Form 990 for tax year 2022

Filed by BELOIT HEALTH SYSTEM FOUNDATION INC.

Totals

Total revenue: $627,826
Total expenses: $1,894,100
Contributions and grants received: $627,826
Grants paid: $0
Program service revenue: $0
Investment income: $0
Other revenue: $0
Total assets, end of year: $13,017,027
Total liabilities, end of year: $93,456
Net assets or fund balances, end of year: $12,923,571
Program services expenses (Part IX): $1,471,769
Management and general expenses: $4,656
Fundraising expenses: $417,675
Program service expenses (Part III): $1,471,769

Program services were 77.7% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

1a · Federated campaigns

$0
1b · Membership dues

$0
1c · Fundraising events

$246,126
1d · Related organizations

$0
1e · Government grants (contributions)

$0
1f · All other contributions, gifts and grants

$381,700
1g · Noncash contributions included above

$0
3 · Investment income

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
4 · Income from investment of tax-exempt bond proceeds

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
5 · Royalties

total $0 · related or exempt $0 · unrelated business $0 · excluded $0
6c · Rental income or loss

real property $0 · personal property $0
7c · Gain or loss

securities $0 · other assets $0
8a · Fundraising events: contributions included on line 1c

$246,126
11e · Other revenue, total

$0

Functional expenses

Part IX, the statement of functional expenses.

11f · Fees: investment management

total $30,077 · fundraising $30,077
11g · Fees: other

total $93,684 · fundraising $93,684
12 · Advertising and promotion

total $42,911 · fundraising $42,911
13 · Office expenses

total $39,142 · fundraising $39,142
19 · Conferences, conventions and meetings

total $760 · fundraising $760
24a · Other expenses: Membership and Licenses

total $544 · program services $0 · management and general $0 · fundraising $544
24b · Other expenses: Life Insurance

total $4,656 · program services $0 · management and general $4,656 · fundraising $0
24c · Other expenses: Distribution to Health System

total $1,471,769 · program services $1,471,769 · management and general $0 · fundraising $0
24e · All other expenses

total $210,557 · fundraising $210,557

Balance sheet

Part X, book values.

2 · Savings and temporary cash investments

beginning of year $1,868,829 · end of year $792,106
3 · Pledges and grants receivable

beginning of year $1,603,475 · end of year $1,128,672
10c · Land, buildings and equipment, net

beginning of year $0
11 · Investments: publicly traded securities

beginning of year $12,075,431 · end of year $10,345,548
15 · Other assets

beginning of year $765,674 · end of year $750,701
17 · Accounts payable and accrued expenses

beginning of year $48,168 · end of year $93,456
25 · Other liabilities

beginning of year $0 · end of year $0
27 · Net assets without donor restrictions

beginning of year $6,466,132 · end of year $4,459,414
28 · Net assets with donor restrictions

beginning of year $9,799,109 · end of year $8,464,157

Mission and programs · 2022

Mission

The mission of Beloit Health System Foundation, Inc. is the development, management and distribution of gifts to assist Beloit Health System in providing excellence in health care for the Stateline area.

Distributions to Beloit Health System

Expenses $1,471,769 · Grants $1,471,769

As filed on the 2022 return.

Listed in Part VII

Timothy McKevett

Board Member

Total calculated

$1,562,021

From this org

$0

From related orgs

$1,618,088

Other

-$56,067

Hours/week

0 + 40 related

Schedule J breakdown matched by us

Base

$0 + $632,922 related

Bonus

$0 + $506,650 related

Other

$0 + $478,516 related

Deferred

$0 + -$56,067 related

Nontaxable benefits

$0

Filer's total

$0 + $1,562,021 related
Nicole Kovarik

Board Member

Total calculated

$171,982

From this org

$0

From related orgs

$166,787

Other

$5,195

Hours/week

0 + 40 related

Schedule J breakdown matched by us

Base

$0 + $160,064 related

Bonus

$0 + $6,723 related

Other

$0

Deferred

$0 + $10,814 related

Nontaxable benefits

$0

Filer's total

$0 + $177,601 related
Tami Scarpetta

Executive Director / Board Member

Total calculated

$137,145

From this org

$0

From related orgs

$128,675

Other

$8,470

Hours/week

0 + 40 related
Doris Mulder

Board Member

Total calculated

$24,033

From this org

$0

From related orgs

$24,033

Other

$0

Hours/week

0 + 10 related
Mark Leach

Chairman

Total calculated

$0

Hours/week

0
Derek Hahn

Vice Chairman

Total calculated

$0

Hours/week

0
Keith Kruse

Treasurer

Total calculated

$0

Hours/week

0
Kim Loerke

Secretary

Total calculated

$0

Hours/week

0
Gary Adamski

Board Member

Total calculated

$0

Hours/week

0
John Bottorff

Board Member

Total calculated

$0

Hours/week

0
Kayla K Hiller

Board Member

Total calculated

$0

Hours/week

0
Mike Marquette

Board Member

Total calculated

$0

Hours/week

0
Stephanie Knueppel

Board Member

Total calculated

$0

Hours/week

0
Todd James

Board Member

Total calculated

$0

Hours/week

0

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

4b · Supplemental nonqualified retirement plan

Answered no

4a · Severance or change-of-control payment
4c · Equity-based compensation arrangement
5a · Pay contingent on this organization's revenues
5b · Pay contingent on a related organization's revenues
6a · Pay contingent on this organization's net earnings
6b · Pay contingent on a related organization's net earnings
7 · Other non-fixed payments
8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Schedule J, Part I, Line 3: Compensation for the Executive Director is paid through Beloit Health System and is determined and approved by a small committee within the Board of Directors. The committee is called the Compensation and Evaluation Committee.
Schedule J, Part I, Line 4: 409(a) Plan Participant is Timothy McKevett. $478,516 was received in 2022

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Beloit Health System Inc

501(c)(3) · Provide medical care to patients · WI
Beloit Memorial Hospital Auxiliary Inc

501(c)(3) · To provide support to Beloit Health System · WI

Provenance

Return type: form_990
Tax year: 2022
Filed: 18 May 2023
IRS schema version: 2022v5.0
Source object: 202311399349301351

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