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        <ExclusionAmt>1694</ExclusionAmt>
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        <TotalRevenueColumnAmt>57577629</TotalRevenueColumnAmt>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
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        <ManagementAndGeneralAmt>20067</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>53546</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>114802</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>101639</ManagementAndGeneralAmt>
        <FundraisingAmt>1323</FundraisingAmt>
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        <ManagementAndGeneralAmt>46843</ManagementAndGeneralAmt>
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        <Desc>Program Supplies</Desc>
        <TotalAmt>640925</TotalAmt>
        <ProgramServicesAmt>640925</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Printing &amp; Publications</Desc>
        <TotalAmt>311734</TotalAmt>
        <ProgramServicesAmt>267284</ProgramServicesAmt>
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        <FundraisingAmt>1996</FundraisingAmt>
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      <OtherExpensesGrp>
        <Desc>Postage and Shipping</Desc>
        <TotalAmt>244069</TotalAmt>
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        <ManagementAndGeneralAmt>33240</ManagementAndGeneralAmt>
        <FundraisingAmt>1562</FundraisingAmt>
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      <OtherExpensesGrp>
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        <FundraisingAmt>1080</FundraisingAmt>
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        <ManagementAndGeneralAmt>5538</ManagementAndGeneralAmt>
        <FundraisingAmt>260</FundraisingAmt>
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        <ProgramServicesAmt>46892400</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10007253</ManagementAndGeneralAmt>
        <FundraisingAmt>304604</FundraisingAmt>
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        <EOYAmt>1929366</EOYAmt>
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        <EOYAmt>23851276</EOYAmt>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>373372</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>875217</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
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        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
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        <CurrentTaxYearMinus3YearsAmt>1290105</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>784401</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1015854</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>196512</CurrentTaxYearAmt>
        <TotalAmt>4597881</TotalAmt>
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        <CurrentTaxYearMinus2YearsAmt>39774352</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>50048262</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>57379423</CurrentTaxYearAmt>
        <TotalAmt>218046008</TotalAmt>
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      <Total509Grp>
        <CurrentTaxYearMinus4YearsAmt>38474374</CurrentTaxYearMinus4YearsAmt>
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        <CurrentTaxYearMinus2YearsAmt>40558753</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>51064116</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>57575935</CurrentTaxYearAmt>
        <TotalAmt>222643889</TotalAmt>
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      <AmountsRcvdDsqlfyPersonGrp>
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      <SubstantialContributorsAmtGrp>
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        <CurrentTaxYearMinus1YearAmt>229538</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1694</CurrentTaxYearAmt>
        <TotalAmt>1559353</TotalAmt>
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        <CurrentTaxYearMinus2YearsAmt>503166</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>229538</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1694</CurrentTaxYearAmt>
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      <InvestmentIncomePYPct>0.00890</InvestmentIncomePYPct>
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    <IRS990ScheduleD documentId="RetDoc1040000001">
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      <EquipmentGrp>
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      <TotalBookValueLandBuildingsAmt>2070937</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
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        <BookValueAmt>2450</BookValueAmt>
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      <OtherAssetsOrgGrp>
        <Desc>Due From Affiliates</Desc>
        <BookValueAmt>7691372</BookValueAmt>
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      <TotalBookValueOtherAssetsAmt>7693822</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Due To Affiliates</Desc>
        <Amt>12851523</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Due To Third-Party Payers</Desc>
        <Amt>467309</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>13318832</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
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      <OtherRevenueAmt>875217</OtherRevenueAmt>
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      <RevenueSubtotalAmt>57577629</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>57577629</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>57204257</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>57204257</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>57204257</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The organizations included in these consolidated financial statements, excluding VNA Private Care, Inc. are qualified as public charities under Section 501 (c)(3) of the Internal Revenue Code. As public charities, 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 position and concluded that the Association has no unrelated business income or uncertain tax positions that require adjustment to the consolidated financial statements.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Assets Transferred from VNA Care Network Foundation 875,217.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
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      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
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      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Mary Ann O'Connor</PersonNm>
        <TitleTxt>President &amp; CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>294031</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>69525</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>63893</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>57893</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>14918</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>500260</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Stephanie Jackman-Havey</PersonNm>
        <TitleTxt>CFO &amp; COO</TitleTxt>
        <BaseCompensationFilingOrgAmt>0</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>170685</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>19315</BonusRelatedOrganizationsAmt>
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        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
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        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>0</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>190000</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Lisa Lessard</PersonNm>
        <TitleTxt>Physical Therapist/PD</TitleTxt>
        <BaseCompensationFilingOrgAmt>167929</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>0</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>167929</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
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      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The sole corporate member shall be VNA Care Network Foundation, Inc. acting through its board of directors except as otherwise provided herein.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>The VNA Care Network Foundation, Inc. shall elect and may remove or suspend directors, shall have all rights to vote with respect to the affairs of the Corporation, and shall have such other powers as provided by law, the Articles of Organization or the By-Laws.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>The VNA Care Network Foundation, Inc. shall elect and may remove or suspend directors, shall have all rights to vote with respect to the affairs of the Corporation, and shall have such other powers as provided by law, the Articles of Organization or the By-Laws.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>990 compiled and reviewed by the CEO and CFO and sent to the Finance Committee for review. The Finance Committee presents to the board for approval. Board members offered a copy of the 990 at that time.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Annually the Board is asked to sign a conflict of interest statement. Also, at the beginning of all Board meetings the Board chair asks if there is any conflicts with any of the agenda items.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>The Executive Compensation Committee made up of independent board members obtain a competive salary survey from an outside independent source. The Executive Compensation Committee then deliberates and decides on the executive compensation. Other officers and key employees are determined by the CEO and the executive committee. This is based on comparable data that was obtained by a competitive salary survey from an outside independent source.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Financial statements are attached to the MA Form PC filed with the attorney general's office, which is open to public inspection. The articles of organization are available at the Massachusetts Secretary of State's office, including on-line. Other governing documents and the conflicts of interest policy are not generally available to the public. Requests for copies of such documents are considered on a case by case basis.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part X, Line 10: Land, Buildings, and Equipment</FormAndLineReferenceDesc>
        <ExplanationTxt>Section 1.263(a)-3(n) Election: VNA Care Network, Inc. 120 Thomas Street, Worcester, MA 01608-1280 EIN 04-2103825 VNA Care Network, Inc. is electing to capitalize repair and maintenance costs under Regulation Section 1.263(a)-3(n).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Assets Transferred from VNA Care Network Foundation 875,217.</ExplanationTxt>
      </SupplementalInformationDetail>
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        <EIN>201916670</EIN>
        <PrimaryActivitiesTxt>Private Duty Home Care</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>MA</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Massachusetts Assurance Company LTD</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <ForeignAddress>
          <AddressLine1Txt>First Caribbean House George Town</AddressLine1Txt>
          <CityNm>Grand Cayman</CityNm>
          <CountryCd>CJ</CountryCd>
        </ForeignAddress>
        <PrimaryActivitiesTxt>Insurance</PrimaryActivitiesTxt>
        <LegalDomicileForeignCountryCd>CJ</LegalDomicileForeignCountryCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>1</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>1</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>0</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>0</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
    </IRS990ScheduleR>
  </ReturnData>
</Return>