2026-07-29T09:24:09-07:00 2025-12-31 990 2025-01-01 391028081 BELOIT HEALTH SYSTEM INC BELO 6083645011 1969 West Hart Road Beloit WI 53511 James Bird CFO 6083645281 2026-07-08 2025 2025-03-06 01:10:19Z James Bird 1969 West Hart Road Beloit WI 53511 314288428 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 1886 0 0 0 0 0 288753391 297794199 3628050 11308708 4794422 4900533 297175863 314003440 0 0 0 0 157768656 160441073 0 0 0 135517432 146545087 293286088 306986160 3889775 7017280 290930011 310860628 106667755 114053426 184262256 196807202 Beloit Health System provides quality medical health care regardless of race, creed, sex, national origin, disability, age or ability to pay. During 2025, the System's Hospital served over 4,500 inpatients including newborns and provided more than 821,000 outpatient services, the NorthPointe facility provided more than 95,000 outpatient services and the Clinics provided more than 221,000 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 55949774 0 64114023 Inpatient Revenue: Total adult admissions of 4,177 with an average daily census of 50 and an average length of stay of 4.4 days. This is in comparison to 2024 where admissions were 4,336 with an average daily census of 55 and an average length of stay of 4.6 days. Total patient days were 18,270 compared to 20,006 in 2024. 203923449 0 233680176 Outpatient Revenue: Total Hospital and NorthPointe outpatient procedures for 2025 were just over 916,000 compared to just over 919,000 in 2024. Total Physician Clinic encounters were just over 221,000, an increase from 217,000 in 2024 due to active physician recruitment. 0 0 0 259873223 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 1886 1 0 0 0 0 0 0 1 0 X 11 7 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 1 1 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 1329221 0 183470 Edward Nabrinsky Physician 40 0 X 1360058 0 0 Leo Egbujiobi MD Physician 40 0 X 1135304 0 13800 Kevin Tomera MD Physician 40 0 X 1060708 0 13800 Roger Kapoor MD VP of Physician Clinics/Medical Affairs/Physician 40 0 X 1044247 0 13800 Charles Laham MD Physician 40 0 X 941516 0 13800 Paul Segal MD Physician 40 0 X 923649 0 13800 Jamie Frantz MD Board Member & Physician 40 0 X 839940 0 13800 Tsu-Hon Wang MD Board Secretary & Physician 40 0 X 807772 0 13800 James Bird VP of Financial Services 40 0 X 472367 0 13800 Robert Lisek MD Board Member & Physician 40 0 X 426728 0 13800 Kenneth Klein MD Board Member & Physician 40 0 X 385638 0 0 Thomas McCawley VP of Human Relations 40 0 X 339699 0 13466 Sharon Cox VP of Nursing Services 40 0 X 337908 0 12730 Nommo Donald Vice President 40 0 X 301342 0 11569 Bonnie Wetter Board Chair 0 0 X 0 0 0 John Wong Board Vice Chair 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 Kristi Cole PhD Board Member 0 0 X 0 0 0 Mark Gliebe Board Member 0 0 X 0 0 0 11706097 0 345435 240 0 1 0 IAS Illinois PC 3510 Firestone Blvd Pensacola FL 32503 Anesthesiology Services 4562414 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 822250 Daily Care LLC 323 N Morrison Street Suite 100 Appleton WI 54911 Hospitalist Physicians 717916 Southern WI Emergency Association 5N327 Switchgrass Lane St Charles IL 60175 Trauma Physicians 701200 14 0 Outpatient Service Revenue 622000 233680176 233680176 0 0 Inpatient Service Revenue 622000 64114023 64114023 0 0 0 0 0 0 297794199 6223696 0 0 6223696 0 0 0 0 0 0 0 0 551602 0 0 0 551602 0 551602 0 0 551602 0 5370000 0 284988 0 5085012 5085012 0 0 5085012 Wellness Center and Spa Revenue 622000 2915599 0 0 2915599 Cafeteria & VIP Grille Revenue 622000 638862 0 0 638862 794470 0 0 794470 4348931 314003440 297794199 0 16209241 6284862 2968169 3316693 0 117257385 98996685 18260700 0 2850273 2352456 497817 0 26244015 21578061 4665954 0 7804538 6441429 1363109 0 509148 5270 503878 0 116338 0 116338 0 20897257 20118926 778331 0 1921879 346957 1574922 0 67032635 63594851 3437784 0 8287978 6840433 1447545 0 7713370 5566042 2147328 0 175814 150431 25383 0 6424 1579 4845 0 3522370 2585420 936950 0 9515654 8277539 1238115 0 1998763 1630499 368264 0 Other Purchased Services 10335097 5859288 4475809 0 Equipment Rental and Maintenance 8183020 7460334 722686 0 WI Provider Tax 5063216 5063216 0 0 Collections Expense 983840 0 983840 0 282284 35638 246646 0 306986160 259873223 47112937 0 8093 7108 26203507 21806841 46603757 62309000 2493256 5669919 7597378 8509376 1934168 2078627 313127092 185985743 120685150 127141349 72994915 66493841 3300000 3300000 9109787 13544567 290930011 310860628 34069892 41277728 8021703 9073293 62682698 61771981 21549 0 1871913 1930424 106667755 114053426 X 184262256 196807202 0 0 184262256 196807202 290930011 310860628 X 7017280 4234889 0 0 0 1292777 X 0 1 X 1 0 X X 1 121 0 0 0 1 0 0 0 1 0 8103971 8103971 0 166606679 85717819 80888860 0 10281866 6247433 4034433 0 117543521 94020491 23523030 0 10591055 0 10591055 127141349 0 Interest Rate Swap Agreements 1691750 Operating Lease Liabilities 238674 1930424 307994731 0 0 0 0 0 307994731 0 6008709 6008709 314003440 306986160 0 0 0 0 0 306986160 0 0 0 306986160 Schedule D, Part II, Line 9 Not applicable Schedule D, Part XI, Line 4b Interest Income: $6,223,696. Loss on Sale of Fixed Assets: ($214,987) 1 1 1 X 1 X 1 1 0 1 1 5351588 0 5351588 0.0174 43482293 22229072 21253221 0.0692 0 0 48833881 22229072 26604809 0.0866 140432 0 140432 0.0005 315169 6690 308479 0.001 130458 0 130458 0.0004 0 0 586059 6690 579369 0.0019 0 0 49419940 22235762 27184178 0.0885 1 4441791 0 36543568 49180197 -12636629 X 1 1 DaVita Inc Dialysis Services 0.2 0 0 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 23 1 0 1 1 X https://www.beloithealthsystem.org/documents/Beloit-Health-System-2023-CHNA-Report-FINAL.pdf X 1 24 1 https://www.beloithealthsystem.org/documents/Beloit-Health-System-2023-CHNA-Report-FINAL.pdf 0 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's primary research methodology consisted of community partner interviews and focus group discussions with employers, including business and organizational representatives, service providers, and community members. A total of 27 stakeholders across Beloit Health System's primary service area were interviewed one-on-one via zoom or telephone options. These interviews provided the opportunity for in-depth conversations about community strengths and challenges faced by stakeholders in regard to the community and health needs, including impacts of the COVID-19 pandemic, as well as ideas for solutions to address identified needs. Additionally, there were 6 focus groups and participants were encouraged to speak about their particular areas of concern, interest, or experience, as many opinions and observations were grounded in both personal and professional experiences. Schedule H, Part V, Section B, Line 6b-Beloit Memorial Hospital A variety of representatives throughout Beloit Health System's service area were contacted to participate in the community health needs assessment. The following group of organizations were represented by individuals in the stakeholder interview and/or focus group discussions. Alliant Energy, Beloit Area Community Health Center, Beloit City Council, Beloit College, Beloit Health System (BHS), Beloit Turner School District, BHS Counseling Center, BHS Emergency Medical Services Advisory Group, BHS Volunteers, City of Beloit, City of Beloit Police Department, City of South Beloit, First Baptist Church, Grinnell Senior Center, Harlem-Roscoe Fire Department, HealthNet of Rock County, Hendricks CareerTek, Latino Service Providers Coalition, The Lincoln Academy, Rock County, Rock County Jumpstart, Roscoe Police Department, Stateline Boys and Girls Club, Stateline Community Foundation, Stateline Family YMCA, Stateline Mass Transit District, and Visit Beloit. Schedule H, Part V, Section B, Line 11-Beloit Memorial Hospital Beloit Health System is addressing identified needs with a designated CHNA Leadership Group comprising of BHS Leadership and board members in which they participated in a two-stage needs scoring process facilitated by Crescendo (outside vendor). From a list of 30 community health needs and service gaps, the Leadership Group identified 10 priority needs based on importance, BHS degree of control, and timeline within which impacts could be foreseen. Of the prioritized needs identified by the Leadership Group, two needs rose to the top in terms of importance, BHS degree of control, and foreseeable impacts within a year. The first need identified was to increase the number of primary care services (such as family doctors or other providers of routine care). Rock County has fewer primary care providers per population compared to WI and the United States. Interviewees and focus group participants alike spoke to the burdens levied on emergency response personnel and services for routine care and for preventable or chronic health conditions exacerbated by lack of access to primary care. Further, among those who took the community survey and reported having unmet medical or mental health needs, a majority reported long wait times to see a provider as a reason for not getting needed care. BHS is well-poised to expand primary care access throughout the communities it serves on each side of the Wisconsin-Illinois state line. By doing so, BHS seeks to address the widely reported challenges associated with access to timely care, as well as to alleviate the burden on emergency response personnel and services through an expanded network of sources of care that are responsive to community needs. The second need identified was improve provider and system communication with patients, including improving the clarity of billing and insurance-related communications. In addition to expanding the array of primary care options available across the community, BHS recognizes the widely identified need for improved communication between patients and providers on topics ranging from care regiments to billing and insurance. Community members spoke to a variety of ongoing challenges related to establishing and maintaining consistent lines of communication with providers, as well as issues specific to insurance and billing. BHS values clear and effective communication as integral to the process of connecting people to appropriate care across the continuum. By prioritizing this need, BHS recognizes that there are several tangible areas, from patient care to insurance and billing, in which it can promote and instill more effective and equitable communication practices across the health system in the coming year and beyond. 11 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 Regional Hospice 1904 E Huebbe Parkway 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 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 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 15 through 18 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 System's Cost to Charge ratio and applying that percentage to the amount of Hospital Medicare Charges obtained from the Provider Statistical and Reimbursement System (PSR) with 2025 service dates. Schedule H, Part III, Section C, Line 9b The Health System'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. Belot 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 Beloit Health System's CHNA, the 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 and mailings 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, Beloit 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 This CHNA describes the BHS Service Area as an area spanning the Wisconsin-Illinois state line region and is defined by the following six zip codes: 53511 (Beloit, WI); 53525 (Clinton, WI); 53576 (Orfordville, WI); 61072 (Rockton, IL); 61073 (Roscoe, IL); and 61080 (South Beloit, IL). The City of Beloit (36,567 residents) is much larger than the neighboring municipalities within the BHS Service Area. Other municipalities with the BHS Service Area include the Town of Beloit, WI (7,751 residents), the Village of Clinton, WI (1,952 residents), the Village of Orfordville, WI (1,429 residents), the City of South Beloit (7,943 residents), the Village of Rockton, IL (8,051 residents), and the Village of Roscoe, IL (11,092 residents). The demographic data for the BHS Service Area, Rock County, WI, and the United States can be used to better understand the makeup of these communities and to identify strengths and areas of need. There are several measures for which the BHS Service Area differs from Rock County and the United States. Some of the most important differences are as follows: The population in the BHS Service Area is projected to grow at a rate slightly less than Wisconsin and substantially less than the United States, but greater than Rock County. The unemployment rate in the BHS Service Area is comparable to that at the national level, each of which is higher than either Wisconsin or Rock County. The population in the BHS Service Area is slightly younger than other geographies. The BHS Service Area is more racially and ethnically diverse than Rock County or Wisconsin, but less diverse than the United States. While the largest concentrations of minority populations live in Beloit, there are a number of outlying areas in which as many as one in three people identify as one or more racial/ethnic minority groups. Every school district in Rock County experienced a decline in the percentage of students with proficient reading ability from 2019 to 2021, with proficiency scores the lowest among the School District of Beloit students. There are fewer multi-unit housing structures, and a smaller fraction of housing units that are mobile homes, in the BHS Service area compared to other geographies. Nearly two in five renters and one in five homeowners are considered to be cost-burdened with regards to housing (that is these households spend 30% or more of household income on rent or mortgage expenses). Rock County has fewer primary care providers per population compared to Wisconsin and the United States and lower percentages of adults that are up to date on various preventative measures compared to national levels. The teen birth rate in Rock County is higher than the Wisconsin or national teen birth rates and teen mothers in Rock County who identify as Black have a rate nearly three times as high as those who identify as White. Crisis services are the most frequently utilized mental health services in Rock County year over year. However, there was a decrease in the number of people receiving crisis services over the 2019 to 2021 period. 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. The System actively provided or participated in the following community-based activities and programs during 2025. 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 to 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 with regard to the patient's ability to pay and considers these discounts a part of their community benefit. Health care services to patients under government programs, such as Medicaid, are also considered to be part of the Health System's benefit provided to the community since a substantial portion of such services are reiumbursed 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 Association. 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 720606 0 229510 0 379105 0 183470 0 0 0 1512691 0 379105 0 Edward Nabrinsky Physician 1360058 0 0 0 0 0 0 0 0 0 1360058 0 0 0 Leo Egbujiobi MD Physician 1135304 0 0 0 0 0 13800 0 0 0 1149104 0 0 0 Kevin Tomera MD Physician 1060708 0 0 0 0 0 13800 0 0 0 1074508 0 0 0 Roger Kapoor MD VP of Physician Clinics/Medical Affairs/Physician 966782 0 77465 0 0 0 13800 0 0 0 1058047 0 0 0 Charles Laham MD Physician 941516 0 0 0 0 0 13800 0 0 0 955316 0 0 0 Paul Segal MD Physician 923649 0 0 0 0 0 13800 0 0 0 937449 0 0 0 Jamie Frantz MD Board Member & Physician 839940 0 0 0 0 0 13800 0 0 0 853740 0 0 0 Tsu-Hon Wang MD Board Secretary & Physician 807772 0 0 0 0 0 13800 0 0 0 821572 0 0 0 James Bird VP of Financial Services 418708 0 53659 0 0 0 13800 0 0 0 486167 0 0 0 Robert Lisek MD Board Member & Physician 426728 0 0 0 0 0 13800 0 0 0 440528 0 0 0 Kenneth Klein MD Board Member & Physician 385638 0 0 0 0 0 0 0 0 0 385638 0 0 0 Thomas McCawley VP of Human Relations 301275 0 38424 0 0 0 13466 0 0 0 353165 0 0 0 Sharon Cox VP of Nursing Services 287755 0 50153 0 0 0 12730 0 0 0 350638 0 0 0 Nommo Donald Vice President 258760 0 42582 0 0 0 11569 0 0 0 312911 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. $375,105 was received in 2025 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 8630902 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 5690000 0 24066904 0 0 0 401397 0 0 0 23665506 0 2010 1 0 1 1 D 7120000 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 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 1, 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 exemption 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 9 Bonnie Wetter: 12228 S. Cty Hwy K Beloit WI 53511...John Wong: 2719 Sharon Drive, 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...Kristi Cole: 2415 Lookout Drive, Beloit WI 53511...Mark Gliebe: 13055 Promontory Trail, Roscoe IL 61073 Form 990, Part VI, Section B, Line 11b The 2025 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 have 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 the 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 rate swap agreement: $(191,921). Net assets released from restrictions for capital improvements: $1,259,174. Other: $225,524 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 2039990 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 Health System Auxiliary uses office space at Beloit Health System. No cash consideration is received.