Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | |||||
| 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 | 212,983,818 | 212,983,818 | ||||
| 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... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 212,983,818 | 212,983,818 | ||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 212,983,818 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 212,983,818 | 212,983,818 | ||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 595,236 | 595,236 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 595,236 | 595,236 | ||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 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.).. | 213,579,054 | 213,579,054 | ||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART III, LINE 2 | HARBIN CLINIC, A PHYSICIAN-LED MULTI-SPECIALTY CLINIC, BECAME A WHOLLY-OWNED SUBSIDIARY OF AH GEORGIA, INC. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA", DBA ATRIUM HEALTH). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE DIRECTORS OF THE FILING ORGANIZATION ARE APPOINTED BY THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY ("CMHA", DBA ATRIUM HEALTH), THE ORGANIZATION'S SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | CMHA, THE SOLE MEMBER OF THE FILING ORGANIZATION, HAS VOTING AND OTHER RIGHTS EXPRESSLY SET FORTH IN THE FILING ORGANIZATION'S BYLAWS, OR AS REQUIRED BY LAW. EXPRESS RIGHTS OF THE SOLE MEMBER PROVIDED IN THE BYLAWS INCLUDE: 1. AMENDING, MODIFYING, OR REPEALING THE ARTICLES OF INCORPORATION; 2. AMENDING, MODIFYING, OR REPEALING ANY PROVISION OF THE BYLAWS THAT AFFECTS ANY RIGHT OR POWER OF THE SOLE MEMBER; AND 3. THE DISSOLUTION OR MERGER OF THE FILING ORGANIZATION, OR THE SALE, PLEDGE, OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS. ADDITIONALLY, CMHA, AS THE SOLE MEMBER, MAY ASSIGN ITS MEMBERSHIP IN THE FILING ORGANIZATION TO ANOTHER PERSON WITHOUT CONSIDERATION IN A WRITING SIGNED BY AN EXECUTIVE OFFICER OF THE SOLE MEMBER AND PROVIDED TO THE SECRETARY OR PRESIDENT OF THE FILING ORGANIZATION. ALL DIRECTORS, OTHER THAN AN INDEPENDENT DIRECTOR (AS DESCRIBED IN THE ORGANIZATION'S BYLAWS), MAY BE REMOVED WITH OR WITHOUT CAUSE BY CMHA AS THE SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE FILING ORGANIZATION DOES NOT HAVE COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| 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 IS APPLICABLE TO ALL "COVERED PERSONS AND APPLIES TO TRANSACTIONS OR OTHER ARRANGEMENTS IN WHICH THE PERSONAL OR FINANCIAL INTERESTS OF A COVERED PERSON MAY APPEAR TO BE ADVANCED BY AN ACTION OF THE ORGANIZATION, OR OTHERWISE WHENEVER A COVERED PERSON'S PERSONAL OR FINANCIAL INTERESTS COULD BE REASONABLY VIEWED AS AFFECTING HIS OR HER OBJECTIVITY OR INDEPENDENCE IN FULFILLING HIS OR HER DUTIES TO THE ORGANIZATION (SUCH TRANSACTION OR ARRANGEMENT, A "COVERED TRANSACTION"). COVERED PERSONS INCLUDES CURRENT OFFICERS, DIRECTORS, SELECTION COMMITTEE MEMBERS, AND EMPLOYEES OF THE ORGANIZATION, AS WELL AS "FAMILY MEMBERS AND "AFFILIATED ENTITIES". "FAMILY MEMBER" INCLUDES ANY SPOUSE (INCLUDING FORMER SPOUSES WITHIN LAST FIVE YEARS), ANCESTOR, SIBLING, CHILD, GRANDCHILD, GREAT-GRANDCHILD, OR THE SPOUSE (OR FORMER SPOUSE WITHIN FIVE YEARS) OF SUCH PERSONS. "AFFILIATED ENTITY" INCLUDES AN ENTITY IN WHICH THE COVERED PERSON IS AN OFFICER, DIRECTOR, TRUSTEE, EMPLOYEE, OR HAS A MORE THAN 10% BENEFICIAL INTEREST (DIRECTLY OR WITH ONE OR MORE FAMILY MEMBERS OR OTHER AFFILIATED ENTITIES). WHEN A COVERED PERSON BECOMES AWARE OF A POSSIBLE COVERED TRANSACTION, HE/SHE HAS A DUTY TO TAKE THE FOLLOWING ACTIONS: IMMEDIATELY DISCLOSE TO THE PRESIDENT OR CHAIR OF THE BOARD OF DIRECTORS; REFRAIN FROM USING HIS/HER PERSONAL INFLUENCE TO ENCOURAGE ENTERING INTO THE COVERED TRANSACTION; AND PHYSICALLY EXCUSE HIMSELF/HERSELF FROM PARTICIPATION IN ANY DISCUSSIONS REGARDING THE COVERED TRANSACTION. THE ORGANIZATION MAY ENTER INTO A COVERED TRANSACTION IF THE BOARD (OR COMMITTEE THEREOF) ACTING IN EITHER CASE WITHOUT THE PARTICIPATION OF THE CONFLICTED PARTY, DETERMINES THAT SUCH TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION. IN ORDER TO ASSIST THE ORGANIZATION IN IDENTIFYING POTENTIAL COVERED TRANSACTIONS, EACH COVERED PERSON WHO SERVES AS A CURRENT OFFICER, DIRECTOR OR KEY EMPLOYEE ANNUALLY COMPLETES AND SIGNS A CONFLICT OF INTEREST DECLARATION ("DECLARATION") PROVIDED BY THE ORGANIZATION, AND UPDATES SUCH DECLARATION AS NECESSARY TO REFLECT CHANGES DURING THE COURSE OF THE YEAR. COMPLETED DECLARATIONS ARE AVAILABLE FOR INSPECTION BY THE BOARD OF DIRECTORS AND THE OFFICERS OF THE ORGANIZATION, AND BY SUCH OTHER PERSONS AS THE PRESIDENT DEEMS APPROPRIATE. THE BOARD (OR COMMITTEE THEREOF) IS RESPONSIBLE FOR REVIEWING ANNUAL DECLARATIONS, RECEIVING DISCLOSURE OF POSSIBLE COVERED TRANSACTIONS, REVIEWING COVERED TRANSACTIONS, MAINTAINING DOCUMENTATION OF REVIEW OF COVERED TRANSACTIONS (INCLUDING NATURE AND RESOLUTION), AND REPORTING TO THE BOARD ALL FINDINGS AND ACTIONS (IF PROCEDURES ARE ADMINISTERED BY A COMMITTEE OF THE BOARD). THE BOARD HAS AUTHORITY TO REVIEW THE OPERATION OF THE COI POLICY AND MAKE CHANGES FROM TIME TO TIME AS IT DEEMS APPROPRIATE. |
| 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 AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. |
| FORM 990, PART XI, LINE 9: | CAPITALIZATION CO 583 148,248,712. REPURCHASE OF MEMBER INTERESTS 123,097,116. NET ASSETS MOVED OVER 25,159,768. |
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| Software Version: |