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        <ServicesDesc>EMR SOFTWARE</ServicesDesc>
        <CompensationAmt>217985</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>1</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>5000</FederatedCampaignsAmt>
      <GovernmentGrantsAmt>746171</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>20129</AllOtherContributionsAmt>
      <TotalContributionsAmt>771300</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NET PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>10820233</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>10820233</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER REVENUE</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>9868</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>9868</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>10830101</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>86847</TotalRevenueColumnAmt>
        <ExclusionAmt>86847</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>2480600</SecuritiesAmt>
        <OtherAmt>6548</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>2280673</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>199927</SecuritiesAmt>
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      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>206475</TotalRevenueColumnAmt>
        <ExclusionAmt>206475</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
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      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncomeFromGamingGrp>
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      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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      <TotalRevenueGrp>
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        <RelatedOrExemptFuncIncomeAmt>10830101</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>293322</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
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      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
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      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
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        <ManagementAndGeneralAmt>127957</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
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        <ProgramServicesAmt>4806972</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3319447</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>49430</ProgramServicesAmt>
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      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1301377</TotalAmt>
        <ProgramServicesAmt>773299</ProgramServicesAmt>
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      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
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        <ManagementAndGeneralAmt>273878</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>13977</TotalAmt>
        <ManagementAndGeneralAmt>13977</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>55320</TotalAmt>
        <ManagementAndGeneralAmt>55320</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
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      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
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        <ProgramServicesAmt>47480</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30706</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
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        <ProgramServicesAmt>292003</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52033</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>336316</TotalAmt>
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        <ManagementAndGeneralAmt>131819</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
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        <ProgramServicesAmt>59068</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38075</ManagementAndGeneralAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>287776</ProgramServicesAmt>
        <ManagementAndGeneralAmt>139594</ManagementAndGeneralAmt>
      </TravelGrp>
      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>36463</TotalAmt>
        <ProgramServicesAmt>22171</ProgramServicesAmt>
        <ManagementAndGeneralAmt>14292</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>854</TotalAmt>
        <ProgramServicesAmt>519</ProgramServicesAmt>
        <ManagementAndGeneralAmt>335</ManagementAndGeneralAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>133231</TotalAmt>
        <ProgramServicesAmt>81011</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52220</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
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        <ProgramServicesAmt>5865</ProgramServicesAmt>
        <ManagementAndGeneralAmt>115358</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT</Desc>
        <TotalAmt>7518</TotalAmt>
        <ProgramServicesAmt>7518</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES &amp; DRUGS</Desc>
        <TotalAmt>222476</TotalAmt>
        <ProgramServicesAmt>222476</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>LICENSES, DUES, SUBSCRIPTIONS</Desc>
        <TotalAmt>15797</TotalAmt>
        <ProgramServicesAmt>9605</ProgramServicesAmt>
        <ManagementAndGeneralAmt>6192</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RECRUITING &amp; RETENTION</Desc>
        <TotalAmt>20154</TotalAmt>
        <ProgramServicesAmt>9245</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10909</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>12709123</TotalAmt>
        <ProgramServicesAmt>7654606</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5054517</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1061399</BOYAmt>
        <EOYAmt>442096</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>75588</BOYAmt>
        <EOYAmt>223376</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1530704</BOYAmt>
        <EOYAmt>1397240</EOYAmt>
      </AccountsReceivableGrp>
      <ReceivablesFromOfficersEtcGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </ReceivablesFromOfficersEtcGrp>
      <RcvblFromDisqualifiedPrsnGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </RcvblFromDisqualifiedPrsnGrp>
      <OthNotesLoansReceivableNetGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </OthNotesLoansReceivableNetGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>23046</BOYAmt>
        <EOYAmt>22927</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>193283</BOYAmt>
        <EOYAmt>203826</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>3486975</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1983634</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1617802</BOYAmt>
        <EOYAmt>1503341</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>4096704</EOYAmt>
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      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <InvestmentsProgramRelatedGrp>
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        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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        <EOYAmt>15684</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>953312</EOYAmt>
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      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>4768</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <TaxExemptBondLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
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      <EscrowAccountLiabilityGrp>
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        <EOYAmt>91441</EOYAmt>
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      <LoansFromOfficersDirectorsGrp>
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        <EOYAmt>0</EOYAmt>
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      <MortgNotesPyblScrdInvstPropGrp>
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        <EOYAmt>0</EOYAmt>
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      <UnsecuredNotesLoansPayableGrp>
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        <EOYAmt>0</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>1367154</BOYAmt>
        <EOYAmt>1044753</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>8646195</BOYAmt>
        <EOYAmt>6860441</EOYAmt>
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      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>8646195</BOYAmt>
        <EOYAmt>6860441</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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        <EOYAmt>7905194</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>-814400</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-971354</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <ContributorInformationGrp>
        <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>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <IRS990ScheduleC documentId="IRS990ScheduleC">
      <TotalGrassrootsLobbyingGrp />
      <TotalDirectLobbyingGrp />
      <TotalLobbyingExpendGrp />
      <OtherExemptPurposeExpendGrp />
      <TotalExemptPurposeExpendGrp />
      <LobbyingNontaxableAmountGrp />
      <GrassrootsNontaxableGrp />
      <TotLbbyngGrassrootMnsNonTxGrp />
      <TotLbbyExpendMnsLbbyngNonTxGrp />
      <VolunteersInd>false</VolunteersInd>
      <PaidStaffOrManagementInd>false</PaidStaffOrManagementInd>
      <MediaAdvertisementsInd>false</MediaAdvertisementsInd>
      <MailingsMembersInd>false</MailingsMembersInd>
      <PublicationsOrBroadcastInd>false</PublicationsOrBroadcastInd>
      <GrantsOtherOrganizationsInd>false</GrantsOtherOrganizationsInd>
      <DirectContactLegislatorsInd>false</DirectContactLegislatorsInd>
      <RalliesDemonstrationsInd>false</RalliesDemonstrationsInd>
      <OtherActivitiesInd>true</OtherActivitiesInd>
      <OtherActivitiesAmt>533</OtherActivitiesAmt>
      <TotalLobbyingExpendituresAmt>533</TotalLobbyingExpendituresAmt>
      <NotDescribedSection501c3Ind>false</NotDescribedSection501c3Ind>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE C, PART II-B, LINE 1(I)</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER LOBBYING ACTIVITIES: THE ORGANIZATION PAYS ANNUAL DUES TO THE MISSOURI ALLIANCE FOR HOME CARE, THE MISSOURI HOSPICE AND PALLIATIVE CARE ASSOCIATION, AND THE NATIONAL HOSPICE AND PALLIATIVE CARE ORGANIZATION. A PORTION OF THESE DUES IS ATTRIBUTABLE TO LOBBYING PURPOSES.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <ArtPublicExhibitionAmountsGrp />
      <HeldWorksArtGrp />
      <AgentTrusteeEtcInd>false</AgentTrusteeEtcInd>
      <InclEscrowCustodialAcctLiabInd>true</InclEscrowCustodialAcctLiabInd>
      <ExplanationProvidedInd>X</ExplanationProvidedInd>
      <CYMinus3YrEndwmtFundGrp />
      <CYMinus4YrEndwmtFundGrp />
      <LandGrp />
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>1670255</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>393472</DepreciationAmt>
        <BookValueAmt>1276783</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
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        <DepreciationAmt>32335</DepreciationAmt>
        <BookValueAmt>13764</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>1770621</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1557827</DepreciationAmt>
        <BookValueAmt>212794</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp />
      <TotalBookValueLandBuildingsAmt>1503341</TotalBookValueLandBuildingsAmt>
      <TotalRevEtcAuditedFinclStmtAmt>10916821</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>-971354</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>-971354</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>11888175</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>6548</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>6548</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>11894723</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>12702575</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>-6548</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>-6548</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>12709123</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>12709123</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART IV, LINE 2B</FormAndLineReferenceDesc>
        <ExplanationTxt>ESCROW AND CUSTODIAL ARRANGEMENTS: THE ORGANIZATION HAS A CHRISTMAS CLUB THAT ALLOWS EMPLOYEES TO ELECT TO HAVE A CERTAIN AMOUNT WITHHELD FROM EACH PAYCHECK. NO ADDITIONAL CONTRIBUTIONS ARE MADE BY THE ORGANIZATION. THE ACCOUNT IS DISTRIBUTED TO THE EMPLOYEES EACH OCTOBER.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART X, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XI, LINE 4B</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON FORM 990, PART VIII, LINE 12, BUT NOT ON LINE 1: $ 6,548 GAIN ON DISPOSAL OF PROPERTY</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PART XII, LINE 2D</FormAndLineReferenceDesc>
        <ExplanationTxt>AMOUNTS INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART IX, LINE 25: $ (6,548) GAIN ON DISPOSAL OF PROPERTY</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>ORGANIZATION'S MISSION: THE MISSION OF THE VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI, INC. IS TO SET THE STANDARD FOR EXCELLENCE IN THE DELIVERY OF HOME CARE SERVICE TO THE CITIZENS OF SOUTHEAST MISSOURI THROUGH THERAPEUTIC, CUSTODIAL, PALLIATIVE, AND PREVENTIVE CARE IN A COOPERATIVE AND SEAMLESS SYSTEM, UTILIZING INNOVATION, DIVERSIFICATION AND COST EFFECTIVE METHODS IN AN ENVIRONMENT THAT FOSTERS LEARNING AND DEMONSTRATES POSITIVE OUTCOMES. THE SERVICES WILL BE PROVIDED WITHOUT REGARD TO AGE, RACE, CREED, DISABILITY, OR ECONOMIC STATUS. THE MISSION WILL BE CARRIED OUT USING THE NOT FOR PROFIT CORPORATION FORM OF DOING BUSINESS AS DEFINED IN CHAPTER 355 OF THE REVISED STATUTES OF MISSOURI.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART III, LINE 4D</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER PROGRAM SERVICES: CONSUMER DIRECTED SERVICES (CDS) ENABLES PHYSICALLY DISABLED INDIVIDUALS TO CONTINUE TO LIVE INDEPENDENTLY WITHIN THEIR OWN HOME RATHER THAN GOING TO A NURSING FACILITY. CDS EMPOWERS THE CONSUMER TO REMAIN IN CONTROL OF THEIR LIVES BY GIVING THEM THE FREEDOM TO CHOOSE THEIR OWN CAREGIVER. PRIVATE DUTY SERVICE IS PROVIDED WHEN NURSING CARE IS NEEDED FOR MORE THAN WHAT CAN BE PROVIDED IN AN INTERMITTENT HOME HEALTH VISIT AND THE PATIENT STILL PREFERS TO RECOVER AT HOME. RNS AND LPNS PROVIDE SKILLED AND NON-SKILLED SERVICES FOR ONE PATIENT OVER A PRE-SET PERIOD OF TIME CALLED A SHIFT. THE AMOUNT OF HOURS PROVIDED DEPENDS ON THE NEEDS OF THE PATIENT. DURABLE MEDICAL EQUIPMENT PROVIDES EQUIPMENT NEEDS TO KEEP PATIENTS SAFE AND COMFORTABLE IN THEIR HOMES. SENIOR COMPANION SERVICES ARE FUNDED IN PART BY A FEDERAL GRANT AND ALLOWS SENIORS TO PROVIDE ASSISTANCE TO SENIORS LIVING AT HOME.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, LINE 1A</FormAndLineReferenceDesc>
        <ExplanationTxt>AUTHORITY DELEGATED TO EXECUTIVE COMMITTEE: THE EXECUTIVE COMMITTEE SHALL ACT ON BEHALF OF THE BOARD OF DIRECTORS BETWEEN REGULAR MEETINGS OF THE BOARD IN A MANNER CONSISTENT WITH THE ESTABLISHED POLICIES OF THE BOARD OF DIRECTORS. THREE OFFICERS OF THE BOARD OF DIRECTORS MUST BE PRESENT TO CONSTITUTE A QUORUM OF THE EXECUTIVE COMMITTEE AND ALLOW CORPORATE BUSINESS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>FAMILY RELATIONSHIPS: HELEN SANDER BOARD MEMBER AND ROSE HORRELL BOARD MEMBER ARE SISTERS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>REVIEW OF FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. MANAGEMENT OF THE ORGANIZATION COMPLETE A THOROUGH REVIEW OF THE 990. THE RETURN IS THEN PRESENTED TO THE BOARD OF DIRECTORS WHO HAVE AN OPPORTUNITY TO ASK QUESTIONS OR MAKE COMMENTS BEFORE THE RETURN IS FILED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: CONFLICT OF INTEREST ANNUAL DISCLOSURES ARE REVIEWED BY THE COMPLIANCE OFFICER. ANY CONFLICTS ARE REVIEWED BY THE CEO AND REPORTED TO THE BOARD ANNUALLY. BOARD MEMBERS WITH POTENTIAL CONFLICTS ABSTAIN FROM VOTING ON ITEMS RELATED TO THAT CONFLICT. CORPORATE OFFICERS AND KEY EMPLOYEES ARE ALSO REQUIRED TO ANNUALLY DISCLOSE CONFLICTS OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION DETERMINATION: THE EXECUTIVE COMMITTEE MET ON 6/16/2022 TO COMPLETE THE CEO ANNUAL EVALUATION WITH INPUT FROM THE NOMINATING &amp; GOVERNANCE COMMITTEE. BASED ON THE NAHC HOME CARE AND SALARY AND BENEFITS REPORT FOR 2021-2022 AND REVIEW OF SIMILAR ORGANIZATIONS ON GUIDESTAR, THE CEO SALARY WAS ADJUSTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION DETERMINATION: THE FINANCE/BUDGET COMMITTEE MEETING HELD ON 6/2/2022 REVIEWED BUDGET ITEMS IN DETAIL INCLUDING PAYROLL. IT WAS DISCUSSED THAT ALL POSITIONS HAVE BEEN REVIEWED BY THE CEO AND HR DIRECTOR WITH INPUT FROM PROGRAM DIRECTORS. WAGES WERE ADJUSTED IN ORDER TO REMAIN COMPETITIVE IN THE CURRENT MARKET. BASED ON AMOUNT AND TIMING OF INCREASE, THE 3% ANNUAL INCREASE AT EVAL WILL BE DETERMINED ON AN EMPLOYEE BY EMPLOYEE BASIS. THE COMPENSATION REVIEW PROCESS INCLUDES A REVIEW OF THE MOST RECENT COPY OF THE NAHC HOME CARE SALAY AND BENEFITS REPORT BOOK (2021-2022) AND LOCAL MARKET.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>DOCUMENT DISCLOSURE: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ALL AVAILABLE TO BE VIEWED AT THE ORGANIZATION'S PLACE OF BUSINESS UPON WRITTEN REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VNA OF SEMO CONSUMER DIRECTED CARE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1124 INDEPENDENCE AVE</AddressLine1Txt>
          <CityNm>KENNETT</CityNm>
          <StateAbbreviationCd>MO</StateAbbreviationCd>
          <ZIPCd>63857</ZIPCd>
        </USAddress>
        <EIN>205778702</EIN>
        <PrimaryActivitiesTxt>CONSUMER DIR</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MO</LegalDomicileStateCd>
        <TotalIncomeAmt>1079802</TotalIncomeAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VNA SEMO</BusinessNameLine1Txt>
        </DirectControllingEntityName>
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</Return>
