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        <ExplanationTxt>FASB ASC Topic 740, Income Taxes provides that a tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination, including resolutions of any related appeals or litigation processes, based on the technical merits. Income tax position must meet a more likely than not recognition threshold at the effective date to be recognized upon the adoption of this interpretation and in subsequent periods. This topic also provides guidance on measurement, derecogntion, classification, interest and penalties, accounting in interim periods, disclosure and transition. The Company recognizes any interest and penalties related to unrecognized tax benefits within the income tax expense line in the accompanying statement of activities and changes in net assets. Accrued interest and penalties are included within the related tax liability line in the consolidated balance sheet. There were no interest and penalties recognized for 2015 or 2014. The Company does not anticipate significant increases or decrease in its uncertain tax positions within the next twelve months.</ExplanationTxt>
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        <PersonNm>Paul Eisenstat</PersonNm>
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        <PersonNm>Stephen Sloan</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>James Haefner</PersonNm>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Patricia Heffernan</PersonNm>
        <TitleTxt>President</TitleTxt>
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        <PersonNm>Terrence Tehan</PersonNm>
        <TitleTxt>COO</TitleTxt>
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        <PersonNm>Margaret Cassady</PersonNm>
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        <PersonNm>David Klein</PersonNm>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEO of the filing organization is compensated by a related organization. His compensation is determined in accordance with a Board of Directors approved Executive Compensation Philosophy. The executive compensation process includes an evaluation of market comparable organizations. The Secretary and CFO and Treasurer of the filing organization are also the Secretary and CFO and Treasurer of the related organization. The process to determine their compensation includes the use of an external consultant and approval of the Board of Directors of the related organization.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>Line 4b - The following persons from Part VII, Section A, Line 1a participated in a supplemental nonqualified retirement plan of a related organization: D. Klein, D. Coleman, S. Sloan, P. Eisenstat, P. Heffernan, J. Haefner, T. Tehan and M. Cassady. Line 4c - D. Klein and J. Haefner both participated in an equity-based compensation arrangement of a related entity that resulted in 2015 distributions of $132,280 and $82,675, respectively.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 2</FormAndLineReferenceDesc>
        <ExplanationTxt>GRHCOC officers Terrence Tehan and Patricia Heffernan are employees of Excellus Health Plan, Inc. (a related organization). Such employees have a business relationship with GRHCA officers Dorothy Coleman, Paul Eisenstat, Stephen Sloan, James Haefner and Margaret Cassady who are also officers on Excellus Health Plan, Inc.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 4</FormAndLineReferenceDesc>
        <ExplanationTxt>GRHCOC bylaws were revised in 2015 to effect the following changes: (1) When calculating whether 75 percent of the directors are Class A directors, if the number of directors then serving is fewer than 16, any number other than a whole number must be rounded down, rather than up. (2) The Chief Operating Officer, who is an employee and not a director, was eliminated from the Executive Committee, which is a committee of the Board under the Not-for-Profit Corporation Law, as amended by the Non-Profit Revitalization Act.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 6</FormAndLineReferenceDesc>
        <ExplanationTxt>The organization has a sole corporate Class A member, as well as individual Class B members who are the same individuals serving as Class B directors of the organization.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Pursuant to a resolution of the Board of Directors of North Star Home Health Management, Inc., the sole Class A member of the organization the Chief Executive Officer of North Star Home Health Management, Inc. is empowered to act on behalf of North Star Home Health Management, Inc. to elect or reelect the organization's Class A directors. The members of the organization elect the Class A and Class B directors at a joint annual meeting of the sole member and Board of Directors of the organization, which is held during the first six months of the year pursuant to the Bylaws of the organization.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>Bylaws amendments must be approved by the sole Class A member. Certain governance actions (such as the sale of all or substantially all of the assets of the organization) require approval of the members under the New York Not-for-Profit Corporation Law.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>A copy of the Form 990 was provided to the Board of Directors prior to filing allowing the opportunity to review.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>All employees review the Code of Conduct at an annual mandatory training. Directors and above also complete an annual questionnaire to identify potential conflicts of interest. Any potential violations are investigated by compliance personnel and corrective measures are taken as appropriate.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, Line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>a) In determining compensation of the organization's CEO, the organization depended on compensation surveys and studies that are completed by Human Resources annually. b) In determining compensation of the organization's Other Officers, the organization depended on compensation surveys and studies that are completed by Human Resources annually.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 18</FormAndLineReferenceDesc>
        <ExplanationTxt>Form 990 is available via Guidestar.org.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing documents, conflict of interest policies, and financial statements are available to the public upon request.</ExplanationTxt>
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          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <EIN>160844109</EIN>
        <PrimaryActivitiesTxt>Provide Home Health Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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          <BusinessNameLine1Txt>North Star Home Health Management Inc</BusinessNameLine1Txt>
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          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
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        <EIN>161005419</EIN>
        <PrimaryActivitiesTxt>Provide Health Services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501(c)(3)</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>170(b)(1)(A)(iii)</PublicCharityStatusTxt>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>Excellus Health Plan Inc</BusinessNameLine1Txt>
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          <CityNm>Rochester</CityNm>
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        <EIN>454058523</EIN>
        <PrimaryActivitiesTxt>Independent Practice Association</PrimaryActivitiesTxt>
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          <CityNm>Rochester</CityNm>
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          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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      <IdRelatedOrgTxblCorpTrGrp>
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          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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      <IdRelatedOrgTxblCorpTrGrp>
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          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <ControlledOrganizationInd>1</ControlledOrganizationInd>
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      <IdRelatedOrgTxblCorpTrGrp>
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          <BusinessNameLine1Txt>Lifetime Benefit Solutions Inc</BusinessNameLine1Txt>
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          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14647</ZIPCd>
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        <EIN>161171765</EIN>
        <PrimaryActivitiesTxt>Third Party Administrator</PrimaryActivitiesTxt>
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        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>MedAmerica Insurance Company of New York</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14647</ZIPCd>
        </USAddress>
        <EIN>161310986</EIN>
        <PrimaryActivitiesTxt>Long Term Care Insurance</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>MedAmerica Insurance Company</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14647</ZIPCd>
        </USAddress>
        <EIN>340977231</EIN>
        <PrimaryActivitiesTxt>Long Term Care Insurance</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>PA</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
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      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>MedAmerica Insurance Company of Florida</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
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        <DirectControllingNACd>N/A</DirectControllingNACd>
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      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
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        <USAddress>
          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14647</ZIPCd>
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        <EIN>161588653</EIN>
        <PrimaryActivitiesTxt>Insurance Agancy</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
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        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>MIG Assurance</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14647</ZIPCd>
        </USAddress>
        <EIN>980210843</EIN>
        <PrimaryActivitiesTxt>Long Term Care Insurer</PrimaryActivitiesTxt>
        <LegalDomicileForeignCountryCd>CJ</LegalDomicileForeignCountryCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>1</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Lifetime Healthcare Companies Workers' Compensation Trust</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>165 Court Street</AddressLine1Txt>
          <CityNm>Rochester</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>14647</ZIPCd>
        </USAddress>
        <EIN>161483185</EIN>
        <PrimaryActivitiesTxt>Grantor Trust</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NY</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>T</EntityTypeTxt>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>0</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>0</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>1</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Genesee Region Home Care Association Inc</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>l</TransactionTypeTxt>
        <InvolvedAmt>4872930</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Arm's Length</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>