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Exhibit E — 1993 Letter Agreement Paychecks, Health Benefits, Hospice RNS

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February 1, 1993

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

Re: 1993 - 1995 Collective Bargaining Agreement between

VNS Home Care and United Federation of Teachers

Dear Ms. Swaim:

This letter is delivered to you with the February 1, 1993 through February 28, 1995 Collective Bargaining Agreement between VNS Home Care ("VNS") and the United Federation of Teachers, Local 2, American Federation of Teachers, AFL-CIO ("Union"), and is to be incorporated as a part thereof.

Separate Paychecks for Per Visit Compensation

Effective July 1, 1993, Employees who are classified as Regular Full-Time, Regular Part-Time and Other Part-Time may elect to receive a separate paycheck for per visit compensation. Employees may only elect such payment once each year, effective at the commencement of the calendar year, except that elections may be made effective July 1, 1993 in the first year of this Agreement. Unless otherwise notified, elections will be continued from year to year. Such elections cannot be revoked until the commencement of the next calendar year - i.e., effective upon the commencement of the next calendar year. Election and revocation notices must be submitted in writing to the Payroll Department by June 1, 1993 or December 1, as applicable.

Upon hire, new employees may elect such payment for the current calendar year.
Health Benefits

If Congress enacts legislation that requires a fundamental restructuring of the way medical benefits are insured or provided, the parties will meet to discuss what changes, if any, would be appropriate in the Benefit Fund, with any changes, other than changes required by law, requiring agreement of both parties.

Current Per Diem Employees in Hospice Program

Current Hospice Per Diem Nurses have the option to convert to Other Part-Time and receive an hourly rate based on the new base rate and applicable experience and education differentials on a pro-rated basis.



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


By: Carol Raphael By: Sandra Feldman
Chief Executive Officer President
and Administrator

Date: April 8, 1993 Date: April 5, 1993