STRATEGY STUDIO / PUBLIC DATA EXPLORER

BELOIT HEALTH SYSTEM INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BELOIT HEALTH SYSTEM INC (EIN 39-1028081)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201133189349307163
Schema version
2010v3.4
Note
A later return for the same period supersedes this one.
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-14T16:13:31-07:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391028081EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1BELOIT HEALTH SYSTEM INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBELONameControl
Phone6083645011Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11969 West Hart RoadAddressLine1
CityBeloitCity
StateWIState
ZIP Code53511ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWilliam GroeperName
TitleVP of Financial ServicesTitle
Phone6083645281Phone
Date Signed2011-11-14DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGregory K BrittonNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11969 West Hart RoadAddressLine1
CityBeloitCity
StateWIState
ZIP Code53511ZIPCode
FieldValueIRS element (for citing)
Gross Receipts182535950GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.beloithealthsystem.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1965YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionThe mission of Beloit Health System is to be a leader in assembling medical, employee, equipment, facility, and community resources in a manner which strives to deliver the highest quality medical and wellness services and improves the overall health status of the community we serve. As Beloit Health System, these services will be delivered at an economic value and in a manner which creates the highest level of patient satisfaction.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees1639TotalNbrEmployees
Total Nbr Volunteers425TotalNbrVolunteers
Total Gross UBI289041TotalGrossUBI
Net Unrelated Business Txbl Income289041NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year120322003ProgramServiceRevenuePriorYear
Program Service Revenue CY177222838ProgramServiceRevenueCY
Investment Income Prior Year843226InvestmentIncomePriorYear
Investment Income Current Year817049InvestmentIncomeCurrentYear
Other Revenue Prior Year3799273OtherRevenuePriorYear
Other Revenue Current Year4496063OtherRevenueCurrentYear
Total Revenue Prior Year124964502TotalRevenuePriorYear
Total Revenue Current Year182535950TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year65903761SalariesEtcPriorYear
Salaries Etc Current Year107711789SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year53481161OtherExpensePriorYear
Other Expenses Current Year67559452OtherExpensesCurrentYear
Total Expenses Prior Year119384922TotalExpensesPriorYear
Total Expenses Current Year175271241TotalExpensesCurrentYear
Revenues Less Expenses Prior Year5579580RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7264709RevenuesLessExpensesCY
Total Assets BOY175759691TotalAssetsBOY
Total Assets EOY191593671TotalAssetsEOY
Total Liabilities BOY107362883TotalLiabilitiesBOY
Total Liabilities EOY113912312TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY68396808NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY77681359NetAssetsOrFundBalancesEOY
Mission DescriptionBeloit Health System provides quality medical health care regardless of race, creed, sex, national origin, disability, age or ability to pay. During 2010, the System's Hospital served over 4,400 inpatients and provided more than 505,000 outpatient services, the NorthPointe facility provided more than 71,000 outpatient services and the Clinics had over 225,000 encounters. The System is equipped to serve the greater Beloit areas entire spectrum of health needs and strives to continue the long-standing tradition of providing excellent general acute care and to better serve the greater Beloit area.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense44442445Expense
Revenue54908370Revenue
DescriptionInpatient Revenue: Total admissions of 4,466 with an average daily census of 50. This was a slight 1% decrease from 2009 mainly due to the continued economic uncertainty from 2009 throughout 2010. Total patient days were 18,233Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense98459309Expense
Revenue122025426Revenue
DescriptionOutpatient Revenue: Beloit Memorial Hospital successfully integrated with the Beloit Clinic in 2010 to create the Beloit Health System. This integration of services substantially increased the number of outpatient services performed from 2009 to 2010. Total outpatient procedures were 578,495, an increase of 9% from the previous year. Total Clinic encounters were 226,787, all new outpatient service revenue for 2010.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp0TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense142901754TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1639NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Beloit Memorial Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6083645102TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11969 West Hart RoadAddressLine1
CityBeloitCity
StateWIState
ZIP Code53511ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
G Curtis Lansbery
Board Chair0XX000
Bonnie D Wetter
Board Vice Chair0XX000
Steven M Eldred
Board Treasurer0XX000
Russel Albert MD
Board Secretary & Physician40XX361491015925
Gregory K Britton
Board Member & System President & CEO40X5267680735709X
Suzanne Anderson
Board Member0X000
Leo Egbujiobi MD
Board Member & Physician40X977925015925
James B Fisher
Board Member0X000
Mark Gliebe
Board Member0X000
James L Packard
Board Member0X000
Tejesh Patel MD
Board Member & Physician40X354696015925
Mario Rojas MD
Board Member & Physician40X511532015925
Bill Sullivan
Board Member & Clinic Division CEO40X251356015925X
Timothy M McKevett
Executive Vice President40279708087361X
William Groeper
Vice President of Financial Services40201008021980X
Doris Mulder
Vice President of Nursing Services40208882096030X
Leland From MD
Vice President of Medical Affairs20131992016818X
Kristinn Armann
Vice President of Human Relations40116300068800X
Emmy Ho MD
Physician40846588015925X
Paul Segal MD
Physician40789041015925X
Tsu-Hon Wang MD
Physician40708675015925X
Ajmal Matloob
Physician40615392015925X
Glenn Tan MD
Physician40556090015925X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7437444TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1185948TotalOtherCompensation
Number Individuals GT100 K89NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensationAddress Line2AddressOfContractor/AddressUS/AddressLine2
JP Cullen & Sons Inc
330 E Delavan DriveJanesvilleWI53546Construction Contractors2222620
Power Wellness Management LLC
2055 W Army Trail RoadAddisonIL60101Wellness Operations Contractor1018963Suite 124
Clear Choice Transcription LLC
PO Box 643455CincinnatiOH452643455Transcription Services676984
Southern WI Emergency Association
1664 N RandallJanesvilleWI53545Trauma Physicians582043
Guenther Electric Inc
220 Liberty AvenueBeloitWI53511Electrical Contractors400045
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Total Contributions0TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Outpatient Service Revenue6220001220254271220254270$0
Inpatient Service Revenue62200054908370549083700$0
Third Party Administration5242922890410289041$0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue177222838TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column812049TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$812,049ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real284982Real
Personal0Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real284982Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column284982TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$284,982ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities0Securities
Other5000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other5000Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column5000TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$5,000ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
Wellness Center & Spa Revenue622000281277800$2,812,778
Cafeteria & Snack Shop Revenue62200054449700$544,497
Physician Billing62200017601600$176,016

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column677790TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$677,790ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue4211081TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column182535950TotalRevenueColumn
Related Or Exempt Function Income176933797RelatedOrExemptFunctionIncome
Unrelated Business Revenue289041UnrelatedBusinessRevenue
Exclusion$5,313,112ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total76708562Total
Program Services63324003ProgramServices
Management And General13384559ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6097497Total
Program Services5030435ProgramServices
Management And General1067062ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total20176452Total
Program Services16645573ProgramServices
Management And General3530879ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4729278Total
Program Services3901654ProgramServices
Management And General827624ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total10935Total
Management And General10935ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total59200Total
Management And General59200ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5674995Total
Program Services4643520ProgramServices
Management And General1031475ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1173649Total
Program Services962392ProgramServices
Management And General211257ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total25713875Total
Program Services23287497ProgramServices
Management And General2426378ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total842737Total
Management And General842737ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5920928Total
Program Services4855161ProgramServices
Management And General1065767ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total377328Total
Program Services207089ProgramServices
Management And General170239ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total19886Total
Program Services8305ProgramServices
Management And General11581ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2716000Total
Program Services2716000ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total9941096Total
Program Services8151699ProgramServices
Management And General1789397ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total849230Total
Program Services849230ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Equipment rental and maintenance644373331307353312998
Other purchased services30654688936672171801
Collection expense3797170379717
Professional memberships1586388275775881
WI Provider Tax421203742120370

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total175271241Total
Program Services142901754ProgramServices
Management And General32369487ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6935BOY
EOY9035EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY11551634BOY
EOY15808573EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY12669481BOY
EOY25058445EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY642519BOY
EOY812752EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2054723BOY
EOY2432468EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2869657BOY
EOY2113888EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis185446369LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec83728429LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY86093095BOY
EOY101717940EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY31526014BOY
EOY32884646EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
EOY3580000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY28345633BOY
EOY7175924EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY175759691BOY
EOY191593671EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11856617BOY
EOY19770232EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY2283635BOY
EOY3245545EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY49465000BOY
EOY70365000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY22966841BOY
EOY2387255EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY20790790BOY
EOY18144280EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY107362883BOY
EOY113912312EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY68396808BOY
EOY77681359EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY68396808BOY
EOY77681359EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY175759691BOY
EOY191593671EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7264709ReconcilationRevenueExpenses
Reconcilation Other Changes2019842ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1700000InvestmentCostOrOtherBasis
Other Cost Or Other Basis5865455OtherCostOrOtherBasis
Book Value7565455BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis102651081OtherCostOrOtherBasis
Depreciation30866891Depreciation
Book Value71784190BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis5883752OtherCostOrOtherBasis
Depreciation2407208Depreciation
Book Value3476544BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis69250277OtherCostOrOtherBasis
Depreciation50454330Depreciation
Book Value18795947BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis95804OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value95804BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings101717940TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Pension Liability$11,127,978
Interest Rate Swap Agreements$6,663,871
Capitalized Leases$352,431
FieldValueIRS element (for citing)
Total Of Amounts18144280TotalOfAmounts
Total Revenue182535950TotalRevenue
Total Expenses175271241TotalExpenses
Excess Or Deficit For Year7264709ExcessOrDeficitForYear
Net Unrealized GL On Investments0NetUnrealizedGLOnInvestments
Donated Services And Facilities0DonatedServicesAndFacilities
Investment Expenses0InvestmentExpenses
Prior Period Adjustments0PriorPeriodAdjustments
Other-$3,901,006OtherAmount
Total Adjustments-3901006TotalAdjustments
Excess Or Deficit Per FS3363703ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt187608894TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments0NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities0DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants0RecoveriesOfPriorYearGrants
Other Revenues182663OtherRevenues
Revenue Not Rptd F990182663RevenueNotRptdF990
Revenue Subtotal187426231RevenueSubtotal
Investment Expenses Not Included0InvestmentExpensesNotIncluded
Other Revenues Not Included-4890281OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-4890281RevenueNotRptdOnFinStmt
Total Revenue Per Form990182535950TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt184245191TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities0DonatedServicesUseOfFacilities
Prior Year Adjustments0PriorYearAdjustments
Losses Reported0LossesReported
Other Expenses Included8973950OtherExpensesIncluded
Expenses Not Rptd F9908973950ExpensesNotRptdF990
Expenses Subtotal175271241ExpensesSubtotal
Investment Expenses Not Included20InvestmentExpensesNotIncluded2
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990175271241TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SchD_P10_S00_L02Schedule D, Part X, Line 2The Health System is a nonprofit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The System is also exempt from state income taxes on related income. In order to account for any uncertain tax positions, the Corporation determines whether it is more likely than not that a tax position will be sustained upon examination on the technical merits of the position, assuming the taxing authority has full knowledge of all information. If the tax position does not meet the more likely than not recognition threshold, the benefit of that position is not recognized in the financial statements. The Corporation recorded no assets or liabilities related to uncertain tax positions in 2010 and 2009. Federal tax returns for the years ended 2007 and beyond remain subject to examination by the Internal Revenue Service
SchD_P11_S00_L08Schedule D, Part XI, Line 8Total is derived from the change in market value on Pension Restoration Assets for $182,663 minus the change in market value of the Interest Rate Swap Agreements ($401,567) and minus the Loss on Early Retirment of Bond Debt ($3,682,102). All nonoperating items are not included on Form 990 Statement of Revenue and Functional Expenses. Total Other is ($3,901,006)
SchD_P12_S00_L02dSchedule D, Part XII, Line 2dChange in market value on Pension Restoration Assets $182,663 included as non operating income on audited financial statements and thus not included on Form 990 Statement of Revenue
SchD_P12_S00_L04bSchedule D, Part XII, Line 4bBad debt expense of $4,890,281 is netted against gross program service revenue on Form 990. This is shown as an operating expense on the audited financial statements
SchD_P13_S00_L02dSchedule D, Part XIII, Line 2dTotal is derived from Bad debt expense of $4,890,281 that is included as operating expenses on audited financial statements but netted against gross program service revenue on Form 990. Plus the Loss on Early Retirement of Bond Debt of $3,682,103 and the negative change in value of Interest Rate Swap Agreements of $401,566 are non operating expenses and not included the Statement of Functional Expenses. Total Other is $8,973,950

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Net Community Benefit Expense11167580NetCommunityBenefitExpense
Percent Of Total Expense0.064PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense31165388TotalCommunityBenefitExpense
Direct Offsetting Revenue16806434DirectOffsettingRevenue
Net Community Benefit Expense14358954NetCommunityBenefitExpense
Percent Of Total Expense0.082PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense31165388TotalCommunityBenefitExpense
Direct Offsetting Revenue16806434DirectOffsettingRevenue
Net Community Benefit Expense25526534NetCommunityBenefitExpense
Percent Of Total Expense0.146PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served17120PersonsServed
Total Community Benefit Expense185926TotalCommunityBenefitExpense
Direct Offsetting Revenue9062DirectOffsettingRevenue
Net Community Benefit Expense176864NetCommunityBenefitExpense
Percent Of Total Expense0.001PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served192PersonsServed
Total Community Benefit Expense196641TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense196641NetCommunityBenefitExpense
Percent Of Total Expense0.001PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served16536PersonsServed
Total Community Benefit Expense88251TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense88251NetCommunityBenefitExpense
Percent Of Total Expense0PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served33848PersonsServed
Total Community Benefit Expense470818TotalCommunityBenefitExpense
Direct Offsetting Revenue9062DirectOffsettingRevenue
Net Community Benefit Expense461756NetCommunityBenefitExpense
Percent Of Total Expense0.002PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served33848PersonsServed
Total Community Benefit Expense31636206TotalCommunityBenefitExpense
Direct Offsetting Revenue16815496DirectOffsettingRevenue
Net Community Benefit Expense25988290NetCommunityBenefitExpense
Percent Of Total Expense0.148PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,019,688BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare27547185AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare116970019CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-89422834MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Beloit Memorial HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11969 West Hart RoadAddressLine1
CityBeloitCity
StateWIState
ZIP Code53511ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Beloit Memorial HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities10NumberOfOtherFacilities

Other Facilities OtherFacilities (11 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Beloit Clinic
1905 E Huebbe ParkwayBeloitWI53511Outpatient physician clinic
Northpointe Health and Wellness
5605 E Rockton RoadRoscoeIL61073Other outpatient physician clinic and diagnostic center
Beloit At-Home Healthcare
1904 E Huebbe ParkwayBeloitWI53511At Home Healthcare practice
Riverside Terrace
3055 S Riverside DriveBeloitWI53511Assisted Living Center
Northpointe Terrace
5601 E Rockton RoadRoscoeIL61073Assisted Living Center
Occupational Health Sports and Family Medicine
1650 Lee LaneBeloitWI53511Outpatient physician clinic
West Side Clinic
1735 Madison AveBeloitWI53511Outpatient physician clinic
Clinton Clinic
307 Ogden AveClintonWI53525Outpatient physician clinic
Darien Clinic
300 N WalworthDarienWI53114Outpatient physician clinic
Janesville Clinic
1321 Creston ParkJanesvilleWI53545Outpatient physician clinic
South Beloit Facility
1655 Blackhawk BlvdSouth BeloitIL61080Unoccupied

Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SchH_P01_S00_L06aSchedule H, Part I, Line 6aEach year the Beloit Health System prepares a community benefit report using the guidelines of the Wisconsin Hospital Association (WHA). It is then submitted to WHA for data tracking and reporting purposes.
SchH_P01_S00_L07Schedule H, Part I, Line 7Costing methodology used was the Ratio of Patient Care Cost to Charges with guidance from the IRS worksheets in the instructions
SchH_P01_S00_L072fSchedule H, Part I, Line 7, Column fNot applicable
SchH_P01_S00_L07gSchedule H, Part I, Line 7gNot applicable
SchH_P03_S0A_L04Schedule H, Part III, Section A, Line 4The carrying amounts of accounts receivable are reduced by allowances that reflect management's best estimate of the amounts that will not be collected. Management provides for contractual adjustments under terms of third-party reimbursement agreements through a reduction of gross revenue and a credit to a valuation allowance based on its assessment of historical collection likelihood and the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to valuation allowance and a credit to patient accounts receivable. Costing methodology used to determine bad debt expense at cost was the Ratio of Patient Care Cost to Charges wth guidance from the IRS worksheets in the instructions.
SchH_P03_S0B_L08Schedule H, Part III, Section B, Line 8Costing methodoloy used for Medicare allowable costs came directly off the 2010 Medicare Cost Report on Worksheet B per the IRS instructions
SchH_P03_S0C_L09bSchedule H, Part III, Section C, Line 9bThe Health System's collection policy states that patient accounts that have aged 100 days are to be reviewed for possible collection or pre-collection activity by a Credit Consultant. For accounts over $100, if it has been determined that no payment is forthcoming from a third-party payor and the patient had made no attempts to satisfy the balance of the account, a pre-collection letter shall be sent to the patient by a collection agency. If satifactory payment arrangements are not made within 15 days of the letter, the account status shall be changed to bad debt. For account balances under $100, if it has been determined that no payment is forthcoming from a third-party payor and the patient has made no attempts to satisfy the balance of the account, the account status shall be changed to bad debt. No pre-collection letter will be sent. All accounts in a Bad Debt status are transferred to a collection agency on the 15th and 30th of each month. Pre-collection accounts are transferred on the same dates. Accounts for services rendered for Hospital physicians or members of the Board shall not be transferred to bad debt or pre-collection without the approval of the Patient Accounts Advisor. The Health System will not force the sale or foreclosure of a patient's primary residence to pay an outstanding medical bill
SchH_P06_S00_L02Schedule H, Part VI, Line 2There are primarily three ways the Health System assesses health care needs of the community. 1) A marketing group is used and their service is to measure through phone interviews, etc. what the needed medical services are, how are our services are perceived, and are there any disconnects between these community needs, our actual services, and the community perception. 2) The Health System also looks at out migration date. Often limited to CMS data, this is what services (by CPT codes) were billed for residents of a particular zip code and where they go to get that service. If the volume of people going to other facilities is large, the Health System will review the costs, etc. of providing that service within the Health System. 3) The Health Systems corporate culture strongly supports due diligence for any request we receive from patients, family members, and their agents. Another way the Health System attempts to assess the health needs of the community is through the Rock County Health Needs Assessment Task Force which has been established for this purpose and meets on a monthly basis. Beloit Health System has 2 representatives on the task force as well as representation from all other area hospitals and major health providers within the County. Primary purpose of this task force is to compile county-wide data as well as Beloit specific data on major health parameters to address through a perception of needs survey. Action plans are then developed to meet gaps between services provided and the needs of the community.
SchH_P06_S00_L03Schedule H, Part VI, Line 3Information about the Health System's charity care benefits are available on the Health System's website as well as in all patient rooms. In addition, admissions staff are trained to offer financial assistance applications to all uninsured patients who inquire at the time of registration. Finally, every patient billing statement includes contact information for the System's charity care benefits.
SchH_P06_S00_L04Schedule H, Part VI, Line 4Beloit, Wisconsin is a community of approximately 38,000 residents and located just north of the Wisconsin-Illinois border. One of the most ethnically diverse communities in the Midwest, the population is 67% Caucasian, 15% African American, 9% Hispanic/Latino, and 1% Asian American, with another 8% from other ethnic backgrounds. They Health System monitors market share based on service areas identified through the use of zip codes. The primary and secondary service area represent a market population of approximately 250,000 people. 93% of the System's patients are from Beloit, Janesville, Clinton (all in Rock County, WI) South Beloit and Rockton (in Winnebago County, IL). The remaining 7% are from other Wisconsin and Illinois communities. Median household income for Rock County, WI is $50,373 and for Winnebago County, IL is $47,859. Unemployment in the area remains high and for 2010, Rock County, WI had an unemployment rate of 11.4% and Winnebago County, IL had an unemployment rate of 16.1%. Sources of Beloit Health System's gross patient revenue are 45.5% Medicare, 15.4% Medicaid, 5.0% Self Pays, and 34.1% Other Insurances.
SchH_P06_S00_L05Schedule H, Part VI, Line 5The Beloit Area Community Health Center has approached the Health System as to provide specialty physician care to indigent patients. This is a project above and beyond the Health System's current charity care process in that physicians are volunteeing their time. In 2010, Beloit Health System doctors volunteered over 250 hours of service which resulted in 375 patients served. In addition to that, certain doctors volunteered their services for Operation Hope (a local program organized by a local church).
SchH_P06_S00_L07Schedule H, Part VI, Line 7Wisconsin

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Gregory K Britton
3830420143726000735709000126247706843730
Leo Egbujiobi MD
94481800033107015925000993850000
Emmy Ho MD
8465880000015925000862513000
Paul Segal MD
7890410000015925000804966000
Tsu-Hon Wang MD
7086750000015925000724600000
Ajmal Matloob
6153920000015925000631317000
Glenn Tan MD
5530580003032015925000572015000
Mario Rojas MD
5115320000015925000527457000
Russel Albert MD
3538080007683015925000377416000
Tejesh Patel MD
33069600024000015925000370621000
Timothy M McKevett
2349420447660008736100036706903266270
Doris Mulder
1754610334210009603000030491202584640
Bill Sullivan
2513460000015925000267271000
William Groeper
18900801200000021980000222988000
Kristinn Armann
1163000000068800000185100000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSchJ_P01_S00_L04Identifier
Return ReferenceSchedule J, Part I, Line 4ReturnReference
Explanation457(f) Plan Participants: Gregory K Britton and Doris Mulder - no payments received to dateExplanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Date IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancingCUSIP NumberCUSIPNumber
Illinois Finance Authority
2010-10-2137895000Proceeds along with existing balances in the 2006A funds were used to refund the Series 2006A Bonds000
Wisconsin Health and Educational Facilities Authority
2010-10-2132470000Refund Series 2006B and refinance loans used for the acquisition of Beloit Clinic and ER renovations00097710BYF3

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredAmount Bond DefeasedAmountBondDefeasedTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundCapitalized InterestCapitalizedInterestRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsCredit EnhancementCreditEnhancementWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresOther Spent ProceedsOtherSpentProceedsAmount UnspentAmountUnspentYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
00378950000002550320000020071011
003247000027642000051085900001445020101011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
000000001
000000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsTerm Of HedgeTermOfHedgeSuperintegrated HedgeSuperintegratedHedgeHedge TerminatedHedgeTerminatedGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
Piper Jaffray
01125.500000
(no name)
000000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
First National Bank & Trust Co
An entity with System Board Members serving as key employees and board members of interested party0Bank accounts and normal business banking0
Marshall & Ilsley Trust Co
An entity with a System board member serving as key employee of interested party0Trustee for Hospital Pension Plans0
Regal Beloit Corp
An entity with a System board member serving as CEO of interested party0Medical claims paid to Health System0

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierSchL_P04_S00_L00Identifier
Return ReferenceSchedule L, Part IVReturnReference
ExplanationAn amount of $0 was entered in column c due to the inability to quantify an accurate total amount for the year. However, all transactions are considered to be in ther normal course of business.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
F990_P06_S0A_L02Form 990, Part VI, Section A, Line 2There are several business relationships on the Board as there are two board members currently key employees of local banks: First National Bank and Trust Company and Marshall and Ilsley Trust Company. All relationships are considered normal banking relationships and all transactions are within the normal course of business
F990_P06_S0B_L11aForm 990, Part VI, Section B, Line 11aForm 990 is prepared by an employee of the Health System's accounting staff and is reviewed by the VP of Financial Services, where it is signed and filed. After filing the return, the VP will present Form 990 to the Board
F990_P06_S0B_L12cForm 990, Part VI, Section B, Line 12cIt is the policy of the Health System that any leadership staff who believes he or she may be acting in contrary to the conflict of interest policy to promptly disclose the conflict to his or her supervisor. Employees should immediately report all known, observed, or potential conflicts of interests to their immediate supervisor or Human Resources. It is the responsiblity of the President to enforce and interpret this policy on all related matters.
F990_P06_S0B_L15Form 990, Part VI, Section B, Line 15The Hospital Board of Directors has established a CEO Evaluation Committee to evaluate the CEOs performance based on criteria and links performance evaluation to compensation. This committee meets at least three times per year to establish and review measurable goals. Outside directors establish performance criteria, compensation, and benefit programs for the CEO
F990_P06_S0C_L19Form 990, Part VI, Section C, Line 19Beloit Health System makes its financial statements available to the public via summary in the annual financial report which is posted on the Health System's website (www.beloithealthsystem.org). Also available on the website is the Board of Trustees Principle Based Governance Policy. It has been adopted by the Trustees and applies to all aspects of the governance to create a consistent, effective, and continuously improving governance system. The principles are divided into three major categories: 1) Board Independence and Leadership 2) Board Processes and Evaluation and 3) Board structure
F990_P11_S00_L05Form 990, Part XI, Line 5Change in pension obligation: $4,840,198 Cumulative effect of Swap termination: $838,518. Net assets released from restrictions and contributions for capital improvements: $784,331. Change in net unrealized gains and losses on investments other than trading securities: $780,417. Change in market valuation of Retirement Supplement Agreement: $182,664. Foundation receivable write-down: $(81,693). Change in market valuation of Swap agreements: $(401,567). Change in fair value of effective portion of interest rate swap agreements: $(1,240,923). Loss on early retirement of bond debt: $(3,682,103).

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
Beloit Health System Foundation Inc
1969 West Hart RoadBeloitWI53511391477854Support Beloit Health SystemWI501(c)(3)3N/A
Beloit Memorial Hospital Auxiliary Inc
1969 West Hart RoadBeloitWI53511390928583Support Beloit Health SystemWI501(c)(3)3N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Beloit Health System Foundation Inc
c509112Actual cash received from Beloit Health System Foundation
Beloit Health System Foundation Inc
o81693Actual expenses incurred by Beloit Health System Foundation and paid by Beloit Health System
Beloit Health System Foundation Inc
m0Beloit Health System Foundation uses office space at Beloit Health System. No amount of consideration is received
Beloit Memorial Hospital Auxiliary Inc
m0Beloit Memorial Hospital Auxiliary uses office space of Beloit Health System. No amount of consideration is received