Instructions For Schedule H (Form 990) - 2016 (Page 2 of 23) in pdf

Deductions, Credits, etc., Part II, line J, for

the United States in Parts I, II, III, or V.

services provided to persons who meet

the partnership tax year ending in the

Information from foreign joint ventures and

the organization's criteria for financial

organization's tax year being reported on

partnerships must be reported in Part IV,

assistance and are unable to pay for all or

the organization's Form 990. If

Management Companies and Joint

a portion of the services. Financial

Schedule K-1 (Form 1065) isn't available,

Ventures. Information concerning foreign

assistance does not include: bad debt or

the organization can use other business

hospitals and facilities can be described in

uncollectible charges that the organization

records to make a reasonable estimate,

Part VI.

recorded as revenue but wrote off due to a

including the most recently available

patient's failure to pay, or the cost of

Except as provided in Part IV, don't

Schedule K-1 (Form 1065), adjusted as

providing such care to such patients; the

report on Schedule H (Form 990)

appropriate to reflect facts known to the

difference between the cost of care

information from an entity organized as a

organization, or information used for

provided under Medicaid or other

separate legal entity from the organization

purposes of determining its proportionate

means-tested government programs or

and treated as a corporation for federal

share of the venture for the organization's

under Medicare and the revenue derived

income tax purposes (except for members

financial statements.

therefrom; self-pay or prompt pay

of a group exemption included in a group

discounts; or contractual adjustments with

5. In the case of a group return filed

return filed by the organization), even if

any third-party payors.

by the hospital organization, hospital

such entity is affiliated with or otherwise

facilities operated directly by members of

related to the organization (for example,

Line 2. Check only one of the three

the group exemption included in the

part of an affiliated health care system).

boxes. “Applied uniformly to all hospitals”

group return, hospital facilities operated by

means that all of the organization's

If an organization isn't required to file Form

a disregarded entity of which a member

hospital facilities use the same financial

990 but chooses to do so, it must file a

included in the group return is the sole

assistance policy. “Applied uniformly to

complete return and provide all of the

member, hospital facilities operated by a

most hospitals” means that the majority of

information requested, including the

joint venture treated as a partnership to

the organization's hospital facilities use

required schedules.

the extent of the group member's

the same financial assistance policy.

proportionate share (determined in the

An organization that did not operate one

“Generally tailored to individual hospitals”

manner described in 4, earlier), and other

or more facilities during the tax year that

means that the majority of the

health care facilities or programs of a

satisfy the definition of hospital facility,

organization's hospital facilities use

member included in the group return even

above, should not file Schedule H (Form

different financial assistance policies. If

if such programs are provided separately

990).

the organization operates only one

from the hospital's license.

hospital facility, check “Applied uniformly

The definition of hospital for

to all hospitals.”

Example. The organization is the sole

Schedule A (Form 990), Public

TIP

member of a disregarded entity. The

Charity Status and Public Support,

Line 3. Answer lines 3a, 3b, and 3c

disregarded entity owns 50% of a joint

Part I, line 3, and the definition of hospital

based on the financial assistance eligibility

venture treated as a partnership. The

for Schedule H (Form 990) aren't the

criteria that apply to (1) the largest number

partnership in turn owns 50% of another

same. Accordingly, an organization that

of the organization's patients based on

joint venture treated as a partnership that

checks box 3 in Part I of Schedule A (Form

patient contacts or encounters or (2) if the

operates a hospital and a freestanding

990) to report that it is a hospital or

organization does not operate its own

outpatient clinic that isn't part of the

cooperative hospital service organization,

hospital facility, the largest number of

hospital's license. (Assume the

must complete and attach Schedule H to

patients of a hospital facility operated by a

proportionate shares of the partnerships

Form 990 only if it meets the definition of

joint venture in which the organization

based on capital account percentages

hospital facility for purposes of

has an ownership interest. For example, if

listed on the partnerships' Schedule K-1

Schedule H (Form 990), as explained

the organization has two hospital facilities,

(Form 1065), Part II, line J, are also 50%.)

above.

use the financial assistance eligibility

The organization would report 25% (50%

criteria used by the hospital facility which

of 50%) of the hospital's and outpatient

has the most patient contacts or

Specific Instructions

clinic's combined information on

encounters during the tax year.

Schedule H (Form 990).

Line 3a. “Federal Poverty Guidelines”

Part I. Financial

Note that while information from all the

(FPG) are the Federal Poverty Guidelines

Assistance and Certain

above sources is combined for purposes

published annually by the U.S.

of Schedule H (Form 990), the

Department of Health and Human

Other Community Benefits

organization is required to list and provide

Services. If the organization has

at Cost

information regarding each of its hospital

established a family or household income

facilities in Part V, Sections A, B, and C

threshold that a patient must meet or fall

Part I requires reporting of financial

whether operated directly by the

below to qualify for free medical care,

assistance policies, the availability of

organization or through a disregarded

check the box in the “Yes” column and

community benefit reports, and the cost of

entity or joint venture treated as a

indicate the specific threshold by checking

financial assistance and other community

partnership. In addition, the organization

benefit activities and programs.

the appropriate box. For instance, if a

must list in Part V, Section D, each of its

patient's family or household income must

Worksheets and accompanying

other health care facilities (for example,

be less than or equal to 250% of FPG for

instructions are provided at the end of the

rehabilitation clinics, other outpatient

the patient to qualify for free care, then

instructions to this schedule to assist in

clinics, diagnostic centers, skilled nursing

completing the table in Part I, line 7.

check the box marked “Other” and enter

facilities) that it operated during the tax

“250%.”

Line 1. A financial assistance policy

year, whether operated directly by the

(FAP), sometimes referred to as a charity

Line 3b. If the organization has

organization or through a disregarded

care policy, is a policy describing how the

established a family or household income

entity or a joint venture treated as a

organization will provide financial

threshold that a patient must meet or fall

partnership.

assistance at its hospital(s) and other

below to qualify for discounted medical

Organizations aren't to report

facilities, if any. Financial assistance

care, check the box in the “Yes” column

information from hospitals located outside

includes free or discounted health

Instructions for Schedule H

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Instructions For Schedule H (Form 990) - 2016 Page 2

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