Instructions For Schedule H (Form 990) - 2016 (Page 7 of 23) in pdf

Note. Don't include publicly traded

facilities, the organization would assign

“Research facility” is a facility that

entities or entities whose sole income is

and list the facility reporting group letter in

conducts research.

passive investment income from interest

the “Facility reporting group” column in

“ER–24 hours” refers to a facility that

or dividends.

Section A. Assign letter A to the facility

operates an emergency room 24 hours a

reporting group with the greatest number

day, 365 days a year.

For purposes of Part IV, the aggregate

of facilities, letter B to the group with the

percentage share of profits or stock

“ER–other” refers to a facility that

second greatest number of facilities, and

ownership percentage of officers,

operates an emergency room for periods

so forth. For instance, three hospital

directors, trustees, key employees, and

less than 24 hours a day, 365 days a year.

facilities with identical answers to the

physicians who are employed as

Complete the “Other (describe)”

Section B checkboxes would be assigned

physicians by, or have staff privileges with,

column for each hospital facility that the

facility group letter A, while two other

one or more of the organization's hospitals

organization operates that isn't described

hospital facilities with identical answers

is measured as of the earlier of the close

in the other columns of Part V, Section A.

would be assigned facility group letter B.

of the tax year of the organization or the

In the upper left hand corner of the Part

Section A. Complete Part V, Section A,

last day the organization was a member of

V, Section A table, list the total number of

by listing all of the organization's hospital

the joint venture. All stock, whether

hospital facilities that the organization

facilities that it operated during the tax

common or preferred, is considered stock

operated during the tax year.

year. List these facilities in order of size

for purposes of determining the stock

from largest to smallest, measured by a

If the organization needs additional

ownership percentage. Provide all the

reasonable method (for example, the

space to list all of its hospital facilities, it

information requested below for each such

number of patients served or total revenue

should duplicate Section A and use as

entity.

many duplicate copies of Section A as

per facility). “Hospital facilities” are

Column (a). Enter the full legal name of

needed, number each page, and

facilities that, at any time during the tax

the entity.

year, were required to be licensed,

renumber the line numbers in the left hand

registered, or similarly recognized as a

margin (an organization with 15 facilities

Column (b). Describe the primary

hospital under state law. A hospital facility

should renumber lines 1–5 on the 2nd

business activity or activities conducted by

page as lines 11–15).

is operated by an organization whether the

the management company, joint

facility is operated directly by the

venture, or separate entity.

Section B. Section B requires reporting

organization or through a disregarded

on a hospital facility by hospital facility

Column (c). Enter the organization's

entity or joint venture treated as a

basis. The organization must complete a

percentage share of profits in the

partnership. For each hospital facility, list

Section B for each of its hospital facilities

partnership or LLC, or stock in the entity

its name, address, primary website

or facility reporting groups listed in

that is owned by the organization.

address, and state license number, (and if

Section A. At the top of each page of

a group return, the name and EIN of the

Column (d). Enter the percentage share

Section B, list the name of the hospital

subordinate hospital organization that

of profits or stock in the entity owned by all

facility or the facility reporting group letter.

operates the hospital facility), and check

of the organization's current officers,

In the space provided, list the line number

the applicable column(s).

directors, trustees, or key employees.

of the hospital facility, or line numbers of

“Licensed hospital” is a facility

the hospital facilities in a facility reporting

Column (e). Enter the percentage share

licensed, registered, or similarly

group (from Part V, Section A).

of profits or stock in the entity owned by all

recognized by a state as a hospital.

physicians who are employees practicing

If the organization could check the

as physicians or who have staff privileges

“General medical and surgical” refers

same checkboxes for all Part V, Section B

with one or more of the organization's

to a hospital primarily engaged in

questions for more than one of its hospital

hospitals.

providing diagnostic and medical

facilities, it may file a single Section B for

treatment (both surgical and nonsurgical)

all facilities in that facility reporting group.

If a physician described above is also a

to inpatients with a wide variety of medical

current officer, director, trustee, or key

References in these Section B

conditions, and that may provide

employee of the organization, include his

instructions to a “hospital facility” taking a

outpatient services, anatomical pathology

or her profits or stock percentage in

certain action mean that the hospital

services, diagnostic X-ray services,

column (d). Don't include this in column

organization took action through or on

clinical laboratory services, operating

(e).

behalf of the hospital facility.

room services, and pharmacy services.

Part IV can be duplicated if more space

Line 1. Answer “Yes” if the hospital

“Children's hospital” is a center for

is needed to list additional management

facility was first licensed, registered, or

provision of health care to children, and

companies and joint ventures.

similarly recognized by a state as a

includes independent acute care

hospital facility in the current tax year or

Part V. Facility Information

children's hospitals, children's hospitals

the immediately preceding tax year.

within larger medical centers, and

In Part V, the organization must list all of

Line 2. Answer “Yes” if the hospital

independent children's specialty and

its hospital facilities in Section A,

facility was acquired or placed into

rehabilitation hospitals.

complete separate Sections B and C for

service as a tax-exempt hospital in the

“Teaching hospital” is a hospital that

each of its hospital facilities or facility

current tax year or the immediately

provides training to medical students,

reporting groups listed in Section A, and

preceding tax year. If “Yes,” provide

interns, residents, fellows, nurses, or other

list its non-hospital health care facilities in

details in Section C.

health professionals and providers,

Section D.

Lines 3 through 12c. A community

provided that such educational programs

health needs assessment (“CHNA”) is an

Facility reporting groups. If the

are accredited by the appropriate national

organization is able to check the same

assessment of the significant health needs

accrediting body.

checkboxes for all Part V, Section B

of the community. To meet the

“Critical access hospital” (CAH) is a

requirements of section 501(r)(3), a CHNA

questions for more than one of its hospital

hospital designated as a CAH by a state

must take into account input from persons

facilities, it may file a single Section B and

that has established a State Medicare

who represent the broad interests of the

Section C for all facilities in that facility

Rural Hospital Flexibility Program in

reporting group. For each of those

community served by the hospital facility,

accordance with Medicare rules.

Instructions for Schedule H

-7-

Instructions For Schedule H (Form 990) - 2016 Page 7

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