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        <ManagementAndGeneralAmt>12306</ManagementAndGeneralAmt>
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        <ManagementAndGeneralAmt>63520</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>113998</ProgramServicesAmt>
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      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
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        <CurrentTaxYearAmt>26666868</CurrentTaxYearAmt>
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        <CurrentTaxYearAmt>26828287</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus1YearAmt>983297</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>1084105</CurrentTaxYearAmt>
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        <CurrentTaxYearMinus3YearsAmt>25852757</CurrentTaxYearMinus3YearsAmt>
        <CurrentTaxYearMinus2YearsAmt>26867930</CurrentTaxYearMinus2YearsAmt>
        <CurrentTaxYearMinus1YearAmt>27474225</CurrentTaxYearMinus1YearAmt>
        <CurrentTaxYearAmt>27912392</CurrentTaxYearAmt>
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      <InvestmentIncomePYPct>0.02750</InvestmentIncomePYPct>
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        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
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          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
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    </IRS990ScheduleB>
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        <BookValueAmt>5361900</BookValueAmt>
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      <BuildingsGrp>
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        <DepreciationAmt>30932918</DepreciationAmt>
        <BookValueAmt>31153486</BookValueAmt>
      </BuildingsGrp>
      <LeaseholdImprovementsGrp>
        <InvestmentCostOrOtherBasisAmt>10057207</InvestmentCostOrOtherBasisAmt>
        <DepreciationAmt>3035971</DepreciationAmt>
        <BookValueAmt>7021236</BookValueAmt>
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      <EquipmentGrp>
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        <DepreciationAmt>4526035</DepreciationAmt>
        <BookValueAmt>1718999</BookValueAmt>
      </EquipmentGrp>
      <TotalBookValueLandBuildingsAmt>45255621</TotalBookValueLandBuildingsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>Occupancy deposits</Desc>
        <Amt>174200</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Prepaid rent</Desc>
        <Amt>6337</Amt>
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      <OtherLiabilitiesOrgGrp>
        <Desc>Interest rate swap</Desc>
        <Amt>88700</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>269237</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>32301453</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>3220952</NetUnrealizedGainsInvstAmt>
      <OtherRevenueAmt>486650</OtherRevenueAmt>
      <RevenueNotReportedAmt>3707602</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>28593851</RevenueSubtotalAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>28593851</TotalRevenuePerForm990Amt>
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      <ExpensesNotReportedAmt>0</ExpensesNotReportedAmt>
      <ExpensesSubtotalAmt>27391592</ExpensesSubtotalAmt>
      <ExpensesNotRptFinclStmtAmt>0</ExpensesNotRptFinclStmtAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part X, Line 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>The Organization has determined that it has no uncertain income tax positions as of September 30, 2017 and 2016. 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, 2014 remain open for examination.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Part XI, Line 2d - Other Adjustments:</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrealized loss on interest rate swap 486,650.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc1042400001">
      <HousingAllowanceOrResidenceInd>X</HousingAllowanceOrResidenceInd>
      <WrittenPolicyRefTAndEExpnssInd>1</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>1</SubstantiationRequiredInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>0</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>0</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>0</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>0</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>0</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>0</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>0</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>0</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>0</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Wilson Sheldon Jr</PersonNm>
        <TitleTxt>Former CEO</TitleTxt>
        <BaseCompensationFilingOrgAmt>209801</BaseCompensationFilingOrgAmt>
        <CompensationBasedOnRltdOrgsAmt>0</CompensationBasedOnRltdOrgsAmt>
        <BonusFilingOrganizationAmount>0</BonusFilingOrganizationAmount>
        <BonusRelatedOrganizationsAmt>0</BonusRelatedOrganizationsAmt>
        <OtherCompensationFilingOrgAmt>0</OtherCompensationFilingOrgAmt>
        <OtherCompensationRltdOrgsAmt>0</OtherCompensationRltdOrgsAmt>
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        <DeferredCompRltdOrgsAmt>0</DeferredCompRltdOrgsAmt>
        <NontaxableBenefitsFilingOrgAmt>0</NontaxableBenefitsFilingOrgAmt>
        <NontaxableBenefitsRltdOrgsAmt>0</NontaxableBenefitsRltdOrgsAmt>
        <TotalCompensationFilingOrgAmt>209801</TotalCompensationFilingOrgAmt>
        <TotalCompensationRltdOrgsAmt>0</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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    </IRS990ScheduleJ>
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      <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>
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        <BondReferenceCd>A</BondReferenceCd>
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        <CurrentRefundingInd>1</CurrentRefundingInd>
        <AdvanceRefundingInd>0</AdvanceRefundingInd>
        <FinalAllocationMadeInd>1</FinalAllocationMadeInd>
        <AdequateBooksAndRecMaintInd>1</AdequateBooksAndRecMaintInd>
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        <OwningBondFinancedPropertyInd>0</OwningBondFinancedPropertyInd>
        <AnyLeaseArrangementsInd>0</AnyLeaseArrangementsInd>
        <MgmtContractBondFincdPropInd>0</MgmtContractBondFincdPropInd>
        <AnyResearchAgreementsInd>0</AnyResearchAgreementsInd>
        <BondIssMeetPrvtSecPymtTestInd>0</BondIssMeetPrvtSecPymtTestInd>
        <ChangeInUseBondFinancedPropInd>0</ChangeInUseBondFinancedPropInd>
        <ProcsNonqualifiedBondRemdtdInd>0</ProcsNonqualifiedBondRemdtdInd>
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        <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>The organization has relied on the integrity of the board members to monitor their independence. Beginning with the 2018 tax year, board members will be asked to annually sign a conflict of interest statement and will be asked to disclose any interests which may give rise to conflicts.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15a</FormAndLineReferenceDesc>
        <ExplanationTxt>The CEO's compensation is set by the compensation committee of the board who are independent.</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>Management fees: Program service expenses 491,883. Management and general expenses 491,882. Fundraising expenses 0. Total expenses 983,765. Contract Medical Services: Program service expenses 755,773. Management and general expenses 0. Fundraising expenses 0. Total expenses 755,773. Miscellaneous: Program service expenses 335,975. Management and general expenses 263,138. Fundraising expenses 0. Total expenses 599,113. Supplies: Program service expenses 560,504. Management and general expenses 0. Fundraising expenses 0. Total expenses 560,504. Contractual dietary: Program service expenses 501,506. Management and general expenses 0. Fundraising expenses 0. Total expenses 501,506. Prescription drugs, etc.: Program service expenses 432,073. Management and general expenses 0. Fundraising expenses 0. Total expenses 432,073. Insurance: Program service expenses 289,276. Management and general expenses 129,923. Fundraising expenses 0. Total expenses 419,199. Office expenses: Program service expenses 92,940. Management and general expenses 213,771. Fundraising expenses 0. Total expenses 306,711. Property Taxes: Program service expenses 45,114. Management and general expenses 0. Fundraising expenses 0. Total expenses 45,114. Dues and Subscriptions: Program service expenses 4,727. Management and general expenses 29,813. Fundraising expenses 0. Total expenses 34,540. Amortization of bond issue costs: Program service expenses 15,127. Management and general expenses 0. Fundraising expenses 0. Total expenses 15,127.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Unrealized gain/loss on interest rate swap 486,650.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
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</Return>