To Our Shareholders

Our Commitment To Growth

Since its inception, EMSC has been a leader in the healthcare services industry. While 2009 was a year of uncertainty for many healthcare companies, we continued to grow and expand our presence in the healthcare market by staying committed to our principles and business plans. We expanded our facility-based physician services in emergency care, radiology, inpatient services, and our newest specialty, anesthesiology. We grew our managed transportation services by adding a host of new payors, providers, and patients. At the same time, across the enterprise we improved operational efficiency, resulting in improved profitability and enhanced patient care.

Our Commitment To Caregivers And Patients

We take this commitment very seriously: providing our physicians, nurses, paramedics, and EMTs with the resources necessary so they can focus on quality care for every patient with the individual attention each needs and deserves. This commitment to quality medical care and excellent service made a difference in the lives of our patients and their families 13 million times in 2009. Every 2.4 seconds an EMSC caregiver provided care to a patient in need -- from a routine diagnosis to a life-saving intervention.

Our Commitment To Performance

Our commitment to improved operational and financial performance resulted in an increase in Adjusted EBITDA of 16 percent, a diluted earnings per share improvement of 34 percent and an increase in our stock price of 48 percent. We also expanded our stockholder base through two equity offerings, creating greater stability and attracting new investors.

Our Commitment To The Future

Uncertainty about the nation’s economy and healthcare reform legislation is expected to remain in the near future. However, we believe our unique position combined with our expertise in providing our services will continue to position us as an attractive partner to our customer base of communities, healthcare facilities, and insurance companies.

We have never lost sight of the commitments necessary to be successful. We will carry those commitments into the new year and take the actions necessary to honor those commitments, one patient at a time.

Sincerely,

William A. Sanger
Chairman, President and Chief Executive Officer