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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Ed Phillips</PersonNm>
        <TitleTxt>Board member</TitleTxt>
        <AverageHoursPerWeekRt>0.25</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>0</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>0</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>0</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>0</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>0</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>0</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>0</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>PHI Management Services LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>2109 Sandy Ridge Road</AddressLine1Txt>
            <CityNm>Colfax</CityNm>
            <StateAbbreviationCd>NC</StateAbbreviationCd>
            <ZIPCd>27235</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Management Services</ServicesDesc>
        <CompensationAmt>1161978</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Legacy Health Care Services Inc</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 743715</AddressLine1Txt>
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            <StateAbbreviationCd>GA</StateAbbreviationCd>
            <ZIPCd>30384</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Therapy Services</ServicesDesc>
        <CompensationAmt>747843</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Fourth Elm Construction LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>NC</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <PersonNm>Derrider D Case</PersonNm>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>NC</StateAbbreviationCd>
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          </USAddress>
        </ContractorAddress>
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      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
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          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
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            <StateAbbreviationCd>NC</StateAbbreviationCd>
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          </USAddress>
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      <TotalContributionsAmt>220437</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
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      <TotalProgramServiceRevenueAmt>27974287</TotalProgramServiceRevenueAmt>
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        <TotalRevenueColumnAmt>1475189</TotalRevenueColumnAmt>
        <ExclusionAmt>1475189</ExclusionAmt>
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      <GrossAmountSalesAssetsGrp>
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      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
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      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>1903112</TotalRevenueColumnAmt>
        <ExclusionAmt>1903112</ExclusionAmt>
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      <TotalRevenueGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>3378301</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <OtherSalariesAndWagesGrp>
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      <PensionPlanContributionsGrp>
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      <OtherEmployeeBenefitsGrp>
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      <FeesForServicesLegalGrp>
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        <ManagementAndGeneralAmt>11736</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
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        <ManagementAndGeneralAmt>64108</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>105694</ProgramServicesAmt>
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      <InterestGrp>
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        <ProgramServicesAmt>948237</ProgramServicesAmt>
        <ManagementAndGeneralAmt>129305</ManagementAndGeneralAmt>
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      <DepreciationDepletionGrp>
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        <ProgramServicesAmt>2357900</ProgramServicesAmt>
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        <ProgramServicesAmt>1698392</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5865</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>Food Costs</Desc>
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        <ProgramServicesAmt>1547791</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Utilities</Desc>
        <TotalAmt>1370299</TotalAmt>
        <ProgramServicesAmt>1313429</ProgramServicesAmt>
        <ManagementAndGeneralAmt>56870</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>Management fees</Desc>
        <TotalAmt>1161979</TotalAmt>
        <ProgramServicesAmt>580990</ProgramServicesAmt>
        <ManagementAndGeneralAmt>580989</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
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        <ProgramServicesAmt>3984159</ProgramServicesAmt>
        <ManagementAndGeneralAmt>724119</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>25098968</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3029526</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>1222725</EOYAmt>
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      <AccountsReceivableGrp>
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      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>153109</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>45509958</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>2686077</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>93008660</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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      <TotalLiabilitiesGrp>
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      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>44580113</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>3444531</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>368498</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>361853</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
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      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
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      <GiftsGrantsContrisRcvd509Grp>
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        <CurrentTaxYearMinus3YearsAmt>191344</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>330720</CurrentTaxYearMinus2YearsAmt>
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        <CurrentTaxYearAmt>220437</CurrentTaxYearAmt>
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      <GrossReceiptsAdmissionsGrp>
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        <CurrentTaxYearMinus1YearAmt>26666868</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>27974287</CurrentTaxYearAmt>
        <TotalAmt>131371502</TotalAmt>
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      <Total509Grp>
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        <CurrentTaxYearMinus3YearsAmt>25953722</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>26490928</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>26828287</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>28194724</CurrentTaxYearAmt>
        <TotalAmt>132632786</TotalAmt>
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      <AmountsRcvdDsqlfyPersonGrp>
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      </AmountsRcvdDsqlfyPersonGrp>
      <SubstantialContributorsAmtGrp>
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      <SubstAndDsqlfyPrsnsTotGrp>
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      <InvestmentIncomePYPct>0.03160</InvestmentIncomePYPct>
      <ThirtyThrPctSuprtTestsCY509Ind>X</ThirtyThrPctSuprtTestsCY509Ind>
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    <IRS990ScheduleB documentId="RetDoc1234500001" />
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        <BookValueAmt>6092768</BookValueAmt>
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      <BuildingsGrp>
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        <BookValueAmt>29628747</BookValueAmt>
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      <LeaseholdImprovementsGrp>
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        <BookValueAmt>7842966</BookValueAmt>
      </LeaseholdImprovementsGrp>
      <EquipmentGrp>
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        <BookValueAmt>1945477</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>45509958</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Occupancy deposits</Desc>
        <Amt>262725</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Prepaid rent</Desc>
        <Amt>26896</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Prepaid entrance fee</Desc>
        <Amt>124200</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>413821</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>32303376</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>368498</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>361853</OtherRevenueAmt>
      <RevenueNotReportedAmt>730351</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>31573025</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>31573025</TotalRevenuePerForm990Amt>
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      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>28128494</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
      <TotalExpensesPerForm990Amt>28128494</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization has determined that it has no uncertain income tax positions as of September 30, 2018 and 2017. Also, the Organization does not anticipate any increase or decrease in unrecognized tax benefits during the next twelve months that would result in a material change in its financial position. The Organization's income tax returns for years ended after September 30, 2015 remain open for examination.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrealized gain on interest rate swap 361,853.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleK documentId="RetDoc1053100001">
      <TaxExemptBondsIssuesGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <IssuerName>
          <BusinessNameLine1Txt>North Carolina Medical Care Commission</BusinessNameLine1Txt>
        </IssuerName>
        <BondIssuerEIN>521309402</BondIssuerEIN>
        <CUSIPNum>657902M41</CUSIPNum>
        <BondIssuedDt>2011-11-01</BondIssuedDt>
        <IssuePriceAmt>37745000</IssuePriceAmt>
        <PurposeDesc>Refunding prior bond issue dated 10/16/03</PurposeDesc>
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        <OnBehalfOfIssuerInd>0</OnBehalfOfIssuerInd>
        <PoolFinancingInd>0</PoolFinancingInd>
      </TaxExemptBondsIssuesGrp>
      <TaxExemptBondsProceedsGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <RetiredAmt>8750000</RetiredAmt>
        <TotalProceedsAmt>37745000</TotalProceedsAmt>
        <CurrentRefundingInd>1</CurrentRefundingInd>
        <AdvanceRefundingInd>0</AdvanceRefundingInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
      </TaxExemptBondsProceedsGrp>
      <TaxExemptBondsPrivateBusUseGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
      </TaxExemptBondsPrivateBusUseGrp>
      <TaxExemptBondsArbitrageGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <Form8038TFiledInd>0</Form8038TFiledInd>
        <RebateNotDueYetInd>0</RebateNotDueYetInd>
        <ExceptionToRebateInd>0</ExceptionToRebateInd>
        <NoRebateDueInd>0</NoRebateDueInd>
        <VariableRateIssueInd>1</VariableRateIssueInd>
        <HedgeIdentifiedInBksAndRecInd>1</HedgeIdentifiedInBksAndRecInd>
        <HedgeProviderName>
          <BusinessNameLine1Txt>Branch Bank &amp; Trust</BusinessNameLine1Txt>
        </HedgeProviderName>
        <TermOfHedgePct>7.000000000000</TermOfHedgePct>
        <SuperintegratedHedgeInd>0</SuperintegratedHedgeInd>
        <HedgeTerminatedInd>0</HedgeTerminatedInd>
        <GrossProceedsInvestedInGICInd>0</GrossProceedsInvestedInGICInd>
        <GrossProceedsInvestedInd>0</GrossProceedsInvestedInd>
        <WrittenProcToMonitorReqsInd>0</WrittenProcToMonitorReqsInd>
      </TaxExemptBondsArbitrageGrp>
      <ProceduresCorrectiveActionGrp>
        <BondReferenceCd>A</BondReferenceCd>
        <ProceduresCorrectiveActionInd>0</ProceduresCorrectiveActionInd>
      </ProceduresCorrectiveActionGrp>
    </IRS990ScheduleK>
    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>The Board has contracted with PHI Management Services, LLC to provide executive level management and advisory services for the period May 1, 2016 to December 31, 2018.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The 990 is reviewed by the Executive Committee and provided to the full Board prior to filing.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board members are required annually to sign a conflict of interest statement and are required to disclose any interests which may give rise to conflicts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization is regulated by the Insurance Commission and the financial statements are part of the Disclosure required by them.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, line 24e</FormAndLineReferenceDesc>
        <ExplanationTxt>Contract Medical Services: Program service expenses 912,849. Management and general expenses 0. Fundraising expenses 0. Total expenses 912,849. Contractual dietary: Program service expenses 797,437. Management and general expenses 0. Fundraising expenses 0. Total expenses 797,437. Miscellaneous: Program service expenses 451,228. Management and general expenses 318,967. Fundraising expenses 0. Total expenses 770,195. Supplies: Program service expenses 596,125. Management and general expenses 0. Fundraising expenses 0. Total expenses 596,125. Prescription drugs, etc.: Program service expenses 437,286. Management and general expenses 0. Fundraising expenses 0. Total expenses 437,286. Insurance: Program service expenses 272,794. Management and general expenses 122,582. Fundraising expenses 0. Total expenses 395,376. Charitable care: Program service expenses 378,762. Management and general expenses 0. Fundraising expenses 0. Total expenses 378,762. Office expenses: Program service expenses 59,074. Management and general expenses 256,418. Fundraising expenses 0. Total expenses 315,492. Property Taxes: Program service expenses 57,460. Management and general expenses 0. Fundraising expenses 0. Total expenses 57,460. Dues and Subscriptions: Program service expenses 4,579. Management and general expenses 26,152. Fundraising expenses 0. Total expenses 30,731. Amortization of bond issue costs: Program service expenses 16,565. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,565.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrealized gain on interest rate swap 361,853.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>