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      <Form990PartVIISectionAGrp>
        <PersonNm>Brian Harwood</PersonNm>
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        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Catherine Simonson</PersonNm>
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        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Judy Peterson</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>James Manahan</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>James Budis</PersonNm>
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        <AverageHoursPerWeekRltdOrgRt>0</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Arsalan Namdar</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Tara Graham</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Alice Means</PersonNm>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Theresa Paquin</PersonNm>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>89165</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>7</IndivRcvdGreaterThan100KCnt>
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      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Core Medical Group</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2 Keewaydin Drive</AddressLine1Txt>
            <CityNm>Salem</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
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        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AMN Healthcare Inc</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>IL</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
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      <FederatedCampaignsAmt>119259</FederatedCampaignsAmt>
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      <FundraisingAmt>70741</FundraisingAmt>
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      <GovernmentGrantsAmt>419252</GovernmentGrantsAmt>
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      <TotalContributionsAmt>3584633</TotalContributionsAmt>
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        <BusinessCd>621610</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>13838279</RelatedOrExemptFuncIncomeAmt>
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        <ExclusionAmt>0</ExclusionAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>Medicaid</Desc>
        <BusinessCd>621610</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>10634102</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>Other Patient Revenue</Desc>
        <BusinessCd>621610</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>5836140</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <TotalProgramServiceRevenueAmt>30308521</TotalProgramServiceRevenueAmt>
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        <RelatedOrExemptFuncIncomeAmt>982909</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <IncmFromInvestBondProceedsGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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        <ExclusionAmt>0</ExclusionAmt>
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        <PersonalAmt>0</PersonalAmt>
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      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>972067</SecuritiesAmt>
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      <NetGainOrLossInvestmentsGrp>
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        <Desc>Misc Program Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>339748</TotalRevenueColumnAmt>
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      <OtherRevenueMiscGrp>
        <Desc>Net Assets Released from restricted for Operations</Desc>
        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>453544</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueMiscGrp>
        <Desc>Other Operating Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>418862</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
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      <MiscellaneousRevenueGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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      <GrantsToDomesticOrgsGrp>
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      <GrantsToDomesticIndividualsGrp>
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      <BenefitsToMembersGrp>
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      <FeesForServicesLegalGrp>
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        <ProgramServicesAmt>13568</ProgramServicesAmt>
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      <FeesForServicesAccountingGrp>
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        <FundraisingAmt>-6144</FundraisingAmt>
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        <FundraisingAmt>12621</FundraisingAmt>
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        <ProgramServicesAmt>8401</ProgramServicesAmt>
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        <FundraisingAmt>16639</FundraisingAmt>
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        <FundraisingAmt>14220</FundraisingAmt>
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        <ProgramServicesAmt>500280</ProgramServicesAmt>
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        <FundraisingAmt>934</FundraisingAmt>
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        <FundraisingAmt>0</FundraisingAmt>
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      <OtherExpensesGrp>
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        <FundraisingAmt>1267</FundraisingAmt>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>287549</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>-19418</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>886511</TotalAmt>
        <ProgramServicesAmt>880593</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5668</ManagementAndGeneralAmt>
        <FundraisingAmt>250</FundraisingAmt>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>-176244</ProgramServicesAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>26964322</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5683623</ManagementAndGeneralAmt>
        <FundraisingAmt>387273</FundraisingAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>0</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>1418305</EOYAmt>
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      <PledgesAndGrantsReceivableGrp>
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        <EOYAmt>529254</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>3222476</EOYAmt>
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      <ReceivablesFromOfficersEtcGrp>
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        <EOYAmt>0</EOYAmt>
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      <RcvblFromDisqualifiedPrsnGrp>
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        <EOYAmt>0</EOYAmt>
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      <OthNotesLoansReceivableNetGrp>
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        <EOYAmt>0</EOYAmt>
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      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>0</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>767980</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>15940138</LandBldgEquipCostOrOtherBssAmt>
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        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>James Manahan</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>James Budis</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>139396</BaseCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Tara Graham</PersonNm>
        <TitleTxt>Director - End of Life Services</TitleTxt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Theresa Paquin</PersonNm>
        <TitleTxt>Director of Adult Home Care</TitleTxt>
        <BaseCompensationFilingOrgAmt>111968</BaseCompensationFilingOrgAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The executive committee establishes the compensation of the President and CEO. This committee then endorsees the CEO proposed compensation of the other key employees. The Executive Committee uses existing policies to give approval in advance of payment and reasonable standard in the process. The Executive Committee establishes President and CEO yearly goals. A bonus is paid based on the number of goals obtain for the year.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>A 457b plan has been established and contributed to for Judy Peterson. A total of $24,016.27 was funded to the account in fiscal year 2018.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="R000007" softwareId="17005980" softwareVersionNum="v1.00">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The 990 is posted on the board forum and both the finance committee and board can review and ask any questions they have.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>The VNA has two policies for Conflict of Interest - One for Board Members and one for staff including officers and highest compensated employees. The VNA monitors compliance of its Board Members with its conflict of interest policy by requiring a yearly signed Conflict of Interest form where the Board Member acknowledges reading the VNA disclosure of potential conflicts of interest or duality policy. The Board member then states that there is no action that would contravene the policy. The Board Member then signs and dates the form. Staff Members, Officers and highest compensated employees are required at hire to read the VNA disclosure of potential conflicts of interest policy and sign a conflict of interest form. Employees are required to notify the VNA if conflict arises. Failure to do so will have ramifications up to termination.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Committee of the Board of Directors reviews the compensation and performance of the President/CEO as well as reviewing and approving the CEO's proposal for other key employees, on an annual basis. The Board's Executive Committee relies on comparative data and existing agency policies in their review and approval.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The VNA makes its governing documents, conflict of interest policy and financial statements available to the public upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Assets released from restriction for operations -$566,445, Net assets released from restriction for capital acquisition -$332,234, Change in investment value -$947,331</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <ReasonableCauseExplanation documentId="R000008" softwareId="17005980" softwareVersionNum="v1.00">
      <ExplanationTxt>I filed an extension because we needed extra time to compile data.</ExplanationTxt>
    </ReasonableCauseExplanation>
  </ReturnData>
</Return>