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      <OtherExpenses>
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        <ManagementAndGeneral>261</ManagementAndGeneral>
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      <InfoInScheduleOPartXI>X</InfoInScheduleOPartXI>
      <ReconcilationRevenueExpenses>85120</ReconcilationRevenueExpenses>
      <ReconcilationOtherChanges>188248</ReconcilationOtherChanges>
      <MethodOfAccountingAccrual>X</MethodOfAccountingAccrual>
      <AccountantCompileOrReview>false</AccountantCompileOrReview>
      <FSAudited>true</FSAudited>
      <FSAuditedBasis>
        <FinancialStatementConsolidated>X</FinancialStatementConsolidated>
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      <AuditCommittee>false</AuditCommittee>
      <FederalGrantAuditRequired>false</FederalGrantAuditRequired>
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        <CurrentTaxYearMinus2Years>6996</CurrentTaxYearMinus2Years>
        <CurrentTaxYearMinus1Year>6440</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>6143</CurrentTaxYear>
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        <CurrentTaxYearMinus1Year>1905784</CurrentTaxYearMinus1Year>
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      <GrossReceiptsFromNonUBI>
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      <TaxRevLeviedForOrgBenefit509>
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      <ValueOfSvcsFcltsFurnishdByGovt>
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      </ValueOfSvcsFcltsFurnishdByGovt>
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        <CurrentTaxYearMinus3Years>2220499</CurrentTaxYearMinus3Years>
        <CurrentTaxYearMinus2Years>2112544</CurrentTaxYearMinus2Years>
        <CurrentTaxYearMinus1Year>1912224</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>2261838</CurrentTaxYear>
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      <AmtsRecdFromDisqualPersons>
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      </AmtsRecdFromDisqualPersons>
      <AmtsFromSubstContributors>
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      <SupportFromDQPsEtc>
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      </SupportFromDQPsEtc>
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      <GrossInvestmentIncome509>
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        <CurrentTaxYear>996</CurrentTaxYear>
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      <Post1975UBTI>
        <Total>0</Total>
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        <CurrentTaxYearMinus1Year>1912742</CurrentTaxYearMinus1Year>
        <CurrentTaxYear>2262834</CurrentTaxYear>
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      <PublicSupportPercentage509>0.99986</PublicSupportPercentage509>
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      <InvestmentIncomePercentage>0.00014</InvestmentIncomePercentage>
      <PriorYrInvestIncomePercentage>0.00010</PriorYrInvestIncomePercentage>
      <ThirtyThreePercntTestsCY509>X</ThirtyThreePercntTestsCY509>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="IRS990ScheduleB">
      <ContributorInfo>
        <ContributorNumber>RESTRICTED</ContributorNumber>
        <ContributorNameBusiness>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorNameBusiness>
        <ContributorAddressUS>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorAddressUS>
        <AggregateContributions>RESTRICTED</AggregateContributions>
      </ContributorInfo>
    </IRS990ScheduleB>
    <IRS990ScheduleC documentId="IRS990ScheduleC">
      <TotalGrassrootsLobbying />
      <TotalDirectLobbying />
      <TotalLobbyingExpenditures />
      <OtherExemptPurposeExpenditures />
      <TotalExemptPurposeExpenditures />
      <LobbyingNontaxableAmount />
      <GrassrootsNontaxableAmount />
      <TotLobbyingGrassrootMinusNonTx />
      <TotLobbyExpendMnsLobbyingNontx />
      <Volunteers>false</Volunteers>
      <PaidStaffOrManagement>false</PaidStaffOrManagement>
      <MediaAdvertisements>false</MediaAdvertisements>
      <MailingsMembers>false</MailingsMembers>
      <PublicationsOrBroadcast>false</PublicationsOrBroadcast>
      <GrantsOtherOrganizations>false</GrantsOtherOrganizations>
      <DirectContactLegislators>false</DirectContactLegislators>
      <RalliesDemonstrations>false</RalliesDemonstrations>
      <OtherActivities>true</OtherActivities>
      <OtherActivitiesAmount>525</OtherActivitiesAmount>
      <TotalLobbyingExpendituresIIB>525</TotalLobbyingExpendituresIIB>
      <NotDescribedIn501c3>false</NotDescribedIn501c3>
      <Form990ScheduleCPartIV>
        <Identifier>LOBBYING ACTIVITIES</Identifier>
        <ReturnReference>SCHEDULE C, PART II-B, LINE 1I</ReturnReference>
        <Explanation>THE ORGANIZATION IS A MEMBER OF PENNSYLVANIA HOMECARE ASSOCIATION, OF WHICH $525, OR 20%, OF ITS $2,625 DUES ARE RELATED TO LOBBYING COSTS.</Explanation>
      </Form990ScheduleCPartIV>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="IRS990ScheduleD">
      <ArtPublicExhibitionAmts />
      <HeldWorksOfArtAmts />
      <CurrentYearMinus3Years />
      <CurrentYearMinus4Years />
      <Land />
      <Buildings />
      <LeaseholdImprovements>
        <OtherCostOrOtherBasis>33412</OtherCostOrOtherBasis>
        <Depreciation>20948</Depreciation>
        <BookValue>12464</BookValue>
      </LeaseholdImprovements>
      <Equipment>
        <OtherCostOrOtherBasis>49989</OtherCostOrOtherBasis>
        <Depreciation>31340</Depreciation>
        <BookValue>18649</BookValue>
      </Equipment>
      <OtherLandBuildings />
      <TotalOfBookValueLandBuildings>31113</TotalOfBookValueLandBuildings>
      <FederalIncomeTaxLiability>0</FederalIncomeTaxLiability>
      <OtherLiabilities>
        <Description>DUE TO AFFILIATES</Description>
        <Amount>217049</Amount>
      </OtherLiabilities>
      <TotalOfAmounts>217049</TotalOfAmounts>
      <TotRevenueEtcAuditedFinclStmt>2428272</TotRevenueEtcAuditedFinclStmt>
      <OtherRevenues>165438</OtherRevenues>
      <RevenueNotRptdF990>165438</RevenueNotRptdF990>
      <RevenueSubtotal>2262834</RevenueSubtotal>
      <TotalRevenuePerForm990>2262834</TotalRevenuePerForm990>
      <TotExpensesEtcAuditedFinclStmt>2154904</TotExpensesEtcAuditedFinclStmt>
      <ExpensesSubtotal>2154904</ExpensesSubtotal>
      <OtherExpensesNotIncluded>22810</OtherExpensesNotIncluded>
      <ExpensesNotRptdOnFinStmt>22810</ExpensesNotRptdOnFinStmt>
      <TotalExpensesPerForm990>2177714</TotalExpensesPerForm990>
      <Form990ScheduleDPartXIII>
        <Identifier>UNCERTAIN TAX POSITIONS</Identifier>
        <ReturnReference>SCHEDULE D, PART X, LINE 2</ReturnReference>
        <Explanation>MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.</Explanation>
      </Form990ScheduleDPartXIII>
      <Form990ScheduleDPartXIII>
        <Identifier>OTHER REVENUE INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART VIII, LINE 12</Identifier>
        <ReturnReference>SCHEDULE D, PART XI, LINE 2D</ReturnReference>
        <Explanation>TRANSFER FROM AFFILIATE $188,248 BAD DEBT EXPENSE (22,810) --------- TOTAL $165,438</Explanation>
      </Form990ScheduleDPartXIII>
      <Form990ScheduleDPartXIII>
        <Identifier>OTHER EXPENSES INCLUDED ON FORM 990, PART IX, LINE 25, BUT NOT ON LINE 1</Identifier>
        <ReturnReference>SCHEDULE D, PART XII, LINE 4B</ReturnReference>
        <Explanation>BAD DEBT EXPENSE $22,810</Explanation>
      </Form990ScheduleDPartXIII>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO">
      <GeneralExplanation>
        <Identifier>MISSION</Identifier>
        <ReturnReference>FORM 990, PART III, LINE 1</ReturnReference>
        <Explanation>COMMUNITY NURSES HOME SUPPORT SERVICES, INC. IS A PRIVATE DUTY AGENCY, DUAL-LICENSED IN HOME HEALTH AND HOME CARE IN NORTHWESTERN PA. THEY PROVIDE FOR LIMITED HOME HEALTH SERVICES, SUCH AS LAB DRAWS AND MEDICATION MANAGEMENT, FOR THOSE INDIVIDUALS FINDING IT DIFFICULT TO TRAVEL. THEY PROVIDE FOR HOME CARE SERVICES SUCH AS PERSONAL CARE/BATHING, MEAL PREPARATION, HOUSEKEEPING, AND MEDICATION REMINDERS TO ALLOW PATIENTS TO REMAIN COMFORTABLY IN THEIR HOMES. FOR THOSE THAT DESIRE SOCIALIZATION, OUR ADULT DAY SERVICES PROVIDE FOR SUPERVISED CARE AND ACTIVITIES TO ENGAGE THE CLIENTS BOTH MENTALLY AND EMOTIONALLY. COMMUNITY NURSES, INC. AND ITS SUBSIDIARIES BELIEVE IN PROVIDING SERVICES ALONG THE CONTINUUM OF CARE TO ALLOW INDIVIDUALS OF EVERY AGE TO REMAIN IN THE COMFORT OF THEIR HOMES FOR AS LONG AS THEY SO CHOOSE.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>MANAGEMENT CONTROL</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINE 3</ReturnReference>
        <Explanation>THE ORGANIZATION'S NON-PROFIT, EXEMPT, PARENT ORGANIZATION, COMMUNITY NURSES, INC., PROVIDES MANAGEMENT SERVICES TO COMMUNITY NURSES HOME HEALTH SUPPORT SERVICES, INC.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>SIGNIFICANT CHANGES TO BYLAWS</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINE 4</ReturnReference>
        <Explanation>THE BYLAWS OF THE ORGANIZATION WERE AMENDED TO ALIGN WITH THE REQUIREMENTS OF THE AFFILIATION THAT TOOK PLACE WITH PENN HIGHLANDS HEALTHCARE EFFECTIVE 7/1/13.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>MEMBERS</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION A, LINE 6, 7A, 7B</ReturnReference>
        <Explanation>THE ORGANIZATION'S PARENT ORGANIZATION IS COMMUNITY NURSES, INC. (CNI). AS THE PARENT ORGANIZATION, CNI APPOINTS THE ORGANIZATION'S BOARD OF DIRECTORS AND HAS FINAL APPROVAL RIGHTS OVER THE FOLLOWING ACTIONS THAT MAY BE TAKEN BY THE ORGANIZATION'S BOARD: APPROVE THE APPOINTMENT OF THE CHAIRMAN OF THE BOARD, APPROVE ANY AMENDMENTS TO THE ORGANIZATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY BECOME EFFECTIVE, APPROVE ALL OPERATING AND CAPITAL BUDGETS OF THE ORGANIZATION, AND APPROVE ANY MERGER CONSOLIDATION, DIVISION, LIQUIDATION, DISSOLUTION, WINDING UP, OR SALE OF ALL OR SUBSTANTIALLY ALL THE ASSETS OF THE ORGANIZATION.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>FORM 990 REVIEW PROCESS</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 11B</ReturnReference>
        <Explanation>THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A DRAFT OF THE 990 IS THOROUGHLY REVIEWED BY THE CFO AND CEO. AFTER ALL CHANGES ARE MADE, IT IS PRESENTED TO THE BOARD OF DIRECTORS BEFORE BEING FILED.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>CONFLICT OF INTEREST POLICY COMPLIANCE</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINE 12C</ReturnReference>
        <Explanation>EVERY YEAR, A QUESTIONNAIRE REGARDING BUSINESS AND FAMILY RELATIONSHIPS IS GIVEN TO THE BOARD OF DIRECTORS &amp; OFFICERS. THESE QUESTIONNAIRES ARE THEN REVIEWED AND ANY CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE BOARD. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST MUST ABSTAIN FROM VOTING ON ANY ISSUES RELATED TO THAT CONFLICT.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>COMPENSATION DETERMINATION</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION B, LINES 15A &amp; 15B</ReturnReference>
        <Explanation>SALARIES ARE REVIEWED ANNUALLY DURING THE BUDGET PROCESS, COMPARED TO THE HOME CARE SALARY &amp; BENEFITS REPORT PRODUCED BY THE NATIONAL ASSOCIATION OF HOMECARE FOR REASONABLENESS, AND APPROVED BY THE BOARD OF DIRECTORS. THE CEO'S AND CFO'S COMPENSATION ARE SPECIFICALLY APPROVED BY THE BOARD.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>GOVERNING DOCUMENT AVAILABILITY</Identifier>
        <ReturnReference>FORM 990, PART VI, SECTION C, LINE 19</ReturnReference>
        <Explanation>THE ARTICLES OF INCORPORATION ARE AVAILABLE ON THE PENNSYLVANIA DEPARTMENT OF STATE'S WEBSITE. ALL DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>OTHER CHANGES IN NET ASSETS</Identifier>
        <ReturnReference>FORM 990, PART XI, LINE 9</ReturnReference>
        <Explanation>TRANSFER FROM AFFILIATE $188,248</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
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          <BusinessNameLine1>ELK REGIONAL HEALTH CENTER</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>763 JOHNSONBURG ROAD</AddressLine1>
          <City>ST MARYS</City>
          <State>PA</State>
          <ZIPCode>15857</ZIPCode>
        </AddressUS>
        <EIN>250585280</EIN>
        <PrimaryActivities>HEALTH CARE</PrimaryActivities>
        <LegalDomicileState>PA</LegalDomicileState>
        <ExemptCodeSection>501(C)(3)</ExemptCodeSection>
        <PublicCharityStatus>3</PublicCharityStatus>
        <DirectControllingEntityName>
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        </DirectControllingEntityName>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
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          <BusinessNameLine1>ELK REGIONAL HEALTH SYSTEM FOUNDATION</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>763 JOHNSONBURG ROAD</AddressLine1>
          <City>ST MARYS</City>
          <State>PA</State>
          <ZIPCode>15857</ZIPCode>
        </AddressUS>
        <EIN>251636685</EIN>
        <PrimaryActivities>SUPPORT</PrimaryActivities>
        <LegalDomicileState>PA</LegalDomicileState>
        <ExemptCodeSection>501(C)(3)</ExemptCodeSection>
        <PublicCharityStatus>11 A I</PublicCharityStatus>
        <DirectControllingEntityName>
          <BusinessNameLine1>ERHS</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
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          <BusinessNameLine1>ELCO HOUSING</BusinessNameLine1>
        </NameOfDisregardedEntity>
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          <AddressLine1>759 JOHNSONBURG ROAD</AddressLine1>
          <City>ST MARYS</City>
          <State>PA</State>
          <ZIPCode>15857</ZIPCode>
        </AddressUS>
        <EIN>251639115</EIN>
        <PrimaryActivities>HOUSING</PrimaryActivities>
        <LegalDomicileState>PA</LegalDomicileState>
        <ExemptCodeSection>501(C)(3)</ExemptCodeSection>
        <PublicCharityStatus>7</PublicCharityStatus>
        <DirectControllingEntityName>
          <BusinessNameLine1>ERHS</BusinessNameLine1>
        </DirectControllingEntityName>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>ELK REGIONAL PROFESSIONAL GROUP INC</BusinessNameLine1>
        </NameOfDisregardedEntity>
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          <City>ST MARYS</City>
          <State>PA</State>
          <ZIPCode>15857</ZIPCode>
        </AddressUS>
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        <PrimaryActivities>HEALTH CARE</PrimaryActivities>
        <LegalDomicileState>PA</LegalDomicileState>
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        <PublicCharityStatus>3</PublicCharityStatus>
        <DirectControllingEntityName>
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        </DirectControllingEntityName>
        <ControlledOrg>false</ControlledOrg>
      </Form990ScheduleRPartII>
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        </NameOfDisregardedEntity>
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          <City>ST MARYS</City>
          <State>PA</State>
          <ZIPCode>15857</ZIPCode>
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          <BusinessNameLine1>ERHS</BusinessNameLine1>
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          <City>ST MARYS</City>
          <State>PA</State>
          <ZIPCode>15857</ZIPCode>
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          <City>ST MARYS</City>
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      <GiftGrantOrCapContrToOtherOrg>false</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>false</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>false</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>false</LoansOrGuaranteesFromOtherOrg>
      <DividendsRelatedOrganization>false</DividendsRelatedOrganization>
      <SaleOfAssetsToOtherOrg>false</SaleOfAssetsToOtherOrg>
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      <ExchangeOfAssets>false</ExchangeOfAssets>
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      <OtherTransferToOtherOrg>true</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>false</OtherTransferFromOtherOrg>
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</Return>