2024-11-13T12:16:23-07:00 2023-12-31 990 2023-01-01 391028081 BELOIT HEALTH SYSTEM INC BELO 6083645011 1969 West Hart Road Beloit WI 53511 James Bird CFO 6083645281 2024-11-13 1 2023 2024-10-15 13:58:12Z James Bird 1969 West Hart Road Beloit WI 53511 277167593 0 X www.beloithealthsystem.org X 1965 WI The mission of Beloit Health System, Inc. is to be the leader in regional health and wellness services that delivers high quality value and satisfaction to our patients and communities we serve. 11 7 1861 0 0 0 0 0 253460627 269037749 2726639 3183992 4254457 4945852 260441723 277167593 0 0 0 0 140788392 147431833 0 0 0 116270876 125723386 257059268 273155219 3382455 4012374 278045148 279624208 112527661 106182701 165517487 173441507 Beloit Health System provides quality medical health care regardless of race, creed, sex, national origin, disability, age or ability to pay. During 2023, the System's Hospital served over 4,300 inpatients including newborns and provided more than 746,000 outpatient services, the NorthPointe facility provided more than 92,000 outpatient services and the Clinics provided more than 208,000 encounters. The Health 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. 0 0 52232663 0 60927047 Inpatient Revenue: Total adult admissions of 4,187 with an average daily census of 52 and an average length of stay of 4.5 days. This is in comparison to 2022 where admissions were 4,161 with an average daily census of 49 and an average length of stay of 4.3 days. Total patient days were 18,939 compared to 17,741 in 2022. 178412982 0 208110702 Outpatient Revenue: Total Hospital and NorthPointe outpatient procedures for 2023 were just over 838,000 compared to just over 820,000 in 2022. Total Physician Clinic encounters were just over 208,000, an increase from 191,000 in 2022 due to active physician recruitment and increases in physician RVU's year over year. 0 0 0 230645645 1 0 0 0 0 0 1 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 1861 1 0 0 0 0 0 0 0 0 X 11 7 1 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 X X Beloit Health System Inc 6083645102 1969 West Hart Road Beloit WI 53511 Timothy M McKevett Non Voting Board Member & System President & CEO 40 0 X 1355693 0 45801 Roger Kapoor MD VP of Physician Clinics/Medical Affairs/Physician 40 0 X 1298687 0 14850 Leo Egbujiobi MD Board Member & Physician 40 0 X 1157463 0 14850 Glenn Tan MD Physician 40 0 X 1004409 0 14850 Paul Segal MD Physician 40 0 X 900572 0 14850 Tsu-Hon Wang MD Board Secretary & Physician 40 0 X 882571 0 14850 Kevin Tomera MD Physician 40 0 X 871968 0 14850 Bin Jatta MD Physician 40 0 X 869180 0 14850 David Yoon MD Physician 40 0 X 864224 0 14850 Jamie Frantz MD Board Member & Physician 40 0 X 821281 0 14850 Kenneth Klein MD Board Member & Physician 40 0 X 433780 0 6600 James Bird VP of Financial Services 40 0 X 421934 0 14850 Robert Lisek MD Board Member & Physician 40 0 X 362094 0 14850 Thomas McCawley VP of Human Relations 40 0.00 X 346728 0 14850 Sharon Cox VP of Nursing Services 40 0 X 332764 0 11901 Nommo Donald Vice President 40.00 0 X 279827 0 12904 James B Fisher Board Chair 0 0 X 0 0 0 Mark Gliebe Board Vice Chair 0 0 X 0 0 0 David McCoy Board Treasurer 0 0 X 0 0 0 Kathy Hendricks Board Member 0 0 X 0 0 0 James Packard Board Member 0 0 X 0 0 0 William DeLong Board Member 0 0 X 0 0 0 John Wong Board Member 0 0 X 0 0 0 12203175 0 255406 213 0 1 0 Hilton M Hudson PC 5261 Fountain Drive Suite A Crown Point IN 46307 Cardiothoracic Surgeon 870000 Joseph Kittah MD 6431 Prairie Park Drive Eau Claire WI 54701 Pulmonology 780000 Daily Care LLC 323 N Morrison Street Suite 100 Appleton WI 54911 Hospitalist Physicians 398252 Yehia Khoga MD 5136 Wil-Acre Drive Loves Park IL 61111 Psychiatry 193200 Tabassum Nafsi MD 9348 Reserve Drive Caledonia IL 61011 Pulmonology 152750 5 0 Outpatient Service Revenue 622000 208110702 208110702 0 0 Inpatient Service Revenue 622000 60927047 60927047 0 0 0 0 0 0 269037749 3183992 0 0 3183992 0 0 0 0 0 0 0 0 531528 0 0 0 531528 0 531528 0 0 531528 0 0 Wellness Center and Spa Revenue 622000 2329168 0 0 2329168 Cafeteria and VIP Grille Revenue 622000 539198 0 0 539198 1545958 0 0 1545958 4414324 277167593 269037749 0 8129844 7692822 4128005 3564817 0 0 105513510 89697971 15815539 0 3030981 2512092 518889 0 24153976 19933619 4220357 0 7040544 5835238 1205306 0 119300 0 119300 0 21785050 20444315 1340735 0 1800154 280127 1520027 0 53883993 50322617 3561376 0 8345104 6916464 1428640 0 6209519 4496846 1712673 0 255907 206416 49491 0 0 3555144 2609476 945668 0 8926215 7646505 1279710 0 1676751 1380754 295997 0 Other Purchased Services 7055288 3344451 3710837 0 Equipment Rental and Maintenance 5947235 5409057 538178 0 WI Provider Tax 5337566 5337566 0 0 Collections Expense 419124 0 419124 0 407036 144126 262910 0 273155219 230645645 42509574 0 7893 7993 31481391 23021240 31959003 36348142 2926344 5577710 6823475 6976651 1994038 1462500 291873474 169929251 117741280 121944223 74568848 73065707 3300000 3300000 7242876 7920042 278045148 279624208 31848925 31694137 5766836 6690923 68326694 64859460 267975 147530 6317231 2790651 112527661 106182701 X 165517487 173441507 0 0 165517487 173441507 278045148 279624208 X 4012374 -26656433 0 0 0 30568079 X 0 1 X 1 0 X X 1 121 0 0 0 1 0 0 0 1 0 8103971 8103971 0 162096643 77912406 84184237 0 9614102 5592439 4021663 0 111190312 86424406 24765906 0 868446 0 868446 121944223 0 Interest Rate Swap Agreements 2290265 Operating Lease Liabilities 500386 2790651 273951452 0 0 0 0 0 273951452 0 3216141 3216141 277167593 273123605 0 0 0 0 0 273123605 0 31614 31614 273155219 Schedule D, Part II, Line 9 Not applicable Schedule D, Part XI, Line 4b Interest Income: $3,183,992. Auditor mapping variance: $32,149. Total Other: $3,216,141 Schedule D, Part XII, Line 4b Auditor mapping variance: $31,614 1 1 1 X 1 X 1 1 0 1 1 5429669 0 5429669 0.0199 49412921 23281419 26131502 0.0957 0 0 54842590 23281419 31561171 0.1156 188415 0 188415 0.0007 29246 0 29246 0.0001 14965 0 14965 0.0001 138804 0 138804 0.0005 0 0 371430 0 371430 0.0014 0 0 55214020 23281419 31932601 0.1170 1 2782344 0 41325829 52920395 -11594566 X 1 1 1 1 Beloit Memorial Hospital 1969 West Hart Road Beloit WI 53511 www.beloithealthsystem.org X X X X Beloit Memorial Hospital 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X https://www.beloithealthsystem.org/documents/2021-Full-Community-Health-Assessment.pdf X https://www.co.rock.wi.us/home/showpublisheddocument/14843/637807001647670000 X 1 22 0 1 0 1 X 200 400 X X X X X X 1 1 X X X 1 X https://www.beloithealthsystem.org/documents/content/financial-assistance-application-english.pdf X https://www.beloithealthsystem.org/documents/content/Financial-Assistance-Application-June-2016.pdf X https://www.beloithealthsystem.org/documents/content/financial-assistance-summary.pdf X X X X X X 1 X 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Beloit Memorial Hospital Beloit Health System is one of many partners in the Health Equity Alliance of Rock County (HEAR), which conducted the most current Community Health Needs Assessment (CHNA) in 2021. Key individual interviews were conducted with representatives from the following sectors of the community: local businesses, schools and higher learning institutions, hospitals and clinics, elected leaders, law enforcement, fire and EMS, faith organizations, social services, and community members who have been historically marginalized. Schedule H, Part V, Section B, Line 6a-Beloit Memorial Hospital Other Hospitals included in the CHNA: 1) Mercy Health 2) Edgerton 3) SSM Health Schedule H, Part V, Section B, Line 6b-Beloit Memorial Hospital Other organizations participating in the Health Equity Alliance of Rock County (HEAR) Community Health Needs Assessment (CHNA): Aging and Disability Resource Center of Rock County, Alzheimer's Association, American Heart Association, Beloit Area Community Health Center, Beloit Library, Beloit NAACP, Building a Safer Evansville (BASE), City of Beloit, City of Janesville, Community Action, Inc., HealthNet of Rock County, Hedberg Public Library, Inclusa Inc., Janesville Community Center, Janesville Mobilizing 4 Change, Nutrition and Health Associates/Women, Infants, and Children (WIC), Rock County Children's Family Resource Center, Rock County Council on Aging, Rock County Human Services Department, Rock County Public Health Department, Rock-Walworth Comprehensive Family Services Head Start/Early Head Start, School District of Beloit, School District of Janesville, Second Harvest Food Bank, South Central Wisconsin Area Health Education Center, Southwest Wisconsin Workforce Development Board, United Way Blackhawk Region, University of Wisconsin Division of Extension, Vivent Health, Youth 2 Youth 4 Change, YMCA of Northern Rock County, YWCA of Rock County Schedule H, Part V, Section B, Line 11-Beloit Memorial Hospital Beloit Health System, in conjunction with the county-wide Community Health Needs Assessment (CHNA), will focus on two health needs as are the other participating organizations participating in the Health Equity Alliance of Rock County (HEAR). 1) Reduce Barriers to Mental Health. 2) Improve Access to Care. Beloit Health System has created their own goals for each of these two areas and will be addressing these needs during the triennium years 2022-2024. There are two goals developed for the need of mental health related issues. Goal #1 is to increase the awareness of mental health problems in the community. Beloit Health System will create opportunities to present depression/suicide and other mental health concerns to the community and improve the identification of mental health issues of the patient population. Goal #2 will be to increase the presence of mental health services within the community by partnering with other Beloit Agencies, including but not limited to Beloit School District and Beloit College. There are two goals developed for Access to Care objective. Goal #1 is to increase knowledge of the benefits of healthy lifestyles and the services provided. Activities include but are not limited to partnering with other Beloit agencies to promote and increase activities to improve wellness. Such activities will include the BHS Safety Fair and free information provided at other Beloit events including but not limited to the Beloit Farmers Market, Beloit Senior Center, and the Stateline Boys and Girls Club. Goal #2 is to improve the relationship between patients and providers. Beloit Health System will actively provide information to providers relating to patient experience, access to health information materials, and continue to include cultural competency for providers and employees. In conclusion, Beloit Health System will continue to work in connection with the Rock County Health Department's Health Equity Alliance of Rock County as they continuously monitor trends and programs affecting the health of Rock County. This committee will meet regularly and consist of all not-for-profit health related agencies that serve Rock County. Progress and findings will be presented in annual meetings where all interested parties are invited to attend. Progress on Beloit Health System goals will be presented to our partners and other collaborating organization. 13 Beloit Clinic 1905 E Huebbe Parkway Beloit WI 53511 Outpatient Physician Clinic NorthPointe Health and Wellness 5605 E Rockton Road Roscoe IL 61073 Other Outpatient Physician Clinic and Diagnostic Center Beloit Cancer Care Center 1670 Lee Lane Beloit WI 53511 Outpatient Cancer Care Clinic Beloit At-Home Healthcare 655 3rd Street Ste 200 Beloit WI 53511 At Home Healthcare Practice Beloit Regional Hospice 655 3rd Street Ste 200 Beloit WI 53511 Hospice Riverside Terrace 3055 S Riverside Drive Beloit WI 53511 Assisted Living Center NorthPointe Terrace 5601 Rockton Road Roscoe IL 61073 Assisted Living Center Occupational Health Sports and Family Medicine 1650 Lee Lane Beloit WI 53511 Outpatient Physician Clinic West Side Clinic 1735 Madison Ave Beloit WI 53511 Outpatient Physician Clinic Clinton Clinic 307 Ogden Ave Clinton WI 53525 Outpatient Physician Clinic Janesville Clinic 1321 Creston Park Janesville WI 53545 Outpatient Physician Clinic Darien Clinic 300 N Walworth Darien WI 53114 Outpatient Physician Clinic South Beloit Clinic 1655 Blackhawk Blvd South Beloit IL 61080 Outpatient Physician Clinic Schedule H, Part I, Line 6a Each year 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. Schedule H, Part I, Line 7 Costing methodology used: Ratio of Patient Care Cost to Charges with guidance from the IRS worksheets in the instructions. Schedule H, Part I, Line 7, Column f Not applicable Schedule H, Part I, Line 7g Not applicable Schedule H, Part III, Section A, Line 4 Page 14 through 16 of the attached audit report discusses patient service revenue and bad debt expense. The costing methodology used was the Ratio of Patient Care Cost to Charges. Schedule H, Part III, Section B, Line 8 Medicare Allowable Costs were determined by using the Health Systems' Cost to Charge Ratio and applying that percentage to the amount of Medicare Charges obtained from the Provider Statistical and Reimbursement System (PSR) with 2023 service dates. Schedule H, Part III, Section C, Line 9b The Health Sytem's collection policy states that patient accounts that have aged at least 84 days to be reviewed for possible collection and pre-collection activity by a Financial Counselor. If it has been determined that no payment is forthcoming from a third-party payer and the patient has failed to establish an acceptable payment arrangement, a pre-collection letter shall be sent to the patient by a collection agency. If satisfactory payment arrangements are not made within 15 days of the pre-collection letter, the account status shall be changed to Bad Debt. All accounts in a Bad Debt status are transferred to a collection agency on a daily basis. Pre-collection accounts are transferred on the same dates. Upon patient request, it is the policy of Beloit Health System to consider a Charity Care adjustment if all other avenues have been exhausted and the patient shows there is no means of making payment on the account. All uninsured patients shall be granted an automatic "Uninsured Patient Discount" under Beloit Health System's Financial Assistance Policy which means that such patients are not charged more than the amounts generally billed to insured patients for the same emergency or other medically necessary care to preserve life or limb. Charity care adjustments are available to eligible persons requiring medically necessary treatment but who are unable to pay for medical services to preserve life or limb. Eligibility for charity care shall be extended to those persons whose family income does not exceed 200% of the current Federal Poverty Guidelines. Persons whose income is not more than 400% of the Guidelines may be eligible for charity care on a reduced charge basis. Charity care adjustments are based on the application materials and other information required under Beloit Health System's Financial Assistance Policy. A charity care adjustment shall be considered only after review of the patient's account and a determination has been made that no third-party reimbursement is available. A Charity Care application may be completed in person with the assistance of a Credit Consultant, or it may be sent by mail accompanied by a letter of explanation from the Credit Consultant. Upon review of the Charity Care application, the Credit Consultant shall determine eligibility and notify the patient of the outcome. If the application receives partial approval, the amount owed by the patient shall be indicated in the appropriate location on the determination notice letter. Also indicated on the form shall be 100% approvals or denials. Charity care approvals shall be in effect for additional services rendered within 90 days of the date of approval. After 90 days, updated financial information may be requested. Beloit Health System will not initiate Extraordinary Collection Actions until an initial determination of Financial Assistance eligibility status is made. Where Beloit Health System initially determines that a patient may be eligible for Financial Assistance, all Extraordinary Collection Actions (including civil actions, garnishments, and reports to collections or credit agencies) shall cease pending a final determination of Financial Assistance eligibility, and further action will not be taken on existing Extraordinary Collection Actions. Schedule H, Part VI, Line 2 In addition to the CHNA County-Wide Plan, Beloit Health System also uses a couple other methods to assess healthcare needs of the community. First, a marketing group is utilized for the purpose of collecting data through phone interviews, mailings, etc. what the needed medical services are, how our services are perceived, and if there are any disconnects between those community needs, our actual services, and the community perception. Second, the Health System also looks at out migration data. 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. Schedule H, Part VI, Line 3 Information about Beloit Health System's financial assistance policy is available on the System's own 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 financial assistance policy. Schedule H, Part VI, Line 4 Rock County is centrally located in the southern part of Wisconsin near the Illinois-Wisconsin border. It encompasses the following cities in its region: Beloit, Brodhead, Clinton, Edgerton, Evansville, Footvile, Fulton, Hanover, Janesville, Johnstown, Magnolia, Milton, Newark, Orfordville, Tiffany, and Union. A population over 160,000 people makes it the 9th largest county in Wisconsin. While the county is slightly less diverse in race and ethnicity than Wisconsin and the United States, the county has seen increases in rates of Black or African American, Asian, Hispanic and Latina, and American Indian and Alaska Native population across the last decade. The White population makes up the majority of Rock County's population at 82.3%. As a whole, Rock County has higher rates of poverty than Wisconsin and the United States with 12.3% of the population living under the poverty threshold. Though poverty is a complex issue with many contributing factors, health, education, and employment status are often good indicators of an area's poverty rate. In terms of health, Rock County has a higher rate of individuals under 65 years old without health insurance and a higher rate of people living with disability than the United States. Additionally, Rock County has a significantly lower proportion of its population with a bachelor's degree or higher. Currently, 22.1% of Rock County has attained a degree from higher education while 30.1% and 32.1% of Wisconsin and the Unites States, respectively, have achieved this level of education. Unemployment rates in Rock County and Wisconsin are lower than the United States rate at 3.4%. Schedule H, Part VI, Line 5 The Health System provides health care services and other financial support through various programs that are designed, among other matters, to enhance the health of the community, including the health of low-income patients. They System actively provided or participated in the following community-based activities and programs during 2023. 1) General health education services such as health fairs, cancer education, heart health education, family planning, and mental health education. 2) Provided health information on the System's website through health-related publications distributed at no charge. 3) Support groups such as AIDS/HIV, diabetes, substance abuse, and weight management. 4) Self-help and wellness programs, such as nutrition, weight management and sports injury prevention. 5) Blood pressure screenings, cholesterol testing, and hearing tests. 6) Crisis intervention counseling. 7) Guidance, referral, and enrollment assistance for public medical programs and other family support assistance. 8) Provided discounted or free medical supplies and equipment to those unable to pay. 9) Delivered hot in-home meals. 10) Provided emergency bus tokens for the indigent to access health care services. 11) Promoted participation in blood drives by employees. 12) Contributed to the education of student nurses and other health care professionals. The Health System also subsidized counseling and dialysis services, provided first aid to community events at no cost, and made cash contributions to support community events. Consistent with the mission of the Health System, care is provided to patients regardless of their ability to pay, including providing services to those patients who cannot afford health insurance because of inadequate resources or are underinsured. The Health System gives discounts from the established charges to self-pay patients without regard to the patient's ability to pay and considers these discounts a part of their community benefit. Health care services to patients under governmental programs, such as Medicaid, are also considered part of the Health System's benefit provided to the community since a substantial portion of such services are reimbursed at amounts less than the cost of providing care. Schedule H, Part VI, Line 6 Not applicable Schedule H, Part VI, Line 7 Beloit Health System files a community benefit report through the Wisconsin Hospital Assocation. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 Timothy M McKevett Non Voting Board Member & System President & CEO 658113 0 347251 0 350329 0 45801 0 0 0 1401494 0 350329 0 Roger Kapoor MD VP of Physician Clinics/Medical Affairs/Physician 1133085 0 165602 0 0 0 14850 0 0 0 1313537 0 0 0 Leo Egbujiobi MD Board Member & Physician 1157463 0 0 0 0 0 14850 0 0 0 1172313 0 0 0 Glenn Tan MD Physician 1004409 0 0 0 0 0 14850 0 0 0 1019259 0 0 0 Paul Segal MD Physician 900572 0 0 0 0 0 14850 0 0 0 915422 0 0 0 Tsu-Hon Wang MD Board Secretary & Physician 882571 0 0 0 0 0 14850 0 0 0 897421 0 0 0 Kevin Tomera MD Physician 871968 0 0 0 0 0 14850 0 0 0 886818 0 0 0 Bin Jatta MD Physician 869180 0 0 0 0 0 14850 0 0 0 884030 0 0 0 David Yoon MD Physician 864224 0 0 0 0 0 14850 0 0 0 879074 0 0 0 Jamie Frantz MD Board Member & Physician 821281 0 0 0 0 0 14850 0 0 0 836131 0 0 0 Kenneth Klein MD Board Member & Physician 433780 0 0 0 0 0 6600 0 0 0 440380 0 0 0 James Bird VP of Financial Services 359680 0 62254 0 0 0 14850 0 0 0 436784 0 0 0 Robert Lisek MD Board Member & Physician 362094 0 0 0 0 0 14850 0 0 0 376944 0 0 0 Thomas McCawley VP of Human Relations 281137 0 65591 0 0 0 14850 0 0 0 361578 0 0 0 Sharon Cox VP of Nursing Services 265775 0 66989 0 0 0 11901 0 0 0 344665 0 0 0 Nommo Donald Vice President 244482 0 35345 0 0 0 12904 0 0 0 292731 0 0 0 Schedule J, Part I, Line 1a Memberships are paid on behalf of all individuals listed on Part VII Section A. These memberships are to the Health System's Fitness Center as well as different social clubs and organizations. This promotes overall health and wellness, social aspects, and getting involved in the community for the Board and key employees of Beloit Health System. Schedule J, Part I, Line 4 409(a) Plan Participant is Timothy McKevett. $350,329 was received in 2023 A Wisconsin Health and Educational Facilities Authority 391337855 000000000 2013-02-26 10864000 Proceeds used for contruction of Cancer Care Center 0 0 0 B Wisconsin Health and Educational Facilities Authority 391337855 97712DRD0 2016-05-25 16801384 Proceeds used for construction of Ambulatory Surgery Center and renovations for Heart Hospital 0 0 0 C Wisconsin Health and Educational Facilities Authority 391337855 97712D3P9 2020-01-07 23981474 Refund prior issue (10/21/10) 0 0 0 D Illinois Finance Authority 861091967 000000000 2020-10-01 29265000 Refund prior issue (10/21/10) 0 0 0 A 7182359 0 10864000 0 0 0 110000 0 0 10754000 0 0 2014 0 0 1 1 B 0 0 16820218 0 0 0 301384 0 0 16518834 0 0 2017 0 0 1 1 C 3745000 0 24066904 0 0 0 401397 0 0 0 23665506 0 2010 1 0 1 1 D 4090000 0 29265000 0 0 0 0 0 0 0 29265000 0 2007 1 0 1 1 A 0 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 0 1 D 0 0 0 0 0 0 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 1 1 0 0 0 0 1 C 0 0 1 1 0 0 0 0 1 D 0 0 1 1 1 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K, Part IV, Line 2c-02/26/2013 10,864,000 Wisconsin Health and Educational Facilities Autho Date the Rebate Computation was performed: 01/31/2018. Note regarding the rebate computation: This debt was issued on a draw-down basis and amounts were drawn as project costs were incurred. As no rebatable arbitrage was earned and the debt service fund was operated on a bona fide basis, no further rebate analysis is necessary. Schedule K, Part IV, Line 2c-05/25/2016 16,801,384 Wisconsin Health and Educational Facilities Autho Date the Rebate Computation was performed: 04/30/2020. Note regarding the rebate computation: Since the bond proceeds have been spent, a spending exception was met, and the debt service fund was operated on a bona fide basis, no further rebate calculations are necessary. Total proceeds do not agree to the issue price in Part I, Column E due to investment earnings. Schedule K, Part IV, Line 2c-01/07/2020 23,981,474 Wisconsin Health and Educational Facilities Autho Date the Rebate Computation was performed: 07/07/2020. Note regarding the rebate computation: Since the bond proceeds have been spent, a spending exception was met, and the debt service fund was operated on a bona fide basis, no further rebate calculations are necessary. Total proceeds do not agree to the issue price in Part I, Column E due to investment earnings. Schedule K, Part IV, Line 2c-10/01/2020 29,265,000 Illinois Finance Authority Date the Rebate Computation was performed: 10/01/2020. Note regarding the rebate computation: Since the bond proceeds have been spent, a spending exception was met, and the debt service fund was operated on a bona fide basis, no further calculations are necessary. Form 990, Part VI, Section A, Line 2 One member of Beloit Health System's Board is currently an employee of First National Bank and Trust Company, which holds banking accounts and a bond hedge of Beloit Health System. Any relationship between this member and other Board members or key employees are considered normal banking relationships, and all transactions are within the normal course of business. Form 990, Part VI, Section A, Line 9 James Fischer: 1754 Sherwood Drive, Beloit WI 53511...Mark Gliebe: 13055 Promontory Trail, Roscoe IL 61073...David McCoy: 2311 E. Ridge Road, Beloit WI 53511...Kathy Hendricks: 1 ABC, Beloit WI 53511...James Packard: 7613 McCurry Road, Roscoe IL 61073...William DeLong: 8339 County Road X, Clinton WI 53525...John Wong: 2719 Sharon Drive, Beloit WI 53511 Form 990, Part VI, Section B, Line 11b The 2023 Form 990 was prepared by an employee of the Health System's accounting staff and is reviewed by the VP of Financial Services, where it is then electronically signed. Prior to filing the return, a draft copy is given to the Board for review at a regularly scheduled meeting. If no changes are recommended, the return will then be e-filed. Form 990, Part VI, Section B, Line 12c It is the policy of Beloit 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. Other employees should immediately report all known, observed or potential conflict of interests to their immediate supervisor or Human Resources. It is the responsibility of the President and CEO to enforce and interpret this policy on all related matters. Form 990, Part VI, Section B, Line 15 The Health System Board of Directors had established a Compensation Committee to evaluate the CEO and Vice Presidents' performance based on criteria and links performance evaluation to compensation. This committee meets at least two times per year to establish and review measurable goals. Outside directors establish performance criteria, compensation, and benefit programs for the CEO and Vice Presidents. Form 990, Part VI, Section C, Line 19 Beloit 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 governance to create a consistent, effective, and continuously improving governance system. The principles are divided into three categories: 1) Board of Independence and Leadership 2) Board of Processes and Evaluation 3) Board Structure Form 990, Part XI, Line 9 Change in fair value of effective portion of interest swap agreements: $125,971. Net assets released from restrictions for capital improvement: $1,094,724. Change in pension obligation other than pension expense: $29,347,384. Total other changes in net assets: $30,568,079 Beloit Health System Foundation Inc 1969 West Hart Road Beloit WI 53511 391477854 Support Beloit Health System WI 501(c)(3) 3 N/A 0 Beloit Memorial Hospital Auxiliary Inc 1969 West Hart Road Beloit WI 53511 390928583 Support Beloit Health System WI 501(c)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 Beloit Health System Foundation Inc c 2220340 Actual cash contributed to Beloit Health System, Inc. Beloit Health System Foundation Inc n 0 Beloit Health System Foundation uses office space at Beloit Health System. No cash consideration is received. Beloit Memorial Hospital Auxiliary Inc n 0 Beloit Memorial Hospital Auxiliary uses office space at Beloit Health System. No cash consideration is received.