<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2020v4.1">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2021-11-15T15:23:19-06:00</ReturnTs>
    <TaxPeriodEndDt>2020-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>111986323</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>MARCUM LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>1899 L STREET NW SUITE 850</AddressLine1Txt>
        <CityNm>WASHINGTON</CityNm>
        <StateAbbreviationCd>DC</StateAbbreviationCd>
        <ZIPCd>20036</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2020-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>131893923</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>AMER</BusinessNameControlTxt>
      <PhoneNum>3016285167</PhoneNum>
      <USAddress>
        <AddressLine1Txt>8515 GEORGIA AVENUE NO 400</AddressLine1Txt>
        <CityNm>SILVER SPRING</CityNm>
        <StateAbbreviationCd>MD</StateAbbreviationCd>
        <ZIPCd>209103492</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>GREGORY DYSON</PersonNm>
      <PersonTitleTxt>CHIEF OPERATING OFFICER</PersonTitleTxt>
      <PhoneNum>3016285167</PhoneNum>
      <SignatureDt>2021-11-15</SignatureDt>
      <DiscussWithPaidPreparerInd>1</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <SigningOfficerGrp>
      <PersonFullName>
        <PersonFirstNm>GREGORY</PersonFirstNm>
        <PersonLastNm>DYSON</PersonLastNm>
      </PersonFullName>
      <SSN>XXX-XX-XXXX</SSN>
    </SigningOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>AARON M FOX</PreparerPersonNm>
      <PTIN>P01365820</PTIN>
      <PhoneNum>2022274000</PhoneNum>
    </PreparerPersonGrp>
    <AdditionalFilerInformation>
      <TrustedCustomerGrp>
        <TrustedCustomerCd>3</TrustedCustomerCd>
        <AuthenticationAssuranceLevelCd>AAL1</AuthenticationAssuranceLevelCd>
        <IdentityAssuranceLevelCd>IAL1</IdentityAssuranceLevelCd>
      </TrustedCustomerGrp>
    </AdditionalFilerInformation>
    <TaxYr>2020</TaxYr>
    <BuildTS>2022-09-23 18:48:47Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="9">
    <IRS990 documentId="RetDoc1038000001" referenceDocumentId="RetDoc1044400001">
      <AddressChangeInd>X</AddressChangeInd>
      <PrincipalOfficerNm>LORESSA COLE</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>8515 GEORGIA AVENUE NO 400</AddressLine1Txt>
        <CityNm>SILVER SPRING</CityNm>
        <StateAbbreviationCd>MD</StateAbbreviationCd>
        <ZIPCd>209103492</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>36295421</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>0</GroupReturnForAffiliatesInd>
      <Organization501cInd organization501cTypeTxt="6">X</Organization501cInd>
      <WebsiteAddressTxt>WWWW.NURSINGWORLD.ORG</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1917</FormationYr>
      <LegalDomicileStateCd>DC</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO ADVANCE AND PROMOTE THE IMPROVEMENT OF HEALTH STANDARDS AND THE STANDARDS OF NURSING.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>9</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>8</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>331</TotalEmployeeCnt>
      <TotalVolunteersCnt>700</TotalVolunteersCnt>
      <TotalGrossUBIAmt>138755</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>59506</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>2145706</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>3106728</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>29569168</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>26731457</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>667409</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>727162</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>2380284</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>1670401</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>34762567</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>32235748</CYTotalRevenueAmt>
      <PYGrantsAndSimilarPaidAmt>1144413</PYGrantsAndSimilarPaidAmt>
      <CYGrantsAndSimilarPaidAmt>841709</CYGrantsAndSimilarPaidAmt>
      <PYBenefitsPaidToMembersAmt>0</PYBenefitsPaidToMembersAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>20390773</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>20067730</CYSalariesCompEmpBnftPaidAmt>
      <PYTotalProfFndrsngExpnsAmt>0</PYTotalProfFndrsngExpnsAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>12918785</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>8173197</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>34453971</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>29082636</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>308596</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>3153112</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>46996311</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>70009459</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>25536904</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>45732105</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>21459407</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>24277354</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>TO ADVANCE AND PROMOTE THE IMPROVEMENT OF HEALTH STANDARDS AND THE STANDARDS OF NURSING AND TO STIMULATE AND PROMOTE THE PROFESSIONAL DEVELOPMENT OF NURSES.</MissionDesc>
      <SignificantNewProgramSrvcInd>0</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>0</SignificantChangeInd>
      <Desc>REVISE AND EXPAND THE FOUNDATIONAL DOCUMENTS FOR NURSES AND NURSING PRACTICE:AMERICAN NURSES ASSOCIATION, INC. (ANA) MAINTAINS AND DISSEMINATES THE CODE OF ETHICS, THE NURSING SOCIAL POLICY STATEMENT, THE SCOPE AND STANDARDS OF CARE FOR NURSING (AND 28 SPECIALTY PRACTICES), POSITION STATEMENTS AND ISSUE BRIEFS. ACTIVITIES INCLUDE CONDUCTING AND SUPPORTING RESEARCH, EVALUATION AND DISSEMINATION OF INFORMATION RELATED TO HEALTH POLICY, NURSES AND NURSING CARE.</Desc>
      <ProgSrvcAccomActy2Grp>
        <Desc>CLARIFY AND STRENGTHEN THE EDUCATIONAL SYSTEM FOR NURSING:ANA SUPPORTS ACTIVITIES RELATED TO MINIMUM EDUCATIONAL REQUIREMENTS FOR DIFFERING LEVELS OF NURSING PRACTICE, ENSURING FEDERAL SUPPORT FOR NURSING EDUCATION, AND SUPPORT FOR LEADERSHIP DEVELOPMENT AND EDUCATIONAL SCHOLARSHIPS FOR MINORITY STUDENTS.</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <Desc>RESTRUCTURE THE ORGANIZATIONAL ARRANGEMENTS FOR DELIVERY OF NURSING SERVICES:ACTIVITIES INCLUDED IN THIS PROGRAM ARE RELATED TO DEVELOPMENT OF COST-EFFECTIVE MODELS FOR DELIVERY OF NURSING CARE AND PROMOTION OF NURSES AS PROVIDERS OF CARE TO THE PUBLIC.</Desc>
      </ProgSrvcAccomActy3Grp>
      <DescribedInSection501c3Ind>0</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd referenceDocumentId="RetDoc1234500001">1</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd referenceDocumentId="RetDoc1039500001">1</PoliticalCampaignActyInd>
      <SubjectToProxyTaxInd referenceDocumentId="RetDoc1039500001">1</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc1040000001">0</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc1040000001">0</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc1040000001">0</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc1040000001">0</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd>1</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc1040000001">1</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc1040000001">0</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc1040000001">0</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc1040000001">1</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc1040000001">1</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc1040000001">1</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">0</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc1040000001">1</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>0</SchoolOperatingInd>
      <ForeignOfficeInd>0</ForeignOfficeInd>
      <ForeignActivitiesInd referenceDocumentId="RetDoc1040500001">1</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd referenceDocumentId="RetDoc1040500001">0</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd referenceDocumentId="RetDoc1040500001">0</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>0</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>0</FundraisingActivitiesInd>
      <GamingActivitiesInd>0</GamingActivitiesInd>
      <OperateHospitalInd>0</OperateHospitalInd>
      <GrantsToOrganizationsInd referenceDocumentId="RetDoc1041900001">1</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd referenceDocumentId="RetDoc1041900001">1</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc1042400001">1</ScheduleJRequiredInd>
      <TaxExemptBondsInd>0</TaxExemptBondsInd>
      <LoanOutstandingInd>0</LoanOutstandingInd>
      <GrantToRelatedPersonInd>0</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>0</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>0</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>0</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>0</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>0</DeductibleArtContributionInd>
      <TerminateOperationsInd>0</TerminateOperationsInd>
      <PartialLiquidationInd>0</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="RetDoc1043400001">0</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="RetDoc1043400001">1</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>1</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd referenceDocumentId="RetDoc1043400001">1</TransactionWithControlEntInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc1043400001">0</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>1</ScheduleORequiredInd>
      <IRPDocumentCnt>210</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>1</BackupWthldComplianceInd>
      <EmployeeCnt>331</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>1</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>1</UnrelatedBusIncmOverLimitInd>
      <Form990TFiledInd>1</Form990TFiledInd>
      <ForeignFinancialAccountInd>0</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>0</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>0</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>1</NondeductibleContributionsInd>
      <NondeductibleContriDisclInd>1</NondeductibleContriDisclInd>
      <IndoorTanningServicesInd>0</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>0</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>0</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>9</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>8</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>0</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>0</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>0</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>0</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>1</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>1</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>1</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>1</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>1</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>0</OfficerMailingAddressInd>
      <LocalChaptersInd>0</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>1</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>1</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>1</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>1</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>1</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>1</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>1</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>1</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>0</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>CA</StatesWhereCopyOfReturnIsFldCd>
      <StatesWhereCopyOfReturnIsFldCd>MD</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>JON LOZARITA</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>3016285167</PhoneNum>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE NO 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>209103492</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>DEBRA HATMAKER</PersonNm>
        <TitleTxt>CHIEF NURSING OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>18.12</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>18.12</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>329819</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>19144</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>GREGORY DYSON</PersonNm>
        <TitleTxt>CHIEF OPERATING OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>16.25</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>247285</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>31753</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LYNN WASYLINA</PersonNm>
        <TitleTxt>CHIEF FINANCIAL OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>12.25</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>24.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>243667</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20148</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BARRY GERSTEN</PersonNm>
        <TitleTxt>CHIEF TECHNOLOGY OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>36.25</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>226047</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16830</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KATHY CHAPPELL</PersonNm>
        <TitleTxt>SVP CERTIFICATION MEASUREMENT ACCREDITAT</TitleTxt>
        <AverageHoursPerWeekRt>16.25</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>217374</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20435</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>STEPHEN FOX</PersonNm>
        <TitleTxt>VP, MEMBERSHIP</TitleTxt>
        <AverageHoursPerWeekRt>36.25</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>192241</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27020</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ANGELO SOMASCHINI</PersonNm>
        <TitleTxt>CHIEF LEGAL OFFICER</TitleTxt>
        <AverageHoursPerWeekRt>36.25</AverageHoursPerWeekRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>194294</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>20442</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>LORESSA COLE</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <AverageHoursPerWeekRt>15.25</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>21.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>195724</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>17172</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ORIANA BEAUDET</PersonNm>
        <TitleTxt>VP, INNOVATION</TitleTxt>
        <AverageHoursPerWeekRt>36.25</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>189092</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>23204</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KAREN SOMERVILLE</PersonNm>
        <TitleTxt>VP, GENERAL MGR PRODUCTS &amp; SERVICES</TitleTxt>
        <AverageHoursPerWeekRt>36.25</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>191256</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>15655</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ERNEST J GRANT PHD RN FAAN</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>10.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>203348</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>INGRIDA LUSIS</PersonNm>
        <TitleTxt>VP POLICY &amp; GOVERNMENT AFFAIRS</TitleTxt>
        <AverageHoursPerWeekRt>36.25</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>186888</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>11115</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>CATHERINE JUDGE</PersonNm>
        <TitleTxt>EXECUTIVE DIRECTOR, ANF</TitleTxt>
        <AverageHoursPerWeekRt>10.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>26.25</AverageHoursPerWeekRltdOrgRt>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>180320</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>16845</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>SUSAN Y SWART EDDMSRNCAE</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>STEPHANIE PIERCEPHDMNRNCNE</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JENNIFER MENSIK KENNEDY PHD</PersonNm>
        <TitleTxt>RN, NEA-BC, FAAN - TREASURER</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JENNIFER GIL BSN RN</PersonNm>
        <TitleTxt>DIRECTOR-AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MARCUS HENDERSON MSNRN</PersonNm>
        <TitleTxt>DIRECTOR-AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>TONISHA MELVIN DNP CRRN NP-C</PersonNm>
        <TitleTxt>DIRECTOR-AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>VARSHA SINGH DNP APN RN</PersonNm>
        <TitleTxt>DIRECTOR-AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JAMES JEFFREY WATSON DNPRNNEA-BC</PersonNm>
        <TitleTxt>DIRECTOR-AT LARGE</TitleTxt>
        <AverageHoursPerWeekRt>1.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2797355</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>239763</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>88</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>1</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>MARKETING GENERAL INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>625 N WASHINGTON STREET</AddressLine1Txt>
            <CityNm>ALEXANDRIA</CityNm>
            <StateAbbreviationCd>VA</StateAbbreviationCd>
            <ZIPCd>22314</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>ADVERTISING</ServicesDesc>
        <CompensationAmt>2424740</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>HEALTHCOM MEDIA</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>LATERN HILL BUSINESS PARK</AddressLine1Txt>
            <CityNm>DOYLESTOWN</CityNm>
            <StateAbbreviationCd>PA</StateAbbreviationCd>
            <ZIPCd>18901</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>PUBLISHING</ServicesDesc>
        <CompensationAmt>1580536</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>PERSONIFY INC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 759470</AddressLine1Txt>
            <CityNm>BALTIMORE</CityNm>
            <StateAbbreviationCd>MD</StateAbbreviationCd>
            <ZIPCd>21275</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SOFTWARE PLATFORM</ServicesDesc>
        <CompensationAmt>645737</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>UNITED STATES POSTAL SERVICE</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>475 LENFANT PLAZA SW</AddressLine1Txt>
            <CityNm>WASHINGTON</CityNm>
            <StateAbbreviationCd>DC</StateAbbreviationCd>
            <ZIPCd>20260</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>POSTAGE</ServicesDesc>
        <CompensationAmt>615000</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>RED RIVER MANAGED SERVICES LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 37567</AddressLine1Txt>
            <CityNm>BALTIMORE</CityNm>
            <StateAbbreviationCd>MD</StateAbbreviationCd>
            <ZIPCd>21297</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>SOFTWARE AS A SERVICE</ServicesDesc>
        <CompensationAmt>556616</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>45</CntrctRcvdGreaterThan100KCnt>
      <RelatedOrganizationsAmt>1078800</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>1569103</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>458825</AllOtherContributionsAmt>
      <TotalContributionsAmt>3106728</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>MEMBERSHIP DUES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>19421657</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>19421657</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>SERVICE FEES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>3572388</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>3572388</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>CONFERENCE FEES</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1998812</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1998812</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PUBLICATIONS</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1738600</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1738600</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>26731457</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>789122</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>84131</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>704991</ExclusionAmt>
      </InvestmentIncomeGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>150507</TotalRevenueColumnAmt>
        <ExclusionAmt>150507</ExclusionAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>429029</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>0</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>429029</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>429029</TotalRevenueColumnAmt>
        <ExclusionAmt>429029</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>3871805</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>3933765</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <SecuritiesAmt>-61960</SecuritiesAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-61960</TotalRevenueColumnAmt>
        <ExclusionAmt>-61960</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <GrossSalesOfInventoryAmt>1012226</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>125908</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>886318</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>886318</RelatedOrExemptFuncIncomeAmt>
      </NetIncomeOrLossGrp>
      <OtherRevenueMiscGrp>
        <Desc>ADVERTISING INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>171467</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>54624</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>116843</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueMiscGrp>
        <Desc>OTHER INCOME</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>33080</TotalRevenueColumnAmt>
        <ExclusionAmt>33080</ExclusionAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>204547</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>32235748</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>27617775</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>138755</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>1372490</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>100000</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>741709</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>1939222</TotalAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>12368471</TotalAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>1625709</TotalAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>2131332</TotalAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>2002996</TotalAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>67953</TotalAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>155688</TotalAmt>
      </FeesForServicesAccountingGrp>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>111764</TotalAmt>
      </FeesForSrvcInvstMgmntFeesGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>7570585</TotalAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>2192345</TotalAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>3316953</TotalAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>3192969</TotalAmt>
      </InformationTechnologyGrp>
      <RoyaltiesGrp>
        <TotalAmt>73120</TotalAmt>
      </RoyaltiesGrp>
      <OccupancyGrp>
        <TotalAmt>1400023</TotalAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>203811</TotalAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>8950</TotalAmt>
      </ConferencesMeetingsGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>1982137</TotalAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>206215</TotalAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>UBI TAXES</Desc>
        <TotalAmt>15841</TotalAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES &amp; SUBSCRIPTIONS</Desc>
        <TotalAmt>565945</TotalAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>HONORARIUM</Desc>
        <TotalAmt>31143</TotalAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SPONSORSHIP</Desc>
        <TotalAmt>15250</TotalAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>-12937495</TotalAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>29082636</TotalAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>1749025</BOYAmt>
        <EOYAmt>1519687</EOYAmt>
      </CashNonInterestBearingGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>311606</BOYAmt>
        <EOYAmt>777196</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1529036</BOYAmt>
        <EOYAmt>1429077</EOYAmt>
      </AccountsReceivableGrp>
      <InventoriesForSaleOrUseGrp>
        <BOYAmt>207257</BOYAmt>
        <EOYAmt>274598</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>1620844</BOYAmt>
        <EOYAmt>1861306</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>15579306</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>12819054</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>4453887</BOYAmt>
        <EOYAmt>2760252</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
        <BOYAmt>28720271</BOYAmt>
        <EOYAmt>31248556</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <InvestmentsOtherSecuritiesGrp>
        <BOYAmt>1055833</BOYAmt>
        <EOYAmt>1052500</EOYAmt>
      </InvestmentsOtherSecuritiesGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>7348552</BOYAmt>
        <EOYAmt>29086287</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>46996311</BOYAmt>
        <EOYAmt>70009459</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>3655705</BOYAmt>
        <EOYAmt>5172473</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>1681551</BOYAmt>
        <EOYAmt>1690542</EOYAmt>
      </DeferredRevenueGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>20199648</BOYAmt>
        <EOYAmt>38869090</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>25536904</BOYAmt>
        <EOYAmt>45732105</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>21116082</BOYAmt>
        <EOYAmt>23907950</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>343325</BOYAmt>
        <EOYAmt>369404</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>21459407</BOYAmt>
        <EOYAmt>24277354</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>46996311</BOYAmt>
        <EOYAmt>70009459</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>3153112</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>2202466</NetUnrlzdGainsLossesInvstAmt>
      <PriorPeriodAdjustmentsAmt>-2100</PriorPeriodAdjustmentsAmt>
      <OtherChangesInNetAssetsAmt>-2535531</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <ConsolidatedBasisFinclStmtInd>X</ConsolidatedBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>1</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>1</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleB documentId="RetDoc1234500001">
      <ContributorInformationGrp>
        <ContributorNum>RESTRICTED</ContributorNum>
        <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>
    <IRS990ScheduleC documentId="RetDoc1039500001">
      <PoliticalExpendituresAmt>0</PoliticalExpendituresAmt>
      <VolunteerHoursCnt>0</VolunteerHoursCnt>
      <Section527PoliticalOrgGrp>
        <OrganizationBusinessName>
          <BusinessNameLine1Txt>ANA-PAC</BusinessNameLine1Txt>
        </OrganizationBusinessName>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE SUITE 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20910</ZIPCd>
        </USAddress>
        <EIN>521254413</EIN>
        <ContributionsRcvdDlvrAmt>248144</ContributionsRcvdDlvrAmt>
      </Section527PoliticalOrgGrp>
      <SubstantiallyAllDuesNondedInd>0</SubstantiallyAllDuesNondedInd>
      <OnlyInHouseLobbyingInd>0</OnlyInHouseLobbyingInd>
      <AgreeCarryoverPriorYearInd>1</AgreeCarryoverPriorYearInd>
      <DuesAssessmentsAmt>19421657</DuesAssessmentsAmt>
      <NonDeductibleLbbyngPltclCYAmt>1957316</NonDeductibleLbbyngPltclCYAmt>
      <NonDedLbbyngPltclCyovAmt>-3683954</NonDedLbbyngPltclCyovAmt>
      <NonDeductibleLbbyngPltclTotAmt>-1726638</NonDeductibleLbbyngPltclTotAmt>
      <AggregateReportedDuesNtcAmt>4189251</AggregateReportedDuesNtcAmt>
      <CarriedOverAmt>-5915889</CarriedOverAmt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I-A, LINE 1:</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA PASSES PAC CONTRIBUTIONS FROM MEMBERS THROUGH TO THE PAC.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleC>
    <IRS990ScheduleD documentId="RetDoc1040000001">
      <CYEndwmtFundGrp>
        <BeginningYearBalanceAmt>343324</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>26080</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>369404</EndYearBalanceAmt>
      </CYEndwmtFundGrp>
      <CYMinus1YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>304292</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>39032</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>343324</EndYearBalanceAmt>
      </CYMinus1YrEndwmtFundGrp>
      <CYMinus2YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>315783</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>-11491</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>304292</EndYearBalanceAmt>
      </CYMinus2YrEndwmtFundGrp>
      <CYMinus3YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>234725</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>81058</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>315783</EndYearBalanceAmt>
      </CYMinus3YrEndwmtFundGrp>
      <CYMinus4YrEndwmtFundGrp>
        <BeginningYearBalanceAmt>197725</BeginningYearBalanceAmt>
        <InvestmentEarningsOrLossesAmt>37000</InvestmentEarningsOrLossesAmt>
        <EndYearBalanceAmt>234725</EndYearBalanceAmt>
      </CYMinus4YrEndwmtFundGrp>
      <BoardDesignatedBalanceEOYPct>0.00000</BoardDesignatedBalanceEOYPct>
      <PrmnntEndowmentBalanceEOYPct>0.09194</PrmnntEndowmentBalanceEOYPct>
      <TermEndowmentBalanceEOYPct>0.90806</TermEndowmentBalanceEOYPct>
      <EndowmentsHeldUnrelatedOrgInd>0</EndowmentsHeldUnrelatedOrgInd>
      <EndowmentsHeldRelatedOrgInd>0</EndowmentsHeldRelatedOrgInd>
      <LeaseholdImprovementsGrp>
        <OtherCostOrOtherBasisAmt>4100185</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2478855</DepreciationAmt>
        <BookValueAmt>1621330</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
        <OtherCostOrOtherBasisAmt>2410089</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>1678324</DepreciationAmt>
        <BookValueAmt>731765</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>9069032</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>8661875</DepreciationAmt>
        <BookValueAmt>407157</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>2760252</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>DEPOSITS</Desc>
        <BookValueAmt>89227</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>INTERCOMPANY RECEIVABLES</Desc>
        <BookValueAmt>28997060</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>29086287</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO AFFILIATES</Desc>
        <Amt>24037606</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>UNFUNDED PENSION LIABILITY</Desc>
        <Amt>11568121</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DEFERRED RENT</Desc>
        <Amt>2299807</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUES COLLECTED ON BEHALF OF C/SNAS</Desc>
        <Amt>963556</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>38869090</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>34450258</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>2202466</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>125908</OtherRevenueAmt>
      <RevenueNotReportedAmt>2328374</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>32121884</RevenueSubtotalAmt>
      <InvestmentExpensesNotIncldAmt>111764</InvestmentExpensesNotIncldAmt>
      <OtherRevenuesNotIncludedAmt>2100</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>113864</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>32235748</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>31632311</TotExpnsEtcAuditedFinclStmtAmt>
      <OtherExpensesIncludedAmt>2661439</OtherExpensesIncludedAmt>
      <ExpensesNotReportedAmt>2661439</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>28970872</ExpensesSubtotalAmt>
      <InvestmentExpensesNotIncld2Amt>111764</InvestmentExpensesNotIncld2Amt>
      <ExpensesNotRptFinclStmtAmt>111764</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>29082636</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART V, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA'S ENDOWMENT INVESTMENT POLICY IS FOCUSED ON PRESERVATION OF CAPITAL AND AMOUNTS ARE INVESTED IN EQUITIES, CORPORATE AND GOVERNMENT BONDS THROUGH EXCHANGE TRADED MUTUAL FUNDS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART X, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION PERFORMED AN EVALUATION OF UNCERTAINTY IN INCOME TAXES FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019, AND DETERMINED THAT THERE WERE NO MATTERS THAT WOULD REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS OR THAT MAY HAVE ANY EFFECT ON ITS TAX-EXEMPT STATUS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>COST OF GOODS SOLD 125,908.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>PRIOR PERIOD ADJUSTMENT 2,100.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XII, LINE 2D - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
        <ExplanationTxt>PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 2,535,531. COST OF GOODS SOLD 125,908.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleF documentId="RetDoc1040500001">
      <AccountActivitiesOutsideUSGrp>
        <RegionTxt>EUROPE (INCLUDING ICELAND &amp; GREENLAND)</RegionTxt>
        <OfficesCnt>0</OfficesCnt>
        <EmployeeCnt>0</EmployeeCnt>
        <TypeOfActivitiesConductedTxt>PROGRAM SERVICES</TypeOfActivitiesConductedTxt>
        <SpecificServicesProvidedTxt>INTERNATIONAL COUNCIL OF NURSES, ANNUAL DUES, NURSING CONFERENCES</SpecificServicesProvidedTxt>
        <RegionTotalExpendituresAmt>337567</RegionTotalExpendituresAmt>
      </AccountActivitiesOutsideUSGrp>
      <AccountActivitiesOutsideUSGrp>
        <RegionTxt>EAST ASIA AND THE PACIFIC</RegionTxt>
        <OfficesCnt>0</OfficesCnt>
        <EmployeeCnt>0</EmployeeCnt>
        <TypeOfActivitiesConductedTxt>PROGRAM SERVICES</TypeOfActivitiesConductedTxt>
        <SpecificServicesProvidedTxt>SERVICE FEES, PUBLICATIONS</SpecificServicesProvidedTxt>
        <RegionTotalExpendituresAmt>3301</RegionTotalExpendituresAmt>
      </AccountActivitiesOutsideUSGrp>
      <AccountActivitiesOutsideUSGrp>
        <RegionTxt>MIDDLE EAST AND NORTH AFRICA - ALGERIA, BAHRAIN, DJIBOUTI, EGYPT,</RegionTxt>
        <OfficesCnt>0</OfficesCnt>
        <EmployeeCnt>0</EmployeeCnt>
        <TypeOfActivitiesConductedTxt>PROGRAM SERVICES</TypeOfActivitiesConductedTxt>
        <SpecificServicesProvidedTxt>SERVICE FEES</SpecificServicesProvidedTxt>
        <RegionTotalExpendituresAmt>587</RegionTotalExpendituresAmt>
      </AccountActivitiesOutsideUSGrp>
      <SubtotalOfficesCnt>0</SubtotalOfficesCnt>
      <SubtotalEmployeesCnt>0</SubtotalEmployeesCnt>
      <ContinuationTotalOfficeCnt>0</ContinuationTotalOfficeCnt>
      <ContinuationTotalEmployeeCnt>0</ContinuationTotalEmployeeCnt>
      <TotalOfficeCnt>0</TotalOfficeCnt>
      <TotalEmployeeCnt>0</TotalEmployeeCnt>
      <SubtotalSpentAmt>341455</SubtotalSpentAmt>
      <ContinuationSpentAmt>0</ContinuationSpentAmt>
      <TotalSpentAmt>341455</TotalSpentAmt>
      <TransferToForeignCorpInd>0</TransferToForeignCorpInd>
      <InterestInForeignTrustInd>0</InterestInForeignTrustInd>
      <ForeignCorpOwnershipInd>0</ForeignCorpOwnershipInd>
      <PassiveForeignInvestmestCoInd>0</PassiveForeignInvestmestCoInd>
      <ForeignPartnershipInd>0</ForeignPartnershipInd>
      <BoycottCountriesInd>1</BoycottCountriesInd>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>IN ACCORDANCE WITH IRS INSTRUCTIONS, ALL AMOUNTS REPORTED IN PART I OF SCHEDULE F ARE REPORTED USING THE ACCRUAL BASIS OF ACCOUNTING, THE SAME METHOD OF ACCOUNTING USED IN THE FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III ACCOUNTING METHOD:</FormAndLineReferenceDesc>
      </SupplementalInformationDetail>
    </IRS990ScheduleF>
    <IRS990ScheduleI documentId="RetDoc1041900001">
      <GrantRecordsMaintainedInd>1</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>FRONTIER HEALTH &amp; RESOURCES</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>6118 ASHWELL WAY</AddressLine1Txt>
          <CityNm>VALLEJO</CityNm>
          <StateAbbreviationCd>CA</StateAbbreviationCd>
          <ZIPCd>94591</ZIPCd>
        </USAddress>
        <RecipientEIN>823086822</RecipientEIN>
        <IRCSectionDesc>N/A</IRCSectionDesc>
        <CashGrantAmt>50000</CashGrantAmt>
        <PurposeOfGrantTxt>INNOV TEAM AWARD</PurposeOfGrantTxt>
      </RecipientTable>
      <Total501c3OrgCnt>0</Total501c3OrgCnt>
      <TotalOtherOrgCnt>1</TotalOtherOrgCnt>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>STIPENDS</GrantTypeTxt>
        <RecipientCnt>58</RecipientCnt>
        <CashGrantAmt>664700</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>INNOV TEAM AWARD</GrantTypeTxt>
        <RecipientCnt>1</RecipientCnt>
        <CashGrantAmt>25000</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <GrantsOtherAsstToIndivInUSGrp>
        <GrantTypeTxt>SCHOLARSHIPS</GrantTypeTxt>
        <RecipientCnt>4</RecipientCnt>
        <CashGrantAmt>52009</CashGrantAmt>
      </GrantsOtherAsstToIndivInUSGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA PROVIDES FELLOWSHIP AWARDS THROUGH THE MINORITY FELLOWSHIP PROGRAM. ANA HAS AN ADVISORY COMMITTEE THAT SERVES AS A POLICY ADVISORY GROUP AND PROVIDES FOR ALL COMPONENTS ON THE PROGRAM. THE COMMITTEE MEMBERS' FUNCTIONS INCLUDE, BUT ARE NOT LIMITED TO REVIEWING EXISTING PROGRAM POLICIES AND PROCEDURES AND MAKING RECOMMENDATIONS; IMPLEMENTING THE APPOINTMENT PROCESS BY SCORING APPLICATIONS AND SELECTING FELLOWS; IMPLEMENTING THE REAPPOINTMENT PROCESS BY EVALUATING AND MAKING RECOMMENDATIONS REGARDING THE FELLOWS' TENURE IN THE PROGRAM; AWARDING POST-DOCTORAL FELLOWSHIPS; ASSISTING FELLOWS TO STRENGTHEN THEIR RESEARCH AND SCHOLARSHIP THROUGH A VARIETY OF ACTIVITIES; AND CONDUCTING PLANNED SITE VISITS AT SELECTED UNIVERSITIES WHERE FELLOWS ARE MATRICULATING IN ACADEMIC PROGRAMS WITH THE INTENT OF ASSESSING THE FELLOW'S OVERALL PERFORMANCE WITHIN THE CONTEXT OF THE ACADEMIC INSTITUTION, AND MAKING RECOMMENDATIONS ON THE FELLOW'S BEHALF. THE DEMANDS OF THE COMMITTEE CAN BEST BE DESCRIBED AS INVOLVED. ADDITIONALLY, THE FEDERAL AWARD HAS DATA COLLECTION REQUIREMENTS, OR IS IMPLEMENTING THEM AND ANA IS COMMITTED TO ENSURING THAT THESE REQUIREMENTS ARE MET. AS A GRANTEE, YOUR ORGANIZATION MUST COMPLY WITH PL 102-62 AND RELATED GPRA REQUIREMENTS THAT INCLUDE THE COLLECTION AND PERIODIC REPORTING OF PERFORMANCE DATA THAT ALLOWS SAMHSA TO ENSURE THE EFFECTIVENESS AND EFFICIENCY OF ITS PROGRAMS. CMHS IS CURRENTLY IN THE PLANNING STAGES OF IMPLEMENTING A WEB-BASED GPRA DATA COLLECTION AND REPORTING SYSTEM. WHEN IMPLEMENTATION OF THE SYSTEM BEGINS, GRANTEES WILL BE REQUIRED TO SUBMIT THEIR GPRA DATA ELECTRONICALLY USING THIS WEB-BASED SYSTEM. GRANTEES WILL ALSO BE REQUIRED TO PARTICIPATE IN THE INITIAL TRAINING AND ONGOING TECHNICAL ASSISTANCE IN ORDER TO ENSURE A SMOOTH TRANSITION TO THE ELECTRONIC SYSTEM AND CONTINUED USER SUPPORT. THE GPO WILL PROVIDE INFORMATION ON THE SPECIFIC DATA TO BE SUBMITTED AND THE SCHEDULE FOR SUBMISSION AS IT BECOMES AVAILABLE.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <IndependentConsultantInd>X</IndependentConsultantInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DEBRA HATMAKER</PersonNm>
        <TitleTxt>CHIEF NURSING OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>327570</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2249</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>17048</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>2096</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>348963</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>GREGORY DYSON</PersonNm>
        <TitleTxt>CHIEF OPERATING OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>245036</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2249</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>19263</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>12490</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>279038</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>LYNN WASYLINA</PersonNm>
        <TitleTxt>CHIEF FINANCIAL OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>241418</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2249</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>16346</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>3802</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>263815</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>BARRY GERSTEN</PersonNm>
        <TitleTxt>CHIEF TECHNOLOGY OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>223798</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2249</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14405</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>2425</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>242877</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KATHY CHAPPELL</PersonNm>
        <TitleTxt>SVP CERTIFICATION MEASUREMENT ACCRED</TitleTxt>
        <BaseCompensationFilingOrgAmt>215228</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2146</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>12152</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>8283</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>237809</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>STEPHEN FOX</PersonNm>
        <TitleTxt>VP, MEMBERSHIP</TitleTxt>
        <BaseCompensationFilingOrgAmt>190122</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2119</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14994</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>12026</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>219261</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ANGELO SOMASCHINI</PersonNm>
        <TitleTxt>CHIEF LEGAL OFFICER</TitleTxt>
        <BaseCompensationFilingOrgAmt>192175</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2119</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>14402</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6040</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>214736</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>LORESSA COLE</PersonNm>
        <TitleTxt>CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>193583</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2141</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>11047</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>6125</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>212896</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ORIANA BEAUDET</PersonNm>
        <TitleTxt>VP, INNOVATION</TitleTxt>
        <BaseCompensationFilingOrgAmt>186873</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2219</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>13898</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>9306</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>212296</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KAREN SOMERVILLE</PersonNm>
        <TitleTxt>VP, GENERAL MGR PRODUCTS &amp; SERVICES</TitleTxt>
        <BaseCompensationFilingOrgAmt>189037</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2219</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>13478</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>2177</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>206911</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERNEST J GRANT PHD RN FAAN</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <BaseCompensationFilingOrgAmt>203348</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>203348</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>INGRIDA LUSIS</PersonNm>
        <TitleTxt>VP POLICY &amp; GOVERNMENT AFFAIRS</TitleTxt>
        <BaseCompensationFilingOrgAmt>184769</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2119</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>11115</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>198003</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>CATHERINE JUDGE</PersonNm>
        <TitleTxt>EXECUTIVE DIRECTOR, ANF</TitleTxt>
        <BaseCompensationFilingOrgAmt>178165</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>2155</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
        <DeferredCompensationFlngOrgAmt>13820</DeferredCompensationFlngOrgAmt>
        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>3025</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>197165</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 1</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA'S EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS IS COMPOSED OF THE OFFICERS WHICH HAVE ALL POWERS OF THE BOARD OF DIRECTORS TO TRANSACT BUSINESS BETWEEN BOARD MEETINGS IN ACCORDANCE WITH THE RULES ESTABLISHED BY THE BOARD OF DIRECTORS. SUCH TRANSACTIONS ARE REPORTED AT THE NEXT REGULAR MEETING OF THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 6</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA HAS THE FOLLOWING CLASSES OF MEMBERS: CONSTITUENT AND STATE NURSES ASSOCIATIONS: THESE INCLUDE STATE NURSES ASSOCIATIONS, MULTI-STATE NURSES ASSOCIATIONS, NURSES ASSOCIATIONS OF THE DISTRICT OF COLUMBIA, NURSES ASSOCIATIONS OF THE TERRITORIES OF THE UNITED STATES OF AMERICA, UNITED STATES OF AMERICA NURSES OVERSEAS ASSOCIATIONS, AND A FEDERAL NURSES ASSOCIATION COMPOSED OF REGISTERED NURSES WHOSE EMPLOYERS ARE MEMBERS OF THE FEDERAL NURSING SERVICES COUNCIL, LIMITED TO MEMBERSHIP OF THE ACTIVE COMPONENT OF THE U.S. ARMY, NAVY, AIR FORCE, AND THE UNIFORMED PUBLIC HEALTH SERVICE NURSES ARE HEREINAFTER REFERRED TO AS C/SNAS. ORGANIZATIONAL AFFILIATES: ANA HAS ORGANIZATIONAL AFFILIATES THAT COULD BE LABOR ORGANIZATIONS, WORKFORCE ADVOCACY ORGANIZATIONS, OR SPECIALTY NURSING ASSOCIATIONS. AN ORGANIZATIONAL AFFILIATE WOULD BE A NATIONAL ORGANIZATION THAT REPRESENTS THE INTERESTS OF REGISTERED NURSES THAT MEETS CRITERIA ESTABLISHED BY THE MEMBERSHIP ASSEMBLY. INDIVIDUAL MEMBERS: AN INDIVIDUAL MEMBER WOULD BE A REGISTERED NURSE WHO ELECTS TO JOIN ANA DIRECTLY. THIS MEMBERSHIP OPTION IS CONTINGENT UPON THE AGREEMENT BETWEEN THE C/SNA AND ANA. INDIVIDUAL AFFILIATES: AN INDIVIDUAL AFFILIATE (ALSO REFERRED TO AS E-MEMBER) IS A REGISTERED NURSE WHO ELECTS TO JOIN ANA IN ACCORDANCE WITH THE PROVISIONS OF THIS SECTION.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7A</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA MEMBERSHIP ASSEMBLY IS RESPONSIBLE FOR SELECTING THE MEMBERS OF THE BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 7B</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA MEMBERSHIP ASSEMBLY IS INVOLVED WITH MAKING ANY GOVERNANCE DECISIONS ALONG WITH THE GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE DRAFT VERSION OF THE FEDERAL FORM 990 IS REVIEWED IN DETAIL BY THE CHIEF OPERATING OFFICER AND CONTROLLER TO ENSURE THAT THE DETAILS TIE TO THE AUDITED FINANCIAL STATEMENTS AND APPROPRIATELY REPRESENT ALL FINANCIAL ACTIVITIES OF ANA. A COPY OF THE DRAFT FEDERAL FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS AND THE CHIEF EXECUTIVE OFFICER PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BOARD MEMBERS OF ANA SIGN DISCLOSURE STATEMENTS UPON ELECTION OR APPOINTMENT, AND EVERY TWO YEARS. THE BOARD OF DIRECTORS FORMALLY ADOPTED THE USE OF CONFLICT OF INTEREST STATEMENTS AND DISCLOSURE FORMS. THE GENERAL COUNSEL REVIEWS THE DISCLOSURE STATEMENTS AND DISCUSSES ANY CONFLICT OR POTENTIAL CONFLICT ON THE PART OF AN ANA BOARD MEMBER WITH THE ANA CHIEF EXECUTIVE OFFICER (CEO) AND PRESIDENT, AND FOLLOW-UP ACTION WOULD BE TAKEN AS NEEDED. PERIODIC TRAINING FOR THE BOARD OF DIRECTORS INCLUDES REFERENCE TO THE MEMBERS' FIDUCIARY. OBLIGATIONS, INCLUDING THE AVOIDANCE OF A CONFLICT OF INTEREST. THE ANA BOARD OF DIRECTORS HAS AN OPERATING POLICY THAT PROHIBITS CONFLICT OF INTEREST, AND THE ANA PRESIDENT CALLS FOR DISCLOSURE OF CONFLICTS AT THE BEGINNING OF EVERY MEETING. CONFLICTED INDIVIDUALS WILL NOT VOTE ON THE MATTER ABOUT WHICH THEY ARE CONFLICTED, AND MAY OR MAY NOT PARTICIPATE IN THE DISCUSSION OF THE MATTER, DEPENDING UPON THE ISSUE AND WHETHER DISCLOSURE OF THE CONFLICT TO THE BOARD PROVIDES ENOUGH PROTECTION TO PERMIT THE BOARD MEMBER TO COMMENT ON THE MATTER OR TO HEAR THE DISCUSSION. FOR THE PAST TEN YEARS, ANA'S PRACTICE HAS BEEN FOR THE BOARD MEMBER TO LEAVE THE ROOM DURING THE DISCUSSION. THE MINUTES REFLECT REFERENCES TO AND DECISIONS ABOUT CONFLICT OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>JOBS AND SALARY GRADES ARE BENCHMARKED TO ENSURE THAT ANA REMAINS COMPETITIVE IN THE CURRENT LABOR MARKET. ALL UNION POSITIONS ARE COVERED BY THE UNION CONTRACT. THESE PROCESSES ARE DOCUMENTED AND HELD IN THE HUMAN RESOURCES DEPARTMENT BY THE DIRECTOR OF HUMAN RESOURCES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>ANA DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR THE FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>CONSULTING SERVICES 7,078,272. TEMPORARY HELP 492,313.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -2,535,531.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc1043400001">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES FOUNDATION INC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE SUITE 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20910</ZIPCd>
        </USAddress>
        <EIN>131893924</EIN>
        <PrimaryActivitiesTxt>SCIENTIFIC RESEARCH, EDUCATION SUPPORT, CHARITABLE AFFILIATE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>DC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES CREDENTIALING CENTER</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE SUITE 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20910</ZIPCd>
        </USAddress>
        <EIN>431565726</EIN>
        <PrimaryActivitiesTxt>PROF. CREDENTIALING FOR REGISTERED NURSES, HEALTH FACILITY ACCREDITATION</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>DC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(6)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>N/A</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>AMERICAN ACADEMY OF NURSING</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>1000 VERMONT AVENUE NW SUITE 910</AddressLine1Txt>
          <CityNm>WASHINGTON</CityNm>
          <StateAbbreviationCd>DC</StateAbbreviationCd>
          <ZIPCd>20005</ZIPCd>
        </USAddress>
        <EIN>522213870</EIN>
        <PrimaryActivitiesTxt>PROVIDE VISIONARY LEADERSHIP TO THE NURSING PROFESSION AND THE PUBLIC</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>DC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>INSTITUTE FOR NURSING RESEARCH AND EDUCATION</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE SUITE 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20910</ZIPCd>
        </USAddress>
        <EIN>263121515</EIN>
        <PrimaryActivitiesTxt>INACTIVE SUBSIDIARY</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>DC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(C)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>LINE 7</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>ANA PAC</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE SUITE 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20910</ZIPCd>
        </USAddress>
        <EIN>521254413</EIN>
        <PrimaryActivitiesTxt>POLITICAL ACTION COMMITTEE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>DC</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>527</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>N/A</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>ANA SERVICE CORPORATION INC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>8515 GEORGIA AVENUE SUITE 400</AddressLine1Txt>
          <CityNm>SILVER SPRING</CityNm>
          <StateAbbreviationCd>MD</StateAbbreviationCd>
          <ZIPCd>20910</ZIPCd>
        </USAddress>
        <EIN>542179203</EIN>
        <PrimaryActivitiesTxt>INACTIVE SUBSIDIARY</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>DC</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>AMERICAN NURSES ASSOCIATION INC</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <EntityTypeTxt>C</EntityTypeTxt>
        <OwnershipPct>1.00000</OwnershipPct>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>1</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMERICAN NURSES CREDENTIALING CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>12961727</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>BOOK VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMERICAN NURSES CREDENTIALING CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>S</TransactionTypeTxt>
        <InvolvedAmt>3566497</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>BOOK VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMERICAN NURSES CREDENTIALING CENTER</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>N</TransactionTypeTxt>
        <InvolvedAmt>2272799</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>BOOK VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMERICAN NURSES FOUNDATION INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>1232786</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>BOOK VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMERICAN NURSES FOUNDATION INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>C</TransactionTypeTxt>
        <InvolvedAmt>1078800</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>BOOK VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>AMERICAN NURSES FOUNDATION INC</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>N</TransactionTypeTxt>
        <InvolvedAmt>153182</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>BOOK VALUE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
