2016-08-01T16:45:37-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2014-10-01 201929953 HARNETT HEALTH SYSTEM FOUNDATION HARN 9108911000 800 TILGHMAN DRIVE DUNN NC 28334 KEVIN JACKSON PRESIDENT/CEO 9108911000 2016-07-20 1 JOHN NORMAN P01506766 7049985200 2016-07-20 2014 2016-12-15 16:53:06Z CORNELIA STEWART 800 TILGHMAN DRIVE DUNN NC 28334 661330 0 X HTTP://MYHARNETTHEALTH.ORG/ABOUTFOUNDATION/ X 2004 NC THE FOUNDATIONS PURPOSE IS TO SUPPLEMENT, ENHANCE AND ENRICH THE FACILITIES PROGRAMS AND SERVICES PROVIDED BY HARNETT HEALTH SYSTEM, INC. 12 12 0 13 0 0 340371 660712 0 0 579 618 -6768 0 334182 661330 33985 62050 0 0 47836 23992 0 0 0 91555 39562 173376 125604 160806 535726 783766 1268057 154224 102789 629542 1165268 THE FOUNDATION'S PURPOSE IS TO SUPPLEMENT, ENHANCE, AND ENRICH THE FACILITIIES PROGRAMS AND SERVICES PROVIDED BY HARNETT HEALTH SYSTEM, INC. 0 0 109434 62050 HARNETT HEALTH SYSTEM FOUNDATION IS COMMITTED TO IMPROVING THE HEALTH AND COMFORT OF THE PEOPLE IN THE COMMUNITITES THAT WE SERVE BY MAKING POSSIBLE NEEDED DEVELOPMENT IN OUR FACILITIES AS WELL AS PROVIDED STATE-OF-THE-ART EQUIPMENT. DURING FY 2015, $54,600 WAS PROVIDED TO HARNETT HEALTH SYSTEM TO PURCHASE EQUIPMENT. 109434 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 X X SHANNON SMITH 9109843000 215 BRIGHTWATER DRIVE LILLINGTON NC 27546 X CORNELIA STEWART CHAIR 4.00 X X 0 0 0 DAL SNIPES VICE CHAIR 4.00 X X 0 0 0 EMMETT ALREDGE III SECRETARY 4.00 X X 0 0 0 TOWNSEND QUINN BOARD MEMBER 1.00 X X 0 0 0 JIMMY JOHNSON BOARD MEMBER 1.00 X 0 0 0 JASON PRICE BOARD MEMBER 1.00 X 0 0 0 MARY ELLEN LAUDER BOARD MEMBER 1.00 X 0 0 0 WALTER WEEKS BOARD MEMBER 1.00 X 0 0 0 MARILYN LEVINSON BOARD MEMBER 1.00 X 0 0 0 ANA BLACKBURN BOARD MEMBER 1.00 X 0 0 0 BOB DOBERSTEIN BOARD MEMBER 1.00 X 0 0 0 SHANNON SMITH EX-OFFICIO, NON-VOTING 1.00 X X 0 0 0 DAN WEATHERLY BOARD MEMBER 1.00 X 0 0 0 0 0 0 0 0 0 0 0 31732 628980 604558 660712 618 618 661330 0 0 618 X 54600 54600 7450 7450 23992 23992 14656 14656 1514 1514 15166 15166 1192 1192 3392 3392 1500 1500 616 616 MISCELLANEOUS 1526 1526 125604 109434 16170 0 724230 603260 59536 64797 600000 0 600000 783766 1268057 154224 102789 154224 102789 X 629542 1165268 629542 1165268 783766 1268057 535726 0 X X 0 1 X 1 1 1 X 125776 251378 200301 340371 60712 978538 125776 251378 200301 340371 60712 978538 978538 217 6010 1042 579 618 8466 987004 0.99140 0.99320 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 600000 600000 600000 X PART X, LINE 2: THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ACCOMPANYING COMBINED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. THE SYSTEM HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2015. 1 HARNETT HEALTH SYSTEM INC PO BOX 1717 DUNN NC 28335 560603898 501(C)(3) 54600 GENERAL SUPPORT 1 SCHOLARSHIPS 2 7450 PART I, LINE 2: A SCHOLARSHIP REVIEW COMMITTEE REVIEWS ALL SCHOLARSHIP APPLICANTS ANONYMOUSLY. THE SCHOLARSHIP IS GIVEN TO A STUDENT BASED ON NEED, ACADEMIC AND NON-ACADEMIC ACHIEVEMENTS. THE STUDENT MUST BE PURSUING A CLINICAL DEGREE IN THE MEDICAL FIELD AND MUST HAVE HAD AN IMMEDIATE MEMBER OF THEIR FAMILY AFFECTED BY CANCER. THE SCHOLARSHIP APPLICATION IS DISTRIBUTED TO ALL HIGH SCHOOLS THROUGHOUT HARNETT COUNTY. X 0 FMV DATE CONTRIBUTED X 1 600000 FMV OF LAND 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE CHAIRPERSON, THE VICE CHAIRPERSON, THE SECRETARY AND THE TREASUER. THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE ORGANIZATION TO THE EXTENT PERMITTED BY LAW DURING THE INTERVALS BETWEEN MEETINGS OF THE BOARD. ALL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE MANAGEMENT OF THE ORGANIZATION. MANAGEMENT DISCUSSED A DRAFT OF THE RETURN WITH THE FULL BOARD AT A BOARD MEETING IN JULY, 2016. THE BOARD DELEGATED AUTHORITY TO REVIEW AND APPROVE THE FORM 990 TO A MEMBER OF THE BOARD WHO ALSO SERVES ON THE FINANCE COMMITTEE OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE LEADERSHIP OF THE BOARD OF TRUSTEES(THROUGHOUT THE YEAR IF NEEDED) AND ADMINISTERED TO ALL VOTING BOARD MEMBERS FORM 990, PART VI, SECTION C, LINE 18 PHOTOCOPIES OF THE RECENT FILINGS OF THE FORM 990 ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. IN ADDITION, RECENT FILINGS OF THE FORM 990 ARE AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 PHOTOCOPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 15,166. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,166. PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. HARNETT HEALTH SYSTEM INC PO BOX 1706 DUNN NC 28335 560603898 HOSPITAL NC 501(C)(3) HOSPITAL N/A 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 HARNETT HEALTH SYSTEM INC B 54600