2025-07-31T10:12:40-05:00 2024-09-30 390859910 BAKER TILLY ADVISORY GROUP LP 20 STANWIX STREET PITTSBURGH PA 15222 990 2023-10-01 561751968 SAMPSON REGIONAL MEDICAL CENTER FOUNDATION SAMP 9105928511 607 BEAMAN STREET CLINTON NC 28328 SHAWN HOWERTON BOARD MEMBER (CEO & CMO OF SRMC) 9105928511 2025-05-27 1 1 KELLY A BROCIOUS CPA P01254262 4126976400 2025-05-27 2023 2025-03-06 01:10:19Z SHAWN HOWERTON 607 BEAMAN STREET CLINTON NC 28328 129155 0 X WWW.SAMPSONRMC.ORG/GIVING/FOUNDATION.ASPX X 1991 NC TO GATHER FUNDS FOR THE BENEFIT OF SAMPSON REGIONAL MEDICAL CENTER, INC. 9 9 0 9 0 0 123882 112253 0 0 13795 16902 0 0 137677 129155 6945 1649 0 0 0 0 0 0 0 77472 85575 84417 87224 53260 41931 1061068 1179334 807180 883515 253888 295819 TO OPERATE EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF SAMPSON REGIONAL MEDICAL CENTER, INC. 0 0 87224 1649 THE FOUNDATION IS COMMITTED TO SUPPORTING THE GOALS OF SAMPSON REGIONAL MEDICAL CENTER. IN THE FISCAL YEAR 2024, THE FOUNDATION'S FUNDS WERE PRIMARILY RAISED THROUGH THE TREE OF LOVE, EMPLOYEE GIVING CAMPAIGN, AND ANNUAL GIVING CAMPAIGN. THE FUNDS RAISED, VARYING IN AMOUNTS BY PROJECT, WERE DESIGNATED FOR SPECIAL PROJECTS AND CAUSES, INCLUDING THE BLOOD DONOR CENTER, ORTHOPEDIC SURGICAL EQUIPMENT, PATIENT EQUIPMENT, AND VISITOR HOSPITALITY SERVICE. ADDITIONALLY, FUNDS WERE DIRECTED TOWARD PROGRAMS ADMINISTERED BY THE FOUNDATION FOR EMPLOYEE FINANCIAL AID OR CAREER DEVELOPMENT. 87224 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X JERRY HEINZMAN HOSPITAL CFO 9105928511 607 BEAMAN STREET CLINTON NC 28328 MANDY DUBOSE PRESIDENT 1.00 X X 0 0 0 JONI FAY FETTERMAN BOARD MEMBER 1.00 X 0 0 0 JANET PRESTAGE BOARD MEMBER 1.00 X 0 0 0 PATTY CHERRY BOARD MEMBER 1.00 X 0 0 0 CHRIS FANN BOARD MEMBER 1.00 X 0 0 0 DEBORAH HALL BOARD MEMBER 1.00 X 0 0 0 DEBORAH JOHNSON BOARD MEMBER 1.00 X 0 0 0 JOHN SURRATT BOARD MEMBER 1.00 X 0 0 0 SHERRY MATTHEWS BOARD MEMBER 1.00 X 0 0 0 SHAWN HOWERTON CEO EX-OFFICIO 1.00 40.00 X 0 439351 22356 AMBER HALSTEAD EXECUTIVE DIRECTOR 8.00 32.00 X 0 170532 14438 0 609883 36794 0 0 1 0 0 112253 112253 16902 16902 129155 0 0 16902 X 1649 1649 17881 17881 67637 67637 57 57 87224 87224 0 0 746035 847398 315033 331936 1061068 1179334 2128 807180 881387 807180 883515 X -257637 -120890 511525 416709 253888 295819 1061068 1179334 41931 0 X X 0 1 X 1 0 X X 1 SAMPSON REGIONAL MEDICAL CENTER INC 560562304 3 1 0 87224 1 0 87224 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE TO AFFILIATE 881387 881387 X 129155 0 129155 0 129155 87224 0 87224 0 87224 PART X, LINE 2: AS AN ESSENTIAL GOVERNMENT FUNCTION OF THE COUNTY, THE HOSPITAL IS GENERALLY EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER SECTION 115 OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE FOUNDATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3); THEREFORE, NO INCOME TAXES ARE REFLECTED IN THE COMBINED FINANCIAL STATEMENTS. SRS IS A LIMITED LIABILITY CORPORATION ("LLC") AND IS TAXED AS A PARTNERSHIP UNDER THE INTERNAL REVENUE CODE AND A SIMILAR STATE STATUTE. INSTEAD OF INCOME TAXES, THE MEMBERS OF AN LLC ARE TAXED ON THE LLC'S TAXABLE INCOME; THEREFORE, NO PROVISION OR LIABILITY FOR FEDERAL OR STATE TAXES HAS BEEN RECORDED BY SRS. THE HOSPITAL OWNS 77.5% OF SRS, BUT AS A NOT-FOR-PROFIT CORPORATION, THE HOSPITAL DOES NOT PAY TAXES ON ITS PROPORTIONAL SHARE OF THE INCOME OF SRS. THE HOSPITAL HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2024. 0 0 0 0 0 0 0 0 0 SHAWN HOWERTON CEO EX-OFFICIO 0 439351 0 0 0 0 0 0 0 22356 0 461707 0 0 AMBER HALSTEAD EXECUTIVE DIRECTOR 0 165593 0 4939 0 0 0 0 0 14438 0 184970 0 0 PART I, LINE 3 SAMPSON REGIONAL MEDICAL CENTER FOUNDATION'S TOP MANAGEMENT OFFICIAL IS PAID BY SAMPSON REGIONAL MEDICAL CENTER. SAMPSON REGIONAL MEDICAL CENTER USES THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE CEO: -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE FOUNDATION SHALL BE APPOINTED BY THE BOARD OF TRUSTEES OF SAMPSON REGIONAL MEDICAL CENTER, INC. NOMINEES FOR THE FOUNDATION BOARD OF DIRECTORS SHALL BE SUBMITTED BY THE FOUNDATION BOARD TO THE SAMPSON REGIONAL MEDICAL CENTER BOARD OF TRUSTEES FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PROVIDED TO EACH VOTING BOARD MEMBER FOR DISCUSSION AND COMMENT BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT EACH BOARD MEMBER MUST FOLLOW. ALL BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY STATING THAT THEY WILL ABIDE BY THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A THE SALARY OF THE EXECUTIVE DIRECTOR FOR THE FOUNDATION IS DETERMINED USING THE PUBLISHED AVERAGES FOR OUR SIZE HOSPITAL FROM THE NORTH CAROLINA HOSPITAL ASSOCIATION. THAT IS USED AS A BASELINE AND PERCENTILES OF THE SALARY FOR THE POSITION ARE DETERMINED. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, RECENT FILLINGS OF THE FORM 990 ARE AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART IX, LINE 11G OTHER: PROGRAM SERVICE EXPENSES 17,881. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,881. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. SAMPSON REGIONAL MEDICAL CENTER INC 607 BEAMAN STREET CLINTON NC 28328 560562304 HEALTHCARE NC 501(C)(3) LINE 3 N/A 0 SAMPSON RADIOLOGY SERVICES LLC 607 BEAMAN STREET CLINTON NC 28328 261845096 MEDICAL EQUIPMENT NC N/A 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0