BELOIT HEALTH SYSTEM AUXILIARY INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BELOIT HEALTH SYSTEM AUXILIARY INC (EIN 39-0928583)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-10
- IRS object ID
- 202003169349305550
- Schema version
- 2019v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-10T12:38:26-07:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390928583 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELOIT HEALTH SYSTEM AUXILIARY INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BELO | BusinessNameControlTxt |
| Phone | 6083645162 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1969 West Hart Road | AddressLine1Txt |
| City | Beloit | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53511 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Richard Johnson | PersonNm |
| Person Title | Vice President | PersonTitleTxt |
| Phone | 6083645162 | PhoneNum |
| Signature | 2020-11-11 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 24.240.147.5 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Richard Johnson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1969 West Hart Road | AddressLine1Txt |
| City | Beloit | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53511 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $189,928 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1954 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | Providing support to Beloit Health System and related Foundation | ActivityOrMissionDesc |
| Voting Members Governing Body | 4 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 250 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $500 | PYContributionsGrantsAmt |
| CY Contributions Grants | $875 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $83,863 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,881 | CYProgramServiceRevenueAmt |
| PY Investment Income | $56 | PYInvestmentIncomeAmt |
| CY Investment Income | $1 | CYInvestmentIncomeAmt |
| PY Other Revenue | $73,392 | PYOtherRevenueAmt |
| CY Other Revenue | $69,627 | CYOtherRevenueAmt |
| PY Total Revenue | $157,811 | PYTotalRevenueAmt |
| CY Total Revenue | $86,384 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $55,590 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $232,517 | PYOtherExpensesAmt |
| CY Other Expenses | $109,319 | CYOtherExpensesAmt |
| PY Total Expenses | $232,517 | PYTotalExpensesAmt |
| CY Total Expenses | $109,319 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$74,706 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$22,935 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $160,472 | TotalAssetsBOYAmt |
| Total Assets EOY | $137,383 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,515 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,361 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $158,957 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $136,022 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Providing support to Beloit Health System and related Foundation | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $40,275 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $78,793 | RevenueAmt |
| Desc | Gifts to Beloit Health System: Based on income generated from the Gift Shop and various small fundraising events, the Auxiliary is able to donate money to the Beloit Health System Foundation, whose main goal is to support the Beloit Health System. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $10,500 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $7,591 | RevenueAmt |
| Desc | Scholarships: Through tips received as the Hospital Snack Shop and other small contributions, the Auxiliary is able to award scholarships to graduating seniors within the community of Beloit, WI | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $0 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $0 | TotalOtherProgSrvcGrantAmt |
| Total Other Prog Srvc Revenue | $0 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $50,775 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (1) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 4 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | 0 | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | 0 | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beloit Health System Auxiliary Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6083645162 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1969 West Hart Road | AddressLine1Txt |
| City | Beloit | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53511 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (4 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| Chuck Ramsden | |||||||
| President | 0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Richard Johnson | |||||||
| Vice President | 0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Bonnie Pody | |||||||
| Secretary | 0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Doug Johnson | |||||||
| Treasurer | 0 | 0 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Federated Campaigns | $0 | FederatedCampaignsAmt |
| Membership Dues | $875 | MembershipDuesAmt |
| Fundraising | $0 | FundraisingAmt |
| Related Organizations | $0 | RelatedOrganizationsAmt |
| Government Grants | $0 | GovernmentGrantsAmt |
| All Other Contributions | $0 | AllOtherContributionsAmt |
| Noncash Contributions | $0 | NoncashContributionsAmt |
| Total Contributions | $875 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt | ExclusionExclusionAmt |
|---|---|---|---|---|---|
| Love Light Event | 900099 | $8,290 | $8,290 | $0 | $0 |
| Patient Services | 900099 | $7,591 | $7,591 | $0 | $0 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,881 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $13,019 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $0 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,019 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $13,019 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $160,152 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $103,544 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $56,608 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $56,608 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $86,384 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,881 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $69,628 | ExclusionAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,864 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $1,864 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,090 | TotalAmt |
| Program Services | $0 | ProgramServicesAmt |
| Management And General | $1,090 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Giftshop Expenses | $55,590 | $0 | $0 | $55,590 |
| Scholarships | $10,500 | $10,500 | $0 | $0 |
| Distributions to Foundation | $40,275 | $40,275 | $0 | $0 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,319 | TotalAmt |
| Program Services | $50,775 | ProgramServicesAmt |
| Management And General | $2,954 | ManagementAndGeneralAmt |
| Fundraising | $55,590 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,325 | BOYAmt |
| EOY | $58,474 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,147 | BOYAmt |
| EOY | $78,909 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,472 | BOYAmt |
| EOY | $137,383 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,515 | BOYAmt |
| EOY | $1,361 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,515 | BOYAmt |
| EOY | $1,361 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,957 | BOYAmt |
| EOY | $136,022 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,957 | BOYAmt |
| EOY | $136,022 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $160,472 | BOYAmt |
| EOY | $137,383 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$22,935 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $0 | NetUnrlzdGainsLossesInvstAmt |
| Donated Services And Use Fclts | $0 | DonatedServicesAndUseFcltsAmt |
| Investment Expense | $0 | InvestmentExpenseAmt |
| Prior Period Adjustments | $0 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Other | Yes (X) | MethodOfAccountingOtherInd |
| Accountant Compile Or Review | Yes (1) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 0 | FSAuditedInd |
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Non Func | Yes (X) | SupportingOrgType3NonFuncInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beloit Health System Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391028081 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $40,275 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $40,275 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | 0 | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | 0 | SupportedOrgVoiceInvestmentInd |
Adjusted Net Income AdjustedNetIncomeGrp
Net ST Capital Gain Adj Net Incm NetSTCapitalGainAdjNetIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Recoveries PY Distributions RecoveriesPYDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Other Gross Income OtherGrossIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $157,811 | PriorYearAmt |
| Current Year | $86,384 | CurrentYearAmt |
Adjusted Gross Income AdjustedGrossIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $157,811 | PriorYearAmt |
| Current Year | $86,384 | CurrentYearAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Production Income ProductionIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $2,754 | PriorYearAmt |
| Current Year | $2,954 | CurrentYearAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $155,973 | PriorYearAmt |
| Current Year | $55,590 | CurrentYearAmt |
Total Adjusted Net Income TotalAdjustedNetIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | -$916 | PriorYearAmt |
| Current Year | $27,840 | CurrentYearAmt |
Minimum Asset Amount MinimumAssetAmountGrp
Average Monthly FMV Of Sec AverageMonthlyFMVOfSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Average Monthly Cash Balances AverageMonthlyCashBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $6,443 | PriorYearAmt |
| Current Year | $5,658 | CurrentYearAmt |
FMV Other Non Exempt Use Asset FMVOtherNonExemptUseAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Total FMV Of Non Exempt Use Asset TotalFMVOfNonExemptUseAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $6,443 | PriorYearAmt |
| Current Year | $5,658 | CurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Discount Claimed | $0 | DiscountClaimedAmt |
Acquisition Indebtedness AcquisitionIndebtednessGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Adjusted FMV Less Indebtedness AdjustedFMVLessIndebtednessGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $6,443 | PriorYearAmt |
| Current Year | $5,658 | CurrentYearAmt |
Cash Deemed Charitable CashDeemedCharitableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $96 | PriorYearAmt |
| Current Year | $84 | CurrentYearAmt |
Net Vl Non Exempt Use Assets NetVlNonExemptUseAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $6,347 | PriorYearAmt |
| Current Year | $5,574 | CurrentYearAmt |
Pct Of Net Vl Non Exempt Use Ast PctOfNetVlNonExemptUseAstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $222 | PriorYearAmt |
| Current Year | $195 | CurrentYearAmt |
Recoveries PY Distri Min Asset RecoveriesPYDistriMinAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Total Minimum Asset TotalMinimumAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $222 | PriorYearAmt |
| Current Year | $195 | CurrentYearAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Adj Net Income Distributable | -$916 | CYAdjNetIncomeDistributableAmt |
| CY Pct85 Adjusted Net Income | -$778 | CYPct85AdjustedNetIncomeAmt |
| CY Total Min Ast Distributable | $222 | CYTotalMinAstDistributableAmt |
| CY Greater Adjusted Minimum | $222 | CYGreaterAdjustedMinimumAmt |
| CY Income Tax Imposed PY | $0 | CYIncomeTaxImposedPYAmt |
| CY Distributable As Adjusted | $222 | CYDistributableAsAdjustedAmt |
Distributions DistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Paid Accomplish Exempt Prps | $40,275 | CYPaidAccomplishExemptPrpsAmt |
| CY Pd In Excess Income Activity | $0 | CYPdInExcessIncomeActivityAmt |
| CY Administrative Expense Paid | $58,544 | CYAdministrativeExpensePaidAmt |
| Exempt Use Assets Acquis Paid | $0 | ExemptUseAssetsAcquisPaidAmt |
| Qualified Set Aside | $0 | QualifiedSetAsideAmt |
| CY Other Distributions | $0 | CYOtherDistributionsAmt |
| CY Total Annual Distributions | $98,819 | CYTotalAnnualDistributionsAmt |
| CY Distri Attentive Suprt Org | $40,275 | CYDistriAttentiveSuprtOrgAmt |
| CY Distributable As Adjusted | $222 | CYDistributableAsAdjustedAmt |
| CY Distribution Yr | 181.419 | CYDistributionYrRt |
Distribution Allocations DistributionAllocationsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Distributable As Adjusted | $222 | CYDistributableAsAdjustedAmt |
| Underdistributions | $0 | UnderdistributionsAmt |
| Excess Distribution Cyov Yr5 | $0 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $0 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $0 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $0 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $210,734 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $210,734 | TotalExcessDistributionCyovAmt |
| Cyov Applied Underdistri PY | $0 | CyovAppliedUnderdistriPYAmt |
| Cyov Applied Underdistr CPY | $0 | CyovAppliedUnderdistrCPYAmt |
| Carryover PY Not Applied | $0 | CarryoverPYNotAppliedAmt |
| Excess Distribution Cyov | $210,734 | ExcessDistributionCyovAmt |
| CY Total Annual Distributions | $98,819 | CYTotalAnnualDistributionsAmt |
| CY Distrib App Underdistri PY | $0 | CYDistribAppUnderdistriPYAmt |
| CY Distri App Distributable | $222 | CYDistriAppDistributableAmt |
| Excess Distribution | $98,597 | ExcessDistributionAmt |
| Remaining Underdistri PY | $0 | RemainingUnderdistriPYAmt |
| Remaining Underdistri CY | $0 | RemainingUnderdistriCYAmt |
| Excess Distri Cyov To Next Yr | $309,331 | ExcessDistriCyovToNextYrAmt |
| Excess From Year5 | $0 | ExcessFromYear5Amt |
| Excess From Year4 | $0 | ExcessFromYear4Amt |
| Excess From Year3 | $0 | ExcessFromYear3Amt |
| Excess From Year2 | $210,734 | ExcessFromYear2Amt |
| Excess From Year1 | $98,597 | ExcessFromYear1Amt |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part IV, Section D, Line 2 | FormAndLineReferenceDesc |
| Explanation | Beloit Health System Auxiliary nominates is own Executive Committee. Beloit Health System (supported organization) supervises the activities and financial results of the Auxiliary, thereby maintaining a close and working relationship. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, Line 11b | The Auxiliary's financial statements are reviewed and compiled by an independent accounting firm. An employee of Beloit Health System's accounting staff prepares the Auxiliary's Form 990 from those compiled statements. When Form 990 is completed, a draft copy of the return is given to the Auxiliary's Executive Committee for review at a regularly scheduled meeting. |
| Form 990, Part VI, Section C, Line 19 | Statements, documents, and policies are available upon request as the address of Beloit Health System. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Beloit Health System Inc | ||||||||||
| 1969 West Hart Road | Beloit | WI | 53511 | 391028081 | Hospital | WI | 501(c)(3) | 3 | N/A | 0 |
| Beloit Health System Foundation Inc | ||||||||||
| 1969 West Hart Road | Beloit | WI | 53511 | 391477854 | Support of Hospital | WI | 501(c)(3) | 3 | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Beloit Health System Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | b | TransactionTypeTxt |
| Involved | $40,275 | InvolvedAmt |
| Method Of Amount Determination | Actual cash distributed to Beloit Health System Foundation | MethodOfAmountDeterminationTxt |