3.24.12 Exempt Organization Returns

Manual Transmittal

December 18, 2018

Purpose

(1) This transmits revised IRM 3.24.12, Integrated Submission and Remittance Processing (ISRP) System, Exempt Organization Returns.

Material Changes

(1) Editorial changes have been made throughout.

(2) All dates have been changed to reflect processing year 2019.

(3) 3.24.12- 34 - 3.24.12-64 - Changed exhibits to 2016 and 2017.

(4) 3.24.12-66 - 3.24.12.96 - New exhibits for Form 990 2018 and subsequent.

(5) 3.24.12-139 - 3.24.12-148 - New exhibits for Form 990-EZ 2018 and subsequent.

(6) 3.24.12-149 - 3.24.12-158 - Changed exhibits to 2016 and 2017.

(7) 3.24.12-190 - Added Return Processing Code (RPC) to Section 01 for Form 990-PF

(8) 3.24.12-213 - 3.24.12-216 - Updated lines for Form 990-T and added RPC field to Section 01.

(9) 3.24.12-224 - Added RPC to Section 01 for Form 1120-POL.

(10) 3.24.12-232 - Two new lines added to Form 4720.

Effect on Other Documents

This supersedes IRM 3.24.12, dated January 1, 2018.

Audience

ISRP Data Transcribers
Wage and Investments (W&I)

Effective Date

(01-01-2019)

Jennifer A. Jett
Acting Director, Business System Planning
Government Entities and Shared Services
Tax Exempt Government Entities

Service Level Agreements (SLAs)

  1. National Service Level Agreements (SLAs) have been established between operating divisions. This section contains specifics regarding SLAs that pertain to activities performed by use of this IRM.

Taxpayer Advocate Service (TAS) SLA

  1. The Taxpayer Advocate Service (TAS) SLA contains basic requirements for handling TAS-referred cases, and include specific actions to take on TAS referrals and specific time frames for completing those actions.

  2. The SLA can be found at http://tas.web.irs.gov/policy/sla/default.aspx and procedures can be found in IRM 13.1.19.2, Taxpayer Advocate Service.

Operations Assistance Requests (OARs)
  1. TAS uses the Operation Assistance Request (OAR) process to refer cases when TAS lacks either the statutory or delegated authority to resolve a taxpayer's problem. TAS utilizes Form 12412, Operations Assistance Request to initiate the OAR process.

  2. In cases requiring an OAR, TAS will complete Form 12412 and forward the case to the Operating Division Liaison via Form 3210. The Operating Division Liaison will review the case, assign it to the appropriate area, and monitor the case through it's conclusion.

  3. Every effort must be made to expedite completion of OAR cases. Time frames for the assigned area to complete the case will be indicated on Form 12412.

    1. If resolution of a taxpayer's case can't be completed by the requested time frame or by a negotiated extension date, the employee will immediately notify his or her manager.

    2. The manager/employee will work with the TAS contact listed on Form 12412 to arrive at agreed upon time frames for follow-up based on the facts and circumstances of the particular case.

    3. The manager/employee assigned the case will discuss the findings and recommendations on the final disposition of the case with the appropriate TAS contact. The TAS contact is responsible for communicating the final decision on the case to the taxpayer however this doesn't prohibit the manager/employee from also communicating that decision to the taxpayer.

    4. If the TAS contact and the manager/employee assigned the case can't agree upon the resolution to the taxpayer's problem, the TAS employee will elevate this disagreement to the manager who will discuss it with the appropriate Operating Division manager. The manager/employee assigned the case will also elevate any disagreement to his or her manager.

  4. For more information, please refer to: IRM 13, Taxpayer Advocate Service and http://tas.web.irs.gov/policy/sla/default.aspx.

Program Scope and Objectives

  1. Purpose - Instructions for transcribing and verifying data from block control documents and returns for the Business Master File Processing of the Exempt Organization Returns, using the Integrated Submission and Remittance Processing (ISRP) system.

  2. Audience - Exempt Organization Data Transcribers at the Ogden Campus is the primary audience for this IRM.

  3. Policy Owner - The Director, Tax Exempt/Government Entities, Business Systems Planning.

  4. Project Owner - Submission Processing Programs

  5. Stakeholders - Exempt Organization Headquarters who rely on transcription of exempt organization returns.

  6. Transcription operators may also need to refer to IRM 3.24.38, BMF General Instructions, for general procedures. If IRM 3.24.12 and IRM 3.24.38 conflict, IRM 3.24.12 takes precedence.

  7. Due to substantial changes to the Form 990, batch and process Forms 990 for 2007 and prior years, Forms 990 for 2008 - 2013, and 2014 and subsequent years, under separate program codes. See IRM 3.24.12.2.3.

  8. When making address updates, unless the filer specifically indicates room or suite, just the number should be entered.

Program Controls

  1. The block control documents below are sources of transcribed control data:

    1. Form 813, Document Register.

    2. Form 1332, Block and Selection Record

    3. Form 3893, Re-entry Document Control

Source Documents

  1. Transcribe data from:

    1. CP 411–414, 420–430, 259A–259G Notices

    2. Form 990, Return of Organization Exempt from Income Tax

    3. Form 990-EZ, Short Form Return of Organization Exempt from Income Tax

    4. Form 990-PF, Return of Private Foundation

    5. Form 990-T, Exempt Organization Business Income Tax Return

    6. Form 1041, Schedule D, Capital Gains and Losses

    7. 1041, Schedule H, Alternative Minimum Tax

    8. Form 1041-A, Trust Accumulation of Charitable Amounts

    9. Form 1120-POL, U. S. Income Tax Return of Certain Political Organizations

    10. Form 4136, Computation of Credit for Federal Tax on Gasoline and Special Fuels

    11. Form 4626, Alternative Minimum Tax–Corporations

    12. Form 4720, Return of Certain Excise Taxes on Charities and Other Persons Under Chapter 41 and 42 of the Internal Revenue Code

    13. Form 4952, Investment Interest Expense Deduction

    14. Form 5227, Split-Interest Trust Information Return

    15. Form 5578, Annual Certificate of Racial Nondiscrimination for a Private School Exempt from Federal Income Tax

    16. Form 5800, Exempt Organization Returns Edit Sheet

    17. Form 8872, Political Organization Report of Contributions and Expenditures

    18. Form 8913, Credit for Federal Telephone Excise Tax Paid

Forms/Program Numbers/Tax Class Doc. Codes

  1. Form 990-EZ 2016 and subsequent will be batched under 13423 and 13424. In order for ISRP to pull up the correct screen for transcription, program code 13430 should be used.

  2. Refer to the table below for forms, programs, and tax class doc codes.

    FORMS PROGRAM NUMBERS TAX CLASS DOC. CODES
    990 (2014 and 2015) 13450 493
    990 (2016 and Subsequent) 13452 493
    990 (2008 - 2013), 425–431 & 259A-259H 13410 493
    990 (2007 and Prior) 13110 490
    990-EZ (2016 and subsequent 13430 (used for ISRP input only) 492
    990-EZ (2016 and subsequent) 13423 492
    990-EZ/527 (2016 and subsequent) 13424 492
    990–EZ (2008 - 2015) 13420 492
    990-EZ (2007 and Prior) 13120 409
    990-T 13141 393
    990-PF 13131 491
    1041-A 13162 481
    4720 13161 471
    5227 13190 483
    5578 13160 984
    1120-POL 13170 320
    5768 15502 977
    8872 16010 462

MUST ENTER Fields

  1. Some fields require entry of data. These are MUST ENTER fields. Transcription Operation Sheets indicate MUST ENTER fields by the presence of stars (★★★★★★). See IRM 3.24.38 for procedures related to MUST ENTER fields.

Check Digit/Name Control

  1. See the following subsections for entering either the Check Digit or Name Control.

Check Digit
  1. Enter the Check Digit as follows:

    1. If the EIN is unaltered on a preprinted label, enter the two alpha characters shown to the left of the EIN in the Check Digit (CD) field. You don't need to press <ENTER>. If the Check Digit is illegible, enter the Name Control.

    2. If the EIN is unaltered in the preprinted entity information of a CP Notice, enter the two alpha characters shown to the right of the EIN in the Check Digit (CD) field. You don't need to press <ENTER>. If the Check Digit is illegible, enter the Name Control.

    Note:

    We moved the EIN and Check Digits for taxpayer privacy. On preprinted forms these items show up toward the title of the form. Enter the EIN and Check Digits. On NCOA labeled forms the EIN appears in this same area but the Check Digits aren’t present. Enter the EIN and then the Name Control.

  2. The system fills the Name Control field with cent (¢) signs and positions the cursor on the EIN field. Enter the EIN.

  3. If the Check Digit is invalid, the error message CHECK DIGIT ERROR appears. The cursor’s position is on the first digit of the EIN.

    1. Check the Check Digit and EIN fields for errors.

    2. If the Check Digit was entered incorrectly, press <F1> to position the cursor on the first position of the Check Digit field. Correct the Check Digit field. If the EIN is correct, press <ENTER>.

    3. If the EIN was entered incorrectly, correct the field using the normal procedures.

    4. If both the Check Digit and EIN fields are correct, press <F7> to override the error message.

Name Control
  1. In all other cases, press <ENTER> for the Check Digit field. The system grays out the Check Digit field and positions the cursor on the Name Control field.

  2. Enter the four character Name Control indented, underlined or edited in the First Name Line area in the Name Control (NC) field (see IRM 3.24.38 for Name Control determination). You don't need to press <ENTER> if entering four characters.

  3. If less than four characters, enter those shown and press <ENTER>.

  4. If the Name Control is missing or illegible, enter one period, then press <ENTER>.

    Note:

    Both fields can't contain entries; however, if both are entered, the system recognizes only the Check Digit and grays out the Name Control field.

Enhanced-Entity Index File

  1. See IRM 3.24.38 for Enhanced-Entity Index File processing.

  2. These procedures affect Forms 990, 990EZ, 990T, 990PF, 5227 and CP 411–414, 420-430, 259A–259G.

Name Control Check Against Enhanced-Entity Index File

  1. The following procedures affect Forms 5578, 1041A, and 4720.

  2. If a document is entered with a Name Control rather than a Check Digit, the system accesses the Enhanced-Entity Index File (E-EIF) to determine if the account is already established on the Master File. This procedure reduces the number of unpostables.

    Note:

    As soon as the EIN field is entered, the system accesses E-EIF. During this time, screen activity occurs and no entry can be made into the terminal. If the account is located, the Name Control entered automatically grayed out and the Check Digit appears in the Check Digit field on the screen. The EIN/Check Digit/Name Control fields bypass verification. If the account isn’t located, the Name Control remains on the screen as entered.

Specific Instructions for Entry of Data

  1. This section provides specific instructions for entering data.

Required Sections & Section Verification

  1. Required sections and section verification:

    Form Required Section Required Section Verified Other Section(s) Other Section(s) Verified
    990 (2014 and 2015 01, 02 100% 03 - 13 Yes - 100% if input
    990 (2016 and Subsequent) 01, 02 100% 03 - 13 Yes - 100% if input
    990 (2008 and subsequent) 01, 02 100% 03–13 Yes - 100% if input
    990–EZ (2008 - 2013) 01, 02 100% 03–12 Yes - 100% if input
    990 & 990–EZ (2007 and Prior) 01, 02 100% 03–12 Yes - 100% if input
    CP411–414, 420–430 & 259A–259G and
    Organization Code "9" filers
    01 100% 02 No
    990–PF 01–13 100% (Sections 01–07, 12 & 13) n/a Yes - if input and doesn't pass the zero balance test (Sections 08–11)
    990–T 01–04 Yes 07, 08, 15, 17, 20 Yes - if input
    *Section 20 is not verified
    1041–A 01 Yes 03 No
    1120–POL 01 Yes 02–05, 15, 20 Yes - 05 verified if input
    4720 01, 02 Yes 03 No
    5227 01–05 Yes n/a n/a
    5578 01 Yes n/a n/a
    5768 01 Yes n/a n/a
    8872 01 Yes 02, 03 Yes - if input

Foreign Address Procedures

  1. ISRP enters the address fields on a foreign address. ISRP won't enter a CCC "U" or Action Code 650 to send the returns to (SCRS) or (ERS).

  2. Refer to IRM 3.24.38.4.4.14.9 for correct procedures for entering foreign addresses.

Money Fields

  1. All fields are DOLLARS AND CENTS unless otherwise specified.

    1. A space and a dollar sign following the prompt (i.e. LN2 $) specifies the field is a dollars only field.

    2. Since many reports generate from the information on these returns, take extreme care when entering the money amounts.

    3. If the instruction calls for dollars only, don't enter cents (e.g., $400.00 entered as 400).

    4. If the instruction calls for dollars and cents, be sure to enter the cents (e.g., $400 entered as 400.00).

Yes/No Boxes

  1. For all Yes/No boxes, enter the digit edited to the right of the Line number.

  2. If un-edited:

    1. Enter "1" if the yes box is checked.

    2. Enter "2" if the no box is checked.

    3. Press <ENTER> only if both boxes are checked, blank or N/A.

Percentage Fields

  1. Input all percentage fields using up to three digits to the left of the decimal.

    Example:

    Input 109.7% as 109%

Program Service Business Codes

  1. Enter all business codes exactly as shown except as follows:

    1. If more than one code is present, enter the first code.

    2. If the code is other than 4 or 6 digits, enter "0" (zero).

    3. If there are any illegible digits, enter "0" (zero).

ISRP Transcription Operation Sheets

  1. The following exhibits represent specific data entry procedures.

Block Header Data Entry

Block Header Data Entry
3.24.12 - 1 Block Header Data Entry
Source Document or Record: FORM 1332 FOR ORIGINAL INPUT DOCUMENTS,
FORMS 3893 FOR RE-ENTRY DOCUMENTS
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) SC Block Control ABC (auto) The screen displays the ABC entered in the EOP Dialog box, as described in IRM 3.24.38.4.1.1. You can't change it.
(2) Block DLN DLN <ENTER> Enter the first 11 digits as shown on:
(a) Form 813 - from the "Block DLN box."
(b) Form 1332 - in the "Block DLN box. "
(c) Form 3893 - in box 2.
(d) The KV Operator verifies the DLN from the first document of the block.
(3) Batch Number BATCH <ENTER> Enter the batch number as follows:
(a) Forms 813, 1332 - from the Batch Control Number box.
(b) Form 3893–from box 3.
(c) If not present, secure the number from the Batch Transmittal Sheet.
(4) Document Count COUNT <ENTER> Enter the document count as follows:
(a) Forms 813, 1332 - the circled serial number. If a full block (100 documents) or if a number isn't circled, enter 100.
(b) Form 3893—from box 4.
(5) Pre-journalized Credit Amount CR <ENTER>
(a) Form 813 – labeled "CR" or "Credit" .
(b) Form 3893 - box 5.
(c) See narrative for amounts.
(d) If neither "CR" or "DR" is labeled, enter as "CR" .
(6) Pre-journalized Debit Amount DB <ENTER>
(a) Form 813 - labeled "DR" or "Debit" .
(a) Form 3893 - box 6.
(b) See narrative for amounts.
(7) Transaction Code TRCODE <ENTER> Press <ENTER>.

Note:

For Form 5768, enter TC 460.

(8) Transaction Date TRDATE <ENTER> Press <ENTER>.
(9) MFT Code MFT <ENTER> Enter the 2 digit code as follows:
(a) Form 813 - from the "Date" box.
(b) Form 3893 - from box 9.
(c) Valid MFT's are:
1 BMF - 05, 06, 15.
2 IRA - (with TC 0) 29.
3 If MFT is other than listed above, Press <ENTER> only.
(10) Secondary Amount SECAMT <ENTER> Enter the bracketed amount as follows:
(a) Form 813 - in the "Total" box.
(b) Form 3893 - from box 10.
(c) NOTE: If zero, press <ENTER> only.
(11) Source Code SOURCE <ENTER> If the control document is a Form 3893, enter from box 11 as follows:
(a) R = "Reprocessable" box checked.
(b) N = "Reinput of Unpostable" box checked.
(c) 4 = "SC Reinput" box checked.
(d) None of the boxes checked, consult your supervisor who determines if a source code is required.
(12) Year Digit YEAR <ENTER> If the control document is a Form 3893, enter the digit from the box 12 (current or otherwise).
(a) This is a MUST ENTER field if the Source Code is "R" , "N" , or "4" .
(13) Period Code PRIOR YEAR <ENTER> No entry.
(14) RPS Indicator RPS <ENTER> Enter "2" if:
(a) Forms 813, 1332 — "RPS" is edited or stamped in the upper center margin or "RRPS" is in the header of Form 1332.
(b) Form 3893 — box 13 is checked.

Form 990 - Section 01 (2014 and 2015)

3.24.12 - 2 SECTION 01
Source Document or Record: Forms 990 - Section 01 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generated the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5 for procedures.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5 for procedures.
(5) E.I.N. EIN <ENTER>
★★★★★★
Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) For a CP 425–431 & 259A-259H, underlined to the right of the "Employer ID Number" .
(b) See standard rules in IRM 3.24.38.
(c) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) For a CP 425–431 & 259A-259H, edited in the area around the Tax Period.
(10) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.

(11) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(12) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(13) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country code.
(14) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(15) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(16) Group Code H(b) BOXHB <ENTER> Enter a "1" or "2" from the yes/no box from the entity area of the return, Line H(b). For a CP425–431 & 259A-259H, press <ENTER> only.
(17) Tax Exempt Status BOXI <ENTER> Enter the edited two digit code from the blank space of Box I.
(18) Type of Organization BOXK RT <ENTER> Enter the edited code from the blank space of Box K. For a CP 425–431 & 259A-259H always enter a "9" .
(19) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 2–7b. For a 420–431 & 259A-259H, enter the edited characters as shown in the center of the return. If a Condition Code is illegible, enter a "#" in its place.
(20) Received Date RDATE <ENTER>
★★★★★★
Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a "G" Condition Code is present and the return is non-remittance, end the document after this element.
(c) If a CP 425–431 & 259A-259H, end the document after this element.
(21) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(22) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(23) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
(24) Preparer Telephone # TEL# <ENTER> Enter the preparer phone number.
(a) If the Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(b) If Type of Organization is a "9" , and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If present, continue to that element and follow the instructions there.
(25) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
"9" from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
"9" , and the "9" is NOT underlined, press <F6> and end the document after this element.

Form 990 - Section 02, Form 5800 - Edit Sheet (2014 and 2015)

3.24.12 - 3 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800 - Edit Sheet (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "02" .
(2) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(3) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(4) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(5) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(6) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.

Form 990 - Section 03 (2014 and 2015)

3.24.12 - 4 SECTION 03
Source Document or Record: Forms 990 - Section 03, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return, ONLY if underlined in green.
(3) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(4) Undertake New Activities Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2.
(5) Make Significant Changes Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3.
(6) Exempt Purpose Code 1 L4A <ENTER> Press Enter only. Don't transcribe a code.
(7) Exempt Purpose Code 2 L4B <ENTER> Press Enter only. Don't transcribe a code.
(8) Exempt Purpose Code 3 L4C <ENTER> Press Enter only. Don't transcribe a code.
(9) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.

Note:

If a "D1" is edited and underlined, pick up as an alpha "D" and numeric "1" . Don't confuse with an alpha "D" and alpha "I" .

(10) 501(c)(3) or 4947(a)(1) Y/N L1 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 1.
(11) Required to Complete Sch B Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 2.
(12) Engage in Direct or Indirect Political Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 3.
(13) Engage in Lobbying Activities Y/N L4 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 4.
(14) Subject to Sec 6033(c) Notice L5 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 5.
(15) Maintain Donor Advised Y/N L6 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 6.
(16) Receive or Hold Conservation Y/N L7 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 7.
(17) Maintain Collections of Works of Art Y/N L8 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 8.
(18) Provide Credit Counseling Y/N L9 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 9.
(19) Hold Assets in Term/Permanent Y/N L10 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 10.
(20) Land, Buildings, Equipment 11A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11a.
(21) Investments Other Securities 11B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11b.
(22) Investments Program Related 11C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11c.
(23) Other Assets 11D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11d.
(24) Other Liabilities 11E <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11e.
(25) Separate or Consolidated Financial Statements 11F <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11f.
(26) Separate Independent Audited Financial 12A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12a.
(27) Consolidated Independent Financial 12B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12b.
(28) School Described in 170(b)(1)(A)(ii) L13 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 13.
(29) Maintain an Office, etc Outside U.S. 14A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14a.
(30) Have Aggregate Revenues/Expenses 14B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14b.
(31) Report > $5000 on Part IX Organizations L15 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 15.
(32) Report > $5000 on Part IX Individuals L16 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 16.
(33) Report > $15,000 on Part IX, Line 11e L17 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 17.
(34) Report > $15,000 on Part VIII, Line 1c/8a L18 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 18.
(35) Report > $15,000 on Part VIII, Line 9a L19 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 19.
(36) Operate Hospitals 20A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20a.
(37) Attach Audited Financial Statements 20B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20b.

Form 990 - Section 04 (2014 and 2015)

3.24.12 - 5 SECTION 04
Source Document or Record: Forms 990 - Section 04, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "04" .
(2) Report > $5000 on Part IX, Line 1 L21 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 21.
(3) Report > $5000 on Part IX, Line 2 L22 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 22.
(4) Answer Yes to Questions 3, 4, 5 L23 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 23.
(5) Any Tax-Exempt Bond with Outstanding Principal 24A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24a.
(6) Invest Any Proceeds 24B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24b.
(7) Maintain an Escrow Account 24C <ENTER> Enter a yes or no from the yes/box from Part IV, Line 24c.
(8) Act as "On Behalf Of" Issuer 24D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24d.
(9) 501(c)(3) / 501(c)(4) Organizations 25A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25a.
(10) Become Aware it Engaged in Excess 25B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25b.
(11) Loan to/by Current/Former Officer L26 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 26.
(12) Provide Grant or Other Assistance L27 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 27.
(13) Business Transaction with Current or Former Officer 28A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28a.
(14) Business Transaction with Family Member 28B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28b.
(15) Business Transaction with Entity of Current/ Former Officer 28C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28c.
(16) Receive or Accrue > $25,000 in Non-Cash L29 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 29.
(17) Receive or Accrue Contributions of Art L30 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 30.
(18) Liquidate, Terminate, Dissolve L31 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 31.
(19) Sell, Exchange, Dispose L32 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 32.
(20) Own 100% of an Entity L33 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 33.
(21) Related to Tax-Exempt / Taxable Entity L34 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 34.
(22) Controlled Entity Within 512(b)(13) L35A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35a.
23 Receive Payment or Engage Transaction Within L35B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35b.
(24) Make Any Transfers L36 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 36.
(25) Conduct More than 5% L37 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 37.
(26) Complete Schedule O L38 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 38.

Form 990 - Section 05 (2014 and 2015)

3.24.12 - 6 SECTION 05
Source Document or Record: Forms 990 - Section 05, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "05" .
(2) Part V Number of Forms/1096 PTVL1A <ENTER> Enter the number shown on Part V, Line 1a.
(3) Number of Forms W-2G L1B <ENTER> Enter the number shown on Part V, Line 1b.
(4) Comply with Backup Withholding Rules L1C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 1c.
(5) Number of Employees / W-3 L2A <ENTER> Enter the number shown on Part V, Line 2a.
(6) File All Required Federal Employment Returns L2B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 2b.
(7) Unrelated Business Income > $1000 L3A <ENTER> Enter a yes or no from the yes/box from Part V, Line 3a.
(8) If Yes, Has Filed a 990-T L3B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 3b.
(9) Interest in or a Signature L4A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 4a.
(10) Party to a Prohibited Tax Shelter L5A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5a.
(11) Taxable Party Notify Organization L5B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5b.
(12) If Yes, Did Organization File 8886-T L5C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5c.
(13) Annual Gross Receipts Normally >$100,000 L6A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6a.
(14) If Yes, Did Organization Include L6B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6b.
(15) >$75 Partly Contribution/Goods/Services L7A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7a.
(16) If Yes, Did Organization Notify Donor L7B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7b.
(17) Sell, Exchange, Otherwise Dispose L7C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7c.
(18) Number of Forms 8282 L7D <ENTER> Enter the number shown on Part V, Line 7d.
(19) Receive Any Funds L7E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7e.
(20) Pay Premiums L7F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7f.
(21) Contributions of Qualified Intellectual Property L7G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7g.
(22) Contributions of Cars, Boats, Airplanes L7H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7h.
(23) Sponsoring Orgs, 509(a)(3) Excess Business Holdings L8 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 8.
(24) Make Taxable Distributions Under 4966 L9A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9a.
(25) Make Distribution to Donor L9B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9b.
(26) Initiation Fees/Capital Contributions 10A $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 10a.
(27) Gross Receipts for Public Use of Facilities 10B $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 10b.
(28) Gross Income/Members/Shareholders 11A $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 11a.
(29) Gross Income from Other Sources 11B $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 11b.
(30) 4947(a)(1) Filing 990 in Lieu of 1041 12A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 12a.
(31) Amount of Tax Exempt Interest 12B $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 12b.
(32) Licensed to Issue Qualified Health Plans 13A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 13a.
(33) Aggregate Amount of Reserves to Maintain 13B $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 13b.
(34) Aggregate Amount of Reserves on Hand 13C $ <ENTER>
MINUS (-)
Enter the amount from Part V, Line 13c.
(35) Receive Payments for Indoor Tanning 14A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14a.
(36) Filed Form 720 to Report Payments 14B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14b.

Form 990 - Section 06 (2014 and 2015)

3.24.12 - 7 SECTION 06
Source Document or Record: Forms 990 - Section 06, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "06" .
(2) Voting Members of Governing Body PG6L1A <ENTER> Enter the number shown on Part VI, Section A, Line 1a.
(3) Independent Voting Members L1B <ENTER> Enter the number shown on Part VI, Section A, Line 1b.
(4) Officer, Director, Trustee Family/Relationship L2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 2.
(5) Delegate Control Over Management L3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 3.
(6) Make Significant Changes L4 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 4.
(7) Become Aware of Material Diversion L5 <ENTER> Enter a yes or no from the yes/box from Part VI, Section A, Line 5.
(8) Members of Stockholders L6 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 6.
(9) Members, Stockholders, Other Persons 7A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7a.
(10) Members Subject to Approval 7B <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7b.
(11) Determining Compensation for CEO, Exec Director 15A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section B, Line 15a.
(12) Total Reportable Compensation from Organization PG8L1D(D) $ <ENTER>
MINUS (-)
Enter the amount from Part VII, Section A, Line 1d, Column D.
(13) Total Reportable Compensation from Related Organization 1D(E) $ <ENTER>
MINUS (-)
Enter the amount from Part VII, Section A, Line 1d, Column E.
(14) Total Compensation from Organization & Related Organizations 1D(F) $ <ENTER>
MINUS (-)
Enter the amount from Part VII, Section A, Line 1d, Column F.
(15) Total Individuals who Received > $100,000 SECTAL2 <ENTER> Enter the number shown on Part VII, Section A, Line 2.
(16) Total Independent Contractors Received > $100,000 SECTBL2 <ENTER> Enter the number shown on Part VII, Section B, Line 2.

Form 990 - Section 07 (2014 and 2015)

3.24.12 - 8 SECTION 07
Source Document or Record: Forms 990 - Section 07, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "07" .
(2) Total Contributions/
Gifts/Grants
PG9L1H $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 1h, Column (A).
(3) Program Service Business Code 2A 2ACODE <ENTER> Enter the number shown on Part VIII, Line 2a.
(4) 2a Program Service Revenue Col. A 2A(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 2a, Column (A).
(5) Program Service Business Code 2B 2BCODE <ENTER> Enter the number shown on Part VIII, Line 2b.
(6) 2b Program Service Revenue Col. A 2B(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 2b, Column (A).
(7) Program Service Business Code 2C 2CCODE <ENTER> Enter the number shown on Part VIII, Line 2c.
(8) 2c Program Service Revenue Col. A 2C(A) $ <ENTER>
MINUS (-)
Enter amount shown on Part VIII, Line 2c, Column (A).
(9) Program Service Business Code 2D 2DCODE <ENTER> Enter the number shown on Part VIII, Line 2d.
(10) 2d Program Service Revenue Col. A 2D(A) $ <ENTER>
MINUS (-)
Enter amount shown on Part VIII, Line 2d, Column (A).
(11) Program Service Business Code 2E 2ECODE <ENTER> Enter the number shown on Part VIII, Line 2e.
(12) 2e Program Service Revenue Col. A 2E(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 2e, Column (A).
(13) 2f Program Service Revenue Col. A 2F(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 2f, Column (A).
(14) 2g Program Service Revenue Total Col. A 2GTOT $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Part VIII, Line 2g, Column (A).
(15) Investment Income Col. A 3(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 3, Column (A).
(16) Tax-Exempt Bond Proceeds Col. A 4(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 4, Column (A).
(17) Royalties Col. A 5(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 5, Column (A).
(18) Gross Rents Real 6(A)I $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6a, Column (i).
(19) Gross Rents Personal 6(A)II $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6a, Column (ii).
(20) Rental Expenses Real 6(B)(I) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6b, Column (i).
(21) Rental Expenses Personal 6(B)(II) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6b, Column (ii).
(22) Rental Income/Loss Real 6C(I) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6c, Column (i).
(23) Rental Income/Loss Personal 6C(II) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6c, Column (ii).
(24) Net Rental Income/Loss Col. A 6D(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 6d, Column (A).

Form 990 - Section 08 (2014 and 2015)

3.24.12 - 9 SECTION 08
Source Document or Record: Forms 990 - Section 08, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08.
(2) Gross Amount from Sales of Assets - Securities PG9L7A(I) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7a, Column (i).
(3) Gross Amount from Sales of Assets - Other 7A(II) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7a, Column (ii).
(4) Cost or Other Basis/Sales - Securities 7B(I) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7b, Column (i).
(5) Cost or Other Basis/Sales - Other 7B(II) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7b, Column (ii).
(6) Gain/Loss - Securities 7C(I) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7c, Column (i).
(7) Gain/Loss - Other 7C(II) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7c, Column (ii).
(8) Net Gain/Loss Col. A 7D(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 7d, Column (A).
(9) Gross Income from Fundraising 8A $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 8a.
(10) Less Direct Expenses 8b 8B $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 8b.
(11) Net Income/Loss from Fundraising Col. A 8C(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 8c, Column (A).
(12) Gross Income from Gaming 9A $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 9a.
(13) Less Direct Expenses 9b 9B $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 9b.
(14) Net Income/Loss from Gaming 9C(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 9c, Column (A).
(15) Gross Sales of Inventory 10A $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 10a.
(16) Less Cost of Goods Sold 10B $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 10b.
(17) Net Income/Loss from Sales Col. A 10C(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 10c, Column (A).
(18) Misc. Revenue Business Code 11a 11ACODE <ENTER> Enter the number shown on Part VIII, Line 11a.
(19) Misc. Revenue Total (A) Col. A 11A(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 11a, Column (A).
(20) Misc. Revenue Business Code 11b 11BCODE <ENTER> Enter the number shown on Part VIII, Line 11b.
(21) Misc. Revenue Total 11B(A) Col. A 11B(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 11b, Column (A).
(22) Misc. Revenue Business Code 11c 11CCODE <ENTER> Enter the number shown on Part VIII, Line 11c.
(23) Misc. Revenue Total 11C(A) Col. A 11C(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 11c, Column (A).
(24) Misc. Revenue Total 11D(A) Col. A 11D(A) $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 11d, Column (A).
(25) Misc. Revenue Total 11E Col. A 11ETOT $ <ENTER>
MINUS (-)
Enter the amount from Part VIII, Line 11e, Column (A).
(26) Total Revenue 12(A) Col. A 12(A) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Part VIII, Line 12, Column (A).

Form 990 - Section 09 (2014 and 2015)

3.24.12 - 10 SECTION 09
Source Document or Record: Forms 990 - Section 09, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 09.
(2) Gross to Government / Organizations in U.S. PG10L1(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 1, Column (A).
(3) Grants / Other Assistance in U.S. L2(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 2, Column (A).
(4) Grants / Other Assistance Outside U.S. L3(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 3, Column (A).
(5) Benefits Paid to / for Members L4(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 4, Column (A).
(6) Compensation of Current Officers / Directors L5(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 5, Column (A).
(7) Compensation to Disqualified Persons L6(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 6, Column (A).
(8) Other Salaries / Wages L7(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 7, Column (A).
(9) Pension Plan Contributions L8(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 8, Column (A).
(10) Other Employee Benefits L9(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 9, Column (A).
(11) Payroll Taxes 10(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 10, Column (A).
(12) Fees for Services / Management 11A(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 11a, Column (A).
(13) Fees for Services / Legal 11B(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 11b, Column (A).
(14) Fees for Services / Accounting 11C(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 11c, Column (A).
(15) Fees for Services / Lobbyists 11D(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 11d, Column (A).
(16) Fees for Services / Professional Fundraising 11E(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 11e, Column(A).
(17) Fees for Services / Investment Management 11F(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 11f, Column (A).
(18) Fees for Services / Other 11G(A) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from shown on Part IX, Line 11g, Column (A).
(19) Advertising / Promotion 12(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 12, Column (A).
(20) Office Expenses 13(A) $ <ENTER>
MINUS (-)
Enter the amount from on Part IX, Line 13, Column (A).
(21) Information Technology 14(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 14, Column (A).
(22) Royalties 15(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 15, Column (A).
(23) Occupancy 16(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 16, Column (A).
(24) Travel 17(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 17, Column (A).
(25) Payments of Travel / Entertainment 18(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 18, Column (A).
(26) Conferences, Conventions / Meetings 19(A) $ <ENTER>
MINUS(-)
Enter the amount from Part IX, Line 19, Column (A).
(27) Interest 20(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 20, Column (A).
(28) Payments to Affiliates 21(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 21, Column (A).
(29) Depreciation / Depletion 22(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 22, Column (A).
(30) Insurance 23(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 23, Column (A).
(31) Other Expenses a 24A(A) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Part IX, Line 24a, Column (A).
(32) Other Expenses b 24B(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 24b, Column (A).
(33) Other Expenses c 24C(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 24c, Column (A).
(34) Other Expenses d 24D(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 24d, Column (A).
(35) Other Expenses e 24E(A) $ <ENTER>
MINUS (-)
Enter the amount from Part IX, Line 24e, Column (A).
(36) NA 24F $ <ENTER> Enter only.
(37) Total Functional Expenses 25(A) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Part IX, Line 25, Column (A).

Form 990 - Section 10 (2014 and 2015)

3.24.12 - 11 SECTION 10
Source Document or Record: Forms 990 - Section 10, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "10" .
(2) Cash EOY PG11L1(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 1, Column (B).
(3) Savings / Temporary Investments EOY L2(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 2, Column (B).
(4) Pledges / Grants Receivable EOY L3(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 3, Column (B).
(5) Accounts Receivable EOY L4(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 4, Column (B).
(6) Receivables from Current / Former EOY L5(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 5, Column (B).
(7) Receivables from Disqualified Persons EOY L6(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 6, Column (B).
(8) Notes / Loans Receivable EOY L7(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 7, Column (B).
(9) Inventories for Sale EOY L8(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 8, Column (B).
(10) Prepaid Expenses EOY L9(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 9, Column (B).
(11) Land / Buildings Less Accumulated EOY 10C(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 10c, Column (B).
(12) Investments Publicly Traded Securities EOY 11(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 11, Column (B).
(13) Investments Other Securities EOY 12(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 12, Column (B).
(14) Investments Program Related EOY 13(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 13, Column (B).
(15) Intangible Assets EOY 14(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 14, Column (B).
(16) Other Assets EOY 15(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 15, Column(B).
(17) Total Assets BOY 16(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆
Enter the amount from Part X, Line 16, Column (A).
(18) Total Assets EOY 16(B) $ <ENTER>
MINUS (-)
Enter the amount from shown on Part X, Line 16, Column (B).
(19) Accounts Payable EOY 17(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 17, Column (B).
(20) Grants Payable EOY 18(B) $ <ENTER>
MINUS (-)
Enter the amount from on Part X, Line 18, Column (B).
(21) Deferred Revenue EOY 19(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 19, Column (B).
(22) Tax-Exempt Bond Liabilities EOY 20(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 20, Column (B).
(23) Escrow Liability EOY 21(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 21, Column (B).
(24) Payable to Current / Former Officers EOY 22(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 22, Column (B).
(25) Secured Mortgages / Notes EOY 23(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 23, Column (B).
(26) Unsecured Notes / Loans EOY 24(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 24, Column (B).
(27) Other Liabilities EOY 25(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 25, Column (B).
(28) Total Liabilities BOY 26(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆
Enter the amount from Part X, Line 26, Column (A).
(29) Total Liabilities EOY 26(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 26, Column (B).
(30) Unrestricted Net Assets EOY 27(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 27, Column (B).
(31) Temporarily Restricted Net Assets EOY 28(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 28, Column (B).
(32) Permanently Restricted Net Assets EOY 29(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 29, Column (B).
(33) Capital Stock / Trust EOY 30(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 30, Column (B).
(34) Paid-In / Capital Surplus EOY 31(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 31, Column (B).
(35) Retained Earnings, Endowment EOY 32(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 32, Column (B).
(36) Total Net Assets or Fund Balances BOY 33(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆
Enter the amount from Part X, Line 33, Column (A).
(37) Total Net Assets or Fund Balances EOY 33(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 33, Column (B).
(38) Total Liabilities / Net Assets Fund Balances EOY 34(B) $ <ENTER>
MINUS (-)
Enter the amount from Part X, Line 34, Column (B).

Form 990 - Schedule A - Section 11 (2014 and 2015)

3.24.12 - 12 SECTION 11
Source Document or Record: Forms 990 - Section 11, Schedule A (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter one of the following:
1 = Type I, 2 = Type II, 3 = Type III – Functionally integrated
4 = Type III – Non-functionally integrated Blank <ENTER>.
If more than one box is checked, enter the corresponding number for the first box checked.
(4) Type I, II or III Supporting Organization 11E <ENTER> Enter a "1" if the box is checked on Schedule A, Part I, Line 11e.
(5) Number of Supported Organizations 11F <ENTER> Enter the number from Line 11f.
(6) EIN A 11G(II)A <ENTER> Enter the EIN in Part I, Line 11g, Row A, Column (ii).
(7) Type of Org A 11G(III)A <ENTER> Enter the type of organization in Part I, Line 11g, Row A, Column (iii).
(8) Listed in Governing Doc A 11G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row A, Column (iv).
(9) Amount of Support A 11G(V) A $ <ENTER> Enter the amount on Part I, Line 11g, Row A, Column (v).
(10) EIN B 11G(II)B <ENTER> Enter the EIN in Part I, Line 11g, Row B, Column (ii).
(11) Type of Org B 11G(III)B <ENTER> Enter the type of organization in Part I, Line 11g, Row B, Column (iii).
(12) Listed in Governing Doc B 11G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row B, Column (iv).
(13) Amount of Support B 11G(V)B $ <ENTER> Enter the amount Part I, Line 11g, Row B, Column (v).
(14) EIN C 11G(II)C <ENTER> Enter the EIN in Part I, Line 11g, Row C, Column (ii).
(15) Type of Org C 11G(III)C <ENTER> Enter the type of organization in Part I, Line 11g, Row C, Column (iii).
(16) Listed in Governing Doc C 11G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row C, Column (iv).
(17) Amount of Support C 11G(V)C $ <ENTER> Enter the amount on Part I, Line 11g, Row C, Column (v).
(18) EIN D 11G(II)D <ENTER> Enter the EIN in Part I, Line 11g, Row D, Column (ii).
(19) Type of Org D 11G(III)D <ENTER> Enter the type of organization in Part I, Line 11g, Row D, Column (iii).
(20) Listed in Governing Doc D 11G(IV)D <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row D, Column (iv).
(21) Amount of Support D 11G(V)D $ <ENTER> Enter the amount on Part I, Line 11g, Row D, Column (v).
(22) EIN E 11G(II)E <ENTER> Enter the EIN in Part I, Line 11g, Row E, Column (ii).
(23) Type of Org E 11G(III)E <ENTER> Enter the type of organization in Part I, Line 11g, Row E, Column (iii).
(24) Listed in Governing Doc E 11G(IV)E <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row E, Column (iv).
(25) Amount of Support E 11G(V)E $ <ENTER> Enter the amount on Part I, Line 11g, Row E, Column (v).
(26) Total Number of Organizations 11G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 11h, Column (i), Total Line.
(27) Total GVTOT $ <ENTER> Enter the amount on Part I, Line 11g, Total, Column (v).
(28) Filling Field     Blank field generates on output.
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)
Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 18 is checked.

Form 990 - Form 990 Section 12 Schedule A (2014 and 2015)

3.24.12 - 13 SECTION 12
Source Document or Record: Forms 990 - Section 12, Schedule A (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)
Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)
Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)
Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-) ★★★★★★
Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Part V Data Present Indicator PTV <ENTER> Enter a 1 if data is present in Part V.

FORM 990 - Section 13, Schedules C & D (2014 and 2015)

3.24.12 - 14 SECTION 13
Source Document or Record: Forms 990 - Section 13, Schedules C & D (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "13" .
(2) Political Expenditures SCHIAL2 $ <ENTER>
MINUS (-)
Enter the amount from Schedule C, Part I-A, Line 2.
(3) Total Number at EOY SCHDL1(A) <ENTER> Enter the number shown on Schedule D, Part I, Line 1, Column (a).
(4) Contributions To L2(A) $ <ENTER>
MINUS (-)
Enter the amount from Schedule D, Part I, Line 2, Column (a).
(5) Grants From L3(A) $ <ENTER>
MINUS (-)
Enter the amount from Schedule D, Part I, Line 3, Column (a).
(6) Aggregate Value L4(A) $ <ENTER>
MINUS (-)
Enter the amount from Schedule D, Part I, Line 4, Column (a).
(7) Inform All Donors Checkbox L5 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 5.
(8) Inform All Grantees Checkbox L6 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 6.

Form 990 - Section 31, Schedule H (2014 and 2015)

3.24.12 - 15 SECTION 31
Source Document or Record: Form 990 - Section 31, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "31" .
(2) Financial Assistance L1A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1a: 1 = yes 2 = no.
(3) Written Policy L1B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1b: 1 = yes 2 = no.
(4) Best Describes L2 <ENTER> Enter the following:
1 = Applied Uniformly to all. 2 = Applied Uniformly to most.
3 = Generally tailored.
(5) FPG Used L3A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3a: 1 = yes 2 = no.
(6) FPG% L3A% <ENTER> Enter the following from Schedule H, Part I, Line 3a percent:
1 = 100%
2 = 150%
3 = 200%
4 = Other.
(7) FPG Discounted Care L3B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3b: 1 = yes
2 = no.
(8) FPG Discounted Care % L3B% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3b percent:
1 = 200%
2 = 250%
3 = 300%
4 = 350%
5 = 400%
6 = Other
If more than one box is checked, enter the number for the largest percent.
(9) Applied to Largest Number of Patients L4 <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 4: 1 = yes
2 = no.
(10) Budget Amounts for Free or Discounted L5A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5a: 1 = yes
2 = no.
(11) Exceed Budget Amount L5B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5b: 1 = yes
2 = no.
(12) Unable to Provide Free or Discounted Care L5C <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5c: 1 = yes
2 = no.
(13) Prepare A Community Benefit Report L6A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6a: 1 = yes
2 = no.
(14) Available to Public L6B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6b: 1 = yes
2 = no.
(15) Financial Assistance C L7AC $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (c).
(16) Financial D L7AD $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (d).
(17) Financial Assistance at Cost Net Community SCHH 7A(E) $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7a, Column (e).
(18) Financial Assistance at Cost Percent 7A(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7a, Column (f).
(19) Medicaid C L7BC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7b, Column (c).
(20) Medicaid D L7BD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7b, Column (d).
(21) Unreimbursed Medicaid Net Community 7B(E) $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7b, Column (e).
(22) Unreimbursed Medicaid Percent 7B(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7b, Column (f).
(23) Cost of Other Means Tested C L7CC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7c, Column (c).
(24) Cost of Other Means Tested D L7DC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7c, Column (d).
(25) Unreimbursed Costs - Other Net Community 7C(E) $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7c, Column (e).
(26) Unreimbursed Costs - Other Percent 7C(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7c, Column (f).
(27) Financial Assistance Total C 7DC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7d, Column (c).
(28) Financial Assistance Total D 7DD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7d, Column (d).
(29) Total Financial Assistance Net Community 7D(E) $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7d, Column (e).
(30) Total Financial Assistance Percent 7D(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7d, Column (f).

Form 990 - Section 32 Schedule H (2014 and 2015)

3.24.12 - 16 SECTION 32
Source Document or Record: Forms 990 - Section 32, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "32" .
(2) Community Health Improvement C 7EC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7e, Column (c).
(3) Community Health Improvement D 7ED $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7e, Column (d).
(4) Community Health Improvement E 7EE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7e, Column (e).
(5) Community Health Improvement Percent 7EF% <ENTER> Enter the percent from Schedule H, Part I, Line 7e, Column (f).
(6) Health Professions C 7FC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7f, Column (c).
(7) Health Professions D 7FD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7f, Column (d).
(8) Health Professions E 7FE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7f, Column (e).
(9) Health Professions Percent 7FF% <ENTER> Enter the percent from Schedule H, Part I, Line 7f, Column (f).
(10) Subsidized Health Services C 7GC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7g, Column (c).
(11) Subsidized Health Services D 7GD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7g, Column (d).
(12) Subsidized Health Services E 7GE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7g, Column (e).
(13) Subsidized Health Services Percent 7GF% <ENTER> Enter the percent from Schedule H, Part I, Line 7g, Column (f).
(14) Research C 7HC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7h, Column (c).
(15) Research D 7HD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7h, Column (d).
(16) Research E 7HE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7h, Column (e).
(17) Research F Percent 7HF% <ENTER> Enter the percent from Schedule H, Part I, Line 7h, Column (f).
(18) Cash & Contributions C 7IC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7i, Column (c).
(19) Cash & Contributions D 7ID $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7i, Column (d).
(20) Cash & Contributions E 7IE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7i, Column (e).
(21) Cash & Contributions % 7IF% <ENTER> Enter the percent from Schedule H, Part I, Line 7i, Column (f).
(22) Total Other Benefits C 7JC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7j, Column (c).
(23) Total Other Benefits D 7JD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7j, Column (d).
(24) Total Other Benefits E 7JE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7j, Column (e).
(25) Total Other Benefits Percent 7JF% <ENTER> Enter the percent from Schedule H, Part I, Line 7j, Column (f).
(26) Total C 7KC $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7k, Column (c).
(27) Total D 7KD $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7k, Column (d).
(28) Total E 7KE $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part I, Line 7k, Column (e).
(29) Total Percent 7KF% <ENTER> Enter the percent from Schedule H, Part I, Line 7k, Column (f).

Form 990 - Section 33 Schedule H (2014 and 2015)

3.24.12 - 17 SECTION 33
Source Document or Record: Forms 990 - Section 33, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "16" .
(2) Total Net Community PIII0E $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part II, Line 10, Column (e).
(3) Total Percent of Expense 10F% <ENTER> Enter the percent from Schedule H, Part II, Line 10 Column (f).
(4) Report Bad Debt Expense PT3L1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part III, Line 1.
(5) Bad Debt Expense Amount L2 $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part III, Line 2.
(6) Estimated Bad Debt Expense Amount L3 $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part III, Line 3.
(7) Revenue from Medicare L5 $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part III, Line 5.
(8) Medicare Allowable Costs L6 $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part III, Line 6.
(9) Medicare Surplus or Shortfall L7 $ <ENTER>
MINUS (-)
Enter the amount from Schedule H, Part III, Line 7.
(10) Costing Methodology or Source Code L8CD <ENTER> Enter the edited code from the right of the boxes from Schedule H, Part III, Line 8.
(11) Written Debt Collection Policy L9A <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9a.
(12) Collection Policy Contain Provision L9B <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9b.
(13) Part IV Code PIVCD <ENTER> Enter the edited digit from Schedule H, Part IV, right margin.
(14) Part V How Many Hospital Facilities Did Organization Operate SECATOP <ENTER> Enter the number shown in the Hospital Facilities area in the top left portion of Schedule H, Part V, Section A.
(15) Part V Section C Indicator Code SECCRM <ENTER> Enter the indicator code from Schedule H, Part V, Section C, right margin.
(16) Part V How Many Non-Hospital Facilities Did Organization Operate SECCTOP <ENTER> Enter the number from the non-hospital health care benefits line.
(17) Part V Section D Indicator Code SECTDRM <ENTER> Enter the edited code from Schedule H, Part V, Section D, right margin.

Form 990 - Section 34 Schedule H (2014 and 2015)

3.24.12 - 18 SECTION 34
Source Document or Record: Forms 990 - Section 34, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "34" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)
Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.

Form 990 - Section 35 Schedule H (2014 and 2015)

3.24.12 - 19 SECTION 35
Source Document or Record: Forms 990 - Section 35, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "35" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.

Form 990 - Section 36 Schedule H (2014 and 2015)

3.24.12 - 20 SECTION 36
Source Document or Record: Forms 990 - Section 36, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "36" .
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Filling Field     Generate blank field on output.
(6) Actions That Require Legal or Judicial Process 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(7) Other Similar Actions 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(8) Notified Financial Assistance Upon Admission 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Notified Financial Assistance Prior to Discharge 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Notified Financial Assistance in Bills 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Documented Its Determination 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Negotiated Commercial Insurance Rate 22A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Average of the Three Lowest Negotiated Commercial Insurance Rates 22B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Medicare Rate 22C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Other 22D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.

Form 990 - Section 37 Schedule H (2014 and 2015)

3.24.12 - 21 SECTION 37
Source Document or Record: Forms 990 - Section 37, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "37" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)
Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.

Form 990 - Section 38 Schedule H (2014 and 2015)

3.24.12 - 22 SECTION 38
Source Document or Record: Forms 990 - Section 38, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "38" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17 is checked.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate a blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.

Form 990 - Section 39 Schedule H (2014 and 2015)

3.24.12 - 23 SECTION 39
Source Document or Record: Forms 990 - Section 39, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "39" .