<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" returnVersion="2022v5.0">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2024-05-31T12:39:20-04:00</ReturnTs>
    <TaxPeriodEndDt>2023-09-30</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmEIN>461041593</PreparerFirmEIN>
      <PreparerFirmName>
        <BusinessNameLine1Txt>FINANCIAL SOLUTION ADVISORS PLLC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>4350 PABLO PROFESSIONAL CT STE 200</AddressLine1Txt>
        <CityNm>JACKSONVILLE</CityNm>
        <StateAbbreviationCd>FL</StateAbbreviationCd>
        <ZIPCd>322243224</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990</ReturnTypeCd>
    <TaxPeriodBeginDt>2022-10-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>561655431</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>INSTITUTE FOR MEDICAL RESEARCH INC</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>INST</BusinessNameControlTxt>
      <PhoneNum>9192507013</PhoneNum>
      <USAddress>
        <AddressLine1Txt>508 FULTON ST 151/IMR</AddressLine1Txt>
        <CityNm>DURHAM</CityNm>
        <StateAbbreviationCd>NC</StateAbbreviationCd>
        <ZIPCd>27705</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>MICHELE PACKARD-MILAM</PersonNm>
      <PersonTitleTxt>INT EXEC DIR</PersonTitleTxt>
      <SignatureDt>2024-05-31</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <SigningOfficerGrp>
      <PersonFullName>
        <PersonFirstNm>MICHELE</PersonFirstNm>
        <PersonLastNm>PACKARD-MILAM</PersonLastNm>
      </PersonFullName>
      <SSN>999009999</SSN>
    </SigningOfficerGrp>
    <IRSResponsiblePrtyInfoCurrInd>false</IRSResponsiblePrtyInfoCurrInd>
    <PreparerPersonGrp>
      <PreparerPersonNm>MICHAEL B MCLEOD CPA</PreparerPersonNm>
      <PTIN>P00966646</PTIN>
      <PhoneNum>9042962024</PhoneNum>
      <PreparationDt>2024-05-31</PreparationDt>
    </PreparerPersonGrp>
    <TaxYr>2022</TaxYr>
    <BuildTS>2023-04-26 12:10:37Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="6">
    <IRS990 documentId="RetDoc1" referenceDocumentId="RetDoc4">
      <PrincipalOfficerNm>MICHELE PACKARD-MILAM</PrincipalOfficerNm>
      <USAddress>
        <AddressLine1Txt>508 FULTON ST 151/IMR</AddressLine1Txt>
        <CityNm>DURHAM</CityNm>
        <StateAbbreviationCd>NC</StateAbbreviationCd>
        <ZIPCd>27705</ZIPCd>
      </USAddress>
      <GrossReceiptsAmt>23354518</GrossReceiptsAmt>
      <GroupReturnForAffiliatesInd>false</GroupReturnForAffiliatesInd>
      <Organization501c3Ind>X</Organization501c3Ind>
      <WebsiteAddressTxt>IMR.ORG</WebsiteAddressTxt>
      <TypeOfOrganizationCorpInd>X</TypeOfOrganizationCorpInd>
      <FormationYr>1989</FormationYr>
      <LegalDomicileStateCd>NC</LegalDomicileStateCd>
      <ActivityOrMissionDesc>TO SUPPORT RESEARCH AND EDUCATION THROUGHOUT THE DURHAM VETERANS AFFAIRS HEALTH CARE SYSTEM.</ActivityOrMissionDesc>
      <VotingMembersGoverningBodyCnt>7</VotingMembersGoverningBodyCnt>
      <VotingMembersIndependentCnt>3</VotingMembersIndependentCnt>
      <TotalEmployeeCnt>155</TotalEmployeeCnt>
      <TotalGrossUBIAmt>0</TotalGrossUBIAmt>
      <PYContributionsGrantsAmt>5071</PYContributionsGrantsAmt>
      <CYContributionsGrantsAmt>0</CYContributionsGrantsAmt>
      <PYProgramServiceRevenueAmt>7856185</PYProgramServiceRevenueAmt>
      <CYProgramServiceRevenueAmt>20502761</CYProgramServiceRevenueAmt>
      <PYInvestmentIncomeAmt>9819</PYInvestmentIncomeAmt>
      <CYInvestmentIncomeAmt>113852</CYInvestmentIncomeAmt>
      <PYOtherRevenueAmt>5272</PYOtherRevenueAmt>
      <CYOtherRevenueAmt>140063</CYOtherRevenueAmt>
      <PYTotalRevenueAmt>7876347</PYTotalRevenueAmt>
      <CYTotalRevenueAmt>20756676</CYTotalRevenueAmt>
      <CYGrantsAndSimilarPaidAmt>0</CYGrantsAndSimilarPaidAmt>
      <CYBenefitsPaidToMembersAmt>0</CYBenefitsPaidToMembersAmt>
      <PYSalariesCompEmpBnftPaidAmt>5103682</PYSalariesCompEmpBnftPaidAmt>
      <CYSalariesCompEmpBnftPaidAmt>11127010</CYSalariesCompEmpBnftPaidAmt>
      <CYTotalProfFndrsngExpnsAmt>0</CYTotalProfFndrsngExpnsAmt>
      <CYTotalFundraisingExpenseAmt>0</CYTotalFundraisingExpenseAmt>
      <PYOtherExpensesAmt>4844190</PYOtherExpensesAmt>
      <CYOtherExpensesAmt>4639240</CYOtherExpensesAmt>
      <PYTotalExpensesAmt>9947872</PYTotalExpensesAmt>
      <CYTotalExpensesAmt>15766250</CYTotalExpensesAmt>
      <PYRevenuesLessExpensesAmt>-2071525</PYRevenuesLessExpensesAmt>
      <CYRevenuesLessExpensesAmt>4990426</CYRevenuesLessExpensesAmt>
      <TotalAssetsBOYAmt>5835101</TotalAssetsBOYAmt>
      <TotalAssetsEOYAmt>13072926</TotalAssetsEOYAmt>
      <TotalLiabilitiesBOYAmt>2384414</TotalLiabilitiesBOYAmt>
      <TotalLiabilitiesEOYAmt>4636548</TotalLiabilitiesEOYAmt>
      <NetAssetsOrFundBalancesBOYAmt>3450687</NetAssetsOrFundBalancesBOYAmt>
      <NetAssetsOrFundBalancesEOYAmt>8436378</NetAssetsOrFundBalancesEOYAmt>
      <InfoInScheduleOPartIIIInd>X</InfoInScheduleOPartIIIInd>
      <MissionDesc>THE PURPOSE OF THE INSTITUTE OF MEDICAL RESEARCH, INC. IS TO SUPPORT RESEARCH AND EDUCATION THROUGHOUT THE DURHAM VETERANS AFFAIRS HEALTHCARE SYSTEM TO ENHANCE THE HEALTH AND LIVES OF VETERANS, THEIR FAMILIES AND THE PUBLIC AT LARGE.</MissionDesc>
      <SignificantNewProgramSrvcInd>false</SignificantNewProgramSrvcInd>
      <SignificantChangeInd>false</SignificantChangeInd>
      <ExpenseAmt>14082272</ExpenseAmt>
      <RevenueAmt>20502761</RevenueAmt>
      <Desc>SUPPORTED A MEDICAL TRAINING AND EDUCATION PROGRAM TO SUPPORT THE VA PHARMACOGENOMICS ACTION FOR CANCER SURVIVORSHIP (PHASER). EXPANDED ACCESS TO PHARMACOGENOMIC (PGX) TESTING, INCLUDING PROVIDING BASIC PGX EDUCATION, TO AN ADDITIONAL 10,000 VETERANS SEEN ACROSS 25 VA HEALTH CARE SYSTEMS NATIONWIDE. ENGAGED IN PHARMACOGENOMIC EDUCATION WITH APPROXIMATELY 1,000 NEW VA PROVIDERS IN ADDITION TO HOSTING MONTHLY PGX BROWN BAG LEARNING SESSIONS AND RELEASING A MONTHLY PGX NEWSLETTER TO OVER 1,700 CLINICIANS. SECURED COMMITMENTS FROM ANOTHER 27 VA HOSPITALS TO IMPLEMENT THE PHASER PGX TESTING PROGRAM. BUILT AND RELEASED NATIONALLY AUTOMATED CLINICAL DECISION SUPPORT TOOLS FOR DRUG-GENE ALERTS FOR ALL STATINS AND SELECT SSRIS, NSAIDS, PPIS, CLOPIDOGREL, ONDANSETRON, AND LOOK TO HAVE RELEASED BEFORE THE END OF THE CALENDAR YEAR ALERTS TO SUPPORT DRUG-GENE ALERTS FOR SELECT TCAS, ATOMOXETINE, PHENYTOIN, TACROLIMUS, TAMOXIFEN, AND VORICONAZOLE. PREPARED THE EDUCATION AND TECHNICAL ENVIRONMENTS FOR A TESTING PANEL EXPANSION FROM 11 TO 15 GENES DUE TO BE RELEASED BY THE END OF THE CALENDAR YEAR.</Desc>
      <ProgSrvcAccomActy2Grp>
        <Desc>SUPPORTED NUMEROUS PROJECTS TO FURTHER AID WITH THE DIAGNOSIS, RISK STRATIFICATION AND LIFE STYLE INTERVENTION FOR THE BENEFIT OF UROLOGY AND ONCOLOGY PATIENTS.</Desc>
      </ProgSrvcAccomActy2Grp>
      <ProgSrvcAccomActy3Grp>
        <Desc>ACCOMODATED MAJOR GROWTH OF A PROSTATE CANCER PROGRAM TO ADD MULTIPLE PROJECTS, ADDING THOUSANDS OF PATIENTS AND NEW AVENUES OF PATIENT EDUCATION AND POTENTIAL TREATMENT.</Desc>
      </ProgSrvcAccomActy3Grp>
      <TotalProgramServiceExpensesAmt>14082272</TotalProgramServiceExpensesAmt>
      <DescribedInSection501c3Ind referenceDocumentId="RetDoc6">true</DescribedInSection501c3Ind>
      <ScheduleBRequiredInd>false</ScheduleBRequiredInd>
      <PoliticalCampaignActyInd>false</PoliticalCampaignActyInd>
      <LobbyingActivitiesInd>false</LobbyingActivitiesInd>
      <SubjectToProxyTaxInd>false</SubjectToProxyTaxInd>
      <DonorAdvisedFundInd referenceDocumentId="RetDoc2">false</DonorAdvisedFundInd>
      <ConservationEasementsInd referenceDocumentId="RetDoc2">false</ConservationEasementsInd>
      <CollectionsOfArtInd referenceDocumentId="RetDoc2">false</CollectionsOfArtInd>
      <CreditCounselingInd referenceDocumentId="RetDoc2">false</CreditCounselingInd>
      <DonorRstrOrQuasiEndowmentsInd referenceDocumentId="RetDoc2">false</DonorRstrOrQuasiEndowmentsInd>
      <ReportLandBuildingEquipmentInd referenceDocumentId="RetDoc2">false</ReportLandBuildingEquipmentInd>
      <ReportInvestmentsOtherSecInd referenceDocumentId="RetDoc2">false</ReportInvestmentsOtherSecInd>
      <ReportProgramRelatedInvstInd referenceDocumentId="RetDoc2">false</ReportProgramRelatedInvstInd>
      <ReportOtherAssetsInd referenceDocumentId="RetDoc2">true</ReportOtherAssetsInd>
      <ReportOtherLiabilitiesInd referenceDocumentId="RetDoc2">true</ReportOtherLiabilitiesInd>
      <IncludeFIN48FootnoteInd referenceDocumentId="RetDoc2">true</IncludeFIN48FootnoteInd>
      <IndependentAuditFinclStmtInd referenceDocumentId="RetDoc2">true</IndependentAuditFinclStmtInd>
      <ConsolidatedAuditFinclStmtInd referenceDocumentId="RetDoc2">false</ConsolidatedAuditFinclStmtInd>
      <SchoolOperatingInd>false</SchoolOperatingInd>
      <ForeignOfficeInd>false</ForeignOfficeInd>
      <ForeignActivitiesInd>false</ForeignActivitiesInd>
      <MoreThan5000KToOrgInd>false</MoreThan5000KToOrgInd>
      <MoreThan5000KToIndividualsInd>false</MoreThan5000KToIndividualsInd>
      <ProfessionalFundraisingInd>false</ProfessionalFundraisingInd>
      <FundraisingActivitiesInd>false</FundraisingActivitiesInd>
      <GamingActivitiesInd>false</GamingActivitiesInd>
      <OperateHospitalInd>false</OperateHospitalInd>
      <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
      <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
      <ScheduleJRequiredInd referenceDocumentId="RetDoc3">true</ScheduleJRequiredInd>
      <TaxExemptBondsInd>false</TaxExemptBondsInd>
      <EngagedInExcessBenefitTransInd>false</EngagedInExcessBenefitTransInd>
      <PYExcessBenefitTransInd>false</PYExcessBenefitTransInd>
      <LoanOutstandingInd>false</LoanOutstandingInd>
      <GrantToRelatedPersonInd>false</GrantToRelatedPersonInd>
      <BusinessRlnWithOrgMemInd>false</BusinessRlnWithOrgMemInd>
      <BusinessRlnWithFamMemInd>false</BusinessRlnWithFamMemInd>
      <BusinessRlnWith35CtrlEntInd>false</BusinessRlnWith35CtrlEntInd>
      <DeductibleNonCashContriInd>false</DeductibleNonCashContriInd>
      <DeductibleArtContributionInd>false</DeductibleArtContributionInd>
      <TerminateOperationsInd>false</TerminateOperationsInd>
      <PartialLiquidationInd>false</PartialLiquidationInd>
      <DisregardedEntityInd referenceDocumentId="RetDoc5">false</DisregardedEntityInd>
      <RelatedEntityInd referenceDocumentId="RetDoc5">true</RelatedEntityInd>
      <RelatedOrganizationCtrlEntInd>false</RelatedOrganizationCtrlEntInd>
      <TrnsfrExmptNonChrtblRltdOrgInd referenceDocumentId="RetDoc5">false</TrnsfrExmptNonChrtblRltdOrgInd>
      <ActivitiesConductedPrtshpInd referenceDocumentId="RetDoc5">false</ActivitiesConductedPrtshpInd>
      <ScheduleORequiredInd>true</ScheduleORequiredInd>
      <IRPDocumentCnt>42</IRPDocumentCnt>
      <IRPDocumentW2GCnt>0</IRPDocumentW2GCnt>
      <EmployeeCnt>155</EmployeeCnt>
      <EmploymentTaxReturnsFiledInd>true</EmploymentTaxReturnsFiledInd>
      <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
      <ForeignFinancialAccountInd>false</ForeignFinancialAccountInd>
      <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      <TaxablePartyNotificationInd>false</TaxablePartyNotificationInd>
      <NondeductibleContributionsInd>false</NondeductibleContributionsInd>
      <QuidProQuoContributionsInd>false</QuidProQuoContributionsInd>
      <Form8282PropertyDisposedOfInd>false</Form8282PropertyDisposedOfInd>
      <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
      <PayPremiumsPrsnlBnftCntrctInd>false</PayPremiumsPrsnlBnftCntrctInd>
      <Form8899Filedind>false</Form8899Filedind>
      <Form1098CFiledInd>false</Form1098CFiledInd>
      <IndoorTanningServicesInd>false</IndoorTanningServicesInd>
      <SubjToTaxRmnrtnExPrchtPymtInd>false</SubjToTaxRmnrtnExPrchtPymtInd>
      <SubjectToExcsTaxNetInvstIncInd>false</SubjectToExcsTaxNetInvstIncInd>
      <InfoInScheduleOPartVIInd>X</InfoInScheduleOPartVIInd>
      <GoverningBodyVotingMembersCnt>7</GoverningBodyVotingMembersCnt>
      <IndependentVotingMemberCnt>3</IndependentVotingMemberCnt>
      <FamilyOrBusinessRlnInd>false</FamilyOrBusinessRlnInd>
      <DelegationOfMgmtDutiesInd>false</DelegationOfMgmtDutiesInd>
      <ChangeToOrgDocumentsInd>false</ChangeToOrgDocumentsInd>
      <MaterialDiversionOrMisuseInd>false</MaterialDiversionOrMisuseInd>
      <MembersOrStockholdersInd>false</MembersOrStockholdersInd>
      <ElectionOfBoardMembersInd>false</ElectionOfBoardMembersInd>
      <DecisionsSubjectToApprovaInd>false</DecisionsSubjectToApprovaInd>
      <MinutesOfGoverningBodyInd>true</MinutesOfGoverningBodyInd>
      <MinutesOfCommitteesInd>true</MinutesOfCommitteesInd>
      <OfficerMailingAddressInd>false</OfficerMailingAddressInd>
      <LocalChaptersInd>false</LocalChaptersInd>
      <Form990ProvidedToGvrnBodyInd>true</Form990ProvidedToGvrnBodyInd>
      <ConflictOfInterestPolicyInd>true</ConflictOfInterestPolicyInd>
      <AnnualDisclosureCoveredPrsnInd>true</AnnualDisclosureCoveredPrsnInd>
      <RegularMonitoringEnfrcInd>true</RegularMonitoringEnfrcInd>
      <WhistleblowerPolicyInd>true</WhistleblowerPolicyInd>
      <DocumentRetentionPolicyInd>true</DocumentRetentionPolicyInd>
      <CompensationProcessCEOInd>true</CompensationProcessCEOInd>
      <CompensationProcessOtherInd>false</CompensationProcessOtherInd>
      <InvestmentInJointVentureInd>false</InvestmentInJointVentureInd>
      <UponRequestInd>X</UponRequestInd>
      <BooksInCareOfDetail>
        <BusinessName>
          <BusinessNameLine1Txt>INSTITUTE FOR MEDICAL RESEARCH</BusinessNameLine1Txt>
        </BusinessName>
        <PhoneNum>9192507013</PhoneNum>
        <USAddress>
          <AddressLine1Txt>508 FULTON STREET 151/IMR</AddressLine1Txt>
          <CityNm>DURHAM</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>27705</ZIPCd>
        </USAddress>
      </BooksInCareOfDetail>
      <Form990PartVIISectionAGrp>
        <PersonNm>LIANA PUSCAS MD</PersonNm>
        <TitleTxt>SECRETARY/TR</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>395036</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>KENNETH GOLDBERG MD</PersonNm>
        <TitleTxt>VICE PRESIDE</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>337448</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DAVID EDELMAN MD</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>244118</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ALYSHIA SMITH DNP</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>40.00</AverageHoursPerWeekRltdOrgRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>209300</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>JEFFREY SMITH</PersonNm>
        <TitleTxt>FMR EX DIR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>93956</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <BusinessName>
          <BusinessNameLine1Txt>RANKIN MCKENZIE LLC</BusinessNameLine1Txt>
        </BusinessName>
        <TitleTxt>FRAC CFO</TitleTxt>
        <AverageHoursPerWeekRt>16.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>13020</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MEGAN MADDEN</PersonNm>
        <TitleTxt>CFO</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>9639</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>BRIAN LETOURNEAU</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>5800</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>DENNIS SHIPMAN</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>1000</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>PHIL LANDIS</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>ROBERT ADAMS MD</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <AverageHoursPerWeekRt>2.00</AverageHoursPerWeekRt>
        <IndividualTrusteeOrDirectorInd>X</IndividualTrusteeOrDirectorInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>MICHELE PACKARD-MILAM</PersonNm>
        <TitleTxt>INT EXEC DIR</TitleTxt>
        <AverageHoursPerWeekRt>40.00</AverageHoursPerWeekRt>
        <OfficerInd>X</OfficerInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>123415</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>1185902</TotReportableCompRltdOrgAmt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ProgramServiceRevenueGrp>
        <Desc>NON-FEDERAL GRANTS</Desc>
        <BusinessCd>541700</BusinessCd>
        <TotalRevenueColumnAmt>17912888</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>17912888</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>FEDERAL GRANTS &amp; CONTRACTS</Desc>
        <BusinessCd>541700</BusinessCd>
        <TotalRevenueColumnAmt>1959773</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1959773</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>PERSONNEL AGREEMENTS</Desc>
        <BusinessCd>541700</BusinessCd>
        <TotalRevenueColumnAmt>630100</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>630100</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>20502761</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>113852</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>113852</RelatedOrExemptFuncIncomeAmt>
      </InvestmentIncomeGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>2597842</SecuritiesAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>2597842</SecuritiesAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <OtherRevenueMiscGrp>
        <Desc>EXPENSE RECOVERY &amp; MISC</Desc>
        <BusinessCd>541700</BusinessCd>
        <TotalRevenueColumnAmt>140063</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>140063</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>140063</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>20756676</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>20756676</RelatedOrExemptFuncIncomeAmt>
      </TotalRevenueGrp>
      <CompCurrentOfcrDirectorsGrp>
        <TotalAmt>190195</TotalAmt>
        <ManagementAndGeneralAmt>190195</ManagementAndGeneralAmt>
      </CompCurrentOfcrDirectorsGrp>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>9173981</TotalAmt>
        <ProgramServicesAmt>8517212</ProgramServicesAmt>
        <ManagementAndGeneralAmt>656769</ManagementAndGeneralAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>118518</TotalAmt>
        <ProgramServicesAmt>116930</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1588</ManagementAndGeneralAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>933922</TotalAmt>
        <ProgramServicesAmt>708031</ProgramServicesAmt>
        <ManagementAndGeneralAmt>225891</ManagementAndGeneralAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>710394</TotalAmt>
        <ProgramServicesAmt>659236</ProgramServicesAmt>
        <ManagementAndGeneralAmt>51158</ManagementAndGeneralAmt>
      </PayrollTaxesGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>67622</TotalAmt>
        <ProgramServicesAmt>19515</ProgramServicesAmt>
        <ManagementAndGeneralAmt>48107</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>24500</TotalAmt>
        <ManagementAndGeneralAmt>24500</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>1422747</TotalAmt>
        <ProgramServicesAmt>1277486</ProgramServicesAmt>
        <ManagementAndGeneralAmt>145261</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>1062</TotalAmt>
        <ProgramServicesAmt>1062</ProgramServicesAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>155843</TotalAmt>
        <ProgramServicesAmt>66761</ProgramServicesAmt>
        <ManagementAndGeneralAmt>89082</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>135601</TotalAmt>
        <ProgramServicesAmt>35146</ProgramServicesAmt>
        <ManagementAndGeneralAmt>100455</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>254556</TotalAmt>
        <ProgramServicesAmt>162732</ProgramServicesAmt>
        <ManagementAndGeneralAmt>91824</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>90738</TotalAmt>
        <ProgramServicesAmt>85390</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5348</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>66866</TotalAmt>
        <ProgramServicesAmt>64851</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2015</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InsuranceGrp>
        <TotalAmt>22335</TotalAmt>
        <ManagementAndGeneralAmt>22335</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>INTER-INSTITUTIONAL AGREE</Desc>
        <TotalAmt>1525033</TotalAmt>
        <ProgramServicesAmt>1525033</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>RESEARCH STUDY COSTS</Desc>
        <TotalAmt>774437</TotalAmt>
        <ProgramServicesAmt>811037</ProgramServicesAmt>
        <ManagementAndGeneralAmt>-36600</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT EXPENSE</Desc>
        <TotalAmt>83906</TotalAmt>
        <ProgramServicesAmt>28312</ProgramServicesAmt>
        <ManagementAndGeneralAmt>55594</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>DUES &amp; SUBSCRIPTIONS</Desc>
        <TotalAmt>13994</TotalAmt>
        <ProgramServicesAmt>3538</ProgramServicesAmt>
        <ManagementAndGeneralAmt>10456</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>15766250</TotalAmt>
        <ProgramServicesAmt>14082272</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1683978</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </TotalFunctionalExpensesGrp>
      <CashNonInterestBearingGrp>
        <BOYAmt>756360</BOYAmt>
        <EOYAmt>1724240</EOYAmt>
      </CashNonInterestBearingGrp>
      <SavingsAndTempCashInvstGrp>
        <BOYAmt>2601759</BOYAmt>
        <EOYAmt>1746984</EOYAmt>
      </SavingsAndTempCashInvstGrp>
      <PledgesAndGrantsReceivableGrp>
        <BOYAmt>2450640</BOYAmt>
        <EOYAmt>6433373</EOYAmt>
      </PledgesAndGrantsReceivableGrp>
      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>12170</BOYAmt>
        <EOYAmt>119747</EOYAmt>
      </PrepaidExpensesDefrdChargesGrp>
      <InvestmentsPubTradedSecGrp>
        <EOYAmt>1960000</EOYAmt>
      </InvestmentsPubTradedSecGrp>
      <OtherAssetsTotalGrp>
        <BOYAmt>14172</BOYAmt>
        <EOYAmt>1088582</EOYAmt>
      </OtherAssetsTotalGrp>
      <TotalAssetsGrp>
        <BOYAmt>5835101</BOYAmt>
        <EOYAmt>13072926</EOYAmt>
      </TotalAssetsGrp>
      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1565677</BOYAmt>
        <EOYAmt>1260111</EOYAmt>
      </AccountsPayableAccrExpnssGrp>
      <DeferredRevenueGrp>
        <BOYAmt>787959</BOYAmt>
        <EOYAmt>2280985</EOYAmt>
      </DeferredRevenueGrp>
      <OtherLiabilitiesGrp>
        <BOYAmt>30778</BOYAmt>
        <EOYAmt>1095452</EOYAmt>
      </OtherLiabilitiesGrp>
      <TotalLiabilitiesGrp>
        <BOYAmt>2384414</BOYAmt>
        <EOYAmt>4636548</EOYAmt>
      </TotalLiabilitiesGrp>
      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
        <BOYAmt>3318755</BOYAmt>
        <EOYAmt>7169582</EOYAmt>
      </NoDonorRestrictionNetAssetsGrp>
      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>131932</BOYAmt>
        <EOYAmt>1266796</EOYAmt>
      </DonorRestrictionNetAssetsGrp>
      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>3450687</BOYAmt>
        <EOYAmt>8436378</EOYAmt>
      </TotalNetAssetsFundBalanceGrp>
      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>5835101</BOYAmt>
        <EOYAmt>13072926</EOYAmt>
      </TotLiabNetAssetsFundBalanceGrp>
      <ReconcilationRevenueExpnssAmt>4990426</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-4735</NetUnrlzdGainsLossesInvstAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
      <FSAuditedInd>true</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
      </FSAuditedBasisGrp>
      <AuditCommitteeInd>true</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>true</FederalGrantAuditRequiredInd>
      <FederalGrantAuditPerformedInd>true</FederalGrantAuditPerformedInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc6">
      <MedicalResearchOrganizationInd>X</MedicalResearchOrganizationInd>
      <HospitalNameAndAddressGrp>
        <SupportedOrganizationName>
          <BusinessNameLine1Txt>DURHAM VETERAN AFFAIRS HEALTH CARE SYSTEM</BusinessNameLine1Txt>
        </SupportedOrganizationName>
        <CityNm>DURHAM</CityNm>
        <StateAbbreviationCd>NC</StateAbbreviationCd>
      </HospitalNameAndAddressGrp>
    </IRS990ScheduleA>
    <IRS990ScheduleD documentId="RetDoc2">
      <OtherAssetsOrgGrp>
        <Desc>OPERATING LEASE RIGHT OF USE, NET</Desc>
        <BookValueAmt>1079059</BookValueAmt>
      </OtherAssetsOrgGrp>
      <OtherAssetsOrgGrp>
        <Desc>SECURITY DEPOSITS</Desc>
        <BookValueAmt>9523</BookValueAmt>
      </OtherAssetsOrgGrp>
      <TotalBookValueOtherAssetsAmt>1088582</TotalBookValueOtherAssetsAmt>
      <OtherLiabilitiesOrgGrp>
        <Desc>OPERATING LEASE LIABILITIES, LNG TRM</Desc>
        <Amt>850338</Amt>
      </OtherLiabilitiesOrgGrp>
      <OtherLiabilitiesOrgGrp>
        <Desc>OPERATING LEASE LIABILITIES, CURRENT</Desc>
        <Amt>245114</Amt>
      </OtherLiabilitiesOrgGrp>
      <TotalLiabilityAmt>1095452</TotalLiabilityAmt>
      <FootnoteTextInd>X</FootnoteTextInd>
      <TotalRevEtcAuditedFinclStmtAmt>20751941</TotalRevEtcAuditedFinclStmtAmt>
      <NetUnrealizedGainsInvstAmt>-4735</NetUnrealizedGainsInvstAmt>
      <RevenueNotReportedAmt>-4735</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>20756676</RevenueSubtotalAmt>
      <TotalRevenuePerForm990Amt>20756676</TotalRevenuePerForm990Amt>
      <TotExpnsEtcAuditedFinclStmtAmt>15766250</TotExpnsEtcAuditedFinclStmtAmt>
      <ExpensesSubtotalAmt>15766250</ExpensesSubtotalAmt>
      <TotalExpensesPerForm990Amt>15766250</TotalExpensesPerForm990Amt>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 3, PART X</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAS EVALUATED THEIR TAX POSITIONS AND DETERMINED THEY HAVE NO UNCERTAIN TAX POSITIONS AS OF SEPTEMBER 30, 2023 AND 2022. SHOULD THE ORGANIZATION'S TAX-EXEMPT STATUS BE CHALLENGED IN THE FUTURE, THE ORGANIZATION'S 2021, 2022 AND 2023 TAX YEARS ARE OPEN FOR EXAMINATION BY THE IRS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleJ documentId="RetDoc3">
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>LIANA PUSCAS MD</PersonNm>
        <TitleTxt>SECRETARY/TREASURER</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>395036</CompensationBasedOnRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>395036</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>KENNETH GOLDBERG MD</PersonNm>
        <TitleTxt>VICE PRESIDENT</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>337448</CompensationBasedOnRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>337448</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DAVID EDELMAN MD</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>244118</CompensationBasedOnRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>244118</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ALYSHIA SMITH DNP</PersonNm>
        <TitleTxt>DIRECTOR</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>209300</CompensationBasedOnRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>209300</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc4">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 - ORGANIZATION'S MISSION</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PURPOSE OF THE INSTITUTE OF MEDICAL RESEARCH, INC. IS TO SUPPORT RESEARCH AND EDUCATION THROUGHOUT THE DURHAM VETERANS AFFAIRS HEALTHCARE SYSTEM TO ENHANCE THE HEALTH AND LIVES OF VETERANS, THEIR FAMILIES AND THE PUBLIC AT LARGE.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 2, PART III, LINE 4A</FormAndLineReferenceDesc>
        <ExplanationTxt>SUPPORTED A MEDICAL TRAINING AND EDUCATION PROGRAM TO SUPPORT THE VA PHARMACOGENOMICS ACTION FOR CANCER SURVIVORSHIP (PHASER). EXPANDED ACCESS TO PHARMACOGENOMIC (PGX) TESTING, INCLUDING PROVIDING BASIC PGX EDUCATION, TO AN ADDITIONAL 10,000 VETERANS SEEN ACROSS 25 VA HEALTH CARE SYSTEMS NATIONWIDE. ENGAGED IN PHARMACOGENOMIC EDUCATION WITH APPROXIMATELY 1,000 NEW VA PROVIDERS IN ADDITION TO HOSTING MONTHLY PGX BROWN BAG LEARNING SESSIONS AND RELEASING A MONTHLY PGX NEWSLETTER TO OVER 1,700 CLINICIANS. SECURED COMMITMENTS FROM ANOTHER 27 VA HOSPITALS TO IMPLEMENT THE PHASER PGX TESTING PROGRAM. BUILT AND RELEASED NATIONALLY AUTOMATED CLINICAL DECISION SUPPORT TOOLS FOR DRUG-GENE ALERTS FOR ALL STATINS AND SELECT SSRIS, NSAIDS, PPIS, CLOPIDOGREL, ONDANSETRON, AND LOOK TO HAVE RELEASED BEFORE THE END OF THE CALENDAR YEAR ALERTS TO SUPPORT DRUG-GENE ALERTS FOR SELECT TCAS, ATOMOXETINE, PHENYTOIN, TACROLIMUS, TAMOXIFEN, AND VORICONAZOLE. PREPARED THE EDUCATION AND TECHNICAL ENVIRONMENTS FOR A TESTING PANEL EXPANSION FROM 11 TO 15 GENES DUE TO BE RELEASED BY THE END OF THE CALENDAR YEAR.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS REVIEWED IN DETAIL BY THE INSTITUTE'S FINANCIAL OFFICER, EXECUTIVE DIRECTOR, AND APPROPRIATE BOARD MEMBER WHO SUBSEQUENTLY RECOMMENDS APPROVAL AND FILING TO THE BOARD OF DIRECTORS. THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>ALL NEW KEY EMPLOYEES AND BOARD MEMBERS ARE REQUIRED ANNUALLY TO COMPLETE A CONFLICT OF INTEREST TRAINING, WHICH SPECIFIES ACTION TO BE TAKEN IN THE EVENT OF A PERCEIVED CONFLICT OF INTEREST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 15A</FormAndLineReferenceDesc>
        <ExplanationTxt>THE EXECUTIVE DIRECTOR'S SALARY WAS REVIEWED NOVEMBER 2022. THE SALARY WAS DETERMINED BY COMPARATIVE VETERAN'S AFFAIRS NON-PROFITS' EXECUTIVE DIRECTORS' SALARIES AND FMV. SALARY WAS DETERMINED BY VOTE OF FULL BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc5">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1Txt>VETERANS AFFAIRS DEPARTMENT</BusinessNameLine1Txt>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1Txt>508 FULTON ST</AddressLine1Txt>
          <CityNm>DURHAM</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>27706</ZIPCd>
        </USAddress>
        <EIN>561932832</EIN>
        <PrimaryActivitiesTxt>HEALTHCARE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NC</LegalDomicileStateCd>
        <DirectControllingEntityName>
          <BusinessNameLine1Txt>NA</BusinessNameLine1Txt>
        </DirectControllingEntityName>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>false</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>true</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>true</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VETERANS AFFAIRS DEPARTMENT</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>N</TransactionTypeTxt>
        <MethodOfAmountDeterminationTxt>INDETERMINABLE</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>VETERANS AFFAIRS DEPARTMENT</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>P</TransactionTypeTxt>
        <InvolvedAmt>750000</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CASH</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>
