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      <MembershipDuesAmt>3199536</MembershipDuesAmt>
      <RelatedOrganizationsAmt>22822</RelatedOrganizationsAmt>
      <AllOtherContributionsAmt>212708</AllOtherContributionsAmt>
      <TotalContributionsAmt>3435066</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>Seminars Meetings</Desc>
        <BusinessCd>900001</BusinessCd>
        <TotalRevenueColumnAmt>911049</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>911049</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
        <Desc>Contract Income</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>107763</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>107763</RelatedOrExemptFuncIncomeAmt>
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      <TotalProgramServiceRevenueAmt>1018812</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>41276</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>41276</RelatedOrExemptFuncIncomeAmt>
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      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>4495154</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1060088</RelatedOrExemptFuncIncomeAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>176835</TotalAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
      </GrantsToDomesticIndividualsGrp>
      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>0</TotalAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>954044</TotalAmt>
        <ProgramServicesAmt>667831</ProgramServicesAmt>
        <ManagementAndGeneralAmt>286213</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
        <TotalAmt>0</TotalAmt>
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      <OtherSalariesAndWagesGrp>
        <TotalAmt>510182</TotalAmt>
        <ProgramServicesAmt>357127</ProgramServicesAmt>
        <ManagementAndGeneralAmt>153055</ManagementAndGeneralAmt>
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      <PensionPlanContributionsGrp>
        <TotalAmt>56589</TotalAmt>
        <ProgramServicesAmt>39612</ProgramServicesAmt>
        <ManagementAndGeneralAmt>16977</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>127828</TotalAmt>
        <ProgramServicesAmt>89480</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38348</ManagementAndGeneralAmt>
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      <PayrollTaxesGrp>
        <TotalAmt>79807</TotalAmt>
        <ProgramServicesAmt>55865</ProgramServicesAmt>
        <ManagementAndGeneralAmt>23942</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>446550</TotalAmt>
        <ProgramServicesAmt>361706</ProgramServicesAmt>
        <ManagementAndGeneralAmt>84844</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>54000</TotalAmt>
        <ManagementAndGeneralAmt>54000</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
        <TotalAmt>0</TotalAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising></FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>0</TotalAmt>
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      <FeesForServicesOtherGrp>
        <TotalAmt>0</TotalAmt>
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      <AdvertisingGrp>
        <TotalAmt>25352</TotalAmt>
        <ProgramServicesAmt>200000</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2187</ManagementAndGeneralAmt>
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      <OfficeExpensesGrp>
        <TotalAmt>119329</TotalAmt>
        <ProgramServicesAmt>59665</ProgramServicesAmt>
        <ManagementAndGeneralAmt>59664</ManagementAndGeneralAmt>
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      <InformationTechnologyGrp>
        <TotalAmt>0</TotalAmt>
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      <RoyaltiesGrp>
        <TotalAmt>0</TotalAmt>
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      <OccupancyGrp>
        <TotalAmt>67975</TotalAmt>
        <ProgramServicesAmt>31948</ProgramServicesAmt>
        <ManagementAndGeneralAmt>36027</ManagementAndGeneralAmt>
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      <TravelGrp>
        <TotalAmt>55017</TotalAmt>
        <ProgramServicesAmt>20906</ProgramServicesAmt>
        <ManagementAndGeneralAmt>34111</ManagementAndGeneralAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
        <TotalAmt>0</TotalAmt>
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      <ConferencesMeetingsGrp>
        <TotalAmt>473599</TotalAmt>
        <ProgramServicesAmt>473599</ProgramServicesAmt>
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      <InterestGrp>
        <TotalAmt>0</TotalAmt>
      </InterestGrp>
      <PaymentsToAffiliatesGrp>
        <TotalAmt>0</TotalAmt>
      </PaymentsToAffiliatesGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>19797</TotalAmt>
        <ProgramServicesAmt>9899</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9898</ManagementAndGeneralAmt>
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      <InsuranceGrp>
        <TotalAmt>17443</TotalAmt>
        <ProgramServicesAmt>8722</ProgramServicesAmt>
        <ManagementAndGeneralAmt>8721</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>Dues</Desc>
        <TotalAmt>915925</TotalAmt>
        <ProgramServicesAmt>915925</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Special Projects</Desc>
        <TotalAmt>115595</TotalAmt>
        <ProgramServicesAmt>115595</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Administrative Support to PACs</Desc>
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        <ProgramServicesAmt>19320</ProgramServicesAmt>
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      <OtherExpensesGrp>
        <Desc>Disposition Losses</Desc>
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      <AllOtherExpensesGrp>
        <TotalAmt>0</TotalAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>4232889</TotalAmt>
        <ProgramServicesAmt>3427200</ProgramServicesAmt>
        <ManagementAndGeneralAmt>807987</ManagementAndGeneralAmt>
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      <CashNonInterestBearingGrp>
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        <EOYAmt>714990</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>3609323</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>38732</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>1356982</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>1006613</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>322543</BOYAmt>
        <EOYAmt>350369</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>1410219</EOYAmt>
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      <OtherAssetsTotalGrp>
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        <EOYAmt>152617</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>7250917</BOYAmt>
        <EOYAmt>6276250</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>4799151</BOYAmt>
        <EOYAmt>344843</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
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        <EOYAmt>3553777</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>156208</BOYAmt>
        <EOYAmt>152617</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>5160456</BOYAmt>
        <EOYAmt>4051237</EOYAmt>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
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        <EOYAmt>2225013</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
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        <EOYAmt>2225013</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
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        <EOYAmt>6276250</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>262265</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-127713</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>false</FSAuditedInd>
      <FederalGrantAuditRequiredInd>false</FederalGrantAuditRequiredInd>
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      <SubstantiallyAllDuesNondedInd>false</SubstantiallyAllDuesNondedInd>
      <OnlyInHouseLobbyingInd>false</OnlyInHouseLobbyingInd>
      <AgreeCarryoverPriorYearInd>true</AgreeCarryoverPriorYearInd>
      <DuesAssessmentsAmt>3199536</DuesAssessmentsAmt>
      <NonDeductibleLbbyngPltclCYAmt>865907</NonDeductibleLbbyngPltclCYAmt>
      <NonDedLbbyngPltclCyovAmt>-227723</NonDedLbbyngPltclCyovAmt>
      <NonDeductibleLbbyngPltclTotAmt>638184</NonDeductibleLbbyngPltclTotAmt>
      <AggregateReportedDuesNtcAmt>639907</AggregateReportedDuesNtcAmt>
      <TaxableAmt>-1723</TaxableAmt>
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      <InclEscrowCustodialAcctLiabInd>false</InclEscrowCustodialAcctLiabInd>
      <LandGrp>
        <OtherCostOrOtherBasisAmt>35320</OtherCostOrOtherBasisAmt>
        <BookValueAmt>35320</BookValueAmt>
      </LandGrp>
      <BuildingsGrp>
        <OtherCostOrOtherBasisAmt>888341</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>638608</DepreciationAmt>
        <BookValueAmt>249733</BookValueAmt>
      </BuildingsGrp>
      <EquipmentGrp>
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        <DepreciationAmt>365430</DepreciationAmt>
        <BookValueAmt>23978</BookValueAmt>
      </EquipmentGrp>
      <OtherLandBuildingsGrp>
        <OtherCostOrOtherBasisAmt>43913</OtherCostOrOtherBasisAmt>
        <DepreciationAmt>2575</DepreciationAmt>
        <BookValueAmt>41338</BookValueAmt>
      </OtherLandBuildingsGrp>
      <TotalBookValueLandBuildingsAmt>350369</TotalBookValueLandBuildingsAmt>
      <OtherSecuritiesGrp>
        <Desc>Financial derivatives and other financial products</Desc>
      </OtherSecuritiesGrp>
      <OtherSecuritiesGrp>
        <Desc>Closely-held equity interests</Desc>
      </OtherSecuritiesGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>Federal income taxes</Desc>
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      <OtherLiabilitiesOrgGrp>
        <Desc>457b Imputed Liability</Desc>
        <Amt>152617</Amt>
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      <GrantRecordsMaintainedInd>true</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Supporters of NC Skileld Nursing Facilities</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>6325 Falls of Neuse Rd 35-259</AddressLine1Txt>
          <CityNm>Raleigh</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>27615</ZIPCd>
        </USAddress>
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        <IRCSectionDesc>527</IRCSectionDesc>
        <CashGrantAmt>108025</CashGrantAmt>
        <PurposeOfGrantTxt>Support of Common Goals</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>FutureCare of NC Inc</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>35-259 6535 Falls of Neuse Rd</AddressLine1Txt>
          <CityNm>Raleigh</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>27615</ZIPCd>
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        <IRCSectionDesc>501c3</IRCSectionDesc>
        <CashGrantAmt>18810</CashGrantAmt>
        <PurposeOfGrantTxt>Support of Common Goals</PurposeOfGrantTxt>
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      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Restore NC Inc</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>4915 Arendell St Ste J PMB 201</AddressLine1Txt>
          <CityNm>Morehead City</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28557</ZIPCd>
        </USAddress>
        <RecipientEIN>999999999</RecipientEIN>
        <IRCSectionDesc>501c4</IRCSectionDesc>
        <CashGrantAmt>50000</CashGrantAmt>
        <PurposeOfGrantTxt>Support of Common Goals</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1Txt>Coalition for North Carolina's Future</BusinessNameLine1Txt>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1Txt>1001 College Ct</AddressLine1Txt>
          <CityNm>New Bern</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>28562</ZIPCd>
        </USAddress>
        <RecipientEIN>999999999</RecipientEIN>
        <IRCSectionDesc>501c3</IRCSectionDesc>
        <CashGrantAmt>15000</CashGrantAmt>
        <PurposeOfGrantTxt>Support of Common Goals</PurposeOfGrantTxt>
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      <TotalOtherOrgCnt>4</TotalOtherOrgCnt>
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      <TravelForCompanionsInd>X</TravelForCompanionsInd>
      <WrittenPolicyRefTAndEExpnssInd>true</WrittenPolicyRefTAndEExpnssInd>
      <SubstantiationRequiredInd>true</SubstantiationRequiredInd>
      <CompensationCommitteeInd>X</CompensationCommitteeInd>
      <Form990OfOtherOrganizationsInd>X</Form990OfOtherOrganizationsInd>
      <WrittenEmploymentContractInd>X</WrittenEmploymentContractInd>
      <CompensationSurveyInd>X</CompensationSurveyInd>
      <BoardOrCommitteeApprovalInd>X</BoardOrCommitteeApprovalInd>
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>true</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
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        <PersonNm>Polly Welsh</PersonNm>
        <TitleTxt>Executive Vice President</TitleTxt>
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        <BonusFilingOrganizationAmount>5000</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>7440</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>5226</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>198666</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Sam Clark</PersonNm>
        <TitleTxt>Vice President of Finance</TitleTxt>
        <BaseCompensationFilingOrgAmt>190050</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>25000</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>8620</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>15840</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>239510</TotalCompensationFilingOrgAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>James A Sholar</PersonNm>
        <TitleTxt>President</TitleTxt>
        <BaseCompensationFilingOrgAmt>364500</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>240000</BonusFilingOrganizationAmount>
        <OtherCompensationFilingOrgAmt>33325</OtherCompensationFilingOrgAmt>
        <DeferredCompensationFlngOrgAmt>32700</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>8679</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>679204</TotalCompensationFilingOrgAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Karen Lennon</PersonNm>
        <TitleTxt>Vice President of Education and Member Services</TitleTxt>
        <BaseCompensationFilingOrgAmt>109494</BaseCompensationFilingOrgAmt>
        <BonusFilingOrganizationAmount>25000</BonusFilingOrganizationAmount>
        <DeferredCompensationFlngOrgAmt>5378</DeferredCompensationFlngOrgAmt>
        <NontaxableBenefitsFilingOrgAmt>8769</NontaxableBenefitsFilingOrgAmt>
        <TotalCompensationFilingOrgAmt>148641</TotalCompensationFilingOrgAmt>
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    <IRS990ScheduleO documentId="990O" softwareId="22015461" softwareVersionNum="22.0.1.0">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Election of members and their rights. The members of the organization vote/elect the Board of Directors every 2 years</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>Decisions subject to approval of members. The amount of dues are subject to the approval by the members of the organization.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 8a</FormAndLineReferenceDesc>
        <ExplanationTxt>Documentation by committee explanation. Although most committees do not consistently keep contemporaneous minutes, the committees report to the governing board and such reports are documented in written minutes.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>Organizations process to review the form 990. Form 990 is reviewed by the executive committee annually before filing. The executive committe has been delegated authority by the board of directors to act behalf of the full board regarding the 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part IX, Line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board members are required to review and sign a disclosure document regarding any such transactions or potential conflicts annually.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, Line 15a and 15b</FormAndLineReferenceDesc>
        <ExplanationTxt>Compensation for the upcoming year for the executive director is examined and set / approved by the executive board annually. The executive director, as ratified by board approval, sets the compensation for other employees. Souces consulted are 990s of other membership organizations, surveys of other healthcare facilities associations, and Bureau of Labor Statistics and Valuation Resources compensation data. The last review was in 2022.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section Section C, Line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Governing documents disclosure. All referenced documents are available upon request and at the Associations office location in Raleigh, North Carolina.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 8b</FormAndLineReferenceDesc>
        <ExplanationTxt>Documentation of minutes of committees with authority to act on behalf of the board. Committees do not always keep contemporaneous minutes at their individual meetings, however such actions are reported to the board during board meetings which are documented in the board minutes.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
  </ReturnData>
</Return>
