SOI 2012 990 Hospital Facilities

EINEmployer Identification NumberEmployer identification number of Hospital (Page 1, Line D)Beginning, sec.D
FisYrFiscal yearFiscal year (ending year)
NAMEHospital nameName of Organization filing Form 990 (Form 990, Page 1, Line C)Beginning, sec.C1
STATEStateTwo-letter state abbreviation of Organization filing Form 990 (Form 990, Page 1, Line C(3))Beginning, sec.C3
zip5Zip code, 5 digitsFirst 5 digits of zip code of Organization filing Form 990 (Form 990, Page 1, Line C(4))Beginning, sec.C3
SUBSECCDSubsection codeHospital IRS subsection code, e.g. 03=501(c)(3), etc. (Page 1, Line I)
hospfclt_cntNumber of facilitiesNumber of hospital facilities (number of rows in Sch H - Part V sub-table)
hrowRow numberRow Identification Number
fclt_numLine Number of Hospital FacilityLine Number of Hospital Facility (from Sched H, Part V, Section A)
fclty_nameFacility nameName of facility
fclty_zipFacility zipZip code of facility
type_of_fcltyFacility typeType of facility
chna_cndctConduct a needs assessment?Conduct a needs assessment? (Sch H, Part V, Line 1)
chna_descrWhat the needs assessment describesWhat the needs assessment describes (Sch H, Part V, Line 1a-1j)
nds_assmnt_cndctYear needs assessment conductedYear needs assessment conducted (Sch H, Part V, Line 2)
tk_into_acctTake into account input from community?Take into account input from community? (Sch H, Part V, Line 3)
oth_fcltConducted with other facilities?Conducted with other facilities? (Sch H, Part V, Line 4)
chna_wdly_avlblNeeds assessment widely available to public?Needs assessment widely available to public? (Sch H, Part V, Line 5)
chna_publicHow needs assessment was made available to publicHow needs assessment was made available to public (Sch H, Part V, Line 5a-5c)
nds_addrssdWhich needs raised by assessment were addressed?Which needs raised by assessment were addressed? (Sch H, Part V, Line 6a-6i)
all_nds_addrssdAll needs addressed?All needs addressed? (Sch H, Part V, Line 7)
org_incr_exc_txIncur 4959 excise tax?Incur 4959 excise tax for failure to conduct 501(r)(3) CHNA? (Sch H, Part V, Line 8a)
fil_4720_rprt_exc_txFile 4720 for excise tax?If Yes to line 8a, File 4720 for excise tax? (Sch H, Part V, Line 8b)
exc_rprt_4720_all_amtAmount of excise taxIf Yes to line 8b, Amount of excise tax (Sch H, Part V, Line 8c)
elgbl_crtr_explndExplain eligibility crieria for assistance?Explain eligibility crieria for assistance? (Sch H, Part V, Line 9)
uss_fpg_frUsed FPG for free care?Used FPG for free care? (Sch H, Part V, Line 10)
fpg_fr_pctFPG fmaily income limit for free careFPG fmaily income limit for free care (Sch H, Part V, Line 10(yes))
uss_fpg_dscntdUsed FPG for discounted care?Used FPG for discounted care? (Sch H, Part V, Line 11)
fpg_dscnt_pctFPG fmaily income limit for discounted careFPG fmaily income limit for discounted care (Sch H, Part V, Line 11(yes))
explns_bssExplain basis for calculating charges?Explain basis for calculating charges? (Sch H, Part V, Line 12)
bss_for_amtsFactors used to calculate chargesFactors used to calculate charges (Sch H, Part V, Line 12a-12h)
explns_applctn_mthdExplain method for applying for assistance?Explain method for applying for assistance? (Sch H, Part V, Line 13)
inclds_pblcty_msrsInclude measures to publicize assistance policyInclude measures to publicize assistance policy (Sch H, Part V, Line 14)
how_msrs_pblczdHow assistance policy was publicizedHow assistance policy was publicized (Sch H, Part V, Line 14a-14g)
actns_nnpymntWritten policy regarding non-payment?Written policy regarding non-payment? (Sch H, Part V, Line 15)
nnpymnt_actn_mthdsNonpayment policy actionsNonpayment policy actions (Sch H, Part V, Line 16a-16e)
coll_actyActions related to collection?Actions related to collection? (Sch H, Part V, Line 17)
coll_acty_mthdsWhich collection activitiesWhich collection activities (Sch H, Part V, Line 17a-17e)
pre_coll_actyEfforts before collection activitiesEfforts before collection activities (Sch H, Part V, Line 18a-18e)
nndscrm_emrgncy_cr_plcyNon-discriminatory emergency room policy?Non-discriminatory emergency room policy? (Sch H, Part V, Line 19)
rsn_no_nndscrm_plcyWhy no non-discriminatory ER policyWhy no non-discriminatory ER policy (Sch H, Part V, Line 19a-19d)
max_amt_dtrmndHow maximum charge amounts determinedHow maximum charge amounts determined (Sch H, Part V, Line 20a-20d)
amt_gnrlly_blldDid hospital charge more than amounts billed?Did hospital charge more than amounts billed? (Sch H, Part V, Line 21)
gr_chrgCharge amounts equal to gross chrage?Charge amounts equal to gross chrage? (Sch H, Part V, Line 22)
SCPLS.C./Cycle/Page/L.C.Service Center Cycle Page Line (unique identifier assigned by the IRS - used to match primary SOI record with related sub-table records)