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        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ARTHUR MULLIGAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ALAN COLAVECCHIO</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>3.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ELLEN DURSTIN</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>3.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LOUISE VAN ALSTYNE</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MONICA DIULIO</PersonNm>
        <TitleTxt>TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>3.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>987819</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>50309</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>15</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <AllOtherContributionsAmt>2007695</AllOtherContributionsAmt>
      <TotalContributionsAmt>2007695</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>HEALTH CARE SERVICES</Desc>
        <BusinessCd>621610</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>10897179</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>HOME ASSISTANCE</Desc>
        <BusinessCd>621610</BusinessCd>
        <TotalRevenueColumnAmt>4104186</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>4104186</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
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      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>687853</TotalRevenueColumnAmt>
        <ExclusionAmt>687853</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>4292646</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
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      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>-160590</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-160590</TotalRevenueColumnAmt>
        <ExclusionAmt>-160590</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>17536323</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>15001365</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>527263</ExclusionAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>270994</TotalAmt>
        <ProgramServicesAmt>181566</ProgramServicesAmt>
        <ManagementAndGeneralAmt>89428</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>10424662</TotalAmt>
        <ProgramServicesAmt>6984524</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3440138</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>383038</TotalAmt>
        <ProgramServicesAmt>256635</ProgramServicesAmt>
        <ManagementAndGeneralAmt>126403</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>791149</TotalAmt>
        <ProgramServicesAmt>530070</ProgramServicesAmt>
        <ManagementAndGeneralAmt>261079</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>568580</TotalAmt>
        <ProgramServicesAmt>380949</ProgramServicesAmt>
        <ManagementAndGeneralAmt>187631</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>40438</TotalAmt>
        <ManagementAndGeneralAmt>40438</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>37727</TotalAmt>
        <ManagementAndGeneralAmt>37727</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>140840</TotalAmt>
        <ManagementAndGeneralAmt>140840</ManagementAndGeneralAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>72163</TotalAmt>
        <ProgramServicesAmt>48349</ProgramServicesAmt>
        <ManagementAndGeneralAmt>23814</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>97707</TotalAmt>
        <ProgramServicesAmt>65464</ProgramServicesAmt>
        <ManagementAndGeneralAmt>32243</ManagementAndGeneralAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>238565</TotalAmt>
        <ProgramServicesAmt>159839</ProgramServicesAmt>
        <ManagementAndGeneralAmt>78726</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>126267</TotalAmt>
        <ProgramServicesAmt>84599</ProgramServicesAmt>
        <ManagementAndGeneralAmt>41668</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>139588</TotalAmt>
        <ProgramServicesAmt>93524</ProgramServicesAmt>
        <ManagementAndGeneralAmt>46064</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>272370</TotalAmt>
        <ProgramServicesAmt>241594</ProgramServicesAmt>
        <ManagementAndGeneralAmt>30776</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>12103</TotalAmt>
        <ProgramServicesAmt>8109</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3994</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
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        <ProgramServicesAmt>66422</ProgramServicesAmt>
        <ManagementAndGeneralAmt>32715</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>23478</TotalAmt>
        <ProgramServicesAmt>15730</ProgramServicesAmt>
        <ManagementAndGeneralAmt>7748</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
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        <ProgramServicesAmt>505263</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES</Desc>
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        <ProgramServicesAmt>84658</ProgramServicesAmt>
        <ManagementAndGeneralAmt>41697</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>FUNDRAISING</Desc>
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        <FundraisingAmt>6744</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PAYROLL PROCESSING</Desc>
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        <ProgramServicesAmt>6423</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3164</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>9713718</ProgramServicesAmt>
        <ManagementAndGeneralAmt>4666293</ManagementAndGeneralAmt>
        <FundraisingAmt>6744</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
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        <EOYAmt>875</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>13813125</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <AccountsReceivableGrp>
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        <EOYAmt>1867051</EOYAmt>
      </AccountsReceivableGrp>
      <LandBldgEquipCostOrOtherBssAmt>2982133</LandBldgEquipCostOrOtherBssAmt>
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      <LandBldgEquipBasisNetGrp>
        <BOYAmt>1041710</BOYAmt>
        <EOYAmt>1584574</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>29934964</EOYAmt>
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      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
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      <DeferredRevenueGrp>
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      <TotalLiabilitiesGrp>
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        <EOYAmt>5631992</EOYAmt>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
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      <DonorRestrictionNetAssetsGrp>
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        <EOYAmt>4274296</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>41568597</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>34494817</BOYAmt>
        <EOYAmt>47200589</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>3149568</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>4881290</NetUnrlzdGainsLossesInvstAmt>
      <InvestmentExpenseAmt>140840</InvestmentExpenseAmt>
      <OtherChangesInNetAssetsAmt>224076</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="990A">
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        <CurrentTaxYearMinus4YearsAmt>40060</CurrentTaxYearMinus4YearsAmt>
        <CurrentTaxYearMinus3YearsAmt>275081</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>419263</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>1122533</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>2007695</CurrentTaxYearAmt>
        <TotalAmt>3864632</TotalAmt>
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      <GrossReceiptsAdmissionsGrp>
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        <CurrentTaxYearMinus1YearAmt>12536794</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>15001365</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus2YearsAmt>10703453</CurrentTaxYearMinus2YearsAmt>
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      <PublicSupportTotal509Amt>59478323</PublicSupportTotal509Amt>
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        <CurrentTaxYearMinus1YearAmt>297633</CurrentTaxYearMinus1YearAmt>
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      <TotalSupportCalendarYearGrp>
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      <PublicSupportPY509Pct>0.95380</PublicSupportPY509Pct>
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      <InvestmentIncomePYPct>0.03000</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="990B">
      <ContributorInformationGrp>
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        <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="990D">
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        <ContributionsAmt>11352</ContributionsAmt>
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        <EndYearBalanceAmt>29934964</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
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        <EndYearBalanceAmt>23863725</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
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        <EndYearBalanceAmt>19264707</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
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        <InvestmentEarningsOrLossesAmt>3428898</InvestmentEarningsOrLossesAmt>
        <AdministrativeExpensesAmt>22785</AdministrativeExpensesAmt>
        <EndYearBalanceAmt>19164291</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
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        <EndYearBalanceAmt>5485393</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <BoardDesignatedBalanceEOYPct>0.85740</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>0.00860</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.13400</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>false</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>false</EndowmentsHeldRelatedOrgInd>
      <LandGrp>
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        <BookValueAmt>469169</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>1986812</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>914020</DepreciationAmt>
        <BookValueAmt>1072792</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
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        <DepreciationAmt>483539</DepreciationAmt>
        <BookValueAmt>42613</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>1584574</TotalBookValueLandBuildingsAmt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Endowment funds intended uses (Part V, line 4)</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V LINE 4 USES OF ENDOWMENT FUNDS - AGENCY ENDOWMENT FUNDS ARE TO BE USED IN ACCORDANCE WITH DONOR INTENTIONS. PERMANENT AND TEMPORARY RESTRICTED FUNDS ARE TO BE USED FOR THE CARE OF INDIGENT AND HOSPICE PATIENTS. GENERAL PURPOSE UNRESTRICTED FUNDS ARE TO BE USED AS VOTED ON BY THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="990J">
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>MICHAEL CASELAS</PersonNm>
        <TitleTxt>EXECUTIVE DIRECTOR</TitleTxt>
        <BaseCompensationFilingOrgAmt>270994</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>18970</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>289964</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANN MARIE GARRISON</PersonNm>
        <TitleTxt>VP CLINICAL SERVICES</TitleTxt>
        <BaseCompensationFilingOrgAmt>177656</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>12436</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>190092</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>NANCY DEMING</PersonNm>
        <TitleTxt>CLINICAL MANAGER</TitleTxt>
        <BaseCompensationFilingOrgAmt>143973</BaseCompensationFilingOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>10078</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>154051</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="990O">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990 governing body review Part VI line 11</FormAndLineReferenceDesc>
        <ExplanationTxt>FORM 990 IS REVIEWED BY THE PRESIDENT OF THE BOARD AND CHAIRMAN OF THE FINANCE COMMITTEE PRIOR TO FILING</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Conflict of interest policy compliance Part VI line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>EVERY DIRECTOR AND OFFICER IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST AND NONDISCLOSURE AGREEMENT</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>CEO executive director top management comp Part VI line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTORS COMPENSATION IS DETERMINED ANNUALLY BY THE BOARD OF DIRECTORS AND IS BASED ON PERFORMANCE AND COMPARATIVE DATA OF SIMILAR POSITIONS IN LIKE ORGANIZATIONS</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Other officer or key employee compensation Part VI line 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION OF OTHER KEY EMPLOYEES IS DETERMINED ANNUALLY AND IS BASED ON PERFORMANCE AND COMPARATIVE DATA OF SIMILAR POSITIONS IN LIKE ORGANIZATIONS</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Governing documents etc available to public Part VI line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AGENCYS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, 990 AND OTHER PUBLIC INFORMATION ARE AVAILABLE FOR REVIEW AT THE AGENCYS OFFICE OR BY WRITTEN REQUEST</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Significant program services not listed on prior year return Part III line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>THE AGENCY ACQUIRED VNA VALLEY CARE DBA FARMINGTON VALLEY VNA, 8 OLD MILL LANE, SIMSBURY, CT ON OCTOBER 2, 2023.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Explanation of other changes in net assets or fund balances Part XI line 9</FormAndLineReferenceDesc>
        <ExplanationTxt>CONTRIBUTIONS TO TEMPORARILY RESTRICTED NET ASSETS $126,229INCOME/REALIZED GAINS FROM TEMPORARILY RESTRICTED NET ASSETS $97,847.......................................................TOTAL $224,076</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part VII response or note to any other line in Part VII</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COMPENSATION OF THE EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES IS DETERMINED ANNUALLY AND IS BASED ON PERFORMANCE AND COMPARATIVE DATA OF SIMILAR POSITIONS IN LIKE ORGANIZATIONS</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="990R">
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>LITCHFIELD COUNTY HOME ASSISTANCE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>32 UNION STREET</AddressLine1Txt>
          <CityNm>WINSTED</CityNm>
          <StateAbbreviationCd>CT</StateAbbreviationCd>
          <ZIPCd>06098</ZIPCd>
        </USAddress>
        <EIN>853475721</EIN>
        <PrimaryActivitiesTxt>HOME ASSISTANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CT</LegalDomicileStateCd>
        <TotalIncomeAmt>294752</TotalIncomeAmt>
        <EndOfYearAssetsAmt>730679</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VISITING NURSE &amp; HOSPICE LITCHFIELD CTY</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
      <IdDisregardedEntitiesGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>SVNA HOME ASSISTANCE</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>30A SALMON KILL ROAD</AddressLine1Txt>
          <CityNm>SALISBURY</CityNm>
          <StateAbbreviationCd>CT</StateAbbreviationCd>
          <ZIPCd>06068</ZIPCd>
        </USAddress>
        <EIN>455554944</EIN>
        <PrimaryActivitiesTxt>HOME ASSISTANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>CT</LegalDomicileStateCd>
        <TotalIncomeAmt>3809434</TotalIncomeAmt>
        <EndOfYearAssetsAmt>2045124</EndOfYearAssetsAmt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VISITING NURSE &amp; HOSPICE LITCHFIELD CTY</BusinessNameLine1Txt>
        </DirectControllingEntityName>
      </IdDisregardedEntitiesGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>