TY 2017 Form 990

- 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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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

UCM COMMUNITY HEALTH & HOSPITAL
DIVISION INC

Employer identification number

36-3181170

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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 ...............................2

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

(i) Name of supported organization	(ii) EIN	(iii) Type of organization (described on lines 1- 10 above (see instructions))	(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)
(A) THE INGALLS MEMORIAL HOSPITAL	362170866	3		No	0	0
(B) UNIVERSITY OF CHICAGO MEDICAL CENTER	363488813	3	Yes		0	0
Total 2

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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.

Yes

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.

Yes

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) 2019

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 (explain in Part VI). 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) 2019

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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
DESIGNATE BY CLASS OR PURPOSE	PART IV, SECTION A, LINE 1 UCHHD DESIGNATES ITS SUPPORTED ORGANIZATIONS BY CLASS OR PURPOSE AS FOLLOWS: THE CORPORATION WILL AT ALL TIMES BE ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC OR EDUCATIONAL PURPOSES WITHIN THE MEANING OF 501(C)(3) OF THE INTERNAL REVENUE LAW (THE "CODE"), TO PROMOTE AND SUPPORT, DIRECTLY OR INDIRECTLY, BY DONATION, LOAN OR OTHERWISE, THE INTERESTS AND PURPOSES OF ORGANIZATIONS THAT PROMOTE THE HEALTH OF THE COMMUNITY AND PROVIDE HEALTHCARE SERVICES, INCLUDING THE UNIVERSITY OF CHICAGO MEDICAL CENTER, AN ILLINOIS NOT-FOR-PROFIT CORPORATION, PROVIDED THAT SUCH ORGANIZATIONS ARE TAX-EXEMPT UNDER 501(C)(3) OF THE CODE ARE DESCRIBED IN 509(A)(1) OR (2) OF THE CODE. IN 509(A)(1) OR (2) OF THE CODE.
PART IV, SECTION B, LINE 2	UCHHD OPERATED FOR THE BENEFIT OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC). UCMC CONTROLS UCHHD AND INDIRECTLY CONTROLS THE INGALLS MEMORIAL HOSPITAL (IMH). UCHHD CARRIED OUT THE PURPOSES OF UCMC BY SUPPORTING IMH TO PROVIDE SUPERIOR HEALTH CARE IN A COMPASSIONATE MANNER WHILE MINDFUL OF EACH PATIENT'S DIGNITY AND INDIVIDUALITY. UCMC CALLS UPON THE SKILLS AND THE EXPERTISE OF ALL WHO WORK TOGETHER TO ADVANCE MEDICAL INNOVATION, SERVE THE HEALTH NEEDS OF THE COMMUNITY AND FURTHER THE KNOWLEDGE OF THOSE DEDICATED TO CARING.

Return Reference

Explanation

DESIGNATE BY CLASS OR PURPOSE

PART IV, SECTION A, LINE 1 UCHHD DESIGNATES ITS SUPPORTED ORGANIZATIONS BY CLASS OR PURPOSE AS FOLLOWS: THE CORPORATION WILL AT ALL TIMES BE ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC OR EDUCATIONAL PURPOSES WITHIN THE MEANING OF 501(C)(3) OF THE INTERNAL REVENUE LAW (THE "CODE"), TO PROMOTE AND SUPPORT, DIRECTLY OR INDIRECTLY, BY DONATION, LOAN OR OTHERWISE, THE INTERESTS AND PURPOSES OF ORGANIZATIONS THAT PROMOTE THE HEALTH OF THE COMMUNITY AND PROVIDE HEALTHCARE SERVICES, INCLUDING THE UNIVERSITY OF CHICAGO MEDICAL CENTER, AN ILLINOIS NOT-FOR-PROFIT CORPORATION, PROVIDED THAT SUCH ORGANIZATIONS ARE TAX-EXEMPT UNDER 501(C)(3) OF THE CODE ARE DESCRIBED IN 509(A)(1) OR (2) OF THE CODE. IN 509(A)(1) OR (2) OF THE CODE.

PART IV, SECTION B, LINE 2

UCHHD OPERATED FOR THE BENEFIT OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC). UCMC CONTROLS UCHHD AND INDIRECTLY CONTROLS THE INGALLS MEMORIAL HOSPITAL (IMH). UCHHD CARRIED OUT THE PURPOSES OF UCMC BY SUPPORTING IMH TO PROVIDE SUPERIOR HEALTH CARE IN A COMPASSIONATE MANNER WHILE MINDFUL OF EACH PATIENT'S DIGNITY AND INDIVIDUALITY. UCMC CALLS UPON THE SKILLS AND THE EXPERTISE OF ALL WHO WORK TOGETHER TO ADVANCE MEDICAL INNOVATION, SERVE THE HEALTH NEEDS OF THE COMMUNITY AND FURTHER THE KNOWLEDGE OF THOSE DEDICATED TO CARING.

Schedule A (Form 990 or 990-EZ) 2019

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

UCM COMMUNITY HEALTH & HOSPITAL
DIVISION INC

Employer identification number

36-3181170

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2019

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

Term 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 .....	448,148		448,148
b	Buildings ....	8,378,307	887,578	7,490,729
c	Leasehold improvements
d	Equipment ....	11,503	9,306	2,197
e	Other .....	271,203	47,461	223,742
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				8,164,816

Schedule D (Form 990) 2019

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
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	22,193,525

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
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
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	32,307,628
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) 2019

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	37,948,752
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-1,212,529
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	-5,316,214
e	Add lines 2a through 2d .....................			2e	-6,528,743
3	Subtract line 2e from line 1..................			3	44,477,495
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	20,062
b	Other (Describe in Part XIII.) ...........	4b	-42,905
c	Add lines 4a and 4b....................			4c	-22,843
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	44,454,652

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	41,936,470
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	42,905
e	Add lines 2a through 2d....................			2e	42,905
3	Subtract line 2e from line 1...................			3	41,893,565
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	20,062
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	20,062
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	41,913,627

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 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 JUNE 30, 2018, THE HEALTH SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. UCCHD 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 ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE.
SCHEDULE D, PART XI, LINE 2D	LOSS ON INVESTMENT IN AFFILIATES ($5,316,214) SCHEDULE D, PART XI, LINE 4B RECLASS RENTAL EXPENSE ($42,905) SCHEDULE D, PART XII, LINE 2D RECLASS RENTAL EXPENSE $42,905

Return Reference

Explanation

SCHEDULE D, PART X, LINE 2

THE 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 JUNE 30, 2018, THE HEALTH SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. UCCHD 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 ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE.

SCHEDULE D, PART XI, LINE 2D

LOSS ON INVESTMENT IN AFFILIATES ($5,316,214) SCHEDULE D, PART XI, LINE 4B RECLASS RENTAL EXPENSE ($42,905) SCHEDULE D, PART XII, LINE 2D RECLASS RENTAL EXPENSE $42,905

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

UCM COMMUNITY HEALTH & HOSPITAL
DIVISION INC

Employer identification number

36-3181170

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 on 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 on 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? .........

Yes

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

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

Only 501(c)(3), 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 nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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) 2019

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)
1AUDRE G BAGNALL BOARD MEMBER/EVP UCMC	(i) (ii)	0 ------------- 499,676	0 ------------- 285,162	0 ------------- 11,202	0 ------------- 99,555	0 ------------- 35,151	0 ------------- 930,746	0 ------------- 0
2SHARON O'KEEFE BOARD MEMBER/PRESIDENT UCMC	(i) (ii)	0 ------------- 1,087,914	0 ------------- 745,025	0 ------------- 303,429	0 ------------- 124,305	0 ------------- 34,021	0 ------------- 2,294,694	0 ------------- 171,626
3KENNETH POLONSKY MD BOARD MEMBER/EVP UCMC	(i) (ii)	0 ------------- 1,705,816	0 ------------- 440,000	0 ------------- 232,122	0 ------------- 343,000	0 ------------- 23,888	0 ------------- 2,744,826	0 ------------- 206,939
4SCOTT STRAUSSER BOARD MEMBER	(i) (ii)	0 ------------- 519,167	0 ------------- 0	0 ------------- 23,035	0 ------------- 8,100	0 ------------- 31,899	0 ------------- 582,201	0 ------------- 0
5KURT E JOHNSON PRESIDENT & CEO TIL 6/30/18	(i) (ii)	0 ------------- 1,771,967	0 ------------- 0	0 ------------- 18,000	0 ------------- 8,100	0 ------------- 22,329	0 ------------- 1,820,396	0 ------------- 0
6ANN MCCOLGAN TREASURER	(i) (ii)	0 ------------- 239,709	0 ------------- 72,403	0 ------------- 131,186	0 ------------- 29,244	0 ------------- 32,429	0 ------------- 504,971	0 ------------- 114,198
7JENNIFER HILL SECRETARY	(i) (ii)	0 ------------- 177,617	0 ------------- 0	0 ------------- 0	0 ------------- 14,019	0 ------------- 31,902	0 ------------- 223,538	0 ------------- 0
8RICHARD W SILVERIA CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 290,850	0 ------------- 100,000	0 ------------- 27,873	0 ------------- 48,490	0 ------------- 1,816	0 ------------- 469,029	0 ------------- 0
9GARY GASBARRA INTERIM CFO TIL 6/30/17	(i) (ii)	0 ------------- 355,193	0 ------------- 178,150	0 ------------- 350,578	0 ------------- 41,011	0 ------------- 21,735	0 ------------- 946,667	0 ------------- 216,878
10LINDA B CONWAY FMR SEC/TREAS TIL 6/30/17	(i) (ii)	0 ------------- 251,525	0 ------------- 0	0 ------------- 2,031	0 ------------- 7,607	0 ------------- 0	0 ------------- 261,163	0 ------------- 0

Schedule J (Form 990) 2019

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	COMPENSATION OF THE PRESIDENT AND CEO OF UCHHD IS DETERMINED BY THE EXECUTIVE COMMITTEE OF INGALLS MEMORIAL HOSPITAL. THE COMMITTEE'S DETERMINATION PROCESS UTILIZES A COMBINATION OF AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION STUDIES/SURVEYS, ALONG WITH APPROVAL BY THE COMPENSATION COMMITTEE.
SCHEDULE J, PART I, LINE 4B	CERTAIN INDIVIDUALS LISTED IN SCHEDULE J, PART II PARTICIPATE IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN TO WHICH UCMC MAKES ANNUAL CONTRIBUTIONS. THESE CONTRIBUTIONS ARE AT RISK AND DO NOT BECOME VESTED AND PAYABLE UNLESS AND UNTIL THE INDIVIDUAL SATISFIES A SUBSTANTIAL FUTURE SERVICE REQUIREMENT. THE FOLLOWING INDIVIDUALS HAD CONTRIBUTIONS MADE TO THE PLAN DURING CALENDAR YEAR 2017: AUDRE G. BAGNALL $79,305 SHARON O'KEEFE $104,055 ANN MCCOLGAN $10,660 RICHARD SILVERIA $40,125 GARY GASBARRA $20,761 THE FOLLOWING INDIVIDUALS HAD DISTRIBUTIONS FROM THE PLAN DURING CALENDAR YEAR 2017: SHARON O'KEEFE $171,626 KENNETH POLONSKY $206,939 ANN MCCOLGAN $114,198 GARY GASBARRA $216,878
SCHEDULE J, PART II	TAXABLE INCOME REPORTED IN COLUMN (B) MAY INCLUDE PAYMENTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN MOST CASES, THESE PAYMENTS WERE EARNED OVER MANY YEARS OF EMPLOYMENT AND THE AMOUNTS HAD PREVIOUSLY BEEN SUBJECT TO VESTING RULES. SERP PAYMENT AMOUNTS EARNED IN PRIOR YEARS WERE PREVIOUSLY REPORTED ON THE FORM 990 AS DEFERRED COMPENSATION AND ARE REPORTED IN THIS 2017 FORM 990 ON SCHEDULE J, PART II, COLUMN (F). AN INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD ANNUALLY REVIEWS THESE BENEFITS IN COMPARISON TO MARKET DATA AND HAS CONCLUDED THAT THESE BENEFITS AND ALL OTHER FORMS OF COMPENSATION PROVIDED TO THESE INDIVIDUALS ARE REASONABLE.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

UCM COMMUNITY HEALTH & HOSPITAL
DIVISION INC

Employer identification number

36-3181170

Return Reference	Explanation
FORM 990, PART VI, LINE 6	PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE VOTING MEMBER OF THE ORGANIZATION IS THE UNIVERSITY OF CHICAGO MEDICAL CENTER. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, IT HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE.
FORM 990, PART VI, LINE 7A	THE BOARD OF DIRECTORS SHALL CONSIST OF NINE INDIVIDUALS. FIVE OF THE NINE DIRECTORS SHALL BE ELECTED BY THE MEMBER BOARD FROM AMONG INDIVIDUALS SERVING AS TRUSTEES OF THE MEMBER BOARD OR MEMBERS OF THE SENIOR LEADERSHIP TEAM OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER.
FORM 990, PART VI, LINE 7B	A DIRECTOR MAY BE REMOVED AT ANY TIME, WITH OR WITHOUT CAUSE, BY THE MEMBER BOARD OR THE EXECUTIVE COMMITTEE OF THE MEMBER BOARD AS DETERMINED BY THE MEMBER BOARD OR THE EXECUTIVE COMMITTEE OF THE MEMBER BOARD, AS THE CASE MAY BE, IN ITS SOLE DISCRETION. UNIVERSITY OF CHICAGO MEDICAL CENTER MUST APPROVE, AMONGST OTHER ITEMS, ANY MODIFICATION OR AMENDMENT TO ANY MISSION STATEMENT, ANY STATEMENT OF GOALS OR VALUES, THESE BYLAWS OR THE CORPORATION'S ARTICLES OF INCORPORATION; THE SALE, LEASE, EXCHANGE, OR DISPOSITION OF SUBSTANTIALLY ALL THE ASSETS OF THE CORPORATION OR ANY OF ITS AFFILIATES; AND THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION OR ANY OF ITS AFFILIATES.
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 OFFICERS 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 COMMITTEE'S REVIEW PERFORMED. PRIOR TO FILING WITH THE IRS, THE FORM 990 WILL BE AVAILABLE AT THE ORGANIZATION'S BOARD MEETING FOR EACH MEMBER'S REVIEW.
FORM 990, PART VI, LINE 12C	PURSUANT TO THE ORGANIZATION'S 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 EXECUTIVE 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 ORGANIZATION'S 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 INGALL'S 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 BODY'S 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 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 SULLIVAN COTTER IN FY2017. 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 DETERMINE COMPENSATION FOR THE CEO WAS LAST UNDERTAKEN IN FY2017.
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	ALL DOCUMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	LOSS ON INVESTMENT IN AFFILIATES ($5,316,214) OTHER ADJUSTMENTS $2,454 ------------ TOTAL ($5,313,760)

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

UCM COMMUNITY HEALTH & HOSPITAL
DIVISION INC

Employer identification number

36-3181170

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
(1) INGALLS CARE NETWORK LLC 71 W 156TH STREET SUITE 500 HARVEY,IL60426 35-2477424	HEALTHCARE	IL	2,835,464	2,511,531	UCHHD

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)ARCH DEVELOPMENT CORPORATION 5555 S WOODLAWN AVENUE CHICAGO,IL60637 36-3485244	TECH TRANSFER	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(2)ASIAN HEALTH COALITION 180 W WASHINGTON ST SUITE 1000 CHICAGO,IL60602 31-1607193	HLTH ACCESS	IL	501(C)(3)	LINE 10	UNIV CHICAGO		No
(3)CHAPIN HALL CENTER FOR CHILDREN 1313 E 60TH STREET CHICAGO,IL60637 36-2167012	POL RES CTR	IL	501(C)(3)	LINE 7	N/A		No
(4)CHICAGO TUMOR INSTITUTE 5801 S ELLIS AVENUE CHICAGO,IL60637 23-7136019	SUPP RESEARCH	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(5)COURT THEATRE FUND 5535 S ELLIS AVENUE CHICAGO,IL60637 36-3203660	SUPP THE ARTS	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(6)FERMI RESEARCH ALLIANCE LLC PO BOX 500 BATAVIA,IL60510 57-1239010	MANAGE LAB	IL	501(C)(3)	LINE 7	NA		No
(7)HYMEN MILGROM SUPPORTING ORGANIZATION 33 N LASALLE ST STE 2131 CHICAGO,IL60602 46-6789522	SUPP EDU RES	VA	501(C)(3)	12D, III	N/A		No
(8)INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY,IL60426 36-3189150	SUPPORT	IL	501(C)(3)	7	UCHHD	Yes
(9)INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY,IL60426 36-3239703	AMBULATORY	IL	501(C)(3)	LINE 12A, I	UCCHD	Yes
(10)INGALLS HOME CARE ONE INGALLS DRIVE HARVEY,IL60426 36-3367939	HEALTHCARE	IL	501(C)(3)	10	UCHHD	Yes
(11)LAKE PARK ASSOCIATES 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6111317	PROP HOLDG	IL	501(C)(2)		UNIV CHICAGO		No
(12)NATIONAL OPINION RESEARCH CENTER (NORC) 55 E MONROE AVENUE CHICAGO,IL60603 36-2167808	SO SCI SRVYS	IL	501(C)(3)	LINE 7	NA		No
(13)PHOENIX OVERLAY FUND LTD 401 N MICHIGAN AVE C/O INVST OFFIC CHICAGO,IL60611	INVESTING	CJ			UNIV CHICAGO		No
(14)PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY,IL60426 36-4132865	HEALTHCARE	IL	501(C)(3)	10	UCHHD	Yes
(15)SOUTHEAST CHICAGO COMMISSION 1511 E 53RD STREET CHICAGO,IL60615 36-2226282	COMM SRVS	IL	501(C)(3)	LINE 7	UNIV CHICAGO		No
(16)THE INGALLS MEMORIAL HOSPITAL ONE INGALLS DRIVE HARVEY,IL60426 36-2170866	HOSPITAL	IL	501(C)(3)	3	UCHHD	Yes
(17)THE JOHN CRERAR FOUNDATION 5730 S ELLIS AVENUE CHICAGO,IL60637 36-3155157	SUPP LIBRARY	IL	501(C)(3)	12D,III	UNIV CHICAGO		No
(18)THE MARINE BIOLOGICAL LABORATORY 7 MBL STREET WOODS HOLE,MA02543 04-2104690	RES & EDU	MA	501(C)(3)	LINE 7	UNIV CHICAGO		No
(19)THE QUADRANGLE CLUB 5801 S ELLIS AVENUE CHICAGO,IL60637 36-1655190	SOCIAL CLUB	IL	501(C)(7)		UNIV CHICAGO		No
(20)THE UNIV OF CHICAGO FDN IN HONG KONG LTD RM100 FAR E CTR C/O WM FAN CO HONG KONG CH	FUNDRAISING	HK			UNIV CHICAGO		No
(21)THE UNIVERSITY OF CHICAGO CLOISTERS CLUB 1212 E 59TH STREET CHICAGO,IL60637	SOCIAL CLUB	IL			UNIV CHICAGO		No
(22)UCHICAGO RESEARCH BANGLADESH LTD HSE 388 ROAD 24 NEW DOH DHAKA BG	RESEARCH	BG			UCH RS INTL		No
(23)UCHICAGO RESEARCH INTERNATIONAL LIMITED 5801 S ELLIS AVENUE CHICAGO,IL60637 26-2741573	RESEARCH	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(24)UCMC TITLE HOLDING CORPORATION 8201 SOUTH CASS AVENUE DARIEN,IL60561 81-2126789	TITLE HOLD	IL	501(C)(3)	12, III	UCMC		No
(25)UCMC TITLE HOLDING CORPORATION II 5841 S MARYLAND AVE MC 1086 CHICAGO,IL60637 82-1736040	TITLE HOLD	IL	501(C)(3)	12, III	UCMC		No
(26)UNIV OF CHI BOOTH SCH OF BUS (SINGAPORE) 101 PENANG ROAD 238466 SINGAPORE SN	EDUCATION	SN			UNIV CHICAGO		No
(27)UNIV OF CHI BOOTH SCH OF BUS (UK) WOOLGATE EXCHANGE 25 BASINGHAL LONDON UK	EDUCATION	UK			UNIV CHICAGO		No
(28)UNIV OF CHICAGO CANCER RESEARCH FD 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6056201	SUPP RESEARCH	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(29)UNIV OF CHICAGO CENTER IN PARIS (FRANCE) 6 RUE THOMAS MANN 75013 PARIES FR	EDUCATION	FR			UNIV CHICAGO		No
(30)UNIV OF CHICAGO CHARTER SCHOOL CORP 5801 S ELLIS AVENUE CHICAGO,IL60637 36-4225812	EDUCATION	IL	501(C)(3)	LINE 2	UNIV CHICAGO		No
(31)UNIV OF CHICAGO PROPERTY HOLDING CO 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6108743	PROP HLDG	IL	501(C)(2)		UNIV CHICAGO		No
(32)UNIV OF CHICAGO RETIREE MEDICAL TRUST 5801 S ELLIS AVENUE CHICAGO,IL60637 36-3999692	MEDICAL TRUST	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(33)UNIV OF CHICAGO SELF INSURANCE TRUST 5801 S ELLIS AVENUE CHICAGO,IL60637 36-3020034	MALPRAC TR	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No
(34)UNIVERSITY OF CHICAGO 5801 S ELLIS AVENUE CHICAGO,IL60637 36-2177139	EDUCATION	IL	501(C)(3)	LINE 2	NA		No
(35)UNIVERSITY OF CHICAGO MEDICAL CENTER 5841 S MARYLAND AVE MC 1086 CHICAGO,IL60637 36-3488183	HOSPITAL	IL	501(C)(3)	3	UNIV CHICAGO		No
(36)UNIVERSITY OF CHICAGO TRUST (INDIA) GB10-12 CLAIRMONT APTS RST HSE BANGALORE IN	FUNDRAISING	IN			UNIV CHICAGO		No
(37)CHICAGO HOME FOR THE INCURABLES 5801 S ELLIS AVENUE CHICAGO,IL60637 36-2169138	SUPP RESEARCH	IL	501(C)(3)	LINE 12A, I	UNIV CHICAGO		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2019

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 LTD 6701 W 159TH STREET TINLEY PARK,IL60477 36-3368549	SURGERY CENTER	IL	IHV	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) CHARITABLE LEAD TRUST (1) 5801 S ELLIS AVENUE CHICAGO,IL60637	CHAR LEAD TRUST	IL	UNIV OF CHICAGO	TRUST					No
(2) CHARITABLE REMAINDER TRUSTS (80) 5801 S ELLIS AVENUE CHICAGO,IL60637	CHAR RMDR TRUST	IL	UNIV OF CHICAGO	TRUST					No
(3) INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY,IL60426 98-0485714	LIAB INSURANCE	CJ	UCHHD	C CORP	1,995,758	13,137,570	100.000 %	Yes
(4) INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY,IL60426 27-3226539	PURCHASING GROUP	IL	UCHHD	C CORP				Yes
(5) INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY,IL60426 36-3485578	INSURANCE SERVICE	IL	IMH	C CORP	14,868,357	2,195,936	100.000 %	Yes
(6) MEDCENTRIX INC ONE INGALLS DRIVE HARVEY,IL60426 36-3374228	BILLING & MGMT	IL	UCHHD	C CORP	6,609,739	2,425,868	100.000 %	Yes
(7) POOLED INCOME FUND (1) 5801 S ELLIS AVENUE CHICAGO,IL60637	POOLED INCO FUND	IL	UNIV OF CHICAGO	C CORP					No
(8) UCHICAGO (BEIJING) CONSULTING CO LTD UNIT 1-10 CULTURE PL OF REMMIN UNI BEIJING CH	CONSULTING	CH	UNIV OF CHICAGO						No
(9) UCHICAGO CENTER IN INDIA PRIVATE LIMITED UNIT 5-10 GRD FL DLF CAPITAL POINT NEW HELHI IN	CONSULTING	IN	UNIV OF CHICAGO	C CORP					No
(10) UCM CARE NETWORK MEDICAL GROUP INC 5841 S MARYLAND AVENUE CHICAGO,IL60637 47-4221241	HEALTH SERVICES	IL	UCMC	C CORP					No
(11) SC CURRICULUM INC 70 WEST MADISON ST CHICAGO,IL60602	SCNC CURRICULUM	IL	UNIV OF CHICAGO	C CORP					No

Schedule R (Form 990) 2019

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) ............................

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

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) ............................

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) INGALLS MEMORIAL HOSPITAL	q	9,453,691	FMV
(2) INGALLS HOME CARE	q	453,104	FMV
(3) INGALLS HEALTH VENTURES	q	635,648	FMV
(4) INGALLS DEVELOPMENT FOUNDATION	q	416,690	FMV
(5) MEDCENTRIX	q	533,578	FMV
(6) INGALLS SAME DAY SURGERY	q	150,846	FMV
(7) PRIMARY HEALTHCARE ASSOCIATES SC	q	42,185	FMV
(8) INGALLS MEMORIAL HOSPITAL	p	278,568	FMV
(9) MEDCENTRIX	p	708,000	FMV
(10) INGALLS PROVIDER GROUP	P	1,764,831	FMV
(11) MEDCENTRIX	a(iv)	53,040	FMV
(12) INGALLS MEMORIAL HOSPITAL	a(iv)	322,001	FMV
(13) PRIMARY HEALTHCARE ASSOCIATES SC	a(iv)	348,828	FMV

Schedule R (Form 990) 2019

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) 2019

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) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. (UCHHD) SUPPORTS AND ENCOURAGES HEALTH AND HUMAN SERVICE BY PROVIDING ASSISTANCE TO RELATED 501 (C) (3) HOSPITALS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	4
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	4
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-7,929
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-7,929

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	15,445,289	43,962,014
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,130,812	500,567
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-6,337	-7,929
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	16,569,764	44,454,652
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
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)....	14,472,107	41,913,627
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	14,472,107	41,913,627
19	Revenue less expenses. Subtract line 18 from line 12.......	2,097,657	2,541,025
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	47,436,829	58,154,307
21	Total liabilities (Part X, line 26).............	45,454,168	60,156,910
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,982,661	-2,002,603

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 38,596,743 including grants of $ ) (Revenue $ 43,962,014 )
	UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. INCREASES EFFICIENCY IN ADMINISTERING PROGRAMS BY SPONSORING PRODUCTIVITY AND COST SAVINGS INITIATIVES FOR RELATED AND AFFILIATED 501(C)(3) ORGANIZATIONS. UCHHD OPERATES TWO PROFESSIONAL OFFICE BUILDINGS TO PROVIDE ACCESS TO HEALTHCARE SERVICES FOR COMMUNITY MEMBERS.

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












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












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses38,596,743

(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)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) AUDRE G BAGNALL...................................................................... BOARD MEMBER/EVP UCMC	1.0 ................. 40.0	X			0	796,040	134,706
(2) RICHARD KING...................................................................... BOARD MEMBER	1.0 ................. 2.0	X			0	0	0
(3) SHARON O'KEEFE...................................................................... BOARD MEMBER/PRESIDENT UCMC	1.0 ................. 40.0	X			0	2,136,368	158,326
(4) DAVID ORTH MD...................................................................... BOARD MEMBER	1.0 ................. 1.0	X			0	0	0
(5) KENNETH POLONSKY MD...................................................................... BOARD MEMBER/EVP UCMC	1.0 ................. 40.0	X			0	2,377,938	366,888
(6) SCOTT STRAUSSER...................................................................... BOARD MEMBER	1.0 ................. 40.0	X			0	542,202	39,999
(7) JOHN A SVOBODA...................................................................... BOARD MEMBER UCMC	1.0 ................. 1.0	X			0	0	0
(8) TERRY VAN DER AA...................................................................... BOARD MEMBER UCMC	1.0 ................. 1.0	X			0	0	0
(9) KURT E JOHNSON...................................................................... PRESIDENT & CEO TIL 6/30/18	1.0 ................. 43.0	X	X		0	1,789,967	30,429
(10) ANN MCCOLGAN...................................................................... TREASURER	1.0 ................. 40.0		X		0	443,298	61,673
(11) JENNIFER HILL...................................................................... SECRETARY	1.0 ................. 40.0		X		0	177,617	45,921
(12) RICHARD W SILVERIA...................................................................... CHIEF FINANCIAL OFFICER	1.0 ................. 40.0		X		0	418,723	50,306
(13) GARY GASBARRA...................................................................... INTERIM CFO TIL 6/30/17	1.0 ................. 40.0			X	0	883,921	62,746
(14) LINDA B CONWAY...................................................................... FMR SEC/TREAS TIL 6/30/17	1.0 ................. 40.0			X	0	253,556	7,607

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	9,819,630	958,601

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

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

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

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		0

		Business Code
2a	MANAGEMENT FEE	900099	11,685,743	11,685,743
b	SELF INSURANCE REVENUE	900099	27,998,099	27,998,099
c	RENTAL INCOME	900099	1,442,708	1,442,708
d	ICN PROGRAM SERVICE REVENUE	900099	2,835,464	2,835,464
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		43,962,014

3 Investment income (including dividends, interest, and othersimilar amounts) ......			77,564			77,564
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		34,976	6a
b	Less: rental expenses		42,905	6b
c	Rental income or (loss)	0	-7,929	6c
d	Net rental income or (loss).......			-7,929		-7,929
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		423,003	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)		423,003	7c
d	Net gain or (loss).........			423,003			423,003
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			44,454,652	43,962,014	-7,929	500,567

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 ...........	0
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........	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	0
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	986,568		986,568	0
b	Legal .........	73,087		73,087
c	Accounting ...........	26,299		26,299
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	20,062		20,062
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	1,606,945	694,363	912,582
12	Advertising and promotion ....	9,763		9,763
13	Office expenses .......	13,438	6,200	7,238
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	80,594		80,594
17	Travel ............	412,471	410,487	1,984
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	492,790		492,790
23	Insurance ...	26,996,270	26,996,270
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	SALARY NON-EMPLOYEES	10,419,574	9,904,660	514,914
b	REAL ESTATE TAXES	540,882	351,573	189,309
c	CONTRACTED SERVICES	182,791	182,791
d	MISCELLANEOUS EXPENSES	31,726	31,726
e	All other expenses	20,367	18,673	1,694
25	Total functional expenses. Add lines 1 through 24e	41,913,627	38,596,743	3,316,884	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 ........			0	1	0
2	Savings and temporary cash investments .........			14,175,457	2	19,483,409
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			2,219,237	4	1,007,714
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			0	8	0
9	Prepaid expenses and deferred charges ......			130,237	9	63,109
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	9,109,161
b	Less: accumulated depreciation	10b	944,345	8,700,510	10c	8,164,816
11	Investments—publicly traded securities .			5,063,574	11	5,546,712
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			9,254,360	13	22,193,525
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			7,893,454	15	1,695,022
16	Total assets. Add lines 1 through 15 (must equal line 33)...			47,436,829	16	58,154,307

17	Accounts payable and accrued expenses .....	19,160,299	17	27,849,282
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		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	0
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	26,293,869	25	32,307,628
26	Total liabilities. Add lines 17 through 25..	45,454,168	26	60,156,910

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	1,982,661	32	-2,002,603
33	Total liabilities and net assets/fund balances ........	47,436,829	33	58,154,307