NOTICE OF PUBLIC HEARING BY THE NORTH CAROLINA MEDICAL CARE COMMISSION REGARDING THE FINANCING AND REFINANCING OF HEALTH CARE FACILITIES WITH THE PROCEEDS OF THE ISSUANCE OF TAX-EXEMPT BONDS NOTICE IS HEREBY GIVEN to all interested persons, as required by Section 147(f) of the Internal Revenue Code of 1986, as amended (the "Code"), that the North Carolina Medical Care Commission (the "Commission") has been requested by University Health Systems of Eastern Carolina, Inc., a North Carolina corporation d/b/a ECU Health (the "Parent Corporation") and Pitt County Memorial Hospital, Incorporated, a North Carolina corporation d/b/a ECU Health Medical Center (the "Corporation"), an affiliate of the Parent Corporation, to issue the Commission's revenue bonds (the "Series 2026 Bonds") in an aggregate principal amount not to exceed $700,000,000 for the purpose of (a) refunding all or a portion of the outstanding (i) North Carolina Medical Care Commission Health Care Facilities Revenue Bonds (Vidant Health), Series 2015, dated April 1, 2015 (the "Series 2015 Bonds"), (ii) North Carolina Medical Care Commission Health Care Facilities Revenue Bonds (Vidant Health), Series 2019B, dated October 23, 2019 (the "Series 2019B Bonds"), (iii) North Carolina Medical Care Commission Health Care Facilities Revenue Refunding Bonds (Vidant Health), Series 2022A, dated March 3, 2022 (the "Series 2022A Bonds"), (iv) North Carolina Medical Care Commission Health Care Facilities Revenue Refunding Bonds (ECU Health), Series 2022B, dated June 15, 2022 (the "Series 2022B Bonds"), (v) North Carolina Medical Care Commission Health Care Facilities Revenue Refunding Bonds (ECU Health), Series 2022C, dated June 15, 2022 (the "Series 2022C Bonds"), and (iv) North Carolina Medical Care Commission Health Care Facilities Revenue Refunding Bonds (ECU Health), Series 2025A, dated June 2, 2025 (the Series 2025A Bonds"), (b) paying the cost of 2026 Project (as defined below) and (c) paying certain fees and expenses incurred in connection with the sale and issuance of the Series 2026 Bonds. The Bonds will be "qualified 501(c)(3) bonds" as defined in Section 145 of the Code for hospital and related health care facilities. The 2026 Project consists of constructing, acquiring, renovating and equipping of various hospital and healthcare facilities owned and operated by the Parent Corporation and its affiliates including, without limitation, (a) renovating, expanding and equipping the 5th and 6th floors of the existing Smith Tower at the ECU Health Medical Center's Greenville, North Carolina campus to add new inpatient beds and related facilities (the "Smith Tower Expansion Project"), (b) constructing and equipping of a new building connected or adjacent to the East Carolina Heart Institute Tower at the ECU Health Medical Center's Greenville, North Carolina campus to house additional operating rooms and related support areas (the "ECHI Heart Tower Project"), (c) constructing and equipping of a new pharmacy central distribution center (the "Pharmacy Project"), and (d) expanding, renovating and equipping an existing ambulatory surgery center to add additional operating, preparation and recovery rooms and related facilities (the "SurgiCenter Expansion Project"). The 2026 Project is located at or in close proximity to the above-referenced Greenville, North Carolina campus at the following addresses: 2100 Stantonsburg Road, 1155 B's BBQ Road, and 102 Bethesda Drive. The proceeds of the Series 2015 Bonds were used, together with certain other available funds, to (a) finance the costs of acquiring, constructing and equipping certain hospital facilities and equipment for the Parent Corporation and its affiliates, including (i) a new approximately 418,000 square foot bed tower and outpatient center dedicated to cancer services located at ECU Health Medical Center, (ii) two new outpatient clinic facilities and (iii) various equipment, furniture, information services and roof improvements (the "2015 Project"), (b) refund certain prior bonds of the Commission issued in 2006 (the "Series 2006 Bonds"), the proceeds of which were used to (i) finance the cost of acquiring land and acquiring, constructing and equipping various hospital facilities and equipment for ECU Health Roanoke-Chowan Hospital, ECU Health Bertie Hospital and ECU Health Chowan Hospital (collectively, the "2006 Project") and (ii) refinance certain outstanding indebtedness of the Parent Corporation, the proceeds of which were used to pay certain costs of the 2006 Project, (c) pay a portion of the interest accruing on the Series 2015 Bonds during construction of the 2015 Project and (d) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2015 Bonds. The projects comprising the 2006 Project are owned and operated by affiliates of the Parent Corporation, including the Corporation, East Carolina Health d/b/a ECU Health Community Hospitals ("ECU Health Community Hospitals"), East Carolina Health – Bertie d/b/a ECU Health Bertie Hospital ("ECU Health Bertie") or East Carolina Health – Chowan, Inc. d/b/a ECU Health Chowan Hospital ("ECU Health Chowan"), and are located at or near the vicinity of 2100 Stantonsburg Road in Greenville, North Carolina, 500 South Academy Street in Ahoskie, North Carolina, 1403 South King Street in Windsor, North Carolina or 211 Virginia Road in Edenton, North Carolina. The projects comprising the 2015 Project are owned and operated by the Parent Corporation or its various affiliates, including, without limitation, the Corporation, ECU Health Bertie, East Carolina Health-Beaufort, Inc. d/b/a ECU Health Beaufort Hospital ("ECU Health Beaufort") or Vidant Medical Group, LLC d/b/a ECU Health Physicians ("ECU Health Physicians") and are located at or near the vicinity of 2100 Stantonsburg Road in Greenville, North Carolina, 101 Clinic Drive in Tarboro, North Carolina, 1403 South King Street in Windsor, North Carolina, 628 East 12th Street in Washington, North Carolina or 601 Old Country Road in Belhaven, North Carolina. The proceeds of the Series 2019B Bonds were used, together with certain other available funds, to (a) finance the costs of acquiring a helicopter to be used for medical transportation purposes by the Parent Corporation and its affiliates (the "2019B Project"), (b) refund a portion of certain prior bonds of the Commission issued in 2012 (the "Series 2012A Bonds"), the proceeds of which were used to refund certain prior bonds of the Commission, the proceeds of which were used to finance or refinance the acquisition, construction, renovation and equipping of certain hospital and outpatient facilities for ECU Health Medical Center, ECU Health Roanoke-Chowan Hospital, ECU Health Bertie Hospital and ECU Health Chowan Hospital (the "2012A Project") and (c) refund certain prior bonds of the Commission issued in 2011 (the "Series 2011 Bonds") and 2016 (the "Series 2016 Bonds") and a taxable term loan note (the "Taxable Note"), the proceeds of which were used to finance or refinance the acquisition, construction, renovation and equipping of various improvements to ECU Health North Hospital and (d) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2019B Bonds. The projects comprising the Series 2012A Project are owned and operated by the Corporation or other affiliates of the Parent Corporation, including ECU Health Community Hospitals, ECU Health Bertie and ECU Health Chowan, and are located at or near the vicinity of 2100 Stantonsburg Road in Greenville, North Carolina, 500 South Academy Street in Ahoskie, North Carolina, 1403 South King Street in Windsor, North Carolina or 211 Virginia Road in Edenton, North Carolina. The projects financed and refinanced with the proceeds of the Series 2011 Bonds, the Series 2016 Bonds and the Taxable Note are owned and operated by Halifax Regional Medical Center, Inc. d/b/a ECU Health North Hospital and are located at or near the vicinity of 250 Smith Church Road in Roanoke Rapids, North Carolina. The projects comprising the 2019B Project are owned and operated by the Parent Corporation and are located at or near the vicinity of 2100 Stantonsburg Road in Greenville, North Carolina. The 2019B Project is owned and operated by the Parent Corporation and is located at or near the vicinity of 2100 Stantonsburg Road in Greenville, North Carolina. The proceeds of the Series 2022A Bonds were used, together with certain other available funds, to (a) refund certain prior bonds of the Commission issued in 2019, the proceeds of which were used to refinance certain outstanding indebtedness of the Parent Corporation, the proceeds of which were used to pay certain costs of the 2012A Project and (b) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2022A Bonds. The proceeds of the Series 2022B Bonds were used, together with certain other available funds, to (a) refund certain prior bonds of the Commission issued in 2013, the proceeds of which were used to currently refund certain prior bonds of the Commission issued in 2008 for the purposes of currently refunding a portion of the Series 2006 Bonds and (b) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2022B Bonds. The proceeds of the Series 2022C Bonds were used, together with certain other available funds, to (a) refund certain prior bonds of the Commission issued in 2011, the proceeds of which were used to (i) pay the costs of acquiring certain land, (ii) construct various hospital improvements and (iii) acquire and install various information systems, medical equipment and furnishings, all for the Parent Corporation, ECU Health Medical Center, ECU Health Bertie Hospital, ECU Health Chowan Hospital, ECU Health Duplin General Hospital, ECU Health Edgecombe Hospital and ECU Health Roanoke-Chowan Hospital (the "2011 ECU Health Project"); and (iv) prepay the lease payments on a long-term lease with an option to purchase all of the health care buildings, facilities and equipment of Beaufort Regional Health System and its affiliates in Beaufort County, North Carolina (the "Beaufort Health System Project"); and (b) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2022C Bonds. The 2011 ECU Health Project is owned or operated by the Parent Corporation or its affiliates, including, without limitation, the Corporation, ECU Health Bertie, ECU Health Chowan, Duplin General Hospital, Inc., East Carolina Health-Heritage, Inc. and East Carolina Health and are located at or near the vicinity of 690 Medical Drive in Greenville, North Carolina; 2100 Stantonsburg Road in Greenville, North Carolina; 1403 South King Street in Windsor, North Carolina; 211 Virginia Road in Edenton, North Carolina; 401 North Main Street in Kenansville, North Carolina; 111 Hospital Drive in Tarboro, North Carolina; and 500 Academy Street in Ahoskie, North Carolina. The Beaufort Health System Project is leased and operated by the Parent Corporation, ECU Health Beaufort or ECU Health Physicians, and is located at or near the vicinity of the following locations, all in Washington, Beaufort County, North Carolina: the 600 block of E. 12th Street; 1209 N. Brown Street and adjacent lot; vacant lots in and around Brown Street Extension; 1240 Cowell Farm Road; 1211 Highland Drive; 601 E. 11th Street; and 1375 Cowell Farm Road. The proceeds of the Series 2025A Bonds were used, together with certain other available funds, to (a) refund certain prior bonds of the Commission issued in 2021 (the "2021A Bonds"), the proceeds of which were used to (i) refund certain outstanding indebtedness of the Commission the proceeds of which were used to finance the 2015 Project and (ii) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2021A Bonds and (b) pay certain fees and expenses incurred in connection with the sale and issuance of the Series 2025A Bonds. The following table sets forth the maximum principal amount of the Series 2026 Bonds expected to be issued for each of the purposes set forth above: Refunding of 2015 Bonds $182,000,000 Refunding of 2019B Bonds $43,500,000 Refunding of 2022A Bonds $70,000,000 Refunding of 2022B Bonds $55,000,000 Refunding of 2022C Bonds $31,500,000 Refunding of 2025A Bonds $113,000,000 2026 Project $205,000,000 Please take notice that the Assistant Secretary of the Commission will hold a public hearing in Conference Room L2-02210 of the North Carolina Department of Health and Human Services located at 1915 Health Services Way in Raleigh, North Carolina on August 21, 2026 at 11:30 a.m. at which time any person may be heard regarding the issuance of the Series 2026 Bonds. Any person wishing to comment in writing on the issuance of the Bonds should do so within seven (7) days after the date of publication of this notice to Geary W. Knapp, Assistant Secretary, North Carolina Medical Care Commission, 1915 Health Services Way, Raleigh, North Carolina 27607. NORTH CAROLINA MEDICAL CARE COMMISSION By: Geary W. Knapp Assistant Secretary IPL0361933 Aug 7 2026