TY 2021 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/1099-NEC)
(1) RANDY NEISWONGER BOARD MEMBER/CHIEF OPERATING OFFICER	1.0 ................. 46.0	X	X		544,558	71,534
(2) AUDRE G BAGNALL BOARD MEMBER/EVP UCMC	1.0 ................. 41.0	X			1,131,712	122,673
(3) DAVID H ORTH MD BOARD MEMBER (THRU 7/1/21)	1.0 ................. 2.0	X			0	0
(4) JOHN A SVOBODA BOARD MEMBER UCMC	1.0 ................. 1.0	X			0	0
(5) JOSEPH P NOLAN TRUSTEE UCMC (EFF. 7/1/22)	1.0 ................. 1.0	X			0	0
(6) KENNETH S POLONSKY MD CHAIRMAN/EVP UCMC	1.0 ................. 61.0	X			2,846,136	785,139
(7) KEVIN M PURCELL BOARD MEMBER	1.0 ................. 2.0	X			0	0
(8) NATHANIEL SUTTON BOARD MEMBER INGALLS (EFF. 10/6/21)	1.0 ................. 1.0	X			0	0
(9) TERRY L VAN DER AA BOARD MEMBER UCMC (THRU 7/1/21)	1.0 ................. 1.0	X			0	0
(10) THOMAS JACKIEWICZ BOARD MEMBER/PRESIDENT UCMC	1.0 ................. 41.0	X			1,795,785	311,782
(11) ANN MCCOLGAN TREASURER	1.0 ................. 45.0		X		488,668	81,343
(12) DOUGLAS SAEGESSER CHIEF FINANCIAL OFFICER (THRU 9/8/2021)	1.0 ................. 43.0		X		447,895	35,479
(13) IVAN SAMSTEIN CHIEF FINANCIAL OFFICER, UCMC	1.0 ................. 48.0		X		854,927	125,085
(14) JENNIFER HILL SECRETARY	1.0 ................. 41.0		X		206,854	48,112
(15) SARA HAGGERTY INTERIM CHIEF FINANCIAL OFFICER (EFF. 10/6/21)	1.0 ................. 43.0		X		310,126	21,533
(16) BRIAN SINOTTE FORMER BOARD MEMBER/PRESIDENT (THRU 5/31/21)	0.0 ................. 0.0			X	423,750	7,627
(17) GARY GASBARRA INTERIM CFO TIL 6/30/17	0.0 ................. 42.0			X	610,418	78,815

(A) Name and business address	(B) Description of services	(C) Compensation
PRICEWATERHOUSECOOPERS LLP 300 MADISON AVENUE NEW YORK,NY10017	INTERNAL AUDIT SERVICES	810,401
SPECTRUM HEALTH PARTNERS LLC 341 COOK SPRINGS BLVD FRANKLIN,TN37067	STAFFING SERVICES	134,958
COMMUNITY COUNSELLING SERVICE CO LLC 155 NORTH WACKER DRIVE SUITE 1790 CHICAGO,IL60606	DEVELOPMENT SERVICES	110,000


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 4

- TIN:

SCHEDULE A
(Form 990)

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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

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

OMB No. 1545-0047

2021

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).)

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 33 1/3% 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 33 1/3% 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 on 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	363488183	3	Yes		0	0
Total 2					0	0

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

Cat. No. 11285F

Schedule A (Form 990) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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, Part IV, Section A, Line 1 Supported Orgs Listed By Name	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.
Schedule A, Part IV, Section B, Line 2 Benefit Of Supp. Org. Other Than The One Operating The Org.	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

Schedule A, Part IV, Section A, Line 1 Supported Orgs Listed By Name

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.

Schedule A, Part IV, Section B, Line 2 Benefit Of Supp. Org. Other Than The One Operating The Org.

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) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

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) 2021

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	2,916,329	5,461,978
c	Leasehold improvements
d	Equipment ....	11,503	11,503	0
e	Other .....	271,203	155,942	115,261
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				6,025,387

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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

Investments - Program 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)457B	2,093,085	F
(2)MALPRACTICE	914,181	F
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	3,007,266

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)INVESTMENTS - ICN				5,230,459
(2)DUE TO AFFILIATES - NET				2,393,002
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				7,623,461

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
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	25,593,717
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) 2021

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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

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
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
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

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 FIN 48 (ASC 740) footnote	THE SYSTEM APPLIES ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S CONSOLIDATED FINANCIAL STATEMENTS. ASC TOPIC 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 TOPIC 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, 2022 AND 2021, THE SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. UCHHD 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.

Return Reference

Explanation

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

THE SYSTEM APPLIES ASC TOPIC 740, INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN A COMPANY'S CONSOLIDATED FINANCIAL STATEMENTS. ASC TOPIC 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 TOPIC 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, 2022 AND 2021, THE SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. UCHHD 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 (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization
UCM Community Health & Hospital Division Inc

Employer identification number

36-3181170

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(f) Total expenditures for and investments in the region
	Central America and the Caribbean	1	0	Investments	9,855,119
















3a	Sub-total ....	1	0		9,855,119
b	Total from continuation sheets to Part I ...	0	0		0
c	Totals (add lines 3a and 3b)	1	0		9,855,119

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021

Schedule F (Form 990) 2021

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of noncash assistance	(h) Description of noncash assistance	(i) Method of valuation (book, FMV, appraisal, other)

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2021

Schedule F (Form 990) 2021Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2021

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2021

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation
Schedule F, Part I, Line 3 Method used to account for expenditures on org's financial statements	CENTRAL AMERICA AND THE CARIBBEAN-Other:FMV

Schedule F (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

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? .............

Yes

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1BRIAN SINOTTE FORMER BOARD MEMBER/PRESIDENT (THRU 5/31/21)	(i) (ii)	0 ------------- 266,509	0 ------------- 148,065	0 ------------- 9,176	0 ------------- 0	0 ------------- 7,627	0 ------------- 431,376	0 ------------- 0
2RANDY NEISWONGER BOARD MEMBER/CHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 423,391	0 ------------- 120,452	0 ------------- 714	0 ------------- 31,927	0 ------------- 39,607	0 ------------- 616,092	0 ------------- 0
3AUDRE G BAGNALL BOARD MEMBER/EVP UCMC	(i) (ii)	0 ------------- 573,434	0 ------------- 220,503	0 ------------- 337,775	0 ------------- 97,410	0 ------------- 25,263	0 ------------- 1,254,386	0 ------------- 94,050
4THOMAS JACKIEWICZ BOARD MEMBER/PRESIDENT UCMC	(i) (ii)	0 ------------- 1,571,443	0 ------------- 60,321	0 ------------- 164,021	0 ------------- 290,623	0 ------------- 21,159	0 ------------- 2,107,567	0 ------------- 0
5KENNETH S POLONSKY MD CHAIRMAN/EVP UCMC	(i) (ii)	0 ------------- 1,589,538	0 ------------- 681,138	0 ------------- 575,460	0 ------------- 760,310	0 ------------- 24,829	0 ------------- 3,631,274	0 ------------- 380,150
6GARY GASBARRA INTERIM CFO TIL 6/30/17	(i) (ii)	0 ------------- 366,230	0 ------------- 102,416	0 ------------- 141,771	0 ------------- 52,141	0 ------------- 26,674	0 ------------- 689,233	0 ------------- 47,146
7RICHARD W SILVERIA FORMER CFO TIL 3/31/20	(i) (ii)	0 ------------- 250,773	0 ------------- 435,412	0 ------------- 1,220,688	0 ------------- 0	0 ------------- 21,121	0 ------------- 1,927,994	0 ------------- 514,033
8SARA HAGGERTY INTERIM CHIEF FINANCIAL OFFICER (EFF. 10/6/21)	(i) (ii)	0 ------------- 243,489	0 ------------- 47,567	0 ------------- 19,069	0 ------------- 10,781	0 ------------- 10,752	0 ------------- 331,659	0 ------------- 0
9JENNIFER HILL SECRETARY	(i) (ii)	0 ------------- 202,795	0 ------------- 4,059	0 ------------- 0	0 ------------- 8,747	0 ------------- 39,364	0 ------------- 254,966	0 ------------- 0
10ANN MCCOLGAN TREASURER	(i) (ii)	0 ------------- 279,136	0 ------------- 76,499	0 ------------- 133,033	0 ------------- 40,057	0 ------------- 41,286	0 ------------- 570,011	0 ------------- 26,910
11DOUGLAS SAEGESSER CHIEF FINANCIAL OFFICER (THRU 9/8/2021)	(i) (ii)	0 ------------- 267,351	0 ------------- 63,944	0 ------------- 116,599	0 ------------- 1,180	0 ------------- 34,300	0 ------------- 483,374	0 ------------- 15,859
12IVAN SAMSTEIN CHIEF FINANCIAL OFFICER, UCMC	(i) (ii)	0 ------------- 692,648	0 ------------- 125,203	0 ------------- 37,077	0 ------------- 81,600	0 ------------- 43,485	0 ------------- 980,012	0 ------------- 0

Schedule J (Form 990) 2021

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 Arrangement used to establish the top management official's compensation	COMPENSATION OF THE PRESIDENT AND CEO OF UCHHD IS REVIEWED AND RECOMMENDED FOR APPROVAL BY THE COMPENSATION COMMITTEE OF UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE COMMITTEE'S DETERMINATION PROCESS UTILIZES A COMBINATION OF AN INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION STUDIES/SURVEYS, ALONG WITH APPROVAL BY THE COMPENSATION COMMITTEE, WHICH IS THEN REVIEWED AND APPROVED BY THE UCMC COMPENSATION COMMITTEE. THE UCHHD COMPENSATION COMMITTEE CONDUCTS ITS REVIEW AND APPROVAL PROCESS IN A MANNER DESIGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW. THIS IS A RIGOROUS REVIEW AND APPROVAL PROCESS DESIGNED FOR TAX-EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE, AND IS DESIGNED TO RESULT IN COMPETITIVE AND REASONABLE COMPENSATION.
Schedule J, Part I, Line 4a Severance or change-of-control payment	IN CALENDAR YEAR 2021, RICHARD SILVERIA AND DOUGLAS SAEGESSER RECEIVED SEVERANCE PAYMENTS FOLLOWING THEIR TERMINATION OF EMPLOYMENT ($1,080,964 TO RICHARD SILVERIA AND $116,599 TO DOUGLAS SAEGESSER). SOME OF THESE AMOUNTS WERE PREVIOUSLY REPORTED ON A PRIOR FORM 990 AS DEFERRED COMPENSATION AS SET FORTH IN COLUMN (F) OF PART II.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	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 IN JANUARY 2022 FOR CALENDAR YEAR 2021: KENNETH POLONSKY ANN MCCOLGAN AUDRE G. BAGNALL DOUGLAS SAEGESSER GARY GASBARRA IVAN SAMSTEIN RANDY NEISWONGER THOMAS JACKIEWICZ THE FOLLOWING INDIVIDUALS BECAME VESTED IN, AND WERE TAXED ON, AMOUNTS PREVIOUSLY CREDITED UNDER THE PLAN TO THE INDIVIDUAL FOR SERVICES PROVIDED TO THE ORGANIZATION IN PRIOR YEARS (INCLUDED IN 2021 W-2S): KENNETH POLONSKY - $380,150 ANN MCCOLGAN - $26,910 AUDRE BAGNALL - $94,050 GARY GASBARRA - $47,146 RICHARD SILVERIA AND DOUGLAS SAEGESSER RECEIVED A DISTRIBUTION FROM A SUPPLEMENTAL RETIREMENT PLAN FOLLOWING THEIR TERMINATION OF EMPLOYMENT, IN ACCORDANCE WITH THE GOVERNING PLAN DOCUMENT ($514,033 TO RICHARD SILVERIA AND $15,859 TO DOUGLAS SAEGESSER). THESE DISTRIBUTIONS WERE REPORTED AS TAXABLE INCOME AND ARE INCLUDED IN THE COMPENSATION DISCLOSED IN SCHEDULE J IN THE REPORTED YEAR.
Schedule J, Part II COLUMN (B)	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 2021 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. THE INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD CONDUCTS ITS REVIEW AND APPROVAL OF ALL EXECUTIVE COMPENSATION, INCLUDING THESE SERP AMOUNTS, IN A MANNER THAT QUALIFIES FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER FEDERAL TAX LAW. THIS IS A RIGOROUS REVIEW PROCESS DESIGNED FOR TAX-EXEMPT ORGANIZATIONS BY THE INTERNAL REVENUE SERVICE, AND IT MEANS THAT THE BOARD COMPENSATION COMMITTEE DOES NOT HAVE ANY CONFLICTS OF INTEREST, AND RELIES ON MARKET DATA COMPILED BY AN INDEPENDENT COMPENSATION CONSULTANT TO SUPPORT ALL EXECUTIVE PAY AS MARKET COMPETITIVE AND REASONABLE.

Schedule J (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

SCHEDULE O
(Form 990)

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

2021

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 Classes of members or stockholders	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 Members or stockholders electing members of governing body	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 Decisions requiring approval by members or stockholders	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 Review of form 990 by governing body	THE FORM 990 IS PREPARED INTERNALLY AND REVIEWED IN DETAIL BY AN INDEPENDENT ACCOUNTING FIRM. 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 THE 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 Conflict of interest policy	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 Process to establish compensation of top management official	THE UNIVERSITY OF CHICAGO MEDICAL CENTER (UCMC) IS RESPONSIBLE FOR DETERMINING AND ADMINISTERING COMPENSATION FOR ALL OFFICERS OF EACH RESPECTIVE ENTITY WITHIN THE UCMC CORPORATE STRUCTURE. ALL COMPENSATION AND BENEFIT APPROVALS ARE MADE (BY THE UCM CHHD COMPENSATION COMMITTEE, AS EXPLAINED BELOW) AS RECOMMENDATIONS TO THE UCMC COMPENSATION COMMITTEE AND ARE SUBJECT TO FURTHER REVIEW AND APPROVAL BY THE UCMC COMPENSATION COMMITTEE. BELOW IS THE PROCESS USED TO ESTABLISH COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL AND SENIOR EXECUTIVES. THE UCM COMMUNITY HOSPITAL AND HEALTHCARE DIVISION, INC (UCM CHHD) COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES (THE COMMITTEE) IS RESPONSIBLE FOR THE OVERSIGHT OF THE UCM CHHD EXECUTIVE COMPENSATION DECISION-MAKING PROCESS. ITS REVIEW PROCESS IS DESIGNED TO SATISFY THE PROCEDURAL CRITERIA NECESSARY TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS (UNDER INTERMEDIATE SANCTIONS REGULATIONS) WITH RESPECT TO THE TOTAL COMPENSATION AND BENEFITS PROVIDED. THE COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS, ALL OF WHOM ARE "DISINTERESTED" WITHIN THE MEANING OF THE INTERMEDIATE SANCTION REGULATIONS. IT REVIEWS AND APPROVES COMPENSATION AND EMPLOYEE BENEFITS PROVIDED TO THE ORGANIZATION'S PRESIDENT AND KEY EXECUTIVES BY FOLLOWING ITS WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT AND WRITTEN COMPENSATION REVIEW PROCESS, WHICH INCLUDES SEEKING COUNSEL FROM OUTSIDE PROFESSIONAL ADVISORS AND RELYING IN ADVANCE ON APPROPRIATE COMPARABILITY DATA (FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILARLY SITUATED HEALTHCARE ORGANIZATIONS) PROVIDED BY AN INDEPENDENT THIRD-PARTY CONSULTANT. THE COMMITTEE REVIEWS AND APPROVES ALL NEW COMPENSATION RANGES, AS WELL AS CURRENT PACKAGES FOR NEWLY HIRED EXECUTIVES , AS NEEDED, BUT AT LEAST ANNUALLY. IT PREPARES A TIMELY AND THOROUGH WRITTEN RECORD OF ITS DELIBERATIONS AND CONCLUSIONS.
Form 990, Part VI, Line 19 Required documents available to the public	UCM CHHD'S BYLAWS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part VII, Section A FORMER OFFICER	GARY GASBARRA IS A CURRENT EXECUTIVE OF UCMC AND THE LISTED COMPENSATION RELATES TO THE EMPLOYEE'S ONGOING POSITION AT UCMC, NOT AS FORMER CFO OF UCM CHHD.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	REVERSAL OF PRIOR YEAR ADJUSTMENT - MEDCENTRIX - 4359; INVESTMENT IN AFFILIATES - -433036;

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

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 71 W 156TH STREET SUITE 500 HARVEY,IL60426 35-2477424	HEALTHCARE	IL	1,772,699	1,846,467	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)	Type I	UNIV CHICAGO		No
(2)ASIAN HEALTH COALITION 180 W WASHINGTON ST SUITE 1 CHICAGO,IL60602 31-1607193	HLTH ACCESS	IL	501(c)(3)	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)	7	NA		No
(4)CHICAGO HOME FOR THE INCURABLES 5801 S ELLIS AVENUE CHICAGO,IL60637 36-2169138	SUPP RESEARCH	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(5)CHICAGO TUMOR INSTITUTE 5801 S ELLIS AVENUE CHICAGO,IL60637 23-7136019	SUPP RESEARCH	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(6)COURT THEATRE FUND 5535 S ELLIS AVENUE CHICAGO,IL60637 36-3203660	SUPP THE ARTS	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(7)FERMI RESEARCH ALLIANCE LLC PO BOX 500 BATAVIA,IL60510 57-1239010	MANAGE LAB	IL	501(c)(3)	7	NA		No
(8)HYMEN MILGROM SUPPORTING ORGANIZATION 33 N LASALLE ST STE 2131 CHICAGO,IL60602 46-6789522	SUPP EDU RES	VA	501(c)(3)	Type III-O	NA		No
(9)INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY,IL60426 36-3189150	SUPPORT	IL	501(c)(3)	7	UCHHD	Yes
(10)INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY,IL60426 36-3239703	AMBULATORY	IL	501(c)(3)	Type I	UCHHD	Yes
(11)INGALLS HOME CARE ONE INGALLS DRIVE HARVEY,IL60426 36-3367939	HEALTHCARE	IL	501(c)(3)	10	IMH		No
(12)INGALLS MEMORIAL HOSPITAL ONE INGALLS DRIVE HARVEY,IL60426 36-2170866	HOSPITAL	IL	501(c)(3)	3	UCHHD	Yes
(13)LAKE PARK ASSOCIATES 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6111317	PROP HOLDG	IL	501(c)(2)		UNIV CHICAGO		No
(14)NATIONAL OPINION RESEARCH CENTER (NORC) 55 E MONROE AVENUE CHICAGO,IL60603 36-2167808	SO SCI SRVYS	IL	501(c)(3)	7	NA		No
(15)PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY,IL60426 36-4132865	HEALTHCARE	IL	501(c)(3)	10	UCHHD	Yes
(16)THE JOHN CRERAR FOUNDATION 5730 S ELLIS AVENUE CHICAGO,IL60637 36-3155157	SUPP LIBRARY	IL	501(c)(3)	Type III-O	UNIV CHICAGO		No
(17)THE MARINE BIOLOGICAL LABORATORY 7 MBL STREET WOODS HOLE,MA02543 04-2104690	RES & EDU	MA	501(c)(3)	7	UNIV CHICAGO		No
(18)THE QUADRANGLE CLUB 5801 S ELLIS AVENUE CHICAGO,IL60637 36-1655190	SOCIAL CLUB	IL	501(c)(7)		UNIV CHICAGO		No
(19)THE UNIV OF CHICAGO FDN IN THE HONG KONG LTD	FUNDRAISING	HK			UNIV CHICAGO		No
(20)THE UNIVERSITY OF CHICAGO CLOISTERS CLUB 1212 E 59TH STREET CHICAGO,IL60637	SOCIAL CLUB	IL			UNIV CHICAGO		No
(21)UCHICAGO RESEARCH BANGLADESH LTD	RESEARCH	BG			UCH RS INTL		No
(22)UCHICAGO RESEARCH INTERNATIONAL LIMITED 5801 S ELLIS AVENUE CHICAGO,IL60637 26-2741573	RESEARCH	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(23)UCM CARE NETWORK MEDICAL GROUP INC 5841 S MARYLAND AVE MC 1086 CHICAGO,IL60637 47-4221241	HEALTH SERVICE	IL	501(c)(3)	10	UCMC		No
(24)UCMC TITLE HOLDING CORPORATION 5841 S MARYLAND AVE MC 1086 CHICAGO,IL60637 81-2126789	TITLE HOLD	IL	501(c)(3)	Type I	UCMC		No
(25)UCMC TITLE HOLDING CORPORATION II NFP 5841 S MARYLAND AVE MC 1086 CHICAGO,IL60637 82-1736040	TITLE HOLD	IL	501(c)(3)	Type I	UCMC		No
(26)UNIV OF CHI BOOTH SCH OF BUS (SINGAPORE)	EDUCATION	SN			UNIV CHICAGO		No
(27)UNIV OF CHI BOOTH SCH OF BUS (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)	Type I	UNIV CHICAGO		No
(29)UNIV OF CHICAGO CENTER IN PARIS (FRANCE)	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)	2	UNIV CHICAGO		No
(31)UNIV OF CHICAGO PROPERTY HOLDING CO 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6108743	PROP HOLDG	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)	Type 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)	Type I	UNIV CHICAGO		No
(34)UNIVERSITY OF CHICAGO 5801 S ELLIS AVENUE CHICAGO,IL60637 36-2177139	EDUCATION	IL	501(c)(3)	2	NA		No
(35)UNIVERSITY OF CHICAGO MEDICAL CENTER 5841 S MARYLAND AVENUE CHICAGO,IL60637 36-3188183	HOSPITAL	IL	501(c)(3)	3	UNIV CHICAGO		No
(36)UNIVERSITY OF CHICAGO TRUST (INDIA) L-9 East Wing Raheja Towers MG R BANGALORE,Karnataka560001 IN	FUNDRAISING	IN			UNIV CHICAGO		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(k) Percentage ownership
(1) INGALLS SAME DAY SURGERY CTR 6701 W 159TH ST TINLEY PARK,IL60477 36-3368549	SURGERY CENTER	IL	NA	N/A				No			No
(2) UCMC-SOLIS ON-CAMPUS MAMMOGRAPHY LLC 15601 DALLAS PARKWAY SUITE 300 ADDISON,TX75001 35-2641914	MAMMOGRAPHY	DE	NA	N/A				No			No
(3) UCMC-SOLIS OFF-CAMPUS MAMMOGRAPHY SERVICES LLC 1501 DALLAS PARKWAY SUITE 300 ADDISON,TX75001 38-4108853	MAMMOGRAPHY	DE	NA	N/A				No			No
(4) PABHS-UCM MSO JV LLC 2845 N SHERIDAN RD SUITE 6400 CHICAGO,IL60657 87-4074642	RADIOLOGY ONCOLOGY	IL	NA	N/A				No			No
(5) PABHS-UCM RADONC JV 2845 N SHERIDAN RD SUITE 6400 CHICAGO,IL60657 87-4057862	RADIOLOGY ONCOLOGY	IL	NA	N/A				No			No

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	(h) Percentage ownership	Yes	No
(1) CHARITABLE LEAD TRUST (0) 5801 S ELLIS AVENUE CHICAGO,IL60637	CHAR LEAD TRUST	IL	NA	Trust					No
(2) CHARITABLE REMAINDER TRUSTS (75) 5801 S ELLIS AVENUE CHICAGO,IL60637	CHAR RMDR TRUST	IL	NA	Trust					No
(3) INGALLS CASUALTY INSURANCE LTD ONE INGALLS DRIVE HARVEY,IL60426 98-0485714	LIAB INSURANCE	CJ	UCHHD	C Corporation	683,217	371,083	100 %	Yes
(4) INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY,IL60426 27-3226539	PURCHASING GROUP	IL	UCHHD	C Corporation	0	0	100 %	Yes
(5) INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY,IL60426 36-3485578	INSURANCE SERVICE	IL	IMH	C Corporation	14,841,124	1,652,064	100 %	Yes
(6) MEDCENTRIX INC ONE INGALLS DRIVE HARVEY,IL60426 36-3374228	BILLING & MGMT	IL	UCHHD	C Corporation	819,550	814,203	100 %	Yes
(7) PHOENIX OVERLAY FUND LTD 401 N MICHIGAN AVE C/O INVST OFFICE CHICAGO,IL60611	INVESTMENT	CJ	NA						No
(8) POOLED INCOME FUND (1) 5801 S ELLIS AVENUE CHICAGO,IL60637	POOLED INCO FUND	IL	NA	C Corporation					No
(9) SC CURRICULUM INC 70 WEST MADISON ST CHICAGO,IL60602	SCNC CURRICULUM	IL	NA	C Corporation					No
(10) UCHICAGO (BEIJING) CONSULTING CO LTD	CONSULTING	CH	NA						No
(11) UCHICAGO CENTER IN INDIA PRIVATE LIMITED	CONSULTING	IN	NA	C Corporation					No
(12) TRULEN INSURANCE SPC LIMITED 98-1571288	LIAB INSURANCE	CJ	UCHHD		13,288,575	90,660,307	100 %	Yes
(13) EMPLOYED PHYSICIANS SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 98-1571310	LIAB INSURANCE	CJ	UCHHD					Yes
(14) HPL-GL SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 98-1571446	LIAB INSURANCE	CJ	UCHHD					Yes
(15) NON-EMPLOYED PHYSICIANS SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC L TD 98-1571387	LIAB INSURANCE	CJ	UCHHD					Yes
(16) UCHICAGO MEDICINE NORTHWEST INDIANA INC 5841 S MARYLAND AVE CHICAGO,IL60637 92-2355855	HEALTHCARE	IN	UCMC	C Corporation					No

Schedule R (Form 990) 2021

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

Yes

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	A	249,395	FMV
(2) PRIMARY HEALTHCARE ASSOCIATES	A	579,865	FMV
(3) MEDCENTRIX	A	46,240	FMV
(4) INGALLS MEMORIAL HOSPITAL	P	278,568	FMV
(5) INGALLS MEMORIAL HOSPITAL	Q	3,820,179	FMV
(6) INGALLS HOME CARE	Q	133,131	FMV
(7) MEDCENTRIX	Q	66,575	FMV
(8) PRIMARY HEALTHCARE ASSOCIATES	Q	257,142	FMV
(9) INGALLS HOME CARE	S	70,985	FMV

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

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	8
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 2021 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	6
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	-2,333
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........		0
9	Program service revenue (Part VIII, line 2g) .........	13,652,843	8,507,381
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	415,835	442,867
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-2,945	-2,333
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	14,065,733	8,947,915
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	13,097,918	9,074,113
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	13,097,918	9,074,113
19	Revenue less expenses. Subtract line 18 from line 12.......	967,815	-126,198
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	52,420,395	31,857,748
21	Total liabilities (Part X, line 26).............	50,424,940	31,359,535
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,995,455	498,213

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 6,811,797 including grants of $ ) (Revenue $ 8,507,381 )
	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 expenses6,811,797

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	11,567,701	1,710,244

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) RICHARD W SILVERIA FORMER CFO TIL 3/31/20	0.0 .......................0.0	X	0	1,906,873	21,121

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	561439	4,340,644	4,340,644
b	ICN PROGRAM REVENUE	900099	1,772,699	1,772,699
c	RENTAL INCOME	531110	1,367,072	1,367,072
d	SELF INSURANCE REVENUE	525100	1,026,966	1,026,966
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		8,507,381

3 Investment income (including dividends, interest, and othersimilar amounts) ......			84,047			84,047
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		28,110	6a
b	Less: rental expenses		30,443	6b
c	Rental income or (loss)	0	-2,333	6c
d	Net rental income or (loss).......			-2,333		-2,333
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		358,820	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	0	358,820	7c
d	Net gain or (loss).........			358,820			358,820
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....			0	0	0	0
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			8,947,915	8,507,381	-2,333	442,867

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......	274,449		274,449
b	Legal .........	39,475		39,475
c	Accounting ...........	1,081,467		1,081,467
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	33,213		33,213
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	481,581	481,581	0	0
12	Advertising and promotion ....	7,865		7,865
13	Office expenses .......	25,766	24,022	1,744
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	677,870	402,243	275,627
17	Travel ............	135	135
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	523,139		523,139
23	Insurance ...	1,127,321	1,127,321
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	4,601,802	4,599,586	2,216
b	CONTRACTED SERVICES	165,303	142,276	23,027
c	PATIENT ADVOCATE FUND	26,034	26,034
d	MEDICAL SUPPLIES	8,458	8,364	94
e	All other expenses	235	235	0	0
25	Total functional expenses. Add lines 1 through 24e	9,074,113	6,811,797	2,262,316	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 ........				1
2	Savings and temporary cash investments .........			24,883,975	2	6,840,027
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			529,623	4	641,173
5	Loans and other receivables from 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 ...........				7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			413,929	9	413,671
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	9,109,161
b	Less: accumulated depreciation	10b	3,083,774	6,559,796	10c	6,025,387
11	Investments—publicly traded securities .			8,137,018	11	7,306,763
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			3,701,936	13	3,007,266
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			8,194,118	15	7,623,461
16	Total assets. Add lines 1 through 15 (must equal line 33)...			52,420,395	16	31,857,748

17	Accounts payable and accrued expenses .....	5,938,426	17	5,765,818
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
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 ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
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	44,486,514	25	25,593,717
26	Total liabilities. Add lines 17 through 25..	50,424,940	26	31,359,535

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	1,995,455	27	498,213
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 ...........	1,995,455	32	498,213
33	Total liabilities and net assets/fund balances ........	52,420,395	33	31,857,748

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No