's approval process. Finally, A.A.C. R9-25-902(C) is proposed.
At the successful conclusion of the proposed transfer/change of ownership, Global Medical, will own 100% interest in the AMR C.O.N.s: Southwest
Ambulance of Tucson dba Kord's Southwest dba American Medical Response dba AMR (C.O.N. 54); Rural Metro Corporation (Pima) (C.O.N. 55); R/M Arizona Holdings, Inc. dba Canyon State Ambulance dba Payson Medical Transport dba Lifestar EMS dba Life Line Ambulance (C.O.N. 58); Life Line
Ambulance Service, Inc. (C.O.N. 62); Southwest Ambulance of Southeastern Arizona, Inc. dba Southwest Ambulance of Safford dba Life Line Ambulance,
(C.O.N. 63); Rural Metro Corporation (Yuma) dba Rural Metro Ambulance Service (C.O.N. 65); Professional Medical Transport, Inc. dba PMT Ambulance dba Life Line Ambulance, (C.O.N. 71); Southwest Ambulance of Casa Grande, Inc. dba American Medical Response dba AMR (C.O.N. 85); Rural Metro
Corporation (Pinal) dba Tri-City Med dba Life Line Ambulance
(C.O.N. 87); River Medical, Inc. dba Life Line Ambulance
(C.O.N. 94); Rural Metro
Corporation (Maricopa) dba
Rural/Metro Ambulance
Service dba Arizona Medical Transport dba AMT (C.O.N. 109); and American Medical
Response of Maricopa, LLC
(C.O.N. 136). No other changes to any terms of the C.O.N.s have been requested at this time. The names on each C.O.N. will be unaffected by the transfer and will remain the same. THE DIRECTOR GIVES NOTICE that unless a written request for hearing regarding this application is received by the Clerk of the Department, Office of Administrative Counsel and Rules, Arizona Department of Health Services, 150 N. 18th Ave., Suite 200, Phoenix, Arizona 85007, by 5:00 p.m. August 27, 2018, the Director may approve the transfer of the AMR C.O.N.s based on the following information.
1. The Proposed Transferor
and the Proposed
Transferee have submitted
the necessary information
and have met the
application requirements of
A.A.C. R9-25-902.
2. If the transfer is approved,
the Proposed Transferee has
agreed to and would be
required to:
a. Maintain existing political
subdivision contracts;
b. Maintain existing C.O.N.
rates and charges;
c. Maintain key operational
d. Maintain Premier EMS
Agency Status;
e. Continue attending local,
regional, and state EMS
f. Continue reporting
response time performance
by political subdivision for
each CON on a bi-annual
g. Continue reporting accounts
receivable and collections
information for each C.O.N.
on a bi-annual basis;
h. Continue participating in
time-sensitive illness and
injury initiatives sponsored
by the Department such as
the SHARE Program;
i. Continue reporting annual
financials for each of the AMR
C.O.N.s separately and for
Global Medical as a whole.
3. C.O.N. 54 is valid through July
13, 2021; C.O.N. 55 is
valid through July 31, 2019;
C.O.N. 58 is valid through
May 31, 2019;
C.O.N. 62 is valid through
September 30, 2019; C.O.N.
63 is valid through August 31,
2019; C.O.N. 65 is valid
through November 30, 2018;
C.O.N. 71 is valid through
October 31, 2018; C.O.N. 85
is valid through April 30,
2021; C.O.N. 87 is valid
through July 31, 2021; C.O.N.
94 is valid through July 31,
2019; C.O.N. 109 is valid
through November 30, 2018;
and C.O.N. 136 is valid
through February 25, 2019.
4. No other changes to any
terms under the AMR
C.O.N.s have been requested.
5. Details of the Applicant's
request for the changes
stated above are open to the
public and are contained in
its application on file with
the Clerk of the Department,
Arizona Department of
Health Services, 150 N. 18th
Ave., Suite 200, Phoenix,
Arizona 85007.

Dated this 24th day of July, 2018

Laura Flores
Director's Designee

Publish August 14 & 21, 2018
Arizona Daily Star
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