TY 2021 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
SODEXO INC P O BOX 360170 PITTSBURGH,PA15251	DIETARY SERVICES	2,810,206
HEALTHPRO HERITAGE LLC 536 OLD HOWELL RD GREENVILLE,SC29615	THERAPY SERVICES	2,340,312
ARAMARK HEALTHCARE SUPPORT SERVICES LLC P O BOX 978839 DALLAS,TX75397	ENVIRONMENTAL SERVICES	768,516
MORRISON MANAGEMENT SPECIALISTS INC PO BOX 102289 ATLANTA,GA30368	DIETARY SERVICES	685,060
RIGHTSOURCING INC PO BOX 515743 LOS ANGELES,CA90051	CONTRACT EMPLOYMENT SERVICES	202,868
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 6

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

AHSNF INC

Employer identification number

84-2727303

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

AHSNF INC

Employer identification number

84-2727303

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	2,193,138		2,193,138
b	Buildings ....	58,827,870	30,855,301	27,972,569
c	Leasehold improvements
d	Equipment ....	8,107,955	5,824,778	2,283,177
e	Other .....	102,999		102,999
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				32,551,883

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	29,042,843
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	THE ATRIUM HEALTH ENTERPRISE AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THE FISCAL YEAR ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ATRIUM HEALTH ENTERPRISE'S COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2021.

Return Reference

Explanation

PART X, LINE 2:

THE ATRIUM HEALTH ENTERPRISE AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE EVALUATED UNCERTAIN TAX POSITIONS FOR THE FISCAL YEAR ENDED DECEMBER 31, 2021, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE ATRIUM HEALTH ENTERPRISE'S COMBINED FINANCIAL STATEMENTS FOR THE YEAR ENDED DECEMBER 31, 2021.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

AHSNF INC

Employer identification number

84-2727303

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1ANTHONY C DEFURIO DIRECTOR, SECRETARY, TREASURER	(i) (ii)	0 ------------- 1,288,212	0 ------------- 1,199,125	0 ------------- 67,492	0 ------------- 291,395	0 ------------- 28,450	0 ------------- 2,874,674	0 ------------- 15,922
2KEN D HAYNES DIRECTOR, PRESIDENT	(i) (ii)	0 ------------- 1,118,239	0 ------------- 1,049,800	0 ------------- 138,258	0 ------------- 257,636	0 ------------- 36,582	0 ------------- 2,600,515	0 ------------- 72,609
3SCOTT C RISSMILLER MD DIRECTOR	(i) (ii)	0 ------------- 944,247	0 ------------- 1,141,425	0 ------------- 35,220	0 ------------- 224,731	0 ------------- 33,705	0 ------------- 2,379,328	0 ------------- 0
4COLLIN LANE TOP MGMT OFFICIAL (TO 8/1/21)	(i) (ii)	0 ------------- 467,323	0 ------------- 180,820	0 ------------- 28,668	0 ------------- 49,387	0 ------------- 29,375	0 ------------- 755,573	0 ------------- 26,661
5RODNEY BALL TOP FINANCIAL OFFICIAL (FR 10/1/20)	(i) (ii)	0 ------------- 388,399	0 ------------- 162,628	0 ------------- 21,087	0 ------------- 40,639	0 ------------- 28,240	0 ------------- 640,993	0 ------------- 18,711
6ROSE COOK FORMER OFFICER (10/1/20)	(i) (ii)	0 ------------- 273,499	0 ------------- 125,063	0 ------------- 40,911	0 ------------- 32,712	0 ------------- 16,690	0 ------------- 488,875	0 ------------- 9,468
7MIKE STOLZENBACH VP, FACILITIES, CONT CARE	(i) (ii)	0 ------------- 241,661	0 ------------- 104,477	0 ------------- 3,308	0 ------------- 25,262	0 ------------- 35,799	0 ------------- 410,507	0 ------------- 0
8JENNIFER SULLIVAN TOP MGMT OFFICIAL (FR 8/2/21)	(i) (ii)	0 ------------- 114,950	0 ------------- 50,000	0 ------------- 76,200	0 ------------- 784	0 ------------- 4,441	0 ------------- 246,375	0 ------------- 0
9SCHAREE LEE EXEC DIR - CONT CARE	(i) (ii)	0 ------------- 134,526	0 ------------- 27,022	0 ------------- 11,395	0 ------------- 12,685	0 ------------- 22,546	0 ------------- 208,174	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 4B	CERTAIN DIRECTORS AND OFFICERS OF THE FILING ORGANIZATION PARTICIPATED IN AND/OR RECEIVED PAYMENTS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS (SERP) OF THEIR EMPLOYER, A RELATED ORGANIZATION. THE DETERMINATION OF THE AMOUNT OF THE NON-QUALIFIED RETIREMENT PLANS FOLLOWED THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES. THE FOLLOWING DIRECTORS AND/OR OFFICERS RECEIVED SERP PAYMENTS IN THEIR CALENDAR YEAR 2021 COMPENSATION FROM CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY (DBA "ATRIUM HEALTH"), A RELATED ORGANIZATION: ANTHONY DEFURIO $23,563 KEN HAYNES $101,371 COLLIN LANE $26,673 RODNEY BALL $18,720 ROSE COOK $9,472

Return Reference

Explanation

PART I, LINE 4B

CERTAIN DIRECTORS AND OFFICERS OF THE FILING ORGANIZATION PARTICIPATED IN AND/OR RECEIVED PAYMENTS FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLANS (SERP) OF THEIR EMPLOYER, A RELATED ORGANIZATION. THE DETERMINATION OF THE AMOUNT OF THE NON-QUALIFIED RETIREMENT PLANS FOLLOWED THE RELATED ORGANIZATION'S COMPENSATION PROCEDURES. THE FOLLOWING DIRECTORS AND/OR OFFICERS RECEIVED SERP PAYMENTS IN THEIR CALENDAR YEAR 2021 COMPENSATION FROM CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY (DBA "ATRIUM HEALTH"), A RELATED ORGANIZATION: ANTHONY DEFURIO $23,563 KEN HAYNES $101,371 COLLIN LANE $26,673 RODNEY BALL $18,720 ROSE COOK $9,472

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

AHSNF INC

Employer identification number

84-2727303

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 3	THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES TO THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA"), AS DESCRIBED IN AN INTEGRATION AGREEMENT ENTERED INTO BETWEEN THE ORGANIZATION AND CMHA, EFFECTIVE FEBRUARY 1, 2020. PER THE INTEGRATION AGREEMENT, THE ORGANIZATION ENGAGED CMHA TO MANAGE AND OVERSEE THE DAY-TO-DAY ACTIVITIES AND OPERATIONS OF THE ORGANIZATION, WHICH INVOLVE CMHA PROVIDING ADMINISTRATIVE SERVICES, RESOURCES, PERSONNEL, AND STAFF. CMHA PROVIDES THESE SERVICES AND STAFF TO THE ORGANIZATION AT COST. DIRECTORS, OFFICERS, AND KEY EMPLOYEES OF THE ORGANIZATION ARE ALSO OFFICERS AND/OR EMPLOYEES OF CMHA. SEE FORM 990, PART VII FOR ALL COMPENSATION RECEIVED BY DIRECTORS, OFFICERS, AND KEY EMPLOYEES FROM CMHA, A RELATED ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY.
FORM 990, PART VI, SECTION A, LINE 7B	THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY MAY REMOVE A DIRECTOR AT ANY TIME WITH OR WITHOUT CAUSE. THE CORPORATION'S ARTICLES OF INCORPORATION MAY BE AMENDED OR RESTATED FROM TIME TO TIME BY THE BOARD OF DIRECTORS, SUBJECT TO APPROVAL BY THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY. THE CORPORATION'S BYLAWS MAY BE AMENDED OR REPEALED, AND NEW BYLAWS MAY BE ADOPTED, BY THE BOARD, EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR BY LAW. ANY AMENDMENT TO THE PROVISIONS PERTAINING TO BOARD APPOINTMENT RIGHTS IS SUBJECT TO APPROVAL BY THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY.
FORM 990, PART VI, SECTION B, LINE 11B	THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT, AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED TO ALL DIRECTORS PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS.
FORM 990, PART VI, SECTION B, LINE 12C	THE CONFLICT OF INTEREST ("COI") POLICY PROTECTS THE INTERESTS OF THE ORGANIZATION WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTERESTS OF AN OFFICER OR DIRECTOR OF THE ORGANIZATION, OR MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION, AND IS INTENDED TO SUPPLEMENT BUT NOT REPLACE ANY FEDERAL/STATE LAWS GOVERNING CONFLICT OF INTEREST THAT ARE APPLICABLE TO THE ORGANIZATION. THE CONFLICT OF INTEREST POLICY APPLIES TO "INTERESTED PERSONS", WHICH ARE DEFINED AS MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS, MEMBERS OF A COMMITTEE WITH DELEGATED POWERS FROM THE ORGANIZATION'S BOARD OF DIRECTORS, OR PRINCIPAL OFFICERS OF THE ORGANIZATION IF ANY SUCH PERSONS HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST, AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS, TO THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE THAT IS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. IN THE EVENT THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE DETERMINES THAT A CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON MAY PRESENT RELEVANT INFORMATION ABOUT THE PROPOSED TRANSACTION OR ARRANGEMENT TO THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE, BUT AFTER SUCH PRESENTATION THE INTERESTED PERSON SHALL LEAVE THE MEETING WHILE THE REMAINING MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE DISCUSS AND VOTE UPON THE PROPOSED TRANSACTION OR ARRANGEMENT. THE CHAIRPERSON OF THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE DISINTERESTED MEMBERS OR APPLICABLE COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN WITH REASONABLE EFFORTS OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT PRESENT A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE DISINTERESTED MEMBERS OR APPLICABLE COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE WHETHER THE PROPOSED TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND FAIR AND REASONABLE AND, IN ACCORDANCE WITH SUCH DETERMINATION, SHALL DETERMINE WHETHER TO APPROVE THE PROPOSED TRANSACTION OR ARRANGEMENT. IF THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE INTERESTED PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE INTERESTED PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE INTERESTED PERSON'S RESPONSE AND MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE ORGANIZATION'S BOARD OF DIRECTORS OR ITS APPLICABLE COMMITTEE DETERMINES THAT THE INTERESTED PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION.
FORM 990, PART VI, SECTION B, LINE 15	THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS, DIRECTORS AND KEY EMPLOYEES. ALL COMPENSATION PAID TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WAS PAID BY A RELATED ORGANIZATION, THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA"). COMPENSATION PAID TO THESE INDIVIDUALS IS REVIEWED AND APPROVED IN ACCORDANCE WITH CMHA'S COMPENSATION POLICIES AND PROCEDURES, WHICH INCLUDE INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH OFFICER'S AND DIRECTOR'S COMPENSATION.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY IS AVAILABLE TO THE PUBLIC ON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY INCLUDING THEM AS PART OF THE ANNUAL INFORMATION STATEMENT OF THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA") FILED ON THE MSRB WEBSITE (EMMA).
FORM 990, PART IX, LINE 11G	OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 8,330,593. MANAGEMENT AND GENERAL EXPENSES 721,430. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,052,023.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

AHSNF INC

Employer identification number

84-2727303

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY PO BOX 32861 CHARLOTTE,NC282322861 58-0529945	HEALTHCARE	NC	NC POLITICAL SUBDIVI				No
(2)ATRIUM HEALTH FOUNDATION PO BOX 32861 CHARLOTTE,NC282322861 56-6060481	FUNDRAISING	NC	501(C)(3)	LINE 7	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(3)ATRIUM HEALTH INC PO BOX 32861 CHARLOTTE,NC282322861 84-3647453	HEALTHCARE MANAGEMENT	NC	501(C)(3)	LINE 10	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(4)AH GEORGIA INC PO BOX 32861 CHARLOTTE,NC282322861 83-1707383	HEALTHCARE MANAGEMENT	NC	501(C)(3)	LINE 10	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(5)ATRIUM HEALTH EMPLOYEE ASSISTANCE INC PO BOX 32861 CHARLOTTE,NC282322861 85-0548753	EMERGENCY ASSISTANCE	NC	501(C)(3)	LINE 7	CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(6)1717 GARDEN TERRACE LLC PO BOX 32861 CHARLOTTE,NC282322861 26-0897680	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(7)3021 NESBITT LLC PO BOX 32861 CHARLOTTE,NC282322861 85-3018530	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(8)ABC PARKWAY LLC PO BOX 32861 CHARLOTTE,NC282322861	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(9)ATRIUM HEALTH HUNTERSVILLE ASC LLC PO BOX 32861 CHARLOTTE,NC282322861 86-3426328	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(10)AV INSURANCE LLC PO BOX 32861 CHARLOTTE,NC282322861 20-5608253	INSURANCE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(11)CAROLINAS HEALTHCARE INFORMATION EXCHANGE LLC PO BOX 32861 CHARLOTTE,NC282322861 35-2437316	HEALTHCARE MANAGEMENT	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(12)CAROLINAS MEDICAL CENTER AT HOME LLC PO BOX 32861 CHARLOTTE,NC282322861 26-1451047	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(13)CAROLINAS SHARED SERVICES LLC PO BOX 32861 CHARLOTTE,NC282322861 34-1988710	HEALTHCARE MANAGEMENT	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(14)CHS FUND STRATEGIES MANAGEMENT LLC PO BOX 32861 CHARLOTTE,NC282322861 81-0849277	INVESTMENT MANAGEMENT	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(15)CLEVELAND AMBULATORY SERVICES LLC PO BOX 32861 CHARLOTTE,NC282322861 56-1909421	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(16)EAST BOULEVARD 1601 LLC PO BOX 32861 CHARLOTTE,NC282322861 26-1098896	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(17)EAST BOULEVARD 1615 LLC PO BOX 32861 CHARLOTTE,NC282322861	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(18)GATEWAY HOLDINGS - INDEPENDENCE LLC PO BOX 32861 CHARLOTTE,NC282322861	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(19)LOOKOUT NC PROPERTIES LLC PO BOX 32861 CHARLOTTE,NC282322861 85-2992379	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(20)PINEVILLE LTACH REHAB HOSPITAL LLC PO BOX 32861 CHARLOTTE,NC282322861 37-1663995	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(21)UNION HEALTH SERVICES LLC PO BOX 32861 CHARLOTTE,NC282322861 30-0597871	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(22)UNION MEDICAL OFFICE BUILDING LLC PO BOX 32861 CHARLOTTE,NC282322861	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(23)UNION MEDICAL SERVICES LLC PO BOX 32861 CHARLOTTE,NC282322861 20-3013475	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(24)WEST STANLY IMAGING LLC PO BOX 32861 CHARLOTTE,NC282322861 26-2414332	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(25)CAROLINAS AMBULATORY SURGERY INC PO BOX 32861 CHARLOTTE,NC282322861 81-2714217	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(26)CAROLINAS COLLEGE OF HEALTH SCIENCES PO BOX 32861 CHARLOTTE,NC282322861	EDUCATION	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(27)CHS PHARMACY SERVICES INC PO BOX 32861 CHARLOTTE,NC282322861 47-3367492	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(28)MERCY EQUIPMENT CORPORATION PO BOX 32861 CHARLOTTE,NC282322861 56-1660616	HEALTHCARE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(29)CAROLINAS HEALTH NETWORK INC PO BOX 32861 CHARLOTTE,NC282322861 56-1899343	HEALTHCARE MANAGEMENT	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(30)1025 KINGS DRIVE TENANT LLC PO BOX 32861 CHARLOTTE,NC282322861	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(31)ABBOT RIDGE LLC PO BOX 32861 CHARLOTTE,NC282322861 86-1766226	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(32)DRE1LLC PO BOX 32861 CHARLOTTE,NC282322861	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(33)LB ACQUISITIONS LLC PO BOX 32861 CHARLOTTE,NC282322861 30-1251297	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(34)ROCKY ROAD 1 LLC PO BOX 32861 CHARLOTTE,NC282322861 86-1257491	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(35)RM1 PROPERTIES LLC PO BOX 32861 CHARLOTTE,NC282322861 85-3038041	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No
(36)RR ASSEMBLAGE LLC PO BOX 32861 CHARLOTTE,NC282322861 85-3897459	REAL ESTATE	NC	NC POLITICAL SUBDIVI		CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) CAROLINAS IMAGING SERVICES LLC 700 E MOREHEAD STREET STE 300 CHARLOTTE,NC28202 91-2185756	HEALTHCARE	NC	N/A				No			No
(2) ENDOSCOPY CENTER - MONROE LLC 11301 CARMEL COMMONS BLVD STE 302 CHARLOTTE,NC28226 26-0731594	HEALTHCARE	NC	N/A				No			No
(3) ENDOSCOPY CENTER HOLDINGS LLC 11301 CARMEL COMMONS BLVD STE 302 CHARLOTTE,NC28226 26-0316896	HEALTHCARE MANAGEMENT	NC	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) ALLIANCE MEDICAL INC PO BOX 32861 CHARLOTTE,NC282322861 56-1682606	HEALTHCARE	NC	N/A	C					No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROMOTE HEALTHCARE AND PUBLIC HEALTH BY OPERATING ONE OR MORE NURSING HOMES (INCLUDING SKILLED NURSING FACILITIES), HOSPITALS, AND/OR HEALTHCARE FACILITIES TO FACILITATE THE CHARITABLE AND GOVERNMENTAL PURPOSES AND ACTIVITIES OF SUCH FACILITIES THAT ARE OR MAY BECOME AFFILIATED WITH THE ORGANIZATION FROM TIME TO TIME.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	3
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	0
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	3
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,109,928	979
9	Program service revenue (Part VIII, line 2g) .........	42,084,897	37,410,859
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-73	4
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	517,898	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	43,712,650	37,411,842
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	720
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	26,583,854	33,121,708
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	31,708,754	25,202,756
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	58,292,608	58,325,184
19	Revenue less expenses. Subtract line 18 from line 12.......	-14,579,958	-20,913,342
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	42,778,339	34,390,165
21	Total liabilities (Part X, line 26).............	17,141,267	29,666,435
22	Net assets or fund balances. Subtract line 21 from line 20.....	25,637,072	4,723,730

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 54,746,567 including grants of $ 720 ) (Revenue $ 37,410,859 )
	THE ORGANIZATION OWNS AND OPERATES SKILLED NURSING FACILITIES THAT PROVIDE SHORT-TERM NURSING AND REHABILITATION SERVICES, LONG-TERM CARE SERVICES, AND END OF LIFE CARE TO PATIENTS IN CHARLOTTE, NC AND ITS SURROUNDING COMMUNITIES.DURING CALENDAR YEAR 2021, THE ORGANIZATION PROVIDED SKILLED NURSING SERVICES TO 1,087 PATIENTS, INCLUDING 967 ADMISSIONS AND 112,181 DAYS OF CARE, AT FIVE LOCATIONS IN THE CHARLOTTE, NC METRO AREA, INCLUDING HUNTERSVILLE OAKS, SARDIS OAKS, CLEVELAND PINES, STANLY MANOR, AND JESSE HELMS NURSING CENTER.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses54,746,567

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)				(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) ANTHONY C DEFURIO...................................................................... DIRECTOR, SECRETARY, TREASURER	1.00 ................. 39.00	X	X			0	2,554,829	319,845
(2) KEN D HAYNES...................................................................... DIRECTOR, PRESIDENT	1.00 ................. 39.00	X	X			0	2,306,297	294,218
(3) SCOTT C RISSMILLER MD...................................................................... DIRECTOR	1.00 ................. 39.00	X				0	2,120,892	258,436
(4) COLLIN LANE...................................................................... TOP MGMT OFFICIAL (TO 8/1/21)	5.00 ................. 35.00		X			0	676,811	78,762
(5) RODNEY BALL...................................................................... TOP FINANCIAL OFFICIAL (FR 10/1/20)	2.00 ................. 38.00		X			0	572,114	68,879
(6) ROSE COOK...................................................................... FORMER OFFICER (10/1/20)	0.00 ................. 40.00				X	0	439,473	49,402
(7) MIKE STOLZENBACH...................................................................... VP, FACILITIES, CONT CARE	15.00 ................. 35.00			X		0	349,446	61,061
(8) JENNIFER SULLIVAN...................................................................... TOP MGMT OFFICIAL (FR 8/2/21)	1.00 ................. 39.00		X			0	241,150	5,225
(9) SCHAREE LEE...................................................................... EXEC DIR - CONT CARE	40.00 ................. 0.00			X		0	172,943	35,231

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	9,433,955	1,171,059

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	979

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		979

		Business Code
2a	PATIENT SERVICE REVENUE	623110	37,374,527	37,374,527
b	DIETARY REVENUE	722513	36,332	36,332
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		37,410,859

3 Investment income (including dividends, interest, and othersimilar amounts) ......			4			4
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			37,411,842	37,410,859	0	4

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	720	720
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	25,900,453	25,306,976	593,477
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,110,684	1,056,136	54,548
9	Other employee benefits .......	4,744,955	4,511,922	233,033
10	Payroll taxes ...........	1,365,616	1,298,548	67,068
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	11,940	10,988	952
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	9,052,023	8,330,593	721,430
12	Advertising and promotion ....	15,479	14,245	1,234
13	Office expenses .......	164,195	150,970	13,225
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	2,955,594	2,717,531	238,063
17	Travel ............	24,841	22,840	2,001
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	8,940	8,220	720
20	Interest ...........	669,676	458,740	210,936
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	3,512,831	2,437,264	1,075,567
23	Insurance ...	121,226	121,226
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	INTERCOMPANY EXPENSE	4,398,371	4,044,098	354,273
b	MEDICAL SUPPLIES	1,794,511	1,794,511
c	DIETARY SUPPLIES	1,293,771	1,293,771
d	BAD DEBT EXPENSE	1,029,253	1,029,253	0
e	All other expenses	150,105	138,015	12,090
25	Total functional expenses. Add lines 1 through 24e	58,325,184	54,746,567	3,578,617	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			15,667	1	1,610
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			7,490,871	4	1,801,618
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			750	8	750
9	Prepaid expenses and deferred charges ......			35,017	9	34,304
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	69,231,962
b	Less: accumulated depreciation	10b	36,680,079	35,236,034	10c	32,551,883
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........				15
16	Total assets. Add lines 1 through 15 (must equal line 33)...			42,778,339	16	34,390,165

17	Accounts payable and accrued expenses .....	1,572,738	17	623,592
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	15,568,529	25	29,042,843
26	Total liabilities. Add lines 17 through 25..	17,141,267	26	29,666,435

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	25,637,072	31	4,723,730
32	Total net assets or fund balances ...........	25,637,072	32	4,723,730
33	Total liabilities and net assets/fund balances ........	42,778,339	33	34,390,165