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Exhibit D — 1991 Letter Agreement; Subpoena

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January 31, 1991

BY HAND

Lucille Swaim
Coordinator of Negotiations
United Federation of Teachers
260 Park Avenue South
New York, New York 10010

Re: 1991 - 1993 Collective Bargaining Agreement between

VNS Home Care and United Federation of Teachers

Dear Ms. Swaim:

This letter is to confirm that a Staff Nurse or Per Diem Nurse Employee who is required by subpoena to testify in a court proceeding regarding a work-related issue may, through his/her Supervisor, contact the VNS Legal Department, and a VNS attorney or VNS-appointed attorney will consult with such Employee regarding the meaning and effects of such subpoena.

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Very truly yours,

Denise M. Davin
Vice President for Human
Resources and Labor Counsel

cc: C. Blum