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          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contract Staffing</ServicesDesc>
        <CompensationAmt>354479</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Advanced Medical Personnel Services</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <CityNm>PITTSBURGH</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>15251</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Contract Staffing</ServicesDesc>
        <CompensationAmt>259655</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Quality in Real Time</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>15 Vebena Avenue</AddressLine1Txt>
            <CityNm>FLORAL PARK</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>11001</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Consulting/Coding</ServicesDesc>
        <CompensationAmt>100280</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>4</CntrctRcvdGreaterThan100KCnt>
      <TotalContributionsAmt>0</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
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        <BusinessCd>621610</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>11939056</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>MEDICAID</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>277894</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>277894</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>INSURANCE</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>3752025</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3752025</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PRIVATE</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>3992</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3992</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PROVISION FOR UNCOLLECTIBLE ACCOUNTS</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>48972</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>48972</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
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        <ExclusionAmt>179</ExclusionAmt>
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        <ExclusionAmt>179</ExclusionAmt>
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      <GrantsToDomesticIndividualsGrp>
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        <ProgramServicesAmt>854093</ProgramServicesAmt>
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        <ProgramServicesAmt>636006</ProgramServicesAmt>
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      <FeesForServicesManagementGrp>
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        <ManagementAndGeneralAmt>2440770</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
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        <ProgramServicesAmt>20004</ProgramServicesAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
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      <FeesForServicesProfFundraising>
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      <FeesForSrvcInvstMgmntFeesGrp>
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      <OtherExpensesGrp>
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        <ProgramServicesAmt>12043490</ProgramServicesAmt>
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      <FederalIncomeTaxLiabilityAmt>0</FederalIncomeTaxLiabilityAmt>
      <TotalLiabilityAmt>0</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>All Care Visiting Nurse Association of Greater Lynn, Inc. is exempt from income tax on related income under Section 501(C)(3) of the Internal Revenue Code. In accordance with Generally Accepted Accounting Principles, the organization annually evaluates its tax status and tax positions taken with respect to its operations and financial position.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="IRS990ScheduleJ">
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>true</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Shawn Potter</PersonNm>
        <TitleTxt>President/CEO</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>397641</CompensationBasedOnRltdOrgsAmt>
        <BonusRelatedOrganizationsAmt>80250</BonusRelatedOrganizationsAmt>
        <OtherCompensationRltdOrgsAmt>4058</OtherCompensationRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>250000</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>23583</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>755532</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Daniel Meyler</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>176110</CompensationBasedOnRltdOrgsAmt>
        <BonusRelatedOrganizationsAmt>26250</BonusRelatedOrganizationsAmt>
        <OtherCompensationRltdOrgsAmt>3018</OtherCompensationRltdOrgsAmt>
        <NontaxableBenefitsRltdOrgsAmt>20019</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>225397</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Mary Winters</PersonNm>
        <TitleTxt>VP of Operations</TitleTxt>
        <BaseCompensationFilingOrgAmt>146482</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>22250</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>2168</OtherCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>4483</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>175383</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part I, Line 4B:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's President/CEO Shawn Potter participates in a supplemental non-qualified retirement plan through the organization's sole corporate member, Health Management Services, Inc. deferred compensation reported for the year ended December 31, 2018 under this plan is $250,000.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's management duties are handled by one of its related entities, Health Management Services, Inc.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Form 990 is provided to the organization's governing body at the HMS, Inc. executive committee meeting before it is signed and filed.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12C:</FormAndLineReferenceDesc>
        <ExplanationTxt>The policy is monitored through organization and annual training. Enforcement has not been an issue, but would occur if necessary.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15:</FormAndLineReferenceDesc>
        <ExplanationTxt>All director salaries are reviewed and approved by a vote of the Board of Directors.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 18:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's Form 990 is available to the public upon request and can be found at the Massachusetts Attorney General website.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization's financial statements are available to the public upon request and can be found at the Massachusetts Attorney General website. The governing documents are conflict of interest policy are available upon request.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9, Changes in Net Assets:</FormAndLineReferenceDesc>
        <ExplanationTxt>Intercompany Equity Transfer $1,327,800</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="IRS990ScheduleR">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>All Care Resources Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>042805564</EIN>
        <PrimaryActivitiesTxt>Healthcare</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>HMS Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>All Care Adult Day Health Center Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>760799712</EIN>
        <PrimaryActivitiesTxt>Healthcare</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>HMS Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>The Visiting Nurse Association Foundatio</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>222581936</EIN>
        <PrimaryActivitiesTxt>Development</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>HMS Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>Health Management Services Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>222581863</EIN>
        <PrimaryActivitiesTxt>Management</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>12</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>All Care Hospice Inc</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>352231860</EIN>
        <PrimaryActivitiesTxt>Healthcare</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>HMS Inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>VNA Ventures Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>042942852</EIN>
        <PrimaryActivitiesTxt>Real Estate M</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>hms inc</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C-Corp</EntityTypeTxt>
        <ControlledOrganizationInd>true</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>All Care Infusion Therapy Company</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>210 Market Street</AddressLine1Txt>
          <CityNm>Lynn</CityNm>
          <StateAbbreviationCd>MA</StateAbbreviationCd>
          <ZIPCd>01901</ZIPCd>
        </USAddress>
        <EIN>043120267</EIN>
        <PrimaryActivitiesTxt>Health Servic</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>vna ventures</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C-Corp</EntityTypeTxt>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>true</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>true</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>true</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part II, Column G and Part IV, Column I:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization has checked "yes" as a Section 512(B)(13) controlled entity. Although the filing organization does not directly control each of the organizations listed, as part of its affiliation with Health Management Services (parent organization), all organizations related under HMS are defined as a controlled entity within the meaning of IRC Section 512(B)(13).</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleR>
  </ReturnData>
</Return>