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        <BusinessNameLine1>BELOIT MEMORIAL HOSPITAL AUXILIARY INC</BusinessNameLine1>
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        <AddressLine1>1969 West Hart Road</AddressLine1>
        <City>Beloit</City>
        <State>WI</State>
        <ZIPCode>53511</ZIPCode>
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      <Name>Marietta Axmear</Name>
      <Title>President</Title>
      <Phone>6083645102</Phone>
      <DateSigned>2011-07-15</DateSigned>
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    <BuildTS>2016-02-24 21:20:13Z</BuildTS>
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    </IRS990ScheduleA>
    <IRS990ScheduleO documentId="R000003" softwareId="10000077" softwareVersion="v1.00">
      <GeneralExplanation>
        <Identifier>F990_P06_S0B_L11a</Identifier>
        <ReturnReference>Form 990, Part VI, Section B, Line 11a</ReturnReference>
        <Explanation>The Auxiliary's financial statements are compiled by an independent accounting firm. An employee of the Hospital's accounting staff prepares the Auxiliary's Form 990 from those compiled statements. When the 990 is completed, a draft copy of the return is given to the Auxiliary's Executive Committee for review at a regularly scheduled board meeting.</Explanation>
      </GeneralExplanation>
      <GeneralExplanation>
        <Identifier>F990_P06_S0C_L19</Identifier>
        <ReturnReference>Form 990, Part VI, Section C, Line 19</ReturnReference>
        <Explanation>Statements, documents, and policies are available upon request at the address of the Beloit Memorial Hospital</Explanation>
      </GeneralExplanation>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="R000004" softwareId="10000077" softwareVersion="v1.00">
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>Beloit Memorial Hospital Inc</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1969 West Hart Road</AddressLine1>
          <City>Beloit</City>
          <State>WI</State>
          <ZIPCode>53511</ZIPCode>
        </AddressUS>
        <EIN>391028081</EIN>
        <PrimaryActivities>Hospital</PrimaryActivities>
        <LegalDomicileState>WI</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>3</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartII>
      <Form990ScheduleRPartII>
        <NameOfDisregardedEntity>
          <BusinessNameLine1>Beloit Health System Foundation Inc</BusinessNameLine1>
        </NameOfDisregardedEntity>
        <AddressUS>
          <AddressLine1>1969 West Hart Road</AddressLine1>
          <City>Beloit</City>
          <State>WI</State>
          <ZIPCode>53511</ZIPCode>
        </AddressUS>
        <EIN>391477854</EIN>
        <PrimaryActivities>Support of Hospital</PrimaryActivities>
        <LegalDomicileState>WI</LegalDomicileState>
        <ExemptCodeSection>501(c)(3)</ExemptCodeSection>
        <PublicCharityStatus>3</PublicCharityStatus>
        <DirectControllingEntityNA>N/A</DirectControllingEntityNA>
        <ControlledOrg>0</ControlledOrg>
      </Form990ScheduleRPartII>
      <ReceiptOfIntAnnRentsRoyalties>0</ReceiptOfIntAnnRentsRoyalties>
      <GiftGrantOrCapContrToOtherOrg>1</GiftGrantOrCapContrToOtherOrg>
      <GiftGrantOrCapContrFrOtherOrg>0</GiftGrantOrCapContrFrOtherOrg>
      <LoansOrGuaranteesToOtherOrg>0</LoansOrGuaranteesToOtherOrg>
      <LoansOrGuaranteesFromOtherOrg>0</LoansOrGuaranteesFromOtherOrg>
      <SaleOfAssetsToOtherOrg>0</SaleOfAssetsToOtherOrg>
      <PurchaseOfAssetsFromOtherOrg>0</PurchaseOfAssetsFromOtherOrg>
      <ExchangeOfAssets>0</ExchangeOfAssets>
      <RentalOfFacilitiesToOtherOrgs>0</RentalOfFacilitiesToOtherOrgs>
      <RentalOfFacilitiesFrOtherOrgs>0</RentalOfFacilitiesFrOtherOrgs>
      <PerformOfServicesForOtherOrgs>0</PerformOfServicesForOtherOrgs>
      <PerformOfServicesByOtherOrgs>0</PerformOfServicesByOtherOrgs>
      <SharingOfFacilities>1</SharingOfFacilities>
      <SharingOfPaidEmployees>1</SharingOfPaidEmployees>
      <ReimbursementPaidToOtherOrg>0</ReimbursementPaidToOtherOrg>
      <ReimbursementPaidByOtherOrg>0</ReimbursementPaidByOtherOrg>
      <OtherTransferToOtherOrg>0</OtherTransferToOtherOrg>
      <OtherTransferFromOtherOrg>0</OtherTransferFromOtherOrg>
      <TransactionsRelatedOrgsTable>
        <NameOfOtherOrganization>
          <BusinessNameLine1>Beloit Health System Foundation Inc</BusinessNameLine1>
        </NameOfOtherOrganization>
        <TransactionType>b</TransactionType>
        <AmountInvolved>85000</AmountInvolved>
        <MethodOfAmtDetermination>Actual cash contributed to Beloit Health System Foundation</MethodOfAmtDetermination>
      </TransactionsRelatedOrgsTable>
    </IRS990ScheduleR>
  </ReturnData>
</Return>