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          <StateAbbreviationCd>CO</StateAbbreviationCd>
          <ZIPCd>80301</ZIPCd>
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      <ForeignOfficeInd>false</ForeignOfficeInd>
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      <OperateHospitalInd>false</OperateHospitalInd>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Description of other expenses Part I line 16</FormAndLineReferenceDesc>
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