2025-11-13T08:59:59-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 227 WEST TRADE STREET SUITE 800 CHARLOTTE NC 28202 990 2024-10-01 561833893 THE BLADEN COUNTY HOSPITAL FOUNDATION BLAD 9108621287 PO BOX 398 ELIZABETHTOWN NC 28337 BRET JOHNSON CFO 9108621287 2025-11-12 1 1 KURT BENNION CPA P01469618 7049985200 2025-11-12 2024 2025-03-06 01:10:19Z BRET JOHNSON PO BOX 398 ELIZABETHTOWN NC 28337 20594 0 X WWW.CAPEFEARVALLEY.COM/BLADEN/FOUNDATION X 1992 NC TO ADVANCE HEALTHCARE IN AND AROUND BLADEN COUNTY, NORTH CAROLINA. 13 13 0 13 0 0 59295 6646 0 0 20650 13948 0 0 79945 20594 0 0 0 0 0 0 0 0 0 1478 4662 1478 4662 78467 15932 626809 642741 0 0 626809 642741 THE MISSION OF THE BLADEN COUNTY HOSPITAL FOUNDATION IS TO SERVE THE COMMUNITY BY BUILDING AWARENESS AND PHILANTHROPIC SUPPORT FOR BLADEN COUNTY HOSPITAL AS IT PROVIDES COMPASSIONATE, QUALITY HEALTHCARE FOR ALL ITS PATIENTS. 0 0 4662 BLADEN COUNTY HOSPITAL FOUNDATION IS THE PHILANTHROPIC ARM OF BLADEN COUNTY HOSPITAL. ALL FUNDS DONATED TO BLADEN COUNTY HOSPITAL FOUNDATION ARE DEDICATED TO PROGRAMS AND SERVICES AT BLADEN COUNTY HOSPITAL. OUR FOUNDATION HAS A SINGLE GENERAL FUND. THE FOUNDATION SUPPORTS BLADEN COUNTY HOSPITAL THROUGH EQUIPMENT PURCHASES, COMMUNITY BENEFITS AND PATIENT AND FAMILY SUPPORT. 4662 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X BRET JOHNSON 9106154829 P O BOX 2000 FAYETTEVILLE NC 283022000 CHARLES RAY PETERSON CHAIR 0.10 0.00 X X 0 0 0 BRIAN CAMPBELL VICE-CHAIR 0.10 0.00 X X 0 0 0 SHIRLEY VANN SECRETARY/TREASURER 0.10 0.00 X X 0 0 0 GENA ANDERSON PEED MEMBER 0.10 0.00 X 0 0 0 MARK GILLESPIE MEMBER 0.10 0.00 X 0 0 0 ASHLEY GRAHAM JONES MEMBER 0.10 0.00 X 0 0 0 DR ANN GREENE MEMBER 0.10 0.00 X 0 0 0 DR SHAUN HINES MEMBER 0.10 0.00 X 0 0 0 DR MANDI LEE MEMBER 0.10 0.00 X 0 0 0 ERIC MATTHEWS MEMBER 0.10 0.00 X 0 0 0 TERRY NANCE MEMBER 0.10 0.00 X 0 0 0 DERRICK RICE MEMBER 0.10 0.00 X 0 0 0 MAURICE WILLIAMS MEMBER 0.10 0.00 X 0 0 0 MICHAEL NAGOWSKI CEO - CFVH 0.00 55.00 X 0 1751758 26851 BRET JOHNSON CFO - CFVH 0.00 55.00 X 0 804547 23349 0 2556305 50200 0 0 1 0 0 6646 6646 13948 13948 20594 0 0 13948 OTHER COSTS 4662 4662 4662 4662 0 0 122083 132330 504726 510411 626809 642741 0 0 X 626809 642741 626809 642741 626809 642741 15932 0 X 0 0 0 X 10929 3697 2767 59295 6646 83334 10929 3697 2767 59295 6646 83334 15376 67958 8279 0 14163 20897 13948 57287 140621 0.48330 0.55780 X PART II, COLUMN E: AMOUNTS REPORTED IN PART II, COLUMN E ARE FOR A SHORT YEAR THAT BEGAN ON OCTOBER 1, 2024, AND ENDED ON DECEMBER 31, 2024. 0 0 0 0 0 0 0 0 0 MICHAEL NAGOWSKI CEO - CFVH 0 1199200 0 549946 0 2612 0 15350 0 11501 0 1778609 0 0 BRET JOHNSON CFO - CFVH 0 610684 0 175770 0 18093 0 15350 0 7999 0 827896 0 0 PART I, LINE 3 EXECUTIVE SALARIES ARE DETERMINED BY A MARKET ANALYSIS INVOLVING COMPARABILITY DATA, INDUSTRY STANDARDS, AND LOCAL ECONOMICS. THE CEO'S SALARY IS A CONDITION OF THE MANAGEMENT AGREEMENT BETWEEN THE BOARD OF DIRECTORS AND CAPE FEAR VALLEY MEDICAL CENTER. THE BOARD HAS INDIRECT APPROVAL OVER THE COMPENSATION PAID TO THE CEO THROUGH THIS AGREEMENT, AND HAS APPROVAL OVER ANY ADDITIONAL AMOUNTS AND INCREASES. CAPE FEAR PREPARES A COMPENSATION STUDY FOR OFFICERS AND KEY EMPLOYEES EXCLUDING THE CEO AND MAKES THE RECOMMENDATIONS TO THE CEO OF HARNETT HEALTH SYSTEM. THOSE RECOMMENDATIONS, INCLUDING ANY AMOUNTS ALLOCATED FOR RAISES AND INCENTIVES, ARE INCLUDED IN THE ANNUAL BUDGET PROCESS WHICH IS APPROVED BY THE FINANCE COMMITIEE OF THE BOARD. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2022. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE FINANCE DEPARTMENT OF THE FOUNDATION'S PARENT, CUMBERLAND COUNTY HOSPITAL SYSTEM, INC. THE FINANCE DEPARTMENT PROVIDES A COPY OF THE COMPLETED FORM 990 TO THE FOUNDATION'S BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BLADEN COUNTY HOSPITAL FOUNDATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE SALARIES ARE DETERMINED BY A MARKET ANALYSIS INVOLVING COMPARABILITY DATA, INDUSTRY STANDARDS, AND LOCAL ECONOMICS. THE CEO'S SALARY IS A CONDITION OF THE MANAGEMENT AGREEMENT BETWEEN THE BOARD OF DIRECTORS AND CAPE FEAR (SEE THE RESPONSE TO LINE 3 ABOVE). THE BOARD HAS INDIRECT APPROVAL OVER THE COMPENSATION PAID TO THE CEO THROUGH THIS AGREEMENT, AND HAS APPROVAL OVER ANY ADDITIONAL AMOUNTS AND INCREASES. CAPE FEAR PREPARES A COMPENSATION STUDY FOR OFFICERS AND KEY EMPLOYEES EXCLUDING THE CEO AND MAKES THE RECOMMENDATIONS TO THE CEO OF HARNETT HEALTH SYSTEM. THOSE RECOMMENDATIONS, INCLUDING ANY AMOUNTS ALLOCATED FOR RAISES AND INCENTIVES, ARE INCLUDED IN THE ANNUAL BUDGET PROCESS WHICH IS APPROVED BY THE FINANCE COMMITIEE OF THE BOARD. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC UPON REQUEST. ORGANIZATION'S FORM 990 IS OPEN FOR PUBLIC INSPECTION, PROVIDES FINANCIAL INFORMATION, AND ADDRESSES ISSUES OF GOVERNANCE SUCH AS THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND GOVERNANCE DOCUMENTS. CUMBERLAND COUNTY HOSPITAL SYSTEM INC PO BOX 2000 FAYETTEVILLE NC 28302 560845796 HEALTH SERVICES NC 501(C)(3) LINE 3 N/A 0 CAPE FEAR VALLEY MEDICAL FOUNDATION INC PO BOX 87526 FAYETTEVILLE NC 28304 561947017 FUNDRAISING NC 501(C)(3) LINE 7 CCHS 0 HARNETT HEALTH SYSTEM INC PO BOX 1706 DUNN NC 28335 560603898 HEALTH SERVICES NC 501(C)(3) LINE 3 CCHS 0 HARNETT HEALTH SYSTEM FOUNDATION 800 TILGMAN DRIVE DUNN NC 28334 201929953 FUNDRAISING NC 501(C)(3) LINE 7 N/A 0 THE MED IMAGING CENTER LLC 3186 VILLAGE DRIVE STE 101 FAYETTEVILLE NC 28304 264473832 HEALTHCARE NC N/A 0 0 HIGHSMITH-RAINEY MED ARTS CENTER ASSOC PO BOX 2000 FAYETTEVILLE NC 28302 561747424 RENTAL ASSOC. NC N/A C 0 CUMBERLAND HLTH PARTNERS INC (INACTIVE) PO BOX 2000 FAYETTEVILLE NC 28302 562043978 BEHAVIORAL HEALTH NC N/A C 0 CAPE FEAR INSURANCE LTD PO BOX 30600 SMB WEST BAY RD GRAND CAYMAN CJ 980449284 INSURANCE CJ N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0