Instructions for Schedule H

2025

Instructions for Schedule H

(Form 990)

Hospitals

Section references are to the Internal Revenue Code unless

otherwise noted.

Future Developments

For the latest information about developments related to Form

990 and its instructions, such as legislation enacted after they

were published, go to IRS.gov/Form990.

General Instructions

Note: Terms in bold are defined in the Glossary of the

Instructions for Form 990.

Background. The Patient Protection and Affordable Care Act

(Affordable Care Act), enacted March 23, 2010, P.L. No.

111-148, added section 501(r) to the Code. Section 501(r)

includes additional requirements a hospital organization must

meet to qualify for tax exemption under section 501(c)(3) in tax

years beginning after March 23, 2010. These additional

requirements address a hospital organization's financial

assistance policy (FAP), policy relating to emergency medical

care, billing and collections, and charges for medical care. Also,

for tax years beginning after March 23, 2012, the Affordable

Care Act requires hospital organizations to conduct community

health needs assessments.

Because section 501(r) requires a hospital organization to

meet these requirements for each of its hospital facilities, Part

V, Facility Information, has been expanded to include a

Section A, Hospital Facilities. In this section, a hospital

organization must list its hospital facilities; that is, its facilities

that, at any time during the tax year, were required to be

licensed, registered, or similarly recognized as a hospital under

state law. Part V also includes Section B, Facility Policies and

Practices, for reporting of information on policies and practices

addressed in section 501(r). The hospital organization must

complete a separate Section B for each of its hospital facilities or

facility reporting groups listed in Section A.

Section 6033(b)(15)(B) also requires hospital organizations to

submit a copy of their audited financial statements to the IRS.

Accordingly, a hospital organization that is required to file Form

990 must attach a copy of its most recent audited financial

statements to its Form 990. If the organization was included in

consolidated audited financial statements but not separate

audited financial statements for the tax year, then it must attach a

copy of the consolidated financial statements, including details

of consolidation. See the instructions for Form 990, Part IV,

line 20b.

Part V, Section D, requires an organization to list all of its

non-hospital health care facilities that it operated during the tax

year, whether or not such facilities were required to be licensed

or registered under state law. The organization shouldn't

complete Part V, Section B, for any of these non-hospital

facilities.

Tip: Section 501(r) final regulations are applicable for tax years

beginning after December 29, 2015.

Oct 2, 2025

Purpose of Schedule

Hospital organizations use Schedule H (Form 990) to provide

information on the activities and policies of, and community

benefit provided by, its hospital facilities and other non-hospital

health care facilities that it operated during the tax year. This

includes facilities operated either directly or through disregarded

entities or joint ventures.

Who Must File

An organization that answered “Yes” on Form 990, Part IV,

line 20a, must complete and attach Schedule H to Form 990.

Schedule H (Form 990) must be completed by a hospital

organization that operated at any time during the tax year at

least one hospital facility. A hospital facility is one that is

required to be licensed, registered, or similarly recognized by a

state as a hospital. Multiple buildings operated by a hospital

organization under a single state license are considered to be a

single hospital facility.

The organization must file a single Schedule H (Form 990)

that combines information from the following.

1. Hospital facilities directly operated by the organization.

2. Hospital facilities operated by disregarded entities of

which the organization is the sole member.

3. Other health care facilities and programs of the hospital

organization or any of the entities described in (1) or (2), even if

provided separately from the hospital's license.

4. Hospital facilities and other health care facilities and

programs operated by any joint venture treated as a

partnership, to the extent of the hospital organization's

proportionate share of the joint venture.

“Proportionate share” is defined as the ending capital account

percentage listed on the Schedule K-1 (Form 1065), Partner's

Share of Income, Deductions, Credits, etc., Part II, line J, for the

partnership tax year ending in the organization's tax year being

reported on the organization's Form 990. If Schedule K-1 (Form

1065) isn't available, the organization can use other business

records to make a reasonable estimate, including the most

recently available Schedule K-1 (Form 1065), adjusted as

appropriate to reflect facts known to the organization, or

information used for purposes of determining its proportionate

share of the venture for the organization's financial statements.

5. In the case of a group return filed by the hospital

organization, hospital facilities operated directly by members of

the group exemption included in the group return, hospital

facilities operated by a disregarded entity of which a member

included in the group return is the sole member, hospital facilities

operated by a joint venture treated as a partnership to the extent

of the group member's proportionate share (determined in the

manner described in (4), earlier), and other health care facilities

or programs of a member included in the group return even if

such programs are provided separately from the hospital's

license.

Instructions for Schedule H (Form 990) (2025) Catalog Number 51526B

Department of the Treasury Internal Revenue Service www.irs.gov

Example. The organization is the sole member of a

disregarded entity. The disregarded entity owns 50% of a joint

venture treated as a partnership. The partnership in turn owns

50% of another joint venture treated as a partnership that

operates a hospital and a freestanding outpatient clinic that isn't

part of the hospital's license. (Assume the proportionate shares

of the partnerships based on capital account percentages listed

on the partnerships' Schedule K-1 (Form 1065), Part II, line J,

are also 50%.) The organization would report 25% (50% of 50%)

of the hospital's and outpatient clinic's combined information on

Schedule H (Form 990).

Note that while information from all the above sources is

combined for purposes of Schedule H (Form 990), the

organization is required to list and provide information regarding

each of its hospital facilities in Part V, Sections A, B, and C,

whether operated directly by the organization or through a

disregarded entity or joint venture treated as a partnership. In

addition, the organization must list in Part V, Section D, each of

its other health care facilities (for example, rehabilitation clinics,

other outpatient clinics, diagnostic centers, skilled nursing

facilities) that it operated during the tax year, whether operated

directly by the organization or through a disregarded entity or a

joint venture treated as a partnership.

Organizations aren't to enter information from hospitals

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

Information from foreign joint ventures and partnerships must be

reported in Part IV, Management Companies and Joint Ventures.

Information concerning foreign hospitals and facilities may be

described in Part VI.

Except as provided in Part IV, don't report on Schedule H

(Form 990) information from an entity organized as a separate

legal entity from the organization and treated as a corporation for

federal income tax purposes (except for members of a group

exemption included in a group return filed by the organization),

even if such entity is affiliated with or otherwise related to the

organization (for example, part of an affiliated health care

system).

If an organization isn't required to file Form 990 but chooses

to do so, it must file a complete return and provide all of the

information requested, including the required schedules.

An organization that didn't operate one or more facilities

during the tax year that satisfy the definition of hospital facility

above shouldn't file Schedule H (Form 990).

Tip: The definition of “hospital” for Schedule A (Form 990),

Public Charity Status and Public Support, Part I, line 3, and the

definition of “hospital” for Schedule H (Form 990) aren't the

same. Accordingly, an organization that checks box 3 in Part I of

Schedule A (Form 990) to enter that it is a hospital or

cooperative hospital service organization must complete and

attach Schedule H to Form 990 only if it meets the definition of

hospital for purposes of Schedule H (Form 990), as explained

above.

Specific Instructions

Part I. Financial Assistance and

Certain Other Community Benefits at

Cost

Part I requires reporting of financial assistance policies, the

availability of community benefit reports, and the cost of financial

assistance and other community benefit activities and programs.

Worksheets and accompanying instructions are provided at the

end of the instructions to this schedule to assist in completing

the table in Part I, line 7.

2

Line 1. A FAP, sometimes referred to as a “charity care policy,” is

a policy describing how the organization will provide financial

assistance at its hospital(s) and other facilities, if any. Financial

assistance includes free or discounted health services provided

to persons who meet the organization's criteria for financial

assistance and are unable to pay for all or a portion of the

services. Financial assistance doesn't include bad debt or

uncollectible charges that the organization recorded as revenue

but wrote off due to a patient's failure to pay, or the cost of

providing such care to such patients; the difference between the

cost of care provided under Medicaid or other means-tested

government programs or under Medicare and the revenue

derived therefrom; self-pay or prompt pay discounts; or

contractual adjustments with any third-party payers.

Line 2. Check only one of the three boxes. “Applied uniformly to

all hospitals” means that all of the organization's hospital

facilities use the same FAP. “Applied uniformly to most

hospitals” means that the majority of the organization's hospital

facilities use the same FAP. “Generally tailored to individual

hospitals” means that the majority of the organization's hospital

facilities use different financial assistance policies. If the

organization operates only one hospital facility, check “Applied

uniformly to all hospitals.”

Line 3. Answer lines 3a, 3b, and 3c, based on the financial

assistance eligibility criteria that apply to (1) the largest number

of the organization's patients based on patient contacts or

encounters; or (2) if the organization doesn't operate its own

hospital facility, the largest number of patients of a hospital

facility operated by a joint venture in which the organization has

an ownership interest. For example, if the organization has two

hospital facilities, use the financial assistance eligibility criteria

used by the hospital facility that has the most patient contacts or

encounters during the tax year.

Line 3a. “Federal Poverty Guidelines” (FPG) are the Federal

Poverty Guidelines published annually by the U.S. Department of

Health and Human Services. If the organization has established

a family or household income threshold that a patient must meet

or fall below to qualify for free medical care, check the box in the

“Yes” column and indicate the specific threshold by checking the

appropriate box. For instance, if a patient's family or household

income must be less than or equal to 250% of FPG for the

patient to qualify for free care, then check the box marked

“Other” and enter “250%.”

Line 3b. If the organization has established a family or

household income threshold that a patient must meet or fall

below to qualify for discounted medical care, check the box in

the “Yes” column and indicate the specific threshold by checking

the appropriate box.

Line 3c. If applicable, describe the other criteria used, such

as asset test or other means test or threshold for free or

discounted care, on Part VI, line 1, of this schedule. An “asset

test” includes (i) a limit on the amount of total or liquid assets that

a patient or the patient's family or household can own for the

patient to qualify for free or discounted care; and/or (ii) a criterion

for determining the level of discounted medical care patients can

receive, depending on the amount of assets that they and/or

their families or households own.

Line 4. “Medically indigent” means persons whom the

organization has determined are unable to pay some or all of

their medical bills because their medical bills exceed a certain

percentage of their family or household income or assets (for

example, due to catastrophic costs or conditions), even though

they have income or assets that otherwise exceed the generally

applicable eligibility requirements for free or discounted care

under the organization's FAP.

Line 5. Answer lines 5a, 5b, and 5c based on the organization's

budgeted amounts under its FAP.

2025 Instructions for Schedule H (Form 990)

Line 5a. Answer “Yes” if the organization established or had

in place at any time during the tax year an annual or periodic

budgeted amount of free or discounted care to be provided

under its FAP. If “No,” skip to line 6a.

Line 5b. Answer “Yes” if the free or discounted care the

organization provided in the applicable period exceeded the

budgeted amount of costs or charges for that period. If “No,” skip

to line 6a.

Line 5c. Answer “Yes” if the organization denied financial

assistance to any patient eligible for free or discounted care

under its FAP or under any of its hospital facilities' financial

assistance policies because the organization's or the facility's

financial assistance budget was exceeded.

Line 6. Answer lines 6a and 6b based on the community benefit

report that the organization prepared for the organization as a

whole during the tax year.

Line 6a. Answer “Yes” if the organization prepared a written

report during the tax year that describes the organization's

programs and services that promote the health of the community

or communities served by the organization. If the organization's

community benefit report is contained in a report prepared by a

related organization, answer “Yes” and identify the related

organization on Part VI, line 1. If “No,” skip to line 7.

Line 6b. Answer “Yes” if the organization made the

community benefit report it prepared during the tax year

available to the public.

Tip: Examples of how an organization can make its community

benefit report available to the public are to post the report on the

organization's website and to make a paper copy of the

community health needs assessment (CHNA) report available

for public inspection upon request and without charge at the

hospital facility.

Lines 7a through 7k. Enter on the table (lines 7a through 7k),

at cost, the organization's financial assistance (as defined in the

instructions for line 1) and certain other community benefits (as

defined in the instructions to Worksheets 1–8). Enter on line 7i

contributions that the organization restricts, in writing, to one or

more of the community benefit activities listed on lines 7a

through 7h. Don't enter such contributions on lines 7a through

7h. To calculate the amounts to be entered on the table, use the

worksheets or other equivalent documentation that substantiates

the information entered consistent with the methodology used on

the worksheets. Don't include bad debt in these amounts. Bad

debt will be entered in Part III.

Tip: If the organization completed worksheets other than on a

combined basis (for example, facility by facility, joint venture by

joint venture), the organization should combine all information

from these worksheets for purposes of entering amounts on the

table. Only the portion of each joint venture or partnership that

represents the organization's proportionate share, based on

capital interest, can be entered on lines 7a through 7k. See

Purpose of Schedule, earlier, for instructions on aggregation.

Use the organization's most accurate costing methodology

(cost accounting system, cost-to-charge ratio, or other) to

calculate the amounts entered on the table. If the organization

uses a cost-to-charge ratio, it can use Worksheet 2, Ratio of

Patient Care Cost to Charges, for this purpose. See the

instructions for Part VI, line 1, regarding an explanation of the

costing methodology used to calculate the amounts entered on

the table.

If the organization included any costs for a physician clinic as

subsidized health services in Part I, line 7g, enter these costs on

Part VI, line 1.

If the organization included any bad debt expense on Form

990, Part IX, line 25, but subtracted this bad debt for purposes of

2025 Instructions for Schedule H (Form 990)

calculating the amount entered in line 7, column (f), enter this

bad debt expense on Part VI, line 1.

The following are descriptions of the type of information

reported in each column of the table.

Column (a). “Number of activities or programs” means the

number of the organization's activities or programs conducted

during the year that involve the community benefit entered on the

line. Enter each activity and program on only one line so that it

isn't counted more than once. Entering in this column is optional.

Column (b). “Persons served” means the number of patient

contacts or encounters in accordance with the filing

organization's records. Persons served can be entered in

multiple rows, as services across different categories may be

provided to the same patient. Entering in this column is optional.

Column (c). “Total community benefit expense” means the

total gross expense of the activity incurred during the year,

calculated by using the pertinent worksheets for each line item.

“Total community benefit expense” includes both “direct costs”

and “indirect costs.” “Direct costs” means salaries and benefits,

supplies, and other expenses directly related to the actual

conduct of each activity or program. “Indirect costs” means costs

that are shared by multiple activities or programs, such as

facilities and administrative costs related to the organization's

infrastructure (space, utilities, custodial services, security,

information systems, administration, materials management, and

others).

Column (d). “Direct offsetting revenue” means revenue from

the activity during the year that offsets the total community

benefit expense of that activity, as calculated on the worksheets

for each line item. “Direct offsetting revenue” includes any

revenue generated by the activity or program, such as payment

or reimbursement for services provided to program patients.

“Direct offsetting revenue” also includes restricted grants or

contributions that the organization uses to provide a community

benefit, such as a restricted grant to provide financial assistance

or fund research. “Direct offsetting revenue” doesn't include

unrestricted grants or contributions that the organization uses to

provide a community benefit. Organizations may describe any

inconsistencies from reporting in prior years in Part VI.

Examples. The organization receives a restricted grant from

an unrelated organization that must be used by the organization

to provide financial assistance. The amount of the restricted

grant is entered as direct offsetting revenue on line 7a, column

(d).

The organization receives an unrestricted grant from an

unrelated organization. The organization decides to use the

grant to increase the amount of financial assistance it provides.

The amount of the unrestricted grant isn't entered as direct

offsetting revenue on line 7a, column (d).

Columns (e) and (f). Don't enter negative numbers. If the

net community benefit expense is less than $0, enter “0.”

Similarly, don't enter a negative percent in column (f), but enter

“0.”

Group return filers. The “total expense” denominator for

purposes of determining the percent of total expense for column

(f) is the amount entered on Form 990, Part IX, line 25, column

(A), of the group return.

Tip: Column (f), “Percent of total expense,” is based on column

(e), “Net community benefit expense,” rather than column (c),

“Total community benefit expense.” Organizations that enter

amounts of direct offsetting revenue might also wish to enter

total community benefit expense (Part I, line 7, column (c)) as a

percentage of total expenses. Although this percentage cannot

be entered in Part I, line 7, column (f), it can be entered on

Schedule H (Form 990), Part VI, line 1.

3

Worksheets for Part I, Line 7

(Financial Assistance and Certain

Other Community Benefits at Cost)

Worksheets 1 through 8 give the definitions of community benefit

to be used in completing Schedule H (Form 990), Part I, lines 7a

through 7k. Use of the worksheets isn't required, and the

organization can use alternative equivalent documentation,

provided that the methodology described in these instructions

(including the instructions for the worksheets) is followed.

Regardless of whether the worksheets or alternative equivalent

documentation is used to compile and enter the required

information, such documentation should not be filed with Form

990 but must be retained by the organization to substantiate the

information entered on Schedule H (Form 990). The worksheets

or alternative equivalent documentation are to be completed

using the organization's most accurate costing methodology,

which can include a cost accounting system, cost-to-charge

ratios, a combination thereof, or some other method.

If the organization is filing a group return or has a disregarded

entity or an ownership interest in one or more joint ventures,

the organization may find it helpful to complete the worksheets

separately for the organization and for each disregarded entity,

joint venture in which the organization had an ownership interest

during the tax year, and group affiliate. In that case, the

organization should combine all information from the worksheets

for purposes of completing line 7. Complete the table by

combining amounts from the organization's worksheets,

amounts from disregarded entities or group affiliates, and

amounts from joint ventures that are attributable to the

organization's proportionate share of each joint venture, in the

aggregation instructions under Purpose of Schedule, earlier.

See Worksheets 1 through 8 and specific instructions for the

worksheets later in these instructions.

Part II. Community Building Activities

Enter in this part the costs of the organization's activities that it

engaged in during the tax year to protect or improve the

community's health or safety, and that aren't entered in Part I of

this schedule. Some community building activities may also

meet the definition of a community health improvement service,

as defined in Worksheet 4. Don't enter in Part II community

building costs that are entered in Part I, line 7e. An organization

that enters information in this Part II must describe in Part VI how

its community building activities promote the health of the

communities it serves.

If the filing organization makes a grant to an organization to

be used to accomplish one of the community building activities

listed in this part, then the organization should include the

amount of the grant on the appropriate line in Part II. If the

organization makes a grant to a joint venture in which it has an

ownership interest to be used to accomplish one of the

community building activities listed in this part, enter the grant on

the appropriate line in Part II, but don't include in Part II the

organization's proportionate share of the amount spent by the

joint venture on such activities to avoid double counting.

Line 1. “Physical improvements and housing” include, but aren't

limited to, the provision or rehabilitation of housing for vulnerable

populations, such as removing building materials that harm the

health of the residents, neighborhood improvement or

revitalization projects, provision of housing for vulnerable

patients upon discharge from an inpatient facility, housing for

low-income seniors, and the development or maintenance of

parks and playgrounds to promote physical activity.

Line 2. “Economic development” can include, but isn't limited to,

assisting small business development in neighborhoods with

4

vulnerable populations and creating new employment

opportunities in areas with high rates of joblessness.

Line 3. “Community support” can include, but isn't limited to,

child care and mentoring programs for vulnerable populations or

neighborhoods, neighborhood support groups, violence

prevention programs, and disaster readiness and public health

emergency activities, such as community disease surveillance or

readiness training beyond what is required by accrediting bodies

or government entities.

Line 4. “Environmental improvements” include, but aren't limited

to, activities to address environmental hazards that affect

community health, such as alleviation of water or air pollution,

safe removal or treatment of garbage or other waste products,

and other activities to protect the community from environmental

hazards. The organization cannot include on this line or in this

part expenditures made to comply with environmental laws and

regulations that apply to activities of itself, its disregarded entity

or entities, a joint venture in which it has an ownership interest,

or a member of a group exemption included in a group return

of which the organization is also a member. Similarly, the

organization cannot include on this line or in this part

expenditures made to reduce the environmental hazards caused

by, or the environmental impact of, its own activities, or those of

its disregarded entities, joint ventures, or group exemption

members, unless the expenditures are for an environmental

improvement activity that:

1. Is provided for the primary purpose of improving

community health,

2. Addresses an environmental issue known to affect

community health, and

3. Is subsidized by the organization at a net loss.

An expenditure may not be entered on this line if the organization

engages in the activity primarily for marketing purposes.

Line 5. “Leadership development and training for community

members” includes, but isn't limited to, training in conflict

resolution; civic, cultural, or language skills; and medical

interpreter skills for community residents.

Line 6. “Coalition building” includes, but isn't limited to,

participation in community coalitions and other collaborative

efforts with the community to address health and safety issues.

Line 7. “Community health improvement advocacy” includes,

but isn't limited to, efforts to support policies and programs to

safeguard or improve public health, access to health care

services, housing, the environment, and transportation.

Line 8. “Workforce development” includes, but isn't limited to,

recruitment of physicians and other health professionals to

medical shortage areas or other areas designated as

underserved, and collaboration with educational institutions to

train and recruit health professionals needed in the community

(other than the health professions education activities entered in

Part I, line 7f).

Line 9. “Other” refers to community building activities that

protect or improve the community's health or safety that aren't

described in the categories listed on lines 1 through 8 above.

Examples might include, but aren’t limited to, spending on food

security, nutrition, and other social determinants of health.

Refer to the instructions to Part I, line 7, columns (a) through

(f), for descriptions of the types of information that should be

entered in each column of Part II.

If the organization is filing a group return or has a

disregarded entity or an ownership interest in one or more

joint ventures, the organization may find it helpful to complete

Part II separately for itself and for each disregarded entity, joint

venture in which the organization had an ownership interest

2025 Instructions for Schedule H (Form 990)

during the tax year, and group affiliate. The organization should

combine the amounts from all such tables, according to the

combined instructions under Purpose of Schedule, earlier, and

include the combined information in Part II.

Part III. Bad Debt, Medicare, &

Collection Practices

Section A

In this section, (a) enter combined bad debt expense; (b) provide

an estimate of how much bad debt expense, if any, reasonably

could be attributable to persons who would likely qualify for

financial assistance under the organization’s FAP; and (c)

provide a rationale for what portion of bad debt, if any, the

organization believes is community benefit. In addition, the

organization must enter whether it has adopted Healthcare

Financial Management Association Statement No. 15, Valuation

and Financial Presentation of Charity Care, Implicit Price

Concessions and Bad Debts by Institutional Healthcare

Providers (“Statement 15”), and provide the text or page number

of its footnote, if applicable, to its audited financial statements

that describe the bad debt expense.

Line 1. Indicate if the organization enters bad debt expense in

accordance with Statement 15.

Note: Statement 15 hasn't been adopted by the American

Institute of Certified Public Accountants (AICPA). The IRS

doesn't require organizations to adopt Statement 15 or use it to

determine bad debt expense or financial assistance costs. Some

organizations may rely on Statement 15 in reporting bad debt

expense and financial assistance in their audited financial

statements. Statement 15 provides instructions for

recordkeeping, valuation, and disclosure for bad debts.

Line 2. Use the most accurate system and methodology

available to the organization to enter bad debt expense. If only a

portion of a patient’s bill for services is written off as a bad debt,

include only the proportionate amount attributable to the bad

debt. Include the organization’s proportionate share of the bad

debt expense of joint ventures in which it had an ownership

interest during the tax year.

Describe in Part VI the methodology used in determining the

amount entered on line 2 as bad debt, including how the

organization accounted for discounts and payments on patient

accounts in determining bad debt expense.

Line 3. Provide an estimate of the amount of bad debt entered

on line 2 that is reasonably attributable to patients who likely

would qualify for financial assistance under the hospital's FAP

as entered on Part I, lines 1 through 4, but for whom insufficient

information was obtained to determine their eligibility. Don't

include this amount in Part I, line 7. Organizations can use

any reasonable methodology to estimate this amount, such as

record reviews, an assessment of financial assistance

applications that were denied due to incomplete documentation,

analysis of demographics, or other analytical methods.

Describe in Part VI the methodology used to determine the

amount entered on line 3 and the rationale, if any, for including

any portion of bad debt as community benefit.

Line 4. In Part VI, provide the footnote from the organization's

audited financial statements on bad debt expense, if

applicable, or the footnotes related to “accounts receivable,”

“allowance for doubtful accounts,” or similar designations.

Alternatively, enter the page number(s) on which the footnote or

footnotes appear in the organization's most recent audited

financial statements, which must be attached to this return. If the

footnote or footnotes address only the filing organization's bad

debt expense or “accounts receivable,” “allowance for doubtful

2025 Instructions for Schedule H (Form 990)

accounts,” or similar designations, provide the exact wording of

the footnote or footnotes, or enter the page number(s) in which

the footnote or footnotes appear in the attached audited financial

statements.

If the organization's financial statements include a footnote on

these issues that also includes other information, enter in Part VI

only the relevant portions of the footnote. If the organization is a

member of a group with consolidated financial statements, the

organization can summarize that portion, if any, of the footnote or

footnotes that apply. If the organization's financial statements

don't include a footnote that discusses bad debt expense,

“accounts receivable,” "allowance for doubtful accounts," or

similar designations, include a statement in Part VI that the

organization's audited financial statements don't include a

footnote discussing these issues and explain how the

organization's financial statements account for bad debt, if at all.

Section B

In this section, (a) combine allowable costs to provide services

reimbursed by Medicare (don't include community benefit costs

included in Part I, line 7), (b) combine Medicare reimbursements

attributable to such costs, and(c) combine Medicare surplus or

shortfall. Include in Section B only those allowable costs and

Medicare reimbursements that are reported in the organization's

Medicare Cost Report(s) for the year, including its share of any

such allowable costs and reimbursement from disregarded

entities and joint ventures in which it has an ownership

interest. Don't include any Medicare-related expenses or

revenue properly entered in Part I, line 7f or 7g.

In Part VI, the organization should describe what portion of its

Medicare shortfall, if any, it believes should constitute community

benefit, and explain its rationale for its position. As described

below, the organization can also enter in Part VI the amount of

any Medicare revenues and costs not included in its Medicare

Cost Report(s) for the year, and can enter a reconciliation of the

amounts entered in Section B (including the surplus or shortfall

entered on line 7) and the total revenues and costs attributable

to all of the organization's Medicare programs.

Line 5. Enter all net patient service revenue (for Medicare fee

for service (FFS) patients) associated with the allowable costs

the organization entered in its Medicare Cost Report(s) for the

year, including payments for indirect medical education (IME)

(except for Medicare Advantage IME), Medicare

disproportionate share hospital (DSH) revenue, coinsurance,

patient deductible, outliers, capital, bad debt, and any other

amounts paid to the organization on the basis of its Medicare

Cost Report. Don't include revenue related to subsidized health

services as entered in Part I, line 7g (see Worksheet 6), research

as entered in Part I, line 7h (see Worksheet 7), or direct graduate

medical education (GME) as entered in Part I, line 7f (see

Worksheet 5). If the organization has more than one Medicare

provider number, combine the revenue attributable to costs

reported on the Medicare Cost Report(s) submitted under each

provider number, and enter the combined revenues on line 5.

Line 6. Enter all Medicare allowable costs reported in the

organization's Medicare Cost Report(s), except those already

entered on line 7g, Part I (subsidized health services), and costs

associated with direct GME already entered on line 7f, Part I

(health professions education). This can be determined using

Worksheet A. If Worksheet A isn't used, the organization must

still subtract the costs attributable to subsidized health services

and direct GME from the Medicare allowable costs it enters on

line 6. If the organization has more than one Medicare provider

number, it should combine the costs reported in the Medicare

Cost Report(s) submitted under each provider number and enter

the combined costs on line 6.

5

Worksheet A (Optional)

Complete Worksheets 5 and 6 before completing this Worksheet

A.

1.

2.

3.

4.

5.

Total Medicare allowable costs (from Medicare

Cost Report) . . . . . . . . . . . . . . . . . . . . . . $

Total Medicare allowable costs (from line 1)

included in Worksheet 6, line 3, col. (A) . . . . . . . $

Total Medicare allowable costs (from line 1)

included in Worksheet 5, line 8 (direct GME) . . . . $

Total adjustments to Medicare allowable costs (add

lines 2 and 3) . . . . . . . . . . . . . . . . . . . . . . $

Total Medicare allowable costs (line 1 minus line 4).

Enter this value on Part III, line 6 . . . . . . . . . . . $

Line 7. Subtract line 6 from the amount on line 5. If line 6

exceeds line 5, enter the surplus (the shortfall) as a negative

number.

Tip: Lines 5, 6, and 7 don't include certain Medicare program

revenues and costs, and thus cannot reflect all of the

organization's revenues and costs associated with its

participation in Medicare programs. The organization can

describe in Part VI the Medicare revenues and costs not

included in its Medicare Cost Report(s) for the year (for example,

revenues and costs for freestanding ambulatory surgery centers,

physician services billed by the organization, clinical laboratory

services, and revenues and costs of Medicare Part C and Part D

programs). The organization can enter on Part VI, line 1, a

reconciliation of amounts entered in Section B (including the

surplus or shortfall entered on line 7) and all of the organization's

total revenues and total expenses attributable to Medicare

programs.

Line 8. Check the box that best describes the costing

methodology used to enter the Medicare allowable costs on

line 6. Describe this methodology in Part VI.

The organization must also describe in Part VI its rationale for

treating the amount entered on Part III, line 7, or any portion of it,

as a community benefit. An organization's rationale must have a

reasonable basis. Don't include this amount in Part I, line 7.

If the organization received any prior year settlements for

Medicare-related services in the current tax year, it can provide

an explanation on Part VI, line 1.

Section C

In this section, enter the organization's written debt collection

policy.

Line 9a. Answer “Yes” if the organization had a written debt

collection policy on the collection of amounts owed by patients

during its tax year.

For purposes of line 9a, a “written debt collection policy”

includes a written billing and collections policy, or in the case of

an organization that doesn't have a separate written billing and

collections policy, a written FAP that includes the actions the

organization may take in the event of nonpayment, including

collection actions and reporting to credit agencies.

Line 9b. Answer “Yes” if the organization's written debt

collection policy that applied to the facilities that served the

largest number of the organization's patients during the tax year

contained provisions for collecting amounts due from those

patients who the organization knows qualify for financial

assistance. If the organization answers “Yes,” describe in Part VI

the collection practices that it follows for such patients, whether

6

or not such practices apply specifically to such patients or more

broadly to also cover other types of patients.

Part IV. Management Companies and

Joint Ventures (Owned 10% or More

by Officers, Directors, Trustees, Key

Employees, and Physicians)

List any management company, joint venture, or other

separate entity (whether treated as a partnership or a

corporation), including joint ventures outside of the United

States, of which the organization is a partner or shareholder:

1. In which persons described in item 1a and/or item 1b

below owned, in the aggregate, more than 10% of the share of

profits of such partnership or limited liability company (LLC)

interest, or stock of the corporation:

a. Persons who were officers, directors, trustees, or key

employees of the organization at any time during the

organization's tax year, and/or

b. Physicians who were employed as physicians by, or had

staff privileges with, one or more of the organization's hospitals;

and

2. That either:

a. Provided management services used by the organization

in its provision of medical care, or

b. Provided medical care, or owned or provided real

property, tangible personal property, or intangible property used

by the organization or by others to provide medical care.

Examples of such joint ventures and management companies

include:

• An ancillary joint venture formed by the organization and its

officers or physicians to conduct an exempt or unrelated

business activity,

• A company owned by the organization and its officers or

physicians that owns and leases to the organization a hospital or

other medical care facility, and

• A company that owns and leases to entities other than the

organization diagnostic equipment or intellectual property used

to provide medical care.

For purposes of Part IV, ownership interests can be direct or

indirect. For example, if a joint venture reported in Part IV is

owned, in part, by a physician group practice owned by staff

physicians of the organization's hospital, report the physicians'

indirect ownership interest in the joint venture in proportion to

their ownership share of the physician group practice.

Note: Don't include publicly traded entities or entities whose

sole income is passive investment income from interest or

dividends.

For purposes of Part IV, the aggregate percentage share of

profits or stock ownership percentage of officers, directors,

trustees, key employees, and physicians who are employed as

physicians by, or have staff privileges with, one or more of the

organization's hospitals is measured as of the earlier of the close

of the tax year of the organization or the last day the organization

was a member of the joint venture. All stock, whether common or

preferred, is considered stock for purposes of determining the

stock ownership percentage. Provide all the information

requested below for each such entity.

Column (a). Enter the full legal name of the entity.

Column (b). Describe the primary business activity or activities

conducted by the management company, joint venture, or

separate entity.

2025 Instructions for Schedule H (Form 990)

Column (c). Enter the organization's percentage share of

profits in the partnership or LLC, or stock in the entity that is

owned by the organization.

Column (d). Enter the percentage share of profits or stock in

the entity owned by all of the organization's current officers,

directors, trustees, or key employees.

Column (e). Enter the percentage share of profits or stock in

the entity owned by all physicians who are employees practicing

as physicians or who have staff privileges with one or more of the

organization's hospitals.

If a physician described above is also a current officer,

director, trustee, or key employee of the organization, include the

physician’s profits or stock percentage in column (d). Don't

include this in column (e).

Part IV can be duplicated if more space is needed to list

additional management companies and joint ventures.

Part V. Facility Information

In Part V, the organization must list all of its hospital facilities in

Section A, complete separate Sections B and C for each of its

hospital facilities or facility reporting groups listed in Section A,

and list its non-hospital health care facilities in Section D.

Facility reporting groups. If the organization is able to check

the same checkboxes for all Part V, Section B, questions for

more than one of its hospital facilities, it may file a single

Section B and Section C for all facilities in that facility reporting

group. For each of those facilities, the organization would assign

and list the facility reporting group letter in the “Facility reporting

group” column in Section A. Assign letter A to the facility

reporting group with the greatest number of facilities, letter B to

the group with the second greatest number of facilities, and so

forth. For instance, three hospital facilities with identical answers

to the Section B checkboxes would be assigned facility group

letter A, while two other hospital facilities with identical answers

would be assigned facility group letter B.

Section A

Complete Part V, Section A, by listing all of the organization's

hospital facilities that it operated during the tax year. List

these facilities in order of size from largest to smallest, measured

by a reasonable method (for example, the number of patients

served or total revenue per facility). “Hospital facilities” are

facilities that, at any time during the tax year, were required to be

licensed, registered, or similarly recognized as a hospital under

state law. A hospital facility is operated by an organization

whether the facility is operated directly by the organization or

through a disregarded entity or joint venture treated as a

partnership. For each hospital facility, list its name, address,

primary website address, and state license number (and if a

group return, the name and employer identification number (EIN)

of the subordinate hospital organization that operates the

hospital facility), and check the applicable column(s).

“Licensed hospital” is a facility licensed, registered, or

similarly recognized by a state as a hospital.

“General medical & surgical” refers to a hospital primarily

engaged in providing diagnostic and medical treatment (both

surgical and nonsurgical) to inpatients with a wide variety of

medical conditions, and that may provide outpatient services,

anatomical pathology services, diagnostic X-ray services,

clinical laboratory services, operating room services, and

pharmacy services.

“Children's hospital” is a center for provision of health care to

children, and includes independent acute care children's

hospitals, children's hospitals within larger medical centers, and

independent children's specialty and rehabilitation hospitals.

2025 Instructions for Schedule H (Form 990)

“Teaching hospital” is a hospital that provides training to

medical students, interns, residents, fellows, nurses, or other

health professionals and providers, provided that such

educational programs are accredited by the appropriate national

accrediting body.

“Critical access hospital” (CAH) is a hospital designated as a

CAH by a state that has established a State Medicare Rural

Hospital Flexibility Program in accordance with Medicare rules.

“Research facility” is a facility that conducts research.

“ER–24 hours” refers to a facility that operates an emergency

room 24 hours a day, 365 days a year.

“ER–other” refers to a facility that operates an emergency

room for periods less than 24 hours a day, 365 days a year.

Complete the “Other (describe)” column for each hospital

facility that the organization operates that isn't described in the

other columns of Part V, Section A.

In the upper left-hand corner of the Part V, Section A, table,

list the total number of hospital facilities that the organization

operated during the tax year.

If the organization needs additional space to list all of its

hospital facilities, it should duplicate Section A and use as many

duplicate copies of Section A as needed, number each page,

and renumber the line numbers in the left-hand margin (an

organization with 15 facilities should renumber lines 1–5 on the

second page as lines 11–15).

Section B

Section B requires reporting on a hospital facility-by-hospital

facility basis. The organization must complete a Section B for

each of its hospital facilities or facility reporting groups listed in

Section A. At the top of each page of Section B, list the name of

the hospital facility or the facility reporting group letter. In the

space provided, list the line number of the hospital facility, or line

numbers of the hospital facilities in a facility reporting group

(from Part V, Section A).

If the organization could check the same checkboxes for all

Part V, Section B, questions for more than one of its hospital

facilities, it may file a single Section B for all facilities in that

facility reporting group.

References in these Section B instructions to a “hospital

facility” taking a certain action mean that the hospital

organization took action through or on behalf of the hospital

facility.

Line 1. Answer “Yes” if the hospital facility was first licensed,

registered, or similarly recognized by a state as a hospital facility

in the current tax year or the immediately preceding tax year.

Line 2. Answer “Yes” if the hospital facility was 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 in Section C.

Lines 3 through 12c. A CHNA is an assessment of the

significant health needs of the community. To meet the

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

be made widely available to the public. Each hospital facility

must conduct a CHNA at least once every 3 years, and adopt an

implementation strategy to meet the community health needs

identified through such CHNA.

Line 3. Answer “Yes” if the hospital facility conducted a CHNA

in the current tax year or in either of the 2 immediately preceding

tax years. If “Yes,” indicate what the CHNA describes by

7

checking all applicable boxes. If the CHNA describes information

that doesn't have a corresponding checkbox, check line 3j,

“Other,” and describe this information in Part V, Section C. If “No,”

skip to line 12.

Line 3a. Check this box if the CHNA report defines the

community served by the hospital facility and a description of

how the community was determined.

Line 3c. Check this box if the CHNA report describes the

resources potentially available to address the significant health

needs identified through the CHNA, including existing health

care facilities and resources within the community that are

available to respond to the health needs of the community.

Line 3d. Check this box if the CHNA report describes the

process and methods used to conduct the CHNA.

Line 3e. In Part V, Section C, indicate if the significant health

needs are a prioritized description of the significant health needs

of the community and identified through the CHNA. If not,

explain how the health needs identified will be prioritized.

Line 3g. Check this box if the CHNA report describes the

process and criteria used in identifying certain health needs as

significant and prioritizing those significant health needs.

Line 3h. Check this box if the CHNA report describes how the

hospital facility solicited and took into account input received

from persons who represent the broad interests of the

community it serves.

Line 3i. Check this box if the CHNA report describes the

evaluation of the impact of any actions that were taken, since the

hospital facility finished conducting its immediately preceding

CHNA, to address the significant health needs identified in the

hospital facility’s prior CHNA(s).

Line 6b. Answer “Yes” if the hospital facility's CHNA was

conducted with one or more organizations other than hospital

facilities. If “Yes,” list in Part V, Section C, the other organizations

with which the hospital facility conducted its CHNA.

Line 7. Answer “Yes” if the hospital facility made its most

recently conducted CHNA widely available to the public. If “Yes,”

indicate how the hospital facility made the CHNA widely

available to the public by checking all applicable boxes. If the

hospital facility made the CHNA widely available to the public by

means other than those listed on lines 7a through 7c, check

line 7d, “Other,” and describe these means in Part V, Section C.

Line 7a. Check this box if the CHNA was made available on the

hospital facility’s website or the hospital organization’s website. If

line 7a is checked, list in the space provided the direct website

address, or URL, where the CHNA can be accessed.

Line 7b. Check this box if the CHNA was made available on a

website other than the hospital facility’s website or the hospital

organization’s website. If line 7b is checked, list in the space

provided the direct website address, or URL, where the CHNA

can be accessed.

Line 7c. Check this box if a paper copy of the CHNA was made

available for public inspection upon request and without charge

at the hospital facility.

Line 8. Answer “Yes” if the hospital facility adopted an

implementation strategy to meet the significant health needs

identified through its most recently conducted CHNA. If “No,”

skip to line 11.

Line 10. Answer “Yes” if the hospital facility’s most recently

adopted implementation strategy is posted on a website. If “Yes,”

answer line 10a. If “No,” skip to line 10b.

Line 5. Answer “Yes” if the hospital facility took into account

input from persons who represent the broad interests of the

community served by the hospital facility, including at least one

state, local, tribal, or regional governmental public health

department (or equivalent department or agency), or a State

Office of Rural Health described in section 338J of the Public

Health Service Act (section 254r), with knowledge, information,

or expertise relevant to the health needs of that community,

members of medically underserved, low-income, and minority

populations in the community served by the hospital facility, or

individuals or organizations serving or representing the interests

of such populations; and written comments received on the

hospital facility's most recently conducted CHNA and most

recently adopted implementation strategy.

If the organization checked “Yes,” summarize in Part V,

Section C, in general terms, how and over what time period such

input was provided (for example, whether through meetings,

focus groups, interviews, surveys, or written comments, and

between what dates); the names of any organizations providing

input; and describe the medically underserved, low-income, or

minority populations being represented by organizations or

individuals that provided input. A CHNA report doesn't need to

name or otherwise identify any specific individual providing input

on the CHNA. In the event a hospital facility solicits, but cannot

obtain, input from a source required by line 5, the hospital

facility's CHNA report must also describe the hospital facility's

efforts to solicit input from such source.

Line 10a. List in the space provided the direct website address,

or URL, where the implementation strategy can be accessed

and skip to line 11.

Line 6a. Answer “Yes” if the hospital facility's CHNA was

conducted with one or more other hospital facilities. “One or

more other hospital facilities” includes related and unrelated

hospital facilities. If “Yes,” list in Part V, Section C, the other

hospital facilities with which the hospital facility conducted its

CHNA.

Line 12b. Answer “Yes” to line 12b if the organization answered

“Yes” to line 12a and filed Form 4720, Return of Certain Excise

Taxes Under Chapters 41 and 42 of the Internal Revenue Code,

to report the section 4959 excise tax it incurred. Answer “Yes” if

the organization filed Form 4720 during the tax year or after the

tax year but prior to the filing of this return.

8

Line 10b. Answer “Yes” if the hospital facility’s most recently

adopted implementation strategy is attached.

Line 11. Explain in Part V, Section C, how the hospital facility is

addressing the significant needs identified in its most recently

conducted CHNA and any such needs that aren't being

addressed together with the reasons why such needs aren't

being addressed. For example, a hospital facility might identify

limited financial or other resources as reasons why it didn't take

action to address a need identified in its most recently

conducted CHNA.

Line 12a. Answer “Yes” if the organization was liable, at any

time during the tax year, for the $50,000 excise tax incurred

under section 4959 for failure to conduct a CHNA and adopt an

implementation strategy as required under section 501(r)(3).

Section 501(r)(3) requires each hospital facility to conduct a

CHNA, in the tax year or in either of the immediately preceding 2

tax years, that takes into account input from persons who

represent the broad interests of the community served by the

facility, including those with special knowledge of or expertise in

public health, and to make the CHNA widely available to the

public. Section 501(r)(3) also requires each hospital facility to

adopt an implementation strategy to meet the community health

needs identified through its CHNA.

2025 Instructions for Schedule H (Form 990)

Line 12c. If line 12b is “Yes,” report the total amount of section

4959 excise tax the organization reported on Form 4720 for all of

its hospital facilities that incurred the tax.

Line 15b. Check this box if the hospital facility described all of

the supporting documentation it may require an individual to

submit as part of the application.

Lines 13 through 16. See the instructions for Part I, line 1, of

Schedule H (Form 990) for the definition of “financial assistance

policy” (FAP). Answer “Yes” only if the FAP applies to all

emergency and other medically necessary care provided by the

hospital facility, including all such care provided in the hospital

facility by a substantially related entity.

Line 15c. Check this box if the hospital facility provided

contact information of hospital facility staff that the hospital

facility has identified as an available source of assistance with

FAP applications.

Line 13. Answer “Yes” if, during the tax year, the hospital

facility had a written FAP that explains eligibility criteria for

financial assistance, and whether such assistance includes free

or discounted care. If “Yes,” indicate the eligibility criteria

explained in the FAP by checking all applicable boxes. If the FAP

describes information that doesn't have a corresponding

checkbox, check line 13h, “Other,” and describe this information

in Part V, Section C.

Line 13a. See the instructions for Part I, line 3a, of Schedule H

(Form 990) for the definition of “Federal Poverty Guidelines”

(FPG). Check this box if, during the tax year, the hospital

facility had a written FAP that used FPG for determining

eligibility for free or discounted medical care. Show the specific

threshold by writing in the percentage amount. If the hospital

facility used FPG for determining eligibility for free or discounted

medical care, but not both free and discounted medical care,

enter “000” in the percentage amount for which FPG wasn't

used.

Line 13b. Check this box if the hospital facility used an income

level other than FPG and explain in Part V, Section C, what

criteria the hospital facility used to determine eligibility for free or

discounted care (including whether the hospital facility used the

income level of patients, patients’ families, or patients’

guarantors as a factor).

Line 13c. Check this box if the hospital facility used the asset

level of patients, patients' families, or patients' guarantors as a

factor in determining eligibility for financial assistance.

Line 13d. Check this box if the hospital facility considered

whether patients were “medically indigent,” as defined in the

instructions for Part I, line 4, of Schedule H (Form 990), in

determining eligibility for financial assistance.

Line 13e. Check this box if the hospital facility used the

insurance status of patients, patients' families, or patients'

guarantors as a factor in determining eligibility for financial

assistance.

Line 13g. Check this box if the hospital facility considered

residency as a factor in determining eligibility for financial

assistance.

Line 14. Answer “Yes” if, during the tax year, the hospital

facility had a written FAP that explained the basis for calculating

amounts charged to patients.

Line 15. Answer “Yes” if, during the tax year, the hospital

facility had a written FAP that explained the method for applying

for financial assistance. If “Yes,” indicate how the hospital

facility’s FAP or FAP application form (including the

accompanying instructions) explained the method for applying

for financial assistance by checking all applicable boxes. If the

FAP explains a method(s) for applying for financial assistance

other than those listed on lines 15a through 15d, check line 15e,

“Other,” and explain the method(s) in Part V, Section C.

Line 15a. Check this box if the hospital facility described all of

the information it may require an individual to provide as part of

the application.

2025 Instructions for Schedule H (Form 990)

Line 15d. Check this box if the hospital facility provided the

contact information of a nonprofit organization or government

agency that the hospital facility has identified as an available

source of assistance with FAP applications.

Line 16. Answer “Yes” if, during the tax year, the FAP was

widely publicized within the community served by the hospital

facility. If “Yes,” indicate how the hospital facility publicized the

policy by checking all applicable boxes. If the hospital facility

publicized the policy within the community served by the hospital

facility by means that aren't listed on lines 16a–16i, check

line 16j, “Other,” and describe in Part V, Section C, how the FAP

was publicized within the community served by the hospital

facility.

Line 16g. Check this box if 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.

Line 16i. Check this box if the FAP, FAP application form, and

plain language summary of the FAP were translated into the

primary language(s) spoken by limited-English proficiency (LEP)

populations, such as by translating these documents into the

language(s) spoken by each LEP language group that

constitutes the lesser of 1,000 individuals or 5% of the

community served by the hospital facility or the population likely

to be affected or encountered by the hospital facility.

Line 16j. “Other” measures to publicize the policy within the

community served by the hospital facility may include, but

aren't limited to, having registration personnel refer uninsured

and/or low-income patients to financial counselors to discuss the

policy. Check the box for line 16j if, instead of the detailed policy,

the hospital facility provided a summary of the policy in a manner

listed on lines 16a–16i.

Line 17. Answer “Yes” if, during the tax year, the hospital

facility had either a separate written billing and collections

policy or a written FAP that described any actions that the

hospital facility (or other authorized party) may take related to

obtaining payment of a bill for medical care, including, but not

limited to, any extraordinary collection actions (ECAs); the

process and time frames the hospital facility (or other authorized

party) uses in taking those actions (including, but not limited to,

the reasonable efforts it will make to determine whether an

individual is FAP-eligible before engaging in ECAs); and the

office, department, committee, or other body with the final

authority or responsibility for determining that the hospital facility

has made reasonable efforts to determine whether an individual

is FAP-eligible and may therefore engage in ECAs against the

individual.

Lines 18 and 19. “Other similar actions” don't include sending

the patient a bill.

Note: Section 501(r)(6) requires a hospital facility to forego

ECAs before the facility has made reasonable efforts to

determine the individual's eligibility under the facility's FAP.

Line 18. Indicate what actions against an individual the

hospital facility was permitted to take during the tax year under

its policies before making reasonable efforts to determine the

9

individual's eligibility under the facility's FAP by checking all

applicable boxes.

Line 18a. Check this box if the FAP permitted reporting adverse

information about the individual to consumer credit reporting

agencies or credit bureaus.

Line 18b. Check this box if the FAP permitted selling an

individual's debt to another party. Don't check the box if, prior to

the sale, the hospital facility entered into a legally binding written

agreement with the purchaser of the debt pursuant to which the

purchaser is prohibited from engaging in any ECAs to obtain

payment for the care; the purchaser is prohibited from charging

interest on the debt in excess of the rate in effect under section

6621(a)(2) at the time the debt is sold; the debt is returnable to

or recallable by the hospital facility upon a determination by the

hospital facility or the purchaser that the individual is

FAP-eligible; and, if the individual is determined to be

FAP-eligible and the debt isn't returned to or recalled by the

hospital facility, the purchaser is required to adhere to

procedures specified in the agreement that ensure that the

individual doesn't pay, and has no obligation to pay, the

purchaser and the hospital facility together more than the

individual is personally responsible for paying as a FAP-eligible

individual.

Line 18c. Check this box if the FAP permitted deferring or

denying, or requiring a payment before providing, medically

necessary care because of an individual’s nonpayment of one or

more bills for previously provided care covered under the

hospital facility’s FAP.

Line 18d. Check this box if the FAP permitted actions that

require a legal or judicial process, including but not limited to

placing a lien on an individual's real property; attaching or

seizing an individual's bank account or any other personal

property; commencing a civil action against an individual;

causing an individual's arrest; causing an individual to be subject

to a writ of body attachment; or garnishing an individual's wages.

Don't include any liens that a hospital facility is entitled to assert

under state law on the proceeds of a judgment, settlement, or

compromise owed to an individual (or the individual’s

representative) as a result of personal injuries for which the

hospital facility provided care and if it files a claim in a

bankruptcy proceeding.

Line 18e. If a hospital facility's policies permitted the facility to

take an action or actions against an individual during the tax year

similar to those listed on lines 18a through 18d before making

reasonable efforts to determine the individual's eligibility under

the facility's FAP, check line 18e, “Other similar actions,” and

describe those actions in Part V, Section C.

Line 18f. If the hospital facility was permitted to make no such

actions, check the box for line 18f, “None of these actions or

other similar actions were permitted.”

Line 19. Indicate any of the actions against an individual that

the hospital facility took during the tax year before making

reasonable efforts to determine the individual's eligibility under

the facility's FAP by checking all applicable boxes. For purposes

of this question, actions against an individual include actions to

obtain payment for the care against any other individual who has

accepted or is required to accept responsibility for the

individual’s hospital bill for the care, and actions of the hospital

facility include actions of any purchaser of the individual’s debt,

any debt collection agency or other party to which the hospital

facility has referred the individual’s debt, or any substantially

related entity.

Line 19a. Check this box if the hospital facility reported adverse

information about the individual to consumer credit reporting

agencies or credit bureaus before making reasonable efforts to

determine the individual's eligibility under the facility's FAP.

10

Line 19b. Check this box if the hospital facility sold an

individual's debt to another party before making reasonable

efforts to determine the individual's eligibility under the facility's

FAP. Don't check the box if, prior to the sale, the hospital facility

entered into a legally binding written agreement with the

purchaser of the debt pursuant to which the purchaser is

prohibited from engaging in any ECAs to obtain payment for the

care; the purchaser is prohibited from charging interest on the

debt in excess of the rate in effect under section 6621(a)(2) at

the time the debt is sold; the debt is returnable to or recallable by

the hospital facility upon a determination by the hospital facility

or the purchaser that the individual is FAP-eligible; and, if the

individual is determined to be FAP-eligible and the debt isn't

returned to or recalled by the hospital facility, the purchaser is

required to adhere to procedures specified in the agreement that

ensure that the individual doesn't pay, and has no obligation to

pay, the purchaser and the hospital facility together more than

the individual is personally responsible for paying as a

FAP-eligible individual.

Line 19c. Check this box if the hospital facility deferred or

denied, or required a payment before providing, medically

necessary care because of an individual’s nonpayment of one or

more bills for previously provided care covered under the

hospital facility’s FAP.

Line 19d. Check this box if the hospital facility took legal action

or pursued a judicial process, including but not limited to placing

a lien on an individual's real property; attaching or seizing an

individual's bank account or any other personal property;

commencing a civil action against an individual; causing an

individual's arrest; causing an individual to be subject to a writ of

body attachment; or garnishing an individual's wages. Don't

include any liens that a hospital facility is entitled to assert under

state law on the proceeds of a judgment, settlement, or

compromise owed to an individual (or the individual’s

representative) as a result of personal injuries for which the

hospital facility provided care and if it filed a claim in a

bankruptcy proceeding.

Line 19e. If the hospital facility took an action or actions against

an individual during the tax year similar to those listed in lines

19a through 19d before making reasonable efforts to determine

the individual's eligibility under the facility's FAP, check line 19e,

“Other similar actions,” and describe those actions in Part V,

Section C.

Line 20. Indicate which efforts the hospital facility or other

authorized party made before initiating any of the actions listed

(whether or not checked) in lines 19a through 19d or described

in Part V, Section C (describing “other similar actions” checked in

line 18e or line 19e), by checking all applicable boxes in lines

20a through 20d. If the hospital facility made efforts other than

those listed in lines 20a through 20d before initiating any of the

actions listed in lines 19a through 19d or described in Part V,

Section C (describing "other similar actions" checked in line 18e

or line 19e), check the box for line 20e, “Other,” and describe in

Part V, Section C.

If the hospital facility made no such efforts before initiating

any of the actions listed (whether or not checked) in lines 19a

through 19d or described in Part V, Section C (describing “other

similar actions” checked in line 18e or line 19e), check the box

for line 20f, “None of these efforts were made.”

Line 20a. Check this box if the hospital facility or other

authorized party provided individuals with a written notice that

indicated financial assistance is available for eligible individuals,

identified the ECA(s) that the hospital facility (or other authorized

party) intended to initiate to obtain payment for the care, and

stated a deadline after which such ECA(s) may be initiated that

was no earlier than 30 days after the date that the written notice

2025 Instructions for Schedule H (Form 990)

was provided, along with a plain language summary of the FAP. If

not, describe in Section C.

Line 20b. Check this box if the hospital facility or other

authorized party made a reasonable effort to orally notify

individuals about the hospital facility’s FAP and about how the

individual may obtain assistance with the FAP application

process at least 30 days before initiating ECAs. If not, describe in

Section C.

Line 20c. Check this box if (1) when an individual submitted an

incomplete FAP application during the application period, the

hospital facility or other authorized party notified the individual

about how to complete the FAP application and gave the

individual a reasonable opportunity to do so in accordance with

Regulations section 1.501(r)-6(c)(5); and (2) when an individual

submitted a complete FAP application during the application

period, the hospital facility or other authorized party determined

whether the individual is FAP-eligible for the care and otherwise

met the requirements described in Regulations section

1.501(r)-6(c)(6). If not, describe in Section C.

Line 20d. Check this box if the hospital facility or other

authorized party made presumptive eligibility determinations in

accordance with Regulations section 1.501(r)-6(c)(2). If not,

describe in Section C.

Line 21. Answer “Yes” if, during the tax year, the hospital

facility had in place a written policy about emergency medical

care that required the hospital facility to provide, without

discrimination, care for emergency medical conditions to

individuals without regard to their eligibility under the hospital

facility's FAP. A hospital facility's emergency medical care policy

doesn't meet this requirement unless it prohibits the hospital

facility from engaging in actions that discourage individuals from

seeking emergency medical care, such as by demanding that

emergency department patients pay before receiving treatment

for emergency medical conditions or by permitting debt

collection activities that interfere with the provision, without

discrimination, of emergency medical care. If “No,” indicate the

reasons why the hospital facility didn't have a written

nondiscriminatory policy relating to emergency medical care by

checking all applicable boxes. If the reason the hospital facility

didn't have a written nondiscriminatory policy relating to

emergency medical care isn't listed in lines 21a through 21c,

check line 21d, “Other,” and describe the reason(s) in Part V,

Section C.

The hospital facility may check “Yes” if it had a written policy

that required compliance with 42 U.S.C. 1395dd (Emergency

Medical Treatment and Active Labor Act (EMTALA)).

For purposes of line 21, the term “emergency medical

conditions” means:

(a) A medical condition manifesting itself by acute symptoms

of sufficient severity (including severe pain) such that the

absence of immediate medical attention could reasonably be

expected to result in:

1. Placing the health of the individual (or, for a pregnant

woman, the health of the woman or the unborn child) in serious

jeopardy,

2. Serious impairment to bodily functions, or

3. Serious dysfunction of any bodily organ or part; or

(b) For a pregnant woman who is having contractions:

1. That there is inadequate time to effect a safe transfer to

another hospital before delivery, or

2. That transfer may pose a threat to the health or safety of

the woman or the unborn child.

2025 Instructions for Schedule H (Form 990)

Lines 22–24. For purposes of lines 22–24, the term

“FAP-eligible” means eligible for assistance under the hospital

facility's FAP.

Line 22. 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 by checking the appropriate box.

Note: Under section 501(r)(5), the maximum amounts that can

be charged to FAP-eligible individuals for emergency or other

medically necessary care are the amounts generally billed to

individuals who have insurance covering such care.

Line 23. Answer “Yes” if, during the tax year, the hospital

facility charged 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 Part V,

Section C, except as provided in the next paragraph.

The hospital facility may check “No” if it charged more than

the amounts generally billed to individuals who had insurance

covering such care to an individual if the charge in excess of

amounts generally billed (AGB) wasn't made or requested as a

pre-condition of providing medically necessary care to the

FAP-eligible individual; as of the time of the charge, the

FAP-eligible individual hadn't submitted a complete FAP

application and hadn't otherwise been determined by the

hospital facility to be FAP-eligible for the care; and, if the

individual subsequently submits a complete FAP application and

is determined to be FAP-eligible for the care, the hospital facility

refunds any amount that exceeds the amount the individual is

determined to be personally responsible for paying as a

FAP-eligible individual, unless such excess amount is less than

$5.

Line 24. Answer “Yes” if, during the tax year, the hospital

facility charged any FAP-eligible individual an amount equal to

the gross charge for any service provided to that individual, and

explain in Part V, Section C, the circumstances in which it used

gross charges. A bill that itemizes a reduction applied to a gross

charge for a service doesn't need to be reported if the amount

charged to the individual for such service is less than the amount

of the gross charge.

The hospital facility may check “No” if it charged gross

charges for any medical care covered under the FAP if the

charge in excess of AGB wasn't made or requested as a

pre-condition of providing medically necessary care to the

FAP-eligible individual; as of the time of the charge, the

FAP-eligible individual hadn't submitted a complete FAP

application and hadn't otherwise been determined by the

hospital facility to be FAP-eligible for the care; and, if the

individual subsequently submits a complete FAP application and

is determined to be FAP-eligible for the care, the hospital facility

refunds any amount that exceeds the amount the individual is

determined to be personally responsible for paying as a

FAP-eligible individual, unless such excess amount is less than

$5.

Section C

Use Section C to provide descriptions required for Part V,

Section B, lines 2, 3e, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j,

18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24, as

applicable. Complete a separate Section C for each hospital

facility or facility reporting group for which the organization

completed Section B; complete one Section C for each

Section B.

If completing Section C for a single hospital facility, identify

the specific name and line number (from Schedule H (Form

11

990), Part V, Section A) of the hospital facility to which the

responses in Section C relate.

If completing Section C for a facility reporting group, list the

reporting group letter, then list each hospital facility in that group

separately by name and line number (from Section A). For each

hospital facility, provide the 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.

• Line 2: If the organization checked “Yes,” provide details

regarding the hospital facility(ies) acquired or placed into

service as a tax-exempt hospital in the current tax year or the

immediately preceding tax year.

• Line 3j: If the organization checked line 3j, describe the other

content included in the hospital facility's CHNA report.

• Line 5: If the organization checked “Yes,” summarize, in

general terms, how and over what time period such input was

provided (for example, whether through meetings, focus groups,

interviews, surveys, or written comments, and between what

dates); the names of any organizations providing input; and

describe the medically underserved, low-income, or minority

populations being represented by organizations or individuals

that provided input. A CHNA report doesn't need to name or

otherwise identify any specific individual providing input on the

CHNA. In the event a hospital facility solicits, but cannot obtain,

input from a source required by line 5, the hospital facility's

CHNA report must also describe the hospital facility's efforts to

solicit input from such source.

• Line 6a: If the organization checked “Yes,” list the other

hospital facilities with which the hospital facility conducted its

CHNA.

• Line 6b: If the organization checked “Yes,” list the

organizations other than hospital facilities with which the hospital

facility conducted its CHNA.

• Line 7d: If the organization checked line 7d, describe the other

means that the hospital facility used to make its CHNA widely

available.

• Line 11: Describe how the hospital facility is addressing the

significant health needs identified in its most recently conducted

CHNA and any such needs that aren't being addressed together

with the reasons why such needs aren't being addressed.

• Line 13b: Describe the criteria the hospital facility used to

determine eligibility for free or discounted care (including

whether the hospital facility used the income level of patients,

patients’ families, or patients’ guarantors as a factor).

• Line 13h: If the organization checked line 13h, describe the

other eligibility criteria used.

• Line 15e: If the organization checked line 15e, describe the

other methods for applying for financial assistance.

• Line 16j: If the organization checked line 16j, describe other

ways that the hospital facility publicized its FAP.

• Line 18e: If the organization checked line 18e, describe the

other similar actions that the hospital facility was permitted to

take under its policies during the tax year before making

reasonable efforts to determine the individual's eligibility under

the facility's FAP.

• Line 19e: If the organization checked line 19e, describe the

other similar actions that the hospital facility was permitted to

take under its policies during the tax year before making

reasonable efforts to determine the individual's eligibility under

the facility's FAP.

• Line 20e: If the organization checked line 20e, describe the

other efforts that the hospital facility made.

• Line 21c: If the organization checked line 21c, describe how

the hospital facility limited who was eligible to receive care for

emergency services.

12

• Line 21d: If the organization checked line 21d, describe the

other reasons why the hospital facility didn't have a written

nondiscriminatory policy for emergency medical care.

• Line 23: If the organization answered “Yes” to line 23, explain

the circumstances in which the hospital facility charged any

FAP-eligible individual more than the amounts generally billed to

individuals who had insurance covering such care.

• Line 24: If the organization answered “Yes” to line 24, explain

the circumstances in which the hospital facility charged any

FAP-eligible individual an amount equal to the gross charge for

any service provided to that individual.

Section D

Complete Part V, Section D, by listing all of the non-hospital

health care facilities that the organization operated during the

tax year. A facility is operated by an organization whether it is

operated directly by the organization or through a disregarded

entity or joint venture treated as a partnership. List each of

these facilities in order of size from largest to smallest, measured

by a reasonable method (for example, the number of patients

served or total revenue per facility). For each non-hospital health

care facility, list its name and address and describe the type of

facility. These types of facilities may include, but aren't limited to,

rehabilitation and other outpatient clinics, diagnostic centers,

mobile clinics, and skilled nursing facilities.

List the total number of non-hospital health care facilities that

the organization operated during the tax year.

If the organization needs additional space to list all of its

non-hospital health care facilities, it should duplicate Section D

and use as many duplicate copies of Section D as needed,

number each page, and renumber the line numbers in the

left-hand margin (for example, an organization with 15 such

facilities should renumber lines 1–5 on the 2nd page as lines 11–

15).

• Line 2: If the organization checked “Yes,” provide details

regarding the hospital facility(ies) acquired or placed into

service as a tax-exempt hospital in the current tax year or the

immediately preceding tax year.

• Line 3j: If the organization checked line 3j, describe the other

content included in the hospital facility's CHNA report.

• Line 5: If the organization checked “Yes,” summarize, in

general terms, how and over what time period such input was

provided (for example, whether through meetings, focus groups,

interviews, surveys, or written comments, and between what

dates); the names of any organizations providing input; and

describe the medically underserved, low-income, or minority

populations being represented by organizations or individuals

that provided input. A CHNA report doesn't need to name or

otherwise identify any specific individual providing input on the

CHNA. In the event a hospital facility solicits, but cannot obtain,

input from a source required by line 5, the hospital facility's

CHNA report must also describe the hospital facility's efforts to

solicit input from such source.

• Line 6a: If the organization checked “Yes,” list the other

hospital facilities with which the hospital facility conducted its

CHNA.

• Line 6b: If the organization checked “Yes,” list the

organizations other than hospital facilities with which the hospital

facility conducted its CHNA.

• Line 7d: If the organization checked line 7d, describe the other

means that the hospital facility used to make its CHNA widely

available.

• Line 11: Describe how the hospital facility is addressing the

significant health needs identified in its most recently conducted

CHNA and any such needs that aren't being addressed together

with the reasons why such needs aren't being addressed.

• Line 13b: Describe the criteria the hospital facility used to

determine eligibility for free or discounted care (including

2025 Instructions for Schedule H (Form 990)

whether the hospital facility used the income level of patients,

patients’ families, or patients’ guarantors as a factor).

• Line 13h: If the organization checked line 13h, describe the

other eligibility criteria used.

• Line 15e: If the organization checked line 15e, describe the

other methods for applying for financial assistance.

• Line 16j: If the organization checked line 16j, describe other

ways that the hospital facility publicized its FAP.

• Line 18e: If the organization checked line 18e, describe the

other similar actions that the hospital facility was permitted to

take under its policies during the tax year before making

reasonable efforts to determine the individual's eligibility under

the facility's FAP.

• Line 19e: If the organization checked line 19e, describe the

other similar actions that the hospital facility was permitted to

take under its policies during the tax year before making

reasonable efforts to determine the individual's eligibility under

the facility's FAP.

• Line 20e: If the organization checked line 20e, describe the

other efforts that the hospital facility made.

• Line 21c: If the organization checked line 21c, describe how

the hospital facility limited who was eligible to receive care for

emergency services.

• Line 21d: If the organization checked line 21d, describe the

other reasons why the hospital facility didn't have a written

nondiscriminatory policy for emergency medical care.

• Line 23: If the organization answered “Yes” to line 23, explain

the circumstances in which the hospital facility charged any

FAP-eligible individual more than the amounts generally billed to

individuals who had insurance covering such care.

• Line 24: If the organization answered “Yes” to line 24, explain

the circumstances in which the hospital facility charged any

FAP-eligible individual an amount equal to the gross charge for

any service provided to that individual.

Part VI. Supplemental Information

Use Part VI to provide the narrative explanations required by the

following questions, and to supplement responses to other

questions on Schedule H (Form 990). In addition, use Part VI to

make disclosures described in section 7 of Rev. Proc. 2015-21.

Identify the specific part, section, and line number that the

response supports, in the order in which they appear on

Schedule H (Form 990). Part VI can be duplicated if more space

is needed.

Rev. Proc. 2015-21, 2015-13 I.R.B. 817, provides guidance

regarding correction and disclosure procedures for hospital

organizations to follow so that certain failures to meet the

requirements of section 501(r) will be excused for purposes of

sections 501(r)(1) and 501(r)(2)(B). Section 7 of the revenue

procedure provides that certain information must be disclosed

on the organization’s Form 990. Provide this information in Part

VI.

Line 1. Provide the following supplemental information.

Part I, line 3c. If applicable, describe the criteria used for

determining eligibility for free or discounted care under the

organization's FAP. Also, describe whether the organization uses

an asset test or other threshold, regardless of income, to

determine eligibility for free or discounted care.

Part I, line 6a. If the organization's community benefit report

is in a report prepared by a related organization, and not in a

separate report prepared by the organization, identify the related

organization and list its EIN.

Part I, line 7g. If applicable, describe if the organization

included as subsidized health services any costs attributable to

a physician clinic, and enter such costs the organization

included.

Part I, line 7, column (f). If applicable, enter the bad debt

expense included in Form 990, Part IX, line 25, column (A) (but

2025 Instructions for Schedule H (Form 990)

subtracted for purposes of calculating the percentages in this

column).

Part I, line 7. Provide an explanation of the costing

methodology used to calculate the amounts entered for each line

in the table. If a cost accounting system was used, indicate

whether the cost accounting system addresses all patient

segments (for example, inpatient, outpatient, emergency room,

private insurance, Medicaid, Medicare, uninsured, or self-pay).

Also, indicate if a cost-to-charge ratio was used for any of the

figures in the table. Describe whether this cost-to-charge ratio

was derived from Worksheet 2, Ratio of Patient Care

Cost-to-Charges, and, if not, what kind of cost-to-charge ratio

was used and how it was derived. If some other costing

methodology was used besides a cost accounting system,

cost-to-charge ratio, or a combination of the two, describe the

method used.

Part II. Describe how the organization’s community building

activities, as reported in Part II, promote the health of the

community or communities the organization serves.

Part III, line 2. Describe the methodology used to determine

the amount on Part III, line 2, including how the organization

accounts for discounts and payments on patient accounts in

determining bad debt expense.

Part III, line 3. Describe the methodology used to determine

the amount entered on line 3. Also, describe the rationale, if any,

for including any portion of bad debt as community benefit.

Part III, line 4. Provide, if applicable, the text of the footnote

to the organization's financial statements that describes bad

debt expense, or enter the page number(s) of the organization's

most recent audited financial statements on which the

footnote appears. If the organization's financial statements

include a footnote on these issues that also includes other

information, enter only the relevant portions of the footnote. If the

organization's financial statements don't contain such a footnote,

enter that the organization's financial statements don't include

such a footnote, and explain how the financial statements

account for bad debt, if at all.

Part III, line 8. Describe the costing methodology used to

determine the Medicare allowable costs entered on Part III,

line 6. Describe, if applicable, the extent to which any shortfall

entered on Part III, line 7, should be treated as a community

benefit, and the rationale for the organization's position.

Part III, line 9b. If the organization has a written debt

collection policy and answered “Yes” to Part III, line 9b, describe

the collection practices in the policy that apply to patients who it

knows qualify for financial assistance, whether the practices

apply specifically to such patients or also cover other types of

patients.

Line 2. If applicable, describe whether and how the organization

assesses the health care needs of the community or

communities it serves, in addition to any CHNA entered in Part V,

Section B.

Line 3. Describe how the organization informs and educates

patients and persons who are billed for patient care about their

eligibility for assistance under federal, state, or local government

programs or under the organization's FAP. For example, enter

whether the organization posts its FAP, or a summary thereof,

applications for financial assistance, and financial assistance

contact information in admissions areas, emergency rooms, and

other areas of the organization's facilities where eligible patients

are likely to be present; provides a copy of the policy, or a

summary thereof, applications for financial assistance, and

financial assistance contact information to patients as part of the

intake process; provides a copy of the policy, or a summary

thereof, applications for financial assistance, and financial

assistance contact information to patients with discharge

materials; includes the policy, or a summary thereof, an

application for financial assistance, and financial assistance

13

contact information, in patient bills; or discusses with the patient

the availability of various government benefits, such as Medicaid

or state programs, and assists the patient with qualification for

such programs, where applicable.

Line 4. Describe the community or communities the

organization serves, taking into account the geographic service

area(s) (urban, suburban, rural, etc.), the demographics of the

community or communities (population, average income,

percentages of community residents with incomes below the

federal poverty guideline, percentage of the hospital's and

community's patients who are uninsured or Medicaid recipients,

etc.), the number of other hospitals serving the community or

communities, and whether one or more federally designated

medically underserved areas or populations are present in the

community.

Line 5. Provide any other information important to describing

how the organization's hospitals or other health care facilities

further its exempt purpose by promoting the health of the

community or communities. Your response should include, but

need not be limited to, whether:

• A majority of the organization's governing body is comprised

of persons who reside in the organization's primary service area

who are neither employees nor independent contractors of

the organization, nor family members thereof;

• The organization extends medical staff privileges to all

qualified physicians in its community for some or all of its

departments or specialties; and

• How the organization applies surplus funds to improvements

in facilities and equipment, patient care, medical training,

education, and research.

Line 6. If the organization is part of an affiliated health care

system, describe the roles of the organization and its affiliates in

promoting the health of the communities served by the system.

For purposes of this question, an “affiliated health care system”

is a system that includes affiliates under common governance or

control, or that cooperate in providing health care services to

their community or communities.

Line 7. Identify all states with which the organization files (or a

related organization files on its behalf) a community benefit

report. Enter only those states in which the organization's own

community benefit report is filed, either by the organization itself

or by a related organization on the organization's behalf.

Worksheet 1. Financial Assistance at

Cost (Part I, Line 7a)

Worksheet 1 can be used to calculate the organization's financial

assistance (sometimes referred to as “charity care”) at cost

entered in Part I, line 7a. Refer to the instructions for Part I, line 1,

for the definition of “financial assistance.”

14

Line 1. Enter the gross patient charges written off to financial

assistance pursuant to the organization's financial assistance

policies. “Gross patient charges” means the total charges at the

organization's full established rates for the provision of patient

care services before deductions from revenue are applied.

Line 3. Multiply line 1 by line 2, or enter estimated cost based

on the organization's cost accounting methodology.

Organizations with a cost accounting system or a cost

accounting method more accurate than the ratio of patient care

cost to charges from Worksheet 2 can rely on that method to

estimate financial assistance cost. An organization that doesn't

use Worksheet 2 to determine a ratio of patient care cost to

charges should make any necessary adjustments for patient

care charges and community benefit programs to avoid double

counting.

Line 4. Enter the Medicaid/provider taxes, fees, and

assessments paid by the organization, if payments received from

an uncompensated care pool or DSH program in the

organization's home state are intended primarily to offset the

cost of financial assistance. If the payments are primarily

intended to offset the cost of Medicaid services, then enter this

amount in Worksheet 3, line 4, column (A). If the primary

purpose of the taxes or payments hasn't been made clear by

state regulation or law, then the organization can allocate the

taxes or payments proportionately between Worksheet 1, line 4,

and Worksheet 3, line 4, column (A), based on a reasonable

estimate of which portions are intended for financial assistance

and Medicaid, respectively. “Medicaid provider taxes” means

amounts paid or transferred by the organization to one or more

states as a mechanism to generate federal Medicaid DSH funds

(portions of the cost of the tax are generally promised back to

organizations either through an increase in the Medicaid

reimbursement rate or through direct appropriation).

Line 6. “Revenue from uncompensated care pools or programs”

means payments received from a state, including Upper

Payment Limit (UPL) funding and Medicaid DSH funds, as direct

offsetting revenue for financial assistance or to enhance

Medicaid reimbursement rates. If such payments are primarily to

offset the cost of Medicaid services, then enter this amount in

Worksheet 3, line 7, column (A). If the primary purpose of the

payments hasn't been made clear by state regulation or law, then

the organization can allocate the payments proportionately

between Worksheet 1, line 6, and Worksheet 3, line 7, column

(A), based on a reasonable estimate of which portions are

intended for financial assistance and Medicaid, respectively.

Line 7. Include the amount of any other offsetting revenue,

including any restricted grants received by the organization.

2025 Instructions for Schedule H (Form 990)

Worksheet 1. Financial Assistance at Cost (Part I, Line 7a)

Keep for Your Records

Gross patient charges

1. Amount of gross patient charges written off under financial assistance policies . . . . . . . . . . . .

1.

Total community benefit expense

2. Ratio of patient care cost to charges (from Worksheet 2, if used) . . . . . . . . . . . . . . . . . . . . . . .

2.

3. Estimated cost (multiply line 1 by line 2, or obtain from cost accounting) . . . . . . . . . . . . . . . . .

3.

4. Medicaid provider taxes, fees, and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

5. Total community benefit expense (add lines 3 and 4; enter in Part I, line 7a, column

(c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Direct offsetting revenue

6. Revenue from uncompensated care pools or programs

..............................

6.

7. Other direct offsetting revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

8. Total direct offsetting revenue (add lines 6 and 7; enter in Part I, line 7a, column (d)) . . . . .

8.

9. Net community benefit expense (subtract line 8 from line 5; enter in Part I, line 7a,

column (e)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

10. Total expense (enter amount from Form 990, Part IX, line 25, column (A), including the

organization's share of joint venture expenses, and excluding any bad debt expense included

on Part IX, line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.

11. Percent of total expense (divide line 9 by line 10; enter in Part I, line 7a, column (f)) . . . . . .

11.

Worksheet 2. Ratio of Patient Care

Cost to Charges

Worksheet 2 can be used to calculate the organization's ratio of

patient care cost to charges. An organization that doesn't use

Worksheet 2 to determine a ratio of patient care cost to charges

should make any necessary adjustments for patient care

charges and community benefit programs to avoid double

counting.

Line 1. Enter the organization's total operating expenses

(excluding bad debt expense) from its most recent audited

financial statements.

Line 2. Enter the cost of nonpatient care activities. “Nonpatient

care activities” include health care operations that generate

“other operating revenue” such as nonpatient food sales,

supplies sold to nonpatients, and medical records abstracting.

The cost of nonpatient care activities doesn't include any total

community benefit expense entered on Worksheets 1 through 8.

If the organization is unable to establish the cost associated

with nonpatient care activities, use other operating revenue from

its most recent audited financial statement as a proxy for these

costs. This proxy assumes no markup exists for other operating

revenue compared to the cost of nonpatient care activities.

Alternatively, if other operating revenue provides a markup

compared to the cost of nonpatient care activities, the

organization can assume such a markup exists when completing

line 2.

%

expenditure isn't double-counted when the ratio of patient care

cost to charges is applied.

Line 4. Enter the sum of the total community benefit expenses

included in “Total operating expense” on line 1 and entered in

Part I, lines 7e, 7f, 7h, and 7i, column (c), so these expenses

aren't double-counted when the ratio of patient care cost to

charges is applied.

Also, include on line 4 the total community benefit expense

entered in Part I, lines 7a, 7b, 7c, and 7g, column (c), if the

organization hasn't relied on the ratio of patient care cost to

charges from this worksheet to determine these expenses, but

rather has relied on a cost accounting system or other cost

accounting method to estimate costs of financial assistance,

Medicaid or other means-tested government programs, or

subsidized health services.

Line 5. Enter the gross expense of community building activities

reported in Part II of Schedule H (Form 990).

Line 9. Enter the gross patient charges for any community

benefit activities or programs for which the organization hasn't

relied on the ratio of patient care cost to charges from this

worksheet to determine the expenses of such activities or

programs. For example, if the organization uses a cost

accounting system or another cost accounting method to

estimate total community benefit expense for Medicaid or any

other means-tested government programs, enter gross charges

for those programs on line 9.

Line 3. Enter the Medicaid provider taxes, fees, and

assessments paid by the organization included on line 1 so this

2025 Instructions for Schedule H (Form 990)

15

Worksheet 2. Ratio of Patient Care Cost to Charges

(can be used for other worksheets)

Keep for Your Records

Patient care cost

1. Total operating expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

Less: adjustments

2. Nonpatient care activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

3. Medicaid provider taxes, fees, and assessments . . . . . . . . . . . . . . . . .

3.

4. Total community benefit expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

5. Total community building expense . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

6. Total adjustments (add lines 2 through 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

7. Adjusted patient care cost (subtract line 6 from line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

Patient care charges

8. Gross patient charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

Less: adjustments

9. Gross charges for community benefit programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

10. Adjusted patient care charges (subtract line 9 from line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.

Calculation of ratio of patient care cost to charges

11. Ratio of patient care cost to charges (divide line 7 by line 10; enter on the applicable lines of

Worksheets 1, 3, or 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Worksheet 3. Medicaid and Other

Means-Tested Government Health

Programs (Part I, Lines 7b and 7c)

Worksheet 3 can be used to report the cost of Medicaid and

other means-tested government health programs. A

“means-tested government program” is a government health

program for which eligibility depends on the recipient's income or

asset level.

“Medicaid” means the United States health program for

individuals and families with low incomes and resources. “Other

means-tested government programs” means

government-sponsored health programs where eligibility for

benefits or coverage is determined by income or assets.

Examples include:

• The State Children's Health Insurance Program (SCHIP), a

United States federal government program that gives funds to

states in order to provide health insurance to families with

children; and

• Other federal, state, or local health care programs.

Report Medicaid and other means-tested government

program revenues and expenses from all states, not just from the

organization's home state.

Line 1, column (A). Enter the gross patient charges for

Medicaid services. Include gross patient charges for all Medicaid

recipients, including those enrolled in managed care plans. In

certain states, SCHIP functions as an expansion of the Medicaid

program, and reimbursements from SCHIP aren't distinguishable

from regular Medicaid reimbursements. Hospitals that cannot

distinguish their SCHIP reimbursements from their Medicaid

16

11.

%

reimbursements can enter SCHIP charges, costs, and offsetting

revenue under column (A).

Line 1, column (B). Enter the amount of gross patient charges

for other means-tested government health programs.

Line 3, column (A). Enter the estimated cost for Medicaid

services. Multiply line 1, column (A), by line 2, column (A), or

enter estimated cost based on the organization's cost

accounting system or method. Organizations with a cost

accounting system or a cost accounting method more accurate

than the ratio of patient care cost to charges from Worksheet 2

can rely on that system or method to estimate the cost of

Medicaid services. Organizations relying on a cost accounting

system or method other than the ratio of patient care cost to

charges from Worksheet 2 should use care not to double-count

community benefit expenses fully accounted for elsewhere on

Schedule H (Form 990), Part I, line 7, such as the cost of health

professions education, community health improvement services,

community benefit operations, subsidized health services, and

research.

Line 3, column (B). Enter the estimated cost for services

provided to patients who receive health benefits from other

means-tested government health programs.

Line 4, column (A). Enter the Medicaid provider taxes, fees,

and assessments paid by the organization if payments received

from an uncompensated care pool, UPL program, or Medicaid

DSH program in the organization's home state are intended

primarily to offset the cost of Medicaid services. If such

payments are primarily intended to offset the cost of financial

assistance, then enter this amount on Worksheet 1, line 4. If the

primary purpose of such taxes or payments hasn't been made

clear by state regulation or law, then the organization can

2025 Instructions for Schedule H (Form 990)

allocate portions of such taxes or payments proportionately

between Worksheet 1, line 4, and Worksheet 3, line 4, column

(A), based on a reasonable estimate of which portions are

intended for financial assistance and Medicaid, respectively.

Line 6, column (A). Enter the net patient service revenue for

Medicaid services, including revenue associated with Medicaid

recipients enrolled in managed care plans. Don't include

Medicaid reimbursement for direct GME costs, which should be

entered on Worksheet 5, line 9. Include Medicaid reimbursement

for indirect GME costs, including the indirect IME portion of

children's health GME. The direct portion of children's health

GME should be entered on Worksheet 5, line 10. Also, include

Medicaid DSH revenue and UPL funding. “Net patient service

revenue” means payments expected to be received from

patients or third-party payers for patient services performed

during the year. “Net patient service revenue” also includes

revenue for services performed during prior years.

Organizations can describe in Part VI the amount of prior year

Medicaid revenue included in Part I, line 7b.

Amounts received from a Medicaid program as

“reimbursement for direct GME” or IME should be treated the

way the Medicaid program that provides reimbursement

classifies the funds.

Line 7, column (A). Enter revenue received from

uncompensated care pools or programs if payments received

from an uncompensated care pool, UPL program, or Medicaid

DSH program in the organization's home state are intended

primarily to offset the cost of Medicaid services. If such

payments are primarily intended to offset the cost of charity care,

then enter this amount on Worksheet 1, line 6. If the primary

purpose of such payments hasn't been made clear by state

regulation or law, then the organization can allocate the

payments proportionately between Worksheet 1, line 6, and

Worksheet 3, line 7, column (A), based on a reasonable estimate

of which portions are intended for financial assistance and

Medicaid, respectively.

Worksheet 3. Medicaid and Other Means-Tested Government

Health Programs (Part I, Lines 7b and 7c)

Keep for Your Records

(A)

Medicaid

(B)

Other

means-tested

government health

programs

Gross patient charges

1. Gross patient charges from the programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

Total community benefit expense

2. Ratio of patient care cost to charges (from Worksheet 2, if used) . . . . . . . . . . . . . .

2.

3. Cost (multiply line 1 by line 2, or obtain from cost accounting)

................

3.

4. Medicaid provider taxes, fees, and assessments . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

5. Total community benefit expense (add lines 3 and 4; enter amount from column

(A) in Part I, line 7b, column (c); and enter amount from column (B) in Part I, line 7c,

column (c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

%

%

%

%

Direct offsetting revenue

6. Net patient service revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

7. Payments from uncompensated care pools or programs . . . . . . . . . . . . . . . . . . . .

7.

8. Other revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

9. Total direct offsetting revenue (add lines 6 through 8; enter amount from column

(A) in Part I, line 7b, column (d); and enter amount from column (B) in Part I, line 7c,

column (d)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

10. Net community benefit expense (subtract line 9 from line 5; enter amount from

column (A) in Part I, line 7b, column (e); and enter amount from column (B) in Part I,

line 7c, column (e)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10.

11. Total expense (enter amount from Form 990, Part IX, line 25, column (A), including

the organization's share of joint venture expenses, and excluding any bad debt

expense included in Part IX, line 25, in both columns (A) and (B)) . . . . . . . . . . . . .

11.

12. Percent of total expense (line 10 divided by line 11; enter amount from column (A)

in Part I, line 7b, column (f); and enter amount from column (B) in Part I, line 7c,

column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.

2025 Instructions for Schedule H (Form 990)

17

Worksheet 4. Community Health Improvement Services and

Community Benefit Operations (Part I, Line 7e)

Keep for Your Records

(A)

Total

community

benefit

expense

1.

Community health improvement services

a.

1a.

b.

1b.

c.

1c.

d.

1d.

e.

1e.

f.

1f.

g.

1g.

h.

1h.

i.

1i.

j.

1j.

2.

Worksheet subtotal (add lines 1a through 1j) . . . . . . . . . . . . . . . . . . .

2.

3.

Community benefit operations

a.

3a.

b.

3b.

c.

3c.

d.

3d.

4.

Worksheet subtotal (add lines 3a through 3d) . . . . . . . . . . . . . . . . . . .

4.

5.

Worksheet total (add lines 2 and 4; enter amounts from columns

(A), (B), and (C) in Part I, line 7e, columns (c), (d), and (e),

respectively) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

Total expense (enter amount from Form 990, Part IX, line 25, column

(A), including the organization's share of joint venture expenses, and

excluding any bad debt expense included on Part IX, line 25) . . . . . .

6.

Percent of total expense (line 5, column (C), divided by line 6;

enter amount in Part I, line 7e, column (f)) . . . . . . . . . . . . . . . . . . . . . .

7.

6.

7.

Worksheet 4. Community Health

Improvement Services and

Community Benefit Operations (Part I,

Line 7e)

Worksheet 4 can be used to report the net cost of community

health improvement services and community benefit operations.

18

(B)

Direct

offsetting

revenue

(C)

Net

community

benefit

expense

(subtract col.

(B) from col. (A)

for lines 1–5)

“Community health improvement services” means activities or

programs, subsidized by the health care organization, carried out

or supported for the express purpose of improving community

health. Such services don't generate inpatient or outpatient

revenue, although there may be a nominal patient fee or sliding

scale fee for these services.

“Community benefit operations” means:

2025 Instructions for Schedule H (Form 990)

• Activities associated with conducting community health needs

assessments,

• Community benefit program administration, and

• The organization's activities associated with fundraising or

grant writing for community benefit programs.

Activities or programs cannot be reported if they are provided

primarily for marketing purposes or if they are more beneficial to

the organization than to the community. For example, the activity

or program may not be reported if it is designed primarily to

increase referrals of patients with third-party coverage; required

for license or accreditation, except when responding to a

community health need, enhancing public health, or relieving the

burden of government to improve health; or restricted to

individuals affiliated with the organization (employees and

physicians of the organization).

To be reported, community need for the activity or program

must be established. Community need can be demonstrated

through the following.

• A CHNA conducted or accessed by the organization.

• Documentation that demonstrated community need or a

request from a public health agency or community group was the

basis for initiating or continuing the activity or program.

• The involvement of unrelated, collaborative tax-exempt or

government organizations as partners in the activity or program

carried out for the express purpose of improving community

health.

Community benefit activities or programs also seek to

achieve a community benefit objective, including improving

access to health services, enhancing public health, advancing

increased general knowledge, and relief of a government burden

to improve health. This includes activities or programs that do

the following.

• Are available broadly to the public and serve low-income

consumers.

• Reduce geographic, financial, or cultural barriers to accessing

health services, and if they ceased would result in access

problems (for example, longer wait times or increased travel

distances).

• Address federal, state, or local public health priorities such as

eliminating disparities in access to health care services or

disparities in health status among different populations.

• Leverage or enhance public health department activities such

as childhood immunization efforts.

• Strengthen community health resilience by improving the

ability of a community to withstand and recover from public

health emergencies.

• Otherwise would become the responsibility of government or

another tax-exempt organization.

• Advance increased general knowledge through education or

research that benefits the public.

Lines 1a through 1j, column (A). Enter the name of each

reported community health improvement activity or program and

total community benefit expense for each. Include both direct

costs and indirect costs in total community benefit expense. Use

additional worksheets if the organization reports more than 10

community health improvement activities or programs.

Lines 3a through 3d, column (A). Enter the name of each

reported community benefit operations activity or program and

total community benefit expense for each. Include both direct

costs and indirect costs in total community benefit expense. Use

additional worksheets if the organization enters more than four

community benefit operations activities or programs.

Report total community benefit expense, direct offsetting

revenue, and net community benefit expense for each line item.

2025 Instructions for Schedule H (Form 990)

Worksheet 5. Health Professions

Education (Part I, Line 7f)

Worksheet 5 can be used to report the net cost of health

professions education.

“Health professions education” means educational programs

that result in a degree, a certificate, or training necessary to be

licensed to practice as a health professional, as required by state

law, or continuing education necessary to retain state license or

certification by a board in the individual's health profession

specialty. It doesn't include education or training programs

available exclusively to the organization's employees and

medical staff or scholarships provided to those individuals.

However, it does include education programs if the primary

purpose of such programs is to educate health professionals in

the broader community. Costs for medical residents and interns

can be included, even if they are considered “employees” for

purposes of Form W-2, Wage and Tax Statement.

Examples of health professions education activities or

programs that should and shouldn't be reported are as follows.

Activity or Program

Report

Example Rationale

Scholarships for

community members

Yes

More benefit to

community than

organization

Scholarships for staff

members

No

More benefit to

organization than

community

Continuing medical

education for community

physicians

Yes

Accessible to all

qualified physicians

Continuing medical

education for own

medical staff

No

Restricted to own

medical staff members

Nurse education if

graduates are free to

seek employment at any

organization

Yes

More benefit to

community than

organization

Nurse education if

graduates are required to

become the

organization's employees

No

Program designed

primarily to benefit the

organization

Lines 1 through 6. Include both direct and indirect costs. Direct

costs of health professions education don't include costs related

to Ph.D. students and post-doctoral students, which are to be

entered on Worksheet 7, Research. See the instructions for Part

I, line 7, column (c), for the definition of “indirect costs.” "Indirect

costs" don't include the estimated cost of “indirect medical

education.”

Direct costs of health professions education include the

following.

• Stipends, fringe benefits of interns, residents, and fellows in

accredited graduate medical education programs.

• Salaries and fringe benefits of faculty directly related to intern

and resident education.

• Salaries and fringe benefits of faculty directly related to

teaching:

1. Medical students;

2. Students enrolled in nursing programs that are licensed

by state law or, if licensing isn't required, accredited by the

recognized national professional organization for the particular

activity;

19

Worksheet 5. Health Professions Education (Part I, Line 7f)

Keep for Your Records

Totals

Total community benefit expense

1. Medical students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

2. Interns, residents, and fellows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

3. Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

4. Other allied health professions, students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

5. Continuing health professions education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

6. Other students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

7. Total community benefit expense (add lines 1 through 6; enter in Part I, line 7f,

column (c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

Direct offsetting revenue

8. Medicare reimbursement for direct GME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

9. Medicaid reimbursement for direct GME . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

10. Continuing health professions education reimbursement/tuition . . . . . . . . . . . . . . . . . . . . . .

10.

11. Other revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11.

12. Total direct offsetting revenue (add lines 8 through 11; enter in Part I, line 7f, column

(d)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12.

13. Net community benefit expense (line 7 minus line 12; enter in Part I, line 7f, column

(e)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13.

14. Total expense (enter amount from Form 990, Part IX, line 25, column (A), including the

organization's share of joint venture expenses, and excluding any bad debt expense

included on Part IX, line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

14.

15. Percent of total expense (line 13 divided by line 14; enter amount in Part I, line 7f,

column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15.

3. Students enrolled in allied health professions education

programs, licensed by state law or, if licensing isn't required,

accredited by the recognized national professional organization

for the particular activity, including, but not limited to, programs in

pharmacy, occupational therapy, dietetics, and pastoral care;

and

4. Continuing health professions education open to all

qualified individuals in the community, including payment for

development of online or other computer-based training

accepted as continuing health professions education by the

relevant professional organization.

• Scholarships provided by the organization to community

members.

Line 8. Enter Medicare reimbursement for direct GME,

reimbursement for approved nursing and allied health education

activities, and direct GME reimbursement received for services

provided to Medicare Advantage patients. For a children's

hospital that receives children's GME payments from Health

Resources and Services Administration (HRSA), count that

portion of the payment equivalent to Medicare direct GME. Don't

include indirect GME reimbursement provided by Medicare or

Medicaid.

Line 9. Enter Medicaid reimbursement for direct GME, including

only that portion of Medicaid GME payment equivalent to

Medicare direct GME and that can be explicitly segregated by

20

%

the organization from other Medicaid net patient revenue. Don't

include indirect GME reimbursement provided by Medicaid,

which is to be entered on Worksheet 3, Unreimbursed Medicaid

and Other Means-Tested Government Programs. Include

Medicaid reimbursement for nursing and allied health education.

If your state pays Medicaid GME reimbursement as a lump sum

that includes both direct and indirect payments, use reasonable

methods to estimate the portion of the lump sum that is direct

(for example, the percent of total Medicare GME payments that

is direct).

Line 10. Enter revenue received for continuing health

professions education reimbursement or tuition.

Line 11. Enter other revenue received for health professions

education activities associated with expenses entered on

Worksheet 5, line 7.

Worksheet 6. Subsidized Health

Services (Part I, Line 7g)

Worksheet 6 can be used to calculate the net cost of subsidized

health services. Complete Worksheet 6 for each subsidized

health service and enter in Part I the total for all subsidized

health services combined.

“Subsidized health services” means clinical services provided

despite a financial loss to the organization. The financial loss is

2025 Instructions for Schedule H (Form 990)

measured after removing losses associated with bad debt,

financial assistance, Medicaid, and other means-tested

government programs. Losses attributable to these items aren't

included when determining which clinical services are

subsidized health services because they are reported as

community benefit elsewhere in Part I or as bad debt in Part III.

Losses attributable to these items are also excluded when

measuring the losses generated by the subsidized health

services. In addition, in order to qualify as a subsidized health

service, the organization must provide the service because it

meets an identified community need. A service meets an

identified community need if it is reasonable to conclude that if

the organization no longer offered the service:

• The service would be unavailable in the community,

• The community's capacity to provide the service would be

below the community's need, or

• The service would become the responsibility of government or

another tax-exempt organization.

Subsidized health services can include qualifying inpatient

programs (for example, neonatal intensive care, addiction

recovery, and inpatient psychiatric units) and outpatient

programs (emergency and trauma services, satellite clinics

designed to serve low-income communities, and home health

programs). Subsidized health services generally exclude

ancillary services that support inpatient and ambulatory

programs such as anesthesiology, radiology, and laboratory

departments. Subsidized health services include services or

care provided at physician clinics and skilled nursing facilities if

such clinics or facilities satisfy the general criteria for subsidized

health services. An organization that includes any costs

associated with stand-alone physician clinics (not other facilities

at which physicians provide services) as subsidized health

services in Part I, line 7g, must describe that it has done so and

enter on Part VI such costs included in Part I, line 7g.

Note: The organization can report a physician clinic as a

subsidized health service only if the organization operated the

clinic and associated hospital services at a financial loss to the

organization during the year.

Line 3, columns (A) through (D). Enter the estimated cost for

each subsidized health service. For column (B), enter bad debt

amounts attributable to the subsidized health service measured

by cost. For column (C), enter amounts attributable to the

subsidized health service for patients who are recipients of

Medicaid and other means-tested government health programs.

For column (D), enter financial assistance amounts attributable

to the subsidized health service measured by cost. Multiply

line 1 by line 2 or enter the estimated expense of each

subsidized health service based on the organization's cost

accounting. Organizations with a cost accounting system or

method more accurate than the ratio of patient care cost to

charges from Worksheet 2 can rely on that system or method to

estimate the cost of each subsidized health service.

Worksheet 7. Research (Part I,

Line 7h)

Worksheet 7 can be used to report the cost of research

conducted by the organization.

“Research” means any study or investigation the goal of

which is to generate increased generalizable knowledge made

available to the public (for example, knowledge about underlying

biological mechanisms of health and disease, natural processes,

or principles affecting health or illness; evaluation of safety and

efficacy of interventions for disease such as clinical trials and

studies of therapeutic protocols; laboratory-based studies;

epidemiology, health outcomes, and effectiveness; behavioral or

sociological studies related to health, delivery of care, or

2025 Instructions for Schedule H (Form 990)

prevention; studies related to changes in the health care delivery

system; and communication of findings and observations,

including publication in a medical journal). The organization can

include the cost of internally funded research it conducts, as well

as the cost of research it conducts funded by a tax-exempt or

government entity.

The organization cannot include in Part I, line 7h, direct or

indirect costs of research funded by an individual or an

organization that isn't a tax-exempt or government entity.

However, the organization can describe in Part VI any research it

conducts that isn't funded by tax-exempt or government entities,

including the cost of such research; the identity of the funder;

how the results of such research are made available to the

public, if at all; and whether the results are made available to the

public at no cost or nominal cost.

Examples of costs of research include, but aren't limited to,

salaries and benefits of researchers and staff, including stipends

for research trainees (Ph.D. candidates or fellows); facilities for

collection and storage of research, data, and samples; animal

facilities; equipment; supplies; tests conducted for research

rather than patient care; statistical and computer support;

compliance (for example, accreditation for human subjects

protection, biosafety, Health Insurance Portability and

Accountability Act (HIPAA), etc.); and dissemination of research

results.

Line 1. Define direct costs under the guidelines and definitions

published by the National Institutes of Health.

Line 2. Define indirect costs under the guidelines and

definitions published by the National Institutes of Health.

Line 4. Enter license fees and royalties the organization

received during the tax year that are directly associated with

research that the organization has (in any tax year) reported on

Schedule H as community benefit.

Line 5. An example of “other revenue” is Medicare

reimbursement associated with any research expense reported

as community benefit.

Worksheet 8. Cash and In-Kind

Contributions for Community Benefit

(Part I, Line 7i)

Worksheet 8 can be used to report cash contributions or grants

and the cost of in-kind contributions that support financial

assistance, health professions education, and other community

benefit activities reportable on Part I, lines 7a through 7h. Report

such contributions on line 7i, and not on lines 7a through 7h.

“Cash and in-kind contributions” means contributions made

by the organization to health care organizations and other

community groups restricted, in writing, to one or more of the

community benefit activities described in the table in Part I, line 7

(and the related worksheets and instructions). “In-kind

contributions” include the cost of staff hours donated by the

organization to the community while on the organization's

payroll, the indirect cost of space donated to tax-exempt

community groups (such as for meetings), and the financial

value (generally measured at cost) of donated food, equipment,

and supplies.

Don't report as cash or in-kind contributions any payments

that the organization makes in exchange for a service, facility, or

product, or that the organization makes primarily to obtain an

economic or physical benefit; for example, payments made in

lieu of taxes that the organization makes to prevent or forestall

local or state property tax assessments, and a teaching

hospital's payments to its affiliated medical school for intern or

resident supervision services by the school's faculty members.

21

Keep for Your Records

Worksheet 6. Subsidized Health Services (Part I, Line 7g)

(A)

Total

subsidized

health

service

program

Program name: ______________________________

Gross patient charges

1. Gross patient charges from program(s) . . . . . . . . .

1.

Total community benefit expense

2. Ratio of patient care cost to charges (from

Worksheet 2, if used) . . . . . . . . . . . . . . . . . . . . . .

2.

3. Total community benefit expense (multiply line 1

by line 2, or obtain from cost accounting; enter

column (E) in Part I, line 7g, column (c)) . . . . . . . .

3.

Direct offsetting revenue

4. Net patient service revenue . . . . . . . . . . . . . . . . .

4.

5. Other revenue . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

6. Total direct offsetting revenue (add lines 4 and 5;

enter column (E) in Part I, line 7g, column

(d)). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.

7. Net community benefit expense (subtract line 6

from line 3; enter column (E) in Part I, line 7g, column

(e)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

8. Total expense (enter amount from Form 990, Part IX,

line 25, column (A), including the organization's

share of joint venture expenses, and excluding any

bad debt expense included on Part IX,

line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

9. Percent of total expense (line 7, column (E),

divided by line 8; enter in Part I, line 7g, column

(f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9.

22

%

(B)

Bad debt

(C)

Medicaid and

other meanstested

government

health

programs

(D)

Financial

assistance

%

%

%

(E)

Totals

(subtract

columns (B),

(C), and (D)

from column

(A))

$

%

2025 Instructions for Schedule H (Form 990)

Keep for Your Records

Worksheet 7. Research (Part I, Line 7h)

Total community benefit expense

1. Direct costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1.

2. Indirect costs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2.

3. Total community benefit expense (add lines 1 and 2; enter in Part I, line 7h, column

(c)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3.

Direct offsetting revenue

4. License fees and royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4.

5. Other revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

6. Total direct offsetting revenue (add lines 4 and 5; enter in Part I, line 7h, column (d)) . . . . . . .

6.

7. Net community benefit expense (subtract line 6 from line 3; enter in Part I, line 7h, column

(e)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.

8. Total expense (enter amount from Form 990, Part IX, line 25, column (A), including the

organization's share of joint venture expenses, and excluding any bad debt expense included on

Part IX, line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8.

9. Percent of total expense (divide line 7 by line 8; enter in Part I, line 7h, column (f)) . . . . . . . . .

9.

Worksheet 8. Cash and In-Kind Contributions for Community

Benefit (Part I, Line 7i)

Keep for Your Records

(A)

Cash

contributions

1.

Total community benefit expense (enter amount from

column (C) in Part I, line 7i, column (c)) . . . . . . . . . . . . . .

1.

2.

Direct offsetting revenue (enter amount from column

(C) in Part I, line 7i, column (d)) . . . . . . . . . . . . . . . . . . . . .

2.

3.

Net community benefit expense (subtract line 2 from

line 1; enter in Part I, line 7i, column (e)) . . . . . . . . . . . . . .

3.

4.

Total expense (enter amount from Form 990, Part IX,

line 25, column (A), including the organization's share of

joint venture expenses, and excluding any bad debt

expense included on Part IX, line 25) . . . . . . . . . . . . . . . .

4.

Percent of total expense (divide line 3 by line 4; enter in

Part I, line 7i, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . .

5.

5.

Report cash contributions and grants made by the

organization to entities and community groups that share the

organization's goals and mission. Don't report cash or in-kind

contributions contributed by employees, or emergency funds

provided by the organization to the organization's employees;

loans, advances, or contributions to the capital of another

organization that are reportable in Part X of the core Form 990;

or unrestricted grants or gifts to another organization that can, at

the discretion of the grantee organization, be used other than to

provide the type of community benefit described in the table in

Part I, line 7.

2025 Instructions for Schedule H (Form 990)

%

(B)

In-kind

contributions

(C)

Total

%

Special rule for grants to joint ventures. If the organization

makes a grant to a joint venture in which it has an ownership

interest to be used to accomplish one of the community benefit

activities reportable in the table, in Part I, line 7, enter the grant

on line 7i, but don't include the organization's proportionate

share of the amount spent by the joint venture on such

activities in any other part of the table, to avoid double counting.

23

Index

B

Bad Debt, Medicare, & Collection

Practices 5

Worksheet (optional) 6

C

Charges for Medical Care 11

Financial Assistance Policy 9

Policy Relating to Emergency

Medical Care 11

Hospital facilities 7

Financial Assistance and Certain

Other Community Benefits at

Cost 2

Contributions for community benefit 3

Community Building Activities 4

Disregarded entity 4

Group return 4

M

F

Management Companies and Joint

Ventures 6

Facility Information:

CHNA 7

Community Health Needs

Assessment 7

Facility Policies & Practices:

Billing and Collections 9

24

P

Patient Protection and Affordable

Care Act:

Hospital facilities 1

Section 501(r) of the Code 1

W

Worksheets:

1-Financial Assistance at Cost 15

2-Ratio of Patient Care Cost to

Charges 15

3-Unreimbursed Medicaid and Other

Means-Tested Government

Programs 16

4-Community Health Improvement

Services and Community Benefit

Operations 19

5-Health Professions Education 20

6-Subsidized Health Services 20

7-Research 21

8-Cash and In-Kind Contributions for

Community Benefit 23