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 Message from CEO/President Bob Packer Home Nursing Agency - Built on a Strong Foundation A strong foundation is the cornerstone for all future growth. Our foundation consists of core principles and philosophies that have guided us through an ever-changing healthcare structure. With escalating healthcare costs, constant fluctuation in reimbursement formulas and an inherent nursing shortage, we continually demonstrate our strength to triumph over these difficult conditions without compromising care, compassion or our compelling emphasis on the patients' best interests - the heart of our mission. Our committed staff, board members and volunteers reflect a superior dedication to our "culture of care" that has led Home Nursing Agency to become the premier provider of in-home and community services in Pennsylvania for over 35 years. Our community partners have provided us with an exceptional foundation to champion causes for the greater good and health of our friends and neighbors. Our new Palliative Care Program, developed in conjunction with the Altoona Regional Health System, is bridging a gap for those with a chronic illness to pursue curative treatment while also embracing the philosophy of living as comfortably as possible. This is right for the patient. This is right for the community. By partnering with the region's Area Offices on Aging, physician offices, senior centers and businesses, the Agency continues to protect communities through the annual Fight the Flu Campaign held throughout Blair, Bedford, Cambria, Centre, Huntingdon, Somerset and Indiana Counties. Moreover, we've joined efforts with a regional taskforce to address Hepatitis C prevention, and launched a media awareness campaign focusing on the importance of diabetes education. Undoubtedly, our strong foundation has allowed us to maintain a position of advocacy and strength even as several for-profit entities attempt to enter our markets, and as economic hardships arise. One of our most pressing concerns has been to safeguard family-sustaining benefits through our employee health insurance plan. This concern is not unique to Home Nursing Agency. In fact, a member of our senior management team was selected to serve on a national committee of Visiting Nurse Associations to help formulate an industry-wide plan. Everyday, I believe our actions are illustrating to the community and to its leaders that we are moving in the right direction in terms of what we do and how we do it. The distinctive "culture of care" exhibited by our 850 employees is evidenced through our procurement of stronger outcomes and assessment capabilities among the 19,000 people we serve - the ultimate accountability of how we deliver our services. Home Nursing Agency has achieved a mark of distinction as one of the "Top 100 Companies to Work for in Pennsylvania" from Great Place to Work® Institute, Inc. We define a great place to work as one where employees trust the people they work for, have pride in what they do, and enjoy the people they work with. These defining characteristics, along with workplace practices, were measured in a random employee survey of full and part-time employees and were the foundation for this prestigious declaration. Throughout our programs and services, our responsive employees continue to take an active role in preventing individuals or families from becoming besieged with hopelessness or despair. We are also extremely grateful for our generous donors who support the Agency's philanthropic endeavors to assist individuals and families in accessing the care they deserve, especially those with little or no means to do so. Our history as non-profit Visiting Nurse Association and community health provider chronicles a charitable care mission unsurpassed by any of our competitors. We reinvest Foundation funds directly into local communities for the fundamental needs of children's health, support groups and care for those facing a life-limiting illness or injury. The resources of Home Nursing Agency's Foundation are used to support Main Street, not Wall Street. I have great confidence in our ability to overcome obstacles and remain the provider of choice among our patients, physicians and vital referral sources. However, success is not an entitlement. It has to be earned over and over again. With your continued support and steadfast commitment, our successes will be perpetual. Sincerely, Robert R. Packer President and Chief Executive Officer 
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