Form 990 (Schedule H) — Hospitals

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f990sh.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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7 Financial Assistance and Certain Other Community Benefits at Cost

(b) Persons served (optional)

(c) Total community benefit expense

(d) Direct offsetting revenue

(e) Net community benefit expense

(f) Percent of total expense

Financial Assistance and Means-Tested Government Programs

a Financial assistance at cost (from

Worksheet 1) . . . . . . . . .

b Medicaid (from Worksheet 3, column a) c Costs of other means-tested government programs (from Worksheet 3, column b) d Total. Financial assistance and means-tested government programs .

Other Benefits e Community health improvement services and community benefit operations (from Worksheet 4) f Health professions education (from Worksheet 5) . . . . . . . . g Subsidized health services (from

Worksheet 6) . . . . . . . . h Research (from Worksheet 7) i Cash and in-kind contributions for community benefit (from Worksheet 8)

j Total. Other benefits . . . . . . k Total. Add lines 7d and 7j . . . .

(a) Number of

activities or programs (optional)

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2025 Created 8/13/25

Schedule H (Form 990) 2025 Page 2 Part II Community Building Activities. Complete this table if the organization conducted any community building activities during the tax year and describe in Part VI how its community building activities promoted the health of the communities it serves.

(a) Name of entity (b) Description of primary

activity of entity

(c) Organization’s

profit % or stock

ownership %

(d) Officers’, directors’, trustees’,

or key employees’

profit % or stock

(e) Physicians’ profit % or stock

ownership %

ownership %

1 2 3 4 5 6 7 8 9 10 11 12 13

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 4 Part V Facility Information (continued) Section B. Facility Policies and Practices

(complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

**1 **
Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the
current tax year or the immediately preceding tax year?
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**2 **
Was the hospital facility 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 of the acquisition in Section C
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**3 **
During the tax year or either of the 2 immediately preceding tax years, did the hospital facility conduct a
CHNA? If “No,” skip to line 12 .
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If “Yes,” indicate what the CHNA report describes (check all that apply):
a
A definition of the community served by the hospital facility
**b **
Demographics of the community
c
Existing health care facilities and resources within the community that are available to respond to the
health needs of the community
d
How data was obtained
e
The significant health needs of the community
f
Primary and chronic disease needs and other health issues of uninsured persons, low-income persons,
and minority groups
g
The process for identifying and prioritizing community health needs and services to meet the
community health needs
h
The process for consulting with persons representing the community’s interests
i
The impact of any actions taken to address the significant health needs identified in the hospital
facility’s prior CHNA
j
Other (describe in Section C)
**4 **
Indicate the tax year the hospital facility last conducted a CHNA: 20
**5 **


In conducting its most recent CHNA, did the hospital facility 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? If “Yes,” describe in Section C how the hospital facility took into account input from
persons who represent the community, and identify the persons the hospital facility consulted
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**6 **

**a **Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other
hospital facilities in Section C
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**b **

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?
If “Yes,” list the other organizations in Section C_.
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7
Did the hospital facility make its CHNA report widely available to the public?
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If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
Hospital facility’s website (list url):
**b **
Other website (list url):
c
Made a paper copy available for public inspection without charge at the hospital facility
d
Other (describe in Section C)
**8 **

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If “No,” skip to line 11
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**9 **
Indicate the tax year the hospital facility last adopted an implementation strategy: 20
10
Is the hospital facility’s most recently adopted implementation strategy posted on a website?.
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a
If “Yes,” list url:
**b **If “No,” is the hospital facility’s most recently adopted implementation strategy attached to this return?.
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11

Describe in Section C how the hospital facility is addressing the significant needs identified in its most
recently conducted CHNA and any such needs that are not being addressed together with the reasons why
such needs are not being addressed.
12 aDid the organization incur an excise tax under section 4959 for the hospital facility’s failure to conduct a
CHNA as required by section 501(r)(3)?.
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**b **If “Yes” to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?.
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**c **If “Yes” to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form
4720 for all of its hospital facilities?$

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Name of hospital facility or letter of facility reporting group: Line number of hospital facility or line numbers of hospital facilities in a facility reporting group (from Part V, Section A):

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 5 Part V Facility Information (continued) Financial Assistance Policy (FAP)

Name of hospital facility or letter of facility reporting group:

|Did the hospital facility have in place during the tax year a written FAP that:
13
Explained eligibility criteria for financial assistance and whether such assistance included free or discounted care?
13
If “Yes,” indicate the eligibility criteria explained in the FAP:
**a **
FPG, with FPG family income limit for eligibility for free care of
and FPG family income limit for eligibility for discounted care of
%
%
**b **
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance status
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
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15
Explained the method for applying for financial assistance?
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15
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions)
explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of their
application
b
Described the supporting documentation the hospital facility may require an individual to submit as part
of their application
c
Provided the contact information of hospital facility staff who can provide an individual with information
about the FAP and FAP application process
d
Provided the contact information of nonprofit organizations or government agencies that may be
sources of assistance with FAP applications
e
Other (describe in Section C)
16
Was widely publicized within the community served by the hospital facility? .
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16
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and
by mail)
e
The FAP application form was available upon request and without charge (in public locations in the
hospital facility and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public
locations in the hospital facility and by mail)
**g **
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
h
Notified members of the community who are most likely to require financial assistance about availability
of the FAP
i
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
j
Other (describe in Section C)|13|||

|Did the hospital facility have in place during the tax year a written FAP that:
13
Explained eligibility criteria for financial assistance and whether such assistance included free or discounted care?
13
If “Yes,” indicate the eligibility criteria explained in the FAP:
**a **
FPG, with FPG family income limit for eligibility for free care of
and FPG family income limit for eligibility for discounted care of
%
%
**b **
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance status
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
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15
Explained the method for applying for financial assistance?
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15
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions)
explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of their
application
b
Described the supporting documentation the hospital facility may require an individual to submit as part
of their application
c
Provided the contact information of hospital facility staff who can provide an individual with information
about the FAP and FAP application process
d
Provided the contact information of nonprofit organizations or government agencies that may be
sources of assistance with FAP applications
e
Other (describe in Section C)
16
Was widely publicized within the community served by the hospital facility? .
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16
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and
by mail)
e
The FAP application form was available upon request and without charge (in public locations in the
hospital facility and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public
locations in the hospital facility and by mail)
**g **
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
h
Notified members of the community who are most likely to require financial assistance about availability
of the FAP
i
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
j
Other (describe in Section C)|14|||

|Did the hospital facility have in place during the tax year a written FAP that:
13
Explained eligibility criteria for financial assistance and whether such assistance included free or discounted care?
13
If “Yes,” indicate the eligibility criteria explained in the FAP:
**a **
FPG, with FPG family income limit for eligibility for free care of
and FPG family income limit for eligibility for discounted care of
%
%
**b **
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance status
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
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15
Explained the method for applying for financial assistance?
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15
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions)
explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of their
application
b
Described the supporting documentation the hospital facility may require an individual to submit as part
of their application
c
Provided the contact information of hospital facility staff who can provide an individual with information
about the FAP and FAP application process
d
Provided the contact information of nonprofit organizations or government agencies that may be
sources of assistance with FAP applications
e
Other (describe in Section C)
16
Was widely publicized within the community served by the hospital facility? .
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16
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and
by mail)
e
The FAP application form was available upon request and without charge (in public locations in the
hospital facility and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public
locations in the hospital facility and by mail)
**g **
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
h
Notified members of the community who are most likely to require financial assistance about availability
of the FAP
i
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
j
Other (describe in Section C)|15|||

|Did the hospital facility have in place during the tax year a written FAP that:
13
Explained eligibility criteria for financial assistance and whether such assistance included free or discounted care?
13
If “Yes,” indicate the eligibility criteria explained in the FAP:
**a **
FPG, with FPG family income limit for eligibility for free care of
and FPG family income limit for eligibility for discounted care of
%
%
**b **
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance status
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
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14
15
Explained the method for applying for financial assistance?
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15
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions)
explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of their
application
b
Described the supporting documentation the hospital facility may require an individual to submit as part
of their application
c
Provided the contact information of hospital facility staff who can provide an individual with information
about the FAP and FAP application process
d
Provided the contact information of nonprofit organizations or government agencies that may be
sources of assistance with FAP applications
e
Other (describe in Section C)
16
Was widely publicized within the community served by the hospital facility? .
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16
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and
by mail)
e
The FAP application form was available upon request and without charge (in public locations in the
hospital facility and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public
locations in the hospital facility and by mail)
**g **
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
h
Notified members of the community who are most likely to require financial assistance about availability
of the FAP
i
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
j
Other (describe in Section C)||||

|Did the hospital facility have in place during the tax year a written FAP that:
13
Explained eligibility criteria for financial assistance and whether such assistance included free or discounted care?
13
If “Yes,” indicate the eligibility criteria explained in the FAP:
**a **
FPG, with FPG family income limit for eligibility for free care of
and FPG family income limit for eligibility for discounted care of
%
%
**b **
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance status
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
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14
15
Explained the method for applying for financial assistance?
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15
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions)
explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of their
application
b
Described the supporting documentation the hospital facility may require an individual to submit as part
of their application
c
Provided the contact information of hospital facility staff who can provide an individual with information
about the FAP and FAP application process
d
Provided the contact information of nonprofit organizations or government agencies that may be
sources of assistance with FAP applications
e
Other (describe in Section C)
16
Was widely publicized within the community served by the hospital facility? .
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16
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and
by mail)
e
The FAP application form was available upon request and without charge (in public locations in the
hospital facility and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public
locations in the hospital facility and by mail)
**g **
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
h
Notified members of the community who are most likely to require financial assistance about availability
of the FAP
i
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
j
Other (describe in Section C)|16|||

|Did the hospital facility have in place during the tax year a written FAP that:
13
Explained eligibility criteria for financial assistance and whether such assistance included free or discounted care?
13
If “Yes,” indicate the eligibility criteria explained in the FAP:
**a **
FPG, with FPG family income limit for eligibility for free care of
and FPG family income limit for eligibility for discounted care of
%
%
**b **
Income level other than FPG (describe in Section C)
c
Asset level
d
Medical indigency
e
Insurance status
f
Underinsurance status
g
Residency
h
Other (describe in Section C)
14
Explained the basis for calculating amounts charged to patients?
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.
.
.
.
.
.
.
.
.
.
.
.
.
14
15
Explained the method for applying for financial assistance?
.
.
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.
.
.
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.
.
.
.
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15
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions)
explained the method for applying for financial assistance (check all that apply):
a
Described the information the hospital facility may require an individual to provide as part of their
application
b
Described the supporting documentation the hospital facility may require an individual to submit as part
of their application
c
Provided the contact information of hospital facility staff who can provide an individual with information
about the FAP and FAP application process
d
Provided the contact information of nonprofit organizations or government agencies that may be
sources of assistance with FAP applications
e
Other (describe in Section C)
16
Was widely publicized within the community served by the hospital facility? .
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.
.
.
.
.
.
.
.
.
16
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
The FAP was widely available on a website (list url):
b
The FAP application form was widely available on a website (list url):
c
A plain language summary of the FAP was widely available on a website (list url):
d
The FAP was available upon request and without charge (in public locations in the hospital facility and
by mail)
e
The FAP application form was available upon request and without charge (in public locations in the
hospital facility and by mail)
f
A plain language summary of the FAP was available upon request and without charge (in public
locations in the hospital facility and by mail)
**g **
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
h
Notified members of the community who are most likely to require financial assistance about availability
of the FAP
i
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
j
Other (describe in Section C)||||

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 6 Part V Facility Information (continued) Billing and Collections Name of hospital facility or letter of facility reporting group:

facility’s FAP:

a Reporting to credit agency(ies) b Selling an individual’s debt to another party

d Actions that require a legal or judicial process e Other similar actions (describe in Section C)

a Reporting to credit agency(ies) b Selling an individual’s debt to another party

d Actions that require a legal or judicial process e Other similar actions (describe in Section C)

not checked) on line 19 (check all that apply):

a Provided a written notice about upcoming extraordinary collection actions (ECAs) and a plain language summary of the FAP at least 30 days before initiating those ECAs (if not, describe in Section C) b Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in Section C) c Processed incomplete and complete FAP applications (if not, describe in Section C) d Made presumptive eligibility determinations (if not, describe in Section C) e Other (describe in Section C) f None of these efforts were made Policy Relating to Emergency Medical Care

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 7 Part V Facility Information (continued) Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals) Name of hospital facility or letter of facility reporting group:

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 8 Part V Facility Information (continued) Section C. Supplemental Information for Part V, Section B. Provide 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.

Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 9 Part V Facility Information (continued) Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest)

How many non-hospital health care facilities did the organization operate during the tax year?

Name and address Type of facility (describe)

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Schedule H (Form 990) 2025

Schedule H (Form 990) 2025 Page 10 Part VI Supplemental Information

Provide the following information.

1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II, and Part III, lines 2, 3, 4, 8, and 9b. 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.

3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons

who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s FAP. 4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.

5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or

other health care facilities further its exempt purpose by promoting the health of the community (for example, open medical staff, community board, use of surplus funds, etc.). 6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served. 7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Schedule H (Form 990) 2025