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IRS990ScheduleH.xsl
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<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE xsl:stylesheet [<!ENTITY nbsp " ">]>
<!-- 06/27/2012 - Modified per UWR #58215 - Jeremy Nichols -->
<!-- 09/21/2012 - Modified per defect #33278 - Jeremy Nichols -->
<!-- 09/25/2012 - Modified per defect #33412 - Jeremy Nichols -->
<!-- 09/25/2012 - Modified per defect #33509 - Jeremy Nichols -->
<!-- 10/04/2012 - Modified per KISAMS #IM00703540 - Jeremy Nichols -->
<xsl:stylesheet xmlns:xsl="http://www.w3.org/1999/XSL/Transform" version="1.0">
<xsl:include href="PopulateTemplate.xsl"/>
<xsl:include href="CommonPathRef.xsl"/>
<xsl:include href="AddHeader.xsl"/>
<xsl:include href="AddOnTable.xsl"/>
<xsl:include href="IRS990ScheduleHStyle.xsl"/>
<xsl:output method="html" indent="yes"/>
<xsl:strip-space elements="*"/>
<xsl:param name="Form990ScheduleHData" select="$RtnDoc/IRS990ScheduleH"/>
<xsl:template match="/">
<html>
<head>
<title>
<xsl:call-template name="FormTitle">
<xsl:with-param name="RootElement" select="local-name($Form990ScheduleHData)"/>
</xsl:call-template>
</title>
<!-- No Browser Caching -->
<meta http-equiv="Pragma" content="no-cache"/>
<meta http-equiv="Cache-Control" content="no-cache"/>
<meta http-equiv="Expires" content="0"/>
<!-- No Proxy Caching -->
<meta http-equiv="Cache-Control" content="private"/>
<!-- Define Character Set -->
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1"/>
<meta name="Description" content="IRS990ScheduleH"/>
<script language="JavaScript" src="{$ScriptPath}/FormDisplay.js" type="text/javascript"/>
<script language="JavaScript" type="text/javascript" >
var intCount;
intCount = 1;
function nextPage()
{
intCount = intCount + 1;
document.write(intCount);
return true;
}
</script>
<xsl:call-template name="InitJS"/>
<style type="text/css">
<xsl:if test="not($Print) or $Print=''">
<xsl:call-template name="IRS990ScheduleHStyle"/>
<xsl:call-template name="AddOnStyle"/>
</xsl:if>
</style>
<xsl:call-template name="GlobalStylesForm"/>
</head>
<body class="styBodyClass">
<form name="IRS990ScheduleH">
<xsl:call-template name="DocumentHeader"/>
<div class="styTBB" style="width:187mm;">
<div class="styFNBox" style="width:36mm;height:4mm;">
<div style="padding-top:1mm;">
<span class="styMainTitle" style="font-size:10pt">SCHEDULE H <span style="width:5mm;"/>(Form 990)</span>
</div>
<div style="padding-top:3mm;padding-bottom:.75mm;">
<span class="styAgency" style="width:30mm">Department of the Treasury</span>
<br/>
<span class="styAgency" style="width:30mm">Internal Revenue Service</span>
</div>
</div>
<div class="styFTBox" style="width:120mm;">
<div class="styMainTitle" style="padding-top:1mm;font-size:14pt;">Hospitals</div>
<div class="styFBT" style="padding-top:1mm;">
<img src="{$ImagePath}/990SchH_Bullet_Md.gif" alt="MediumBullet"/>
Complete if the organization answered "Yes" to Form 990, Part IV, question 20.<br/>
<img src="{$ImagePath}/990SchH_Bullet_Md.gif" alt="MediumBullet"/> Attach to Form 990.
<img src="{$ImagePath}/990SchH_Bullet_Md.gif" alt="MediumBullet"/> See separate instructions.
</div>
</div>
<div class="styTYBox" style="width:30.5mm;">
<div class="styOMB">OMB No. 1545-0047</div>
<div class="styTaxYear" style="height:4mm;padding-top:0mm;padding-bottom:0mm;">
20<span class="styTYColor">12</span>
</div>
<div class="styPartName" style="font-size:6.5pt;width:30.5mm;padding-top:0mm;text-align:left;padding-left:5mm;">Open to Public Inspection</div>
</div>
</div>
<!-- Begin Name and Identifying Number Section-->
<div class="styBB" style="width:187mm;clear:both;font-family:verdana;font-size:7pt;">
<div class="styFNBox" style="width:134mm;height:8mm;">
<span class="styBoldText">Name of the organization</span>
<br/>
<div style="font-family:verdana;font-size:6pt;height:6.25mm">
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">BusinessNameLine1</xsl:with-param>
</xsl:call-template>
<br/>
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">BusinessNameLine2</xsl:with-param>
</xsl:call-template>
</div>
</div>
<div class="styGenericDiv" style="width:52mm;height:4mm;padding-left:1mm;">
<span class="styBoldText">Employer identification number</span>
<br/>
<br/>
<xsl:call-template name="PopulateReturnHeaderFiler">
<xsl:with-param name="TargetNode">EIN</xsl:with-param>
</xsl:call-template>
</div>
</div>
<!-- End Name and Identifying Number Section-->
<div class="styBB" style="width: 187mm;">
<div class="styPartName" style="width: 15mm; ">Part I</div>
<div class="styPartDesc" style=" width: 167mm">Financial Assistance and Certain Other Community Benefits at Cost</div>
</div>
<!-- line 1 Yes - No boxes -->
<div class="IRS990ScheduleH_LineContainer" style="width:187mm;height:4mm;padding-top:0mm;">
<div class="IRS990ScheduleH_LineIndex" style="border-top-width:0px;height:4mm;"/>
<div class="IRS990ScheduleH_LineDesc" style="width:155mm;height:4mm;border-right-width:0px;border-top-width:0px;"/>
<div class="IRS990ScheduleH_LineIndexMid" style="border-top-width:0px;width:8mm;padding-top:.25mm;border-bottom-width:0px;height:4mm;"/>
<div class="IRS990ScheduleH_LineIndexMid" style="border-top-width:0px;width:8mm;height:4mm;padding-top:.25mm;border-bottom-width:0px;font-size:7pt;">Yes</div>
<div class="IRS990ScheduleH_LineIndexMid" style="border-right-width:0px;width:8mm;height:4mm;padding-top:.25mm;border-bottom-width:0px;font-size:7pt;border-top-width:0px;">No</div>
</div>
<!-- Line 1a -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;">1a</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.25mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a
<span style="width:1.5mm;"/>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">...</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;font-size:7pt;border-top-width:1px;border-bottom-width:1px;">
<b>1a</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;border-bottom-width:1px;padding-top:1mm;font-size:7pt;border-top-width:1px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCarePolicy"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;border-top-width:1px;font-size:7pt;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCarePolicy"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 1b -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:4mm;">b</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.25mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
If "Yes," was it a written policy? <span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">.......................</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;border-bottom-width:1px;">
<b>1b</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;border-bottom-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/WrittenPolicy"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;border-top-width:0px;font-size:7pt;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/WrittenPolicy"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 2 -->
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;">2</div>
<div class="styLNDesc" style="width:155mm;height:8mm;">
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
</div>
<div class="styShadingCell" style="width:8mm;height:8mm;"/>
<div class="styShadingCell" style="width:8mm;height:8mm;"/>
<div class="styShadingCell" style="width:8mm;height:8mm;"/>
</div>
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;"/>
<div class="styLNDesc" style="width:155mm;height:5mm;">
<span style="width:75mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/PolicyAppliedToAllHospitals"/>
<xsl:with-param name="BackupName">Form990ScheduleHPolicyAppliedToAllHospitals</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/PolicyAppliedToAllHospitals"/>
<xsl:with-param name="BackupName">Form990ScheduleHPolicyAppliedToAllHospitals</xsl:with-param>
</xsl:call-template>
Applied uniformly to all hospital facilities
</label>
</span>
<span style="width:75mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/PolicyAppliedToMostHospitals"/>
<xsl:with-param name="BackupName">Form990ScheduleHPolicyAppliedToMostHospitals</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/PolicyAppliedToMostHospitals"/>
<xsl:with-param name="BackupName">Form990ScheduleHPolicyAppliedToMostHospitals</xsl:with-param>
</xsl:call-template>
Applied uniformly to most hospital facilities
</label>
</span>
<span style="width:75mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/PolicyTailoredToIndHospitals"/>
<xsl:with-param name="BackupName">Form990ScheduleHPolicyTailoredToIndHospitals</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/PolicyTailoredToIndHospitals"/>
<xsl:with-param name="BackupName">Form990ScheduleHPolicyTailoredToIndHospitals</xsl:with-param>
</xsl:call-template>
Generally tailored to individual hospital facilities
</label>
</span>
</div>
<div class="styShadingCell" style="width:8mm;height:10mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:10mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:10mm;padding-bottom:1mm;border-top-width:0px;"/>
</div>
<!-- Line 3 -->
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;">3</div>
<div class="styLNDesc" style="width:155mm;height:6mm;">
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
</div>
<div class="styShadingCell" style="width:8mm;height:8mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:8mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:8mm;padding-bottom:1mm;border-top-width:0px;"/>
</div>
<!-- Line 3a -->
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:3mm;padding-left:4mm;padding-top:1mm;">a</div>
<div class="styLNDesc" style="width:155mm;height:3mm;padding-top:1mm;padding-bottom:0mm;font-size:6.5pt;">
<span class="styNormalText">
Did the organization use Federal Poverty Guidelines <span style="font-size:6pt;">(FPG)</span> as a factor in determining eligibility for providing <i>free</i> care?
</span>
</div>
<div class="styShadingCell" style="width:8mm;height:4mm;padding-bottom:1.5mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:4mm;padding-bottom:1.5mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:4mm;padding-bottom:1.5mm;border-top-width:0px;"/>
</div>
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:1mm;padding-top:1mm;"/>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:0mm;font-size:7pt;">
<span class="styNormalText">
If "Yes," indicate which of the following was the FPG family income limit for eligibility for <i>free</i> care: <span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;"/>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:5mm;width:8.25mm;border-left-width:1px;padding-top:1mm;border-bottom-width:1px;">
<b>3a</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:5mm;padding-top:1mm;border-left-width:0px;border-bottom-width:1px;">
<span style="font-weight: normal;padding-top:1mm;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/FPGReferenceFreeCare"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:5mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/FPGReferenceFreeCare"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 3a Checkboxes -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:5mm;"/>
<div class="styLNDesc" style="width:155mm;height:5mm;">
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent100"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent100</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent100"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent100</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
100%
</label>
</span>
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent150"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent150</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent150"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent150</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
150%
</label>
</span>
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent200"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent200</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent200"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent200</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
200%
</label>
</span>
<span style="width:82mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/OtherPercentage/Other"/>
<xsl:with-param name="BackupName">Form990ScheduleHOtherPercentage</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/OtherPercentage/Other"/>
<xsl:with-param name="BackupName">Form990ScheduleHOtherPercentage</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
Other
<span class="styIRS990ScheduleHUnderlinedText" style="width:64mm;text-align: right">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/OtherPercentage/FreeOtherPercentage"/>
</xsl:call-template>
</span>
<span style="width: 1mm"></span>
</label>
<xsl:if test="(count($Form990ScheduleHData/OtherPercentage/FreeOtherPercentage)=0) ">
%
</xsl:if>
</span>
</div>
<div class="styShadingCell" style="width:8mm;height:5mm;padding-top:1mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:5mm;padding-bottom:1mm;border-top-width:0px;padding-top:1mm;"/>
<div class="styShadingCell" style="width:8mm;height:5mm;padding-bottom:1mm;border-top-width:0px;padding-top:1mm;"/>
</div>
<!-- Line 3b -->
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:4mm;padding-top:1mm;">b</div>
<div class="styLNDesc" style="width:155mm;height:3mm;padding-top:1mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
Did the organization use FPG as a factor in determining eligibility for providing <i>discounted</i> care? If "Yes," indicate
</span>
</div>
<div class="styShadingCell" style="width:8mm;height:5mm;padding-top:1mm;padding-bottom:0mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:5mm;padding-bottom:0mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:5mm;padding-bottom:1mm;border-top-width:0px;"/>
</div>
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:3mm;padding-top:1mm;"/>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:0mm;padding-bottom:0mm;">
<span class="styNormalText">which of the following was the family income limit for eligibility for discounted care: </span>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">.........</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:5mm;width:8.25mm;border-left-width:1px;padding-top:1mm;padding-bottom:0mm;border-bottom-width:1px;">
<b>3b</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:5mm;padding-top:1mm;border-left-width:0px;border-bottom-width:1px;">
<span style="font-weight: normal;padding-top:1mm;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/FPGReferenceDiscountedCare"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:5mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/FPGReferenceDiscountedCare"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 3b Checkboxes -->
<div style="width:187mm;height:3mm;">
<div class="styLNLeftNumBox" style="height:3mm;"/>
<div class="styLNDesc" style="width:155mm;height:3mm;padding-bottom:1mm;">
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent200D"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent200D</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent200D"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent200D</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
200%
</label>
</span>
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent250"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent250</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent250"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent250</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
250%
</label>
</span>
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent300"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent300</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent300"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent300</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
300%
</label>
</span>
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent350"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent350</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent350"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent350</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
350%
</label>
</span>
<span style="width:14.5mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent400"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent400</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/Pcent400"/>
<xsl:with-param name="BackupName">Form990ScheduleHPcent400</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
400%
</label>
</span>
<span style="width:82mm;">
<input type="checkbox" class="IRS990ScheduleH_Checkbox">
<xsl:call-template name="PopulateCheckbox">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/DiscountedOther/Other"/>
<xsl:with-param name="BackupName">Form990ScheduleHDiscountedOther</xsl:with-param>
</xsl:call-template>
</input>
<label>
<xsl:call-template name="PopulateLabel">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/DiscountedOther/Other"/>
<xsl:with-param name="BackupName">Form990ScheduleHDiscountedOther</xsl:with-param>
</xsl:call-template>
<span style="width:0.5mm;"/>
Other
<span class="styIRS990ScheduleHUnderlinedBox" style="font-size: 7pt;width:64mm;text-align: right">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/DiscountedOther/DiscountedOtherPercentage"/>
</xsl:call-template>
</span>
<span style="width: 1mm"></span>
</label>
<xsl:if test="(count($Form990ScheduleHData/DiscountedOther/DiscountedOtherPercentage)=0) ">
%
</xsl:if>
</span>
</div>
<div class="styShadingCell" style="width:8mm;height:6mm;padding-top:0mm;padding-bottom:0mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:6mm;padding-bottom:0mm;padding-top:0mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:6mm;padding-bottom:0mm;padding-top:0mm;border-top-width:0px;"/>
</div>
<!-- Line 3c -->
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:4mm;padding-top:1mm;">c</div>
<div class="styLNDesc" style="width:155mm;height:3mm;padding-top:1mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText" style="width:155mm;">If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based </span>
<span class="styNormalText" style="width:155mm;">criteria for determining eligibility for free or discounted care. Include in the description whether the organization </span>
<span class="styNormalText" style="width:155mm;">used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or </span>
<span class="styNormalText" style="width:155mm;">discounted care. </span>
</div>
<div class="styShadingCell" style="width:8mm;height:14mm;padding-top:1mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:14mm;padding-bottom:1mm;padding-top:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:14mm;padding-bottom:0mm;padding-top:1mm;border-top-width:0px;"/>
</div>
<!-- Line 4 -->
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;padding-top:1mm;">4</div>
<div class="styLNDesc" style="width:155mm;height:3mm;padding-top:1mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"?
<span style="width:1mm;"/>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">..............</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;padding-bottom:0mm;border-bottom-width:1px;">
<br/>
<b>4</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;padding-top:1mm;border-left-width:0px;border-bottom-width:1px;">
<br/>
<span style="font-weight: normal;padding-top:1mm;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/FreeDiscCareMedicallyIndigent"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;">
<br/>
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/FreeDiscCareMedicallyIndigent"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 5a -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;">5a</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.25mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? <span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">............................</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;border-bottom-width:1px;">
<br/>
<b>5a</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;border-bottom-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;">
<br/>
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/AmountsBudgetedForCharityCare"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;border-top-width:0px;font-size:7pt;">
<br/>
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/AmountsBudgetedForCharityCare"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 5b -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:4mm;">b</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.25mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?
<span style="width:0.5mm;"/>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">......</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;border-bottom-width:1px;">
<b>5b</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;border-bottom-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/ExpensesExceededBudget"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;border-top-width:0px;font-size:7pt;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/ExpensesExceededBudget"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 5c -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:4mm;">c</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.25mm;padding-bottom:0mm;font-size:7pt;">
<span style="width:155mm;">If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted</span>
<span style="width:155mm;">care to a patient who was eligibile for free or discounted care?
<span style="width:3mm;"/>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:2mm;">..............</span></span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:6mm;width:8.25mm;border-left-width:1px;padding-top:4mm;font-size:7pt;border-top-width:0px;border-bottom-width:1px;">
<b>5c</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:6mm;border-bottom-width:1px;padding-top:4mm;font-size:7pt;border-top-width:0px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnableToProvideCare"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:6mm;width:7.5mm;padding-top:4mm;border-right-width:0px;border-bottom-width:1px;border-top-width:0px;font-size:7pt;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnableToProvideCare"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 6a -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;">6a</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.5mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
Did the organization prepare a community benefit report during the tax year?
<span style="width:1.5mm;"/>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:3mm;">..........</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;border-bottom-width:1px;">
<b>6a</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;border-bottom-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/AnnualCommunityBenefitReport"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;border-top-width:0px;font-size:7pt;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/AnnualCommunityBenefitReport"/>
</xsl:call-template>
</span>
</div>
</div>
<!-- Line 6b -->
<div style="width:187mm">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:4mm;">b</div>
<div class="styLNDesc" style="width:155mm;height:4mm;padding-top:.5mm;padding-bottom:0mm;font-size:7pt;">
<span class="styNormalText">
If "Yes," did the organization make it available to the public?
<span style="width:3.5mm;"/>
<span style="letter-spacing:4mm; font-weight:bold; font-size:7pt; margin-left:3mm;">..............</span>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:8.25mm;border-left-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;border-bottom-width:1px;">
<b>6b</b>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;border-bottom-width:1px;padding-top:1mm;font-size:7pt;border-top-width:0px;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateYesBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/ReportPublicallyAvailable"/>
</xsl:call-template>
</span>
</div>
<div class="IRS990ScheduleH_LineIndexMid" style="height:4mm;width:7.5mm;padding-top:1mm;border-right-width:0px;border-bottom-width:1px;border-top-width:0px;font-size:7pt;">
<span style="font-weight: normal;">
<xsl:call-template name="PopulateNoBoxText">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/ReportPublicallyAvailable"/>
</xsl:call-template>
</span>
</div>
</div>
<div style="width:187mm;">
<div class="styLNLeftNumBox" style="height:4mm;padding-left:2mm;"/>
<div class="styLNDesc" style="width:155mm;height:8mm;">
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
</div>
<div class="styShadingCell" style="width:8mm;height:8mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:8mm;padding-bottom:1mm;border-top-width:0px;"/>
<div class="styShadingCell" style="width:8mm;height:8mm;padding-bottom:1mm;border-top-width:0px;"/>
</div>
<!-- Line 7 Charity Care and Certain Other Community Benefits at Cost -->
<div style="width:187mm;height:3mm;border-style:solid; border-bottom-width:1px;border-top-width:1px; border-right-width:0px;border-left-width:0px;padding-top:0mm;float:left;">
<div class="styLNLeftNumBox" style="height:3mm;padding-left:2mm;padding-top:0mm;">7</div>
<span class="styNormalText" style="width:170mm;font-size:7.5pt;padding-top:0mm;">
<span style="width:2mm;"/>
Financial Assistance and Certain Other Community Benefits at Cost
</span>
</div>
<div class="styTable" style="border-top-width: 1px; width:187mm;border-bottom-width:1px;height:100%; ">
<table class="styTable" style="border-color:black;" cellspacing="0">
<thead>
<tr>
<th colspan="2" class="styIRS990ScheduleHTheadCell" scope="col" style="width:41mm;text-align:center;font-size:7.5pt;border-bottom-width:0px;border-left-width:0px;">
<span class="styBoldText">Financial Assistance and</span><br/>
<span class="styBoldText">Means-Tested</span><br/>
<span class="styBoldText">Government Programs</span><br/>
</th>
<th class="styIRS990ScheduleHTheadCell" style="width:17mm;font-size:6pt;" scope="col">
<span class="styBoldText">(a)</span> Number of activities or programs (optional)
</th>
<th class="styIRS990ScheduleHTheadCell" style="vertical-align:top;width:16mm;font-size:6pt;padding-top:1mm;" scope="col">
<span class="styBoldText">(b)</span> Persons served (optional)
</th>
<th class="styIRS990ScheduleHTheadCell" style="vertical-align:top;padding-top:1mm;width:30mm;font-size:6pt;" scope="col">
<span class="styBoldText">(c)</span> Total community benefit expense
</th>
<th class="styIRS990ScheduleHTheadCell" style="vertical-align:top;padding-top:1mm;width:30mm;font-size:6pt;" scope="col">
<span class="styBoldText">(d)</span> Direct offsetting revenue
</th>
<th class="styIRS990ScheduleHTheadCell" style="vertical-align:top;padding-top:1mm;width:30mm;font-size:6pt;" scope="col">
<span class="styBoldText">(e)</span> Net community benefit expense
</th>
<th class="styIRS990ScheduleHTheadCell" style="vertical-align:top;padding-top:1mm;width:17mm;border-right-width:0px;font-size:6pt;" scope="col">
<span class="styBoldText">(f)</span> Percent of total expense
</th>
</tr>
</thead>
<tfoot/>
<!-- Line 7a -->
<tbody valign="top">
<tr>
<td style="width:4.5mm;font-size:6pt;text-align:right;">a</td>
<td class="styTableCell" style="text-align:left; border-bottom-width: 0px; border-left-width: 0px; border-top-width: 0px;border-right-width:0px;padding-left:2.5mm;">
Financial Assistance at cost<br/>
(from Worksheet 1)
<!--Dotted Line-->
<span style="letter-spacing:3.5mm; font-weight:bold; margin-left:4mm;">..</span>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCareAtCost/NumberOfActivitiesOrPrograms"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCareAtCost/PersonsServed"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCareAtCost/TotalCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCareAtCost/DirectOffsettingRevenue"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCareAtCost/NetCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CharityCareAtCost/PercentOfTotalExpense"/>
</xsl:call-template>
</td>
</tr>
<!-- Line 7b -->
<tr>
<td style="width:4.5mm;font-size:6pt;text-align:right;">b</td>
<td class="styTableCell" style="text-align:left; border-bottom-width: 0px; border-left-width: 0px; border-top-width: 0px;border-right-width:0px;padding-left:2.5mm;">
Medicaid (from Worksheet 3,<br/>
column a)
<!--Dotted Line-->
<span style="letter-spacing:3.5mm; font-weight:bold; margin-left:4mm;">....</span>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedMedicaid/NumberOfActivitiesOrPrograms"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedMedicaid/PersonsServed"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedMedicaid/TotalCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedMedicaid/DirectOffsettingRevenue"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedMedicaid/NetCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedMedicaid/PercentOfTotalExpense"/>
</xsl:call-template>
</td>
</tr>
<!-- Line 7c -->
<tr>
<td style="width:4.5mm;font-size:6pt;text-align:right;">c</td>
<td class="styTableCell" style="text-align:left; border-bottom-width: 0px; border-left-width: 0px; border-top-width: 0px;border-right-width:0px;padding-left:2.5mm;">
Costs of other means-tested<br/>
government programs (from<br/>
Worksheet 3, column b)
<!--Dotted Line-->
<span style="letter-spacing:3.5mm; font-weight:bold; margin-left:4mm;">.</span>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedCosts/NumberOfActivitiesOrPrograms"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedCosts/PersonsServed"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedCosts/TotalCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedCosts/DirectOffsettingRevenue"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedCosts/NetCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/UnreimbursedCosts/PercentOfTotalExpense"/>
</xsl:call-template>
</td>
</tr>
<!-- Line 7d -->
<tr>
<td style="width:4.5mm;font-size:6pt;text-align:right;">d</td>
<td class="styTableCell" style="text-align:left; border-bottom-width: 0px; border-left-width: 0px; border-top-width: 0px;border-right-width:0px;padding-left:2.5mm;">
<b>Total</b> Financial Assistance<br/>
and Means-Tested<br/>
Government Programs
<!--Dotted Line-->
<span style="letter-spacing:3.5mm; font-weight:bold; margin-left:3mm;">.</span>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/TotalCharityCare/NumberOfActivitiesOrPrograms"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/TotalCharityCare/PersonsServed"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/TotalCharityCare/TotalCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/TotalCharityCare/DirectOffsettingRevenue"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/TotalCharityCare/NetCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell ">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/TotalCharityCare/PercentOfTotalExpense"/>
</xsl:call-template>
</td>
</tr>
<!-- Line 7e -->
<tr>
<td colspan="2" class="styIRS990ScheduleHTheadCell" scope="col" style="width:41mm;text-align:center;font-size:7.5pt;border-bottom-width:0px;border-left-width:0px;">
<span class="styBoldText">Other Benefits</span>
<br/>
</td>
<td class="styIRS990ScheduleHCell " rowspan="2">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CommunityHealthServices/NumberOfActivitiesOrPrograms"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell " rowspan="2">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CommunityHealthServices/PersonsServed"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell " rowspan="2">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CommunityHealthServices/TotalCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell " rowspan="2">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CommunityHealthServices/DirectOffsettingRevenue"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell " rowspan="2">
<xsl:call-template name="PopulateAmount">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CommunityHealthServices/NetCommunityBenefitExpense"/>
</xsl:call-template>
</td>
<td class="styIRS990ScheduleHCell " rowspan="2">
<xsl:call-template name="PopulatePercent">
<xsl:with-param name="TargetNode" select="$Form990ScheduleHData/CommunityHealthServices/PercentOfTotalExpense"/>
</xsl:call-template>
</td>
</tr>
<tr>
<td style="width:4.5mm;font-size:6pt;text-align:right;">e</td>
<td class="styTableCell" style="text-align:left; border-bottom-width: 0px; border-left-width: 0px; border-top-width: 0px;border-right-width:0px;padding-left:2.5mm;">
Community health<br/>
improvement services and<br/>
community benefit operations<br/>
(from Worksheet 4)
<!--Dotted Line-->
<span style="letter-spacing:3.5mm; font-weight:bold; margin-left:3mm;">..</span>
</td>
</tr>
<!-- Line 7f -->
<tr>
<td style="width:4.5mm;font-size:6pt;text-align:right;">f</td>
<td class="styTableCell" style="text-align:left; border-bottom-width: 0px; border-left-width: 0px; border-top-width: 0px;border-right-width:0px;padding-left:2.5mm;">
Health professions education<br/>
(from Worksheet 5)