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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
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        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JUNE CASTLE</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>BASIL ARIGLIO</PersonNm>
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        <AverageHoursPerWeekRltdOrgRt>14.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>255556</ReportableCompFromRltdOrgAmt>
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        <PersonNm>MARY KATE ROLF</PersonNm>
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        <PersonNm>ANDREA LAZAREK-LAQUAY</PersonNm>
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        <PersonNm>CHERYL MANNA</PersonNm>
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        <PersonNm>JOSEPH TWARDY</PersonNm>
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        <PersonNm>DR JOEL AMIDON</PersonNm>
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        <PersonNm>JANET BILLINGTON</PersonNm>
        <TitleTxt>CCO/EVP BUSINESS OPTIMIZ</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JESSICA NELSON</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>RYAN BLEHAR</PersonNm>
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        <PersonNm>JOSEPH CHEVRETTE</PersonNm>
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        <PersonNm>AMANDA FREDERICK</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <ContractorCompensationGrp>
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          <BusinessName>
            <BusinessNameLine1Txt>THE HAYNER HOYT CORPORATION</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>625 ERIE BLVD WEST</AddressLine1Txt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
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        <ContractorAddress>
          <USAddress>
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        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>VNA OF WNY</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>ELIXIR RX SOLUTIONS LLC</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>TERACAI</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>400 S SALINA ST</AddressLine1Txt>
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      <AllOtherContributionsAmt>360000</AllOtherContributionsAmt>
      <TotalContributionsAmt>1013778</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PREMIUM &amp; MEDICAID EXCESS REVENUE</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>188964754</TotalRevenueColumnAmt>
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      <ProgramServiceRevenueGrp>
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        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>10931256</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10931256</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
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        <BusinessCd>623000</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>247349</RelatedOrExemptFuncIncomeAmt>
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        <RelatedOrExemptFuncIncomeAmt>58720</RelatedOrExemptFuncIncomeAmt>
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        <ExclusionAmt>169234</ExclusionAmt>
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        <BusinessCd>900099</BusinessCd>
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      <OtherRevenueMiscGrp>
        <Desc>VNA OF WCNY WITHHOLD</Desc>
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        <RelatedOrExemptFuncIncomeAmt>140304</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueMiscGrp>
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        <RelatedOrExemptFuncIncomeAmt>11607</RelatedOrExemptFuncIncomeAmt>
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      <MiscellaneousRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>93055</RelatedOrExemptFuncIncomeAmt>
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        <ManagementAndGeneralAmt>384905</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>148532892</ProgramServicesAmt>
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        <ProgramServicesAmt>7460776</ProgramServicesAmt>
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        <ProgramServicesAmt>362278</ProgramServicesAmt>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>190719513</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14052117</ManagementAndGeneralAmt>
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        <EOYAmt>23824216</EOYAmt>
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        <EOYAmt>2204787</EOYAmt>
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        <EOYAmt>815096</EOYAmt>
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        <BOYAmt>22904496</BOYAmt>
        <EOYAmt>26537615</EOYAmt>
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        <EOYAmt>20870190</EOYAmt>
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        <EOYAmt>15438003</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>89689907</EOYAmt>
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        <EOYAmt>21153090</EOYAmt>
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        <EOYAmt>16761744</EOYAmt>
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        <EOYAmt>12585052</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>44517823</BOYAmt>
        <EOYAmt>50499886</EOYAmt>
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        <BOYAmt>39102640</BOYAmt>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>JESSICA NELSON</PersonNm>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <PersonNm>JOSEPH CHEVRETTE</PersonNm>
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        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
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        <FormAndLineReferenceDesc>PART I, LINE 3</FormAndLineReferenceDesc>
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          <PersonNm>JENNAFER ROLF</PersonNm>
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        <RelationshipDescriptionTxt>DAUGHTER OF CEO</RelationshipDescriptionTxt>
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        <TransactionDesc>EMPLOYEE-SALARY</TransactionDesc>
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      <BusTrInvolveInterestedPrsnGrp>
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          <PersonNm>BROOKE D'AMICO</PersonNm>
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        <RelationshipDescriptionTxt>DAUGHTER OF CFO</RelationshipDescriptionTxt>
        <TransactionAmt>88768</TransactionAmt>
        <TransactionDesc>EMPLOYEE-SALARY</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>THOMAS ARIGLIO</PersonNm>
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        <RelationshipDescriptionTxt>SON OF CFO</RelationshipDescriptionTxt>
        <TransactionAmt>59004</TransactionAmt>
        <TransactionDesc>EMPLOYEE-SALARY</TransactionDesc>
        <SharingOfRevenuesInd>0</SharingOfRevenuesInd>
      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>BRIAN CAVANAGH</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>BROTHER OF CEO</RelationshipDescriptionTxt>
        <TransactionAmt>93799</TransactionAmt>
        <TransactionDesc>EMPLOYEE-SALARY</TransactionDesc>
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      </BusTrInvolveInterestedPrsnGrp>
      <BusTrInvolveInterestedPrsnGrp>
        <NameOfInterested>
          <PersonNm>JANET SZILAGYI</PersonNm>
        </NameOfInterested>
        <RelationshipDescriptionTxt>DAUGHTER OF CEO</RelationshipDescriptionTxt>
        <TransactionAmt>34520</TransactionAmt>
        <TransactionDesc>EMPLOYEE-SALARY</TransactionDesc>
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        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>THE SOLE MEMBER OF VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK, INC. IS NASCENTIA HEALTH, INC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>NASCENTIA HEALTH, INC. MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>NASCENTIA HEALTH, INC. IS THE SOLE MEMBER OF VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK, INC. THE MEMBER RESERVES TO ITSELF ALL THE RIGHTS AND POWERS OF CORPORATE MEMBERSHIP CREATED BY THE LAWS OF THE STATE OF NEW YORK OR THE CERTIFICATE OF INCORPORATION OR THE BY-LAWS OF THE CORPORATION. SPECIFICALLY, THE MEMBER RESERVES THE AUTHORITY TO APPOINT DIRECTORS TO THE GOVERNING BODY, TO AMEND THE BY-LAWS OF THE CORPORATION, AND TO APPROVE THE SALE, TRANSFER, OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>MANAGEMENT REVIEWS FORM 990, THEN SENDS ENCRYPTED E-MAIL TO THE BOARD MEMBERS NOTIFYING THEM THAT THE FORM IS AVAILABLE FOR THEM TO REVIEW PRIOR TO THE FILING OF THE FORM.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE WRITTEN CONFLICT OF INTEREST POLICY IS REVIEWED ON AN ANNUAL BASIS. SIGNATURES FROM THE BOARD MEMBERS DISCLOSING CONFLICTS OF INTEREST ARE UPDATED ON AN ANNUAL BASIS AS WELL.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S EXECUTIVE COMMITTEE IS THE COMPENSATION COMMITTEE AND THEY APPROVE THE COMPENSATION OF THE CEO. THE COMMITTEE USES THE ANNUAL BENCHMARK HOMECARE SALARY AND BENEFITS REPORT, AND ALSO LOOKS AT EXECUTIVE COMPENSATION OF SIMILAR SIZE ORGANIZATIONS AS WELL AND EVALUATES HER PERFORMANCE FOR THE YEAR. THE CEO USES THE SAME METHOD FOR THE COMPENSATION OF THE OTHER KEY EMPLOYEES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>PENSION/POST RETIREMENT 1,420,677. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -54,082. OTHER COMPONENTS OF NET PERIODIC BENEFIT COST -1,585,506.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 12, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR.</ExplanationTxt>
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          <BusinessNameLine1Txt>NASCENTIA NEIGHBORHOOD AT THE BEECHES LLC</BusinessNameLine1Txt>
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</Return>