Schedule H (Form 990) - Hospitals - 2015 Page 9
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Schedule H (Form 990) 2015
Page
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.
Schedule H (Form 990) 2015
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