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        <FormAndLineReferenceDesc>PART V, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOUNDATION HOLDS A PERMANENT ENDOWMENT TO BE MAINTAINED IN PERPETUITY TO GENERATE INCOME TO SUPPORT THE OPERATIONS OF VISITING NURSE FOUNDATION AND ITS AFFILIATED ENTITIES.</ExplanationTxt>
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        <ExplanationTxt>THE ASSOCIATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ASSOCIATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022 AND 2021, THE ASSOCIATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED.</ExplanationTxt>
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        <ExplanationTxt>DIRECTORS, OFFICERS AND KEY EMPLOYEES COMPLETE AND SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. ELECTRONIC COPIES ARE KEPT IN THE ADMINISTRATIVE OFFICE. MEMBERS OF THE BOARD OF DIRECTORS ARE AWARE OF THE POLICY AND EXCUSE THEMSELVES FROM THE VOTE WHEN APPROPRIATE. THE CONFLICT OF INTEREST POLICY STATEMENTS ARE REVIEWED BY THE PRESIDENT AND CEO, WHO MAKES HIMSELF AWARE OF ANY POTENTIAL CONFLICTS THAT MAY ARISE. ALL MEMBERS OF THE BOARD OF DIRECTORS AND LEADERSHIP TEAM COMPLETE AND SIGN CONFLICT OF INTEREST STATEMENTS. BOARD MEMBERS ARE REQUIRED BY THE ORGANIZATION'S BYLAWS TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST OR CONFLICT OF INTEREST TRANSACTIONS TO BE APPROVED BY BOARD VOTE.</ExplanationTxt>
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        <ExplanationTxt>THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS APPROVES THE COMPENSATION FOR THE CEO. SALARY COMPARISONS ARE CONDUCTED WHEN DETERMINED NECESSARY BY THE COMMITTEE; A PAID COMPARABILITY STUDY HAS BEEN USED, AND REVIEWS OF COMPARABLE ORGANIZATIONS' FORMS 990 HAVE BEEN DONE IN THE PAST, THE MOST RECENT IN 2021. A PERFORMANCE EVALUATION PROCESS IS COMPLETED ANNUALLY BY THE BOARD OF DIRECTORS AND THE EXECUTIVE COMMITTEE MAKES THE FINAL DETERMINATION ON THE CEO'S SALARY BASED ON THE EVALUATION PROCESS. ALL DISCUSSIONS ARE RECORDED IN COMMITTEE MINUTES.</ExplanationTxt>
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        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VII, SECTION B; FORM 990 PART VIII; AND FORM 990 PART IX:</FormAndLineReferenceDesc>
        <ExplanationTxt>VISITING NURSE FOUNDATION (VNF) SHARES ITS FACILITY, ITS EMPLOYEES AND OTHER EXPENSES WITH FIVE RELATED ORGANIZATIONS: VISITING NURSE ASSOCIATION OF THE MIDLANDS, VISITING NURSE HEALTH SERVICES, VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, EASTER SEAL SOCIETY OF NEBRASKA, INC., AND VNA HOSPICE OF SOUTHWEST IOWA. VNF PAYS MANAGEMENT FEES TO THOSE ORGANIZATIONS. FEES PAID ARE REPORTED ON PART IX, LINE 11A. AS THE FEES ARE PAID TO A RELATED OPERATING CHARITABLE ENTITY, THE MANAGEMENT FEES PAID ARE NOT REPORTED AS AN INDEPENDENT CONTRACTOR PAYMENT ON PART VII, SECTION B.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FINANCE AND AUDIT COMMITTEE IS RESPONSIBLE FOR EVALUATION AND OVERSIGHT OF THE FINANCIAL NEEDS AND STATUS OF THE VNA AND FOR THE ESTABLISHMENT AND REVIEW OF POLICIES DESIGNED TO MEET SUCH NEEDS. THE COMMITTEE REVIEWS AND RECOMMENDS APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS, REVIEWS AND RECOMMENDS APPROVAL TO THE VNA BOARD OF MONTHLY FINANCIAL PROGRESS TOWARD ANNUAL BUDGET PLANS AS REPORTED BY STAFF, ENSURES ACCURACY OF FINANCIAL REPORTING INCLUDING MONITORING OF INTERNAL CONTROLS, OVERSEES THE ACCOUNTING AND FINANCIAL REPORTING PROCESS AND THE INDEPENDENT AUDIT OF THE FINANCIAL STATEMENTS AND SELECTS, OVERSEES AND COMPENSATES THE EXTERNAL AUDITORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VISITING NURSE ASSOCIATION OF THE MIDLANDS</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>12565 WEST CENTER ROAD STE 100</AddressLine1Txt>
          <CityNm>OMAHA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68144</ZIPCd>
        </USAddress>
        <EIN>470690207</EIN>
        <PrimaryActivitiesTxt>HOME CARE, HOSPICE, PHARMACY</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NE</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VISITING NURSE HEALTH SERVICES</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VISITING NURSE HEALTH SERVICES</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>12565 WEST CENTER ROAD STE 100</AddressLine1Txt>
          <CityNm>OMAHA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68144</ZIPCd>
        </USAddress>
        <EIN>470690286</EIN>
        <PrimaryActivitiesTxt>COMMUNITY, PUBLIC HEALTH</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NE</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>822 S MAIN SUITE 102</AddressLine1Txt>
          <CityNm>COUNCIL BLUFFS</CityNm>
          <StateAbbreviationCd>IA</StateAbbreviationCd>
          <ZIPCd>51503</ZIPCd>
        </USAddress>
        <EIN>420681048</EIN>
        <PrimaryActivitiesTxt>HOME CARE, PUBLIC HEALTH</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VISITING NURSE HEALTH SERVICES</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>EASTER SEAL SOCIETY OF NEBRASKA INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>12565 WEST CENTER ROAD STE 100</AddressLine1Txt>
          <CityNm>OMAHA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68144</ZIPCd>
        </USAddress>
        <EIN>470457872</EIN>
        <PrimaryActivitiesTxt>DISABILITY ASSISTANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NE</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VISITING NURSE HEALTH SERVICES</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VNA HOSPICE OF SOUTHWEST IOWA</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>12565 WEST CENTER ROAD STE 100</AddressLine1Txt>
          <CityNm>OMAHA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68144</ZIPCd>
        </USAddress>
        <EIN>470733773</EIN>
        <PrimaryActivitiesTxt>HOSPICE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>IA</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 10</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>VISITING NURSE HEALTH SERVICES</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>1</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</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>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VISITING NURSE ASSOCIATION OF THE MIDLANDS</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>P</TransactionTypeTxt>
        <InvolvedAmt>582058</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VISITING NURSE ASSOCIATION OF THE MIDLANDS</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>E</TransactionTypeTxt>
        <InvolvedAmt>11448514</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>R</TransactionTypeTxt>
        <InvolvedAmt>53899</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FAIR MARKET VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE R, PAGE 3, PART V, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>VISITING NURSE FOUNDATION SHARES ITS FACILITY WITH FIVE AFFILIATES, EASTER SEAL SOCIETY OF NEBRASKA, INC., VISITING NURSE ASSOCIATION OF THE MIDLANDS, VNA HOSPICE OF SOUTHWEST IOWA, VISITING NURSE ASSOCIATION OF POTTAWATTAMIE COUNTY, AND VISITING NURSE HEALTH SERVICES. USE OF THE FACILITY BY THE FIVE ORGANIZATIONS OVERLAPS. THEREFORE, IT IS DIFFICULT TO QUANTIFY THE COST OF THE PORTION USED BY EACH ORGANIZATION.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
