Subsidized Health Services (Part I, line 7g)

This question would benefit from allowing a narrative response in Part VI beyond that currently allowed.

DISCUSSION: In some cases, the percentage of these numbers may be small, as many of these services may be captured elsewhere on the Schedule H. It is suggested that you describe these services in Part VI, including what is being provided to the community.

NARRATIVE REQUIRED: Yes, if applicable. Part VI, line 1, to describe whether the organization included as subsidized health services any costs attributable to a physician clinic, and report such costs the organization included.

SAMPLE NARRATIVE:

Subsidized health services reported in Section 7g include details from two different community benefit programs of hospital, namely VNA of Rural County, a licensed home health provider and Primary Care Always, a licensed community clinic. The costs attributable to Primary Care Always include expenses of $XXXX attributable to a physician clinic. Both programs are operated despite financial losses to the organization for at least the past five years. VNA of Rural County is the only home health agency in the county. Primary Care Always is one of only two primary care clinics in Rural County charging on a sliding scale based upon the patient's ability to pay.

Worksheet 6 (Click here for Worksheet 6 instructions)

			(A) Total subsidized health service program	(B) Bad debt	(C) Medicaid and other means-tested government programs	(D) Charity care	(E) Totals (subtract columns (B), (C), and (D) from column (A))
Program Name:__________________
1.	Gross patient charges from program(s)	1.	_________	_________	_________	_________	_________
Total community benefit expense
2.	Ratio of patient cost to charges (from Worksheet 2, if used)	2.	_______%	_______%	_______%	_______%	_______%
3.	Cost (multiply line 1 by line 2, or obtain from cost accounting; enter column (E) on Part I, line 7g, column (c))	3.	_________	_________	_________	_________	_________
Direct offsetting revenue
4.	Net patient service revenue	4.	_________	_________	_________	_________	_________
5.	Other revenue	5.	_________	_________	_________	_________	_________
6.	Total direct offsetting revenue (add lines 4 and 5; enter column (E) on Part I, line 7g, column (d))	6.	_________	_________	_________	_________	_________
7.	Net community benefit expense (subtract line 6 from line 3; enter column (E) on Part I, line 7g, column (e))	7.	_________	_________	_________	_________	_________
8.	Total expense (enter amount from Form 990, Part IX, line 25, column (A), and include the organization's share of joint venture expenses)	8.					$________
9.	Percent of total expense (line 7, column (E) divided by line 8; enter on Part I, line 7g, column (f))	9.					_______%

Subsidized Health Services (Part I, line 7g)

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