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      <Desc>SKILLED NURSING SERVICES: WORKING UNDER THE DIRECTION OF THE REFERRING PHYSICIAN, OUR TEAM OF NURSES, PHYSICAL THERAPIST, OCCUPATIONAL THERAPISTS, SPEECH THERAPISTS, MEDICAL SOCIAL WORKERS AND NUTRITIONISTS ARE UNIQUELY COMMITTED TO HIGH QUALITY OUTCOMES AND SUPERIOR PATIENT SATISFACTION. MEDICAL SUPERVISION: ALL SERVICES ARE PROVIDED UNDER A PLAN OF CARE ESTABLISHED AND MONITORED BY THE PATIENTS PHYSICIAN. DISEASE MANAGEMENT AND CLINICAL PATH IMPLEMENTATION: FOCUSING ON EDUCATION, NUTRITION, PATIENT COMPLIANCE AND COMMUNICATION, OUR DISEASE MANAGEMENT PROGRAMS HELP TO CONTROL THE DISEASE PROCESS AND MAXIMIZE WELLNESS. THE GOAL IS TO PROVIDE A TEMPLATE OF CARE THAT CAN BE MODIFIED BASED ON INDIVIDUAL PATIENT NEEDS. EACH PATH IDENTIFIES KEY GOALS AND ACTIONS TO MEET THOSE GOALS AS WELL AS SPECIFIC TEACHING TO BE PROVIDED. PATIENTS CAN OFTEN BE EFFECTIVELY MANAGED ONCE STABILIZED VIA ROUTINE PHONE MANAGEMENT. THIS APPROACH HAS RESULTED IN REDUCED HOSPITALIZATIONS AND EMERGENCY ROOM VISITS. ALL PATHS ARE DEVELOPED UTILIZING AN INTERDISCIPLINARY APPROACH INVOLVING ALL KEY DISCIPLINES. CURRENT PATHS INCLUDE DIABETES, CONGESTIVE HEART FAILURE, PNEUMONIA, DVT, ASTHMA, COPD AND IDDM. OUR CARE PATHS ARE YOUR PATH TO INDEPENDENCE. NURSING: OUR HOME HEALTH RNS ASSESS AND CARE FOR PATIENTS OF ALL AGES AND CONDITIONS. THEIR SERVICES INCLUDE PATIENT OBSERVATION AND ASSESSMENT, PATIENT AND FAMILY TEACHING, THE ADMINISTRATION OF MEDICATIONS, WOUND CARE, TRACHEOTOMIES, GASTROSTOMY TUBES AND FOLY CATHETERS AS WELL AS AN ASSORTMENT OF OTHER TREATMENTS AS ORDERED. WOUND CARE: INDIVIDUALS WITH WOUNDS ACCOUNT FOR ONE-THIRD OF PATIENTS IN HOME CARE. THE VNA HAS A DEDICATED WOUND CARE TEAM WITH THE LARGEST NUMBER OF CERTIFIED WOUND, OSTOMY AND CONTINENCE (CWOCN) NURSES IN THE AREA. OUR SPECIALISTS WORK CLOSELY WITH ATTENDING PHYSICIANS TO ENSURE COORDINATION AND CONTINUITY OF CARE. DIGITAL PHOTOS ARE REGULARLY EXCHANGED TO SHOW HEALING PROGRESS. OUR PROGRAM HIGHLIGHTS PREVENTION, HEALTH MAINTENANCE, THERAPEUTIC INTERVENTION, REHABILITATION, DIGITAL PHOTOGRAPHY, VACUUM ASSISTED WOUND CLOSURE, ADVANCED WOUND CARE PRODUCTS AND MONOCHROMATIC INFRARED ENERGY. REHABILITATION SERVICES: OUR REHABILITATION SERVICES HAVE THE ABILITY TO COMBINE THE INTENSITY OF INPATIENT THERAPY WITH THE SPECIALIZATION OF OUTPATIENT SERVICES. THE USE OF REHABILITATION AT HOME HAS INCREASED DRAMATICALLY OVER THE PAST DECADE. WE TREAT OUR PATIENTS WHERE THEY MOST PREFER TO BE, IN THEIR OWN HOMES. WE PROVIDE A COMPLETE ARRAY OF REHABILITATION SERVICES. PHYSICAL THERAPY: PHYSICAL THERAPISTS (PTS) ARE HEALTH CARE PROFESSIONALS WHO DIAGNOSE AND TREAT INDIVIDUALS OF ALL AGES, FROM NEWBORNS TO THE VERY OLDEST, WHICH HAVE MEDICAL PROBLEMS OR OTHER HEALTH-RELATED CONDITIONS THAT LIMIT THEIR ABILITIES TO MOVE AND PERFORM FUNCTIONAL ACTIVITIES IN THEIR DAILY LIVES. OCCUPATIONAL THERAPY: OCCUPATIONAL THERAPISTS PROVIDE SKILLED TREATMENT THAT HELPS INDIVIDUALS ACHIEVE INDEPENDENCE IN ALL FACETS OF THEIR LIVES. OCCUPATIONAL THERAPY ASSISTS PEOPLE IN DEVELOPING THE SKILLS FOR THE JOB OF LIVING NECESSARY FOR INDEPENDENT AND SATISFYING LIVES. SPEECH THERAPY: SPEECH/LANGUAGE PATHOLOGISTS EVALUATE, DIAGNOSE AND TREAT SPEECH, LANGUAGE, COGNITIVE-COMMUNICATION AND SWALLOWING DISORDERS IN INDIVIDUALS OF ALL AGES, FROM INFANTS TO THE ELDERLY. MEDICAL SOCIAL WORK: MEDICAL SOCIAL WORKERS PROVIDE PSYCHOSOCIAL SUPPORT TO PEOPLE, FAMILIES OR VULNERABLE POPULATIONS SO THEY CAN COPE WITH CHRONIC, ACUTE OR TERMINAL ILLNESS. THEY ALSO ADVISE FAMILY CAREGIVERS, COUNSEL PATIENTS AND HELP PLAN FOR PATIENTS NEEDS AFTER DISCHARGE FROM HEALTH CARE. NUTRITIONAL THERAPY: REGISTERED DIETICIANS PROVIDE RELIABLE, OBJECTIVE NUTRITION INFORMATION, SEPARATE FACTS FROM FADS AND TRANSLATE THE LATEST SCIENTIFIC FINDINGS INTO EASY-TO-UNDERSTAND NUTRITION INFORMATION. THEY WORK CLOSELY WITH OTHER MEMBERS OF OUR TEAM, ESPECIALLY WITH DIABETIC PATIENTS, AND THOSE RECEIVING NUTRITIONAL INTAKE FROM ALTERNATIVE SOURCES. AT THE VNA, OUR NOT-FOR-PROFIT STATUS ALLOWS US TO RE-INVEST IN THE LATEST, MOST EFFECTIVE THERAPIES TO IMPROVE THE RECOVERY OF OUR PATIENTS. WE CONSTANTLY MONITOR THE REHABILITATION LITERATURE TO IDENTIFY THE NEWEST, RESEARCH DRIVEN THERAPIES AND APPLY THEM TO THE HOME SETTING. SOME OF THE SPECIALTY AREAS IN WHICH WE ARE HIGHLY PROFICIENT INCLUDE FALLS RISK ASSESSMENT AND INTERVENTION. AN EVIDENT-BASED FALLS RISK ASSESSMENT IS INCLUDED WITH EVERY PATIENT EVALUATION WE PERFORM. WE USE OBJECTIVE, WELL RESEARCHED TOOLS AND INTERVENTIONS TO TRACK AND IMPROVE THE ABILITY OF OUR PATIENTS TO SAFELY WALK AND FUNCTION WITHIN THEIR ENVIRONMENT. WE ALSO PROVIDE AN EXTENSIVE HOME EVALUATION AND OFFER A COMPREHENSIVE LIST OF RECOMMENDATIONS TO IMPROVE THE SAFETY OF OUR PATIENTS AS THEY PROGRESS THROUGHOUT THEIR DAILY ACTIVITIES. TOTAL JOINT REPLACEMENT FAST TRACK: A PROGRAM WHICH ALLOWS PATIENTS WHO HAVE HAD A TOTAL KNEE OR HIP REPLACEMENT TO RETURN HOME STRAIGHT FROM THE HOSPITAL AFTER THEIR SURGERY. OUR TEAM IS DEDICATED TO PROVIDING INITIAL VISITS THE DAY AFTER YOU RETURN HOME AND IN SOME CASES, A PRE-OPERATIVE VISIT MAY BE ARRANGED TO PREPARE YOU IN ADVANCE FOR YOUR RETURN THERAPY. FREQUENCIES OF UP TO 6 DAYS A WEEK ARE POSSIBLE, AND YOU WILL BENEFIT FROM AS MANY OF THE COMPREHENSIVE VNA SERVICES AS YOU NEED. VESTIBULAR DYSFUNCTION AND INTERVENTION PROGRAM: A SPECIFIC PHYSICAL THERAPY TREATMENT PROGRAM FOR DIZZINESS CAUSED BY INNER EAR DYSFUNCTION. OSTEOPOROSIS AND COMPRESSION FRACTURE MANAGEMENT: A PROGRAM OF PROGRESSIVE EXERCISES AND POSITIONING RECOMMENDATIONS SPECIFICALLY DESIGNED TO DECREASE PAIN, IMPROVE POSTURE, MODIFY RISK FACTORS AND INCREASE MOBILITY IN THE POPULATION WITH THIS DEBILITATING CONDITION. ADVANCED MULTIDISCIPLINARY WOUND CARE: A PHYSICAL THERAPY TREATMENT PROGRAM LED BY A CERTIFIED WOUND SPECIALIST WHICH MAY UTILIZE ELECTRICAL STIMULATION, CONSERVATIVE SHARP DEBRIDEMENT, POSITIONING AND EDUCATION TO PROMOTE HEALING OF CHRONIC AND DIFFICULT TO HEAL WOUNDS. LOW VISION ASSESSMENT AND INTERVENTION: AN OCCUPATIONAL THERAPY PROGRAM WHICH INCLUDES ADAPTIVE TECHNIQUES FOR FUNCTIONING INDEPENDENTLY WITH LOW VISUAL ACUITY. INSTRUCTION IN INNOVATIVE TECHNIQUES FOR DIABETIC AND STORMY CARE FOR PATIENTS WITH LOW VISION IS ALSO AVAILABLE. VITAL STIM THERAPY: A SPEECH THERAPY PROGRAM WHERE SPECIFICALLY CALIBRATED ELECTRICAL STIMULATION IS UTILIZED ALONG WITH TARGETED EXERCISES TO IMPROVE THE ABILITY TO SWALLOW. THIS THERAPY HAS DEMONSTRATED RESULTS WHICH INCLUDE THE COMPLETE RETURN TO NORMAL SWALLOWING IN PATIENTS WHO HAVE RELIED ON FEEDING TUBES FOR YEARS TO OBTAIN THEIR NUTRITIONAL INTAKE. PEDIATRIC SERVICES: THE VNA HAS THE LARGEST TEAM OF PEDIATRIC NURSES AND PEDIATRIC INFUSION NURSES IN THE REGION. VNA PEDIATRIC NURSES ARE DEDICATED STAFF TRAINED IN SPECIAL CARE AND NEEDS OF CHILDREN OF ALL AGES. THE HIGHLY SPECIALIZED CAREGIVERS FROM THE VNA INCLUDES NURSES, REHAB THERAPISTS AND PHARMACISTS. ADULT DAY SERVICES: A PROGRAM THAT IS DESIGNED TO MEET THE NEEDS OF THE CHRONICALLY ILL AND IMPAIRED ADULTS (AGES 18 AND ABOVE) WHO LIVE IN THE COMMUNITY. SOCIALIZATION, ASSISTANCE WITH PERSONAL CARE AND A WIDE VARIETY OF ACTIVITIES HELP INDIVIDUALS TO MAINTAIN THEIR INDEPENDENCE AND SELF-WORTH. ADULT DAY PROGRAMS OFFER FAMILIES AN OPPORTUNITY TO TAKE A BREAK FROM THE CONSTANT DEMANDS OF CARING FOR LOVED ONES WHO DEPEND ON THEM FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. INDIVIDUALS ATTEND ON A PLANNED BASIS, WHICH MAY RANGE FROM ONE TO FIVE DAYS PER WEEK, ACCORDING TO YOUR SPECIAL NEEDS. TELEHEALTH HOME MONITORING: TELEHEALTH USES TELECOMMUNICATION DEVICES PLACED IN PATIENTS HOMES TO TAKE THEIR VITAL SIGNS EVERY DAY, REMIND THE PATIENT TO TAKE MEDICATION AND ANSWER SIMPLE QUESTIONS ABOUT THEIR CONDITION IN THE COMFORT OF THEIR HOME. A TELEHEALTH NURSE WILL TRAIN THE PATIENT TO INTERPRET HIS OR HER BLOOD PRESSURE, OXIMETRY LEVELS, PULSE RATES AND WEIGHT WITH EQUIPMENT INSTALLED IN THEIR HOME. THE PATIENT WILL TRANSMIT THEIR RESULTS TO THE VNA FOR REVIEW DAILY. IF ANY READINGS ARE OUTSIDE OF THE PARAMETERS SET BY THE PHYSICIAN, AN IMMEDIATE HOME INTERVENTION WILL TAKE PLACE TO ADDRESS THE PATIENTS NEEDS.</Desc>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>BARRY SWARTZ</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
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        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
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      <Form990PartVIISectionAGrp>
        <PersonNm>GEORGE MATTHEWS</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DON BOYD</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>41.0</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>LAURA PAOLUCCI</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID HUGHES</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>WILLIAM COUGHLIN</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>MICHAEL BANAS MD</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.0</AverageHoursPerWeekRltdOrgRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ANOTHONY PERNA</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JUDY BAUMGARTNER</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>74424</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>8802</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JODY LOMEO</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>0.5</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.5</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>1324753</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>489360</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>JOHN SWIATKOWSKI</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>41.0</AverageHoursPerWeekRltdOrgRt>
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        <OtherCompensationAmt>166462</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>DANIEL OWEN</PersonNm>
        <TitleTxt>DIRECTOR OF FINANCE</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>40611</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>8303</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>LISA GREISLER</PersonNm>
        <TitleTxt>VICE PRESIDENT &amp; COO</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>KENNETH SCHONBACHLER</PersonNm>
        <TitleTxt>DIRECTOR OF BUS DEV &amp; PT TRANS</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>FREDERICK PORDUM II</PersonNm>
        <TitleTxt>DIRECTOR OF REHABILITATION</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT SCHNEIDER II</PersonNm>
        <TitleTxt>INFUSION THERAPY NURSE</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>ROSEMARY SLAWICH</PersonNm>
        <TitleTxt>HOME HEALTH NURSE</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Hanna Burkhart</PersonNm>
        <TitleTxt>Infusion Therapy Nurse</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>HOMECARE HOMEBASE LLC</PersonNm>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>6688 NORTH CENTRAL EXPRESSWAY SUIT</AddressLine1Txt>
            <CityNm>DALLAS</CityNm>
            <StateAbbreviationCd>TX</StateAbbreviationCd>
            <ZIPCd>75206</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>COMPUTER SERVICE</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>MEDTRONIC CARE MANAGEMENT SERVICES</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>7980 CENTURY BLVD</AddressLine1Txt>
            <CityNm>CHANHASSEN</CityNm>
            <StateAbbreviationCd>MN</StateAbbreviationCd>
            <ZIPCd>55317</ZIPCd>
          </USAddress>
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        <ServicesDesc>TELEHEALTH SERVICES</ServicesDesc>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>FLC SPINDRIFT LLC</PersonNm>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>350 ESSJAY RD SUITE 101</AddressLine1Txt>
            <CityNm>WILLIAMSVILLE</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>14221</ZIPCd>
          </USAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>VERIZON WIRELESS</PersonNm>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 408</AddressLine1Txt>
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            <StateAbbreviationCd>NJ</StateAbbreviationCd>
            <ZIPCd>07101</ZIPCd>
          </USAddress>
        </ContractorAddress>
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      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>DAYMARCK LLC</PersonNm>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>1800 EAST BROADWAY AVE 300</AddressLine1Txt>
            <CityNm>BISMARCK</CityNm>
            <StateAbbreviationCd>ND</StateAbbreviationCd>
            <ZIPCd>58501</ZIPCd>
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        <ServicesDesc>MEDICAL CODING</ServicesDesc>
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      <GovernmentGrantsAmt>286134</GovernmentGrantsAmt>
      <TotalContributionsAmt>286134</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT REVENUE</Desc>
        <TotalRevenueColumnAmt>83642569</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>83642569</RelatedOrExemptFuncIncomeAmt>
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      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>350560</TotalRevenueColumnAmt>
        <ExclusionAmt>350560</ExclusionAmt>
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      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </RoyaltiesRevenueGrp>
      <RentalIncomeOrLossGrp>
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        <PersonalAmt>0</PersonalAmt>
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      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>166000</SecuritiesAmt>
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      <GainOrLossGrp>
        <SecuritiesAmt>166000</SecuritiesAmt>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>166000</TotalRevenueColumnAmt>
        <ExclusionAmt>166000</ExclusionAmt>
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      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
      </NetIncmFromFundraisingEvtGrp>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
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        <Desc>SALE OF MEDICAL RECORDS</Desc>
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        <RelatedOrExemptFuncIncomeAmt>35541</RelatedOrExemptFuncIncomeAmt>
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      <OtherRevenueTotalAmt>35541</OtherRevenueTotalAmt>
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        <ExclusionAmt>516560</ExclusionAmt>
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      <GrantsToDomesticOrgsGrp>
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      <GrantsToDomesticIndividualsGrp>
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      <BenefitsToMembersGrp>
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        <ProgramServicesAmt>306704</ProgramServicesAmt>
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        <ProgramServicesAmt>6999954</ProgramServicesAmt>
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        <ProgramServicesAmt>2851694</ProgramServicesAmt>
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      <FeesForServicesLegalGrp>
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      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
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      <FeesForServicesProfFundraising>
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      <FeesForSrvcInvstMgmntFeesGrp>
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      </FeesForSrvcInvstMgmntFeesGrp>
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        <ProgramServicesAmt>3804950</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1790564</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>65308</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30733</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>644267</ProgramServicesAmt>
        <ManagementAndGeneralAmt>303184</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
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        <ProgramServicesAmt>593562</ProgramServicesAmt>
        <ManagementAndGeneralAmt>279324</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>2235256</ProgramServicesAmt>
        <ManagementAndGeneralAmt>248362</ManagementAndGeneralAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>0</TotalAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>0</TotalAmt>
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      <PaymentsToAffiliatesGrp>
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        <ProgramServicesAmt>421103</ProgramServicesAmt>
        <ManagementAndGeneralAmt>198166</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>246185</TotalAmt>
        <ProgramServicesAmt>167406</ProgramServicesAmt>
        <ManagementAndGeneralAmt>78779</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>1032523</TotalAmt>
        <ProgramServicesAmt>1032523</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>BAD DEBT EXPENSE</Desc>
        <TotalAmt>795644</TotalAmt>
        <ProgramServicesAmt>795644</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>OTHER EXPENSES</Desc>
        <TotalAmt>254791</TotalAmt>
        <ProgramServicesAmt>173258</ProgramServicesAmt>
        <ManagementAndGeneralAmt>81533</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>MEMBERSHIP DUES</Desc>
        <TotalAmt>54548</TotalAmt>
        <ProgramServicesAmt>37093</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17455</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>75520516</TotalAmt>
        <ProgramServicesAmt>59848596</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15671920</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>6174819</BOYAmt>
        <EOYAmt>10732882</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>0</BOYAmt>
        <EOYAmt>0</EOYAmt>
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        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KENNETH SCHONBACHLER</PersonNm>
        <TitleTxt>DIRECTOR OF BUS DEV &amp; PT TRANS</TitleTxt>
        <BaseCompensationFilingOrgAmt>139011</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>1948</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>13877</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>154836</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>HEALTH OR SOCIAL CLUB DUES</FormAndLineReferenceDesc>
        <ExplanationTxt>SCHEDULE J, PART I, LINE 1A AS PART OF THEIR COMPENSATION PACKAGE CERTAIN DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION ARE ENTITLED TO CHOOSE AS AN EXECUTIVE PERK THE BENEFIT OF BUSINESS RELATED SOCIAL DUES OR INITIATION FEES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>EXECUTIVE DEFERRED RETIREMENT PLAN</FormAndLineReferenceDesc>
        <ExplanationTxt>SCHEDULE J, PART I, QUESTION 4B DURING THE YEAR, THE FOLLOWING OFFICER LISTED ON FORM 990, PART VII, SECTION A PARTICIPATED IN THE EXECUTIVE DEFERRED RETIREMENT PLAN: DONALD BOYD. EMPLOYER AND EMPLOYEE CONTRIBUTIONS DURING THE YEAR TO THIS PLAN HAVE BEEN REPORTED, AS REQUIRED, ON SCHEDULE J, PART II, COLUMNS (B)(III) AND (C). DURING 2015, THE FOLLOWING OFFICER RECEIVED PAYMENTS UNDER AN EXECUTIVE DEFERRED RETIREMENT PLAN: DONALD BOYD $85,644.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>COMPENSATION ARRANGEMENT CONTINGENT ON NET EARNINGS OF THE ORGANIZATION</FormAndLineReferenceDesc>
        <ExplanationTxt>SCHEDULE J, PART I, QUESTION 6A THE ORGANIZATION PLACES A CERTAIN PORTION OF AN EXECUTIVES TOTAL AVAILABLE COMPENSATION AT RISK ANNUALLY AND A PROPORTION OF THAT AT-RISK AMOUNT IS DEPENDENT UPON CERTAIN OPERATING PERFORMANCE TARGETS OF THE ORGANIZATION, BOTH FINANCIAL AND NON-FINANCIAL. DURING 2014, CERTAIN FINANCIAL OPERATING TARGETS WHICH WERE SET BY THE COMPENSATION COMMITTEE OF KALELDA HEALTH (A RELATED NOT-FOR-PROFIT ORGANIZATION), INCLUDING TOTAL NET OPERATING MARGIN WERE MET AND EXCEEDED RESULTING IN COMPENSATION UNDER THIS ARRANGEMENT PAID TO OFFICERS DURING 2015.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART I, LINE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>VNA OF WNY IS A CERTIFIED HOME HEALTH AGENCY PROVIDING SKILLED NURSING SERVICES, REHABILITATION SERVICES AND TELEHEALTH HOME MONITORING PRIMARILY TO MEDICARE AND MEDICAID PATIENTS. IT ALSO OPERATES AN ADULT DAY CENTER. DESCRIPTION OF CLASSES OF MEMBERS &amp; MEMBER RIGHTS FORM 990, PART VI, QUESTION 6 THE ORGANIZATION IS A MEMBERSHIP (NOT A STOCK) CORPORATION UNDER NEW YORK STATE LAW THE ORGANIZATIONS SOLE CORPORATE MEMBER IS KALEIDA HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION. FORM 990 PART VI, QUESTION 7A IN ACCORDANCE WITH THE TERMS AND REQUIREMENTS OF ITS GOVERNING DOCUMENTS (I.E. BYLAWS), ON AN ANNUAL BASIS, THE ORGANIZATIONS CURRENT BOARD MEMBERS RECOMMEND THE LIST OF CANDIDATES FOR MEMBERSHIP TO THE GOVERNING BODY FOR THE SUBSEQUENT TERM TO THE EXECUTIVE COMMITTEE OF KALEIDA HEALTH. THE EXECUTIVE COMMITTEE OF KALEIDA HEALTH, AS THE REPRESENTATIVES OF THE ORGANIZATION SOLE CORPORATE MEMBER, APPROVES AND ELECTS THESE CANDIDATES TO SERVE AS THE ORGANIZATIONS BOARD OF DIRECTORS. FORM 990, PART VI, QUESTION 7B KALEIDA HEALTH, AS THE SOLE CORPORATE MEMBER, ALSO HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATIONS GOVERNING BODY INCLUDING THE AMENDMENT OF BYLAWS AND CHARTERS, REMOVAL OF MEMBERS OF THE GOVERNING BODY, AND THE DECISION TO DISSOLVE THE ORGANIZATION. DESCRIBE THE PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW 990 FORM 990, PART VI, QUESTION 11A THE FORM 990 IS REVIEWED BY THE ORGANIZATIONS MANAGEMENT IN CONSULATION WITH THE ORGANIZATIONS TAX ADVISORS, KPMG. THIS FINANCIAL REVIEW IS BASED ON THE ORGANIZATIONS AUDITED FINANCIAL STATEMENTS FOR THE RELECANT TIME PERIOD BEFORE THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE. THE ORGANIZATIONS BOARD OF DIRECTORS ARE ALSO PROVIDED A COMPLETE COPY OF THE FINAL FORM 990 FOR REVIEW PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, QUESTION 12C UPON EMPLOYMENT AND ANNUALLY THEREAFTER EACH KEY EMPLOYEE AND OFFICER OF THE ORGANIZATION IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST AND DISCLOSURE FORM, PROVIDING SUFFICIENT INFORMATION ABOUT HIS/HER PERSONAL INTERESTS AND RELATIONSHIPS SO THE ORGANIZATION CAN (1) DETERMINE WHETHER ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST MAY EXIST, AND (2) MONITOR WORK OR SERVICE ASSIGNMENTS TO AVOID PLACING THE KEY EMPLOYEE, OFFICER OR DIRECTOR IN A POSITION WHERE THERE MAY BE AN APPEARANCE, POTENTIAL OR ACTUAL, OF A CONFLICT OF INTEREST OR A QUESTION OF OBJECTIVITY. THE COMPLETED CONFLICT OF INTEREST AND DISCLOSURE FORMS FOR DIRECTORS ARE RETURNED TO THE ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>COMPENSATION APPROVAL PROCESS</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, QUESTION 15A &amp; 15B ON AN ANNUAL BASIS, THE ORGANIZATIONS MANAGEMENT TEAM REVIEWS AND APPROVES THE COMPENSATION PACKAGE OF THE ORGANIZATIONS KEY EMPLOYEES. THIS PROCESS ALSO INCLUDES A 360 PEER REVIEW. THE ORGANIZATIONS OFFICER COMPENSATION ARRANGEMENTS ARE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF KALEIDA HEALTH, A RELATED NOT-FOR-PROFIT ORGANIZATION AND SOLE MEMBER OF THE ORGANIZATION. INFORMATION REVIEWED FOR THE OFFICERS INCLUDES COMPARABLE DATA FROM SIMILAR SIZE TAX-EXEMPT ORGANIZATIONS IN THE WESTERN NEW YORK COMMUNITY AS WELL AS THE COMPENSATION FOR THESE POSITIONS (AS DISCLOSED ON FORM 990) WITH OTHER ORGANIZATIONS IN THE HEALTH CARE INDUSTRY THAT ARE OF SIMILAR SIZE, DEMOGRAPHICS AND GEOGRAPHY. REVIEW AND APPROVAL OF THE COMPENSATION ARRANGEMENT BY THE COMPENSATION COMMITTEE IS DOCUMENTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY &amp; FIN STMNTS TO GEN PUBLIC</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990, PART VI, QUESTION 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT THE OFFICES OF KALEIDA HEALTH (A RELATED NOT-FOR-PROFIT ORGANIZATION) AT 726 EXCHANGE STREET, SUITE 200, BUFFALO, NY 14210. A NOMINAL FEE IS CHARGED IF COPIES ARE REQUESTED.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 8</FormAndLineReferenceDesc>
        <ExplanationTxt>PRIOR PERIOD ADJUSTMENTS FINANCIAL STATEMENT ADJUSTMENT TO ACCOUNTS RECIEVABLE $-190,000</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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          <BusinessNameLine1Txt>Kaleida Health</BusinessNameLine1Txt>
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          <AddressLine1Txt>726 Exchange Street</AddressLine1Txt>
          <CityNm>Buffalo</CityNm>
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          <BusinessNameLine1Txt>Millard Fillmore Ambulatory Surgery Ctr</BusinessNameLine1Txt>
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          <AddressLine1Txt>726 Exchange Street</AddressLine1Txt>
          <CityNm>Buffalo</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14210</ZIPCd>
        </USAddress>
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        <PrimaryActivitiesTxt>Support Org</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        <PublicCharityStatusTxt>11A</PublicCharityStatusTxt>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VNA Home Care Services</BusinessNameLine1Txt>
        </DisregardedEntityName>
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          <AddressLine1Txt>726 Exchange Street</AddressLine1Txt>
          <CityNm>Buffalo</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14210</ZIPCd>
        </USAddress>
        <EIN>161491203</EIN>
        <PrimaryActivitiesTxt>Home Health</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        <PublicCharityStatusTxt>9</PublicCharityStatusTxt>
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        <ControlledOrganizationInd>false</ControlledOrganizationInd>
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      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
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          <CityNm>Buffalo</CityNm>
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        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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          <BusinessNameLine1Txt>KH</BusinessNameLine1Txt>
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          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <EIN>161579143</EIN>
        <PrimaryActivitiesTxt>Fundraising</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        <PublicCharityStatusTxt>7</PublicCharityStatusTxt>
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          <CityNm>Buffalo</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <EIN>161332044</EIN>
        <PrimaryActivitiesTxt>Fundraising</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Harlem Road Leasing</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>3435 Main Street</AddressLine1Txt>
          <CityNm>Buffalo</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14214</ZIPCd>
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        <EIN>205588135</EIN>
        <PrimaryActivitiesTxt>Equipment Leasing</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>N/A</PredominantIncomeTypeTxt>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Amton Imaging LLC</BusinessNameLine1Txt>
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          <AddressLine1Txt>199 Park Club Lane Suite 300</AddressLine1Txt>
          <CityNm>Williamsville</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <EIN>262925470</EIN>
        <PrimaryActivitiesTxt>Health Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>N/A</PredominantIncomeTypeTxt>
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      <IdRelatedOrgTxblPartnershipGrp>
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          <BusinessNameLine1Txt>Site E LLC</BusinessNameLine1Txt>
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          <AddressLine1Txt>726 Exchange Street Suite 200</AddressLine1Txt>
          <CityNm>Buffalo</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14210</ZIPCd>
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        <EIN>272124795</EIN>
        <PrimaryActivitiesTxt>Real Estate Mgmt</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        </DirectControllingEntityName>
        <PredominantIncomeTypeTxt>N/A</PredominantIncomeTypeTxt>
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      <IdRelatedOrgTxblPartnershipGrp>
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          <CityNm>Buffalo</CityNm>
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      <IdRelatedOrgTxblPartnershipGrp>
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          <BusinessNameLine1Txt>Southtowns Imaging LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>5959 Big Tree Road Suite 105</AddressLine1Txt>
          <CityNm>Orchard Park</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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      <IdRelatedOrgTxblPartnershipGrp>
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          <BusinessNameLine1Txt>Collaborative Care Ventures LLC</BusinessNameLine1Txt>
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          <CityNm>Buffalo</CityNm>
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        <PredominantIncomeTypeTxt>N/A</PredominantIncomeTypeTxt>
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      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Great Lakes Medical Billing Svcs LLC</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>199 Park Club Lane Suite 300</AddressLine1Txt>
          <CityNm>Williamsville</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <PredominantIncomeTypeTxt>N/A</PredominantIncomeTypeTxt>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Harlem Imaging LLC</BusinessNameLine1Txt>
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          <AddressLine1Txt>199 Park Club Lane Suite 300</AddressLine1Txt>
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        <PrimaryActivitiesTxt>Imaging Services</PrimaryActivitiesTxt>
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          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
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      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Altus Management LLC</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>840 Aero Drive Suite 150</AddressLine1Txt>
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      <IdRelatedOrgTxblCorpTrGrp>
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          <BusinessNameLine1Txt>Kaleida Properties Inc</BusinessNameLine1Txt>
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      <IdRelatedOrgTxblCorpTrGrp>
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        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Kaleida Healthnow Inc</BusinessNameLine1Txt>
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        <EntityTypeTxt>C Corp</EntityTypeTxt>
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      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
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      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>true</LoansOrGuaranteesFromOthOrgInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>