TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) G Curtis Lansbery Board Chair	0	X	X		0	0
(2) Bonnie D Wetter Board Vice Chair	0	X	X		0	0
(3) Steven M Eldred Board Treasurer	0	X	X		0	0
(4) Russel Albert MD Board Secretary & Physician	40	X	X		361,491	15,925
(5) Gregory K Britton Board Member & System President & CEO	40	X		X	526,768	459,717
(6) Suzanne Anderson Board Member	0	X			0	0
(7) Leo Egbujiobi MD Board Member & Physician	40	X			977,925	15,925
(8) James B Fisher Board Member	0	X			0	0
(9) Mark Gliebe Board Member	0	X			0	0
(10) James L Packard Board Member	0	X			0	0
(11) Tejesh Patel MD Board Member & Physician	40	X			354,696	15,925
(12) Mario Rojas MD Board Member & Physician	40	X			511,532	15,925
(13) Bill Sullivan Board Member & Clinic Division CEO	40	X		X	251,356	15,925
(14) Timothy M McKevett Executive Vice President	40			X	279,708	87,361
(15) William Groeper Vice President of Financial Services	40			X	201,008	21,980
(16) Doris Mulder Vice President of Nursing Services	40			X	208,882	96,030
(17) Leland From MD Vice President of Medical Affairs	20			X	131,992	16,818

(A) Name and business address	(B) Description of services	(C) Compensation
JP Cullen & Sons Inc 330 E Delavan Drive Janesville,WI53546	Construction Contractors	2,222,620
Power Wellness Management LLC 2055 W Army Trail Road Suite 124 Addison,IL60101	Wellness Operations Contractor	1,018,963
Clear Choice Transcription LLC PO Box 643455 Cincinnati,OH452643455	Transcription Services	676,984
Southern WI Emergency Association 1664 N Randall Janesville,WI53545	Trauma Physicians	582,043
Guenther Electric Inc 220 Liberty Avenue Beloit,WI53511	Electrical Contractors	400,045
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 15

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	76,708,562	63,324,003	13,384,559
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	6,097,497	5,030,435	1,067,062
9	Other employee benefits .......	20,176,452	16,645,573	3,530,879
10	Payroll taxes ...........	4,729,278	3,901,654	827,624
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	10,935		10,935
c	Accounting ...........	59,200		59,200
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........	5,674,995	4,643,520	1,031,475
12	Advertising and promotion ....	1,173,649	962,392	211,257
13	Office expenses .......	25,713,875	23,287,497	2,426,378
14	Information technology ......	842,737		842,737
15	Royalties ..
16	Occupancy ...........	5,920,928	4,855,161	1,065,767
17	Travel ............	377,328	207,089	170,239
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	19,886	8,305	11,581
20	Interest ...........	2,716,000	2,716,000
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	9,941,096	8,151,699	1,789,397
23	Insurance ..............	849,230	849,230
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	Equipment rental and maintenance	6,443,733	3,130,735	3,312,998
b	Other purchased services	3,065,468	893,667	2,171,801
c	Collection expense	379,717	0	379,717
d	Professional memberships	158,638	82,757	75,881
e	WI Provider Tax	4,212,037	4,212,037	0
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	175,271,241	142,901,754	32,369,487	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	6,935	1	9,035
2	Savings and temporary cash investments .......	11,551,634	2	15,808,573
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	12,669,481	4	25,058,445
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	642,519	7	812,752
8	Inventories for sale or use ..............	2,054,723	8	2,432,468
9	Prepaid expenses and deferred charges ............	2,869,657	9	2,113,888
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	185,446,369
b	Less: accumulated depreciation. .....	10b	83,728,429	86,093,095	10c	101,717,940
11	Investments—publicly traded securities ..........	31,526,014	11	32,884,646
12	Investments—other securities. See Part IV, line 11 ......		12
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14	3,580,000
15	Other assets. See Part IV, line 11 ...........	28,345,633	15	7,175,924
16	Total assets. Add lines 1 through 15 (must equal line 34)...	175,759,691	16	191,593,671
	17	Accounts payable and accrued expenses .	11,856,617	17	19,770,232
18	Grants payable ..........		18
19	Deferred revenue ..........	2,283,635	19	3,245,545
20	Tax-exempt bond liabilities ..........	49,465,000	20	70,365,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	22,966,841	23	2,387,255
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	20,790,790	25	18,144,280
26	Total liabilities. Add lines 17 through 25.....	107,362,883	26	113,912,312
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	68,396,808	27	77,681,359
28	Temporarily restricted net assets .....	0	28	0
29	Permanently restricted net assets .....	0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	68,396,808	33	77,681,359
34	Total liabilities and net assets/fund balances .....	175,759,691	34	191,593,671

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	1,700,000	5,865,455		7,565,455
b	Buildings ................	0	102,651,081	30,866,891	71,784,190
c	Leasehold improvements ............	0	5,883,752	2,407,208	3,476,544
d	Equipment ................	0	69,250,277	50,454,330	18,795,947
e	Other .................	0	95,804	0	95,804
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........					101,717,940

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes		0
Pension Liability		11,127,978
Interest Rate Swap Agreements		6,663,871
Capitalized Leases		352,431






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		18,144,280
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	182,535,950
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	175,271,241
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	7,264,709
4	Net unrealized gains (losses) on investments ..........................	4	0
5	Donated services and use of facilities .............................	5	0
6	Investment expenses ...................................	6	0
7	Prior period adjustments ..................................	7	0
8	Other (Describe in Part XIV) .................................	8	-3,901,006
9	Total adjustments (net). Add lines 4 - 8 .............................	9	-3,901,006
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	3,363,703

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	187,608,894
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	0
b	Donated services and use of facilities .........	2b	0
c	Recoveries of prior year grants ...........	2c	0
d	Other (Describe in Part XIV): ............	2d	182,663
e	Add lines 2a through 2d .....................			2e	182,663
3	Subtract line 2e from line 1.....................			3	187,426,231
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	0
b	Other (Describe in Part XIV): ...........	4b	-4,890,281
c	Add lines 4a and 4b.......................			4c	-4,890,281
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	182,535,950

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	184,245,191
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	0
b	Prior year adjustments ..............	2b	0
c	Other losses ................	2c	0
d	Other (Describe in Part XIV): ............	2d	8,973,950
e	Add lines 2a through 2d......................			2e	8,973,950
3	Subtract line 2e from line 1.....................			3	175,271,241
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	0
b	Other (Describe in Part XIV): ............	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	175,271,241

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
SchD_P10_S00_L02	Schedule D, Part X, Line 2	The 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_L08	Schedule D, Part XI, Line 8	Total 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_L02d	Schedule D, Part XII, Line 2d	Change 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_L04b	Schedule D, Part XII, Line 4b	Bad 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_L02d	Schedule D, Part XIII, Line 2d	Total 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 D (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..					11,167,580	6.4 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .			31,165,388	16,806,434	14,358,954	8.2 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	0	0	31,165,388	16,806,434	25,526,534	14.6 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....		17,120	185,926	9,062	176,864	0.1 %
f Health professions education (from Worksheet 5) ..		192	196,641	0	196,641	0.1 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..		16,536	88,251	0	88,251	0 %
jTotal Other Benefits ...	0	33,848	470,818	9,062	461,756	0.2 %
kTotal. Add lines 7d and 7j. ..	0	33,848	31,636,206	16,815,496	25,988,290	14.8 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense (at cost).....

2,019,688

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

27,547,185

Enter Medicare allowable costs of care relating to payments on line 5.....

116,970,019

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-89,422,834

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Beloit Memorial Hospital 1969 West Hart Road Beloit,WI53511	X	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:Beloit Memorial Hospital

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?10
Name and address		Type of Facility (Describe)
1	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
2	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
3	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
4	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
5	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
6	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
7	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
8	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
9	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
10	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic
11	Beloit Clinic 1905 E Huebbe Parkway Beloit,WI53511	Outpatient physician clinic

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
SchH_P01_S00_L06a	Schedule H, Part I, Line 6a	Each 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_L07	Schedule H, Part I, Line 7	Costing methodology used was the Ratio of Patient Care Cost to Charges with guidance from the IRS worksheets in the instructions
SchH_P01_S00_L072f	Schedule H, Part I, Line 7, Column f	Not applicable
SchH_P01_S00_L07g	Schedule H, Part I, Line 7g	Not applicable
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	The 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_L08	Schedule H, Part III, Section B, Line 8	Costing methodoloy used for Medicare allowable costs came directly off the 2010 Medicare Cost Report on Worksheet B per the IRS instructions
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	The 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_L02	Schedule H, Part VI, Line 2	There 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_L03	Schedule H, Part VI, Line 3	Information 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_L04	Schedule H, Part VI, Line 4	Beloit, 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_L05	Schedule H, Part VI, Line 5	The 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_L07	Schedule H, Part VI, Line 7	Wisconsin

Schedule H (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) Leo Egbujiobi MD	(i) (ii)	944,818 0	0 0	33,107 0	15,925 0	0 0	993,850 0	0 0
(2) Gregory K Britton	(i) (ii)	383,042 0	143,726 0	0 0	459,717 0	0 0	986,485 0	684,373 0
(3) Emmy Ho MD	(i) (ii)	846,588 0	0 0	0 0	15,925 0	0 0	862,513 0	0 0
(4) Paul Segal MD	(i) (ii)	789,041 0	0 0	0 0	15,925 0	0 0	804,966 0	0 0
(5) Tsu-Hon Wang MD	(i) (ii)	708,675 0	0 0	0 0	15,925 0	0 0	724,600 0	0 0
(6) Ajmal Matloob	(i) (ii)	615,392 0	0 0	0 0	15,925 0	0 0	631,317 0	0 0
(7) Glenn Tan MD	(i) (ii)	553,058 0	0 0	3,032 0	15,925 0	0 0	572,015 0	0 0
(8) Mario Rojas MD	(i) (ii)	511,532 0	0 0	0 0	15,925 0	0 0	527,457 0	0 0
(9) Russel Albert MD	(i) (ii)	353,808 0	0 0	7,683 0	15,925 0	0 0	377,416 0	0 0
(10) Tejesh Patel MD	(i) (ii)	330,696 0	0 0	24,000 0	15,925 0	0 0	370,621 0	0 0
(11) Timothy M McKevett	(i) (ii)	234,942 0	44,766 0	0 0	87,361 0	0 0	367,069 0	326,627 0
(12) Doris Mulder	(i) (ii)	175,461 0	33,421 0	0 0	96,030 0	0 0	304,912 0	258,464 0
(13) Bill Sullivan	(i) (ii)	251,346 0	0 0	0 0	15,925 0	0 0	267,271 0	0 0
(14) William Groeper	(i) (ii)	189,008 0	12,000 0	0 0	21,980 0	0 0	222,988 0	0 0
(15) Kristinn Armann	(i) (ii)	116,300 0	0 0	0 0	68,800 0	0 0	185,100 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SchJ_P01_S00_L04	Schedule J, Part I, Line 4	457(f) Plan Participants: Gregory K Britton and Doris Mulder - no payments received to date

Schedule J (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
BELOIT HEALTH SYSTEM INC

Employer identification number
39-1028081

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	Illinois Finance Authority			10-21-2010	37,895,000	Proceeds along with existing balances in the 2006A funds were used to refund the Series 2006A Bonds		X		X		X
B	Wisconsin Health and Educational Facilities Authority		97710BYF3	10-21-2010	32,470,000	Refund Series 2006B and refinance loans used for the acquisition of Beloit Clinic and ER renovations		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	0		0
2 Amount of bonds defeased . . . .	0		0
3 Total proceeds of issue . . . .	37,895,000		32,470,000
4 Gross proceeds in reserve funds . .	0		2,764,200
5 Capitalized interest from proceeds.	0		0
6 Proceeds in refunding escrow. . . . .	0		0
7 Issuance costs from proceeds . . .	255,032		510,859
8 Credit enhancement from proceeds.	0		0
9 Working capital expenditures from proceeds . .	0		0
10 Capital expenditures from proceeds . .	0		0
11 Other spent proceeds . .	0		0
12 Other unspent proceeds. . .	0		14,450
13 Year of substantial completion . . .	2007		2010
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?	X		X
15 Were the bonds issued as part of an advance refunding issue?		X		X
16 Has the final allocation of proceeds been made? . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?		X		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .	0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .	0 %		0 %
6 Total of lines 4 and 5 . . .. . . . . .	0 %		0 %
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X		X
2 Is the bond issue a variable rate issue?	X			X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?	X			X
b Name of provider .	Piper Jaffray
c Term of hedge . .	25.5
d Was the hedge superintegrated? .		X
e Was a hedge terminated? .		X
4a Were gross proceeds invested in a GIC? .		X		X
b Name of provider .
c Term of GIC . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .
5 Were any gross proceeds invested beyond an available temporary period? .		X		X
6 Did the bond issue qualify for an exception to rebate? . . .		X		X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2010

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) First National Bank & Trust Co	An entity with System Board Members serving as key employees and board members of interested party	0	Bank accounts and normal business banking		No
(2) Marshall & Ilsley Trust Co	An entity with a System board member serving as key employee of interested party	0	Trustee for Hospital Pension Plans		No
(3) Regal Beloit Corp	An entity with a System board member serving as CEO of interested party	0	Medical claims paid to Health System		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation
SchL_P04_S00_L00	Schedule L, Part IV	An 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.

Schedule L (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Identifier	Return Reference	Explanation
F990_P00_S00_L0B	Form 990, Header, Line B	The estimated amount of other compensation has been revised to reflect the discount rate and mortality table used for the December 31, 2010 disclosure report for the Retirement Benefit Restoration Agreement for Gregory K. Britton. This change affected the number originally reported for Gregory K. Britton on Part VII column F as well as Schedule J Part II column C.
F990_P06_S0A_L02	Form 990, Part VI, Section A, Line 2	There 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_L11a	Form 990, Part VI, Section B, Line 11a	Form 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_L12c	Form 990, Part VI, Section B, Line 12c	It 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_L15	Form 990, Part VI, Section B, Line 15	The 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_L19	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 major categories: 1) Board Independence and Leadership 2) Board Processes and Evaluation and 3) Board structure
F990_P11_S00_L05	Form 990, Part XI, Line 5	Change 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).

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:	10000077
Software Version:	v1.00

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

BELOIT HEALTH SYSTEM INC

Employer identification number

39-1028081

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Beloit Health System Foundation Inc 1969 West Hart Road Beloit,WI53511 39-1477854	Support Beloit Health System	WI	501(c)(3)	3	N/A
(2) Beloit Memorial Hospital Auxiliary Inc 1969 West Hart Road Beloit,WI53511 39-0928583	Support Beloit Health System	WI	501(c)(3)	3	N/A

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) Beloit Health System Foundation Inc	c	509,112	Actual cash received from Beloit Health System Foundation
(2) Beloit Health System Foundation Inc	o	81,693	Actual expenses incurred by Beloit Health System Foundation and paid by Beloit Health System
(3) Beloit Health System Foundation Inc	m	0	Beloit Health System Foundation uses office space at Beloit Health System. No amount of consideration is received
(4) Beloit Memorial Hospital Auxiliary Inc	m	0	Beloit Memorial Hospital Auxiliary uses office space of Beloit Health System. No amount of consideration is received
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:	10000077
Software Version:	v1.00

1	Briefly describe the organization’s mission or most significant activities: The 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.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	5
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	1,639
6	Total number of volunteers (estimate if necessary) ....	6	425
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	289,041
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	289,041

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	120,322,003	177,222,838
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	843,226	817,049
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,799,273	4,496,063
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	124,964,502	182,535,950
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	65,903,761	107,711,789
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	53,481,161	67,559,452
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	119,384,922	175,271,241
19	Revenue less expenses. Subtract line 18 from line 12......	5,579,580	7,264,709
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	175,759,691	191,593,671
21	Total liabilities (Part X, line 26)............	107,362,883	113,912,312
22	Net assets or fund balances. Subtract line 21 from line 20 .....	68,396,808	77,681,359

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	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 44,442,445 including grants of $ ) (Revenue $ 54,908,370 )
	Inpatient 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 18,233

4b	(Code: ) (Expenses $ 98,459,309 including grants of $ ) (Revenue $ 122,025,426 )
	Outpatient 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.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses$ 142,901,754

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) Kristinn Armann Vice President of Human Relations	40	X		116,300	0	68,800
(19) Emmy Ho MD Physician	40		X	846,588	0	15,925
(20) Paul Segal MD Physician	40		X	789,041	0	15,925
(21) Tsu-Hon Wang MD Physician	40		X	708,675	0	15,925
(22) Ajmal Matloob Physician	40		X	615,392	0	15,925
(23) Glenn Tan MD Physician	40		X	556,090	0	15,925

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,437,444	0	909,956

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			0
			Business Code
2a	Outpatient Service Revenue		622,000	122,025,427	122,025,427	0	0
b	Inpatient Service Revenue		622,000	54,908,370	54,908,370	0	0
c	Third Party Administration		524,292	289,041	0	289,041	0
d
e
f	All other program service revenue .			0	0	0	0
g	Total. Add lines 2a–2f........			177,222,838
3	Investment income (including dividends, interest
	and other similar amounts).....			812,049	0	0	812,049
4	Income from investment of tax-exempt bond proceeds..			0	0	0	0
5	Royalties............			0	0	0	0
		(i) Real	(ii) Personal
6a	Gross Rents	284,982	0
b	Less: rental expenses	0	0
c	Rental income or (loss)	284,982	0
d	Net rental income or (loss).......			284,982	0	0	284,982
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	0	5,000
b	Less: cost or other basis and sales expenses	0	0
c	Gain or (loss)	0	5,000
d	Net gain or (loss)..........			5,000	0	0	5,000
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	Wellness Center & Spa Revenue		622,000	2,812,778	0	0	2,812,778
b	Cafeteria & Snack Shop Revenue		622,000	544,497	0	0	544,497
c	Physician Billing		622,000	176,016	0	0	176,016
d	All other revenue ....			677,790	0	0	677,790
e	Total. Add lines 11a–11d ......			4,211,081
12	Total revenue. See Instructions....			182,535,950	176,933,797	289,041	5,313,112


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			6,935	1	9,035
2	Savings and temporary cash investments .......			11,551,634	2	15,808,573
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			12,669,481	4	25,058,445
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			642,519	7	812,752
8	Inventories for sale or use ..............			2,054,723	8	2,432,468
9	Prepaid expenses and deferred charges ............			2,869,657	9	2,113,888
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	185,446,369
b	Less: accumulated depreciation. .....	10b	83,728,429	86,093,095	10c	101,717,940
11	Investments—publicly traded securities ..........			31,526,014	11	32,884,646
12	Investments—other securities. See Part IV, line 11 ......				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14	3,580,000
15	Other assets. See Part IV, line 11 ...........			28,345,633	15	7,175,924
16	Total assets. Add lines 1 through 15 (must equal line 34)...			175,759,691	16	191,593,671
17	Accounts payable and accrued expenses .			11,856,617	17	19,770,232
18	Grants payable ..........				18
19	Deferred revenue ..........			2,283,635	19	3,245,545
20	Tax-exempt bond liabilities ..........			49,465,000	20	70,365,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			22,966,841	23	2,387,255
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			20,790,790	25	18,144,280
26	Total liabilities. Add lines 17 through 25.....			107,362,883	26	113,912,312
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			68,396,808	27	77,681,359
28	Temporarily restricted net assets .....			0	28	0
29	Permanently restricted net assets .....			0	29	0
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			68,396,808	33	77,681,359
34	Total liabilities and net assets/fund balances .....			175,759,691	34	191,593,671