TY 2022 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) DENNIS IRVIN VICE CHAIRMAN	1.0 ................. 0	X	X	0	0	0
(2) EMILY CHASE INTERIM PRESIDENT (7/10/22 THRU 3/7/23)	1.0 ................. 44.0	X	X	0	814,302	143,404
(3) GRETCHEN PACHOLEK BOARD MEMBER/VP PATIENT CARE & CNO, INGALLS (EFF. 9/6/22)	40.0 ................. 1.0	X	X	0	281,868	23,582
(4) KEVIN M PURCELL CHAIRMAN	1.0 ................. 2.0	X	X	0	0	0
(5) MICHAEL ANTONIADES INTERIM PRESIDENT, INGALLS (EFF. 3/7/23)	40.0 ................. 4.0	X	X	0	0	0
(6) RANDY NEISWONGER PRESIDENT IMH (THRU 7/10/22)	40.0 ................. 7.0	X	X	388,177	0	36,830
(7) SAMUEL J CUTRARA JR SECRETARY/TREASURER	1.0 ................. 1.0	X	X	0	0	0
(8) DOROTHY JONES MD BOARD MEMBER (THRU 12/31/2022)	1.0 ................. 0	X		0	0	0
(9) ENGIN YILMAZ MD BOARD MEMBER	1.0 ................. 41.0	X		0	275,322	22,698
(10) FRANCIS ALMEDA MD BOARD MEMBER	1.0 ................. 0	X		0	0	0
(11) HENRY JOHNSON BOARD MEMBER	1.0 ................. 0	X		0	0	0
(12) KAVEH RAHMANI DO BOARD MEMBER (EFF. 1/1/23)	1.0 ................. 42.0	X		0	572,067	29,040
(13) MARK KOZLOFF MD BOARD MEMBER	1.0 ................. 41.0	X		0	652,231	49,997
(14) MILDRED WILLIAMS-REID BOARD MEMBER (THRU 12/31/2022)	1.0 ................. 0	X		0	0	0
(15) NATHANIEL SUTTON BOARD MEMBER	1.0 ................. 1.0	X		0	0	0
(16) PAULA JACKSON BOARD MEMBER (EFF. 1/1/23)	1.0 ................. 0	X		0	0	0
(17) STEPHEN WEBER MD BOARD MEMBER	1.0 ................. 41.0	X		0	1,060,835	176,337

(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)	(F) Estimated amount of other compensation from the organization and related organizations
(18) THOMAS JACKIEWICZ BOARD MEMBER/PRESIDENT UCMC (EFF. 7/1/22)	1.0 .......................42.0	X					0	2,303,568	335,026
(19) ANN MCCOLGAN ASSISTANT TREASURER (THRU 5/1/23)	1.0 .......................45.0		X				0	453,543	87,898
(20) IVAN SAMSTEIN CHIEF FINANCIAL OFFICER	1.0 .......................48.0		X				0	1,193,414	211,348
(21) MICHELLE SALOMON ASSISTANT TREASURER (EFF. 5/2/23)	1.0 .......................45.0		X				0	0	0
(22) TOMASZ SAMEK ASSISTANT SECRETARY	40.0 .......................2.0		X				0	246,895	35,857
(23) PAUL DONOHUE VP PHILANTHROPY AND COMMUNITY	40.0 .......................0			X			252,250	0	68,268
(24) JENNIFER ARIADO REGISTERED NURSE	40.0 .......................0				X		217,696	0	55,920
(25) KRISTINE SHIELDS DIRECTOR, OCCUPATIONAL MEDICINE AND URGENT AID SERVICES	40.0 .......................0				X		209,434	0	3,316
(26) MARY JO CRANDALL VP OPERATIONS	40.0 .......................0				X		278,731	0	17,098
(27) NEGIN KIYAVASH DIRECTOR OF PHARMACY	40.0 .......................0				X		218,059	0	30,703
(28) POONAM DESAI EXECUTIVE DIRECTOR, AMBULATORY	40.0 .......................0				X		235,951	0	53,633
(29) DOUGLAS SAEGESSER FORMER VP OF FINANCE (THRU 9/8/2021)	0.0 .......................0.0					X	253,258	0	23,612
(30) RICHARD W SILVERIA FORMER CHIEF FINANCIAL OFFICER (THRU 4/22/21)	0.0 .......................0.0					X	0	251,969	0

(A) Name and business address	(B) Description of services	(C) Compensation
VAYA WORKFORCE SOLUTIONS 5930 CORNERSTONE COURT WEST SAN DIEGO,CA92121	CONTRACT LABOR	40,580,428
CROTHALL HEALTHCARE 25271 NETWORK PLACE CHICAGO,IL60673	HEALTHCARE SUPPORT SERVICES	7,267,463
SYNERGY BEHAVIORAL HEALTHCARE 1566 W ALGONQUIN ROAD CHICAGO,IL60673	BEHAVIORAL HEALTH	5,374,696
CARDINAL HEALTH VALUELINK PO BOX 70539 CHICAGO,IL60673	SUPPLY CHAIN SERVICES	4,975,759
TRIMEDX HOLDINGS LLC 5451 LAKEVIEW PARKWAY SOUTH DR INDIANAPOLIS,IN46268	CLINICAL ASSET SERVICES	4,485,223
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 82

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

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 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 ...............................

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

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


Total

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

Cat. No. 11285F

Schedule A (Form 990) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 2022 (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—2022. 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—2021. 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—2022. 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—2021. 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) 2022

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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) 2022	(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 2022 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2021 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2022 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2021 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests-2022. 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—2021. 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) 2022

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) 2022

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.

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

Section C. Type II Supporting Organizations

Yes

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

Section D. All Type III Supporting Organizations

Yes

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

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

By reason of the relationship described in 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) 2022

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) 2022

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 2022 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-2022	(iii) Distributable Amount for 2022
1 Distributable amount for 2022 from Section C, line 6
2 Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2022:
a From 2017.......
b From 2018.......
c From 2019.......
d From 2020.......
e From 2021.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2022 distributable amount
i Carryover from 2017 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2022 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2022 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2018.....
b Excess from 2019.....
c Excess from 2020.....
d Excess from 2021.....
e Excess from 2022.....

Schedule A (Form 990) (2022)

Schedule A (Form 990) 2022

Page 8

Part VI

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

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2022

Name of the organization

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990) (2022)

Schedule B (Form 990) (2022) Page 2

Name of organization The Ingalls Memorial Hospital

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 3

Name of organization The Ingalls Memorial Hospital		Employer identification number 36-2170866

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2022)

Schedule B (Form 990) (2022)

Page 4


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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990) (2022)

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2021

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Part I-A

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

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

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

A Check SchCMd Bullet

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

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

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

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

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

(a)

Yes|No

(b)

Amount

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

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

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

Yes

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

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

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

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

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

Yes

16,860

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

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

Yes

33,685

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

50,545

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

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

Return Reference	Explanation
Schedule C, Part II-B, Line 1g DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	The Vice President of Government Affairs for University of Chicago Medicine has contact with legislators and government officials on behalf of Ingalls Memorial Hospital. Topics include Medicare and Medicaid funding and proposed staffing legislation.
Schedule C, Part II-B, Line 1i DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	THE HOSPITAL PAYS DUES TO THE ILLINOIS HEALTH AND HOSPITAL ASSOCIATION. A PORTION OF THESE DUES ARE USED TO SUPPORT LOBBYING BY THE ASSOCIATION FOCUSED ON ADVOCACY AND REPRESENTATION.

Schedule C (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- 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

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Part I

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

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 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 .....	6,464,807		6,464,807
b	Buildings ....	175,155,610	43,033,978	132,121,632
c	Leasehold improvements	0	0	0
d	Equipment ....	122,500,127	58,161,143	64,338,984
e	Other .....	3,237,115	2,058,020	1,179,095
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				204,104,518

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

Part IX

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

(a) Description				(b) Book value
(1)DUE FROM AFFILIATES
(2)RESTRICTED INVESTMENTS - FDN
(3)OTHER LONG TERM ASSETS
(4)DUE FROM AFFILIATES				66,084,630
(5)RESTRICTED INVESTMENTS - FDN				2,139,502
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				68,224,132

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
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	8,036,700
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, 2023 AND 2022, THE SYSTEM DOES NOT HAVE AN ASSET OR LIABILITY RECORDED FOR UNRECOGNIZED TAX POSITIONS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE.

Schedule D (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

200% 250% 300% 350% 400% Other 60000 %

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

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

Yes

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

Yes

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

Yes

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

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

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .			10,816,048	0	10,816,048	3.07 %
b	Medicaid (from Worksheet 3, column a) . . . . .			118,006,816	97,305,371	20,701,445	5.88 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .			0	0	0	0 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	128,822,864	97,305,371	31,517,493	8.95 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			803,824	0	803,824	0.23 %
f	Health professions education (from Worksheet 5) . . .			1,695,226	598,387	1,096,839	0.31 %
g	Subsidized health services (from Worksheet 6) . . . .			0	0	0	0 %
h	Research (from Worksheet 7) .			0	0	0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			102,075	0	102,075	0.03 %
j	Total. Other Benefits . .	0	0	2,601,125	598,387	2,002,738	0.57 %
k	Total. Add lines 7d and 7j .	0	0	131,423,989	97,903,758	33,520,231	9.51 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022

Schedule H (Form 990) 2022

Page

Part II

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

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense
1	Physical improvements and housing			1,784		1,784
2	Economic development					0
3	Community support					0
4	Environmental improvements					0
5	Leadership development and training for community members					0
6	Coalition building					0
7	Community health improvement advocacy					0
8	Workforce development					0
9	Other					0
10	Total	0	0	1,784	0	1,784

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

7,305,165

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

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

Section B. Medicare

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

117,432,919

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

133,647,861

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

-16,214,942

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

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

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1NONE
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2022

Page

Part VFacility Information

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

Schedule H (Form 990) 2022

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

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

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

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

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

Yes

6 a

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

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

Yes

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

Yes

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

Hospital facility’s website (list url): https://www.uchicagomedicine.org/about-us/community/benefit/health-needs-ingalls-memorial/chna

Other website (list url):

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

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

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

Yes

If "Yes" (list url): https://www.uchicagomedicine.org/about-us/community/benefit/health-needs-ingalls-memorial/chna

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

10b

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

12a

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

12a

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

12b

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

Schedule H (Form 990) 2022

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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

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

Yes

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

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.0%
and FPG family income limit for eligibility for discounted care of 600.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

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

Yes

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

Yes

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

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

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

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

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

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

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

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

(SEE STATEMENT)

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

(SEE STATEMENT)

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

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

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

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

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 6

Part VFacility Information (continued)

Billing and Collections

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

Yes

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

Yes

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

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

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

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

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

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2022

Page 7

Part VFacility Information (continued)

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

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

Yes

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

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2022

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. The CHNA process engaged several internal and external stakeholders to collect, curate, and interpret data, and then use that data to prioritize the health needs of the community. Partners and stakeholder groups also provided insight and expertise around the indicators to be assessed, types of focus group questions to be asked, interpretation of results, and prioritization of areas of highest need. Leaders from University of Chicago Medicine Ingalls Memorial (Ingalls), and the Urban Health Initiative (UHI) worked with Metopio to guide the strategic direction of the CHNA and engage the CHNA Steering Committee, other various internal committees, and workgroups to ensure broad engagement of diverse perspectives across Ingalls. Metopio is a software and services company grounded in the philosophy that communities are connected through places and people. Metopio's visualization tools use secondary data FROM FEDERAL SOURCES AND STATE AND LOCAL HEALTH DEPARTMENTS to reveal valuable, interconnected factors that influence outcomes in different locations. The Ingalls Community Benefit Management Team guided the strategic direction of the CHNA while relying on the expertise of community stakeholders throughout the CHNA process. Ingalls' partners and stakeholders provided insight and expertise about the assessment of key indicators, the types of focus group questions, how to interpret results, and how to prioritize the areas of highest need. The Community Benefit Management Team is composed of key staff members with expertise in key areas related to Ingalls' community benefit activities. This group discusses and validates community benefit programs and activities, monitors CHNA policies, provides input on the CHNA strategic implementation plan and strategies, reviews and approves grant funding requests, provides feedback on community engagement activities, and provides input for the Annual Report. The Community Advisory Council (CAC) was established by Ingalls in June 2020 and is a representative group of volunteer members who live and/or work in the Ingalls Service Area. The CAC members serve as advisors to Ingalls on issues of interest to the community. The CAC is an essential partner in achieving Ingalls goals related to broader community interests, community benefit, access to care, and effective community engagement. Specifically, the CAC played a key role in identifying community organizations for our focus groups, disseminating the survey, and ensuring diverse community voices were heard throughout the CHNA process. THE INCLUSION OF PATIENT VOICE IN THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS A CORNERSTONE OF THE PROCESS. PRIMARY DATA FOR THE CHNA WAS COLLECTED THROUGH THE FOLLOWING METHODS: 1) 419 COMMUNITY RESIDENT SURVEYS COMPLETED IN ENGLISH AND SPANISH, IN BOTH ELECTRONIC AND PAPER VERSIONS 2) 4 COMMUNITY RESIDENT FOCUS GROUPS WITH 12 OR FEWER RESIDENTS IN EACH GROUP. TOPICS INCLUDED MENTAL HEALTH, MATERNAL AND CHILD HEALTH, YOUTH HEALTH, AND ADULT HEALTH 3) 8 KEY INFORMANT INTERVIEWS WITH RESIDENTS FROM UNDERSERVED POPULATIONS DURING DEVELOPMENT OF THE STRATEGIC IMPLEMENTATION PLAN, INGALLS CONSULTED SUBJECT MATTER EXPERTS ON INGALLS'S HEALTH PRIORITIES. THROUGHOUT the CHNA PROCESS, INGALLS WAS ABLE TO TAKE INTO ACCOUNT VARIOUS DIFFERING COMMUNITY VIEWPOINTS.
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. For the 2021- 2022 CHNA cycle, the UChicago Medicine hospitals (University of Chicago Medical Center and UChicago Medicine Ingalls Memorial) partnered in an effort to address shared priorities for the system. Both hospitals received input from community organizations, federally qualified health centers and community members. IMH CONTRACTED WITH METOPIO TO COMPLETE THE 2021-2022 COMMUNITY HEALTH NEEDS ASSESSMENT. METOPIO IS A SOFTWARE AND SERVICES COMPANY GROUNDED IN THE PHILOSOPHY THAT COMMUNITIES ARE CONNECTED THROUGH PLACES AND PEOPLE. METOPIO'S VISUALIZATION TOOLS USE DATA TO REVEAL VALUABLE, INTERCONNECTED FACTORS THAT INFLUENCE OUTCOMES IN DIFFERENT LOCATIONS. LEADERS FROM INGALLS AND UHI WORKED WITH METOPIO TO GUIDE THE STRATEGIC DIRECTION OF THE CHNA AND ENGAGED THE CHNA STEERING COMMITTEE, OTHER VARIOUS INTERNAL COMMITTEES, AND WORKGROUP TO ENSURE BROAD ENGAGEMENT OF DIVERSE PERSPECTIVES ACROSS INGALLS MEMORIAL.
Schedule H, Part V, Section B, Line 7 Facility , 1	Facility , 1 - INGALLS MEMORIAL HOSPITAL. THE RESULTS OF THE CHNA REPORT HAVE BEEN DISCUSSED AT COMMUNITY MEETINGS, WITH REFERENCE TO THE FULL REPORT'S AVAILABILITY ON THE HOSPITAL'S WEBSITE AND PAPER COPIES AVAILABLE IN THE INGALLS MEMORIAL MAIN LOBBY AND THE PROFESSIONAL OFFICE BUILDING FRONT DESKS. THE CHNA HAS ALSO BEEN MADE WIDELY AVAILABLE TO VARIOUS CHICAGOLAND COMMUNITY NEWS OUTLETS, INCLUDING THE CHICAGO SUN-TIMES AND WVON-1690 AM.
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. THE MOST RECENT INGALLS CHNA WAS CONDUCTED IN 2021-2022. THE IMPLEMENTATION STRATEGY FOR THIS CHNA FOR YEARS 2023-2025 WAS ADOPTED BY THE UNIVERSITY OF CHICAGO MEDICAL CENTER'S BOARD OF DIRECTOR'S GOVERNMENT AND COMMUNITY RELATIONS COMMITTEE. THIS COMMITTEE RECEIVED AND REVIEWED THE 2021-2022 CHNA REPORT, FY 2020-2022 EVALUATION REPORT, AND 2023-2025 STRATEGIC IMPLEMENTATION PLAN AND FORMALLY APPROVED ALL THREE DOCUMENTS IN MAY 2022. THE HEALTH PRIORITIES IDENTIFIED IN THE MOST RECENT CHNA WERE: 1. PREVENT AND MANAGE CHRONIC DISEASES: HEART DISEASE, DIABETES, CANCER 2. PROVIDE ACCESS TO CARE AND SERVICES: MATERNAL HEALTH, MENTAL HEALTH 3. REDUCE INEQUITIES CAUSED BY SOCIAL DETERMINANTS OF HEALTH: FOOD INSECURITY, WORKFORCE DEVELOPMENT INGALLS WILL ADDRESS THE NEEDS IDENTIFIED IN ITS MOST RECENT CHNA THROUGH EXECUTION OF THE IMPLEMENTATION STRATEGY. INGALLS WILL ADDRESS THE IDENTIFED NEEDS THROUGH THE FOLLOWING APPROACHES: 1) CARE DELIVERY INITIATIVES. THE CARE DELIVERY INITIATIVES INCLUDE A MYRIAD OF INITIATIVES THAT PROVIDE DIRECT HEALTH AND WELLNESS SERVICES TO COMMUNITY MEMBERS. THESE SERVICES ARE EXECUTED IN MULTIPLE WAYS THAT INCLUDE LEVERAGING INGALLS RESOURCES AND PARTNERING WITH COMMUNITY HEALTH CENTERS AND COMMUNITY-BASED CLINICAL SERVICES. 2) COMMUNITY IMPACT GRANTS. GRANT OPPORTUNITIES ARE PROVIDED TO COMMUNITY-BASED ORGANIZATIONS THAT IMPLEMENT PROGRAMS TO ADDRESS THE INGALLS PRIORITY AREAS WITHIN THE INGALLS SERVICE AREA. 3) COMMUNITY-BASED EDUCATION & OUTREACH. INGALLS OUTREACH AND ENGAGEMENT COMPONENTS ARE DIRECTLY ALIGNED WITH THE HOSPITALS' PRIORITY AREAS, PROMOTING EDUCATION AND AWARENESS TO COMMUNITY MEMBERS IN THE TARGETED SERVICE AREAS. THESE ACTIVITIES ARE INTENDED TO BETTER INFORM AND EDUCATE THE COMMUNITY REGARDING HEALTH PROMOTION AND DISEASE SELF-MANAGEMENT PRACTICES. 4) PARTNERSHIPS: INNOVATIVE PARTNERSHIPS WITH A COMMUNITY HEALTH LENS THAT LEVERAGE TECHNOLOGY, CROSS-SECTOR COLLABORATIONS, AND MULTI-DISCIPLINARY APPLICATION LEARNINGS TO IMPROVE HEALTH AND ENGAGE THE COMMUNITY. 5) POLICY & ADVOCACY: INFORM POPULATION HEALTH STRATEGIES, CONNECTIONS BETWEEN THE COMMUNITY AND CLINICAL SPHERES OF WORK, INSTITUTIONAL ADVOCACY EFFORTS, POLICY CHANGE, AND COMMUNITY PARTNERSHIPS. RATIONALE FOR UNADDRESSED NEEDS: In acknowledging the wide range of priority health issues that emerged from the CHNA process, Ingalls determined that it could only effectively focus on those which fit within the current resources available. While violence was not selected as a health priority area for FY 2023-2025, it affects the health status of the whole community. Consequently, violence will be addressed in relation to each of the priority health areas by focusing on the social inequities caused by the social determinants of health (SDOH) and by providing access to mental health services. This framework retains four of the health priorities from the FY 2020-2022 Strategic Implementation Plan: heart disease, diabetes, cancer, and maternal health. In the FY 2020-2022 SIP, asthma was selected as a priority health area. During the last cycle, Ingalls invested resources to address asthma. As a result of these efforts (and other factors), there was a decline in asthma emergency department (ED) visits. Consequently, asthma is not a priority health area for the FY 2023-2025 SIP. The hospital will continue to invest resources to sustain this positive outcome by supporting existing programs. ADDITIONALLY, INGALLS WILL CONTINUE TO WORK WITH PARTNERS, INCLUDING THE LOCAL PUBLIC HEALTH DEPARTMENTS, COMMUNITY ORGANIZATIONS AND FEDERAL QUALIFIED HEALTH CENTERS TO MEET THE HEALTH NEEDS OF OUR PATIENT SERVICE AREA. PLEASE SEE A REPORT OF INGALLS COMMUNITY ACTIVITIES IN PART VI, LINE 5.
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - THE INGALLS MEMORIAL HOSPITAL. A PATIENT IS NOT REQUIRED TO PAY MORE THAN 20% OF HIS/HER FAMILY INCOME FOR ALL EMERGENCY AND OTHER MEDICALLY NECESSARY CARE PROVIDED BY IMH IN A 12-MONTH PERIOD. THE MEDICAL INDIGENCY DISCOUNT APPLIES TO ANY PATIENT WHOSE PATIENT BALANCE DUE FOR EMERGENCY AND OTHER MEDICALLY NECESSARY SERVICES EXCEEDS 20% OF HIS/HER ADJUSTED GROSS INCOME IN THE YEAR THAT THE PATIENT RECEIVED CARE.

Schedule H (Form 990) 2022

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Part VFacility Information (continued)

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

Schedule H (Form 990) 2022

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Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I Line 3c	AUTOMATIC UNINSURED SELF-PAY DISCOUNT A DISCOUNT OF 80% OF GROSS CHARGES, PROVIDED TO ALL UNINSURED PATIENTS WITHOUT REQUIRING EVIDENCE OF INABILITY TO PAY. THIS DISCOUNT IS DESIGNED TO ENSURE THAT PATIENTS ARE CHARGED AT A RATE GENERALLY COMPARABLE TO THAT APPLIED TO INSURED PATIENTS. 1. THERE IS NO APPLICATION PROCESS FOR THE PATIENT TO RECEIVE THE UNINSURED DISCOUNT. THE DISCOUNT IS APPLIED BASED ON THE ACCOUNT'S SELF-PAY/UNINSURED STATUS. 2. PATIENTS RECEIVING PRE-NEGOTIATED DISCOUNTS FOR HOSPITAL SERVICES WILL NOT BE ELIGIBLE FOR THIS UNINSURED DISCOUNT. 3. IF A PATIENT IS SUBSEQUENTLY APPROVED FOR FINANCIAL ASSISTANCE, THE AUTOMATIC DISCOUNT WILL BE REVERSED SO THAT THE FULL AMOUNT CAN BE RECOGNIZED AS A CHARITY ALLOWANCE. 4. IF A PATIENT SUBSEQUENTLY PROVIDES EVIDENCE OF INSURANCE COVERAGE, THE AUTOMATIC DISCOUNT WILL BE REVERSED AND THE INSURANCE COVERAGE PROVIDED WILL BE BILLED ACCORDINGLY. 5. PATIENT WHO ARE OTHERWISE INSURED AND CHOOSE NOT TO USE THEIR INSURANCE COVERAGE ARE INELIGIBLE FOR THIS AUTOMATIC DISCOUNT.
Schedule H, Part I Line 7	INGALLS UTILIZES A COST TO CHARGE METHODOLOGY. CHARGES ASSOCIATED WITH THE RELATED CATEGORIES ARE THEN USED TO DETERMINE COST RELATED TO SUCH REVENUE.
Schedule H, Part V, Section B, Line 4	THE HOSPITAL IS REPORTING THE TAX YEAR BEGINNING FOR WHICH IT LAST CONDUCTED ITS CHNA. THE CHNA WAS FINALIZED DURING THE TAX YEAR ENDED JUNE 30, 2022.
Schedule H, Part III Line 1	INGALLS FOLLOWS GAAP PRINCIPLES AND UNDER THE NEW REPORTING STANDARD ASC 606, BAD DEBT IS NOW IMPLICIT PRICE CONCESSIONS. THE REPORTING OF BAD DEBT ALSO CONFORMS TO THE UPDATED HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION NO. 15.
Schedule H, Part I Line 5a	WHILE INGALLS PROJECTS AN ANTICIPATED AMOUNT OF DISCOUNTED CARE EACH FISCAL YEAR WHEN CREATING ITS ANNUAL BUDGET, NO SPECIFIC LINE ITEM OR LIMIT IS INCLUDED IN THE BUDGET. THE ABSENCE OF A LINE ITEM IN NO WAY LIMITS THE AMOUNT OF DISCOUNTED CARE INGALLS PROVIDES.
Schedule H, Part V, Section B, Line 16a FAP AVAILABLE WEBSITE	https://www.uchicagomedicine.org/-/media/pdfs/adult-pdfs/patients-and-visitors/patients/ingalls-financial-assistance/patient-financial-assistance-discounts-and-collections-policy-signed.pdf
Schedule H, Part V, Section B, Line 16b FAP APPLICATION FORM WEBSITE	https://www.uchicagomedicine.org/-/media/pdfs/adult-pdfs/patients-and-visitors/patients/ingalls-financial-assistance/financial-assistance-application.pdf
Schedule H, Part V, Section B, Line 16c PLAIN LANGUAGE FAP SUMMARY WEBSITE	https://www.uchicagomedicine.org/-/media/pdfs/adult-pdfs/patients-and-visitors/patients/ingalls-financial-assistance/ingalls-financial-assistance-plain-language-summary.pdf
Schedule H, Part VI, Line 5	THE UNIVERSITY OF CHICAGO INGALLS MEMORIAL HOSPITAL (INGALLS) IS A COMMUNITY HOSPITAL THAT WORKS WITH ITS COMMUNITY AND PARTNERS TO IMPROVE HEALTH, PREVENT DISEASES AND ADDRESS THE SOCIAL DETERMINANTS OF HEALTH IN ITS SERVICE AREA. Community Impact Grants Ingalls Community Impact Grants program, PROVIDES NOT-FOR-PROFIT, COMMUNITY-BASED ORGANIZATIONS FUNDING TO SUPPORT HEALTH PROGRAMMING OR A FUNDRAISING EVENT. PRIORITY CONSIDERATION IS GIVEN TO THOSE GRANTS THAT ARE IN LINE WITH Ingalls' STRATEGIC HEALTH PRIORITIES. FUNDING TO COMMUNITY ORGANIZATIONS HELPS THEM EXPAND THEIR CAPABILITIES TO SERVE MORE COMMUNITY MEMBERS. IN FY 2023, INGALLS AWARDED $98K IN Community Impact GRANTS, WHICH WERE USED TO ADDRESS THE HEALTH PRIORITY AREAS. - $25,000 GRANT FOR TCA HEALTH'S FRESH RX PROGRAM, PROVIDING NUTRITION EDUCATION, HEALTH SCREENINGS AND FOOD BAGS TO MEDICALLY AT-RISK SENIORS AND PATIENTS WITH DIABETES AND HYPERTENSION AND OTHER CHRONIC DISEASES. - $25,000 GRANT FOR SOUTH SUBURBAN PADS PROGRAM TO PROVIDE 100,000 FREE MEALS TO 450 HOMELESS PEOPLE. - $25,000 GRANT FOR YOUR CAREER TAPESTRY'S CAREER EXPLORATION AND READINESS PROGRAM FOR UNDER RESOURCED STUDENTS AGED 12-19 - $18,000 GRANT FOR CANCER SUPPORT CENTER'S "KICK IT, CANCER" PROGRAM WHOSE MISSION IS TO PROVIDE MORE ACCESS TO CARE AND ONGOING SUPPORT TO ANYONE IMPACTED BY CANCER. - $5,000 GRANT FOR COOK COUNTY SOUTHLAND JUVENILE JUSTICE COUNCIL FOR STIPENDS TO HELP WITH TRANSPORTATION FOR PERSONS TAKING PART IN THE SUMMER JOBS PROGRAM. UChicago Medicine's Liaisons in Care (LinC) program addresses health inequities by hiring and utilizing Community Health Workers (CHWs) both in healthcare and community settings. CHWs are frontline public health workers who are trusted in the community. This trusting relationship enables CHWs to serve as a link between health and social services and the community members to facilitate their access to services and improve quality of life. CHWs have extended to support patients at Ingalls. CHWs play an essential role in community health programs dealing with asthma and health disease at Ingalls. This helps to further expand community members' access to health and social service resources, health education and assistance with healthcare navigation. CHRONIC DISEASES: DIABETES, HEART DISEASE AND CANCER LEADING AN ACTIVE LIFESTYLE AND EATING HEALTHY FOODS ARE IMPORTANT FACTORS IN PREVENTING AND MANAGING CHRONIC (LONG-TERM) DISEASES LIKE HEART DISEASE, DIABETES, AND CANCER. INGALLS MEMORIAL IS DEDICATED TO BRINGING FREE NUTRITION AND FITNESS CLASSES TO COMMUNITY MEMBERS IN THE SOUTH SUBURBS. THE 2021 - 2022 DATA SHOWED THAT IN THE INGALLS PSA, THE HEART DISEASE MORTALITY RATE FOR NON-HISPANIC BLACK PEOPLE IS 26% HIGHER THAN OTHER RACIAL AND ETHNIC GROUPS. IN ADDITION, THE EMERGENCY DEPARTMENT (ED) VISIT RATE FOR HYPERTENSION IS AMONG THE HIGHEST IN THE STATE AND THE ED VISIT RATE FOR HEART FAILURE IS IN THE 90TH PERCENTILE. DIABETES: THE RATE OF DIABETES IS 15% HIGHER IN THE INGALLS PSA THAN IN SOUTH SUBURBAN COOK COUNTY. THE DIAGNOSIS RATES FOR PROSTATE CANCER, LUNG CANCER, AND COLORECTAL CANCER ARE SIGNIFICANTLY HIGHER IN THE INGALLS PSA. ADDITIONALLY, THE DISTANT/SYSTEMIC CANCER DIAGNOSIS RATE, WHICH REFERS TO A DIAGNOSIS OF STAGE 4 OR METASTATIC CANCER, IS HIGHER IN THE INGALLS PSA THAN IN COOK COUNTY, ON AVERAGE. IN FISCAL YEAR 2023 DIETETIC INTERNS GAVE COMMUNITY NUTRITION TALKS FOCUSED ON TOPICS SUCH AS WEIGHT MANAGEMENT FOR CANCER PREVENTION, READING FOOD LABELS AND HEALTHY TIPS FOR EATING OUT 104 PEOPLE ATTENDED. IN FISCAL YEAR 2023, INGALLS MEMORIAL ALSO PARTNERED WITH ARMORED FITNESS & NUTRITION TO OFFER FITNESS CLASSES TO HELP MANAGE CHRONIC DISEASES. CLASSES SUCH AS CARDIO DRUMMING AND HIP-HOP CARDIO DANCE HAVE TAKEN PLACE AT COMMUNITY LOCATIONS IN HAZEL CREST. BETWEEN NOVEMBER 2022 AND NOVEMBER 2023, 22 CLASSES TOOK PLACE WITH APPROXIMATELY 225 TOTAL ATTENDANCE. ACCESS TO MATERNAL HEALTH - HEALTHY BABY NETWORK THE HEALTHY BABY NETWORK (HBN) WAS ESTABLISHED TO ADDRESS THE NUMBER OF WOMEN GIVING BIRTH WHO HAVE NOT RECEIVED PRENATAL CARE. THE LACK OF PRENATAL CARE RESULTS IN PREMATURE BIRTHS, BABIES WITH LOW BIRTH WEIGHTS, INCREASED MORBIDITY AND MORTALITY AND NUMEROUS OTHER COMPLICATIONS THAT HAVE BEEN EASILY TREATED. IN FISCAL YEAR 2023, OUTCOMES FOR HBN ENROLLEES INCLUDED: - 109 WOMEN ACCESSED PRENATAL CARE - 88 FULL-TERM DELIVERIES (96% OF HBN DELIVERIES) - 86 NORMAL WEIGHT BABIES (93% OF HBN DELIVERIES) IN 2023, HBN'S YEARLY DRIVE THRU BABY SHOWER PROVIDED 250 BAGS THAT WERE HANDED OUT WITHIN ONE HOUR OF THE START OF THE EVENT, INCLUDING TWO STROLLERS AND CAR SEAT SETS, TWO PACK AND PLAYS AND ONE STROLLER FOR RANDOM GIVE-A-WAYS. THIS SHOWS THE CURRENT NEED OF INCREASED ACCESS TO MATERNAL HEALTH SERVICES IN THE SOUTHLAND. INGALLS DEVELOPMENT FOUNDATION THE INGALLS DEVELOPMENT FOUNDATION'S PURPOSE IS TO CONNECT DONORS WITH PHILANTHROPIC INVESTMENT OPPORTUNITIES TO TRANSFORM COMMUNITY MEDICINE IN THE UCHICAGO MEDICINE INGALLS MEMORIAL SERVICE AREA. IN 2023, THE FOUNDATION PROVIDED: - $150,000 TO FUND WOOD STREET COMMUNITY HEALTH CORRIDOR, INGALLS COMMUNITY DEVELOPMENT INVESTMENTS. THIS INCLUDED AN OVERALL PLAN TO PROMOTE ECONOMIC DEVELOPMENT IN HARVEY, ILLINOIS. - $750,000 FOR CANCER RESEARCH PROGRAMS AND OPERATIONS TO SUPPORT GENETIC SCREENING, FINANCIAL COUNSELING PROGRAMS AND COMMUNITY HEALTH RESEARCH ON SOCIAL DETERMINANTS OF HEALTH THAT AFFECT CANCER PATIENTS. - $115,000 FOR COMMUNITY SCHOLARSHIPS TO HELP GRADUATING HIGH SCHOOL STUDENTS ATTEND COLLEGE CLASSES AND IMPROVE THEIR CAREER GOALS. OUTREACH AND SUPPORT - MENTAL HEALTH THE COVID-19 PANDEMIC UNLEASHED THE BRUTAL TRUTH - MENTAL HEALTH IS AS IMPORTANT AS PHYSICAL HEALTH. THE 2021-2022 DATA SHOWED THAT INGALLS MEMORIAL'S SERVICE AREA HAS ONE OF THE HIGHEST BEHAVIORAL HEALTH EMERGENCY ROOM VISIT RATES IN THE STATE FOR ADULTS. TO ADDRESS THE NEED, INGALLS OFFERED FOUR FREE WORKSHOPS ON MENTAL HEALTH, WELLNESS AND SELF-CARE. SINCE SPRING 2023, INGALLS MEMORIAL HAS HOSTED A SERIES OF SEVEN IN-PERSON AND ONLINE MENTAL HEALTH WORKSHOPS. COMMUNITY MEMBERS LEARNED THROUGH THESE WORKSHOP SERIES HOW TO BETTER MANAGE THEIR MENTAL HEALTH AND WELLNESS THROUGH STRESS COPING SKILLS, SELF-CARE, AND EFFECTIVE WAYS FOR DEALING WITH EMOTIONS. FROM APRIL 2023 TO NOVEMBER 2023, OVER 75 PEOPLE PARTICIPATED IN THE MENTAL WELLBEING WORKSHOP SERIES. ADDRESSING FOOD INSECURITY UCHICAGO MEDICINE INGALLS MEMORIAL OPENED THREE ONSITE FOOD PANTRIES FOR ITS ONCOLOGY PATIENTS. THE PROGRAM DOES NOT REQUIRE INDIVIDUALS TO SIGN FOR EMERGENCY FOOD IF THEY ARE UNCOMFORTABLE. THE NUTRITION STATIONS ARE IN HARVEY, FLOSSMOOR, AND TINLEY PARK. FROM JUNE 2022 TO JUNE 2023, 2,383 PEOPLE WERE GIVEN 14,430 POUNDS OF FOOD, WHICH IS 48 TIMES MORE THAN THE PAST YEAR. IN 2023, THE NUTRITION STATIONS OFFERED POP-UP PRODUCE STATIONS AT ALL THREE LOCATIONS, FEATURING FRESH FRUITS AND VEGETABLES AND A FOOD PREPARATION DEMONSTRATION. ABOUT 80 FAMILIES FROM ACROSS THE SOUTHLAND UTILIZED THESE POP-UPS. COMMUNITY ADVISORY COUNCIL (CAC) THE INGALLS CAC, IS COMPRISED OF 14 MEMBERS AND SEEKS COMMUNITY INPUT ON HEALTH ISSUES THAT ARE IMPORTANT TO ITS PRIMARY SERVICE AREA AND SURROUNDING COMMUNITIES. THE COUNCIL TALKS TO THE COMMUNITY TO HELP GUIDE FUTURE DECISIONS FOR RESOURCES OF UCHICAGO MEDICINE INGALLS MEMORIAL HOSPITAL IN HARVEY AND INGALLS AMBULATORY LOCATIONS. COMMUNITY BOARD THE INGALLS BOARD OF DIRECTORS MEMBERSHIP IS COMPRISED OF LOCAL BUSINESS AND COMMUNITY MEMBERS THAT LIVE IN THE CHICAGO AND THE SOUTH SUBURBAN REGION. IN ADDITION TO THE IMH PRESIDENT, ONE EMPLOYED PHYSICIAN SERVES AS AN ELECTED BOARD MEMBER. ALL MEMBERS ARE IN COMPLIANCE WITH THE BOARD CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO COMPLETE AN ANNUAL CERTIFICATION AND DISCLOSURE FORM. QUALIFIED PHYSICIANS INGALLS RESPONDS TO REQUESTS FOR APPLICATIONS TO JOIN THE MEDICAL STAFF MADE BY QUALIFIED PHYSICIANS IN THE COMMUNITY. THE INGALLS PROFESSIONAL AFFAIRS COMMITTEE REVIEWS INQUIRIES AND PROVIDES APPLICATIONS TO PHYSICIANS WHO MEET THE MINIMUM QUALIFICATIONS FOR MEDICAL STAFF MEMBERSHIP IF THERE IS A NEED FOR A PARTICULAR SERVICE AND/OR A PATIENT NEED EXISTS WITHIN THE COMMUNITY.
Schedule H, Part VI, Line 5 (cont.)	STAFF EDUCATION IN FY 2023 INGALLS INVESTED $1.096 MILLION IN MEDICAL EDUCATION. THE INGALLS MEDICAL STAFF SUPPORTS IMPROVEMENTS IN PATIENT CARE AND ONGOING EDUCATION TO THE MEDICAL AND PROFESSIONAL STAFF THROUGH FUNDING OF MEDICAL EDUCATION ACTIVITIES. INGALLS IS ACCREDITED BY THE ILLINOIS STATE MEDICAL SOCIETY TO AWARD CME CATEGORY 1 CREDIT. THE CME COMMITTEE IS RESPONSIBLE FOR OVERSIGHT OF MONTHLY CME ACTIVITIES WHICH ARE SPONSORED BY THE HOSPITAL. BOTH MEDICAL AND PROFESSIONAL (NURSING, QUALITY MANAGEMENT, ETC.) STAFF ARE INVITED AND ENCOURAGED TO ATTEND THE PROGRAMS. TO PROMOTE COMMUNITY HEALTH ACTIVITIES AND PROGRAMS, INGALLS DISTRIBUTES INFORMATION VIA: - EXTERNAL NEWSLETTERS - COMMUNITY PARTNERS - MESSAGE BOARDS - SOCIAL MEDIA PLATFORMS
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	THE AMOUNT REPORTED AS BAD DEBT EXPENSE IS DETERMINED BY APPLYING THE RATIO OF COST TO CHARGES (RCC) TO THE TOTAL CHARGES WRITTEN OFF TO BAD DEBT AS REPORTED IN THE AUDITED FINANCIAL STATEMENTS. THE RCC WAS DETERMINED UTILIZING WORKSHEET 2 FROM FORM 990, SCHEDULE H INSTRUCTIONS. THE BASIS FOR THIS COSTING METHODOLOGY IS THE HOSPITAL'S OPERATING EXPENSES (EXCLUDING BAD DEBT) ADJUSTED BY OTHER OPERATING REVENUE AND COMMUNITY BENEFIT EXPENSE DIVIDED BY GROSS PATIENT CHARGES.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	IMH RUNS PRESUMPTIVE ELIGIBILITY FOR FINANCIAL ASSISTANCE WHEN SUFFICIENT INFORMATION CANNOT BE OBTAINED. AS A RESULT, IMH DOES NOT BELIEVE THERE IS ANY BAD DEBT FOR INDIVIDUALS THAT WOULD OTHERWISE QUALIFY FOR ASSISTANCE.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	FOOTNOTE TO FINANCIAL STATEMENTS: IN ACCORDANCE WITH ASC TOPIC 606, REVENUE FROM CONTRACTS WITH CUSTOMERS, THE SYSTEM DOES NOT ADJUST THE PROMISED AMOUNT OF CONSIDERATION FROM PATIENTS AND THIRD-PARTY PAYORS FOR THE EFFECTS OF A SIGNIFICANT FINANCING COMPONENT DUE TO THE EXPECTATION THAT THE PERIOD BETWEEN THE TIME THE SERVICE IS PROVIDED TO A PATIENT AND THE TIME THAT THE PATIENT OR A THIRD-PARTY PAYOR PAYS FOR SERVICE WILL BE ONE YEAR OR LESS. REVENUES ARE RECOGNIZED IN THE AMOUNTS TO WHICH IT EXPECTS TO BE ENTITLED, WHICH ARE THE TRANSACTION PRICES ALLOCATED TO THE DISTINCT SERVICES. THE SYSTEM HAS AGREEMENTS WITH GOVERNMENTAL AND OTHER THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE SYSTEM AT AMOUNTS DIFFERENT FROM ESTABLISHED CHARGES. PAYMENT ARRANGEMENTS FOR MAJOR THIRD-PARTY PAYORS MAY BE BASED ON PROSPECTIVELY DETERMINED RATES, REIMBURSED COST, DISCOUNTED CHARGES, PER DIEM PAYMENTS, OR OTHER METHODS. THE TRANSACTION PRICE IS DETERMINED BASED ON GROSS CHARGES FOR SERVICES PROVIDED, REDUCED BY EXPLICIT PRICE CONCESSIONS PROVIDED TO THIRD-PARTY PAYERS, DISCOUNTS PROVIDED TO UNINSURED PATIENTS IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE PROGRAM, AND IMPLICIT PRICE CONCESSIONS PROVIDED PRIMARILY TO UNINSURED PATIENTS. THE ESTIMATES OF EXPLICIT PRICE CONCESSIONS AND DISCOUNTS ARE BASED ON CONTRACTUAL AGREEMENTS, DISCOUNT POLICIES, AND HISTORICAL EXPERIENCE. THE ESTIMATES OF IMPLICIT PRICE CONCESSIONS ARE BASED ON HISTORICAL COLLECTION EXPERIENCE WITH THESE CLASSES OF PATIENTS USING THE PORTFOLIO APPROACH.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	THE HOSPITAL BELIEVES THE FULL AMOUNT OF THE SHORTFALL FROM MEDICARE SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE IT SERVES ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY, AND IT CANNOT NEGOTIATE CONTRACTUAL RATES WITH THE MEDICARE PROGRAM. THE HOSPITAL MUST ACCEPT WHAT THE MEDICARE PROGRAM PAYS. THE METHODOLOGY USED IN DETERMINING MEDICARE SHORTFALL REPORTED IN THE COMMUNITY BENEFITS REPORT IS MEDICARE NET PATIENT SERVICE REVENUE LESS MEDICARE CHARGES MULTIPLIED BY THE MEDICARE COST REPORT COST TO CHARGE RATIO.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	INGALLS MEMORIAL HOSPITAL HAS A FIDUCIARY DUTY TO SEEK REIMBURSEMENT FOR SERVICES IT HAS PROVIDED FROM INDIVIDUALS WHO ARE ABLE TO PAY, FROM THIRD PARTY INSURERS WHO COVER THE COST OF CARE, AND FROM OTHER PROGRAMS OF ASSISTANCE FOR WHICH THE PATIENT IS ELIGIBLE. TO DETERMINE WHETHER A PATIENT IS ABLE TO PAY FOR THE SERVICES PROVIDED AS WELL AS TO ASSIST THE PATIENT IN FINDING ALTERNATIVE COVERAGE OPTIONS IF THEY ARE UNINSURED OR UNDERINSURED, THE HOSPITAL FOLLOWS THE FOLLOWING CRITERIA RELATED TO BILLING AND COLLECTING FROM PATIENTS. COLLECTING INFORMATION ON PATIENT HEALTH COVERAGE AND FINANCIAL RESOURCES PATIENT OBLIGATIONS: PRIOR TO THE DELIVERY OF ANY HEALTH CARE SERVICES (EXCEPT FOR CASES THAT ARE AN EMERGENCY OR URGENT CARE SERVICE LEVEL), THE PATIENT IS EXPECTED TO PROVIDE TIMELY AND ACCURATE INFORMATION ON THEIR INSURANCE STATUS, DEMOGRAPHIC INFORMATION, CHANGES TO THEIR FAMILY INCOME OR INSURANCE STATUS, AND INFORMATION ON ANY DEDUCTIBLES OR CO-PAYMENTS THAT ARE OWED BASED ON THEIR EXISTING INSURANCE OR FINANCIAL PROGRAM'S PAYMENT OBLIGATIONS. THE DETAILED INFORMATION WILL INCLUDE: A. FULL NAME, ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, CITIZENSHIP AND RESIDENCY INFORMATION, AND THE PATIENT'S APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY THEIR BILL; B. FULL NAME OF THE PATIENT'S GUARANTOR, THEIR ADDRESS, TELEPHONE NUMBER, DATE OF BIRTH, SOCIAL SECURITY NUMBER (IF AVAILABLE), CURRENT HEALTH INSURANCE COVERAGE OPTIONS, AND THEIR APPLICABLE FINANCIAL RESOURCES THAT MAY BE USED TO PAY FOR THE PATIENT'S BILL; AND C. OTHER RESOURCES THAT MAY BE USED TO PAY THEIR BILL, INCLUDING OTHER INSURANCE PROGRAMS, MOTOR VEHICLE OR HOMEOWNERS INSURANCE POLICIES IF THE TREATMENT WAS DUE TO AN ACCIDENT, WORKER'S COMPENSATION PROGRAMS, AND STUDENT INSURANCE POLICIES, AMONG OTHERS. IT IS ULTIMATELY THE PATIENT'S OBLIGATION TO KEEP TRACK OF AND TIMELY PAY THEIR UNPAID HOSPITAL BILL, INCLUDING ANY EXISTING CO-PAYMENTS, CO-INSURANCE, AND DEDUCTIBLES. THE PATIENT IS FURTHER REQUIRED TO INFORM EITHER THEIR CURRENT HEALTH INSURER (IF THEY HAVE ONE) OR THE AGENCY THAT DETERMINED THE PATIENT'S ELIGIBILITY STATUS IN A PUBLIC HEALTH INSURANCE PROGRAM OF ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS. THE HOSPITAL MAY ALSO ASSIST THE PATIENT WITH UPDATING THEIR ELIGIBILITY IN A PUBLIC PROGRAM WHEN THERE ARE ANY CHANGES IN FAMILY INCOME OR INSURANCE STATUS, BUT ONLY IF THE HOSPITALS MADE AWARE BY THE PATIENT OF FACTS THAT MAY INDICATE A CHANGE IN THE PATIENT'S ELIGIBILITY STATUS. PATIENTS ARE REQUIRED TO NOTIFY THE STATE PUBLIC PROGRAM (OFFICE OF MEDICAID), INFORMATION RELATED TO ANY LAWSUIT OR INSURANCE CLAIM THAT WILL COVER THE COST OF THE SERVICES PROVIDED BY THE HOSPITAL. HOSPITAL OBLIGATIONS: INGALLS MEMORIAL HOSPITAL WILL MAKE ALL REASONABLE AND DILIGENT EFFORTS TO COLLECT THE PATIENT INSURANCE STATUS AND OTHER INFORMATION TO VERIFY COVERAGE FOR THE HEALTH CARE SERVICES TO BE PROVIDED BY INGALLS MEMORIAL HOSPITAL. THESE EFFORTS MAY OCCUR WHEN THE PATIENT IS SCHEDULING THEIR SERVICES, DURING PREREGISTRATION, WHILE THE PATIENT IS ADMITTED IN THE HOSPITAL, UPON DISCHARGE, OR DURING THE COLLECTION PROCESS WHICH MAY OCCUR FOR A REASONABLE TIME FOLLOWING DISCHARGE FROM THE HOSPITAL. THIS INFORMATION WILL BE OBTAINED PRIOR TO THE DELIVERY OF ANY NONEMERGENT AND NON-URGENT HEALTH CARE SERVICES (I.E., ELECTIVE PROCEDURES AND SCHEDULED PROCEDURES). INGALLS MEMORIAL HOSPITAL WILL DELAY ANY ATTEMPT TO OBTAIN THIS INFORMATION DURING THE DELIVERY OF ANY EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) LEVEL EMERGENCY LEVEL OR URGENT CARE SERVICES, IF THE PROCESS TO OBTAIN THIS INFORMATION WILL DELAY OR INTERFERE WITH EITHER THE MEDICAL SCREENING EXAMINATION OR THE SERVICES UNDERTAKEN TO STABILIZE AN EMERGENCY MEDICAL CONDITION. THE HOSPITAL'S REASONABLE AND DILIGENT EFFORTS WILL INCLUDE, BUT ARE NOT LIMITED TO, REQUESTING INFORMATION ABOUT THE PATIENT'S INSURANCE STATUS, CHECKING ANY AVAILABLE PUBLIC OR PRIVATE INSURANCE DATABASES, AND FOLLOWING THE BILLINGS RULES OF A KNOWN THIRD PARTY PAYER. IF THE PATIENT OR GUARANTOR/GUARDIAN IS UNABLE TO PROVIDE THE INFORMATION NEEDED, AND THE PATIENT CONSENTS, THE HOSPITAL WILL MAKE REASONABLE EFFORTS TO CONTACT RELATIVES, FRIENDS, GUARANTOR/GUARDIAN, AND THE THIRD PARTY FOR ADDITIONAL INFORMATION. INGALLS MEMORIAL HOSPITAL WILL ALSO MAKE REASONABLE AND DILIGENT EFFORTS TO INVESTIGATE WHETHER A THIRD PARTY RESOURCE MAY BE RESPONSIBLE FOR THE SERVICES PROVIDED BY THE HOSPITAL, INCLUDING BUT NOT LIMITED TO: (1) A MOTOR VEHICLE OR HOMEOWNER'S LIABILITY POLICY, (2) GENERAL ACCIDENT OR PERSONAL INJURY PROTECTION POLICIES, (3) WORKER'S COMPENSATION PROGRAMS, (4) STUDENT INSURANCE POLICIES, AMONG OTHERS. IN ACCORDANCE WITH APPLICABLE STATE REGULATIONS OR THE INSURANCE CONTRACT, FOR ANY CLAIM WHERE INGALLS MEMORIAL HOSPITAL'S REASONABLE AND DILIGENT EFFORTS RESULTED IN A PAYMENT FROM A PRIVATE INSURER OR PUBLIC PROGRAM, INGALLS MEMORIAL HOSPITAL WILL REPORT THE RECOVERY AND OFF SET IT AGAINST THE CLAIM PAID BY THE PRIVATE INSURER OR PUBLIC PROGRAM.THE HOSPITAL FURTHER MAINTAINS ALL INFORMATION IN ACCORDANCE WITH APPLICABLE FEDERAL AND STATE PRIVACY, SECURITY AND ID THEFT LAWS.
Schedule H, Part V, Section B, Line 16a FAP website	- INGALLS MEMORIAL HOSPITAL: Line 16a URL: (SEE STATEMENT);
Schedule H, Part V, Section B, Line 16b FAP Application website	- INGALLS MEMORIAL HOSPITAL: Line 16b URL: (SEE STATEMENT);
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- INGALLS MEMORIAL HOSPITAL: Line 16c URL: (SEE STATEMENT);
Schedule H, Part VI, Line 2 Needs assessment	INGALLS ASSESSES THE HEALTH CARE NEEDS OF THE SOUTH SUBURBAN SERVICE AREA THROUGH THE IMPLEMENTATION OF THE CHNA, STAKEHOLDER ENGAGEMENT, AND COMMUNITY IMPACT GRANT OPPORTUNITIES FOR COMMUNITY-BASED ORGANIZATIONS. INGALLS CONDUCTED ITS CHNA BETWEEN APRIL 2021 AND FEBRUARY 2022 USING A PROCESS THAT WAS ADAPTED FROM THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) FRAMEWORK. THIS PLANNING FRAMEWORK FOCUSES ON COMMUNITY ENGAGEMENT, PARTNERSHIP DEVELOPMENT, AND INCLUSION OF THOSE WHO HAVE HISTORICALLY BEEN EXCLUDED FROM DECISION-MAKING PROCESSES. PRIMARY DATA FOR THE CHNA WAS COLLECTED THROUGH FOUR CHANNELS. > COMMUNITY RESIDENT SURVEYS > COMMUNITY RESIDENT FOCUS GROUPS > HEALTHCARE AND SOCIAL SERVICE PROVIDER FOCUS GROUP > KEY INFORMANT INTERVIEWS THE COMMUNITY RESIDENT SURVEY TOOL WAS DEVELOPED BY INGALLS & UCMC STAFF, INGALLS COMMUNITY ADVISORY COUNCIL AND BASED ON A DESIGN USED BY OTHER PUBLIC HEALTH AGENCIES. THE FINAL SURVEY TOOL INCLUDED 29 QUESTIONS AND ASKED RESPONDENTS TO IDENTIFY HEALTH NEEDS OF YOUTH (0-17 YEARS), ADULTS (18-64 YEARS), AND SENIORS (65+ YEARS). COMMUNITY RESIDENT SURVEYS WERE AVAILABLE ONLINE AND IN PERSON IN BOTH ENGLISH AND SPANISH. COMMUNITY PARTNERS DISTRIBUTED THE SURVEY THROUGH VARIOUS CHANNELS WITH A PARTICULAR EMPHASIS ON SURVEYING TYPICALLY UNDERREPRESENTED POPULATIONS, SUCH AS COMMUNITIES OF COLOR, IMMIGRANTS AND MEMBERS OF THE LGBTQ+ COMMUNITY. INGALLS HELD FOUR FOCUS GROUPS, EACH COVERING A SPECIFIC HEALTH AREA OR POPULATION: > ADULT HEALTH > MATERNAL AND CHILD HEALTH > YOUTH HEALTH > HEALTHCARE AND SOCIAL SERVICE PROVIDERS DUE TO THE COVID-19 PANDEMIC, INGALLS CONDUCTED MOST OF ITS FOCUS GROUPS VIRTUALLY. IN-PERSON AND VIRTUAL FOCUS GROUPS LASTED 90 MINUTES WITH UP TO 12 COMMUNITY MEMBERS IN EACH ONE. IN ADDITION TO THE FOUR GROUPS, THE COMMUNITY BENEFIT MANAGEMENT TEAM IDENTIFIED EIGHT KEY INFORMANTS FOR ONE-ON-ONE INTERVIEWS. KEY INFORMANTS WERE CHOSEN BASED ON THEIR AREA OF EXPERTISE TO FURTHER VALIDATE THEMES THAT EMERGED FROM THE SURVEYS AND FOCUS GROUPS. KEY INFORMANT INTERVIEWS WERE CONDUCTED VIRTUALLY AND EACH LASTED 30 MINUTES. SECONDARY POPULATION HEALTH AND DEMOGRAPHIC DATA WAS COLLECTED FROM A VARIETY OF SOURCES, INCLUDING ILLINOIS HOSPITAL ASSOCIATION (IHA) COMPDATA. INGALLS USED A COMMON SET OF HEALTH INDICATORS TO UNDERSTAND THE PREVALENCE OF MORBIDITY AND MORTALITY IN THE SERVICE AREA. ALL DATA WERE UPLOADED AND ANALYZED USING THE METOPIO DATA PLATFORM. BUILDING ON INGALLS'S PAST CHNA, THE DATA PRIORITY SETTING TEAM, WHICH INCLUDED THE DIRECTOR, COMMUNITY RELATIONS & VOLUNTEER SERVICE AT INGALLS AND STAFF FROM UNIVERSITY OF CHICAGO MEDICINE'S (UCM'S) COMMUNITY BENEFIT AND EVALUATION TEAM, WORKED WITH THE COMMUNITY BENEFIT MANAGEMENT TEAM AND THE COMMUNITY BENEFIT COMMITTEE AS WELL AS SEVERAL WORKGROUPS TO PRIORITIZE HEALTH ISSUES FOR INGALLS NEXT THREE YEARS OF COMMUNITY BENEFIT PROGRAMMING FROM 2023-2025. USING THE CHNA AS A FOUNDATIONAL TOOL, THE DATA PRIORITY SETTING TEAM REVIEWED AND COMPARED THE 2020-2021 INGALLS SERVICE AREA HEALTH OUTCOME DATA TO PREVIOUS HEALTH OUTCOME DATA. NEW DATA AND HEALTH ISSUES THAT WERE WORSE THAN PREVIOUS YEARS WERE SLATED FOR CONSIDERATION. FOR MORE INFORMATION ON INGALLS'S SELECTED HEALTH PRIORITY AREAS PLEASE SEE PART V, SECTION B, LINE 11.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THE ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNS THROUGHOUT THE PATIENT REGISTRATION AREAS REGARDING PATIENT PAYMENT OPTIONS. IN ADDITION, PATIENTS ARE INFORMED VIA THE HOSPITAL'S WEBSITE, INDIVIDUAL PATIENT STATEMENTS, AND FINANCIAL COUNSELORS. BELOW ARE SOME ADDITIONAL DETAILS REGARDING HOW THE HOSPITAL INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SIGNAGE: SIGNS OR SIMILAR WRITTEN NOTICES REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAM WILL BE VISIBLE AT ALL HOSPITAL POINTS OF SERVICE TO CREATE AWARENESS OF THE FINANCIAL ASSISTANCE PROGRAM. AT A MINIMUM, SIGNAGE WILL BE POSTED IN THE EMERGENCY DEPARTMENT AND ADMISSION REGISTRATION AREA. ALL PUBLIC INFORMATION AND/OR FORMS REGARDING THE PROVISION OF FINANCIAL ASSISTANCE PROGRAM WILL USE LANGUAGES THAT ARE APPROPRIATE FOR THE SERVICE AREA IN ACCORDANCE WITH THE STATE'S LANGUAGE ASSISTANCE SERVICES ACT. HOSPITAL BILL/INVOICE: PATIENT BILLS OR STATEMENTS INCLUDE A PROMINENT STATEMENT THAT PATIENTS WHO MEET CERTAIN INCOME REQUIREMENTS MAY QUALIFY FOR FINANCIAL ASSISTANCE AND INFORMATION REGARDING HOW A PATIENT MAY APPLY FOR CONSIDERATION UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THE FOLLOWING ARE MADE PUBLICLY AVAILABLE VIA THE HOSPITAL'S WEBSITE: https://www.uchicagomedicine.org/patients-visitors/patient-information/billing/financial-assistance-at-ingalls 1. PATIENT BROCHURES 2. FINANCIAL ASSISTANCE POLICY 3. APPLICATION FORMS USED TO DETERMINE A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE. 4. PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE POLICY
Schedule H, Part VI, Line 4 Community information	INGALLS SERVICE AREA CONSISTS OF A LARGE, MEDICALLY UNDER RESOURCED, LOWER INCOME POPULATION IN SOUTH SUBURBAN COOK COUNTY. BASED ON THE RESULTS OF THE 2021-2022 CHNA, THE INGALLS PATIENT SERVICE AREA ("PSA") HAS UNDERGONE SIGNIFICANT POPULATION CHANGES OVER THE LAST DECADE. THE 2015-2019 ESTIMATES FROM THE AMERICAN COMMUNITY SURVEY REVEALED THAT THE INGALLS PSA'S POPULATION DECLINED BY 4.9%, WHILE THE TOTAL POPULATON OF COOK COUNTY INCREASED BY 1.6%, AND SOUTH SUBURBAND COOK COUNTY (SSCC) DECREASED BY 2.2%. THE INGALLS PSA IS COMPRISED OF INGALLS SERVICE AREA IS THORNTON TOWNSHIP, WHICH CONSISTS OF 13 ZIP CODES, 20 CITIES/MUNICIPALITIES. THE INGALLS PSA COMPRISES OF 56,994 RESIDENTS, MANY OF WHOM ARE SERVED BY INGALLS. SOME OF THE COMMUNITIES IN INGALL SERVICE AREA HAVE SOME OF THE HIGHEST CHRONIC DISEASE RATES IN SUBURBAN COOK COUNTY. THE POPULATION OF THE INGALLS PSA IS APPROXIMATELY 62.5 PERCENT BLACK, 19.8% Hispanic/Latinx , 14.4% non-Hispanic White, 0.6% Asian & Pacific Islander, 0.1% Native Americans in all three areas, and people identifying as two or more races account for 2.1% in both the Ingalls PSA . IN THE INGALLS PSA, 18.7 % OF INDIVIDUALS LIVE BELOW THE FEDERAL POVERTY LEVEL-THIS IS 1.5 TIMES THE STATE LEVEL. THE UNEMPLOYMENT RATE IS 12.9% IN THE INGALLS PSA COMPARED TO 8.9% IN SOUTH SUBURBAN COOK COUNTY AND 5.9% IN ILLINOIS. 12.8% OF RESIDENTS IN INGALLS PSA ARE FOOD INSECURE. 9.1% OF THOSE IN THE INGALLS PSA DO NOT HAVE HEALTH INSURANCE COMPARED TO 6.8% IN SOUTH SUBURBAN COOK COUNTY AND 8.8% IN COOK COUNTY. 31.4% HAVE MEDICAID COVERAGE, WHICH IS 1.5 TIMES THE STATE LEVEL. IN THE INGALLS PSA PREVENTABLE CHRONIC DISEASE HOSPITALIZATION RATES ARE AMONG THE HIGHEST 1% IN ILLINOIS. THESE DISEASES AFFECT BLACK COMMUNITY MEMBERS AT AN UNEQUAL RATE. THE EMERGENCY DEPARTMENT VISIT RATE FOR HYPERTENSION IN THE INGALLS PSA IS AMONG THE HIGHEST IN THE STATE. ADDITIONALLY, THE EMERGENCY DEPARTMENT VISIT RATE FOR HEART FAILURE IS IN THE 90TH PERCENTILE. THE RATE OF DIABETES IS 15% HIGHER IN THE INGALLS PSA THAN IN SOUTH SUBURBAN COOK COUNTY. THE RATE OF OBESTIY, WHICH IS A RISK FACTOR FOR TYPE 2 DIABETES, IS NEARLY 35.5% IN THE SERVICE AREA. ON AVERAGE, PEOPLE WHO LIVE IN INGALLS PSA HAVE A MORE ADVANCED STAGE OF CANCER WHEN THEY ARE DIAGNOSED THAN OTHER RESIDENTS IN SOUTH SUBURBAN COOK COUNTY, COOK COUNTY AND ILLINOIS. IN ADDITION TO THE PREVENTABLE CHRONIC DISEASES, THE INGALLS PSA HAS ONE OF THE HIGHEST BEHAVIORAL HEALTH ED VISIT RATES IN THE STATE FOR ADULTS. INGALLS IS ONE OF THE FEW HOSPITALS- LOCATED IN SOUTH SUBURBAN COOK COUNTY.
Schedule H, Part VI, Line 6 Affiliated health care system	THE INGALLS MEMORIAL HOSPITAL IS PART OF THE INGALLS HEALTH SYSTEM THAT IS NOW KNOWN AS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. THE INGALLS HEALTH SYSTEM WAS INCORPORATED TO SUPPORT AND ENCOURAGE HEALTH AND HUMAN SERVICES THROUGH THE FOLLOWING AFFILIATES: THE INGALLS MEMORIAL HOSPITAL INGALLS HEALTH VENTURES MEDCENTRIX, INC. INGALLS DEVELOPMENT FOUNDATION INGALLS HEALTH COUNCIL INGALLS HOME CARE INGALLS PROVIDER GROUP INGALLS CASUALTY INSURANCE INGALLS SAME DAY SURGERY, LTD. INGALLS CARE NETWORK PRIMARY HEALTHCARE ASSOCIATES, SC TRULEN INSURANCE SPC LIMITED
Schedule H, Part VI, Line 7 State filing of community benefit report	IL

Schedule H (Form 990) 2022

Additional Data

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Software Version:	2022v5.0

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990.
lBullet

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

OMB No. 1545-0047

2022

Open to Public
Inspection

Name of the organization
The Ingalls Memorial Hospital

Employer identification number
36-2170866

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

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

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

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) TCA HEALTH INC 1029 E 130TH ST CHICAGO,IL60628	36-2743287	501(C)(3)	25,000	COMMUNITY IMPACT GRANT
(2) YOUR CAREER TAPESTRY 6040 ASPEN LN MATTESON,IL60443	84-2421142	501(C)(3)	25,000	COMMUNITY IMPACT GRANT
(3) SOUTH SUBURBAN PADS 414 W LINCOLN HWY CHICAGO HEIGHTS,IL60411	36-3744405	501(C)(3)	25,000	COMMUNITY IMPACT GRANT
(4) CANCER SUPPORT CENTER 2028 ELM ROAD HOMEWOOD,IL60426	36-3880404	501(C)(3)	18,000	COMMUNITY IMPACT GRANT
(5) COOK CTY SOUTHLAND JUV JUSTICE COUNSEL 336 FOREST BLVD PARK FOREST,IL60466	47-5564646	501(C)(3)	5,000	COMMUNITY IMPACT GRANT
(6) FAMILY CHRISTIAN HEALTH CENTER 31 W 155TH ST HARVEY,IL60426	36-4346917	501(C)(3)	18,000	KID FEST SPONSORSHIP

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2022

Page 2

Part III

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

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

(1) SCHOLARSHIPS	64	43,350	CASH	N/A
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

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

Return Reference	Explanation
Schedule I, Part I, Line 2 PROCEDURES FOR MONITORING USE OF GRANT FUNDS	INGALLS DEVELOPMENT FOUNDATION'S BOARD OF DIRECTORS APPROVES THE GRANTS MADE TO OTHER ORGANIZATIONS. FUNDS ARE THEN TRANSFERRED TO INGALLS MEMORIAL HOSPITAL FOR DISBURSEMENT. ENTITIES RECEIVING GRANT FUNDS MUST PROVIDE A WRITTEN FINAL REPORT AND BUDGET NARRATIVE TO ENSURE THE FUNDS WERE EXPENDED TO ATTAIN GRANT OBJECTIVES.
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	SCHOLARSHIPS ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS IN ORDER TO ENSURE THE FUNDS ARE USED FOR THEIR INTENDED PURPOSE.

Schedule I (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2022

Open to Public Inspection

Name of the organization

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes 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 ............

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2022

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)
1EMILY CHASE INTERIM PRESIDENT (7/10/22 THRU 3/7/23)	(i) (ii)	0 ------------- 533,446	0 ------------- 240,486	0 ------------- 40,370	0 ------------- 105,854	0 ------------- 37,550	0 ------------- 957,706	0 ------------- 0
2RANDY NEISWONGER PRESIDENT IMH (THRU 7/10/22)	(i) (ii)	257,241 ------------- 0	127,836 ------------- 0	3,100 ------------- 0	7,947 ------------- 0	28,883 ------------- 0	425,007 ------------- 0	0 ------------- 0
3GRETCHEN PACHOLEK BOARD MEMBER/VP PATIENT CARE & CNO, INGALLS (EFF. 9/6/22)	(i) (ii)	0 ------------- 222,778	0 ------------- 44,800	0 ------------- 14,290	0 ------------- 23,582	0 ------------- 0	0 ------------- 305,450	0 ------------- 0
4THOMAS JACKIEWICZ BOARD MEMBER/PRESIDENT UCMC (EFF. 7/1/22)	(i) (ii)	0 ------------- 1,636,423	0 ------------- 616,836	0 ------------- 50,309	0 ------------- 323,694	0 ------------- 11,333	0 ------------- 2,638,595	0 ------------- 0
5MARK KOZLOFF MD BOARD MEMBER	(i) (ii)	0 ------------- 400,417	0 ------------- 229,317	0 ------------- 22,497	0 ------------- 15,250	0 ------------- 34,747	0 ------------- 702,228	0 ------------- 0
6KAVEH RAHMANI DO BOARD MEMBER (EFF. 1/1/23)	(i) (ii)	0 ------------- 376,577	0 ------------- 195,301	0 ------------- 188	0 ------------- 15,250	0 ------------- 13,790	0 ------------- 601,106	0 ------------- 0
7STEPHEN WEBER MD BOARD MEMBER	(i) (ii)	0 ------------- 723,563	0 ------------- 221,297	0 ------------- 115,975	0 ------------- 146,950	0 ------------- 29,387	0 ------------- 1,237,171	0 ------------- 115,975
8ENGIN YILMAZ MD BOARD MEMBER	(i) (ii)	0 ------------- 251,734	0 ------------- 23,588	0 ------------- 0	0 ------------- 22,075	0 ------------- 623	0 ------------- 298,020	0 ------------- 0
9RICHARD W SILVERIA FORMER CHIEF FINANCIAL OFFICER (THRU 4/22/21)	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 251,969	0 ------------- 0	0 ------------- 0	0 ------------- 251,969	0 ------------- 0
10ANN MCCOLGAN ASSISTANT TREASURER (THRU 5/1/23)	(i) (ii)	0 ------------- 275,729	0 ------------- 68,220	0 ------------- 109,594	0 ------------- 49,787	0 ------------- 38,111	0 ------------- 541,441	0 ------------- 29,271
11TOMASZ SAMEK ASSISTANT SECRETARY	(i) (ii)	0 ------------- 221,439	0 ------------- 25,084	0 ------------- 373	0 ------------- 16,856	0 ------------- 19,001	0 ------------- 282,753	0 ------------- 0
12IVAN SAMSTEIN CHIEF FINANCIAL OFFICER	(i) (ii)	0 ------------- 873,834	0 ------------- 287,750	0 ------------- 31,830	0 ------------- 176,154	0 ------------- 35,194	0 ------------- 1,404,763	0 ------------- 0
13DOUGLAS SAEGESSER FORMER VP OF FINANCE (THRU 9/8/2021)	(i) (ii)	0 ------------- 0	0 ------------- 0	253,258 ------------- 0	0 ------------- 0	23,612 ------------- 0	276,870 ------------- 0	0 ------------- 0
14PAUL DONOHUE VP PHILANTHROPY AND COMMUNITY	(i) (ii)	209,047 ------------- 0	39,168 ------------- 0	4,035 ------------- 0	19,810 ------------- 0	48,458 ------------- 0	320,518 ------------- 0	0 ------------- 0
15JENNIFER ARIADO REGISTERED NURSE	(i) (ii)	207,080 ------------- 0	10,555 ------------- 0	61 ------------- 0	6,878 ------------- 0	49,041 ------------- 0	273,616 ------------- 0	0 ------------- 0
16MARY JO CRANDALL VP OPERATIONS	(i) (ii)	248,014 ------------- 0	28,679 ------------- 0	2,038 ------------- 0	17,098 ------------- 0	0 ------------- 0	295,829 ------------- 0	0 ------------- 0
17POONAM DESAI EXECUTIVE DIRECTOR, AMBULATORY	(i) (ii)	209,639 ------------- 0	26,134 ------------- 0	178 ------------- 0	6,198 ------------- 0	47,435 ------------- 0	289,584 ------------- 0	0 ------------- 0
18NEGIN KIYAVASH DIRECTOR OF PHARMACY	(i) (ii)	195,385 ------------- 0	22,415 ------------- 0	259 ------------- 0	6,099 ------------- 0	24,604 ------------- 0	248,762 ------------- 0	0 ------------- 0
19KRISTINE SHIELDS DIRECTOR, OCCUPATIONAL MEDICINE AND URGENT AID SERVICES	(i) (ii)	188,005 ------------- 0	20,859 ------------- 0	570 ------------- 0	3,316 ------------- 0	0 ------------- 0	212,750 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2022

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 4a Severance or change-of-control payment	IN CALENDAR YEAR 2022, RICHARD SILVERIA AND DOUGLAS SAEGESSER RECEIVED SEVERANCE PAYMENTS FOLLOWING THEIR TERMINATION OF EMPLOYMENT ($251,969 TO RICHARD SILVERIA AND $258,060 TO DOUGLAS SAEGESSER).
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 2023 FOR CALENDAR YEAR 2022: ANN MCCOLGAN EMILY CHASE GRETCHEN PACHOLEK IVAN SAMSTEIN MARY JO CRANDALL PAUL DONOHUE STEPHEN WEBER 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 THE 2022 W-2'S): ANN MCCOLGAN - $29,271 STEPHEN WEBER - $115,975
Schedule J, Part I, Line 7 Non-fixed payments	SEVEN PERSONS LISTED IN PART VII, SECTION A, LINE 1A RECEIVED NON-FIXED NON-RECURRING PAYMENTS DURING CALENDAR YEAR 2022. THESE NON-FIXED PAYMENTS ARE RELATED TO PERFORMANCE BONUSES.
Schedule J, Part II	TAXABLE INCOME REPORTED IN COLUMN (B) MAY INCLUDE PAYMENTS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). IN MOST CASES, THESE PAYMENTS WERE EARNED OVER MANY YEARS OF EMPLOYMENT AND THE AMOUNTS HAD PREVIOUSLY BEEN SUBJECT TO VESTING RULES. SERP PAYMENT AMOUNTS EARNED IN PRIOR YEARS WERE PREVIOUSLY REPORTED ON THE FORM 990 AS DEFERRED COMPENSATION AND ARE REPORTED IN THIS 2022 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. FOR THE INDIVIDUALS LISTED ON SCHEDULE J, PART II THAT ARE IDENTIFIED AS FORMER OFFICERS OR KEY EMPLOYEES, THE COMPENSATION LISTED IS EITHER THE FAIR MARKET VALUE COMPENSATION PAID TO THEM FOR SERVICES THEY PERFORMED AS ACTIVE EMPLOYEES OF IMH OR A RELATED ORGANIZATION (AND WAS NOT PAID TO THEM DUE TO THEIR FORMERLY HAVING BEEN LISTED AS OFFICERS OR KEY EMPLOYEES), OR COMPENSATION AS A COMBINATION OF SERVICES AND SEVERANCE: RICHARD SILVERIA AND DOUGLAS SAEGESSER.

Schedule J (Form 990) 2022

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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
The Ingalls Memorial Hospital

Employer identification number
36-2170866

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	ILLINOIS FINANCE AUTHORITY 2017	86-1091967	000000000	12-29-2017	41,180,000	REFUNDING 2004 BONDS		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	10,675,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	41,180,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	349,422
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............
11 Other spent proceeds .............	40,830,578
12 Other unspent proceeds .............
13 Year of substantial completion .............	2017
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part Ⅴ

Procedures To Undertake Corrective Action

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

Part Ⅵ

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

Return Reference	Explanation
Schedule K, Part V BOND POLICY	WRITTEN TAX-EXEMPT BOND PROCEDURES WERE ADOPTED ON FEBRUARY 12, 2018.
Schedule K, Part IV, Line 2c REBATE COMPUTATION	INGALLS MEMORIAL HOSPITAL PERFORMED A REBATE COMPUTATION ON FEBRUARY 09, 2023.

Schedule K (Form 990) 2021

Additional Data

Software ID:	22016089
Software Version:	2022v5.0

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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

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Return Reference	Explanation
Form 990, Part III, Line 4d Description of other program services	(Expenses $ 16,524,965 including grants of $ 159,350)(Revenue $ 19,714,845) OTHER PROGRAM SERVICES RELATED TO THE PROVISION OF HEALTHCARE INCLUDE LABORATORY SERVICES, PATIENT FINANCIAL SERVICES, COST OF FACILITIES, MALPRACTICE INSURANCE, AND OTHER SUPPORT SERVICES.
Form 990, Part VI, Line 1a PART VI, LINE 1A	THE BOARD OF DIRECTORS SHALL APPOINT ANNUALLY FROM ITS MEMBERSHIP AN EXECUTIVE COMMITTEE OF NOT LESS THAN FIVE (5) NOR MORE THAN NINE (9) MEMBERS, OF WHICH THREE (3) MEMBERS SHALL BE THE CHAIRMAN, THE VICE CHAIRMAN, AND THE SECRETARY/TREASURER OF THE HOSPITAL. THE EXECUTIVE COMMITTEE SHALL HAVE AND EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS NOT PROHIBITED BY STATUTE OR SECTION 1 OF THE HOSPITAL'S BYLAWS BETWEEN MEETINGS THEREOF.
Form 990, Part VI, Line 6 Classes of members or stockholders	PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE VOTING MEMBER OF THE ORGANIZATION IS UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., A RELATED TAX-EXEMPT ORGANIZATION. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, IT HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	DIRECTORS, OTHER THAN THE DIRECTORS EX OFFICIO, SHALL BE ELECTED ANNUALLY BY UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC., OR AT SUCH OTHER TIMES AS MAY BE DETERMINED BY THE SOLE MEMBER OF THE CORPORATION.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. SHALL RETAIN THE RIGHT TO REMOVE ANY DIRECTOR, OTHER THAN DIRECTORS EX OFFICIO, WITH OR WITHOUT CAUSE, AT ANY TIME. UCM COMMUNITY HEALTH & HOSPITAL DIVISION, INC. MUST APPROVE ANY MODIFICATION OR AMENDMENT TO ANY MISSION STATEMENT, STATEMENT OF GOALS OR VALUES, THE ARTICLES OF INCORPORATION OR THE BYLAWS OF THE CORPORATION; THE SALE, LEASE, EXCHANGE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; AND THE MERGER, CONSOLIDATION OR DISSOLUTION OF THE CORPORATION.
Form 990, Part VI, Line 11b Review of form 990 by governing body	THE FORM 990 IS PREPARED INTERNALLY AND REVIEWED IN DETAIL BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. THE FULL FORM 990, INCLUDING SUPPLEMENTAL SCHEDULES, WAS PRESENTED BY THE CHIEF FINANCIAL OFFICER TO THE FINANCE COMMITTEE AT A COMMITTEE MEETING. THE FULL BOARD HAS GRANTED TO THE FINANCE COMMITTEE AUTHORITY TO APPROVE THE FORM 990. THE FULL BOARD WILL RECEIVE A REPORT FROM THE FINANCE COMMITTEE DESCRIBING THE FINANCE COMMITTEE'S REVIEW PERFORMED. PRIOR TO FILING WITH THE IRS, THE FORM 990 WILL BE AVAILABLE AT THE ORGANIZATION'S BOARD MEETING FOR EACH MEMBER'S REVIEW.
Form 990, Part VI, Line 12c 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 HEALTH AND HOSPITAL DIVISION, INC (UCM CHHD) COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES (THE COMMITTEE) IS RESPONSIBLE FOR THE OVERSIGHT OF THE INGALLS MEMORIAL HOSPITAL 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 SANCTIONS 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 15b Process to establish compensation of other employees	AN INDEPENDENT COMPENSATION CONSULTANT REVIEWS THE REASONABLENESS OF PROPOSED TOTAL DIRECT COMPENSATION FOR EACH EXECUTIVE BY PERFORMING A MARKET COMPARISON FOR EACH EXECUTIVE. THE MARKET COMPARISON INVOLVES COLLECTING SURVEY DATA FOR FUNCTIONALLY SIMILAR POSITIONS AT SIMILAR HEALTHCARE ORGANIZATIONS. PERFORMANCE GOALS ARE NORMALLY ESTABLISHED BASED ON THE BUDGET/BUSINESS PLAN APPROVED BY THE BOARD FOR THE FISCAL YEAR. THE OUTSIDE CONSULTANT OPINES WHETHER OR NOT PERFORMANCE GOALS HAVE BEEN REACHED BEFORE A FISCAL YEAR END. PAYMENTS ARE PRESENTED TO THE COMPENSATION COMMITTEE FOR REVIEW AND APPROVAL. THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES PREPARES A TIMELY AND THOROUGH WRITTEN RECORD OF ITS DELIBERATIONS AND CONCLUSIONS.
Form 990, Part VI, Line 19 Required documents available to the public	IMH'S BYLAWS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part VIII, Line 2f Other Program Service Revenue	Client Service Revenue - Total Revenue: 79118, Related or Exempt Function Revenue: 79118, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Parking revenue - Total Revenue: 255, Related or Exempt Function Revenue: 255, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	All other revenue - Total Revenue: 511342, Related or Exempt Function Revenue: 511342, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Xray equipment and staff lease - Total Revenue: 193117, Related or Exempt Function Revenue: 193117, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Rad Techs - Total Revenue: 43450, Related or Exempt Function Revenue: 43450, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees	Patient Care Services - Total Expense: 25289897, Program Service Expense: 24705272, Management and General Expenses: 584625, Fundraising Expenses: ; Environmental/Hospitality Svcs - Total Expense: 5854625, Program Service Expense: 5347558, Management and General Expenses: 507067, Fundraising Expenses: ; Food Services - Total Expense: 5459776, Program Service Expense: 4094832, Management and General Expenses: 1364944, Fundraising Expenses: ; Family Care Centers - Total Expense: 3042139, Program Service Expense: 2730458, Management and General Expenses: 311681, Fundraising Expenses: ; Patient Financial Services - Total Expense: 2559046, Program Service Expense: , Management and General Expenses: 2559046, Fundraising Expenses: ; Patient Transportation - Total Expense: 1690741, Program Service Expense: 1690741, Management and General Expenses: , Fundraising Expenses: ; Laboratory Services - Total Expense: 1441637, Program Service Expense: 1310954, Management and General Expenses: 130683, Fundraising Expenses: ; Other - Total Expense: 4984108, Program Service Expense: 1798492, Management and General Expenses: 3185616, Fundraising Expenses: ; UCMC Chargebacks - Total Expense: 2212938, Program Service Expense: 1201991, Management and General Expenses: 1010947, Fundraising Expenses: ; Rental Expense RECLASS - Total Expense: -5914, Program Service Expense: , Management and General Expenses: -5914, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	FAIR VALUE OF DERIVATIVE INSTRUMENTS - 1888237; CHANGE IN INTEREST OF FOUNDATION - -1069986; TRANSFERS FROM AFFILIATES - 30052600;

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:	22016089
Software Version:	2022v5.0

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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

The Ingalls Memorial Hospital

Employer identification number

36-2170866

Part I

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

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)ADVENTIST BOLINGBROOK HOSPITAL 500 REMINGTON BLVD BOLINGBROOK,IL60440 65-1219504	HOSPITAL	IL	501(c)(3)	3	ADVENT MIDWEST HEALTH		No
(2)ADVENTIST GLENOAKS HOSPITAL 701 WINTHROP AVE GLENDALE HEIGHTS,IL60139 36-3208390	HOSPITAL	IL	501(c)(3)	3	ADVENT MIDWEST HEALTH		No
(3)ADVENTIST HEALTH PARTNERS INC 5101 S WILLOW SPRINGS RD B1013 LA GRANGE,IL60525 36-4138353	PHYSICIAN PRACTICES	IL	501(c)(3)	3	AHS MIDWEST MGMT		No
(4)ADVENTIST MIDWEST HEALTH 120 N OAK STREET HINSDALE,IL60521 36-2276984	2 HOSPITALS	IL	501(c)(3)	3	NA		No
(5)AHP SPECIALTY CARE NFP 5101 S WILLOW SPRINGS RD B1013 LA GRANGE,IL60525 81-1105774	PHYSICIAN PRACTICES	IL	501(c)(3)	3	AHS MIDWEST MGMT		No
(6)AHS MIDWEST MANAGEMENT INC 500 REMINGTON BLVD BOLINGBROOK,IL60440 36-3354567	PHYSICIAN PRACTICE MANAGEMENT	IL	501(c)(3)	Type I	ADVENT MIDWEST HEALTH		No
(7)ARCH DEVELOPMENT CORPORATION 5555 S WOODLAWN AVENUE CHICAGO,IL60637 36-3485244	TECH TRANSFER	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(8)ASIAN HEALTH COALITION 180 W WASHINGTON ST SUITE 1 CHICAGO,IL60602 31-1607193	HLTH ACCESS	IL	501(c)(3)	10	UNIV CHICAGO		No
(9)CHAPIN HALL CENTER FOR CHILDREN 1313 E 60TH STREET CHICAGO,IL60637 36-2167012	POL RES CTR	IL	501(c)(3)	7	NA		No
(10)CHICAGO HOME FOR THE INCURABLES 5801 S ELLIS AVENUE CHICAGO,IL60637 36-2169138	SUPP RESEARCH	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(11)CHICAGO TUMOR INSTITUTE 5801 S ELLIS AVENUE CHICAGO,IL60637 23-7136019	SUPP RESEARCH	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(12)COURT THEATRE FUND 5535 S ELLIS AVENUE CHICAGO,IL60637 36-3203660	SUPP THE ARTS	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(13)FERMI RESEARCH ALLIANCE LLC PO BOX 500 BATAVIA,IL60510 57-1239010	MANAGE LAB	IL	501(c)(3)	7	NA		No
(14)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
(15)INGALLS DEVELOPMENT FOUNDATION ONE INGALLS DRIVE HARVEY,IL60426 36-3189150	SUPPORT	IL	501(c)(3)	7	UCHHD		No
(16)INGALLS HEALTH VENTURES ONE INGALLS DRIVE HARVEY,IL60426 36-3239703	AMBULATORY	IL	501(c)(3)	Type I	UCHHD		No
(17)INGALLS HOME CARE ONE INGALLS DRIVE HARVEY,IL60426 36-3367939	HEALTHCARE	IL	501(c)(3)	10	IMH	Yes
(18)LAKE PARK ASSOCIATES 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6111317	PROP HOLDG	IL	501(c)(2)		UNIV CHICAGO		No
(19)NATIONAL OPINION RESEARCH CENTER (NORC) 55 E MONROE AVENUE CHICAGO,IL60603 36-2167808	SO SCI SRVYS	IL	501(c)(3)	7	NA		No
(20)PRIMARY HEALTHCARE ASSOCIATES SC 71 W 156TH STREET HARVEY,IL60426 36-4132865	HEALTHCARE	IL	501(c)(3)	10	UCHHD		No
(21)THE JOHN CRERAR FOUNDATION 5730 S ELLIS AVENUE CHICAGO,IL60637 36-3155157	SUPP LIBRARY	IL	501(c)(3)	Type III-O	UNIV CHICAGO		No
(22)THE MARINE BIOLOGICAL LABORATORY 7 MBL STREET WOODS HOLE,MA02543 04-2104690	RES & EDU	MA	501(c)(3)	7	UNIV CHICAGO		No
(23)THE QUADRANGLE CLUB 5801 S ELLIS AVENUE CHICAGO,IL60637 36-1655190	SOCIAL CLUB	IL	501(c)(7)		UNIV CHICAGO		No
(24)THE UNIV OF CHICAGO FDN IN THE HONG KONG LTD	FUNDRAISING	HK			UNIV CHICAGO		No
(25)THE UNIVERSITY OF CHICAGO CLOISTERS CLUB 1212 E 59TH STREET CHICAGO,IL60637	SOCIAL CLUB	IL			UNIV CHICAGO		No
(26)UCHICAGO MEDICINE NORTHWEST INDIANA INC 5841 S MARYLAND AVE CHICAGO,IL60637 92-2355855	HOSPITAL	IN	501(c)(3)	3	UCMC		No
(27)UCHICAGO RESEARCH BANGLADESH LTD	RESEARCH	BG			UCH RS INTL		No
(28)UCHICAGO RESEARCH INTERNATIONAL LIMITED 5801 S ELLIS AVENUE CHICAGO,IL60637 26-2741573	RESEARCH	IL	501(c)(3)	Type I	UNIV CHICAGO		No
(29)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
(30)UCM COMMUNITY HEALTH & HOSPITAL DIVISION ONE INGALLS DRIVE HARVEY,IL60426 36-3181170	MANAGEMENT	IL	501(c)(3)	Type I	UCMC		No
(31)UCMC TITLE HOLDING CORPORATION 5841 S MARYLAND AVE MC 1086 CHICAGO,IL60637 81-2126789	TITLE HOLD	IL	501(c)(3)	Type I	UCMC		No
(32)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
(33)UNIV OF CHI BOOTH SCH OF BUS (SINGAPORE)	EDUCATION	SN			UNIV CHICAGO		No
(34)UNIV OF CHI BOOTH SCH OF BUS (UK)	EDUCATION	UK			UNIV CHICAGO		No
(35)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
(36)UNIV OF CHICAGO CENTER IN PARIS (FRANCE)	EDUCATION	FR			UNIV CHICAGO		No
(37)UNIV OF CHICAGO CHARTER SCHOOL CORP 5801 S ELLIS AVENUE CHICAGO,IL60637 36-4225812	EDUCATION	IL	501(c)(3)	2	UNIV CHICAGO		No
(38)UNIV OF CHICAGO PROPERTY HOLDING CO 5801 S ELLIS AVENUE CHICAGO,IL60637 36-6108743	PROP HOLDG	IL	501(c)(2)		UNIV CHICAGO		No
(39)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
(40)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
(41)UNIVERSITY OF CHICAGO 5801 S ELLIS AVENUE CHICAGO,IL60637 36-2177139	EDUCATION	IL	501(c)(3)	2	NA		No
(42)UNIVERSITY OF CHICAGO MEDICAL CENTER 5841 S MARYLAND AVENUE CHICAGO,IL60637 36-3188183	HOSPITAL	IL	501(c)(3)	3	UNIV CHICAGO		No
(43)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) ADVENTIST MIDWESTUSP SURGERY CENTERS LLC 14201 DALLAS PARKWAY DALLAS,TX75254 20-3256430	SURGERY CENTER	IL	NA	N/A				No			No
(2) INGALLS SAME DAY SURGERY CTR 6701 W 159TH ST TINLEY PARK,IL60477 36-3368549	SURGERY CENTER	IL	NA	N/A				No			No
(3) UCMC-SOLIS ON-CAMPUS MAMMOGRAPHY LLC 15601 DALLAS PARKWAY SUITE 500 ADDISON,TX75001 35-2641914	MAMMOGRAPHY	DE	NA	N/A				No			No
(4) UCMC-SOLIS OFF-CAMPUS MAMMOGRAPHY SERVICES LLC 15601 DALLAS PARKWAY SUITE 300 ADDISON,TX75001 38-4108853	MAMMOGRAPHY	DE	NA	N/A				No			No
(5) PABHS-UCM MSO JV LLC 2845 N SHERIDAN RD SUITE 6400 CHICAGO,IL60657 87-4074642	RADIOLOGY ONCOLOGY	IL	NA	N/A				No			No
(6) PABHS-UCM RADONC JV 2846 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 (68) 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	NA	C Corporation					No
(4) INGALLS HEALTH COUNCIL ONE INGALLS DRIVE HARVEY,IL60426 27-3226539	PURCHASING GROUP	IL	NA	C Corporation					No
(5) INGALLS PROVIDER GROUP ONE INGALLS DRIVE HARVEY,IL60426 36-3485578	INSURANCE SERVICE	IL	NA	C Corporation	11,717,423	1,830,329	100 %	Yes
(6) MEDCENTRIX INC ONE INGALLS DRIVE HARVEY,IL60426 36-3374228	BILLING & MGMT	IL	NA	C Corporation					No
(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						No
(13) EMPLOYED PHYSICIANS SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 98-1571310	LIAB INSURANCE	CJ	UCHHD						No
(14) HPL-GL SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC LTD 98-1571446	LIAB INSURANCE	CJ	UCHHD						No
(15) NON-EMPLOYED PHYSICIANS SP A SEGREGATED PORTFOLIO OF TRULEN INSURANCE SPC L TD 98-1571387	LIAB INSURANCE	CJ	UCHHD						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) ............................

Yes

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

Yes

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) INGALLS HOME CARE - A(iv)	A	84,000	FMV
(2) INGALLS PROVIDER GROUP	Q	837,505	FMV
(3) INGALLS PROVIDER GROUP	S	103,089	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:	22016089
Software Version:	2022v5.0

1	Briefly describe the organization’s mission or most significant activities: INGALLS MEMORIAL HOSPITAL IS A NONPROFIT ACUTE CARE HOSPITAL ORGANIZED FOR THE PURPOSE OF PROVIDING PATIENT CARE, EDUCATION, AND RESEARCH.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,526
6	Total number of volunteers (estimate if necessary) .............	6	58
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	730,710
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) .........	11,362,917	1,547,563
9	Program service revenue (Part VIII, line 2g) .........	328,667,723	319,991,733
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	7,831,360	2,452,022
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,445,923	2,134,730
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	350,307,923	326,126,048
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	166,500	159,350
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)	161,832,244	146,968,087
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 319,077
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	196,854,273	205,170,506
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	358,853,017	352,297,943
19	Revenue less expenses. Subtract line 18 from line 12.......	-8,545,094	-26,171,895
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	479,733,184	435,712,336
21	Total liabilities (Part X, line 26).............	257,529,322	208,322,855
22	Net assets or fund balances. Subtract line 21 from line 20.....	222,203,862	227,389,481

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 235,244,086 including grants of $ ) (Revenue $ 236,109,353 )
	INGALLS MEMORIAL (IMH) INCLUDES A 400+ CERTIFIED BED HOSPITAL AND A NETWORK OF COMPREHENSIVE OUTPATIENT CENTERS THAT FEATURE A FULL ARRAY OF HIGH-TECH DIAGNOSTIC AND TREATMENT SERVICES. IMH MAKES SURE THAT OUR RESOURCES ARE DIRECTED TO AREAS THAT RESULT IN THE GREATEST BENEFIT TO OUR PATIENTS AND THE COMMUNITY.

4b	(Code: ) (Expenses $ 40,931,203 including grants of $ ) (Revenue $ 45,903,993 )
	OPEN FOR FY2023: THE PHARMACY PROVIDES SERVICES TO BOTH OUR INPATIENTS AND INFUSION CENTER PATIENTS. INCLUDED IN THE SERVICES PROVIDED ARE ANTIBIOTIC DOSING, DOSING BASED ON KIDNEY FUNCTION, BLOOD GLUCOSE MANAGEMENT, AND ANTICOAGULANT DOSING AND MONITORING. THE INPATIENT PHARMACY IS OPEN 24/7. WE PROCESS APPROXIMATELY 44,600 MEDICATION ORDERS AND MAKE 4,300 INTERVENTIONS PER MONTH.

4c	(Code: ) (Expenses $ 19,520,694 including grants of $ ) (Revenue $ 19,786,878 )
	IMH PERFORMS AN ARRAY OF SURGICAL SERVICES INCLUDING ELECTIVE, NON-ELECTIVE, COMPLEX AND HIGHLY SPECIALIZED PROCEDURES. SURGEONS ON STAFF AT INGALLS SPECIALIZE IN EVERY AREA OF SURGERY, INCLUDING, BUT NOT LIMITED TO CARDIOTHORACIC SURGERY, ORTHOPEDIC SURGERY, NEUROSURGERY, SPINE SURGERY, GENERAL SURGERY, AND VASCULAR SURGERY. IN FY2023 INGALLS PERFORMED OVER 1,000 INPATIENT SURGERIES AND 2,100 AMBULATORY SURGERIES.

	(Code: ) (Expenses $ 16,524,965 including grants of $ 159,350 ) (Revenue $ 19,714,845 )
	OTHER PROGRAM SERVICES RELATED TO THE PROVISION OF HEALTHCARE INCLUDE LABORATORY SERVICES, PATIENT FINANCIAL SERVICES, COST OF FACILITIES, MALPRACTICE INSURANCE, AND OTHER SUPPORT SERVICES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 16,524,965 including grants of $ 159,350 ) (Revenue $ 19,714,845 )
4e	Total program service expenses312,220,948

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,053,556	8,106,013	1,404,568

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,547,563
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.......		1,547,563

		Business Code
2a	NET PATIENT REVENUE	622110	317,004,661	317,004,661
b	RENTAL INCOME	900099	1,655,736	1,655,736
c	LAB SERVICES	621500	730,710		730,710
d	FOOD SERVICE	900099	418,164	418,164
e	BONUS FROM IPG	900099	103,089	103,089
f	All other program service revenue.		79,373	79,373	0	0
g	Total. Add lines 2a–2f .....		319,991,733

3 Investment income (including dividends, interest, and othersimilar amounts) ......			784,929			784,929
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		649,287	6a
b	Less: rental expenses		768,603	6b
c	Rental income or (loss)	0	-119,316	6c
d	Net rental income or (loss).......			-119,316			-119,316
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,667,093	7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)	0	1,667,093	7c
d	Net gain or (loss).........			1,667,093			1,667,093
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	340B PROGRAM		900099	700,607	700,607
b	BANK REBATES		900099	526,962	526,962
c	MANAGEMENT FEES		900099	278,568	278,568
d	All other revenue ....			747,909	747,909	0	0
e	Total. Add lines 11a–11d ......			2,254,046
12	Total revenue. See instructions.....			326,126,048	321,515,069	730,710	2,332,706

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	116,000	116,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	43,350	43,350
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 ...........	477,365	79,144	79,144	319,077
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........	125,954,656	114,175,729	11,778,927
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,632,655	2,414,291	218,364
9	Other employee benefits .......	10,393,916	8,863,958	1,529,958
10	Payroll taxes ...........	7,509,495	6,833,601	675,894
11	Fees for services (non-employees):
a	Management ......	4,085,223		4,085,223
b	Legal .........	204,415		204,415
c	Accounting ...........	270,220		270,220
d	Lobbying ...........	33,685		33,685
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	618,005		618,005
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	52,528,993	42,880,298	9,648,695	0
12	Advertising and promotion ....	1,283,312		1,283,312
13	Office expenses .......	3,958,855	2,685,463	1,273,392
14	Information technology ......	13,608,049	9,491,877	4,116,172
15	Royalties ..
16	Occupancy ...........	5,198,759	4,773,120	425,639
17	Travel ............	90,577	58,158	32,419
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	3,131,542	3,131,542
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	16,128,075	16,128,075
23	Insurance ...	12,318,279	9,628,921	2,689,358
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	61,373,294	61,350,075	23,219
b	PUBLIC ASSESSMENT	22,117,489	22,117,489
c	REPAIRS & MAINTENANCE	6,330,305	5,904,568	425,737
d	LAUNDRY SERVICES	1,079,325	1,078,319	1,006
e	All other expenses	812,104	466,970	345,134	0
25	Total functional expenses. Add lines 1 through 24e	352,297,943	312,220,948	39,757,918	319,077
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 ........			5,220	1	5,220
2	Savings and temporary cash investments .........			23,814	2	22,802
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			41,394,560	4	39,263,221
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 ............			6,777,269	8	9,420,115
9	Prepaid expenses and deferred charges ......			2,316,969	9	1,716,266
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	307,357,659
b	Less: accumulated depreciation	10b	103,253,141	196,154,818	10c	204,104,518
11	Investments—publicly traded securities .			129,349,004	11	112,956,062
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			103,711,530	15	68,224,132
16	Total assets. Add lines 1 through 15 (must equal line 33)...			479,733,184	16	435,712,336

17	Accounts payable and accrued expenses .....	144,685,915	17	103,365,052
18	Grants payable ...		18
19	Deferred revenue .........	6,330,281	19	7,150,629
20	Tax-exempt bond liabilities .........	32,143,937	20	30,280,334
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 ..	61,371,463	23	59,490,140
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	12,997,726	25	8,036,700
26	Total liabilities. Add lines 17 through 25..	257,529,322	26	208,322,855

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	218,994,374	27	225,249,979
28	Net assets with donor restrictions ...........	3,209,488	28	2,139,502
	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 ...........	222,203,862	32	227,389,481
33	Total liabilities and net assets/fund balances ........	479,733,184	33	435,712,336