If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care. (Part I, line 3c)

DISCUSSION: Many hospitals supplement eligibility criteria based on FPG to provide financial assistance to needy patients who might not qualify at, or who might qualify for, a lower amount of financial assistance under its FPG criteria. Additional criteria for providing financial assistance beyond FPG may include asset tests, catastrophic event allowances or other special circumstances allowances.

NARRATIVE REQUIRED: Yes. Part VI, line 1, if the filing organization does not use FPG as the basis for determining eligibility for financial assistance, you must describe the "income-based" criteria used and whether the organization uses an asset test or other means test or threshold

INSTRUCTIONS: Click here for the applicable IRS Schedule H instructions.

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