TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) EUGENE FEINGOLD...................................................................... CHAIRMAN OF THE BOARD	1.0 ................. 3.0	X	X	0	0
(2) RICHARD KING...................................................................... BOARD MEMBER, SECRETARY	1.0 ................. 2.0	X	X	0	0
(3) DENNIS IRVIN...................................................................... BOARD MEMBER, VICE CHAIRMAN	1.0 ................. 2.0	X	X	0	0
(4) MICHAEL HICKS...................................................................... COO/BOARD MEMBER	40.0 ................. 0.0	X	X	600,239	37,710
(5) KURT JOHNSON...................................................................... PRESIDENT & CEO/BOARD MEMBER	40.0 ................. 4.0	X	X	1,470,732	45,265
(6) KATHLEEN MIKOS...................................................................... CHIEF NURSING/BOARD MEMBER	40.0 ................. 0.0	X	X	470,769	28,367
(7) STEVEN ANDERSON...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0
(8) RICHARD ANDERSON...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0
(9) LYNDELL BECKHAM...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0
(10) SAMUEL CUTRARA JR...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0
(11) HEATHER DAVIS...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0
(12) ROBERT HARRIS...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0
(13) JERRY ITKONEN MD...................................................................... BOARD MEMBER	0.0 ................. 0.0	X		0	0
(14) HENRY JOHNSON...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0
(15) TIMOTHY JOHNSON...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0
(16) CARL JOHNSON II MD...................................................................... BOARD MEMBER	1.0 ................. 0.0	X		0	0
(17) MICHAEL KAMRADT...................................................................... BOARD MEMBER	1.0 ................. 1.0	X		0	0

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(18) NEAL KITCHELL........................................................................ BOARD MEMBER	1.0 .......................1.0	X			0	0	0
(19) MARK KOZLOFF MD........................................................................ PHYSICIAN/BOARD MEMBER	1.0 .......................42.0	X			0	588,659	20,393
(20) DAVID ORTH MD........................................................................ BOARD MEMBER	1.0 .......................2.0	X			0	0	0
(21) CRESSA PERISH MD........................................................................ BOARD MEMBER	1.0 .......................0.0	X			0	0	0
(22) KEVIN PURCELL........................................................................ BOARD MEMBER	1.0 .......................1.0	X			0	0	0
(23) NATHANIEL SUTTON........................................................................ BOARD MEMBER	1.0 .......................1.0	X			0	0	0
(24) MICHAEL DEVORE........................................................................ CHIEF INFORMATION OFFICER	40.0 .......................0.0		X		264,320	0	28,283
(25) PAUL DONOHUE........................................................................ VP PHILANTHROPY AND COMMUNITY	40.0 .......................0.0		X		90,980	0	13,902
(26) DIANE JACOBY........................................................................ ASSISTANT SECRETARY, VP	40.0 .......................2.0		X		574,185	0	44,667
(27) DEBORAH NELSON........................................................................ VICE PRESIDENT/COO MEDCENTRIX	40.0 .......................0.0		X		85,331	0	19,966
(28) TAMARA PROFIRIO........................................................................ VICE PRESIDENT/COO MEDCENTRIX	40.0 .......................0.0		X		240,938	0	17,170
(29) ALETHA ROSS........................................................................ VICE PRESIDENT OF HR	40.0 .......................0.0		X		323,419	0	27,195
(30) ANDREW STEFO........................................................................ VP - FINANCE/CFO	40.0 .......................1.0		X		630,796	0	24,263
(31) SCOTT STRAUSSER........................................................................ VP - BUSINESS DEVELOPMENT	40.0 .......................0.0		X		514,396	0	20,546
(32) LINDA CONWAY........................................................................ ASSOCIATE GENERAL COUNSEL	40.0 .......................0.0			X	217,213	0	7,236
(33) MARY JO CRANDALL........................................................................ LEAN FACILITATOR	40.0 .......................0.0			X	211,746	0	5,860
(34) LAWRENCE KLONOWSKI........................................................................ MANAGER MEDICAL PHYSICS	40.0 .......................0.0			X	206,546	0	33,267
(35) LYNN PHILIPSON........................................................................ DIRECTOR OF MANAGED CARE	40.0 .......................0.0			X	199,379	0	6,501
(36) HEIDI RUHE........................................................................ ASSOC VP BUSINESS DEVELOPMENT	40.0 .......................0.0			X	198,575	0	40,014

(A) Name and business address	(B) Description of services	(C) Compensation
ARAMARK CORPORATION, 25271 NETWORK PLACE CHICAGO,IL60673	CONTRACT FOOD, PLANT	22,356,227
SYNERGY BEHAVIORAL HEALTHCARE, 1566 W ALGONQUIN ROAD 3149 HOFFMAN ESTATES,IL60192	IN PT AND OUT PT PSY	4,881,100
CERNER HEALTH SERVICES, C/O US BANK PO BOX 959167 ST LOUIS,MO63195	IT SUPPORT	4,791,070
REED CONSTRUCTION, 600 W JACKSON BLVD STE 500 CHICAGO,IL606615625	CONSTRUCTION COMPANY	4,393,859
JAMERSON BAUWENS, 3160 MCCARTHUR BLVD NORTHBROOK,IL60062	MED ELECTRIC INSTALL	1,532,861
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 197

- 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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

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 described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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. See section 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 in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. If the organization did not check a 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—2015. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. 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 VI 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) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization THE INGALLS MEMORIAL HOSPITAL

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 3

Name of organization THE INGALLS MEMORIAL HOSPITAL		Employer identification number 36-2170866

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Page 4


Name of organization THE INGALLS MEMORIAL HOSPITAL			Employer identification number 36-2170866
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2015

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

44,908

Total. Add lines 1c through 1i ....................................................................................................

44,908

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1I	THE HOSPITAL PAYS DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE USED TO SUPPORT LOBBYING BY THE ASSOCIATION FOCUSED ON ADVOCACY AND REPRESENTATION.

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

Part I

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

			(a) Donor advised funds	(b) Funds and other accounts

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of 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 can 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" on 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 education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 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, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, 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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), 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)

Revenue included on 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 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

Using the organization’s acquisition, 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 XIII.

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" on 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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
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, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" on 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	Net investment earnings, gains, and 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 current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

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

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land ...	416,863		416,863
b	Buildings	293,960,391	153,872,722	140,087,669
c	Leasehold improvements	12,211,665	10,762,484	1,449,181
d	Equipment ...	206,810,443	175,082,167	31,728,276
e	Other ...	21,650,350		21,650,350
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				195,332,339

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
TENDER PREMIUM PAYABLE (SWAP)	13,001,339
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	13,001,339
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	291,232,906
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-3,251,991
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-2,394,157
e	Add lines 2a through 2d .....................			2e	-5,646,148
3	Subtract line 2e from line 1..................			3	296,879,054
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	818,224
b	Other (Describe in Part XIII.) ...........	4b	-777,499
c	Add lines 4a and 4b....................			4c	40,725
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	296,919,779

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	317,327,309
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	777,499
e	Add lines 2a through 2d....................			2e	777,499
3	Subtract line 2e from line 1...................			3	316,549,810
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	818,224
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	818,224
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	317,368,034

Part XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART X, LINE 2	THE HEALTH SYSTEM APPLIES THE PROVISIONS OF ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S FINANCIAL STATEMENTS. ASC 740 PRESCRIBES A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN. UNDER ASC 740, TAX POSITIONS ARE EVALUATED FOR RECOGNITION, DERECOGNITION, AND MEASUREMENT USING CONSISTENT CRITERIA AND PROVIDE MORE INFORMATION ABOUT THE UNCERTAINTY IN INCOME TAX ASSETS AND LIABILITIES. AS OF SEPTEMBER 30, 2016, THE HOSPITAL DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE CODE.
SCHEDULE D, PART XI, LINE 2D	INTEREST RATE SWAP VALUATION (2,394,157)
SCHEDULE D, PART XI, LINE 4B	RECLASS OF RENTAL EXPENSE (777,499)
SCHEDULE D, PART XII, LINE 2D	RECLASS OF RENTAL EXPENSE 777,499

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did 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.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	6,165,171		6,165,171	1.940 %
b	Medicaid (from Worksheet 3, column a) . . . . .	81,365,357	53,986,742	27,378,615	8.630 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	87,530,528	53,986,742	33,543,786	10.570 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	654,421		654,421	0.210 %
f	Health professions education (from Worksheet 5) . . .	583,323	238,620	344,703	0.110 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	268,163		268,163	0.080 %
j	Total. Other Benefits . .	1,505,907	238,620	1,267,287	0.400 %
k	Total. Add lines 7d and 7j .	89,036,435	54,225,362	34,811,073	10.970 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(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

Did 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. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,773,224

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

1,266,593

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

102,663,068

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

126,429,678

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

-23,766,610

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

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(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) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	INGALLS MEMORIAL HOSPITAL ONE INGALLS DRIVE HARVEY,IL60426 WWW.INGALLS.ORG 0001099	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	INGALLS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): INGALLS.HEALTHFORECAST.NET

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): INGALLS.HEALTHFORECAST.NET

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	INGALLS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 0.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

(SEE STATEMENT)

The FAP application form was widely available on a website (list url):

(SEE STATEMENT)

A plain language summary of the FAP was widely available on a website (list url):
(SEE STATEMENT)

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	INGALLS MEMORIAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
PART V, SECTION B, LINE 4	THE HOSPITAL IS REPORTING THE TAX YEAR BEGINNING FOR WHICH IT LAST CONDUCTED ITS CHNA. THE CHNA WAS FINALIZED DURING THE TAX YEAR ENDED SEPTEMBER 30, 2016. PART V, SECTION B, LINE 5 IN CONDUCTING ITS MOST RECENT CHNA, THE HOSPITAL SOUGHT TO SOLICIT INPUT FROM INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY. POTENTIAL PARTICIPANTS IN THE CHNA INCLUDED PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. THESE PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS WERE CONTACTED BY EMAIL AND ASKED TO PARTICIPATE IN A SURVEY. THROUGHOUT THIS PROCESS, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY POPULATIONS, OR OTHER MEDICALLY UNDERSERVED POPULATIONS.
PART V, SECTION B, LINE 6B	THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS SPONSORED BY INGALLS MEMORIAL HOSPITAL IN COOPERATION WITH THE METROPOLITAN CHICAGO HEALTHCARE COUNCIL. THE PROJECT ALSO RECEIVED INPUT FROM A COMMUNITY HEALTH NEEDS COMMITTEE, CREATED FOR THIS PURPOSE, WHICH WAS COMPRISED OF REPRESENTATIVES OF THE PARTNERING ORGANIZATIONS AS WELL AS OTHER CITIZENS CHOSEN FOR THEIR RELEVANT EXPERIENCE AND INTERESTS.
PART V, SECTION B, LINE 9	THE HOSPITAL IS REPORTING THE TAX YEAR BEGINNING FOR WHICH IT LAST ADOPTED AN IMPLEMENTATION STRATEGY RELATING TO THE TAX YEAR ENDED SEPTEMBER 30, 2016. PART V, SECTION B, LINE 11 THE SIGNIFICANT NEEDS IN THE COMMUNITY WERE IDENTIFIED AS ACCESS TO CARE; HEART DISEASE AND STROKE; CANCER CARE; NUTRITION, PHYSICAL ACTIVITY & WEIGHT; AND INFANT HEALTH AND FAMILY PLANNING. TO ADDRESS ACCESS TO CARE, INGALLS REFERENCED HEALTH DATA FINDINGS WHICH SUGGEST OPPORTUNITIES TO ADDRESS BARRIERS TO HEALTHCARE ACCESS AROUND APPOINTMENT AVAILABILITY AND LOCATING A PHYSICIAN. PHYSICIAN RECRUITMENT, ENHANCED CLINICAL SERVICES, AND EXPANSION OF OUTPATIENT SERVICES WERE THE PRIMARY REASONS FOR THE MERGER BETWEEN THE UNIVERSITY OF CHICAGO MEDICINE AND INGALLS HEALTH SYSTEM, NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE MERGED HEALTH SYSTEMS WILL IMPROVE ACCESS ACROSS THE SPECTRUM OF CARE BE IT FOR A ROUTINE, PREVENTATIVE CHECKUP OR A COMPLEX, LIFE SUSTAINING TREATMENT. INGALLS HELD A COMMUNITY LEADERS FORUM, PARTNERING WITH ELECTED OFFICIALS, EDUCATORS, FAITH LEADERS, COMMUNITY NON-PROFITS, PATIENTS, PHYSICIANS, AND STAFF, TO SHARE INFORMATION AROUND ACCESS TO CARE THROUGH THE UCM/INGALLS MERGER. ADDRESSING THE ISSUE OF HEART DISEASE AND STROKE, INGALLS HAS IMPLEMENTED A NUMBER OF ACTION STEPS FOCUSED ON PREVENTATIVE CARE IN THE COMMUNITY, WHILE ALSO INVESTING MORE THAN $1 MILLION IN DIRECT CARDIAC EQUIPMENT AND PATIENT CARE SERVICES IN THE HOSPITAL. ACTION ITEMS INCLUDE A MONTHLY WALKING PROGRAM WITH HEALTH EDUCATION LECTURES AND SCREENING HELD AT COMMUNITY CENTERS AND LOCAL MALLS; THE SOUTHLAND HEALTH FAIR WHICH PROVIDES EKG TESTS, CARDIAC COUNSELING, AND PATIENT EDUCATION AND REACHES MORE THAN 600 PARTICIPANTS; LIFELINE SCREENING OFFERED TO OVER 90 PATIENTS PER MONTH AT THE INGALLS WELLNESS CENTER; AND COMMUNITY HEALTH FAIRS, FEATURING INFORMATION BOOTHS, FITNESS TESTS, AND OTHER ACTIVITIES OFFERED IN PARTNERSHIP WITH THE AMERICAN HEART ASSOCIATION AND INGALLS CARDIOLOGY DEPARTMENT AND WELLNESS CENTER. TO ADDRESS CANCER, INGALLS WILL CONTINUE TO INVEST IN THE LARGEST COMMUNITY BASED CANCER RESEARCH PROGRAM IN THE SOUTH SUBURBS, SCREENING 300 PATIENTS ANNUALLY AND ENROLLING 60 PARTICIPANTS IN ACTIVE CLINICAL DRUG TRIALS, ONE THIRD OF WHICH ARE MINORITY PATIENTS. IN ADDITION, INGALLS WILL IMPLEMENT A NUMBER OF COMMUNITY BASED INITIATIVES, INCLUDING: CONQUERING BREAST CANCER FORUM, AN ANNUAL EVENT FOR 300-500 PARTICIPANTS IN WHICH A FREE FORUM ADDRESSES HEALTH DISPARITIES IN BREAST CANCER AMONG MINORITY PATIENTS POPULATIONS; FREE MAMMOGRAMS, THROUGH PARTNERSHIP WITH SILVER LINING FOUNDATION, TYPICALLY PROVIDED TO 5-10 PATIENTS PER MONTH; AND THE COMMUNITY IMPACT GRANT, FUNDED THROUGH INGALLS DEVELOPMENT FOUNDATION, WHICH SECURES RESOURCES FOR PATIENTS TO PAY FOR CANCER TREATMENTS. IN RESPONSE TO FINDINGS THAT OBESITY AND OVERWEIGHT CONDITIONS AMONG CHILDREN AND ADULTS ARE UNFAVORABLE IN THE REGION, INGALLS WILL IMPLEMENT A NUMBER OF ACTION STEPS, INCLUDING: NUTRITION COUNSELING OFFERED VIA A SERIES OF FREE WORKSHOPS AND COOKING DEMONSTRATIONS PROMOTING GOOD NUTRITION BY A LICENSED DIETICIAN; AND THE COMMUNITY GARDEN, LOCATED IN THE PARKING STRUCTURE OF INGALLS HOSPITAL, WHICH DELIVERS 200 POUNDS OF FRESH PRODUCE TO AREA FOOD PANTIES. TO ADDRESS FINDINGS THAT THE BIRTH WEIGHT AND INFANT DEATH RATE IN THE INGALLS SERVICE AREA IS WORSE THAN THE REGION, STATE, AND NATION, INGALLS WILL CONTINUE TO INVEST IN THE FOLLOWING ACTIONS: HEALTH BABY NETWORK, WHICH IS DESIGNED TO GET ECONOMICALLY DISADVANTAGED PREGNANT ADOLESCENTS AND TEENS THE HEALTHCARE AND SOCIAL SERVICES THEY NEED IN ORDER TO ENSURE HEALTHIER OUTCOMES FOR THEMSELVES AND THEIR UNBORN CHILDREN. THIS PROGRAM, ON AVERAGE, IS PROVIDED TO 7% OF THE 800-1,000 DELIVERIES MADE BY THE HOSPITAL EACH YEAR; KID FIT CAMP, IN WHICH AN ESTIMATED 500 PARTICIPANTS STRIVE TO ACHIEVE GRADUAL WEIGHT LOSS AND MAINTENANCE TO ENSURE PROPER GROWTH AND DEVELOPMENT; COMMUNITY SCHOLARSHIPS PROVIDE 14 SCHOLARSHIPS TO HIGH SCHOOL SENIORS WHO WILL BE SENIORS GRADUATING TO PURSUE CAREERS STUDYING HEALTHCARE. IN ADDITION TO THE PRIORITY AREAS IDENTIFIED, INGALLS REMAINS COMMITTED AS PART OF THE COMMUNITY HEALTH NEEDS IMPLEMENTATION TO ADDRESS, THROUGH DIRECT PATIENT CARE IN PARTNERSHIP WITH OUR PHYSICIANS, THE FOLLOWING HEALTH NEEDS IDENTIFIED IN THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT: CHRONIC KIDNEY DISEASE, DIABETES, HIV/AIDS, INJURY & VIOLENCE, MENTAL HEALTH, POTENTIALLY DISABLING CONDITIONS, RESPIRATORY DISEASE, SEXUALLY TRANSMITTED DISEASES, SUBSTANCE ABUSE, AND TOBACCO ABUSE.
PART V, SECTION B, LINE 16A	HTTPS://WWW.INGALLS.ORG/PDF/INGALLS%20HOSPITAL%20FAP%20PROGRAM%20DETAILS.P DF PART V, SECTION B, LINE 16B HTTPS://WWW.INGALLS.ORG/PDF/FAP_APPLICATION.PDF PART V, SECTION B, LINE 16C HTTPS://WWW.INGALLS.ORG/PDF/INGALLS%20HOSPITAL%20FAP%20PROGRAM%20DETAILS.P DF

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?7
Name and address		Type of Facility (describe)
1	INGALLS FAMILY CARE CENTER 1600 TORRENCE AVENUE CALUMET CITY,IL60409	URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES
2	INGALLS CARE CENTER 4742 CAL SAG ROAD CRESTWOOD,IL60445	QUICK CARE CENTER AND OCCUPATIONAL HEALTH
3	INGALLS FAMILY CARE CENTER 6701 WEST 159TH STREET TINLEY PARK,IL60477	URGENT AID, PRIMARY CARE, AND SPECIALIST SERVICES
4	INGALLS FAMILY CARE CENTER 19550 GOVERNORS HIGHWAY FLOSSMOOR,IL60422	URGENT AID AND SPECIALIST SERVICES
5	INGALLS WELLNESS CENTER 2920 WELLNESS CENTER HOMEWOOD,IL60430	COMPLEMENTARY MEDICINE AND COMMUNITY HEALTH PROGRAMS
6	THE VILLA AT SOUTH HOLLAND 16300 WAUSAU AVENUE SOUTH HOLLAND,IL60473	HEALTHCARE AND REHABILITATION CENTER
7	INGALLS CARE CENTER 16246 PRINCE DRIVE SOUTH HOLLAND,IL60473	INDUSTRIAL, MEDICAL REHABILITATION AND PHYSICIAN OFFICES
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
PART I, LINE 3C	AUTOMATIC UNINSURED SELF-PAY DISCOUNT A DISCOUNT OF 65% OF GROSS CHARGES, PROVIDED TO ALL UNINSURED PATIENTS WITHOUT REQUIRING EVIDENCE OF INABILITY TO PAY. THIS DISCOUNT IS DESIGNED TO ENSURE THAT PATIENTS ARE CHARGED AT A RATE GENERALLY COMPARABLE TO THAT APPLIED TO INSURED PATIENTS. 1. THERE IS NO APPLICATION PROCESS FOR THE PATIENT TO RECEIVE THE UNINSURED DISCOUNT. THE DISCOUNT IS APPLIED BASED ON THE ACCOUNTS SELF-PAY/UNINSURED STATUS. 2. PATIENTS RECEIVING PRE-NEGOTIATED DISCOUNTS FOR HOSPITAL SERVICES WILL NOT BE ELIGIBLE FOR THIS UNINSURED DISCOUNT. 3. IF A PATIENT IS SUBSEQUENTLY APPROVED FOR FINANCIAL ASSISTANCE, THE AUTOMATIC DISCOUNT WILL BE REVERSED SO THAT THE FULL AMOUNT CAN BE RECOGNIZED AS A CHARITY ALLOWANCE. 4. IF A PATIENT SUBSEQUENTLY PROVIDES EVIDENCE OF INSURANCE COVERAGE, THE AUTOMATIC DISCOUNT WILL BE REVERSED AND THE INSURANCE COVERAGE PROVIDED WILL BE BILLED ACCORDINGLY. 5. PATIENT WHO ARE OTHERWISE INSURED AND CHOOSE NOT TO USE THEIR INSURANCE COVERAGE ARE INELIGIBLE FOR THIS AUTOMATIC DISCOUNT. PART I, LINE 7 INGALLS UTILIZES A COST TO CHARGE METHODOLOGY. CHARGES ASSOCIATED WITH THE RELATED CATEGORIES ARE THEN USED TO DETERMINE COST RELATED TO SUCH REVENUE.
PART III, LINE 2	THE AMOUNT REPORTED AS BAD DEBT EXPENSE IS DETERMINED BY APPLYING THE RATIO OF COST TO CHARGES (RCC) TO THE TOTAL CHARGES WRITTEN OFF TO BAD DEBT AS REPORTED IN THE AUDITED FINANCIAL STATEMENTS. THE RCC WAS DETERMINED UTILIZING WORKSHEET 2 FROM FORM 990, SCHEDULE H INSTRUCTIONS. THE BASIS FOR THIS COSTING METHODOLOGY IS THE HOSPITALS OPERATING EXPENSES (EXCLUDING BAD DEBT) ADJUSTED BY OTHER OPERATING REVENUE AND COMMUNITY BENEFIT EXPENSE DIVIDED BY GROSS PATIENT CHARGES. CHARGES.
PART III, LINE 3	BASED ON AN ANALYSIS OF PATIENT ACCOUNT DETAIL, IT IS ESTIMATED THAT APPROXIMATELY 18.7% OF THE BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY IF SUFFICIENT INFORMATION WAS OBTAINED. THE PERCENTAGE WAS DERIVED BY TAKING THE TOTAL AMOUNT OF BAD DEBT WRITTEN OFF FOR SELF PAY PATIENTS PER THE HOSPITAL'S PATIENT ACCOUNTS SYSTEM OVER THE TOTAL AMOUNT OF BAD DEBT WRITTEN OFF FOR ALL TYPES OF PATIENT ACCOUNTS.
PART III, LINE 4	PATIENTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENTS ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR ACCOUNTS RECEIVABLE, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH PATIENT RESPONSIBILITY (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE PATIENTS ARE SCREENED AGAINST THE SYSTEMS CHARITY CARE POLICY. FOR ANY REMAINING PATIENT RESPONSIBILITY BALANCE, THE SYSTEM RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLE IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE SYSTEMS ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS, WHICH INCLUDES UNINSURED PATIENTS, RESIDUAL COPAYMENTS AND DEDUCTIBLES FOR WHICH MANAGED CARE HAS ALREADY PAID, AND CERTAIN AGED MEDICAID AND MEDICAID MANAGED CARE ACCOUNTS RECEIVABLE, INCREASED FROM 21.5% OF ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2015 TO 28.8% OF ACCOUNTS RECEIVABLE AT SEPTEMBER 30, 2016. WRITE-OFFS INCREASED IN FISCAL YEAR 2016 TO 20,370. THE SYSTEM DID NOT HAVE SIGNIFICANT WRITE OFFS FROM THIRD PARTY PAYORS.
PART III, LINE 8	THE HOSPITAL BELIEVES THE FULL AMOUNT OF THE SHORTFALL FROM MEDICARE SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IT SERVES ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY, AND IT CANNOT NEGOTIATE CONTRACTUAL RATES WITH THE MEDICARE PROGRAM. THE HOSPITAL MUST ACCEPT WHAT THE MEDICARE PROGRAM PAYS. THE METHODOLOGY USED IN DETERMINING MEDICARE USED IN THE COMMUNITY BENEFITS REPORT IS MEDICARE CHARGES MULTIPLIED BY THE MEDICARE COST REPORT, COST TO CHARGE RATIO.
PART III, LINE 9B	INGALLS MEMORIAL HOSPITAL HAS A FIDUCIARY DUTY TO SEEK REIMBURSEMENT FOR SERVICES IT HAS PROVIDED FROM INDIVIDUALS WHO ARE ABLE TO PAY, FROM THIRD PARTY INSURERS WHO COVER THE COST OF CARE, AND FROM OTHER PROGRAMS OF ASSISTANCE FOR WHICH THE PATIENT IS ELIGIBLE. TO DETERMINE WHETHER A PATIENT IS ABLE TO PAY FOR THE SERVICES PROVIDED AS WELL AS TO ASSIST THE PATIENT IN FINDING ALTERNATIVE COVERAGE OPTIONS IF THEY ARE UNINSURED OR UNDERINSURED, THE HOSPITAL FOLLOWS THE FOLLOWING CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. COLLECTING INFORMATION ON PATIENT HEALTH COVERAGE AND FINANCIAL RESOURCES PATIENT OBLIGATIONS: PRIOR TO THE DELIVERY OF ANY HEALTH CARE SERVICES (EXCEPT FOR CASES THAT ARE AN EMERGENCY OR URGENT CARE SERVICE LEVEL), THE PATIENT IS EXPECTED TO PROVIDE TIMELY AND ACCURATE INFORMATION ON THEIR INSURANCE STATUS, DEMOGRAPHIC INFORMATION, CHANGES TO THEIR FAMILY INCOME OR INSURANCE STATUS, AND INFORMATION ON ANY DEDUCTIBLES OR CO-PAYMENTS THAT ARE OWED BASED ON THEIR EXISTING INSURANCE OR FINANCIAL PROGRAM'S PAYMENT OBLIGATIONS. THE DETAILED INFORMATION WILL INCLUDE: A. FULL NAME, ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, CITIZENSHIP AND RESIDENCY INFORMATION, AND THE PATIENT'S APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY THEIR BILL; B. FULL NAME OF THE PATIENT'S GUARANTOR, THEIR ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, AND THEIR APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY FOR THE PATIENT'S BILL; AND C. OTHER RESOURCES THAT MAY BE USED TO PAY THEIR BILL, INCLUDING OTHER INSURANCE PROGRAMS, MOTOR VEHICLE OR HOMEOWNERS INSURANCE POLICIES IF THE TREATMENT WAS DUE TO AN ACCIDENT, WORKER'S COMPENSATION PROGRAMS, AND STUDENT INSURANCE POLICIES, AMONG OTHERS. IT IS ULTIMATELY THE PATIENT'S OBLIGATION TO KEEP TRACK OF AND TIMELY PAY THEIR UNPAID HOSPITAL BILL, INCLUDING ANY EXISTING CO-PAYMENTS, CO-INSURANCE, AND DEDUCTIBLES. THE PATIENT IS FURTHER REQUIRED TO INFORM EITHER THEIR CURRENT HEALTH INSURER (IF THEY HAVE ONE) OR THE AGENCY THAT DETERMINED THE PATIENT'S ELIGIBILITY STATUS IN A PUBLIC HEALTH INSURANCE PROGRAM OF ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS. THE HOSPITAL MAY ALSO ASSIST THE PATIENT WITH UPDATING THEIR ELIGIBILITY IN A PUBLIC PROGRAM WHEN THERE ARE ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS, BUT ONLY IF THE HOSPITALS MADE AWARE BY THE PATIENT OF FACTS THAT MAY INDICATE A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS. PATIENTS ARE REQUIRED TO NOTIFY THE STATE PUBLIC PROGRAM (OFFICE OF MEDICAID), INFORMATION RELATED TO ANY LAWSUIT OR INSURANCE CLAIM THAT WILL COVER THE COST OF THE SERVICES PROVIDED BY THE HOSPITAL. HOSPITAL OBLIGATIONS: INGALLS MEMORIAL HOSPITAL WILL MAKE ALL REASONABLE AND DILIGENT EFFORTS TO COLLECT THE PATIENT INSURANCE STATUS AND OTHER INFORMATION TO VERIFY COVERAGE FOR THE HEALTH CARE SERVICES TO BE PROVIDED BY INGALLS MEMORIAL HOSPITAL. THESE EFFORTS MAY OCCUR WHEN THE PATIENT IS SCHEDULING THEIR SERVICES, DURING PREREGISTRATION, WHILE THE PATIENT IS ADMITTED IN THE HOSPITAL, UPON DISCHARGE, OR DURING THE COLLECTION PROCESS WHICH MAY OCCUR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THIS INFORMATION WILL BE OBTAINED PRIOR TO THE DELIVERY OF ANY NONEMERGENT AND NON-URGENT HEALTH CARE SERVICES (I.E., ELECTIVE PROCEDURES AND SCHEDULED PROCEDURES). INGALLS MEMORIAL HOSPITAL WILL DELAY ANY ATTEMPT TO OBTAIN THIS INFORMATION DURING THE DELIVERY OF ANY EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) LEVEL EMERGENCY LEVEL OR URGENT CARE SERVICES, IF THE PROCESS TO OBTAIN THIS INFORMATION WILL DELAY OR INTERFERE WITH EITHER THE MEDICAL SCREENING EXAMINATION OR THE SERVICES UNDERTAKEN TO STABILIZE AN EMERGENCY MEDICAL CONDITION. THE HOSPITAL'S REASONABLE AND DILIGENT EFFORTS WILL INCLUDE, BUT IS NOT LIMITED TO, REQUESTING INFORMATION ABOUT THE PATIENT'S INSURANCE STATUS, CHECKING ANY AVAILABLE PUBLIC OR PRIVATE INSURANCE DATABASES, AND FOLLOWING THE BILLINGS RULES OF A KNOWN THIRD PARTY PAYER. IF THE PATIENT OR GUARANTOR/GUARDIAN IS UNABLE TO PROVIDE THE INFORMATION NEEDED, AND THE PATIENT CONSENTS, THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO CONTACT RELATIVES, FRIENDS, GUARANTOR/GUARDIAN, AND THE THIRD PARTY FOR ADDITIONAL INFORMATION. INGALLS MEMORIAL HOSPITAL WILL ALSO MAKE REASONABLE AND DILIGENT EFFORTS TO INVESTIGATE WHETHER A THIRD PARTY RESOURCE MAY BE RESPONSIBLE FOR THE SERVICES PROVIDED BY THE HOSPITAL, INCLUDING BUT NOT LIMITED TO: (1) A MOTOR VEHICLE OR HOMEOWNER'S LIABILITY POLICY, (2) GENERAL ACCIDENT OR PERSONAL INJURY PROTECTION POLICIES, (3) WORKER'S COMPENSATION PROGRAMS, (4) STUDENT INSURANCE POLICIES, AMONG OTHERS. IN ACCORDANCE WITH APPLICABLE STATE REGULATIONS OR THE INSURANCE CONTRACT, FOR ANY CLAIM WHERE INGALLS MEMORIAL HOSPITAL'S REASONABLE AND DILIGENT EFFORTS RESULTED IN A PAYMENT FROM A PRIVATE INSURER OR PUBLIC PROGRAM, INGALLS MEMORIAL HOSPITAL WILL REPORT THE RECOVERY AND OFF SET IT AGAINST THE CLAIM PAID BY THE PRIVATE INSURER OR PUBLIC PROGRAM. THE HOSPITAL FURTHER MAINTAINS ALL INFORMATION IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE PRIVACY, SECURITY AND ID THEFT LAWS.
PART VI, LINE 2	IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT WAS CONDUCTED, THE HOSPITAL HAS A COMMUNITY RELATIONS DEPARTMENT WHOSE SOLE PURPOSE IS TO ASSESS AND ADDRESS THE HEALTHCARE NEEDS OF THE COMMUNITY. THE HOSPITAL PARTNERS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS, AND PLAN NEWLY NEEDED SERVICES. SPECIFIC ATTENTION IS PAID TO THE NEEDS OF LOW INCOME AND VULNERABLE POPULATIONS.
PART VI, LINE 3	THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THE ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNS THROUGHOUT THE PATIENT REGISTRATION AREAS REGARDING PATIENT PAYMENT OPTIONS. IN ADDITION, PATIENTS ARE INFORMED VIA THE HOSPITAL'S WEBSITE, INDIVIDUAL PATIENT STATEMENTS, AND FINANCIAL COUNSELORS. BELOW ARE SOME ADDITIONAL DETAILS REGARDING HOW THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE: SIGNS OR SIMILAR WRITTEN NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM WILL BE VISIBLE AT ALL HOSPITAL POINTS OF SERVICE TO CREATE AWARENESS OF THE FINANCIAL ASSISTANCE PROGRAM. AT A MINIMUM, SIGNAGE WILL BE POSTED IN THE EMERGENCY DEPARTMENT AND ADMISSION REGISTRATION AREA. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISION OF FINANCIAL ASSISTANCE PROGRAM WILL USE LANGUAGES THAT ARE APPROPRIATE FOR THE SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. HOSPITAL BILL/INVOICE: PATIENT BILLS OR STATEMENTS INCLUDE A PROMINENT STATEMENT THAT PATIENTS WHO MEET CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR FINANCIAL ASSISTANCE AND INFORMATION REGARDING HOW A PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE FOLLOWING ARE MADE PUBLICLY AVAILABLE VIA THE HOSPITALS WEBSITE, HTTPS://WWW.INGALLS.ORG/FINANCIAL-ASSISTANCE 1. PATIENT BROCHURES 2. FINANCIAL ASSISTANCE POLICY 3. APPLICATION FORMS USED TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. 4. PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE POLICY
PART VI, LINE 4	THE HOSPITAL'S IMMEDIATE SERVICES AREA FACES A NUMBER OF DIFFERENT CHALLENGES SUCH AS: THE HIGHEST RATE IN THE METRO AREA FOR PERSONS BELOW POVERTY LEVEL, THE GREATEST NUMBERS OF PERSONS ON MEDICAID, THE HIGHEST RATES OF UNINSURED INDIVIDUALS, AND THE HIGHEST RATES OF UNEMPLOYED INDIVIDUALS. THE MEDIAN INCOME FOR A HOUSEHOLD IN THE HOSPITAL'S SERVICE AREA WAS $22,014, AND THE MEDIAN INCOME FOR A FAMILY WAS $35,292. ABOUT 32.2% OF FAMILIES AND 36.4% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 51.1% OF THOSE UNDER AGE 18 AND 18.7% OF THOSE AGE 65 OR OVER. THE INFORMATION ABOVE WAS OBTAINED FROM THE UNITED STATES CENSUS BUREAU. HTTP//FACTFINDER.CENSUS.GOV. 2015 DATA
PART VI, LINE 5	INGALLS MEMORIAL HOSPITAL IS LOCATED IN HARVEY, IL, A COMMUNITY WHERE THE MEDIAN HOUSEHOLD INCOME IS $22,000. OF THE APPROXIMATELY 25,000 RESIDENTS, 36.4% LIVE AT OR BELOW THE POVERTY LINE (ACCORDING TO 2011-2015 AMERICAN COMMUNITY SURVEY 5-YEAR PROFILES). INGALLS IS COMMITTED TO PROMOTING THE HEALTH OF THE LOCAL COMMUNITY AND WORKS TO ADDRESS SPECIFIC NEEDS BY LEADING AND COLLABORATING ON PROJECTS THAT WILL DIRECTLY IMPACT THE HEALTHCARE OF AREA RESIDENTS. PROMOTION OF COMMUNITY HEALTH: ONE PROJECT THAT INGALLS OFFERS IS THE HEALTHY BABY NETWORK WHICH IS A COLLABORATION WITH LOCAL SOCIAL SERVICE AGENCIES TO PROVIDE PRENATAL MEDICAL CARE AND LINKAGE WITH SOCIAL SERVICE PROGRAMS FOR MOTHERS WHO ARE AT RISK FOR PRE-TERM DELIVERIES DUE TO LACK OF PRENATAL CARE. INGALLS ALSO OFFERS ACCESS TO FREE AND /DISCOUNTED PHYSICALS, DENTAL SCREENINGS AND VACCINATIONS FOR SCHOOL AGED CHILDREN WHO ARE AT RISK OF NOT STARTING THE SCHOOL YEAR ON TIME BECAUSE OF LACK OF ACCESS TO CARE. EACH YEAR INGALLS PROVIDES CARE TO BETWEEN 500 AND 600 CHILDREN ON DAY. IN ADDITION TO THE HEALTHCARE OFFERINGS, INGALLS HANDS OUT OVER 1,000 BAGS OF SCHOOL SUPPLIES TO CHILDREN IN ATTENDANCE SO THAT SOME OF THE FINANCIAL BURDEN CAN BE LIFTED FROM FAMILIES IN NEED. EACH YEAR INGALLS HOSTS A COMMUNITY HEALTH FAIR. THIS EVENT IS ONE OF THE MOST COMPREHENSIVE HEALTH FAIRS IN CHICAGOS SOUTHLAND REGION AND OFFERS OVER 25 FREE SCREENINGS (INCLUDING TOTAL CHOLESTEROL BLOOD TESTS AND 12-LEAD EKG). ON AVERAGE APPROXIMATELY 600 ATTENDEES TAKE ADVANTAGE OF THE FREE SCREENINGS FOR THIS EVENT AND THERE ARE NO RESIDENCY RESTRICTIONS. COMMUNITY BOARD: THE INGALLS BOARD OF DIRECTORS MEMBERSHIP IS COMPRISED OF LOCAL BUSINESS AND COMMUNITY MEMBERS THAT LIVE IN THE CHICAGO AND THE SOUTH SUBURBAN REGION. IN ADDITION TO THE PRESIDENT, ONE EMPLOYED PHYSICIAN SERVES AS AN ELECTED BOARD MEMBER. ALL MEMBERS ARE IN COMPLIANCE WITH THE BOARD CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO COMPLETE AN ANNUAL CERTIFICATION AND DISCLOSURE FORM. QUALIFIED PHYSICIANS: INGALLS RESPONDS TO REQUESTS FOR APPLICATIONS TO JOIN THE MEDICAL STAFF MADE BY QUALIFIED PHYSICIANS IN THE COMMUNITY. THE INGALLS PROFESSIONAL AFFAIRS COMMITTEE REVIEWS INQUIRIES AND PROVIDES APPLICATIONS TO PHYSICIANS WHO MEET THE MINIMUM QUALIFICATIONS FOR MEDICAL STAFF MEMBERSHIP IF THERE IS A NEED FOR A PARTICULAR SERVICE AND/OR A PATIENT NEED EXISTS WITHIN THE COMMUNITY. STAFF EDUCATION: THE INGALLS MEDICAL STAFF SUPPORTS IMPROVEMENTS IN PATIENT CARE AND ONGOING EDUCATION TO THE MEDICAL AND PROFESSIONAL STAFF THROUGH FUNDING OF MEDICAL EDUCATION ACTIVITIES. INGALLS IS ACCREDITED BY THE ILLINOIS STATE MEDICAL SOCIETY TO AWARD CME CATEGORY 1 CREDIT. THE CME COMMITTEE IS RESPONSIBLE FOR OVERSIGHT OF MONTHLY CME ACTIVITIES WHICH ARE SPONSORED BY THE HOSPITAL. BOTH MEDICAL AND PROFESSIONAL (NURSING, QUALITY MANAGEMENT, ETC.) STAFF ARE INVITED AND ENCOURAGED TO ATTEND THE PROGRAMS.
PART VI, LINE 6	THE INGALLS MEMORIAL HOSPITAL IS PART OF THE INGALLS HEALTH SYSTEM THAT IS NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE INGALLS HEALTH SYSTEM WAS INCORPORATED TO SUPPORT AND ENCOURAGE HEALTH AND HUMAN SERVICES THROUGH THE FOLLOWING AFFILIATES: THE INGALLS MEMORIAL HOSPITAL INGALLS HEALTH VENTURES MEDCENTRIX, INC. INGALLS DEVELOPMENT FOUNDATION INGALLS HEALTH COUNCIL INGALLS HOME CARE INGALLS PROVIDER GROUP INGALLS CASUALTY INSURANCE INGALLS SAME DAY SURGERY, LTD. INGALLS CARE NETWORK PRIMARY HEALTHCARE ASSOCIATES, SC PRIMARY HEALTHCARE ASSOCIATES, SC
PART VI, LINE 7	THE INGALLS MEMORIAL HOSPITAL FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF ILLINOIS.

Schedule H (Form 990) 2015

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
THE INGALLS MEMORIAL HOSPITAL

Employer identification number
36-2170866

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

(1) INGALLS DEVELOPMENT FOUNDATION
One Ingalls Drive
Harvey,IL60426

36-3189150

501(c)(3)

20,050,000

SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of non-cash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of non-cash assistance

(1) SCHOLARSHIPS	203	96,449
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

PART I, LINE 2

INGALLS MEMORIAL HOSPITAL (IMH) PROVIDED A CONTRIBUTION TO INGALLS DEVELOPMENT FOUNDATION (IDF) TO ADEQUATELY FUND AND PERPETUATE THE FOUNDATIONS OPERATIONS IN ORDER TO SUPPORT THE INGALLS HEALTH SYSTEM, NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. IMH ALSO PROVIDED A CONTRIBUTION TO IDF FOR THEIR YEARLY BENEFIT SHOW. SCHOLARSHIPS ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS IN ORDER TO ENSURE THE FUNDS ARE USED FOR THEIR INTENDED PURPOSE.

Schedule I (Form 990) 2015

Additional Data

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

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 on 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 or provision of all of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

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 on 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? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on 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," on line 5a or 5b, describe in Part III.

For persons listed on 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," on line 6a or 6b, describe in Part III.

For persons listed on 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 ............

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(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 in column(B) reported as deferred on prior Form 990
(A) Name and Title		(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)
1MICHAEL HICKSCOO/BOARD MEMBER	(i) (ii)	488,826 ------------- 0	90,722 ------------- 0	20,691 ------------- 0	7,950 ------------- 0	29,760 ------------- 0	637,949 ------------- 0	0 ------------- 0
2KURT JOHNSONPRESIDENT & CEO/BOARD MEMBER	(i) (ii)	1,214,467 ------------- 0	224,120 ------------- 0	32,145 ------------- 0	7,950 ------------- 0	37,315 ------------- 0	1,515,997 ------------- 0	0 ------------- 0
3KATHLEEN MIKOSCHIEF NURSING/BOARD MEMBER	(i) (ii)	377,066 ------------- 0	67,981 ------------- 0	25,722 ------------- 0	7,950 ------------- 0	20,417 ------------- 0	499,136 ------------- 0	0 ------------- 0
4MARK KOZLOFF MDPHYSICIAN/BOARD MEMBER	(i) (ii)	0 ------------- 562,988	0 ------------- 0	0 ------------- 25,671	0 ------------- 6,625	0 ------------- 13,768	0 ------------- 609,052	0 ------------- 0
5MICHAEL DEVORECHIEF INFORMATION OFFICER	(i) (ii)	229,844 ------------- 0	23,637 ------------- 0	10,839 ------------- 0	7,090 ------------- 0	21,193 ------------- 0	292,603 ------------- 0	0 ------------- 0
6DIANE JACOBYASSISTANT SECRETARY, VP	(i) (ii)	471,318 ------------- 0	79,836 ------------- 0	23,031 ------------- 0	7,950 ------------- 0	36,717 ------------- 0	618,852 ------------- 0	0 ------------- 0
7TAMARA PROFIRIOVICE PRESIDENT/COO MEDCENTRIX	(i) (ii)	240,640 ------------- 0	0 ------------- 0	298 ------------- 0	250 ------------- 0	16,920 ------------- 0	258,108 ------------- 0	0 ------------- 0
8ALETHA ROSSVICE PRESIDENT OF HR	(i) (ii)	267,877 ------------- 0	53,224 ------------- 0	2,318 ------------- 0	6,600 ------------- 0	20,595 ------------- 0	350,614 ------------- 0	0 ------------- 0
9ANDREW STEFOVP - FINANCE/CFO	(i) (ii)	510,723 ------------- 0	94,351 ------------- 0	25,722 ------------- 0	7,950 ------------- 0	16,313 ------------- 0	655,059 ------------- 0	0 ------------- 0
10SCOTT STRAUSSERVP - BUSINESS DEVELOPMENT	(i) (ii)	424,514 ------------- 0	69,191 ------------- 0	20,691 ------------- 0	7,950 ------------- 0	12,596 ------------- 0	534,942 ------------- 0	0 ------------- 0
11LINDA CONWAYASSOCIATE GENERAL COUNSEL	(i) (ii)	197,029 ------------- 0	16,500 ------------- 0	3,684 ------------- 0	6,366 ------------- 0	870 ------------- 0	224,449 ------------- 0	0 ------------- 0
12MARY JO CRANDALLLEAN FACILITATOR	(i) (ii)	187,857 ------------- 0	23,143 ------------- 0	746 ------------- 0	5,552 ------------- 0	308 ------------- 0	217,606 ------------- 0	0 ------------- 0
13LAWRENCE KLONOWSKIMANAGER MEDICAL PHYSICS	(i) (ii)	198,662 ------------- 0	0 ------------- 0	7,884 ------------- 0	5,342 ------------- 0	27,925 ------------- 0	239,813 ------------- 0	0 ------------- 0
14LYNN PHILIPSONDIRECTOR OF MANAGED CARE	(i) (ii)	169,296 ------------- 0	25,500 ------------- 0	4,583 ------------- 0	5,838 ------------- 0	663 ------------- 0	205,880 ------------- 0	0 ------------- 0
15HEIDI RUHEASSOC VP BUSINESS DEVELOPMENT	(i) (ii)	157,548 ------------- 0	39,962 ------------- 0	1,065 ------------- 0	3,011 ------------- 0	37,003 ------------- 0	238,589 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 3	INGALLS MEMORIAL HOSPITAL IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. CORPORATE STRUCTURE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL. IN SETTING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT COMPARABILITY STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. IN ADDITION, THE ORGANIZATION RECEIVED AN INDEPENDENT COMPENSATION REVIEW BY WILLIS TOWERS WATSON IN SEPTEMBER 2015. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS, DELIBERATIONS, AND APPROVAL OF THE TOP MANAGEMENT OFFICIAL'S COMPENSATION IN THE MEETING MINUTES. THE PROCESS FOR REVIEWING AND DETERMINING COMPENSATION FOR THE CEO WAS LAST UNDERTAKEN IN SEPTEMBER 2015.
SCHEDULE J, PART I, LINE 4	SOME OF THE INDIVIDUALS LISTED ON THE FORM 990 HAVE A SEVERANCE PROVISION IN CONJUNCTION WITH THEIR EMPLOYMENT WITH THE HOSPITAL. THE SEVERANCE PROVISIONS RANGE FROM 26 WEEKS TO 76 WEEKS, DEPENDING ON THE TERM OF EMPLOYMENT, WITH UP TO AN ADDITIONAL 24 WEEKS TO 30 WEEKS SEVERANCE IF THE LOSS OF EMPLOYMENT OCCURS AS A RESULT OF JOB ELIMINATION OR GOOD REASON TERMINATION AS A RESULT OF A CHANGE OF CONTROL.
SCHEDULE J, PART I, LINE 7	THE COMPENSATION PACKAGE FOR THE CEO INCLUDES THE OPPORTUNITY TO EARN INCENTIVE COMPENSATION BASED ON A COMBINATION OF MEETING OR EXCEEDING PRE-DETERMINED GOALS. ALL INCENTIVE COMPENSATION IS SUBJECT TO REVIEW AND APPROVAL BY THE COMPENSATION COMMITTEE AND HAS BEEN REPORTED ON SCHEDULE J, PART II, COLUMN B(II).

Schedule J (Form 990) 2015

Additional Data

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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 Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization
THE INGALLS MEMORIAL HOSPITAL

Employer identification number
36-2170866

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	86-1091967	45200BHK7	11-16-2007	48,000,000	REFUNDING OF 2004 BOND ISSUANCE		X		X		X
B	ILLINOIS FINANCE AUTHORITY	86-1091967	45203HPE6	02-06-2013	64,815,040	REFUNDING /1994 ISSUANCE & CAPITAL		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,200,000		0
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	48,000,000		64,815,292
4 Gross proceeds in reserve funds .............	0		0
5 Capitalized interest from proceeds .............	0		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	0		1,183,106
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	0		0
10 Capital expenditures from proceeds .............	0		30,160,252
11 Other spent proceeds .............	48,000,000		33,471,934
12 Other unspent proceeds .............	0		0
13 Year of substantial completion .............	2007		2015
	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 Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2015

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 of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
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 .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X	X
b Exception to rebate? ........		X		X
c No rebate due? .........	X			X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X			X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X
b Name of provider ..........	Merrill Lynch		0
c Term of hedge .........	2950 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........	0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
TOTAL PROCEEDS OF ISSUE	BOND ISSUE B, PART II, LINE 3 THE DIFFERENCE BETWEEN THE ISSUE PRICE AND TOTAL PROCEEDS OF ISSUE IS INTEREST EARNINGS OF $252.
NO REBATE DUE	BOND A, PART IV, LINE 4C THE COMPUTATION DATE FOR THE NOVEMBER 16, 2007 BOND ISSUE IS JANUARY 17, 2013.
WRITTEN PROCEDURES	THE ORGANIZATION IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES.

Schedule K (Form 990) 2015

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- 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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

Return Reference	Explanation
FORM 990, PART VI, LINE 1A	THE BOARD OF DIRECTORS SHALL APPOINT ANNUALLY FROM ITS MEMBERSHIP AN EXECUTIVE COMMITTEE OF NOT LESS THAN FIVE (5) NOR MORE THAN NINE (9) MEMBERS, OF WHICH THREE (3) MEMBERS SHALL BE THE CHAIRMAN, THE VICE CHAIRMAN, AND THE SECRETARY/TREASURER OF THE HOSPITAL. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS NOT PROHIBITED BY STATUTE OR SECTION 1 OF THE HOSPITAL'S BYLAWS BETWEEN MEETINGS THEREOF.
FORM 990, PART VI, LINE 4	ON OCTOBER 1, 2016, THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC), AN INDEPENDENT HEALTH SYSTEM SERVING CHICAGO, ACQUIRED INGALLS HEALTH SYSTEM (IHS), NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., AND ITS AFFILIATES THROUGH AN AFFILIATION AND MEMBER SUBSTITUTION. AS A RESULT OF THIS TRANSACTION, IHS AND ITS AFFILIATES BECAME A WHOLLY-OWNED SUBSIDIARY OF UCMC THROUGH A NEWLY CREATED COMMUNITY HEALTH AND HOSPITAL DIVISION OF UCMC. INGALLS MEMORIAL HOSPITAL (IMH) FILED AMENDED AND RESTATED ARTICLES OF INCORPORATION ON SEPTEMBER 30, 2016 TO REFLECT THE FOLLOWING CHANGES: - THE NAME OF ITS SOLE MEMBER CHANGED FROM INGALLS HEALTH SYSTEM TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. - IN THE EVENT OF DISSOLUTION, IMH WILL FIRST PAY OR MAKE PROVISION FOR THE PAYMENT OF ALL OF THE LIABILITIES AND OBLIGATIONS OF THE ORGANIZATION. THEREAFTER, THE BOARD WILL ADOPT AND IMPLEMENT A PLAN OF DISTRIBUTION TO THE SOLE MEMBER, IF THE SOLE MEMBER IS IN EXISTENCE AND QUALIFIED UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). IF THE SOLE MEMBER IS NOT IN EXISTENCE OR SO QUALIFIED, THE ASSETS WILL BE DISTRIBUTED TO AN ORGANIZATION THAT AT THE TIME QUALIFY UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). ANY SUCH ASSETS NOT DISPOSED WILL BE DISPOSED OF BY A COURT OF COMPETENT JURISDICTION OF THE COUNTY IN WHICH THE PRINCIPAL OFFICE OF THE ORGANIZATION IS THEN LOCATED TO AN ORGANIZATION(S) QUALIFIED UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). IN ADDITION, IMH AMENDED AND RESTATED ITS BYLAWS ON SEPTEMBER 30, 2016 TO REFLECT THE FOLLOWING CHANGES: - THE PURPOSES OF IMH WILL BE TO PROMOTE ANY TYPE AND NUMBER OF HEALTH CARE SERVICES, EDUCATIONAL SERVICES, RESEARCH SERVICES, AND ASSISTANCE TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. - THE NAME OF ITS SOLE MEMBER CHANGED FROM INGALLS HEALTH SYSTEM TO UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. - SECTIONS ADDED AND AMENDED TO DESCRIBE THE GENERAL POWERS AND RESERVED POWERS OF THE SOLE MEMBER. - AMENDMENTS TO THE GENERAL POWERS OF THE BOARD OF DIRECTORS. - THE NUMBER OF DIRECTORS SHALL BE SEVENTEEN AND THE NUMBER OF DIRECTORS EX OFFICIO SHALL BE EIGHT. - AT ALL MEETINGS OF THE BOARD OF DIRECTORS A MAJORITY THEREOF OR NINE DIRECTORS WHICHEVER SHALL BE LESS, PROVIDED THAT IN NO EVENT SHALL A QUORUM CONSIST OF LESS THAN ONE-THIRD (1/3) OF THE WHOLE BOARD OF DIRECTORS, SHALL BE NECESSARY AND SUFFICIENT TO CONSTITUTE A QUORUM FOR THE TRANSACTION OF BUSINESS, AND THE ACT OF A MAJORITY OF THE DIRECTORS PRESENT AT A MEETING AT WHICH THERE IS A QUORUM SHALL BE THE ACT OF THE BOARD OF DIRECTORS. - THE OFFICERS OF THE CORPORATION SHALL BE A PRESIDENT, A SECRETARY/TREASURER, AND SUCH OTHER OFFICERS AND ASSISTANT OFFICERS AS THE BOARD MAY AUTHORIZE. - THE ARTICLES OF INCORPORATION AND BYLAWS OF IMH MAY BE AMENDED, MODIFIED OR REPEALED, AND NEW AND DIFFERENT BYLAWS AND ARTICLES OF INCORPORATION MAY BE ADOPTED, ONLY BY THE SOLE MEMBER.
FORM 990, PART VI, LINE 6	PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE VOTING MEMBER OF THE ORGANIZATION IS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., FORMERLY KNOWN AS INGALLS HEALTH SYSTEM, A RELATED TAX-EXEMPT ORGANIZATION. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, IT HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE. FORM 990, PART VI, LINE 7A PRIOR TO 9/30/2016, UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. (FORMERLY INGALLS HEALTH SYSTEM) HAS THE RIGHT TO ELECT AND APPOINT ANY BOARD OF DIRECTOR OF THE ORGANIZATION. EFFECTIVE 9/30/2016, DIRECTORS, OTHER THAN THE DIRECTORS EX OFFICIO, SHALL BE ELECTED ANNUALLY BY UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., OR AT SUCH OTHER TIMES AS MAY BE DETERMINED BY THE SOLE MEMBER OF THE CORPORATION.
FORM 990, PART VI, LINE 7B	PRIOR TO 9/30/2016, UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. (FORMERLY INGALLS HEALTH SYSTEM) HAS THE RIGHT TO REMOVE ANY BOARD OF DIRECTOR OF THE ORGANIZATION WITHOUT CAUSE AT ANY TIME. UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. HAS THE EXCLUSIVE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY. SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY INCLUDE, BUT ARE NOT LIMITED TO, THE RIGHT TO APPROVE LONG-TERM CAPITAL AND OPERATIONAL BUDGETS, TO APPROVE A PLAN OF DISSOLUTION OR MERGER WITH ANOTHER ORGANIZATION, AND TO APPROVE THE DEVELOPMENT, CONSTRUCTION OR IMPLEMENTATION OF ANY NEW HEALTHCARE FACILITY, PROGRAM, OR SERVICE. EFFECTIVE 9/30/2016, UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. SHALL RETAIN THE RIGHT TO REMOVE ANY DIRECTOR, OTHER THAN DIRECTORS EX OFFICIO, WITH OR WITHOUT CAUSE, AT ANY TIME. UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. MUST APPROVE ANY MODIFICATION OR AMENDMENT TO ANY MISSION STATEMENT, STATEMENT OF GOALS OR VALUES, THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; AND THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION.
FORM 990, PART VI, LINE 11B	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. THE FULL FORM 990, INCLUDING SUPPLEMENTAL SCHEDULES, WAS PRESENTED BY THE CHIEF FINANCIAL OFFICER TO THE FINANCE COMMITTEE AT A COMMITTEE MEETING. THE FULL BOARD HAS GRANTED TO THE FINANCE COMMITTEE AUTHORITY TO APPROVE THE FORM 990. THE FULL BOARD WILL RECEIVE A REPORT FROM THE FINANCE COMMITTEE DESCRIBING THE FINANCE COMMITTEES REVIEW PERFORMED. PRIOR TO FILING WITH THE IRS, THE FORM 990 WILL BE AVAILABLE AT THE ORGANIZATIONS BOARD MEETING FOR EACH MEMBERS REVIEW.
FORM 990, PART VI, LINE 12C	PURSUANT TO THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, ALL OFFICERS, DIRECTORS, BOARD MEMBERS, AND KEY EMPLOYEES MUST AVOID SITUATIONS IN WHICH THEIR PERSONAL INTERESTS MAY CONFLICT, OR APPEAR TO CONFLICT, WITH THE INTEREST OF INGALLS, AND INGALLS REVIEWS ITS OWN RELATIONSHIPS WITH OTHER CARE PROVIDERS, EDUCATIONAL INSTITUTIONS, AND PAYERS TO DETERMINE IF POTENTIAL CONFLICTS EXISTS. BOARD MEMBERS AND EMPLOYEES SHALL HAVE THE CONTINUING AFFIRMATIVE DUTY TO REPORT TO THE PRESIDENT AND CHIEF FINANCIAL OFFICER (CEO) OF INGALLS ANY PERSONAL OWNERSHIP OF INTEREST OR OTHER RELATIONSHIP THAT MIGHT AFFECT THEIR ABILITY TO EXERCISE IMPARTIAL, ETHICAL BUSINESS JUDGMENTS IN THE AREA OF THEIR RESPONSIBILITIES. PER THE ORGANIZATIONS CONFLICT OF INTEREST POLICY, BOARD MEMBERS AND EMPLOYEES AT MANAGEMENT LEVEL WILL BE REQUIRED TO COMPLETE A CERTIFICATION AND DISCLOSURE FORM, ON A SCHEDULE DETERMINED BY THE CORPORATE COMPLIANCE OFFICER. COMPLETION OF THIS FORM IS A REQUIREMENT FOR ALL BOARD MEMBERS AND MANAGERIAL EMPLOYEES, AND MAY BE REQUIRED OF NON-MANAGEMENT EMPLOYEES AS DETERMINED BY THE PRESIDENT AND CEO AND CORPORATE COMPLIANCE OFFICER. EMPLOYEES ALSO HAVE A DUTY TO REPORT CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST OF WHICH THEY MAY BE AWARE OF INVOLVING OTHER EMPLOYEES. EACH SITUATION REPORTED SHALL BE REVIEWED BY THE PRESIDENT AND CEO, AND INGALLS CORPORATE COMPLIANCE OFFICER, AND A DETERMINATION SHALL BE MADE AS TO WHETHER A CONFLICT OF INTEREST EXISTS OF MAY ARISE FROM SUCH SITUATION. THE DECISION OF THE PRESIDENT AND CEO AND CORPORATE COMPLIANCE OFFICER REGARDING WHETHER A CONFLICT EXISTS SHALL BE FINAL. PERSONS WITH A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODYS RESOLUTION OF SUCH CONFLICT. THE ORGANIZATION FURTHER PROMOTES KNOWLEDGE AND UNDERSTANDING OF THE CONFLICT OF INTEREST POLICY IN THE EMPLOYEE HANDBOOK. EACH EMPLOYEE IS REQUIRED TO SIGN AN ACKNOWLEDGEMENT OF THE HANDBOOK UPON EMPLOYMENT.
FORM 990, PART VI, LINE 15A	INGALLS MEMORIAL HOSPITAL IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. CORPORATE STRUCTURE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL. IN SETTING THE TOP MANAGEMENT OFFICIALS COMPENSATION, THE EXECUTIVE COMMITTEE RELIES ON RECENT COMPARABILITY STUDIES THAT PROVIDE COMPENSATION DATA FOR SIMILARLY QUALIFIED PERSONS IN COMPARABLE ORGANIZATIONS TO SUPPORT ITS DECISION-MAKING PROCESS. IN ADDITION, THE ORGANIZATION RECEIVED AN INDEPENDENT COMPENSATION REVIEW BY WILLIS TOWERS WATSON IN SEPTEMBER 2015. THE COMMITTEE ADEQUATELY DOCUMENTS ITS COMPENSATION DETERMINATIONS, DELIBERATIONS, AND APPROVAL OF THE TOP MANAGEMENT OFFICIALS COMPENSATION IN THE MEETING MINUTES. THE PROCESS FOR REVIEWING AND DETERMINE COMPENSATION FOR THE CEO WAS LAST UNDERTAKEN IN SEPTEMBER 2015.
FORM 990, PART VI, LINE 15B	AN OUTSIDE COMPENSATION CONSULTANT IS USED TO RENDER A REASONABLE OPINION AS TO WHAT PERCENTAGE OF INCREASE AN OFFICER OR KEY EMPLOYEE SHOULD RECEIVE BY PERFORMING A MARKET COMPARISON FOR ALL OFFICERS AND KEY EMPLOYEES. THE PROCESS TO DETERMINE AN INCREASE IN COMPENSATION OF SALARY INCREASES ARE APPROVED ANNUALLY BY THE PRESIDENT AND EXECUTIVE COMMITTEE ONCE RECEIVED BY THE OUTSIDE CONSULTANT. DIRECTORS AND MANAGERS RECEIVE AN INCREASE IN COMPENSATION BASED ON WHETHER OR NOT PERFORMANCE GOALS HAVE BEEN REACHED BEFORE A FISCAL YEAR STARTS. PERFORMANCE GOALS ARE PUT TOGETHER BY THE DIRECTOR OR MANAGER AND SUBMITTED TO THE VICE PRESIDENT FOR APPROVAL. APPROVED GOALS ARE THEN REVIEWED BY ALL OTHER EXECUTIVES. ONCE APPROVED BY ALL, THESE ARE THE GOALS FOR THE YEAR AFTER THE YEAR IS OVER. THE PERFORMANCE GOALS ARE REVIEWED BY THE VICE PRESIDENT AND DIRECTOR OR MANAGER. MARKET ADJUSTMENTS ARE SET BY THE IMMEDIATE VICE PRESIDENT AND SENT TO ALL EXECUTIVES FOR THEIR APPROVAL.
FORM 990, PART VI, LINE 19	DURING FISCAL YEAR ENDED 9/30/2016, THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICTS OF INTEREST POLICIES WERE NOT MADE PUBLICLY AVAILABLE. THE HOSPITAL IS IN THE PROCESS OF CHANGING THIS POLICY FOR THE FOLLOWING FISCAL PERIOD.
FORM 990, PART VII, SECTION B, LINE 1	EXPENSES OF INGALLS MEMORIAL HOSPITAL (IMH) AND RELATED ENTITIES (SEE SCHEDULE R) ARE PAID BY INGALLS HEALTH SYSTEM (IHS) NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. IHS IS RESPONSIBLE FOR ISSUING THE 1099'S TO INDEPENDENT CONTRACTORS, AND SUBSEQUENTLY ALLOCATES A PERCENTAGE OF THE EXPENSE AND RECEIVES REIMBURSEMENT FROM THE RELATED ENTITIES.
FORM 990, PART VIII, LINE 7A	THE ORGANIZATION'S INVESTMENTS ARE HELD IN A POOLED INVESTMENT ACCOUNT MANAGED BY NORTHERN TRUST. REALIZED GAINS AND LOSSES ARE POOLED AND ALLOCATED TO THE PARTICIPANTS. THE INGALLS MEMORIAL HOSPITAL RECEIVES MONTHLY INFORMATION ON THE FUNDS FROM NORTHERN TRUST AND DETERMINES THE TOTAL GAIN OR LOSS AMOUNTS. HOWEVER DETAIL IS NOT PROVIDED.
FORM 990, PART XI, LINE 9	INTEREST RATE SWAP VALUATION (2,394,157) CHANGE IN INTEREST OF FOUNDATION (391,000) ------------ Total (2,785,157)
FORM 990 PART IX LINE 11G	DESCRIPTION:Data processing TOTAL FEES:10976225
FORM 990 PART IX LINE 11G	DESCRIPTION:PHYSICIAN FEES TOTAL FEES:9154896
FORM 990 PART IX LINE 11G	DESCRIPTION:ENVIRONMENTAL TOTAL FEES:4442492
FORM 990 PART IX LINE 11G	DESCRIPTION:BIOMED TOTAL FEES:4188070
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACT SERVICES TOTAL FEES:38161812

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

THE INGALLS MEMORIAL HOSPITAL

Employer identification number

36-2170866

Part I

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

(a) Name, address, and EIN (if applicable) 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 entity?
(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)INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY,IL60426 36-3189150	SUPPORT	IL	501(C)(3)	7	UCHHD		No
(2)INGALLS HOME CARE ONE INGALLS DRIVE HARVEY,IL60426 36-3367939	HEALTHCARE	IL	501(C)(3)	9	IMH	Yes
(3)UCM COMMUNITY HEALTH & HOSPITAL DIVISION ONE INGALLS DRIVE HARVEY,IL60426 36-3181170	MANAGEMENT	IL	501(C)(3)	11 TYPE II	UCMC		No
(4)INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY,IL60426 36-3239703	AMBULATORY	IL	501(C)(3)	11 TYPE II	UCHHD		No
(5)PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY,IL60426 36-4132865	HEALTHCARE	IL	501(C)(3)	9	UCHHD		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2015

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) INGALLS SAME DAY SURGERY CENTER 6701 W 159TH STREET TINLEY PARK,IL60477 36-3368549	SURGERY CENTER	IL	NA	N/A	0	0			0			0 %

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	(i) Section 512(b)(13) controlled entity?
(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		Yes	No
(1) INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY,IL60426 36-3485578	INSURANCE SERVICE	IL	IMH	C Corp	0	7,444,543	100.000 %	Yes
(2) MEDCENTRIX INC ONE INGALLS DRIVE HARVEY,IL60426 36-3374228	BILLING & MGMT	IL	UCHHD	C Corp	0	0	0 %		No
(3) INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY,IL60426 98-0485714	LIAB INSURANCE	CJ	UCHHD	C Corp	0	0	0 %		No
(4) INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY,IL60426 27-3226539	PURCHASING GROUP	IL	UCHHD	C Corp	0	0	0 %		No

Schedule R (Form 990) 2015

Page 3

Part V

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

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

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, or (iv) rent from a controlled entity .....................

Yes

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

Yes

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

Yes

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

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

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

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

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

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

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

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) INGALLS HOME CARE	a(iv)	84,000	FMV

Schedule R (Form 990) 2015

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

Schedule R (Form 990) 2015

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: INGALLS MEMORIAL HOSPITAL IS A NOT-FOR PROFIT ACUTE CARE HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING PATIENT CARE, EDUCATION, AND RESEARCH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	23
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	2,705
6	Total number of volunteers (estimate if necessary) .............	6	182
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	961,319
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	997,367	2,000,693
9	Program service revenue (Part VIII, line 2g) .........	282,051,535	279,421,204
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	19,283,201	13,716,080
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,036,175	1,781,802
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	304,368,278	296,919,779
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	126,600	20,146,449
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)	114,252,979	111,633,854
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–24e)....	163,455,298	185,587,731
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	277,834,877	317,368,034
19	Revenue less expenses. Subtract line 18 from line 12.......	26,533,401	-20,448,255
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	534,093,025	482,410,942
21	Total liabilities (Part X, line 26).............	211,611,577	195,829,295
22	Net assets or fund balances. Subtract line 21 from line 20.....	322,481,448	286,581,647

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 227,322,111 including grants of $ 20,119,699 ) (Revenue $ 180,293,418 )
	INGALLS MEMORIAL(IMH)INCLUDES A 500+ CERTIFIED BED HOSPITAL AND A NETWORK OF COMPREHENSIVE OUTPATIENT CENTERS THAT FEATURE A FULL ARRAY OF HIGH-TECH DIAGNOSTIC AND TREATMENT SERVICES. IMH MAKES SURE THAT OUR RESOURCES ARE DIRECTED TO AREAS THAT RESULT IN THE GREATEST BENEFIT TO OUR PATIENTS AND THE COMMUNITY.

4b	(Code: ) (Expenses $ 26,743,145 including grants of $ ) (Revenue $ 60,960,180 )
	THE PHARMACY PROVIDES SERVICE TO BOTH OUR INPATIENTS AND INFUSION CENTER PATIENTS. INCLUDED IN THE SERVICES PROVIDED ARE ANTIBIOTIC DOSING, DOSING BASED ON KIDNEY FUNCTION, BLOOD GLUCOSE MANAGEMENT, AND ANTICOAGULANT DOSING AND MONITORING. THE INPATIENT PHARMACY IS OPEN 24/7. WE PROCESS APPROXIMATELY 45,000 MEDICATION ORDERS AND MAKE 1,700 INTERVENTIONS PER MONTH.

4c	(Code: ) (Expenses $ 19,059,709 including grants of $ ) (Revenue $ 39,158,179 )
	INGALLS PERFORMS AN ARRAY OF SURGICAL SERVICES INCLUDING ELECTIVE, NON-ELECTIVE, COMPLEX AND HIGHLY SPECIALIZED PROCEDURES. SURGEONS ON STAFF AT INGALLS SPECIALIZE IN EVERY AREA OF SURGERY, INCLUDING, BUT NOT LIMITED TO CARDIOTHORACIC SURGERY, ORTHOPEDIC SURGERY, NEUROSURGERY, SPINE SURGERY, GENERAL SURGERY, AND VASCULAR SURGERY. IN FY 2016 INGALLS PERFORMED 2,525 INPATIENT SURGERIES AND 3,240 AMBULATORY SURGERIES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses273,124,965

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,299,564	588,659	420,605

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	2,000,693
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	0

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		2,000,693

		Business Code
2a	Net Patient Revenue	900099	269,987,443	269,987,443
b	Rental Income	900099	2,553,988	2,553,988
c	LAB SERVICES	621500	954,142		954,142
d	CLIENT SERVICE REVENUE	900099	949,661	949,661
e	MEDIC TRAINING	900099	119,220	119,220
f	All other program service revenue.			4,856,750	4,856,750
g Total.Add lines 2a–2f.....			279,421,204

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			1,092,151		7,177	1,084,974
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		1,126,756
b	Less: rental expenses		777,499
c	Rental income or (loss)	0	349,257
d	Net rental income or (loss)......			349,257			349,257
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	0	12,623,929
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	0	12,623,929
d	Net gain or (loss).....			12,623,929			12,623,929
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..			0
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..			0
Business Code			Miscellaneous Revenue
11a	EXPENSE REIMBURSEMENT & MGMT FEES		900099	887,801	887,801
b	GIFT SHOP		900099	354,226			354,226
c	PARKING INCOME		900099	87,746			87,746
d	All other revenue ....			102,772	102,772
e	Total. Add lines 11a–11d ......			1,432,545
12	Total revenue. See Instructions......			296,919,779	279,457,635	961,319	14,500,132

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	20,050,000	20,050,000
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	96,449	96,449
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	10,255,402	8,794,007	1,461,395
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	85,993,465	77,829,973	8,163,492
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,028,854	1,846,257	182,597
9	Other employee benefits .......	6,316,153	5,747,700	568,453
10	Payroll taxes ...........	7,039,980	6,406,382	633,598
11	Fees for services (non-employees):
a	Management ......	10,255,402		10,255,402
b	Legal .........	607,381		607,381
c	Accounting ...........	163,982		163,982
d	Lobbying ...........	44,908		44,908
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	818,224	818,224
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	66,923,495	53,574,723	13,348,772
12	Advertising and promotion ....	1,321,244		1,321,244
13	Office expenses .......	1,640,173	1,476,156	164,017
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	5,524,646	3,591,020	1,933,626
17	Travel ............	418,801	347,605	71,196
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	4,738,647	3,885,690	852,957
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	16,571,428	14,582,857	1,988,571
23	Insurance ...	13,464,994	12,387,795	1,077,199
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	44,307,369	44,307,369		0
b	PUBLIC AID ASSESSMENT	14,360,208	14,360,208		0
c	REAL ESTATE TAXES	1,355,000	880,750	474,250	0
d	LAUNDRY SERVICES	1,101,010	1,101,010		0
e	All other expenses	1,970,819	1,040,790	930,029
25	Total functional expenses. Add lines 1 through 24e	317,368,034	273,124,965	44,243,069	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			16,690,300	1	0
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			41,385,841	4	34,641,963
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			5,721,103	8	5,256,985
9	Prepaid expenses and deferred charges ......			3,803,988	9	3,951,722
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	535,049,712
b	Less: accumulated depreciation	10b	339,717,373	192,018,062	10c	195,332,339
11	Investments—publicly traded securities .			260,815,096	11	216,934,465
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			3,063,752	13	2,629,877
14	Intangible assets ...............			663,952	14	636,045
15	Other assets. See Part IV, line 11 ...........			9,930,931	15	23,027,546
16	Total assets. Add lines 1 through 15 (must equal line 34)...			534,093,025	16	482,410,942

17	Accounts payable and accrued expenses .....	84,100,222	17	65,248,474
18	Grants payable ...	0	18	0
19	Deferred revenue .........	-1,383,657	19	712,478
20	Tax-exempt bond liabilities .........	109,949,339	20	107,696,467
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	9,170,537
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	18,945,673	25	13,001,339
26	Total liabilities. Add lines 17 through 25..	211,611,577	26	195,829,295

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	318,061,321	27	282,552,520
28	Temporarily restricted net assets ...........	4,420,127	28	4,029,127
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), 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 ...........	322,481,448	33	286,581,647
34	Total liabilities and net assets/fund balances ........	534,093,025	34	482,410,942