﻿<?xml version="1.0" encoding="utf-8"?>
<Return returnVersion="2015v3.0" xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2017-02-14T08:40:00-07:00</ReturnTs>
    <TaxPeriodEndDt>2016-06-30</TaxPeriodEndDt>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2015-07-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>030179603</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>VISITING NURSE ASSOCIATION OF CHITTENDEN AND GRAND ISLE COUNTIES</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>VISI</BusinessNameControlTxt>
      <PhoneNum>8026581900</PhoneNum>
      <USAddress>
        <AddressLine1Txt>1110 Prim Road</AddressLine1Txt>
        <CityNm>Colchester</CityNm>
        <StateAbbreviationCd>VT</StateAbbreviationCd>
        <ZIPCd>05446</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>James Manahan</PersonNm>
      <PersonTitleTxt>CFO</PersonTitleTxt>
      <PhoneNum>8028604432</PhoneNum>
      <SignatureDt>2017-01-02</SignatureDt>
    </BusinessOfficerGrp>
    <TaxYr>2015</TaxYr>
    <BuildTS>2021-01-29 14:40:06Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="8">
    <IRS990 documentId="R000001" referenceDocumentId="R000007 R000008" softwareId="15000352" softwareVersionNum="v1.00">
      <PrincipalOfficerNm>James Manahan</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>1110 Prim Road</AddressLine1Txt>
        <CityNm>Colchester</CityNm>
        <StateAbbreviationCd>VT</StateAbbreviationCd>
        <ZIPCd>05446</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>34613290</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>www.vnacares.org</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1906</FormationYr>
      <LegalDomicileStateCd>VT</LegalDomicileStateCd>
      <ActivityOrMissionDesc>The VNA cares for individuals and families through health and related services in home and other community setting for the residents of Chittenden and Grand Isle Counties.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>20</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>20</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>848</TotalEmployeeCnt>
      <TotalVolunteersCnt>586</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>4717090</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>5727811</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>28337947</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>27008998</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>1589898</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>830055</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>0</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>220359</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>34644935</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>33787223</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>21573470</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>22318493</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>-15410</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>581725</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>9657613</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>7254958</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>31231083</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>29558041</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>3413852</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>4229182</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>27213790</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>31531391</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>5387785</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>6480177</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>21826005</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>25051214</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>The VNA cares for individuals and families through health and related services in home and other community settings</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <ExpenseAmt>7966286</ExpenseAmt>
      <RevenueAmt>9617152</RevenueAmt>
      <Desc>Home Care Serving 2,900 patients and doing 58,829 visits</Desc>
      <ProgSrvcAccomActy2Grp>
        <ExpenseAmt>3204755</ExpenseAmt>
        <RevenueAmt>4425087</RevenueAmt>
        <Desc>Hospice End of Life Services serving 712 patients with 24,666 per diem days</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <ExpenseAmt>2207513</ExpenseAmt>
        <RevenueAmt>2258673</RevenueAmt>
        <Desc>Vermont Respite House serving 220 patients and 3,814 bed days</Desc>
      </ProgSrvcAccomActy3Grp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>3509140</ExpenseAmt>
        <RevenueAmt>2856818</RevenueAmt>
        <Desc>Family Child Services serving 983 patients and doing 11,457 visits</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>109589</ExpenseAmt>
        <RevenueAmt>0</RevenueAmt>
        <Desc>Madison Deane Initiative End of Life Education</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>761120</ExpenseAmt>
        <RevenueAmt>980286</RevenueAmt>
        <Desc>Private Duty Program skilled nursing care and Private care services to 289 patients</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>3439340</ExpenseAmt>
        <RevenueAmt>3692906</RevenueAmt>
        <Desc>Choice for Care Highest Needs Personal care serviced to 380 clients</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>515570</ExpenseAmt>
        <RevenueAmt>624328</RevenueAmt>
        <Desc>Choices for Care Homemaker Program servicing 231 clients</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>496712</ExpenseAmt>
        <RevenueAmt>575524</RevenueAmt>
        <Desc>Anderson Parkway personal care services to 10 disabled adults</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>1344454</ExpenseAmt>
        <RevenueAmt>1605170</RevenueAmt>
        <Desc>Adult Day Program serving 181 clients at 3 locations</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>34300</ExpenseAmt>
        <RevenueAmt>32129</RevenueAmt>
        <Desc>Traumatic Brain Injury serving 2 clients</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <ProgSrvcAccomActyOtherGrp>
        <ExpenseAmt>299175</ExpenseAmt>
        <RevenueAmt>340925</RevenueAmt>
        <Desc>Health Promotions provides services to senior housing and wellness flu clinics</Desc>
      </ProgSrvcAccomActyOtherGrp>
      <TotalOtherProgSrvcExpenseAmt>10509400</TotalOtherProgSrvcExpenseAmt>
      <TotalOtherProgSrvcGrantAmt>0</TotalOtherProgSrvcGrantAmt>
      <TotalOtherProgSrvcRevenueAmt>10708086</TotalOtherProgSrvcRevenueAmt>
      <TotalProgramServiceExpensesAmt>23887954</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="R000002">1</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="R000003">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>0</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>0</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>0</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd>0</DonorAdvisedFundInd>
      <ConservationEasementsInd>0</ConservationEasementsInd>
      <CollectionsOfArtInd>0</CollectionsOfArtInd>
      <CreditCounselingInd>0</CreditCounselingInd>
      <TempOrPermanentEndowmentsInd referenceDocumentId="R000004">1</TempOrPermanentEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="R000004">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd>0</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd>0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd>0</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="R000004">1</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="R000004">1</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="R000004">1</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="R000004">0</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd>0</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd referenceDocumentId="R000005">1</FundraisingActivitiesInd>
      <GamingActivitiesInd>0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd>0</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>0</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="R000006">1</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>0</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>0</PYExcessBenefitTransInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWithOfficerEntInd>0</BusinessRlnWithOfficerEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd>0</DisregardedEntityInd>
      <RelatedEntityInd>0</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>0</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>0</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>35</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>848</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>0</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>0</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>1</QuidProQuoContributionsInd>
      <QuidProQuoContriDisclInd>1</QuidProQuoContriDisclInd>
      <Form8282PropertyDisposedOfInd>0</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>0</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>0</PayPremiumsPrsnlBnftCntrctInd>
      <Form8899Filedind>0</Form8899Filedind>
      <Form1098CFiledInd>0</Form1098CFiledInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>20</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>20</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>0</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>0</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>0</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>1</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>1</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>1</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>Patricia Gratton</PersonNm>
        <PhoneNum>8028604429</PhoneNum>
        <USAddress>
          <AddressLine1Txt>1110 Prim Road</AddressLine1Txt>
          <CityNm>Colchester</CityNm>
          <StateAbbreviationCd>VT</StateAbbreviationCd>
          <ZIPCd>05446</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>Tania Bertsch MD</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Beverly Coston</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Rosemary Dale APRN</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Patti Fisher MD</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Evan Goldsmith</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Joe Hameline III</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Megan McIntosh Frenzen</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Steve Grant MD</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Frank Harris</PersonNm>
        <TitleTxt>Vice Chair</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jeanne Hutchins</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Kathleen C Keleher RN</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>John Maitland</PersonNm>
        <TitleTxt>Board Chair</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Barbara Martin</PersonNm>
        <TitleTxt>Board Secretary</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Peter Martin</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Senator Dick Mazza</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Sandy McDowell</PersonNm>
        <TitleTxt>Board Treasurer</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Linda Tarr Whelan</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>John Bartlett</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Harriet Williams</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>1</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Judy Peterson</PersonNm>
        <TitleTxt>President</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>222976</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18979</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>James Manahan</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>139034</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>22597</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>James Budis</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>134758</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>18979</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Arsalan Namdar</PersonNm>
        <TitleTxt>VP of IT</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>109031</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>6807</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jennifer Archambault</PersonNm>
        <TitleTxt>VP of HR</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>108949</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>2320</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Alice Means</PersonNm>
        <TitleTxt>VP Quality and Education</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>106894</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20660</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Christine Werneke</PersonNm>
        <TitleTxt>VP of Marketing and Business Development</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>105262</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23346</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Theresa Paquin</PersonNm>
        <TitleTxt>Director of Adult Home Care</TitleTxt>
        <AverageHoursPerWeekRt>40</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>103894</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>5603</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>1030798</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>119291</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>8</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Core Medical Group</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2 Keewaydin Drive</AddressLine1Txt>
            <CityNm>Salem</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03079</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Provided Traveler Nurses</ServicesDesc>
        <CompensationAmt>233876</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>MAS Medical Staffing</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>156 Harvey Road</AddressLine1Txt>
            <CityNm>Londonderry</CityNm>
            <StateAbbreviationCd>NH</StateAbbreviationCd>
            <ZIPCd>03053</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Provided Traveler Nurses</ServicesDesc>
        <CompensationAmt>139808</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>2</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>223298</FederatedCampaignsAmt>
      <MembershipDuesAmt>0</MembershipDuesAmt>
      <FundraisingAmt>83709</FundraisingAmt>
      <RelatedOrganizationsAmt>0</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>783756</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>4637048</AllOtherContributionsAmt>
      <NoncashContributionsAmt>285000</NoncashContributionsAmt>
      <TotalContributionsAmt>5727811</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Medicare</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>12095764</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>12095764</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Medicaid</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>9987275</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>9987275</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Other Patient Revenue</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>4925959</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4925959</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>27008998</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>868733</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>868733</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </RoyaltiesRevenueGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>771979</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>810657</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>-38678</SecuritiesAmt>
        <OtherAmt>0</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-38678</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-38678</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>83709</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>15410</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>-15410</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-15410</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <OtherRevenueMiscGrp>
        <Desc>Misc Program Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>174269</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>174269</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>Misc Admin Revenue</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>61500</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>61500</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>235769</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>33787223</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>27244767</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>814645</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>362010</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>362010</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>17549123</TotalAmt>
        <ProgramServicesAmt>15125717</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2217161</ManagementAndGeneralAmt>
        <FundraisingAmt>206245</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>648889</TotalAmt>
        <ProgramServicesAmt>521142</ProgramServicesAmt>
        <ManagementAndGeneralAmt>121757</ManagementAndGeneralAmt>
        <FundraisingAmt>5990</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2385197</TotalAmt>
        <ProgramServicesAmt>1944786</ProgramServicesAmt>
        <ManagementAndGeneralAmt>429774</ManagementAndGeneralAmt>
        <FundraisingAmt>10637</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>1373274</TotalAmt>
        <ProgramServicesAmt>1172368</ProgramServicesAmt>
        <ManagementAndGeneralAmt>185117</ManagementAndGeneralAmt>
        <FundraisingAmt>15789</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>11045</TotalAmt>
        <ManagementAndGeneralAmt>11045</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>67440</TotalAmt>
        <ProgramServicesAmt>5004</ProgramServicesAmt>
        <ManagementAndGeneralAmt>62436</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>-15410</TotalAmt>
        <FundraisingAmt>-15410</FundraisingAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>207347</TotalAmt>
        <FundraisingAmt>207347</FundraisingAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1540412</TotalAmt>
        <ProgramServicesAmt>1309803</ProgramServicesAmt>
        <ManagementAndGeneralAmt>228284</ManagementAndGeneralAmt>
        <FundraisingAmt>2325</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>167155</TotalAmt>
        <ProgramServicesAmt>34187</ProgramServicesAmt>
        <ManagementAndGeneralAmt>96639</ManagementAndGeneralAmt>
        <FundraisingAmt>36329</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>408262</TotalAmt>
        <ProgramServicesAmt>133150</ProgramServicesAmt>
        <ManagementAndGeneralAmt>257857</ManagementAndGeneralAmt>
        <FundraisingAmt>17255</FundraisingAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>493012</TotalAmt>
        <ProgramServicesAmt>191799</ProgramServicesAmt>
        <ManagementAndGeneralAmt>291463</ManagementAndGeneralAmt>
        <FundraisingAmt>9750</FundraisingAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>854154</TotalAmt>
        <ProgramServicesAmt>547396</ProgramServicesAmt>
        <ManagementAndGeneralAmt>305992</ManagementAndGeneralAmt>
        <FundraisingAmt>766</FundraisingAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>532347</TotalAmt>
        <ProgramServicesAmt>523470</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8447</ManagementAndGeneralAmt>
        <FundraisingAmt>430</FundraisingAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>40065</TotalAmt>
        <ProgramServicesAmt>19926</ProgramServicesAmt>
        <ManagementAndGeneralAmt>19785</ManagementAndGeneralAmt>
        <FundraisingAmt>354</FundraisingAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>394020</TotalAmt>
        <ProgramServicesAmt>166788</ProgramServicesAmt>
        <ManagementAndGeneralAmt>226546</ManagementAndGeneralAmt>
        <FundraisingAmt>686</FundraisingAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>96572</TotalAmt>
        <ManagementAndGeneralAmt>96572</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>Medicaid Tax</Desc>
        <TotalAmt>1155413</TotalAmt>
        <ProgramServicesAmt>1155413</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Recruitment</Desc>
        <TotalAmt>111859</TotalAmt>
        <ProgramServicesAmt>8031</ProgramServicesAmt>
        <ManagementAndGeneralAmt>103828</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Bad Debt</Desc>
        <TotalAmt>285858</TotalAmt>
        <ProgramServicesAmt>221000</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>64858</FundraisingAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>889997</TotalAmt>
        <ProgramServicesAmt>807974</ProgramServicesAmt>
        <ManagementAndGeneralAmt>63649</ManagementAndGeneralAmt>
        <FundraisingAmt>18374</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>29558041</TotalAmt>
        <ProgramServicesAmt>23887954</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5088362</ManagementAndGeneralAmt>
        <FundraisingAmt>581725</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>0</BOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2817840</BOYAmt>
        <EOYAmt>1606148</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>54882</BOYAmt>
        <EOYAmt>1255923</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>2687663</BOYAmt>
        <EOYAmt>3088201</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>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>358606</BOYAmt>
        <EOYAmt>408282</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>15011862</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>7217812</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>2992894</BOYAmt>
        <EOYAmt>7794050</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>18301905</BOYAmt>
        <EOYAmt>15825036</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <InvestmentsProgramRelatedGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </InvestmentsProgramRelatedGrp>
      <IntangibleAssetsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </IntangibleAssetsGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>1553751</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>27213790</BOYAmt>
        <EOYAmt>31531391</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>3962801</BOYAmt>
        <EOYAmt>5099816</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <GrantsPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </GrantsPayableGrp>
      <DeferredRevenueGrp>
        <BOYAmt>464964</BOYAmt>
        <EOYAmt>395240</EOYAmt>
      </DeferredRevenueGrp>
      <TaxExemptBondLiabilitiesGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </TaxExemptBondLiabilitiesGrp>
      <EscrowAccountLiabilityGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </EscrowAccountLiabilityGrp>
      <LoansFromOfficersDirectorsGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <MortgNotesPyblScrdInvstPropGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </MortgNotesPyblScrdInvstPropGrp>
      <UnsecuredNotesLoansPayableGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
      </UnsecuredNotesLoansPayableGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>960020</BOYAmt>
        <EOYAmt>985121</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>5387785</BOYAmt>
        <EOYAmt>6480177</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
      <UnrestrictedNetAssetsGrp>
        <BOYAmt>9796255</BOYAmt>
        <EOYAmt>10594823</EOYAmt>
      </UnrestrictedNetAssetsGrp>
      <TemporarilyRstrNetAssetsGrp>
        <BOYAmt>5244802</BOYAmt>
        <EOYAmt>7665443</EOYAmt>
      </TemporarilyRstrNetAssetsGrp>
      <PermanentlyRstrNetAssetsGrp>
        <BOYAmt>6784948</BOYAmt>
        <EOYAmt>6790948</EOYAmt>
      </PermanentlyRstrNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>21826005</BOYAmt>
        <EOYAmt>25051214</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>27213790</BOYAmt>
        <EOYAmt>31531391</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>4229182</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-17463</NetUnrlzdGainsLossesInvstAmt>
      <DonatedServicesAndUseFcltsAmt>0</DonatedServicesAndUseFcltsAmt>
      <PriorPeriodAdjustmentsAmt>0</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>-986510</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="R000002" softwareId="15000352" softwareVersionNum="v1.00">
      <PubliclySupportedOrg509a2Ind>X</PubliclySupportedOrg509a2Ind>
      <GiftsGrantsContrisRcvd509Grp>
        <CurrentTaxYearMinus4YearsAmt>1866349</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>2287438</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>2481825</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>4717090</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>3090800</CurrentTaxYearAmt>
        <TotalAmt>14443502</TotalAmt>
      </GiftsGrantsContrisRcvd509Grp>
      <GrossReceiptsAdmissionsGrp>
        <CurrentTaxYearMinus4YearsAmt>23473531</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>24446409</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>26873593</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>28128672</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>27008998</CurrentTaxYearAmt>
        <TotalAmt>129931203</TotalAmt>
      </GrossReceiptsAdmissionsGrp>
      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>25339880</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>26733847</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>29355418</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>32845762</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>30099798</CurrentTaxYearAmt>
        <TotalAmt>144374705</TotalAmt>
      </Total509Grp>
      <PublicSupportTotal509Amt>144374705</PublicSupportTotal509Amt>
      <GrossInvestmentIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>351543</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>351315</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>378654</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>435331</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>485481</CurrentTaxYearAmt>
        <TotalAmt>2002324</TotalAmt>
      </GrossInvestmentIncome509Grp>
      <Post1975UBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>0</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>0</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>0</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>0</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>0</CurrentTaxYearAmt>
        <TotalAmt>0</TotalAmt>
      </Post1975UBTIGrp>
      <InvestmentIncomeAndUBTIGrp>
        <CurrentTaxYearMinus4YearsAmt>351543</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>351315</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>378654</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>435331</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>485481</CurrentTaxYearAmt>
        <TotalAmt>2002324</TotalAmt>
      </InvestmentIncomeAndUBTIGrp>
      <OtherIncome509Grp>
        <CurrentTaxYearMinus4YearsAmt>82806</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>151924</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>273373</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>209275</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>235769</CurrentTaxYearAmt>
        <TotalAmt>953147</TotalAmt>
      </OtherIncome509Grp>
      <TotalSupportCalendarYearGrp>
        <CurrentTaxYearMinus4YearsAmt>25774229</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>27237086</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>30007445</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>33490368</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>30821048</CurrentTaxYearAmt>
        <TotalAmt>147330176</TotalAmt>
      </TotalSupportCalendarYearGrp>
      <PublicSupportCY509Pct>0.97994</PublicSupportCY509Pct>
      <PublicSupportPY509Pct>0.981</PublicSupportPY509Pct>
      <InvestmentIncomeCYPct>0.01359</InvestmentIncomeCYPct>
      <InvestmentIncomePYPct>0.013</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
      <Form990ScheduleAPartVIGrp>
        <FormAndLineReferenceDesc>Schedule A, Part III, Line 12</FormAndLineReferenceDesc>
        <ExplanationTxt>Billing Service Revenue 2015 61500, 2014 63645 2013 87502 2012 24000 2011 24000 Misc Program Revenue 2015 174269 2014 145630 2013 184582 2012 114671 2011 51782</ExplanationTxt>
      </Form990ScheduleAPartVIGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="R000003" softwareId="15000352" softwareVersionNum="v1.00">
      <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>
    <IRS990ScheduleD documentId="R000004" softwareId="15000352" softwareVersionNum="v1.00">
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>9402713</BeginningYearBalanceAmt>
        <ContributionsAmt>6000</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>5453938</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>406260</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>0</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>0</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>14456391</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>9401073</BeginningYearBalanceAmt>
        <ContributionsAmt>9000</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>2977877</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>358200</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>0</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>0</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>12029750</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>8537104</BeginningYearBalanceAmt>
        <ContributionsAmt>25743</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>1198878</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>360652</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>0</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>0</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>9401073</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>8111115</BeginningYearBalanceAmt>
        <ContributionsAmt>9318</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>793179</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>376508</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>0</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>0</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>8537104</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>8432026</BeginningYearBalanceAmt>
        <ContributionsAmt>4540</ContributionsAmt>
        <InvestmentEarningsOrLossesAmt>-2509</InvestmentEarningsOrLossesAmt>
        <GrantsOrScholarshipsAmt>322942</GrantsOrScholarshipsAmt>
        <OtherExpendituresAmt>0</OtherExpendituresAmt>
        <AdministrativeExpensesAmt>0</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>8111115</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <BoardDesignatedBalanceEOYPct>0</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>0.47</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.53</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>577539</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>0</OtherCostOrOtherBasisAmt>
        <BookValueAmt>577539</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>8830706</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>0</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2377195</DepreciationAmt>
        <BookValueAmt>6453511</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <InvestmentCostOrOtherBasisAmt>0</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>0</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>0</DepreciationAmt>
        <BookValueAmt>0</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>5603617</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>0</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>4840617</DepreciationAmt>
        <BookValueAmt>763000</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>0</InvestmentCostOrOtherBasisAmt>
        <OtherCostOrOtherBasisAmt>0</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>0</DepreciationAmt>
        <BookValueAmt>0</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>7794050</TotalBookValueLandBuildingsAmt>
      <FederalIncomeTaxLiabilityAmt>0</FederalIncomeTaxLiabilityAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Due To Third Party Payors</Desc>
        <Amt>326485</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Charitable Remainder Trust Liability</Desc>
        <Amt>597738</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Deferred Compensation Payable</Desc>
        <Amt>60898</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>985121</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>29863378</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>-17463</NetUnrealizedGainsInvstAmt>
      <DonatedServicesAndUseFcltsAmt>-285000</DonatedServicesAndUseFcltsAmt>
      <RecoveriesPriorYearGrantsAmt>0</RecoveriesPriorYearGrantsAmt>
      <OtherRevenueAmt>-3354007</OtherRevenueAmt>
      <RevenueNotReportedAmt>-3656470</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>33519848</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>46375</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>221000</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>267375</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>33787223</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>29064810</TotExpnsEtcAuditedFinclStmtAmt>
      <DonatedServicesUseFcltsAmt>0</DonatedServicesUseFcltsAmt>
      <PriorYearAdjustmentsAmt>0</PriorYearAdjustmentsAmt>
      <LossesReportedAmt>0</LossesReportedAmt>
      <OtherExpensesIncludedAmt>-272231</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>-272231</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>29337041</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>0</InvestmentExpensesNotIncld2Amt>
      <OtherExpensesNotIncludedAmt>221000</OtherExpensesNotIncludedAmt>
      <ExpensesNotRptFinclStmtAmt>221000</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>29558041</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part V, Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>To fund future losses in programs that do not break even</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part X, Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>The Association is a not for profit corporation as described in section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. As a public charity, the association is exempt from state and federal income taxes on income earned in accordance with its tax exempt purpose. Unrelated business income is subject to state and federal income tax. Management has evaluated the Association's tax positions and concluded that the Association has no unrelated business income or uncertain tax positions that require adjustment to the financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XI, Line 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>Change in restricted and temporary restricted fund balance</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XI, Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Patient Bad Debt 221000</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XII, Line 2d</FormAndLineReferenceDesc>
        <ExplanationTxt>Endowment Cap Bad Debt 64858, CRT Payment 52959, Bank fees 24512 and released to operations 129876</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part XII, Line 4b</FormAndLineReferenceDesc>
        <ExplanationTxt>Patient bad debts</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleG documentId="R000005" softwareId="15000352" softwareVersionNum="v1.00">
      <FundraisingEventInformationGrp>
        <Event1Nm>VRH Fun Rum</Event1Nm>
        <GrossReceiptsEvent1Amt>49364</GrossReceiptsEvent1Amt>
        <CharitableContriEvent1Amt>0</CharitableContriEvent1Amt>
        <GrossRevenueEvent1Amt>49364</GrossRevenueEvent1Amt>
        <CashPrizesEvent1Amt>0</CashPrizesEvent1Amt>
        <NonCashPrizesEvent1Amt>0</NonCashPrizesEvent1Amt>
        <RentFacilityCostsEvent1Amt>0</RentFacilityCostsEvent1Amt>
        <FoodAndBeverageEvent1Amt>0</FoodAndBeverageEvent1Amt>
        <EntertainmentEvent1Amt>0</EntertainmentEvent1Amt>
        <OtherDirectExpensesEvent1Amt>1340</OtherDirectExpensesEvent1Amt>
        <Event2Nm>Family Room Fashion Show</Event2Nm>
        <GrossReceiptsEvent2Amt>30145</GrossReceiptsEvent2Amt>
        <CharitableContriEvent2Amt>0</CharitableContriEvent2Amt>
        <GrossRevenueEvent2Amt>30145</GrossRevenueEvent2Amt>
        <CashPrizesEvent2Amt>0</CashPrizesEvent2Amt>
        <NonCashPrizesEvent2Amt>0</NonCashPrizesEvent2Amt>
        <RentFacilityCostsEvent2Amt>0</RentFacilityCostsEvent2Amt>
        <FoodAndBeverageEvent2Amt>0</FoodAndBeverageEvent2Amt>
        <EntertainmentEvent2Amt>0</EntertainmentEvent2Amt>
        <OtherDirectExpensesEvent2Amt>14070</OtherDirectExpensesEvent2Amt>
        <OtherEventsTotalCnt>0</OtherEventsTotalCnt>
        <GrossReceiptsTotalAmt>79509</GrossReceiptsTotalAmt>
        <CharitableContributionsTotAmt>0</CharitableContributionsTotAmt>
        <GrossRevenueTotalEventsAmt>79509</GrossRevenueTotalEventsAmt>
        <CashPrizesTotalEventsAmt>0</CashPrizesTotalEventsAmt>
        <NonCashPrizesTotalEventsAmt>0</NonCashPrizesTotalEventsAmt>
        <RentFcltyCostsTotalEventsAmt>0</RentFcltyCostsTotalEventsAmt>
        <FoodAndBeverageTotalEventsAmt>0</FoodAndBeverageTotalEventsAmt>
        <EntertainmentTotalEventsAmt>0</EntertainmentTotalEventsAmt>
        <OthDirectExpnssTotalEventsAmt>15410</OthDirectExpnssTotalEventsAmt>
        <DirectExpenseSummaryEventsAmt>15410</DirectExpenseSummaryEventsAmt>
        <NetIncomeSummaryAmt>64099</NetIncomeSummaryAmt>
      </FundraisingEventInformationGrp>
    </IRS990ScheduleG>
    <IRS990ScheduleJ documentId="R000006" softwareId="15000352" softwareVersionNum="v1.00">
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Judy Peterson</PersonNm>
        <TitleTxt>President</TitleTxt>
        <BaseCompensationFilingOrgAmt>202976</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>20000</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>13334</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6336</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>242646</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>James Manahan</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>139034</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>8330</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14267</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>161631</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>James Budis</PersonNm>
        <TitleTxt>Vice President</TitleTxt>
        <BaseCompensationFilingOrgAmt>134758</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>4038</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14941</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>153737</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Arsalan Namdar</PersonNm>
        <TitleTxt>VP of IT</TitleTxt>
        <BaseCompensationFilingOrgAmt>109031</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>6515</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>292</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>115838</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Jennifer Archambault</PersonNm>
        <TitleTxt>VP of HR</TitleTxt>
        <BaseCompensationFilingOrgAmt>108949</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>2027</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>293</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>111269</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Alice Means</PersonNm>
        <TitleTxt>VP Quality and Education</TitleTxt>
        <BaseCompensationFilingOrgAmt>106894</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>6393</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>14267</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>127554</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Christine Werneke</PersonNm>
        <TitleTxt>VP of Marketing and Business Development</TitleTxt>
        <BaseCompensationFilingOrgAmt>105262</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>6014</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>17332</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>128608</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Theresa Paquin</PersonNm>
        <TitleTxt>Director of Adult Home Care</TitleTxt>
        <BaseCompensationFilingOrgAmt>103894</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>5311</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>292</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>109497</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Committee establishes the compensation of the President and CEO. This committee then endorses the CEO proposed compensation of the other key employees. That Executive Committee uses existing policies to give approval in advance of payment and reasonable standards in the process. The Executive Committee establishes President and CEO yearly goals. A bonus is paid based on number of goals obtain for the year.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="R000007" softwareId="15000352" softwareVersionNum="v1.00">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B</FormAndLineReferenceDesc>
        <ExplanationTxt>Line 15a and 15b The Executive Committee of the Board of Directors reviews the compensation and performance of the President/CEO, as well as reviewing and approval 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 B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The 990 is posted on the board forum and both the finance committee and board can ask and review 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 conflict 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 conflicts arise. Failure to do so will have ramification up to termination.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Committee establishes the compensation of the President and CEO. This committee then endorses the CEO proposed compensation of the other key employees. That Executive Committee uses existing policies to give approval in advance of payment and reasonable standards in the process.</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 IX, Line 11g</FormAndLineReferenceDesc>
        <ExplanationTxt>Contracted Nurses $311,292, Contract PT $15758, Contract Transportation $152,321. Contractual Service Payroll $122,082, Hospital Charges $47,434, Nursing Home Bed Days $572,102, Contractual Medical Director $138,653 and general consulting $180,770</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrealized Losses in Restricted Assets 37457, Unrealized Losses in Unrestricted Assets -38678, Unrealized Losses in Temp Restricted Assets -16242, current CRT Liability -597738, non cash donation -285000 and CRT payment -86309</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <ReasonableCauseExplanation documentId="R000008" softwareId="15000352" softwareVersionNum="v1.00">
      <ExplanationTxt>Filed Extension</ExplanationTxt>
    </ReasonableCauseExplanation>
  </ReturnData>
</Return>