| Southern Appalachian Highlands Conservancy | Asheville | C340 Environment | $48M | 2 |
| NORTH CAROLINA COMMUNITY FOUNDATION | Raleigh | T310 Philanthropy, Voluntarism & Grantmaking Foundations | $47.9M | 7 |
| NORTH CAROLINA MEDICAL SOCIETY EMPLOYEE BENEFIT TRUST | Raleigh | E80 Health Care | $47.8M | 4 |
| Lower Cape Fear Hospice Incorporated dba Lower Cape Fear LifeCare | Wilmington | P740 Human Services | $47.7M | 9 |
| NORTH CAROLINA WESLEYAN UNIVERSITY INC | Rocky Mount | B420 Education | $47.4M | 8 |
| PLANNED PARENTHOOD SOUTH ATLANTIC INC | Raleigh | E420 Health Care | $47.1M | 9 |
| Deerfield Episcopal Retirement Community Inc | Asheville | P750 Human Services | $47M | 10 |
| TRIAD MATH AND SCIENCE ACADEMY COMPANY | Greensboro | B29 Education | $46.7M | 5 |
| NORTH CAROLINA CHARTER EDUCATIONAL FOUNDATION INC | Mooresville | B29 Education | $46.3M | 0 |
| NORTH CAROLINA COMMUNITY CARE NETWORKS INC | Garner | E21 Health Care | $45.5M | 13 |
| THE JUST TRUST FOR EDUCATION | Durham | I50 Crime & Legal-Related | $45.4M | 12 |
| Hospice of Henderson County Inc | Flat Rock | — | $45.4M | 12 |
| DURHAM ACADEMY INC | Durham | B200 Education | $45.3M | 15 |
| Lutheran Family Services in the Carolinas | Salisbury | P400 Human Services | $44.8M | 10 |
| WAKEMED GROUP RETURN | Raleigh | E21 Health Care | $44.6M | 37 |
| WARREN WILSON COLLEGE | Asheville | B420 Education | $44.5M | 12 |
| SMITH RICHARDSON FOUNDATION INC | Greensboro | T20Z Philanthropy, Voluntarism & Grantmaking Foundations | $44.4M | 11 |
| BAPTIST RETIREMENT HOMES OF NORTH CAROLINA INCORPORATED | Winston Salem | P750 Human Services | $44.3M | 8 |
| THALES ACADEMY | Raleigh | B24 Education | $43.5M | 1 |
| Hospice of Surry County Inc | Dobson | P74Z Human Services | $42.9M | 10 |
| SPRINGMOOR INC | Raleigh | P750 Human Services | $42.5M | 6 |
| LINCOLN COMMUNITY HEALTH CENTER INC | Durham | E32Z Health Care | $42.4M | 6 |
| CAROLINA CARING INC | Newton | P74Z Human Services | $42.4M | 6 |
| ECONOMIC DEVELOPMENT PARTNERSHIP OF NORTH CAROLINA INC | Raleigh | S30 Community Improvement & Capacity Building | $42.1M | 7 |
| HOSPICE & PALLIATIVE CARECENTER | Winstonsalem | P74Z Human Services | $41.9M | 8 |
| HABITAT FOR HUMANITY OF THE CHARLOTTE REGION INC | Charlotte | L20Z Housing & Shelter | $41.9M | 8 |
| BAPTIST CHILDREN'S HOMES OF NORTH CAROLINA INCORPORATED | Thomasville | P700 Human Services | $41.7M | 9 |
| CAROMONT HEALTH | Gastonia | E110 Health Care | $41.4M | 8 |
| CHILD CARE SERVICES ASSOCIATION | Chapel Hill | — | $41.3M | 5 |
| RAVENSCROFT SCHOOL | Raleigh | B200 Education | $41.1M | 7 |
| MANNA FOOD BANK INC | Mills River | K31Z Food, Agriculture & Nutrition | $40.9M | 3 |
| ACCREDITATION COMMISSION FOR HEALTH CARE INC | Cary | P30Z Human Services | $40.4M | 26 |
| WELL-SPRING RETIREMENT COMMUNITY INC | Greensboro | P750 Human Services | $39.9M | 7 |
| Young Men's Christian Association of Northwest North Carolina (4626) | Winston Salem | P270 Human Services | $39.9M | 7 |
| THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL FOUNDATION INC | Chapel Hill | B114 Education | $39.4M | 12 |
| Moravian Home Incorporated dba Salemtowne | Winstonsalem | P750 Human Services | $39.3M | 10 |
| THOMPSON CHILD & FAMILY FOCUS INC | Matthews | — | $39.3M | 7 |
| PENDER MEMORIAL HOSPITAL INCORPORATED | Winston Salem | E22 Health Care | $38.7M | 9 |
| ROBESON HEALTH CARE CORPORATION | Pembroke | E32Z Health Care | $38.1M | 5 |
| Maryfield Inc | High Point | P750 Human Services | $38.1M | 6 |
| Livingstone College | Salisbury | B42Z Education | $38M | 15 |
| BREVARD COLLEGE CORPORATION | Brevard | B420 Education | $37.9M | 7 |
| HARNETT HEALTH SYSTEM INC | Dunn | E220 Health Care | $37.8M | 11 |
| PFEIFFER UNIVERSITY | Misenheimer | B430 Education | $37.6M | 11 |
| GALLOWAY RIDGE INC | Pittsboro | L220 Housing & Shelter | $37.4M | 7 |
| THE PRESBYTERIAN HOME AT CHARLOTTE INC | Charlotte | P750 Human Services | $36.9M | 8 |
| THE PINES AT DAVIDSON INC | Davidson | P750 Human Services | $36.8M | 8 |
| CARMEL COUNTRY CLUB INC | Charlotte | — | $36.5M | 9 |
| Habitat for Humanity of Wake County Inc | Raleigh | — | $36.5M | 3 |
| LEES-MCRAE COLLEGE INC | Banner Elk | B420 Education | $36.3M | 8 |
