2015-08-14T09:02:28-05:00 2014-09-30 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2013-10-01 201929953 HARNETT HEALTH SYSTEM FOUNDATION HARN 9108911000 800 TILGHMAN DRIVE DUNN NC 28334 DAN WEATHERLY PRESIDENT/CEO 9108911000 2015-08-13 1 JOHN NORMAN P01506766 7049985200 2013 2016-03-07 17:11:31Z CORNELIA STEWART 800 TILGHMAN DRIVE DUNN NC 28334 350155 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. 16 16 0 48 0 0 200301 340371 0 0 1042 579 0 -6768 201343 334182 25397 33985 0 0 30927 47836 0 0 0 144527 91555 200851 173376 492 160806 515109 783766 12023 154224 503086 629542 THE FOUNDATIONS PURPOSE IS TO SUPPLEMENT, ENHANCE AND ENRICH THE FACILITIES PROGRAMS AND SERVICES PROVIDED BY HARNETT HEALTH SYSTEM, INC. 0 0 173376 33985 BETSY JOHNSON REGIONAL HOSPITAL FOUNDATION IS COMMITTED TO IMPROVING THE HEALTH AND COMFORT OF THE PEOPLE IN THE COMMUNITIES THAT WE SERVE BY MAKING POSSIBLE NEEDED DEVELOPMENT IN OUR FACILITIES AS WELL AS PROVIDING STATE OF THE ART EQUIPMENT. 173376 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 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 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 X X JANE GASKINS 9108911000 107 E BROAD ST DUNN NC 28335 CORNELIA STEWART CHAIR 4.00 X X 0 0 0 LINDA HAYES VICE CHAIR 4.00 X X 0 0 0 EMMETT ALDREDGE III SECRETARY 4.00 X X 0 0 0 TOWNSEND QUINN TREASURER 4.00 X X 0 0 0 BOB DOBERSTEIN BOARD MEMBER 1.00 X 0 0 0 JIMMY JOHNSON BOARD MEMBER 1.00 X 0 0 0 MARY ELLEN LAUDER BOARD MEMBER 1.00 X 0 0 0 DAL SNIPES BOARD MEMBER 1.00 X 0 0 0 ROBBIE TART BOARD MEMBER (EX OFFICIO VOTING) 1.00 X 0 0 0 ED TURLINGTON 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 GARY STEIMLE BOARD MEMBER 1.00 X 0 0 0 ROBIN NICHOLS BOARD MEMBER 1.00 40.00 X 0 161745 0 ANA BLACKBURN BOARD MEMBER 1.00 X 0 0 0 KENNETH BRYAN BOARD MEMBER (EX OFFICIO VOTING) 1.00 40.00 X 0 460057 67427 DR JERRY WALLACE BOARD MEMBER (EX OFFICIO NON VOTING) 1.00 X 0 0 0 LYNN LAMBERT BOARD MEMBER (EX OFFICIO VOTING) 1.00 40.00 X 0 273068 63370 MAUREEN MERCHO BOARD MEMBER (EX OFFICIO NON VOTING) 1.00 X 0 0 0 0 894870 130797 0 0 1 0 0 193779 70187 76405 340371 579 579 9205 193779 15973 -6768 -6768 334182 0 0 -6189 33985 33985 47836 47836 0 2070 2070 MISCELLANEOUS 89485 89485 173376 173376 0 0 515109 724230 59536 515109 783766 12023 154224 12023 154224 X 503086 629542 503086 629542 515109 783766 X 160806 -34350 X 0 0 0 X 290872 125776 251378 200301 340371 1208698 290872 125776 251378 200301 340371 1208698 1208698 412 217 6010 1042 579 8260 1216958 0.99320 0.99120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 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, 2014. 1 FINANCIAL ASSISTANCE 8 COLLEGE TUITION SCHOLARSHIPS 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 1 1 X X 0 0 0 0 0 0 0 0 0 ROBIN NICHOLS BOARD MEMBER 0 147342 0 14403 0 0 0 0 0 0 0 161745 0 0 KENNETH BRYAN BOARD MEMBER (EX OFFICIO VOTING) 0 432370 0 13601 0 14086 0 20346 0 47081 0 527484 0 0 LYNN LAMBERT BOARD MEMBER (EX OFFICIO VOTING) 0 265246 0 7822 0 0 0 18840 0 44530 0 336438 0 0 PART I, LINE 1B INVOICE VALUE $0-25,000 REQUIRES DIRECTOR SIGNATURE. $25,000 AND GREATER REQUIRES DIRECTOR SIGNATURE AND A COSIGNATURE FROM A VP. PART I, LINE 4 THE PERSONS WITH COMPENSATION LISTED IN FORM 990, PART VII ARE PAID BY HARNETT HEALTH SYSTEM. THE SYSTEM HAS A BONUS INCENTIVE PLAN THAT CERTAIN EMPLOYEES ARE ELIGIBLE FOR. THE PLAN IS BASED ON A COMBINATION OF PATIENT SATISFACTION, MEETING THE BUDGET, AND SAFETY REPORTS. THE BOARD OF DIRECTORS APPROVES HOW MUCH CAN BE PAID OUT IN TOTAL EACH YEAR. X 2 65233 FMV DATE CONTRIBUTED 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 ORGANIZATIONS FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY THE MANAGEMENT. THE FORM WAS REVIEWED AT A FULL MEETING OF THE BOARD OF DIRECTORS PRIOR TO THE FILING DATE. 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 XI, LINE 9: TRANSFERS TO RESTRICTED FUNDS -34,350. HARNETT HEALTH SYSTEM INC PO BOX 1706 DUNN NC 28335 560603898 HOSPITAL NC 501(C)(3) HOSPITAL N/A 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0