﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2023v5.1" xsi:schemaLocation="http://www.irs.gov/efile">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-11-06T05:39:28-08:00</ReturnTs>
    <TaxPeriodEndDt>2023-12-31</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>204943540</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>ABBATE DEMARINIS LLP</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>3200 Sunrise Hwy</AddressLine1Txt>
        <CityNm>Wantagh</CityNm>
        <StateAbbreviationCd>NY</StateAbbreviationCd>
        <ZIPCd>11793</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2023-01-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>132590983</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>TOLSTOY FOUNDATION NURSING HOME INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>TOLS</BusinessNameControlTxt>
      <PhoneNum>8452686813</PhoneNum>
      <USAddress>
        <AddressLine1Txt>100 LAKE ROAD PO BOX 319</AddressLine1Txt>
        <CityNm>VALLEY COTTAGE</CityNm>
        <StateAbbreviationCd>NY</StateAbbreviationCd>
        <ZIPCd>10989</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>DOROTHY CORBETT</PersonNm>
      <PersonTitleTxt>Administrator</PersonTitleTxt>
      <PhoneNum>8452686813</PhoneNum>
      <SignatureDt>2024-04-17</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>true</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>ANTHONY ABBATE</PreparerPersonNm>
      <PTIN>P00240210</PTIN>
      <PhoneNum>5167456600</PhoneNum>
      <PreparationDt>2024-11-06</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2023</TaxYr>
    <BuildTS>2024-10-15 13:58:12Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="4">
    <IRS990 documentId="IRS990-01" referenceDocumentId="IRS990ScheduleO-01" softwareId="23017509">
      <PrincipalOfficerNm>DOROTHY CORBETT</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>100 LAKE RD</AddressLine1Txt>
        <CityNm>VALLEY COTTAGE</CityNm>
        <StateAbbreviationCd>NY</StateAbbreviationCd>
        <ZIPCd>10989</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>11198763</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>www.tfrnc.org</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1990</FormationYr>
      <LegalDomicileStateCd>NY</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO PROVIDE NURSING CARE&amp;REHABILITATION SERVICES TO ELDERLY PATIENTS</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>6</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>6</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>299</TotalEmployeeCnt>
      <TotalVolunteersCnt>0</TotalVolunteersCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <NetUnrelatedBusTxblIncmAmt>0</NetUnrelatedBusTxblIncmAmt>
      <PYContributionsGrantsAmt>12556</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>8368</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>12249503</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>9926282</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>750</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>550</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>18897</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>1263563</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>12281706</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>11198763</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>7679220</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>7329968</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>4023455</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>3496735</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>11702675</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>10826703</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>579031</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>372060</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>2725103</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>2686073</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>3551734</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>3140644</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>-826631</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>-454571</NetAssetsOrFundBalancesEOYAmt>
      <MissionDesc>TO PROVIDE NURSING CARE&amp;REHABILITATION SERVICES TO ELDERLY PATIENTS</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>9534846</ExpenseAmt>
      <GrantAmt>0</GrantAmt>
      <RevenueAmt>11198763</RevenueAmt>
      <Desc>TO PROVIDE skilled NURSING CARE TO THE ELDERLY</Desc>
      <TotalProgramServiceExpensesAmt>9534846</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="IRS990ScheduleA-01" referenceDocumentName="IRS990ScheduleA">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd>false</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">true</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">true</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="IRS990ScheduleD-01" referenceDocumentName="IRS990ScheduleD">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd>false</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd>false</DisregardedEntityInd>
      <RelatedEntityInd>false</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TransactionWithControlEntInd>false</TransactionWithControlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd>false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd>false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>0</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <BackupWthldComplianceInd>true</BackupWthldComplianceInd>
      <EmployeeCnt>299</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <DAFExcessBusinessHoldingsInd>false</DAFExcessBusinessHoldingsInd>
      <TaxableDistributionsInd>false</TaxableDistributionsInd>
      <DistributionToDonorInd>false</DistributionToDonorInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>6</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>6</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>false</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>false</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>false</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>false</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <StatesWhereCopyOfReturnIsFldCd>NY</StatesWhereCopyOfReturnIsFldCd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <PersonNm>DOROTHY CORBETT</PersonNm>
        <PhoneNum>8452686813</PhoneNum>
        <USAddress>
          <AddressLine1Txt>100 LAKE ROAD</AddressLine1Txt>
          <CityNm>VALLEY COTTAGE</CityNm>
          <StateAbbreviationCd>NY</StateAbbreviationCd>
          <ZIPCd>10989</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>Dominic Fillipone</PersonNm>
        <TitleTxt>CHAIRMAN</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Alexander Benzemann</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>George Soroka</PersonNm>
        <TitleTxt>BOARD MEMBER</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Victoria Wohlsen</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>VICTOR TOMOSHENKO</PersonNm>
        <TitleTxt>Board Member</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>IRENE ORLOW</PersonNm>
        <TitleTxt>SECRETARY</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DOROTHY CORBETT</PersonNm>
        <TitleTxt>ADMINISTRATOR / CEO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <KeyEmployeeInd>X</KeyEmployeeInd>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>129708</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Courtney A Modafferi</PersonNm>
        <TitleTxt>Director of Nursing</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>115543</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>245251</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>0</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>2</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>false</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Preferred Therapy</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>850 Silas Dean Highway</AddressLine1Txt>
            <CityNm>Wethersfield</CityNm>
            <StateAbbreviationCd>CT</StateAbbreviationCd>
            <ZIPCd>06109</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Therapy Services</ServicesDesc>
        <CompensationAmt>671487</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>EMS LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>245 MAIN ST</AddressLine1Txt>
            <CityNm>CHESTER</CityNm>
            <StateAbbreviationCd>NC</StateAbbreviationCd>
            <ZIPCd>07930</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>HOUSEKEEPING SERVICE</ServicesDesc>
        <CompensationAmt>170802</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>2</CntrctRcvdGreaterThan100KCnt>
      <AllOtherContributionsAmt>8368</AllOtherContributionsAmt>
      <TotalContributionsAmt>8368</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>NURSING HOME</Desc>
        <BusinessCd>623000</BusinessCd>
        <TotalRevenueColumnAmt>9926282</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>9926282</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>550</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </InvestmentIncomeGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>1263563</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1263563</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
      <OtherRevenueTotalAmt>1263563</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>11198763</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>11190395</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalRevenueGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>5336530</TotalAmt>
        <ProgramServicesAmt>4769627</ProgramServicesAmt>
        <ManagementAndGeneralAmt>566903</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </CompDisqualPersonsGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>346289</TotalAmt>
        <ProgramServicesAmt>309513</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36776</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>1228202</TotalAmt>
        <ProgramServicesAmt>1097767</ProgramServicesAmt>
        <ManagementAndGeneralAmt>130435</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>418947</TotalAmt>
        <ProgramServicesAmt>374455</ProgramServicesAmt>
        <ManagementAndGeneralAmt>44492</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>25604</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>25604</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>75751</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>75751</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>164879</TotalAmt>
        <ProgramServicesAmt>164879</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>19471</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>19471</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AdvertisingGrp>
      <InformationTechnologyGrp>
        <TotalAmt>40744</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>40744</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InformationTechnologyGrp>
      <InterestGrp>
        <TotalAmt>29255</TotalAmt>
        <ProgramServicesAmt>29255</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>127377</TotalAmt>
        <ProgramServicesAmt>127377</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>222254</TotalAmt>
        <ProgramServicesAmt>222254</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>NURSING</Desc>
        <TotalAmt>116027</TotalAmt>
        <ProgramServicesAmt>116027</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>FOOD AND NUTRITION</Desc>
        <TotalAmt>289355</TotalAmt>
        <ProgramServicesAmt>289355</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>SOCIAL SERVICES</Desc>
        <TotalAmt>400</TotalAmt>
        <ProgramServicesAmt>400</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>CLEANLINESS &amp; SAFETY</Desc>
        <TotalAmt>733156</TotalAmt>
        <ProgramServicesAmt>733156</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>1652462</TotalAmt>
        <ProgramServicesAmt>1300781</ProgramServicesAmt>
        <ManagementAndGeneralAmt>351681</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>10826703</TotalAmt>
        <ProgramServicesAmt>9534846</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1291857</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>334588</BOYAmt>
        <EOYAmt>197688</EOYAmt>
      </CashNonInterestBearingGrp>
      <AccountsReceivableGrp>
        <BOYAmt>1422875</BOYAmt>
        <EOYAmt>1521510</EOYAmt>
      </AccountsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>163454</BOYAmt>
        <EOYAmt>167690</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <LandBldgEquipCostOrOtherBssAmt>6733715</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>6203868</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>518021</BOYAmt>
        <EOYAmt>529847</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>286165</BOYAmt>
        <EOYAmt>269338</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>2725103</BOYAmt>
        <EOYAmt>2686073</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>2943505</BOYAmt>
        <EOYAmt>2669744</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>608229</BOYAmt>
        <EOYAmt>470900</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>3551734</BOYAmt>
        <EOYAmt>3140644</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>-826631</BOYAmt>
        <EOYAmt>-454571</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>0</BOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>-826631</BOYAmt>
        <EOYAmt>-454571</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>2725103</BOYAmt>
        <EOYAmt>2686073</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>372060</ReconcilationRevenueExpnssAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="IRS990ScheduleA-01" softwareId="23017509">
      <HospitalInd>X</HospitalInd>
      <OtherSupportSumAmt>0</OtherSupportSumAmt>
      <PublicSupportCY170Pct>0</PublicSupportCY170Pct>
      <PublicSupportTotal509Amt>0</PublicSupportTotal509Amt>
      <PublicSupportCY509Pct>0</PublicSupportCY509Pct>
      <InvestmentIncomeCYPct>0</InvestmentIncomeCYPct>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="IRS990ScheduleD-01" softwareId="23017509">
      <LandGrp>
        <InvestmentCostOrOtherBasisAmt>55323</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>55323</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <InvestmentCostOrOtherBasisAmt>5649441</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>5649441</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
        <InvestmentCostOrOtherBasisAmt>1028951</InvestmentCostOrOtherBasisAmt>
        <BookValueAmt>1028951</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>6733715</TotalBookValueLandBuildingsAmt>
      <OtherAssetsOrgGrp>
        <Desc>OTHER ASSETS</Desc>
        <BookValueAmt>269338</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>269338</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>PATIENT FUND LIABILITY</Desc>
        <Amt>117686</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>LINE OF CREDIT</Desc>
        <Amt>183524</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Capital Lease Payable</Desc>
        <Amt>156630</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>DUE TO MEDICAID</Desc>
        <Amt>13060</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>470900</TotalLiabilityAmt>
      <TotalRevEtcAuditedFinclStmtAmt>11198763</TotalRevEtcAuditedFinclStmtAmt>
      <RevenueSubtotalAmt>11198763</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>11198763</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>10826703</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>10826703</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>10826703</TotalExpensesPerForm990Amt>
    </IRS990ScheduleD>
    <IRS990ScheduleO documentId="IRS990ScheduleO-01" softwareId="23017509">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>Administrator reviews the 990 before submission.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Yearly Review</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt VI, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Available upon request</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Pt XII, Line 2c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board of Directors</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>EQUIPMENT RENT 72554. 72554. 0. 0.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>SEWER TAX 23270. 23270. 0. 0.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>NYS CASH ASSESSMENT 351681. 0. 351681. 0.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>OTHER ADMINISTRATIVE EXPENSES 189219. 189219. 0. 0.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>ACTIVITIES 8131. 8131. 0. 0.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>ANCILLARY SERVICES 1007607. 1007607. 0. 0.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>