The nonprofit hospital's plans to expand its facility in Smithfield and build a new medical center in Clayton were updated last month. On April 15, the hospital submitted a certificate-of-need request with state regulators seeking approval to open a 27-bed hospital in Clayton, spokeswoman Suzette Rodriguez said.

The hospital expects to break ground this summer on a $31 million outpatient center and emergency room in Clayton, she said.

At its main campus in Smithfield, the hospital plans to erect a five-story, 110-bed tower and to renovate its 56-year-old core building, Rodriguez said. Construction on the tower also is expected to begin this summer.

The hospital's $137 million loan, backed by the U.S. Department of Housing and Urban Development, was announced by U.S. Sen. Elizabeth Dole's office.