Part 3. Submission Processing

Chapter 24. ISRP System

Section 12. Exempt Organization Returns

3.24.12 Exempt Organization Returns

Manual Transmittal

November 21, 2023

Purpose

(1) This transmits revised IRM 3.24.12, Integrated Submission and Remittance Processing (ISRP) System, Exempt Organization Returns.

Material Changes

(1) IRM 3.24.12.2.2 - Added Form 3800 and 8936, Source Document.

(2) IRM 3.24.12-240 - Updated Form 990-T, Section 04

(3) IRM 3.24.12-251 - Added Form 990-T, Section 23.

(4) IRM 3.24.12-252 - Added Form 990-T, Section 24.

(5) IRM 3.24.12-253 - Added Form 990-T, Section 25.

(6) IRM 3.24.12-254 - Added Form 990-T, Section 31.

(7) IRM 3.24.12-261 - Updated Form 1120-POL, Section 05. Updated to match current Form

(8) Exhibit 3.24.12-263 - Form 1120-POL-Section 19, Updated to match current Form 8978.

(9) Exhibit 3.24.12-264 - Form 1120-POL-Section 20, Added instructions for Form 8913.

(10) Exhibit 3.24.12-265 - Added Form 1120-POL, Section 23.

(11) Exhibit 3.24.12-266 - Added Form 1120-POL, Section 24.

(12) Exhibit 3.24.12-267 - Added Form 1120-POL, Section 25.

(13) Exhibit 3.24.12-268 - Added Form 1120-POL, Section 31.

(14) Incorporated IPU 23U0229 issued 02-03-2023 Exhibit 3.24.12-240 - Section 4, Element 2 and 5 Updated to match Current Form 990T.

(15) Incorporated IPU 23U0229 issued 02-03-2023 Exhibit 3.24.12-262 - Section 2, Element 27 Updated to match current Form 4720.

(16) Incorporated IPU 22U0047 issued 01-01-2023 Exhibit 3.24.12-227 - 235 - Update to instructions to match parts on Form 990-PF.

(17) Incorporated IPU 22U0047 issued 01-01-2023 Exhibit 3.24.12-237 - Change to line on element 21.

(18) Editorial changes have been made throughout the IRM for clarity. Reviewed and updated grammar, punctuation, links, titles, tax years/dates, website addresses and IRM references if needed.

(19) Updated Prompts and Lines throughout the IRM for clarity.

Effect on Other Documents

This supersedes IRM 3.24.12, dated January 1, 2023. This IRM also incorporates IRM Procedural Updates (IPUs) 23U0229 issued 02-03-2023 and 22U0047 issued 01-01-2023

Audience

ISRP Data Transcribers
Wage and Investments (W&I)

Effective Date

(01-01-2024)

Jennifer A. Jett
Director, Business System Planning
Government Entities and Shared Services
Tax Exempt Government Entities

3.24.12.1 (01-01-2023)

Taxpayer Advocate Service (TAS)

  1. The Taxpayer Advocate Service (TAS) is an independent organization within the Internal Revenue Service (IRS), led by the National Taxpayer Advocate. Its job is to protect taxpayers’ rights by striving to ensure that every taxpayer is treated fairly and knows and understands their rights under the Taxpayer Bill of Rights (TBOR). TAS offers free help to taxpayers, including when taxpayers face financial difficulties due to an IRS problem, when they are unable to resolve tax problems they haven’t been able to resolve on their own, or when they need assistance to address an IRS system, process, or procedure that is not functioning as it should. TAS has at least one taxpayer advocate office located in every state, the District of Columbia, and Puerto Rico.

  2. TAS uses Form 12412, Operations Assistance Request (OAR), to start the OAR process of referring a case to the Wage and Investment (W&I) Division, to affect the resolution of the taxpayer’s problem. For more information, refer to IRM 13.1.19, TAS Operations Assistance Request (OAR) Process.

  3. Refer taxpayers to TAS when the contact meets TAS criteria or when Form 911, Request for Taxpayer Advocate Service Assistance (and Application for Taxpayer Assistance Order), is attached and steps cannot be taken to resolve the taxpayer’s issue the same day.

  4. The definition of “same day resolution” is within 24 hours. the following two situations meet the definition of “same day resolution”:

    • The issue can be resolved within 24 hours.

    • IRS takes steps within 24 hours to resolve the taxpayer’s issue.

  5. When making a TAS referral, use Form 911 and forward to TAS following your local procedures.

  6. See IRM 13.1.7, Taxpayer Advocate Service (TAS) Case Criteria, for more information.

3.24.12.1.1 (01-01-2024)

Service Level Agreements (SLAs)

  1. The National Taxpayer Advocate reached agreements with the Commissioners of Wage and Investment (W&I), Small Business and Self Employed (SB/SE) Division, Tax Exempt and Government Entities (TE/GE), Criminal Investigation (CI), Appeals, and Large Business and International (LB&I) that outline the procedures and responsibilities for the processing Taxpayer Advocate Service (TAS) casework when either the statutory or delegated authority to complete case transactions rests outside of TAS. These agreements are known as Service Level Agreements (SLAs).

  2. SLAs are located in Service Level Agreements between the Tax Exempt & Government Entities Division and the Taxpayer Advocate Service.

3.24.12.1.1.1 (01-01-2023)
Operations Assistance Requests (OARs)

  1. TAS uses the Operation Assistance Request (OAR) process to refer cases when TAS lacks either the statutory or delegated authority to resolve a taxpayer's problem. TAS utilizes Form 12412, Operations Assistance Request to initiate the OAR process.

  2. In cases requiring an OAR, TAS will complete Form 12412 and forward the case to the Operating Division Liaison via Form 3210. The Operating Division Liaison will review the case, assign it to the appropriate area, and monitor the case through it's conclusion.

  3. Every effort must be made to expedite completion of OAR cases. Time frames for the assigned area to complete the case will be indicated on Form 12412.

    1. If resolution of a taxpayer's case can't be completed by the requested time frame or by a negotiated extension date, the employee will immediately notify his or her manager.

    2. The manager/employee will work with the TAS contact listed on Form 12412 to arrive at agreed upon time frames for follow-up based on the facts and circumstances of the particular case.

    3. The manager/employee assigned the case will discuss the findings and recommendations on the final disposition of the case with the appropriate TAS contact. The TAS contact is responsible for communicating the final decision on the case to the taxpayer however this doesn't prohibit the manager/employee from also communicating that decision to the taxpayer.

    4. If the TAS contact and the manager/employee assigned the case can't agree upon the resolution to the taxpayer's problem, the TAS employee will elevate this disagreement to the manager who will discuss it with the appropriate Operating Division manager. The manager/employee assigned the case will also elevate any disagreement to his or her manager.

  4. For more information, please refer to: IRM 13, Taxpayer Advocate Service and http://tas.web.irs.gov/policy/sla/default.aspx.

3.24.12.2 (01-01-2023)

Program Scope and Objectives

  1. Purpose - Instructions for transcribing and verifying data from block control documents and returns for the Business Master File Processing of the Exempt Organization Returns, using the Integrated Submission and Remittance Processing (ISRP) system.

  2. Audience - Exempt Organization Data Transcribers at the Ogden Campus is the primary audience for this IRM.

  3. Policy Owner - The Director, Tax Exempt/Government Entities, Business Systems Planning.

  4. Project Owner - Submission Processing Programs

  5. Stakeholders - Exempt Organization Headquarters who rely on transcription of exempt organization returns.

  6. Transcription operators may also need to refer to IRM 3.24.38, BMF General Instructions, for general procedures. If IRM 3.24.12 and IRM 3.24.38 conflict, IRM 3.24.12 takes precedence.

  7. Due to substantial changes to the Form 990, batch and process Forms 990 for 2007 and prior years, Forms 990 for 2008 - 2013, and 2014 and subsequent years, under separate program codes. See IRM 3.24.12.2.3.

  8. When making address updates, unless the filer specifically indicates room or suite, just the number should be entered.

3.24.12.2.1 (01-01-2023)

Program Controls

  1. The block control documents below are sources of transcribed control data:

    1. Form 813, Document Register

    2. Form 1332, Block and Selection Record

    3. Form 3893, Re-entry Document Control

3.24.12.2.2 (01-01-2024)

Source Documents

  1. Transcribe data from:

    1. CP 411–414, 420–430, 259A–259G Notices

    2. Form 990, Return of Organization Exempt from Income Tax

    3. Form 990-EZ, Return of Organization Exempt from Income Tax

    4. Form 990-PF, Return of Private Foundation

    5. Form 990-T, Exempt Organization Business Income Tax Return

    6. Form 1041, Schedule D, Capital Gains and Losses

    7. Form 1041, Schedule H, Alternative Minimum Tax

    8. Form 1041-A, Trust Accumulation of Charitable Amounts

    9. Form 1120-POL, U. S. Income Tax Return of Certain Political Organizations

    10. Form 3800, General Business Credit

    11. Form 4136, Computation of Credit for Federal Tax on Gasoline and Special Fuels

    12. Form 4626, Alternative Minimum Tax–Corporations

    13. Form 4720, Return of Certain Excise Taxes on Charities and Other Persons Under Chapter 41 and 42 of the Internal Revenue Code

    14. Form 4952, Investment Interest Expense Deduction

    15. Form 5227, Split-Interest Trust Information Return

    16. Form 5578, Annual Certificate of Racial Nondiscrimination for a Private School Exempt from Federal Income Tax

    17. Form 5800, Exempt Organization Returns Edit Sheet

    18. Form 8872, Political Organization Report of Contributions and Expenditures

    19. Form 8913, Credit for Federal Telephone Excise Tax Paid

    20. Form 8936, Schedule A, Clean Vehicle Credit.

3.24.12.2.3 (01-01-2023)

Forms/Program Numbers/Tax Class Doc. Codes

  1. Form 990-EZ 2016 and subsequent will be batched under 13423 and 13424. In order for ISRP to pull up the correct screen for transcription, program code 13430 should be used.

  2. Refer to the table below for forms, programs, and tax class doc codes.

    FORMS PROGRAM NUMBERS TAX CLASS DOC. CODES
    990 (2014 and 2015) 13450 493
    990 (2016 - 2018) 13452 493
    990 (2019 and Subsequent) 13456 493
    990 (2008 - 2013), 425–431 & 259A-259H 13410 493
    990 (2007 and Prior) 13110 490
    990-EZ (2016 and subsequent 13430 (used for ISRP input only) 492
    990-EZ (2016 and subsequent) 13423 492
    990-EZ/527 (2016 and subsequent) 13424 492
    990–EZ (2008 - 2015) 13420 492
    990-EZ (2007 and Prior) 13120 409
    990-T 13141 393
    990-PF 13131 491
    1041-A 13162 481
    4720 13161 471
    5227 13190 483
    5578 13160 984
    1120-POL 13170 320
    5768 15502 977
    8872 16010 462

3.24.12.2.4 (01-01-2023)

MUST ENTER Fields

  1. Some fields require entry of data. These are MUST ENTER fields. Transcription Operation Sheets indicate MUST ENTER fields by the presence of stars (★★★★★★). See IRM 3.24.38 for procedures related to MUST ENTER fields.

3.24.12.2.5 (01-01-2023)

Check Digit/Name Control

  1. See the following subsections for entering either the Check Digit or Name Control.

3.24.12.2.5.1 (01-01-2023)
Check Digit

  1. Enter the Check Digit as follows:

    1. If the EIN is unaltered on a preprinted label, enter the two alpha characters shown to the left of the EIN in the Check Digit (CD) field. You don't need to press <ENTER>. If the Check Digit is illegible, enter the Name Control.

    2. If the EIN is unaltered in the preprinted entity information of a CP Notice, enter the two alpha characters shown to the right of the EIN in the Check Digit (CD) field. You don't need to press <ENTER>. If the Check Digit is illegible, enter the Name Control.

    Note:

    We moved the EIN and Check Digits for taxpayer privacy. On preprinted forms these items show up toward the title of the form. Enter the EIN and Check Digits. On NCOA labeled forms the EIN appears in this same area but the Check Digits aren’t present. Enter the EIN and then the Name Control.

  2. The system fills the Name Control field with cent (¢) signs and positions the cursor on the EIN field. Enter the EIN.

  3. If the Check Digit is invalid, the error message CHECK DIGIT ERROR appears. The cursor’s position is on the first digit of the EIN.

    1. Check the Check Digit and EIN fields for errors.

    2. If the Check Digit was entered incorrectly, press <F1> to position the cursor on the first position of the Check Digit field. Correct the Check Digit field. If the EIN is correct, press <ENTER>.

    3. If the EIN was entered incorrectly, correct the field using the normal procedures.

    4. If both the Check Digit and EIN fields are correct, press <F7> to override the error message.

3.24.12.2.5.2 (01-01-2023)
Name Control

  1. In all other cases, press <ENTER> for the Check Digit field. The system grays out the Check Digit field and positions the cursor on the Name Control field.

  2. Enter the four character Name Control indented, underlined or edited in the First Name Line area in the Name Control (NC) field (see IRM 3.24.38 for Name Control determination). You don't need to press <ENTER> if entering four characters.

  3. If less than four characters, enter those shown and press <ENTER>.

  4. If the Name Control is missing or illegible, enter one period, then press <ENTER>.

    Note:

    Both fields can't contain entries; however, if both are entered, the system recognizes only the Check Digit and grays out the Name Control field.

3.24.12.2.6 (01-01-2023)

Enhanced-Entity Index File

  1. See IRM 3.24.38 for Enhanced-Entity Index File processing.

  2. These procedures affect Forms 990, 990EZ, 990T, 990PF, 5227 and CP 411–414, 420-430, 259A–259G.

3.24.12.2.7 (01-01-2023)

Name Control Check Against Enhanced-Entity Index File

  1. The following procedures affect Forms 5578, 1041A, and 4720.

  2. If a document is entered with a Name Control rather than a Check Digit, the system accesses the Enhanced-Entity Index File (E-EIF) to determine if the account is already established on the Master File. This procedure reduces the number of unpostables.

    Note:

    As soon as the EIN field is entered, the system accesses E-EIF. During this time, screen activity occurs and no entry can be made into the terminal. If the account is located, the Name Control entered automatically grayed out and the Check Digit appears in the Check Digit field on the screen. The EIN/Check Digit/Name Control fields bypass verification. If the account isn’t located, the Name Control remains on the screen as entered.

3.24.12.3 (01-01-2023)

Specific Instructions for Entry of Data

  1. This section provides specific instructions for entering data.

3.24.12.3.1 (01-01-2023)

Required Sections & Section Verification

  1. Required sections and section verification:

    Form Required Section Required Section Verified Other Section(s) Other Section(s) Verified
    990 (2014 and 2015 01, 02 100% 03 - 13 Yes - 100% if input
    990 (2016 and Subsequent) 01, 02 100% 03 - 13 Yes - 100% if input
    990 (2008 and subsequent) 01, 02 100% 03–13 Yes - 100% if input
    990–EZ (2008 - 2013) 01, 02 100% 03–12 Yes - 100% if input
    990 & 990–EZ (2007 and Prior) 01, 02 100% 03–12 Yes - 100% if input
    CP411–414, 420–430 & 259A–259G and
    Organization Code "9" filers    		 01 100% 02 No
    990–PF 01–13 100% (Sections 01–07, 12 & 13) n/a Yes - if input and doesn't pass the zero balance test (Sections 08–11)
    990–T 01–04 Yes 07, 08, 15, 17, 20 Yes - if input
    *Section 20 is not verified
    1041–A 01 Yes 03 No
    1120–POL 01 Yes 02–05, 15, 20 Yes - 05 verified if input
    4720 01, 02 Yes 03 No
    5227 01–05 Yes n/a n/a
    5578 01 Yes n/a n/a
    5768 01 Yes n/a n/a
    8872 01 Yes 02, 03 Yes - if input

3.24.12.3.2 (01-01-2023)

Foreign Address Procedures

  1. ISRP enters the address fields on a foreign address. ISRP won't enter a CCC "U" or Action Code 650 to send the returns to (SCRS) or (ERS).

  2. Refer to IRM 3.24.38.4.4.14.9 for correct procedures for entering foreign addresses.

3.24.12.3.3 (01-01-2023)

Money Fields

  1. All fields are DOLLARS AND CENTS unless otherwise specified.

    1. A space and a dollar sign following the prompt (i.e. LN2 $) specifies the field is a dollars only field.

    2. Since many reports generate from the information on these returns, take extreme care when entering the money amounts.

    3. If the instruction calls for dollars only, don't enter cents (e.g., $400.00 entered as 400).

    4. If the instruction calls for dollars and cents, be sure to enter the cents (e.g., $400 entered as 400.00).

3.24.12.3.4 (01-01-2023)

Yes/No Boxes

  1. For all Yes/No boxes, enter the digit edited to the right of the Line number.

  2. If un-edited:

    1. Enter "1" if the yes box is checked.

    2. Enter "2" if the no box is checked.

    3. Press <ENTER> only if both boxes are checked, blank or N/A.

3.24.12.3.5 (01-01-2023)

Percentage Fields

  1. Input all percentage fields using up to three digits to the left of the decimal.

    Example:

    Input 109.7% as 109%

3.24.12.3.6 (01-01-2023)

Program Service Business Codes

  1. Enter all business codes exactly as shown except as follows:

    1. If more than one code is present, enter the first code.

    2. If the code is other than 4 or 6 digits, enter "0" (zero).

    3. If there are any illegible digits, enter "0" (zero).

3.24.12.4 (01-01-2023)

ISRP Transcription Operation Sheets

  1. The following exhibits represent specific data entry procedures.

Exhibit 3.24.12-1

Block Header Data Entry

Block Header Data Entry
3.24.12 - 1 Block Header Data Entry
Source Document or Record: FORM 1332 FOR ORIGINAL INPUT DOCUMENTS,
FORMS 3893 FOR RE-ENTRY DOCUMENTS
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) SC Block Control ABC (auto) The screen displays the ABC entered in the EOP Dialog box, as described in IRM 3.24.38.4.1.1. You can't change it.
(2) Block DLN DLN <ENTER> Enter the first 11 digits as shown on:
(a) Form 813 - from the "Block DLN box."
(b) Form 1332 - in the "Block DLN box. "
(c) Form 3893 - in box 2.
(d) The KV Operator verifies the DLN from the first document of the block.
(3) Batch Number BATCH <ENTER> Enter the batch number as follows:
(a) Forms 813, 1332 - from the Batch Control Number box.
(b) Form 3893–from box 3.
(c) If not present, secure the number from the Batch Transmittal Sheet.
(4) Document Count COUNT <ENTER> Enter the document count as follows:
(a) Forms 813, 1332 - the circled serial number. If a full block (100 documents) or if a number isn't circled, enter 100.
(b) Form 3893—from box 4.
(5) Pre-journalized Credit Amount CR <ENTER>
(a) Form 813 – labeled "CR" or "Credit" .
(b) Form 3893 - box 5.
(c) See narrative for amounts.
(d) If neither "CR" or "DR" is labeled, enter as "CR" .
(6) Pre-journalized Debit Amount DB <ENTER>
(a) Form 813 - labeled "DR" or "Debit" .
(a) Form 3893 - box 6.
(b) See narrative for amounts.
(7) Transaction Code TRCODE <ENTER> Press <ENTER>.

Note:

For Form 5768, enter TC 460.
(8) Transaction Date TRDATE <ENTER> Press <ENTER>.
(9) MFT Code MFT <ENTER> Enter the 2 digit code as follows:
(a) Form 813 - from the "Date" box.
(b) Form 3893 - from box 9.
(c) Valid MFT's are:
1 BMF - 05, 06, 15.
2 IRA - (with TC 0) 29.
3 If MFT is other than listed above, Press <ENTER> only.
(10) Secondary Amount SECAMT <ENTER> Enter the bracketed amount as follows:
(a) Form 813 - in the "Total" box.
(b) Form 3893 - from box 10.
(c) NOTE: If zero, press <ENTER> only.
(11) Source Code SOURCE <ENTER> If the control document is a Form 3893, enter from box 11 as follows:
(a) R = "Reprocessable" box checked.
(b) N = "Reinput of Unpostable" box checked.
(c) 4 = "SC Reinput" box checked.
(d) None of the boxes checked, consult your supervisor who determines if a source code is required.
(12) Year Digit YEAR <ENTER> If the control document is a Form 3893, enter the digit from the box 12 (current or otherwise).
(a) This is a MUST ENTER field if the Source Code is "R" , "N" , or "4" .
(13) Period Code PRIOR YEAR <ENTER> No entry.
(14) RPS Indicator RPS <ENTER> Enter "2" if:
(a) Forms 813, 1332 — "RPS" is edited or stamped in the upper center margin or "RRPS" is in the header of Form 1332.
(b) Form 3893 — box 13 is checked.
Exhibit 3.24.12-2

Form 990 - Section 01 (2014 and 2015)

3.24.12 - 2 SECTION 01
Source Document or Record: Forms 990 - Section 01 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generated the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5 for procedures.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5 for procedures.
(5) E.I.N. EIN <ENTER>
★★★★★★		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) For a CP 425–431 & 259A-259H, underlined to the right of the "Employer ID Number" .
(b) See standard rules in IRM 3.24.38.
(c) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6)???not on prp Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7)not on PRP Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8)not on PRP ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) For a CP 425–431 & 259A-259H, edited in the area around the Tax Period.
(10) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.
(11) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(12) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(13) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country code.
(14) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(15) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(16) Group Code H(b) BOXHB <ENTER> Enter a "1" or "2" from the yes/no box from the entity area of the return, Line H(b). For a CP425–431 & 259A-259H, press <ENTER> only.
(17) Tax Exempt Status BOXI <ENTER> Enter the edited two digit code from the blank space of Box I.
(18) Type of Organization BOXK RT <ENTER> Enter the edited code from the blank space of Box K. For a CP 425–431 & 259A-259H always enter a "9" .
(19) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 2–7b. For a 420–431 & 259A-259H, enter the edited characters as shown in the center of the return. If a Condition Code is illegible, enter a "#" in its place.
(20) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a "G" Condition Code is present and the return is non-remittance, end the document after this element.
(c) If a CP 425–431 & 259A-259H, end the document after this element.
(21) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(22) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(23) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
(24) Preparer Telephone # TEL# <ENTER> Enter the preparer phone number.
(a) If the Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(b) If Type of Organization is a "9" , and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If present, continue to that element and follow the instructions there.
(25) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
"9" from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
"9" , and the "9" is NOT underlined, press <F6> and end the document after this element.
Exhibit 3.24.12-3

Form 990 - Section 02, Form 5800 - Edit Sheet (2014 and 2015)

3.24.12 - 3 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800 - Edit Sheet (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "02" .
(2) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(3) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(4) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(5) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(6) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-4

Form 990 - Section 03 (2014 and 2015)

3.24.12 - 4 SECTION 03
Source Document or Record: Forms 990 - Section 03, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return, ONLY if underlined in green.
(3) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(4) Undertake New Activities Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2.
(5) Make Significant Changes Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3.
(6) Exempt Purpose Code 1 L4A <ENTER> Press Enter only. Don't transcribe a code.
(7) Exempt Purpose Code 2 L4B <ENTER> Press Enter only. Don't transcribe a code.
(8) Exempt Purpose Code 3 L4C <ENTER> Press Enter only. Don't transcribe a code.
(9) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.

Note:

If a "D1" is edited and underlined, pick up as an alpha "D" and numeric "1" . Don't confuse with an alpha "D" and alpha "I" .
(10) 501(c)(3) or 4947(a)(1) Y/N L1 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 1.
(11) Required to Complete Sch B Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 2.
(12) Engage in Direct or Indirect Political Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 3.
(13) Engage in Lobbying Activities Y/N L4 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 4.
(14) Subject to Sec 6033(c) Notice L5 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 5.
(15) Maintain Donor Advised Y/N L6 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 6.
(16) Receive or Hold Conservation Y/N L7 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 7.
(17) Maintain Collections of Works of Art Y/N L8 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 8.
(18) Provide Credit Counseling Y/N L9 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 9.
(19) Hold Assets in Term/Permanent Y/N L10 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 10.
(20) Land, Buildings, Equipment 11A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11a.
(21) Investments Other Securities 11B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11b.
(22) Investments Program Related 11C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11c.
(23) Other Assets 11D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11d.
(24) Other Liabilities 11E <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11e.
(25) Separate or Consolidated Financial Statements 11F <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11f.
(26) Separate Independent Audited Financial 12A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12a.
(27) Consolidated Independent Financial 12B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12b.
(28) School Described in 170(b)(1)(A)(ii) L13 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 13.
(29) Maintain an Office, etc Outside U.S. 14A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14a.
(30) Have Aggregate Revenues/Expenses 14B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14b.
(31) Report > $5000 on Part IX Organizations L15 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 15.
(32) Report > $5000 on Part IX Individuals L16 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 16.
(33) Report > $15,000 on Part IX, Line 11e L17 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 17.
(34) Report > $15,000 on Part VIII, Line 1c/8a L18 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 18.
(35) Report > $15,000 on Part VIII, Line 9a L19 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 19.
(36) Operate Hospitals 20A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20a.
(37) Attach Audited Financial Statements 20B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20b.
Exhibit 3.24.12-5

Form 990 - Section 04 (2014 and 2015)

3.24.12 - 5 SECTION 04
Source Document or Record: Forms 990 - Section 04, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "04" .
(2) Report > $5000 on Part IX, Line 1 L21 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 21.
(3) Report > $5000 on Part IX, Line 2 L22 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 22.
(4) Answer Yes to Questions 3, 4, 5 L23 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 23.
(5) Any Tax-Exempt Bond with Outstanding Principal 24A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24a.
(6) Invest Any Proceeds 24B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24b.
(7) Maintain an Escrow Account 24C <ENTER> Enter a yes or no from the yes/box from Part IV, Line 24c.
(8) Act as "On Behalf Of" Issuer 24D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24d.
(9) 501(c)(3) / 501(c)(4) Organizations 25A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25a.
(10) Become Aware it Engaged in Excess 25B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25b.
(11) Loan to/by Current/Former Officer L26 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 26.
(12) Provide Grant or Other Assistance L27 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 27.
(13) Business Transaction with Current or Former Officer 28A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28a.
(14) Business Transaction with Family Member 28B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28b.
(15) Business Transaction with Entity of Current/ Former Officer 28C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28c.
(16) Receive or Accrue > $25,000 in Non-Cash L29 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 29.
(17) Receive or Accrue Contributions of Art L30 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 30.
(18) Liquidate, Terminate, Dissolve L31 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 31.
(19) Sell, Exchange, Dispose L32 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 32.
(20) Own 100% of an Entity L33 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 33.
(21) Related to Tax-Exempt / Taxable Entity L34 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 34.
(22) Controlled Entity Within 512(b)(13) L35A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35a.
23 Receive Payment or Engage Transaction Within L35B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35b.
(24) Make Any Transfers L36 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 36.
(25) Conduct More than 5% L37 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 37.
(26) Complete Schedule O L38 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 38.
Exhibit 3.24.12-6

Form 990 - Section 05 (2014 and 2015)

3.24.12 - 6 SECTION 05
Source Document or Record: Forms 990 - Section 05, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "05" .
(2) Part V Number of Forms/1096 PTVL1A <ENTER> Enter the number shown on Part V, Line 1a.
(3) Number of Forms W-2G L1B <ENTER> Enter the number shown on Part V, Line 1b.
(4) Comply with Backup Withholding Rules L1C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 1c.
(5) Number of Employees / W-3 L2A <ENTER> Enter the number shown on Part V, Line 2a.
(6) File All Required Federal Employment Returns L2B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 2b.
(7) Unrelated Business Income > $1000 L3A <ENTER> Enter a yes or no from the yes/box from Part V, Line 3a.
(8) If Yes, Has Filed a 990-T L3B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 3b.
(9) Interest in or a Signature L4A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 4a.
(10) Party to a Prohibited Tax Shelter L5A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5a.
(11) Taxable Party Notify Organization L5B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5b.
(12) If Yes, Did Organization File 8886-T L5C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5c.
(13) Annual Gross Receipts Normally >$100,000 L6A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6a.
(14) If Yes, Did Organization Include L6B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6b.
(15) >$75 Partly Contribution/Goods/Services L7A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7a.
(16) If Yes, Did Organization Notify Donor L7B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7b.
(17) Sell, Exchange, Otherwise Dispose L7C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7c.
(18) Number of Forms 8282 L7D <ENTER> Enter the number shown on Part V, Line 7d.
(19) Receive Any Funds L7E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7e.
(20) Pay Premiums L7F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7f.
(21) Contributions of Qualified Intellectual Property L7G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7g.
(22) Contributions of Cars, Boats, Airplanes L7H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7h.
(23) Sponsoring Orgs, 509(a)(3) Excess Business Holdings L8 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 8.
(24) Make Taxable Distributions Under 4966 L9A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9a.
(25) Make Distribution to Donor L9B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9b.
(26) Initiation Fees/Capital Contributions 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10a.
(27) Gross Receipts for Public Use of Facilities 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10b.
(28) Gross Income/Members/Shareholders 11A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11a.
(29) Gross Income from Other Sources 11B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11b.
(30) 4947(a)(1) Filing 990 in Lieu of 1041 12A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 12a.
(31) Amount of Tax Exempt Interest 12B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 12b.
(32) Licensed to Issue Qualified Health Plans 13A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 13a.
(33) Aggregate Amount of Reserves to Maintain 13B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13b.
(34) Aggregate Amount of Reserves on Hand 13C $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13c.
(35) Receive Payments for Indoor Tanning 14A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14a.
(36) Filed Form 720 to Report Payments 14B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14b.
Exhibit 3.24.12-7

Form 990 - Section 06 (2014 and 2015)

3.24.12 - 7 SECTION 06
Source Document or Record: Forms 990 - Section 06, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "06" .
(2) Voting Members of Governing Body PG6L1A <ENTER> Enter the number shown on Part VI, Section A, Line 1a.
(3) Independent Voting Members L1B <ENTER> Enter the number shown on Part VI, Section A, Line 1b.
(4) Officer, Director, Trustee Family/Relationship L2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 2.
(5) Delegate Control Over Management L3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 3.
(6) Make Significant Changes L4 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 4.
(7) Become Aware of Material Diversion L5 <ENTER> Enter a yes or no from the yes/box from Part VI, Section A, Line 5.
(8) Members of Stockholders L6 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 6.
(9) Members, Stockholders, Other Persons 7A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7a.
(10) Members Subject to Approval 7B <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7b.
(11) Determining Compensation for CEO, Exec Director 15A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section B, Line 15a.
(12) Total Reportable Compensation from Organization PG8L1D(D) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column D.
(13) Total Reportable Compensation from Related Organization 1D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column E.
(14) Total Compensation from Organization & Related Organizations 1D(F) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column F.
(15) Total Individuals who Received > $100,000 SECTAL2 <ENTER> Enter the number shown on Part VII, Section A, Line 2.
(16) Total Independent Contractors Received > $100,000 SECTBL2 <ENTER> Enter the number shown on Part VII, Section B, Line 2.
Exhibit 3.24.12-8

Form 990 - Section 07 (2014 and 2015)

3.24.12 - 8 SECTION 07
Source Document or Record: Forms 990 - Section 07, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter "07" .
(2) Total Contributions/
Gifts/Grants		 PG9L1H $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 1h, Column (A).
(3) Program Service Business Code 2A 2ACODE <ENTER> Enter the number shown on Part VIII, Line 2a.
(4) 2a Program Service Revenue Col. A 2A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2a, Column (A).
(5) Program Service Business Code 2B 2BCODE <ENTER> Enter the number shown on Part VIII, Line 2b.
(6) 2b Program Service Revenue Col. A 2B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2b, Column (A).
(7) Program Service Business Code 2C 2CCODE <ENTER> Enter the number shown on Part VIII, Line 2c.
(8) 2c Program Service Revenue Col. A 2C(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2c, Column (A).
(9) Program Service Business Code 2D 2DCODE <ENTER> Enter the number shown on Part VIII, Line 2d.
(10) 2d Program Service Revenue Col. A 2D(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2d, Column (A).
(11) Program Service Business Code 2E 2ECODE <ENTER> Enter the number shown on Part VIII, Line 2e.
(12) 2e Program Service Revenue Col. A 2E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2e, Column (A).
(13) 2f Program Service Revenue Col. A 2F(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2f, Column (A).
(14) 2g Program Service Revenue Total Col. A 2GTOT $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 2g, Column (A).
(15) Investment Income Col. A 3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 3, Column (A).
(16) Tax-Exempt Bond Proceeds Col. A 4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 4, Column (A).
(17) Royalties Col. A 5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 5, Column (A).
(18) Gross Rents Real 6(A)I $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (i).
(19) Gross Rents Personal 6(A)II $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (ii).
(20) Rental Expenses Real 6(B)(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (i).
(21) Rental Expenses Personal 6(B)(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (ii).
(22) Rental Income/Loss Real 6C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (i).
(23) Rental Income/Loss Personal 6C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (ii).
(24) Net Rental Income/Loss Col. A 6D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6d, Column (A).
Exhibit 3.24.12-9

Form 990 - Section 08 (2014 and 2015)

3.24.12 - 9 SECTION 08
Source Document or Record: Forms 990 - Section 08, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08..
(2) Gross Amount from Sales of Assets - Securities PG9L7A(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (i).
(3) Gross Amount from Sales of Assets - Other 7A(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (ii).
(4) Cost or Other Basis/Sales - Securities 7B(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (i).
(5) Cost or Other Basis/Sales - Other 7B(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (ii).
(6) Gain/Loss - Securities 7C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (i).
(7) Gain/Loss - Other 7C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (ii).
(8) Net Gain/Loss Col. A 7D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7d, Column (A).
(9) Gross Income from Fundraising 8A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8a.
(10) Less Direct Expenses 8b 8B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8b.
(11) Net Income/Loss from Fundraising Col. A 8C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8c, Column (A).
(12) Gross Income from Gaming 9A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9a.
(13) Less Direct Expenses 9b 9B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9b.
(14) Net Income/Loss from Gaming 9C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9c, Column (A).
(15) Gross Sales of Inventory 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10a.
(16) Less Cost of Goods Sold 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10b.
(17) Net Income/Loss from Sales Col. A 10C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10c, Column (A).
(18) Misc. Revenue Business Code 11a 11ACODE <ENTER> Enter the number shown on Part VIII, Line 11a.
(19) Misc. Revenue Total (A) Col. A 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11a, Column (A).
(20) Misc. Revenue Business Code 11b 11BCODE <ENTER> Enter the number shown on Part VIII, Line 11b.
(21) Misc. Revenue Total 11B(A) Col. A 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11b, Column (A).
(22) Misc. Revenue Business Code 11c 11CCODE <ENTER> Enter the number shown on Part VIII, Line 11c.
(23) Misc. Revenue Total 11C(A) Col. A 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11c, Column (A).
(24) Misc. Revenue Total 11D(A) Col. A 11D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11d, Column (A).
(25) Misc. Revenue Total 11E Col. A 11ETOT $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11e, Column (A).
(26) Total Revenue 12(A) Col. A 12(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 12, Column (A).
Exhibit 3.24.12-10

Form 990 - Section 09 (2014 and 2015)

3.24.12 - 10 SECTION 09
Source Document or Record: Forms 990 - Section 09, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 09..
(2) Gross to Government / Organizations in U.S. PG10L1(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 1, Column (A).
(3) Grants / Other Assistance in U.S. L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 2, Column (A).
(4) Grants / Other Assistance Outside U.S. L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 3, Column (A).
(5) Benefits Paid to / for Members L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 4, Column (A).
(6) Compensation of Current Officers / Directors L5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 5, Column (A).
(7) Compensation to Disqualified Persons L6(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 6, Column (A).
(8) Other Salaries / Wages L7(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 7, Column (A).
(9) Pension Plan Contributions L8(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 8, Column (A).
(10) Other Employee Benefits L9(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 9, Column (A).
(11) Payroll Taxes 10(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 10, Column (A).
(12) Fees for Services / Management 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11a, Column (A).
(13) Fees for Services / Legal 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11b, Column (A).
(14) Fees for Services / Accounting 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11c, Column (A).
(15) Fees for Services / Lobbyists 11D(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11d, Column (A).
(16) Fees for Services / Professional Fundraising 11E(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11e, Column(A).
(17) Fees for Services / Investment Management 11F(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11f, Column (A).
(18) Fees for Services / Other 11G(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from shown on Part IX, Line 11g, Column (A).
(19) Advertising / Promotion 12(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 12, Column (A).
(20) Office Expenses 13(A) $ <ENTER>
MINUS (-)		 Enter the amount from on Part IX, Line 13, Column (A).
(21) Information Technology 14(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 14, Column (A).
(22) Royalties 15(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 15, Column (A).
(23) Occupancy 16(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 16, Column (A).
(24) Travel 17(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 17, Column (A).
(25) Payments of Travel / Entertainment 18(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 18, Column (A).
(26) Conferences, Conventions / Meetings 19(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 19, Column (A).
(27) Interest 20(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 20, Column (A).
(28) Payments to Affiliates 21(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 21, Column (A).
(29) Depreciation / Depletion 22(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 22, Column (A).
(30) Insurance 23(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 23, Column (A).
(31) Other Expenses a 24A(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 24a, Column (A).
(32) Other Expenses b 24B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24b, Column (A).
(33) Other Expenses c 24C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24c, Column (A).
(34) Other Expenses d 24D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24d, Column (A).
(35) Other Expenses e 24E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24e, Column (A).
(36) NA 24F $ <ENTER> Enter only.
(37) Total Functional Expenses 25(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 25, Column (A).
Exhibit 3.24.12-11

Form 990 - Section 10 (2014 and 2015)

3.24.12 - 11 SECTION 10
Source Document or Record: Forms 990 - Section 10, (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "10" .
(2) Cash EOY PG11L1(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 1, Column (B).
(3) Savings / Temporary Investments EOY L2(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 2, Column (B).
(4) Pledges / Grants Receivable EOY L3(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 3, Column (B).
(5) Accounts Receivable EOY L4(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 4, Column (B).
(6) Receivables from Current / Former EOY L5(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 5, Column (B).
(7) Receivables from Disqualified Persons EOY L6(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 6, Column (B).
(8) Notes / Loans Receivable EOY L7(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 7, Column (B).
(9) Inventories for Sale EOY L8(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 8, Column (B).
(10) Prepaid Expenses EOY L9(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 9, Column (B).
(11) Land / Buildings Less Accumulated EOY 10C(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 10c, Column (B).
(12) Investments Publicly Traded Securities EOY 11(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 11, Column (B).
(13) Investments Other Securities EOY 12(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 12, Column (B).
(14) Investments Program Related EOY 13(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 13, Column (B).
(15) Intangible Assets EOY 14(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 14, Column (B).
(16) Other Assets EOY 15(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 15, Column(B).
(17) Total Assets BOY 16(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 16, Column (A).
(18) Total Assets EOY 16(B) $ <ENTER>
MINUS (-)		 Enter the amount from shown on Part X, Line 16, Column (B).
(19) Accounts Payable EOY 17(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 17, Column (B).
(20) Grants Payable EOY 18(B) $ <ENTER>
MINUS (-)		 Enter the amount from on Part X, Line 18, Column (B).
(21) Deferred Revenue EOY 19(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 19, Column (B).
(22) Tax-Exempt Bond Liabilities EOY 20(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 20, Column (B).
(23) Escrow Liability EOY 21(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 21, Column (B).
(24) Payable to Current / Former Officers EOY 22(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 22, Column (B).
(25) Secured Mortgages / Notes EOY 23(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 23, Column (B).
(26) Unsecured Notes / Loans EOY 24(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 24, Column (B).
(27) Other Liabilities EOY 25(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 25, Column (B).
(28) Total Liabilities BOY 26(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 26, Column (A).
(29) Total Liabilities EOY 26(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 26, Column (B).
(30) Unrestricted Net Assets EOY 27(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 27, Column (B).
(31) Temporarily Restricted Net Assets EOY 28(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 28, Column (B).
(32) Permanently Restricted Net Assets EOY 29(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 29, Column (B).
(33) Capital Stock / Trust EOY 30(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 30, Column (B).
(34) Paid-In / Capital Surplus EOY 31(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 31, Column (B).
(35) Retained Earnings, Endowment EOY 32(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 32, Column (B).
(36) Total Net Assets or Fund Balances BOY 33(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 33, Column (A).
(37) Total Net Assets or Fund Balances EOY 33(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 33, Column (B).
(38) Total Liabilities / Net Assets Fund Balances EOY 34(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 34, Column (B).
Exhibit 3.24.12-12

Form 990 - Schedule A - Section 11 (2014 and 2015)

3.24.12 - 12 SECTION 11
Source Document or Record: Forms 990 - Section 11, Schedule A (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter one of the following:
1 = Type I, 2 = Type II, 3 = Type III – Functionally integrated
4 = Type III – Non-functionally integrated Blank <ENTER>.
If more than one box is checked, enter the corresponding number for the first box checked.
(4) Type I, II or III Supporting Organization 11E <ENTER> Enter a "1" if the box is checked on Schedule A, Part I, Line 11e.
(5) Number of Supported Organizations 11F <ENTER> Enter the number from Line 11f.
(6) EIN A 11G(II)A <ENTER> Enter the EIN in Part I, Line 11g, Row A, Column (ii).
(7) Type of Org A 11G(III)A <ENTER> Enter the type of organization in Part I, Line 11g, Row A, Column (iii).
(8) Listed in Governing Doc A 11G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row A, Column (iv).
(9) Amount of Support A 11G(V) A $ <ENTER> Enter the amount on Part I, Line 11g, Row A, Column (v).
(10) EIN B 11G(II)B <ENTER> Enter the EIN in Part I, Line 11g, Row B, Column (ii).
(11) Type of Org B 11G(III)B <ENTER> Enter the type of organization in Part I, Line 11g, Row B, Column (iii).
(12) Listed in Governing Doc B 11G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row B, Column (iv).
(13) Amount of Support B 11G(V)B $ <ENTER> Enter the amount Part I, Line 11g, Row B, Column (v).
(14) EIN C 11G(II)C <ENTER> Enter the EIN in Part I, Line 11g, Row C, Column (ii).
(15) Type of Org C 11G(III)C <ENTER> Enter the type of organization in Part I, Line 11g, Row C, Column (iii).
(16) Listed in Governing Doc C 11G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row C, Column (iv).
(17) Amount of Support C 11G(V)C $ <ENTER> Enter the amount on Part I, Line 11g, Row C, Column (v).
(18) EIN D 11G(II)D <ENTER> Enter the EIN in Part I, Line 11g, Row D, Column (ii).
(19) Type of Org D 11G(III)D <ENTER> Enter the type of organization in Part I, Line 11g, Row D, Column (iii).
(20) Listed in Governing Doc D 11G(IV)D <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row D, Column (iv).
(21) Amount of Support D 11G(V)D $ <ENTER> Enter the amount on Part I, Line 11g, Row D, Column (v).
(22) EIN E 11G(II)E <ENTER> Enter the EIN in Part I, Line 11g, Row E, Column (ii).
(23) Type of Org E 11G(III)E <ENTER> Enter the type of organization in Part I, Line 11g, Row E, Column (iii).
(24) Listed in Governing Doc E 11G(IV)E <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row E, Column (iv).
(25) Amount of Support E 11G(V)E $ <ENTER> Enter the amount on Part I, Line 11g, Row E, Column (v).
(26) Total Number of Organizations 11G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 11h, Column (i), Total Line.
(27) Total G(V)TOT $ <ENTER> Enter the amount on Part I, Line 11g, Total, Column (v).
(28) Filling Field     Blank field generates on output.
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-13

Form 990 - Form 990 Section 12, Schedule A (2014 and 2015)

3.24.12 - 13 SECTION 12
Source Document or Record: Forms 990 - Section 12, Schedule A (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Part V Data Present Indicator PTV <ENTER> Enter a 1 if data is present in Part V.
Exhibit 3.24.12-14

Form 990 - Section 13, Schedules C & D (2014 and 2015)

3.24.12 - 14 SECTION 13
Source Document or Record: Forms 990 - Section 13, Schedules C & D (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "13" .
(2) Political Expenditures SCHC1AL2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Total Number at EOY SCHDL1(A) <ENTER> Enter the number shown on Schedule D, Part I, Line 1, Column (a).
(4) Contributions To L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 2, Column (a).
(5) Grants From L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 3, Column (a).
(6) Aggregate Value L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 4, Column (a).
(7) Inform All Donors Checkbox L5 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 5.
(8) Inform All Grantees Checkbox L6 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 6.
Exhibit 3.24.12-15

Form 990 - Section 31, Schedule H (2014 and 2015)

3.24.12 - 15 SECTION 31
Source Document or Record: Form 990 - Section 31, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "31" .
(2) Financial Assistance L1A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1a: 1 = yes 2 = no.
(3) Written Policy L1B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1b: 1 = yes 2 = no.
(4) Best Describes L2 <ENTER> Enter the following:
1 = Applied Uniformly to all. 2 = Applied Uniformly to most.
3 = Generally tailored.
(5) FPG Used L3A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3a: 1 = yes 2 = no.
(6) FPG% L3A% <ENTER> Enter the following from Schedule H, Part I, Line 3a percent:
1 = 100%
2 = 150%
3 = 200%
4 = Other.
(7) FPG Discounted Care L3B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3b: 1 = yes
2 = no.
(8) FPG Discounted Care % L3B% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3b percent:
1 = 200%
2 = 250%
3 = 300%
4 = 350%
5 = 400%
6 = Other
If more than one box is checked, enter the number for the largest percent..
(9) Applied to Largest Number of Patients L4 <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 4: 1 = yes
2 = no.
(10) Budget Amounts for Free or Discounted L5A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5a: 1 = yes
2 = no.
(11) Exceed Budget Amount L5B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5b: 1 = yes
2 = no.
(12) Unable to Provide Free or Discounted Care L5C <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5c: 1 = yes
2 = no.
(13) Prepare A Community Benefit Report L6A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6a: 1 = yes
2 = no.
(14) Available to Public L6B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6b: 1 = yes
2 = no.
(15) Financial Assistance C L7AC $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (c).
(16) Financial D L7AD $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (d).
(17) Financial Assistance at Cost Net Community SCHH 7A(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7a, Column (e).
(18) Financial Assistance at Cost Percent 7A(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7a, Column (f).
(19) Medicaid C L7BC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (c).
(20) Medicaid D L7BD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (d).
(21) Unreimbursed Medicaid Net Community 7B(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (e).
(22) Unreimbursed Medicaid Percent 7B(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7b, Column (f).
(23) Cost of Other Means Tested C L7CC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (c).
(24) Cost of Other Means Tested D L7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (d).
(25) Unreimbursed Costs - Other Net Community 7C(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (e).
(26) Unreimbursed Costs - Other Percent 7C(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7c, Column (f).
(27) Financial Assistance Total C 7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (c).
(28) Financial Assistance Total D 7DD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (d).
(29) Total Financial Assistance Net Community 7D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (e).
(30) Total Financial Assistance Percent 7D(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7d, Column (f).
Exhibit 3.24.12-16

Form 990 - Section 32, Schedule H (2014 and 2015)

3.24.12 - 16 SECTION 32
Source Document or Record: Forms 990 - Section 32, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "32" .
(2) Community Health Improvement C 7EC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (c).
(3) Community Health Improvement D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (d).
(4) Community Health Improvement E 7EE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (e).
(5) Community Health Improvement Percent 7EF% <ENTER> Enter the percent from Schedule H, Part I, Line 7e, Column (f).
(6) Health Professions C 7FC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (c).
(7) Health Professions D 7FD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (d).
(8) Health Professions E 7FE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (e).
(9) Health Professions Percent 7FF% <ENTER> Enter the percent from Schedule H, Part I, Line 7f, Column (f).
(10) Subsidized Health Services C 7GC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (c).
(11) Subsidized Health Services D 7GD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (d).
(12) Subsidized Health Services E 7GE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (e).
(13) Subsidized Health Services Percent 7GF% <ENTER> Enter the percent from Schedule H, Part I, Line 7g, Column (f).
(14) Research C 7HC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (c).
(15) Research D 7HD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (d).
(16) Research E 7HE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (e).
(17) Research F Percent 7HF% <ENTER> Enter the percent from Schedule H, Part I, Line 7h, Column (f).
(18) Cash & Contributions C 7IC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (c).
(19) Cash & Contributions D 7ID $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (d).
(20) Cash & Contributions E 7IE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (e).
(21) Cash & Contributions % 7IF% <ENTER> Enter the percent from Schedule H, Part I, Line 7i, Column (f).
(22) Total Other Benefits C 7JC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (c).
(23) Total Other Benefits D 7JD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (d).
(24) Total Other Benefits E 7JE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (e).
(25) Total Other Benefits Percent 7JF% <ENTER> Enter the percent from Schedule H, Part I, Line 7j, Column (f).
(26) Total C 7KC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (c).
(27) Total D 7KD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (d).
(28) Total E 7KE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (e).
(29) Total Percent 7KF% <ENTER> Enter the percent from Schedule H, Part I, Line 7k, Column (f).
Exhibit 3.24.12-17

Form 990 - Section 33, Schedule H (2014 and 2015)

3.24.12 - 17 SECTION 33
Source Document or Record: Forms 990 - Section 33, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "16" .
(2) Total Net Community PII10E $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part II, Line 10, Column (e).
(3) Total Percent of Expense 10F% <ENTER> Enter the percent from Schedule H, Part II, Line 10 Column (f).
(4) Report Bad Debt Expense PT3L1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part III, Line 1.
(5) Bad Debt Expense Amount L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 2.
(6) Estimated Bad Debt Expense Amount L3 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 3.
(7) Revenue from Medicare L5 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 5.
(8) Medicare Allowable Costs L6 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 6.
(9) Medicare Surplus or Shortfall L7 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 7.
(10) Costing Methodology or Source Code L8CD <ENTER> Enter the edited code from the right of the boxes from Schedule H, Part III, Line 8.
(11) Written Debt Collection Policy L9A <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9a.
(12) Collection Policy Contain Provision L9B <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9b.
(13) Part IV Code PIVCD <ENTER> Enter the edited digit from Schedule H, Part IV, right margin.
(14) Part V How Many Hospital Facilities Did Organization Operate SECATOP <ENTER> Enter the number shown in the Hospital Facilities area in the top left portion of Schedule H, Part V, Section A.
(15) Part V Section C Indicator Code SECCRM <ENTER> Enter the indicator code from Schedule H, Part V, Section C, right margin.
(16) Part V How Many Non-Hospital Facilities Did Organization Operate SECCTOP <ENTER> Enter the number from the non-hospital health care benefits line.
(17) Part V Section D Indicator Code SECTDRM <ENTER> Enter the edited code from Schedule H, Part V, Section D, right margin.
Exhibit 3.24.12-18

Form 990 - Section 34, Schedule H (2014 and 2015)

3.24.12 - 18 SECTION 34
Source Document or Record: Forms 990 - Section 34, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "34" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-19

Form 990 - Section 35, Schedule H (2014 and 2015)

3.24.12 - 19 SECTION 35
Source Document or Record: Forms 990 - Section 35, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "35" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-20

Form 990 - Section 36, Schedule H (2014 and 2015)

3.24.12 - 20 SECTION 36
Source Document or Record: Forms 990 - Section 36, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "36" .
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Filling Field     Generate blank field on output.
(6) Actions That Require Legal or Judicial Process 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(7) Other Similar Actions 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(8) Notified Financial Assistance Upon Admission 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Notified Financial Assistance Prior to Discharge 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Notified Financial Assistance in Bills 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Documented Its Determination 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Negotiated Commercial Insurance Rate 22A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Average of the Three Lowest Negotiated Commercial Insurance Rates 22B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Medicare Rate 22C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Other 22D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-21

Form 990 - Section 37, Schedule H (2014 and 2015)

3.24.12 - 21 SECTION 37
Source Document or Record: Forms 990 - Section 37, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "37" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-22

Form 990 - Section 38, Schedule H (2014 and 2015)

3.24.12 - 22 SECTION 38
Source Document or Record: Forms 990 - Section 38, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "38" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17 is checked.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate a blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-23

Form 990 - Section 39, Schedule H (2014 and 2015)

3.24.12 - 23 SECTION 39
Source Document or Record: Forms 990 - Section 39, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "39" .
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Filling Field     Generate blank field on output.
(6) Actions That Require Legal or Judicial Process 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(7) Other Similar Actions 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(8) Notified Financial Assistance Upon Admission 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Notified Financial Assistance Prior to Discharge 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Notified Financial Assistance in Bills 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Documented Its Determination 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Negotiated Commercial Insurance Rate 22A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Average of the Three Lowest Negotiated Commercial Insurance Rates 22B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Medicare Rate 22C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Other 22D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-24

Form 990 - Section 40, Schedule H (2014 and 2015)

3.24.12 - 24 SECTION 40
Source Document or Record: Forms 990 - Section 40, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "40" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-25

Form 990 - Section 41, Schedule H (2014 and 2015)

3.24.12 - 25 SECTION 41
Source Document or Record: Forms 990 - Section 41, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "41" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17 is checked.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-26

Form 990 - Section 42, Schedule H (2014 and 2015)

3.24.12 - 26 SECTION 42
Source Document or Record: Forms 990 - Section 42, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "42" .
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Filling Field     Generate blank field on output.
(6) Actions That Require Legal or Judicial Process 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(7) Other Similar Actions 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(8) Notified Financial Assistance Upon Admission 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Notified Financial Assistance Prior to Discharge 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Notified Financial Assistance in Bills 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Documented Its Determination 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Negotiated Commercial Insurance Rate 22A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Average of the Three Lowest Negotiated Commercial Insurance Rates 22B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Medicare Rate 22C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Other 22D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-27

Form 990 - Section 43, Schedule H (2014 and 2015)

3.24.12 - 27 SECTION 43
Source Document or Record: Forms 990 - Section 43, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "43" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-28

Form 990 - Section 44, Schedule H (2014 and 2015)

3.24.12 - 28 SECTION 44
Source Document or Record: Forms 990 - Section 44, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "44" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17 is checked.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-29

Form 990 - Section 45, Schedule H (2014 and 2015)

3.24.12 - 29 SECTION 45
Source Document or Record: Forms 990 - Section 45, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "45" .
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Filling Field     Generate blank field on output.
(6) Actions That Require Legal or Judicial Process 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(7) Other Similar Actions 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(8) Notified Financial Assistance Upon Admission 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Notified Financial Assistance Prior to Discharge 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Notified Financial Assistance in Bills 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Documented Its Determination 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Negotiated Commercial Insurance Rate 22A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Average of the Three Lowest Negotiated Commercial Insurance Rates 22B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Medicare Rate 22C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Other 22D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-30

Form 990 - Section 46, Schedule H (2014 and 2015)

3.24.12 - 30 SECTION 46
Source Document or Record: Forms 990 - Section 46, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "46" .
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-31

Form 990 - Section 47, Schedule H (2014 and 2015)

3.24.12 - 31 SECTION 47
Source Document or Record: Forms 990 - Section 47, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "47" .
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a" 1" if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) Filling Field     Generate a blank field on output.
(19) Other 16I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16i is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17 is checked.
(21) Reporting to Credit Agency 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Filling Field     Generate blank field on output.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-32

Form 990 - Section 48, Schedule H (2014 and 2015)

3.24.12 - 32 SECTION 48
Source Document or Record: Forms 990 - Section 48, Schedule H (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "48" .
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Filling Field     Generate blank field on output.
(6) Actions That Require Legal or Judicial Process 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(7) Other Similar Actions 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(8) Notified Financial Assistance Upon Admission 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Notified Financial Assistance Prior to Discharge 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Notified Financial Assistance in Bills 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Documented Its Determination 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Negotiated Commercial Insurance Rate 22A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Average of the Three Lowest Negotiated Commercial Insurance Rates 22B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Medicare Rate 22C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Other 22D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-33

Form 990 - Section 49, Schedules L and R (2014 and 2015)

3.24.12 - 33 SECTION 49
Source Document or Record: Forms 990 - Section 49, Schedules L & R (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "49" .
(2) Excess Benefit Transactions PT1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part 1.
(3) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
(4) Interest, Annuities, Royalties, Yes/No Box SCHR PT51A <ENTER> Enter a yes or a no from the yes/no box from Schedule R, Part V, Line 1a.
Exhibit 3.24.12-34

Form 990 - Section 01 (2016 and 2017)

Form 990-Section 01 (2016 and 2017)
3.24.12 - 34 SECTION 01
Source Document or Record: Forms 990 - Section 01 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section 01 always generates. No entry required.
(2) Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generated the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5 for procedures.
(3a) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5 for procedures.
(4) E.I.N. EIN <ENTER>
★★★★★★		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) For a CP 425–431 & 259A-259H, underlined to the right of the Employer ID Number.
(b) See standard rules in IRM 3.24.38.
(c) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(5) Address Check ADDRESS CHECK? <ENTER> Enter Y or N as appropriate.
(6) Street Key STREET KEY <ENTER> See IRM 3.24.38
(7) ZIP Key ZIP KEY <ENTER> SeeIRM 3.24.38
(8) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under title of form.
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) For a CP 425–431 & 259A-259H, edited in the area around the Tax Period.
(9) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.
(10) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(11) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a G Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(12) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country code.
(13) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(14) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(15) Group Code H(b) BOXHB <ENTER> Enter a 1 or 2 from the yes/no box from the entity area of the return, Line H(b). For a CP425–431 & 259A-259H, press <ENTER> only.
(16) Tax Exempt Status BOXI <ENTER> Enter the edited two digit code from the blank space of Box I.
(17) Type of Organization BOXK RT <ENTER> Enter the edited code from the blank space of Box K. For a CP 425–431 & 259A-259H always enter a 9.
(18) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 2–7b. For a 420–431 & 259A-259H, enter the edited characters as shown in the center of the return. If a Condition Code is illegible, enter a # in its place.
(19) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a G Condition Code is present and the return is non-remittance, end the document after this element.
(c) If a CP 425–431 & 259A-259H, end the document after this element.
(20) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(21) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(22) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
(23) Preparer Telephone # TEL# <ENTER> Enter the preparer phone number.
(a) If the Type of Organization is a 9, and the "9" is underlined, don't end the document. Continue transcribing the return.
(b) If Type of Organization is a 9, and the 9 is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If present, continue to that element and follow the instructions there.
(24) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the 600 series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the 600 series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a G Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
9 from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
9, and the 9 is NOT underlined, press <F6> and end the document after this element.
Exhibit 3.24.12-35

Form 990 - Section 02 (2016 and 2017)

Form 990 - Section 02 (2016 and 2017)
3.24.12 - 35 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800 - Edit Sheet (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 02.
(2) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(3) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(4) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(5) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(6) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-36

Form 990 - Section 03 (2016 and 2017)

Form 990 - Section 03 (2016 and 2017)
3.24.12 - 36 SECTION 03
Source Document or Record: Forms 990 - Section 03, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 03.
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return, ONLY if underlined in green.
(3) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(4) Undertake New Activities Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2.
(5) Make Significant Changes Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3.
(6) Exempt Purpose Code 1 L4A <ENTER> Press Enter only. Don't transcribe a code.
(7) Exempt Purpose Code 2 L4B <ENTER> Press Enter only. Don't transcribe a code.
(8) Exempt Purpose Code 3 L4C <ENTER> Press Enter only. Don't transcribe a code.
(9) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.

Note:

If a "D1" is edited and underlined, pick up as an alpha "D" and numeric "1" . Don't confuse with an alpha "D" and alpha "I" .
(10) 501(c)(3) or 4947(a)(1) Y/N L1 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 1.
(11) Required to Complete Sch B Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 2.
(12) Engage in Direct or Indirect Political Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 3.
(13) Engage in Lobbying Activities Y/N L4 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 4.
(14) Subject to Sec 6033(c) Notice L5 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 5.
(15) Maintain Donor Advised Y/N L6 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 6.
(16) Receive or Hold Conservation Y/N L7 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 7.
(17) Maintain Collections of Works of Art Y/N L8 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 8.
(18) Provide Credit Counseling Y/N L9 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 9.
(19) Hold Assets in Term/Permanent Y/N L10 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 10.
(20) Land, Buildings, Equipment 11A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11a.
(21) Investments Other Securities 11B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11b.
(22) Investments Program Related 11C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11c.
(23) Other Assets 11D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11d.
(24) Other Liabilities 11E <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11e.
(25) Separate or Consolidated Financial Statements 11F <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11f.
(26) Separate Independent Audited Financial 12A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12a.
(27) Consolidated Independent Financial 12B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12b.
(28) School Described in 170(b)(1)(A)(ii) L13 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 13.
(29) Maintain an Office, etc Outside U.S. 14A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14a.
(30) Have Aggregate Revenues/Expenses 14B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14b.
(31) Report > $5000 on Part IX Organizations L15 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 15.
(32) Report > $5000 on Part IX Individuals L16 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 16.
(33) Report > $15,000 on Part IX, Line 11e L17 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 17.
(34) Report > $15,000 on Part VIII, Line 1c/8a L18 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 18.
(35) Report > $15,000 on Part VIII, Line 9a L19 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 19.
(36) Operate Hospitals 20A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20a.
(37) Attach Audited Financial Statements 20B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20b.
Exhibit 3.24.12-37

Form 990 - Section 04 (2016 and 2017)

Form 990 - Section 04 (2016 and 2017)
3.24.12 - 37 SECTION 04
Source Document or Record: Forms 990 - Section 04, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 04.
(2) Report > $5000 on Part IX, Line 1 L21 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 21.
(3) Report > $5000 on Part IX, Line 2 L22 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 22.
(4) Answer Yes to Questions 3, 4, 5 L23 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 23.
(5) Any Tax-Exempt Bond with Outstanding Principal 24A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24a.
(6) Invest Any Proceeds 24B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24b.
(7) Maintain an Escrow Account 24C <ENTER> Enter a yes or no from the yes/box from Part IV, Line 24c.
(8) Act as On Behalf Of Issuer 24D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24d.
(9) 501(c)(3) / 501(c)(4) Organizations 25A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25a.
(10) Become Aware it Engaged in Excess 25B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25b.
(11) Loan to/by Current/Former Officer L26 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 26.
(12) Provide Grant or Other Assistance L27 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 27.
(13) Business Transaction with Current or Former Officer 28A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28a.
(14) Business Transaction with Family Member 28B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28b.
(15) Business Transaction with Entity of Current/ Former Officer 28C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28c.
(16) Receive or Accrue > $25,000 in Non-Cash L29 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 29.
(17) Receive or Accrue Contributions of Art L30 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 30.
(18) Liquidate, Terminate, Dissolve L31 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 31.
(19) Sell, Exchange, Dispose L32 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 32.
(20) Own 100% of an Entity L33 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 33.
(21) Related to Tax-Exempt / Taxable Entity L34 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 34.
(22) Controlled Entity Within 512(b)(13) 35A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35a.
23 Receive Payment or Engage Transaction Within 35B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35b.
(24) Make Any Transfers L36 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 36.
(25) Conduct More than 5% L37 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 37.
(26) Complete Schedule O L38 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 38.
Exhibit 3.24.12-38

Form 990 - Section 05 (2016 and 2017)

Form 990 - Section 05 (2016 and 2017)
3.24.12 - 38 SECTION 05
Source Document or Record: Forms 990 - Section 05, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 05.
(2) Part V Number of Forms/1096 PTVL1A <ENTER> Enter the number shown on Part V, Line 1a.
(3) Number of Forms W-2G L1B <ENTER> Enter the number shown on Part V, Line 1b.
(4) Comply with Backup Withholding Rules L1C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 1c.
(5) Number of Employees / W-3 L2A <ENTER> Enter the number shown on Part V, Line 2a.
(6) File All Required Federal Employment Returns L2B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 2b.
(7) Unrelated Business Income > $1000 L3A <ENTER> Enter a yes or no from the yes/box from Part V, Line 3a.
(8) If Yes, Has Filed a 990-T L3B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 3b.
(9) Interest in or a Signature L4A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 4a.
(10) Party to a Prohibited Tax Shelter L5A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5a.
(11) Taxable Party Notify Organization L5B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5b.
(12) If Yes, Did Organization File 8886-T L5C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5c.
(13) Annual Gross Receipts Normally >$100,000 L6A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6a.
(14) If Yes, Did Organization Include L6B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6b.
(15) >$75 Partly Contribution/Goods/Services L7A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7a.
(16) If Yes, Did Organization Notify Donor L7B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7b.
(17) Sell, Exchange, Otherwise Dispose L7C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7c.
(18) Number of Forms 8282 L7D <ENTER> Enter the number shown on Part V, Line 7d.
(19) Receive Any Funds L7E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7e.
(20) Pay Premiums L7F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7f.
(21) Contributions of Qualified Intellectual Property L7G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7g.
(22) Contributions of Cars, Boats, Airplanes L7H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7h.
(23) Sponsoring Orgs, 509(a)(3) Excess Business Holdings L8 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 8.
(24) Make Taxable Distributions Under 4966 L9A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9a.
(25) Make Distribution to Donor L9B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9b.
(26) Initiation Fees/Capital Contributions 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10a.
(27) Gross Receipts for Public Use of Facilities 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10b.
(28) Gross Income/Members/Shareholders 11A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11a.
(29) Gross Income from Other Sources 11B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11b.
(30) 4947(a)(1) Filing 990 in Lieu of 1041 12A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 12a.
(31) Amount of Tax Exempt Interest 12B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 12b.
(32) Licensed to Issue Qualified Health Plans 13A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 13a.
(33) Aggregate Amount of Reserves to Maintain 13B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13b.
(34) Aggregate Amount of Reserves on Hand 13C $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13c.
(35) Receive Payments for Indoor Tanning 14A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14a.
(36) Filed Form 720 to Report Payments 14B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14b.
Exhibit 3.24.12-39

Form 990 - Section 06 (2016 and 2017)

Form 990 - Section 06 (2016 and 2017)
3.24.12 - 39 SECTION 06
Source Document or Record: Forms 990 - Section 06, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 06.
(2) Voting Members of Governing Body PG6L1A <ENTER> Enter the number shown on Part VI, Section A, Line 1a.
(3) Independent Voting Members L1B <ENTER> Enter the number shown on Part VI, Section A, Line 1b.
(4) Officer, Director, Trustee Family/Relationship L2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 2.
(5) Delegate Control Over Management L3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 3.
(6) Make Significant Changes L4 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 4.
(7) Become Aware of Material Diversion L5 <ENTER> Enter a yes or no from the yes/box from Part VI, Section A, Line 5.
(8) Members of Stockholders L6 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 6.
(9) Members, Stockholders, Other Persons 7A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7a.
(10) Members Subject to Approval 7B <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7b.
(11) Determining Compensation for CEO, Exec Director 15A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section B, Line 15a.
(12) Total Reportable Compensation from Organization PG8L1D(D) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column D.
(13) Total Reportable Compensation from Related Organization 1D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column E.
(14) Total Compensation from Organization & Related Organizations 1D(F) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column F.
(15) Total Individuals who Received > $100,000 SECTAL2 <ENTER> Enter the number shown on Part VII, Section A, Line 2.
(16) Total Independent Contractors Received > $100,000 SECTBL2 <ENTER> Enter the number shown on Part VII, Section B, Line 2.
Exhibit 3.24.12-40

Form 990 - Section 07 (2016 and 2017)

Form 990 - Section 07 (2016 and 2017)
3.24.12 - 40 SECTION 07
Source Document or Record: Forms 990 - Section 07, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 07.
(2) Total Contributions/
Gifts/Grants		 PG9L1H $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 1h, Column (A).
(3) Program Service Business Code 2A 2ACODE <ENTER> Enter the number shown on Part VIII, Line 2a.
(4) 2a Program Service Revenue Col. A 2A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2a, Column (A).
(5) Program Service Business Code 2B 2BCODE <ENTER> Enter the number shown on Part VIII, Line 2b.
(6) 2b Program Service Revenue Col. A 2B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2b, Column (A).
(7) Program Service Business Code 2C 2CCODE <ENTER> Enter the number shown on Part VIII, Line 2c.
(8) 2c Program Service Revenue Col. A 2C(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2c, Column (A).
(9) Program Service Business Code 2D 2DCODE <ENTER> Enter the number shown on Part VIII, Line 2d.
(10) 2d Program Service Revenue Col. A 2D(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2d, Column (A).
(11) Program Service Business Code 2E 2ECODE <ENTER> Enter the number shown on Part VIII, Line 2e.
(12) 2e Program Service Revenue Col. A 2E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2e, Column (A).
(13) 2f Program Service Revenue Col. A 2F(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2f, Column (A).
(14) 2g Program Service Revenue Total Col. A 2GTOT $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 2g, Column (A).
(15) Investment Income Col. A 3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 3, Column (A).
(16) Tax-Exempt Bond Proceeds Col. A 4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 4, Column (A).
(17) Royalties Col. A 5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 5, Column (A).
(18) Gross Rents Real 6(A)I $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (i).
(19) Gross Rents Personal 6(A)II $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (ii).
(20) Rental Expenses Real 6(B)(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (i).
(21) Rental Expenses Personal 6(B)(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (ii).
(22) Rental Income/Loss Real 6C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (i).
(23) Rental Income/Loss Personal 6C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (ii).
(24) Net Rental Income/Loss Col. A 6D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6d, Column (A).
Exhibit 3.24.12-41

Form 990 - Section 08 (2016 and 2017)

Form 990 - Section 08 (2016 and 2017)
3.24.12 - 41 SECTION 08
Source Document or Record: Forms 990 - Section 08, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08..
(2) Gross Amount from Sales of Assets - Securities PG9L7A(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (i).
(3) Gross Amount from Sales of Assets - Other 7A(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (ii).
(4) Cost or Other Basis/Sales - Securities 7B(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (i).
(5) Cost or Other Basis/Sales - Other 7B(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (ii).
(6) Gain/Loss - Securities 7C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (i).
(7) Gain/Loss - Other 7C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (ii).
(8) Net Gain/Loss Col. A 7D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7d, Column (A).
(9) Gross Income from Fundraising 8A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8a.
(10) Less Direct Expenses 8b 8B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8b.
(11) Net Income/Loss from Fundraising Col. A 8C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8c, Column (A).
(12) Gross Income from Gaming 9A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9a.
(13) Less Direct Expenses 9b 9B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9b.
(14) Net Income/Loss from Gaming 9C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9c, Column (A).
(15) Gross Sales of Inventory 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10a.
(16) Less Cost of Goods Sold 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10b.
(17) Net Income/Loss from Sales Col. A 10C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10c, Column (A).
(18) Misc. Revenue Business Code 11a 11ACODE <ENTER> Enter the number shown on Part VIII, Line 11a.
(19) Misc. Revenue Total (A) Col. A 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11a, Column (A).
(20) Misc. Revenue Business Code 11b 11BCODE <ENTER> Enter the number shown on Part VIII, Line 11b.
(21) Misc. Revenue Total 11B(A) Col. A 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11b, Column (A).
(22) Misc. Revenue Business Code 11c 11CCODE <ENTER> Enter the number shown on Part VIII, Line 11c.
(23) Misc. Revenue Total 11C(A) Col. A 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11c, Column (A).
(24) Misc. Revenue Total 11D(A) Col. A 11D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11d, Column (A).
(25) Misc. Revenue Total 11E Col. A 11ETOT $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11e, Column (A).
(26) Total Revenue 12(A) Col. A 12(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 12, Column (A).
Exhibit 3.24.12-42

Form 990 - Section 09 (2016 and 2017)

Form 990 - Section 09 (2016 and 2017)
3.24.12 - 42 SECTION 09
Source Document or Record: Forms 990 - Section 09, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 09..
(2) Gross to Government / Organizations in U.S. PG10L1(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 1, Column (A).
(3) Grants / Other Assistance in U.S. L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 2, Column (A).
(4) Grants / Other Assistance Outside U.S. L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 3, Column (A).
(5) Benefits Paid to / for Members L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 4, Column (A).
(6) Compensation of Current Officers / Directors L5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 5, Column (A).
(7) Compensation to Disqualified Persons L6(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 6, Column (A).
(8) Other Salaries / Wages L7(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 7, Column (A).
(9) Pension Plan Contributions L8(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 8, Column (A).
(10) Other Employee Benefits L9(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 9, Column (A).
(11) Payroll Taxes 10(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 10, Column (A).
(12) Fees for Services / Management 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11a, Column (A).
(13) Fees for Services / Legal 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11b, Column (A).
(14) Fees for Services / Accounting 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11c, Column (A).
(15) Fees for Services / Lobbyists 11D(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11d, Column (A).
(16) Fees for Services / Professional Fundraising 11E(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11e, Column(A).
(17) Fees for Services / Investment Management 11F(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11f, Column (A).
(18) Fees for Services / Other 11G(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from shown on Part IX, Line 11g, Column (A).
(19) Advertising / Promotion 12(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 12, Column (A).
(20) Office Expenses 13(A) $ <ENTER>
MINUS (-)		 Enter the amount from on Part IX, Line 13, Column (A).
(21) Information Technology 14(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 14, Column (A).
(22) Royalties 15(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 15, Column (A).
(23) Occupancy 16(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 16, Column (A).
(24) Travel 17(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 17, Column (A).
(25) Payments of Travel / Entertainment 18(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 18, Column (A).
(26) Conferences, Conventions / Meetings 19(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 19, Column (A).
(27) Interest 20(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 20, Column (A).
(28) Payments to Affiliates 21(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 21, Column (A).
(29) Depreciation / Depletion 22(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 22, Column (A).
(30) Insurance 23(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 23, Column (A).
(31) Other Expenses a 24A(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 24a, Column (A).
(32) Other Expenses b 24B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24b, Column (A).
(33) Other Expenses c 24C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24c, Column (A).
(34) Other Expenses d 24D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24d, Column (A).
(35) Other Expenses e 24E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24e, Column (A).
(36) NA 24F$ <ENTER> Enter only.
(37) Total Functional Expenses 25(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 25, Column (A).
Exhibit 3.24.12-43

Form 990 - Section 10 (2016 and 2017)

Form 990 - Section 10 (2016 and 2017)
3.24.12 - 43 SECTION 10
Source Document or Record: Forms 990 - Section 10, (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 10.
(2) Cash EOY PG11L1(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 1, Column (B).
(3) Savings / Temporary Investments EOY L2(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 2, Column (B).
(4) Pledges / Grants Receivable EOY L3(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 3, Column (B).
(5) Accounts Receivable EOY L4(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 4, Column (B).
(6) Receivables from Current / Former EOY L5(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 5, Column (B).
(7) Receivables from Disqualified Persons EOY L6(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 6, Column (B).
(8) Notes / Loans Receivable EOY L7(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 7, Column (B).
(9) Inventories for Sale EOY L8(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 8, Column (B).
(10) Prepaid Expenses EOY L9(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 9, Column (B).
(11) Land / Buildings Less Accumulated EOY 10C(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 10c, Column (B).
(12) Investments Publicly Traded Securities EOY 11(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 11, Column (B).
(13) Investments Other Securities EOY 12(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 12, Column (B).
(14) Investments Program Related EOY 13(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 13, Column (B).
(15) Intangible Assets EOY 14(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 14, Column (B).
(16) Other Assets EOY 15(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 15, Column(B).
(17) Total Assets BOY 16(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 16, Column (A).
(18) Total Assets EOY 16(B) $ <ENTER>
MINUS (-)		 Enter the amount from shown on Part X, Line 16, Column (B).
(19) Accounts Payable EOY 17(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 17, Column (B).
(20) Grants Payable EOY 18(B) $ <ENTER>
MINUS (-)		 Enter the amount from on Part X, Line 18, Column (B).
(21) Deferred Revenue EOY 19(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 19, Column (B).
(22) Tax-Exempt Bond Liabilities EOY 20(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 20, Column (B).
(23) Escrow Liability EOY 21(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 21, Column (B).
(24) Payable to Current / Former Officers EOY 22(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 22, Column (B).
(25) Secured Mortgages / Notes EOY 23(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 23, Column (B).
(26) Unsecured Notes / Loans EOY 24(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 24, Column (B).
(27) Other Liabilities EOY 25(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 25, Column (B).
(28) Total Liabilities BOY 26(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 26, Column (A).
(29) Total Liabilities EOY 26(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 26, Column (B).
(30) Unrestricted Net Assets EOY 27(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 27, Column (B).
(31) Temporarily Restricted Net Assets EOY 28(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 28, Column (B).
(32) Permanently Restricted Net Assets EOY 29(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 29, Column (B).
(33) Capital Stock / Trust EOY 30(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 30, Column (B).
(34) Paid-In / Capital Surplus EOY 31(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 31, Column (B).
(35) Retained Earnings, Endowment EOY 32(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 32, Column (B).
(36) Total Net Assets or Fund Balances BOY 33(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 33, Column (A).
(37) Total Net Assets or Fund Balances EOY 33(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 33, Column (B).
(38) Total Liabilities / Net Assets Fund Balances EOY 34(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 34, Column (B).
Exhibit 3.24.12-44

Form 990 - Section 11, Schedule A (2016 and 2017)

Form 990 - Section 11 Schedule A (2016 and 2017)
3.24.12 - 44 SECTION 11
Source Document or Record: Form 990 - Section 11, Schedule A (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 11.
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter one of the following from Line 12:
1 = Type I, 2 = Type II, 3 = Type III – Functionally integrated
4 = Type III – Non-functionally integrated Blank <ENTER>.
If more than one box is checked, enter the corresponding number for the first box checked.
(4) Type I, II or III Supporting Organization 11E <ENTER> Enter a 1 if the box is checked on Schedule A, Part I, Line 12e.
(5) Number of Supported Organizations 11F <ENTER> Enter the number from Line 12f.
(6) EIN A 12G(II)A <ENTER> Enter the EIN in Part I, Line 11g, Row A, Column (ii).
(7) Type of Org A 12G(III)A <ENTER> Enter the type of organization in Part I, Line 11g, Row A, Column (iii). If more than one digit, enter the first digit only.
(8) Listed in Governing Doc A 12G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row A, Column (iv).
(9) Amount of Support A 12G(V) A$ <ENTER> Enter the amount on Part I, Line 12g, Row A, Column (v).
(10) EIN B 12G(II)B <ENTER> Enter the EIN in Part I, Line 12g, Row B, Column (ii).
(11) Type of Org B 12G(III)B <ENTER> Enter the type of organization in Part I, Line 12g, Row B, Column (iii).
(12) Listed in Governing Doc B 12G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row B, Column (iv).
(13) Amount of Support B 12G(V)B $ <ENTER> Enter the amount Part I, Line 12g, Row B, Column (v).
(14) EIN C 12G(II)C <ENTER> Enter the EIN in Part I, Line 12g, Row C, Column (ii).
(15) Type of Org C 12G(III)C <ENTER> Enter the type of organization in Part I, Line 12g, Row C, Column (iii).
(16) Listed in Governing Doc C 12G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row C, Column (iv).
(17) Amount of Support C 12G(V)C $ <ENTER> Enter the amount on Part I, Line 12g, Row C, Column (v).
(18) EIN D 12G(II)D <ENTER> Enter the EIN in Part I, Line 12g, Row D, Column (ii).
(19) Type of Org D 12G(III)D <ENTER> Enter the type of organization in Part I, Line 12g, Row D, Column (iii).
(20) Listed in Governing Doc D 12G(IV)D <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row D, Column (iv).
(21) Amount of Support D 12G(V)D $ <ENTER> Enter the amount on Part I, Line 12g, Row D, Column (v).
(22) EIN E 12G(II)E <ENTER> Enter the EIN in Part I, Line 12g, Row E, Column (ii).
(23) Type of Org E 12G(III)E <ENTER> Enter the type of organization in Part I, Line 12g, Row E, Column (iii).
(24) Listed in Governing Doc E 12G(IV)E <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row E, Column (iv).
(25) Amount of Support E 12G(V)E $ <ENTER> Enter the amount on Part I, Line 12g, Row E, Column (v).
(26) Filling Field     Blank field generated on output.
(27) Total Number of Organizations 12G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 12h, Column (i), Total Line.
(28) Total Amount of Support GVTOT $ <ENTER> Enter the amount on Part I, Line 12g, Total, Column (v).
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-45

Form 990 - Section 12, Schedule A (2016 and 2017)

Form 990 - Section 12 Schedule A (2016 and 2017)
3.24.12 - 45 SECTION 12
Source Document or Record: Forms 990 - Section 12, Schedule A (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 12.
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Filling Field     Generates a blank field on output.
(29) Excess Distributions C PTVE3C $ <ENTER> Enter the amount from Part V, Section E, Line 3c.
(30) Excess Distributions D PTVE3D $ <ENTER> Enter the amount from Part V, Section E, Line 3d.
(31) Excess Distributions E PTVE3E $ <ENTER> Enter the amount from Part V, Section E, Line 3e.
(32) Excess Distributions Breakdown B PTVE8B <ENTER> Enter the amount from Part V, Section E, Line 3b.
(33) Excess Distributions Breakdown C PTVE8C <ENTER> Enter the amount from Part V, Section E, Line 3c.
(34) Excess Distributions Breakdown D PTVE8D <ENTER> Enter the amount from Part V, Section E, Line 3d.
(35) Excess Distributions Breakdown E PTVE8E <ENTER> Enter the amount from Part V, Section E, Line 3e.
Exhibit 3.24.12-46

Form 990 - Section 13, Schedules C & D (2016 and 2017)

Form 990 - Section 13, Schedules C & D (2016 and 2017)
3.24.12 - 46 SECTION 13
Source Document or Record: Forms 990 - Section 13, Schedules C & D (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Political Expenditures SCHIAL2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Total Number at EOY SCHDL1(A) <ENTER> Enter the number shown on Schedule D, Part I, Line 1, Column (a).
(4) Contributions To L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 2, Column (a).
(5) Grants From L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 3, Column (a).
(6) Aggregate Value L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 4, Column (a).
(7) Inform All Donors Checkbox L5 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 5.
(8) Inform All Grantees Checkbox L6 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 6.
Exhibit 3.24.12-47

Form 990 - Section 31, Schedule H (2016 and 2017)

Form 990 - Section 31, Schedule H (2016 and 2017)
3.24.12 - 47 SECTION 31
Source Document or Record: Form 990 - Section 31, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 31.
(2) Financial Assistance L1A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1a: 1 = yes 2 = no.
(3) Written Policy L1B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1b: 1 = yes 2 = no.
(4) Best Describes L2 <ENTER> Enter the following:
1 = Applied Uniformly to all. 2 = Applied Uniformly to most.
3 = Generally tailored.
(5) FPG Used L3A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3a: 1 = yes 2 = no.
(6) FPG% L3A% <ENTER> Enter the following from Schedule H, Part I, Line 3a percent:
1 = 100%
2 = 150%
3 = 200%
4 = Other.
(7) FPG Discounted Care L3B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3b: 1 = yes
2 = no.
(8) FPG Discounted Care % L3B% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3b percent:
1 = 200%
2 = 250%
3 = 300%
4 = 350%
5 = 400%
6 = Other
If more than one box is checked, enter the number for the largest percent..
(9) Applied to Largest Number of Patients L4 <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 4: 1 = yes
2 = no.
(10) Budget Amounts for Free or Discounted L5A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5a: 1 = yes
2 = no.
(11) Exceed Budget Amount L5B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5b: 1 = yes
2 = no.
(12) Unable to Provide Free or Discounted Care L5C <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5c: 1 = yes
2 = no.
(13) Prepare A Community Benefit Report L6A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6a: 1 = yes
2 = no.
(14) Available to Public L6B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6b: 1 = yes
2 = no.
(15) Financial Assistance C L7AC $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (c).
(16) Financial D L7AD $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (d).
(17) Financial Assistance at Cost Net Community SCHH 7A(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7a, Column (e).
(18) Financial Assistance at Cost Percent 7A(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7a, Column (f).
(19) Medicaid C L7BC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (c).
(20) Medicaid D L7BD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (d).
(21) Unreimbursed Medicaid Net Community 7B(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (e).
(22) Unreimbursed Medicaid Percent 7B(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7b, Column (f).
(23) Cost of Other Means Tested C L7CC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (c).
(24) Cost of Other Means Tested D L7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (d).
(25) Unreimbursed Costs - Other Net Community 7C(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (e).
(26) Unreimbursed Costs - Other Percent 7C(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7c, Column (f).
(27) Financial Assistance Total C 7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (c).
(28) Financial Assistance Total D 7DD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (d).
(29) Total Financial Assistance Net Community 7D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (e).
(30) Total Financial Assistance Percent 7D(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7d, Column (f).
Exhibit 3.24.12-48

Form 990 - Section 32, Schedule H (2016 and 2017)

Form 990 - Section 32, Schedule H (2016 and 2017)
3.24.12 - 48 SECTION 32
Source Document or Record: Forms 990 - Section 32, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 32.
(2) Community Health Improvement C 7EC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (c).
(3) Community Health Improvement D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (d).
(4) Community Health Improvement E 7EE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (e).
(5) Community Health Improvement Percent 7EF% <ENTER> Enter the percent from Schedule H, Part I, Line 7e, Column (f).
(6) Health Professions C 7FC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (c).
(7) Health Professions D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (d).
(8) Health Professions E 7FE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (e).
(9) Health Professions Percent 7FF% <ENTER> Enter the percent from Schedule H, Part I, Line 7f, Column (f).
(10) Subsidized Health Services C 7GC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (c).
(11) Subsidized Health Services D 7GD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (d).
(12) Subsidized Health Services E 7GE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (e).
(13) Subsidized Health Services Percent 7GF% <ENTER> Enter the percent from Schedule H, Part I, Line 7g, Column (f).
(14) Research C 7HC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (c).
(15) Research D 7HD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (d).
(16) Research E 7HE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (e).
(17) Research F Percent 7HF% <ENTER> Enter the percent from Schedule H, Part I, Line 7h, Column (f).
(18) Cash & Contributions C 7IC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (c).
(19) Cash & Contributions D 7ID $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (d).
(20) Cash & Contributions E 7IE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (e).
(21) Cash & Contributions % 7IF% <ENTER> Enter the percent from Schedule H, Part I, Line 7i, Column (f).
(22) Total Other Benefits C 7JC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (c).
(23) Total Other Benefits D 7JD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (d).
(24) Total Other Benefits E 7JE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (e).
(25) Total Other Benefits Percent 7JF% <ENTER> Enter the percent from Schedule H, Part I, Line 7j, Column (f).
(26) Total C 7KC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (c).
(27) Total D 7KD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (d).
(28) Total E 7KE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (e).
(29) Total Percent 7KF% <ENTER> Enter the percent from Schedule H, Part I, Line 7k, Column (f).
Exhibit 3.24.12-49

Form 990 - Section 33, Schedule H (2016 and 2017)

Form 990 - Section 33, Schedule H (2016 and 2017)
3.24.12 - 49 SECTION 33
Source Document or Record: Forms 990 - Section 33, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 16.
(2) Total Net Community PIII0E $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part II, Line 10, Column (e).
(3) Total Percent of Expense 10F% <ENTER> Enter the percent from Schedule H, Part II, Line 10 Column (f).
(4) Report Bad Debt Expense PT3L1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part III, Line 1.
(5) Bad Debt Expense Amount L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 2.
(6) Estimated Bad Debt Expense Amount L3 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 3.
(7) Revenue from Medicare L5 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 5.
(8) Medicare Allowable Costs L6 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 6.
(9) Medicare Surplus or Shortfall L7 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 7.
(10) Costing Methodology or Source Code L8CD <ENTER> Enter the edited code from the right of the boxes from Schedule H, Part III, Line 8.
(11) Written Debt Collection Policy L9A <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9a.
(12) Collection Policy Contain Provision L9B <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9b.
(13) Part IV Code PIVCD <ENTER> Enter the edited digit from Schedule H, Part IV, right margin.
(14) Part V How Many Hospital Facilities Did Organization Operate SECATOP <ENTER> Enter the number shown in the Hospital Facilities area in the top left portion of Schedule H, Part V, Section A.
(15) Part V Section C Indicator Code SECCRM <ENTER> Enter the indicator code from Schedule H, Part V, Section C, right margin.
(16) Part V How Many Non-Hospital Facilities Did Organization Operate SECCTOP <ENTER> Enter the number from the non-hospital health care benefits line.
(17) Part V Section D Indicator Code SECTDRM <ENTER> Enter the edited code from Schedule H, Part V, Section D, right margin.
Exhibit 3.24.12-50

Form 990 - Section 34, Schedule H (2016 and 2017)

Form 990 - Section 34, Schedule H (2016 and 2017)
3.24.12 - 50 SECTION 34
Source Document or Record: Forms 990 - Section 34, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-51

Form 990 - Section 35, Schedule H (2016 and 2017)

Form 990- Section 35, Schedule H (2016 and 2017)
3.24.12 - 51 SECTION 35
Source Document or Record: Forms 990 - Section 35, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-52

Form 990 - Section 36, Schedule H (2016 and 2017)

Form 990 - Section 36, Schedule H (2016 and 2017)
3.24.12 - 52 SECTION 36
Source Document or Record: Forms 990 - Section 36, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-53

Form 990 - Section 37, Schedule H (2016 and 2017)

Form 990 - Section 37, Schedule H (2016 and 2017)
3.24.12 - 53 SECTION 37
Source Document or Record: Forms 990 - Section 37, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-54

Form 990 - Section 38, Schedule H (2016 and 2017)

Form 990 - Section 38, Schedule H (2016 and 2017)
3.24.12 - 54 SECTION 38
Source Document or Record: Forms 990 - Section 38, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-55

Form 990 - Section 39, Schedule H (2016 and 2017)

Form 990 - Section 39, Schedule H (2016 and 2017)
3.24.12 - 55 SECTION 39
Source Document or Record: Forms 990 - Section 39, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-56

Form 990 - Section 40, Schedule H (2016 and 2017)

Form 990 - Section 40, Schedule H (2016 and 2017)
3.24.12 - 56 SECTION 40
Source Document or Record: Forms 990 - Section 40, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-57

Form 990 - Section 41, Schedule H (2016 and 2017)

Form 990 - Section 41, Schedule H (2016 and 2017)
3.24.12 - 57 SECTION 41
Source Document or Record: Forms 990 - Section 41, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-58

Form 990 - Section 42, Schedule H (2016 and 2017)

Form 990 - Section 42, Schedule H (2016 and 2017)
3.24.12 - 58 SECTION 42
Source Document or Record: Forms 990 - Section 42, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-59

Form 990 - Section 43, Schedule H (2016 and 2017)

Form 990 - Section 43, Schedule H (2016 and 2017)
3.24.12 - 59 SECTION 43
Source Document or Record: Forms 990 - Section 43, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-60

Form 990 - Section 44, Schedule H (2016 and 2017)

Form 990 - Section 44, Schedule H (2016 and 2017)
3.24.12 - 60 SECTION 44
Source Document or Record: Forms 990 - Section 44, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-61

Form 990 - Section 45, Schedule H (2016 and 2017)

Form 990 - Section 45, Schedule H (2016 and 2017)
3.24.12 - 61 SECTION 45
Source Document or Record: Forms 990 - Section 45, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-62

Form 990 - Section 46, Schedule H (2016 and 2017)

Form 990 - Section 46, Schedule H (2016 and 2017)
3.24.12 - 62 SECTION 46
Source Document or Record: Forms 990 - Section 46, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-63

Form 990 - Section 47, Schedule H (2016 and 2017)

Form 990 - Section 47, Schedule H (2016 and 2017)
3.24.12 - 63 SECTION 47
Source Document or Record: Forms 990 - Section 47, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-64

Form 990 - Section 48, Schedule H (2016 and 2017)

Form 990 - Section 48, Schedule H (2016 and 2017)
3.24.12 - 64 SECTION 48
Source Document or Record: Forms 990 - Section 48, Schedule H (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-65

Form 990 - Section 49, Schedules L and R (2016 and 2017)

Form 990 - Section 49 Schedules L and R (2016 and 2017)
3.24.12 - 65 SECTION 49
Source Document or Record: Forms 990 - Section 49, Schedules L & R (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 49.
(2) Excess Benefit Transactions PT1RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part 1.
(3) Approved by Board or Committee PT2RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
(4) Interest, Annuities, Royalties, Yes/No Box SCHRPT51A <ENTER> Enter a yes or a no from the yes/no box from Schedule R, Part V, Line 1a.
Exhibit 3.24.12-66

Form 990 - Section 01 (2018)

Form 990 - Section 01 (2018)
3.24.12 - 66 SECTION 01
Source Document or Record: Forms 990 - Section 01 (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section 01 always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generated the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5 for procedures.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5 for procedures.
(5) E.I.N. EIN <ENTER>
★★★★★★		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) For a CP 425–431 & 259A-259H, underlined to the right of the Employer ID Number.
(b) See standard rules in IRM 3.24.38.
(c) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter Y or N as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under title of form.
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) For a CP 425–431 & 259A-259H, edited in the area around the Tax Period.
(10) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.
(11) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(12) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a G Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(13) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country code.
(14) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(15) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(16) Group Code H(b) BOXHB <ENTER> Enter a 1 or 2 from the yes/no box from the entity area of the return, Line H(b). For a CP425–431 & 259A-259H, press <ENTER> only.
(17) Tax Exempt Status BOXI <ENTER> Enter the edited two digit code from the blank space of Box I.
(18) Type of Organization BOXK RT <ENTER> Enter the edited code from the blank space of Box K. For a CP 425–431 & 259A-259H always enter a 9.
(19) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 2–7b. For a 420–431 & 259A-259H, enter the edited characters as shown in the center of the return. If a Condition Code is illegible, enter a # in its place.
(20) Return Processing Code RPC <ENTER> Enter the edited codes on Page 1, in the right margin next to line 1.
(21) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a G Condition Code is present and the return is non-remittance, end the document after this element.
(c) If a CP 425–431 & 259A-259H, end the document after this element.
(22) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(23) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(24) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
(25) Preparer Telephone # TEL# <ENTER> Enter the preparer phone number.
(a) If the Type of Organization is a 9, and the "9" is underlined, don't end the document. Continue transcribing the return.
(b) If Type of Organization is a 9, and the 9 is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If present, continue to that element and follow the instructions there.
(26) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the 600 series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the 600 series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a G Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
9 from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
9, and the 9 is NOT underlined, press <F6> and end the document after this element.
Exhibit 3.24.12-67

Form 990 - Section 02 (2018)

Form 990- Section 02 (2018)
3.24.12 - 67 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800 - Edit Sheet (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 02.
(2) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(3) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(4) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(5) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(6) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-68

Form 990 - Section 03 (2018)

Form 990 - Section 03 (2018)
3.24.12 - 68 SECTION 03
Source Document or Record: Forms 990 - Section 03, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 03.
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return, ONLY if underlined in green.
(3) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(4) Undertake New Activities Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2.
(5) Make Significant Changes Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3.
(6) Exempt Purpose Code 1 L4A <ENTER> Press Enter only. Don't transcribe a code.
(7) Exempt Purpose Code 2 L4B <ENTER> Press Enter only. Don't transcribe a code.
(8) Exempt Purpose Code 3 L4C <ENTER> Press Enter only. Don't transcribe a code.
(9) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.

Note:

If a "D1" is edited and underlined, pick up as an alpha "D" and numeric "1" . Don't confuse with an alpha "D" and alpha "I" .
(10) 501(c)(3) or 4947(a)(1) Y/N L1 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 1.
(11) Required to Complete Sch B Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 2.
(12) Engage in Direct or Indirect Political Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 3.
(13) Engage in Lobbying Activities Y/N L4 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 4.
(14) Subject to Sec 6033(c) Notice L5 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 5.
(15) Maintain Donor Advised Y/N L6 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 6.
(16) Receive or Hold Conservation Y/N L7 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 7.
(17) Maintain Collections of Works of Art Y/N L8 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 8.
(18) Provide Credit Counseling Y/N L9 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 9.
(19) Hold Assets in Term/Permanent Y/N L10 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 10.
(20) Land, Buildings, Equipment 11A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11a.
(21) Investments Other Securities 11B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11b.
(22) Investments Program Related 11C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11c.
(23) Other Assets 11D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11d.
(24) Other Liabilities 11E <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11e.
(25) Separate or Consolidated Financial Statements 11F <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11f.
(26) Separate Independent Audited Financial 12A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12a.
(27) Consolidated Independent Financial 12B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12b.
(28) School Described in 170(b)(1)(A)(ii) L13 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 13.
(29) Maintain an Office, etc Outside U.S. 14A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14a.
(30) Have Aggregate Revenues/Expenses 14B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14b.
(31) Report > $5000 on Part IX Organizations L15 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 15.
(32) Report > $5000 on Part IX Individuals L16 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 16.
(33) Report > $15,000 on Part IX, Line 11e L17 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 17.
(34) Report > $15,000 on Part VIII, Line 1c/8a L18 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 18.
(35) Report > $15,000 on Part VIII, Line 9a L19 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 19.
(36) Operate Hospitals 20A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20a.
(37) Attach Audited Financial Statements 20B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20b.
Exhibit 3.24.12-69

Form 990 - Section 04 (2018)

Form 990 - Section 04 (2018)
3.24.12 - 69 SECTION 04
Source Document or Record: Forms 990 - Section 04, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 04.
(2) Report > $5000 on Part IX, Line 1 L21 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 21.
(3) Report > $5000 on Part IX, Line 2 L22 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 22.
(4) Answer Yes to Questions 3, 4, 5 L23 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 23.
(5) Any Tax-Exempt Bond with Outstanding Principal 24A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24a.
(6) Invest Any Proceeds 24B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24b.
(7) Maintain an Escrow Account 24C <ENTER> Enter a yes or no from the yes/box from Part IV, Line 24c.
(8) Act as On Behalf Of Issuer 24D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24d.
(9) 501(c)(3) / 501(c)(4) Organizations 25A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25a.
(10) Become Aware it Engaged in Excess 25B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25b.
(11) Loan to/by Current/Former Officer L26 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 26.
(12) Provide Grant or Other Assistance L27 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 27.
(13) Business Transaction with Current or Former Officer 28A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28a.
(14) Business Transaction with Family Member 28B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28b.
(15) Business Transaction with Entity of Current/ Former Officer 28C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28c.
(16) Receive or Accrue > $25,000 in Non-Cash L29 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 29.
(17) Receive or Accrue Contributions of Art L30 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 30.
(18) Liquidate, Terminate, Dissolve L31 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 31.
(19) Sell, Exchange, Dispose L32 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 32.
(20) Own 100% of an Entity L33 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 33.
(21) Related to Tax-Exempt / Taxable Entity L34 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 34.
(22) Controlled Entity Within 512(b)(13) L35A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35a.
23 Receive Payment or Engage Transaction Within 35B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35b.
(24) Make Any Transfers L36 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 36.
(25) Conduct More than 5% L37 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 37.
(26) Complete Schedule O L38 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 38.
Exhibit 3.24.12-70

Form 990 - Section 05 (2018)

Form 990 - Section 05 (2018)
3.24.12 - 70 SECTION 05
Source Document or Record: Forms 990 - Section 05, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 05.
(2) Part V Number of Forms/1096 PTVL1A <ENTER> Enter the number shown on Part V, Line 1a.
(3) Number of Forms W-2G L1B <ENTER> Enter the number shown on Part V, Line 1b.
(4) Comply with Backup Withholding Rules L1C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 1c.
(5) Number of Employees / W-3 L2A <ENTER> Enter the number shown on Part V, Line 2a.
(6) File All Required Federal Employment Returns L2B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 2b.
(7) Unrelated Business Income > $1000 L3A <ENTER> Enter a yes or no from the yes/box from Part V, Line 3a.
(8) If Yes, Has Filed a 990-T L3B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 3b.
(9) Interest in or a Signature L4A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 4a.
(10) Party to a Prohibited Tax Shelter L5A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5a.
(11) Taxable Party Notify Organization L5B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5b.
(12) If Yes, Did Organization File 8886-T L5C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5c.
(13) Annual Gross Receipts Normally >$100,000 L6A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6a.
(14) If Yes, Did Organization Include L6B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6b.
(15) >$75 Partly Contribution/Goods/Services L7A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7a.
(16) If Yes, Did Organization Notify Donor L7B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7b.
(17) Sell, Exchange, Otherwise Dispose L7C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7c.
(18) Number of Forms 8282 L7D <ENTER> Enter the number shown on Part V, Line 7d.
(19) Receive Any Funds L7E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7e.
(20) Pay Premiums L7F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7f.
(21) Contributions of Qualified Intellectual Property L7G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7g.
(22) Contributions of Cars, Boats, Airplanes L7H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7h.
(23) Sponsoring Orgs, 509(a)(3) Excess Business Holdings L8 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 8.
(24) Make Taxable Distributions Under 4966 L9A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9a.
(25) Make Distribution to Donor L9B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9b.
(26) Initiation Fees/Capital Contributions 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10a.
(27) Gross Receipts for Public Use of Facilities 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10b.
(28) Gross Income/Members/Shareholders 11A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11a.
(29) Gross Income from Other Sources 11B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11b.
(30) 4947(a)(1) Filing 990 in Lieu of 1041 12A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 12a.
(31) Amount of Tax Exempt Interest 12B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 12b.
(32) Licensed to Issue Qualified Health Plans 13A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 13a.
(33) Aggregate Amount of Reserves to Maintain 13B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13b.
(34) Aggregate Amount of Reserves on Hand 13C $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13c.
(35) Receive Payments for Indoor Tanning 14A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14a.
(36) Filed Form 720 to Report Payments 14B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14b.
Exhibit 3.24.12-71

Form 990 - Section 06 (2018)

Form 990 - Section 06 (2018)
3.24.12 - 71 SECTION 06
Source Document or Record: Forms 990 - Section 06, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 06.
(2) Voting Members of Governing Body PG6L1A <ENTER> Enter the number shown on Part VI, Section A, Line 1a.
(3) Independent Voting Members L1B <ENTER> Enter the number shown on Part VI, Section A, Line 1b.
(4) Officer, Director, Trustee Family/Relationship L2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 2.
(5) Delegate Control Over Management L3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 3.
(6) Make Significant Changes L4 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 4.
(7) Become Aware of Material Diversion L5 <ENTER> Enter a yes or no from the yes/box from Part VI, Section A, Line 5.
(8) Members of Stockholders L6 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 6.
(9) Members, Stockholders, Other Persons 7A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7a.
(10) Members Subject to Approval 7B <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7b.
(11) Determining Compensation for CEO, Exec Director 15A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section B, Line 15a.
(12) Total Reportable Compensation from Organization PG8L1D(D) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column D.
(13) Total Reportable Compensation from Related Organization 1D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column E.
(14) Total Compensation from Organization & Related Organizations 1D(F) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column F.
(15) Total Individuals who Received > $100,000 SECTAL2 <ENTER> Enter the number shown on Part VII, Section A, Line 2.
(16) Total Independent Contractors Received > $100,000 SECTBL2 <ENTER> Enter the number shown on Part VII, Section B, Line 2.
Exhibit 3.24.12-72

Form 990 - Section 07 (2018)

Form 990 - Section 07 (2018)
3.24.12 - 72 SECTION 07
Source Document or Record: Forms 990 - Section 07, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 07.
(2) Total Contributions/
Gifts/Grants		 PG9L1H $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 1h, Column (A).
(3) Program Service Business Code 2A 2ACODE <ENTER> Enter the number shown on Part VIII, Line 2a.
(4) 2a Program Service Revenue Col. A 2A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2a, Column (A).
(5) Program Service Business Code 2B 2BCODE <ENTER> Enter the number shown on Part VIII, Line 2b.
(6) 2b Program Service Revenue Col. A 2B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2b, Column (A).
(7) Program Service Business Code 2C 2CCODE <ENTER> Enter the number shown on Part VIII, Line 2c.
(8) 2c Program Service Revenue Col. A 2C(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2c, Column (A).
(9) Program Service Business Code 2D 2DCODE <ENTER> Enter the number shown on Part VIII, Line 2d.
(10) 2d Program Service Revenue Col. A 2D(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2d, Column (A).
(11) Program Service Business Code 2E 2ECODE <ENTER> Enter the number shown on Part VIII, Line 2e.
(12) 2e Program Service Revenue Col. A 2E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2e, Column (A).
(13) 2f Program Service Revenue Col. A 2F(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2f, Column (A).
(14) 2g Program Service Revenue Total Col. A 2GTOT $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 2g, Column (A).
(15) Investment Income Col. A 3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 3, Column (A).
(16) Tax-Exempt Bond Proceeds Col. A 4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 4, Column (A).
(17) Royalties Col. A 5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 5, Column (A).
(18) Gross Rents Real 6(A)I $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (i).
(19) Gross Rents Personal 6(A)II $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (ii).
(20) Rental Expenses Real 6(B)(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (i).
(21) Rental Expenses Personal 6(B)(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (ii).
(22) Rental Income/Loss Real 6C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (i).
(23) Rental Income/Loss Personal 6C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (ii).
(24) Net Rental Income/Loss Col. A 6D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6d, Column (A).
Exhibit 3.24.12-73

Form 990 - Section 08 (2018)

Form 990 - Section 08 (2018)
3.24.12 - 73 SECTION 08
Source Document or Record: Forms 990 - Section 08, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08..
(2) Gross Amount from Sales of Assets - Securities PG9L7A(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (i).
(3) Gross Amount from Sales of Assets - Other 7A(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (ii).
(4) Cost or Other Basis/Sales - Securities 7B(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (i).
(5) Cost or Other Basis/Sales - Other 7B(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (ii).
(6) Gain/Loss - Securities 7C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (i).
(7) Gain/Loss - Other 7C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (ii).
(8) Net Gain/Loss Col. A 7D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7d, Column (A).
(9) Gross Income from Fundraising 8A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8a.
(10) Less Direct Expenses 8b 8B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8b.
(11) Net Income/Loss from Fundraising Col. A 8C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8c, Column (A).
(12) Gross Income from Gaming 9A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9a.
(13) Less Direct Expenses 9b 9B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9b.
(14) Net Income/Loss from Gaming 9C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9c, Column (A).
(15) Gross Sales of Inventory 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10a.
(16) Less Cost of Goods Sold 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10b.
(17) Net Income/Loss from Sales Col. A 10C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10c, Column (A).
(18) Misc. Revenue Business Code 11a 11ACODE <ENTER> Enter the number shown on Part VIII, Line 11a.
(19) Misc. Revenue Total (A) Col. A 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11a, Column (A).
(20) Misc. Revenue Business Code 11b 11BCODE <ENTER> Enter the number shown on Part VIII, Line 11b.
(21) Misc. Revenue Total 11B(A) Col. A 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11b, Column (A).
(22) Misc. Revenue Business Code 11c 11CCODE <ENTER> Enter the number shown on Part VIII, Line 11c.
(23) Misc. Revenue Total 11C(A) Col. A 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11c, Column (A).
(24) Misc. Revenue Total 11D(A) Col. A 11D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11d, Column (A).
(25) Misc. Revenue Total 11E Col. A 11ETOT $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11e, Column (A).
(26) Total Revenue 12(A) Col. A 12(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 12, Column (A).
Exhibit 3.24.12-74

Form 990 - Section 09 (2018)

Form 990 - Section 09 (2018)
3.24.12 - 74 SECTION 09
Source Document or Record: Forms 990 - Section 09, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 09..
(2) Gross to Government / Organizations in U.S. PG10L1(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 1, Column (A).
(3) Grants / Other Assistance in U.S. L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 2, Column (A).
(4) Grants / Other Assistance Outside U.S. L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 3, Column (A).
(5) Benefits Paid to / for Members L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 4, Column (A).
(6) Compensation of Current Officers / Directors L5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 5, Column (A).
(7) Compensation to Disqualified Persons L6(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 6, Column (A).
(8) Other Salaries / Wages L7(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 7, Column (A).
(9) Pension Plan Contributions L8(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 8, Column (A).
(10) Other Employee Benefits L9(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 9, Column (A).
(11) Payroll Taxes 10(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 10, Column (A).
(12) Fees for Services / Management 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11a, Column (A).
(13) Fees for Services / Legal 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11b, Column (A).
(14) Fees for Services / Accounting 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11c, Column (A).
(15) Fees for Services / Lobbyists 11D(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11d, Column (A).
(16) Fees for Services / Professional Fundraising 11E(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11e, Column(A).
(17) Fees for Services / Investment Management 11F(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11f, Column (A).
(18) Fees for Services / Other 11G(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from shown on Part IX, Line 11g, Column (A).
(19) Advertising / Promotion 12(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 12, Column (A).
(20) Office Expenses 13(A) $ <ENTER>
MINUS (-)		 Enter the amount from on Part IX, Line 13, Column (A).
(21) Information Technology 14(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 14, Column (A).
(22) Royalties 15(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 15, Column (A).
(23) Occupancy 16(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 16, Column (A).
(24) Travel 17(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 17, Column (A).
(25) Payments of Travel / Entertainment 18(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 18, Column (A).
(26) Conferences, Conventions / Meetings 19(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 19, Column (A).
(27) Interest 20(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 20, Column (A).
(28) Payments to Affiliates 21(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 21, Column (A).
(29) Depreciation / Depletion 22(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 22, Column (A).
(30) Insurance 23(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 23, Column (A).
(31) Other Expenses a 24A(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 24a, Column (A).
(32) Other Expenses b 24B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24b, Column (A).
(33) Other Expenses c 24C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24c, Column (A).
(34) Other Expenses d 24D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24d, Column (A).
(35) Other Expenses e 24E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24e, Column (A).
(36) NA 24F(A) $ <ENTER> Enter only.
(37) Total Functional Expenses 25(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 25, Column (A).
Exhibit 3.24.12-75

Form 990 - Section 10 (2018)

Form 990 - Section 10 (2018)
3.24.12 - 75 SECTION 10
Source Document or Record: Forms 990 - Section 10, (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 10.
(2) Cash EOY PG11L1(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 1, Column (B).
(3) Savings / Temporary Investments EOY L2(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 2, Column (B).
(4) Pledges / Grants Receivable EOY L3(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 3, Column (B).
(5) Accounts Receivable EOY L4(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 4, Column (B).
(6) Receivables from Current / Former EOY L5(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 5, Column (B).
(7) Receivables from Disqualified Persons EOY L6(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 6, Column (B).
(8) Notes / Loans Receivable EOY L7(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 7, Column (B).
(9) Inventories for Sale EOY L8(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 8, Column (B).
(10) Prepaid Expenses EOY L9(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 9, Column (B).
(11) Land / Buildings Less Accumulated EOY 10C(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 10c, Column (B).
(12) Investments Publicly Traded Securities EOY 11(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 11, Column (B).
(13) Investments Other Securities EOY 12(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 12, Column (B).
(14) Investments Program Related EOY 13(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 13, Column (B).
(15) Intangible Assets EOY 14(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 14, Column (B).
(16) Other Assets EOY 15(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 15, Column(B).
(17) Total Assets BOY 16(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 16, Column (A).
(18) Total Assets EOY 16(B) $ <ENTER>
MINUS (-)		 Enter the amount from shown on Part X, Line 16, Column (B).
(19) Accounts Payable EOY 17(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 17, Column (B).
(20) Grants Payable EOY 18(B) $ <ENTER>
MINUS (-)		 Enter the amount from on Part X, Line 18, Column (B).
(21) Deferred Revenue EOY 19(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 19, Column (B).
(22) Tax-Exempt Bond Liabilities EOY 20(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 20, Column (B).
(23) Escrow Liability EOY 21(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 21, Column (B).
(24) Payable to Current / Former Officers EOY 22(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 22, Column (B).
(25) Secured Mortgages / Notes EOY 23(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 23, Column (B).
(26) Unsecured Notes / Loans EOY 24(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 24, Column (B).
(27) Other Liabilities EOY 25(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 25, Column (B).
(28) Total Liabilities BOY 26(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 26, Column (A).
(29) Total Liabilities EOY 26(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 26, Column (B).
(30) Unrestricted Net Assets EOY 27(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 27, Column (B).
(31) Temporarily Restricted Net Assets EOY 28(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 28, Column (B).
(32) Permanently Restricted Net Assets EOY 29(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 29, Column (B).
(33) Capital Stock / Trust EOY 30(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 30, Column (B).
(34) Paid-In / Capital Surplus EOY 31(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 31, Column (B).
(35) Retained Earnings, Endowment EOY 32(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 32, Column (B).
(36) Total Net Assets or Fund Balances BOY 33(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 33, Column (A).
(37) Total Net Assets or Fund Balances EOY 33(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 33, Column (B).
(38) Total Liabilities / Net Assets Fund Balances EOY 34(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 34, Column (B).
Exhibit 3.24.12-76

Form 990 - Section 11, Schedule A (2018)

Form 990 - Section 11 Schedule A (2018)
3.24.12 - 76 SECTION 11
Source Document or Record: Form 990 - Section 11, Schedule A (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 11.
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter one of the following from Line 12:
1 = Type I, 2 = Type II, 3 = Type III – Functionally integrated
4 = Type III – Non-functionally integrated Blank <ENTER>.
If more than one box is checked, enter the corresponding number for the first box checked.
(4) Type I, II or III Supporting Organization 11E <ENTER> Enter a 1 if the box is checked on Schedule A, Part I, Line 12e.
(5) Number of Supported Organizations 11F <ENTER> Enter the number from Line 12f.
(6) EIN A 12G(II)A <ENTER> Enter the EIN in Part I, Line 12g, Row A, Column (ii).
(7) Type of Org A 12G(III)A <ENTER> Enter the type of organization in Part I, Line 12g, Row A, Column (iii).
(8) Listed in Governing Doc A 12G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row A, Column (iv).
(9) Amount of Support A 12G(V) A $ <ENTER> Enter the amount on Part I, Line 12g, Row A, Column (v).
(10) EIN B 12G(II)B <ENTER> Enter the EIN in Part I, Line 12g, Row B, Column (ii).
(11) Type of Org B 12G(III)B <ENTER> Enter the type of organization in Part I, Line 12g, Row B, Column (iii).
(12) Listed in Governing Doc B 12G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row B, Column (iv).
(13) Amount of Support B 12G(V)B $ <ENTER> Enter the amount Part I, Line 12g, Row B, Column (v).
(14) EIN C 12G(II)C <ENTER> Enter the EIN in Part I, Line 12g, Row C, Column (ii).
(15) Type of Org C 12G(III)C <ENTER> Enter the type of organization in Part I, Line 12g, Row C, Column (iii).
(16) Listed in Governing Doc C 12G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row C, Column (iv).
(17) Amount of Support C 12G(V)C $ <ENTER> Enter the amount on Part I, Line 12g, Row C, Column (v).
(18) EIN D 12G(II)D <ENTER> Enter the EIN in Part I, Line 12g, Row D, Column (ii).
(19) Type of Org D 12G(III)D <ENTER> Enter the type of organization in Part I, Line 12g, Row D, Column (iii).
(20) Listed in Governing Doc D 12G(IV)D <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row D, Column (iv).
(21) Amount of Support D 12G(V)D $ <ENTER> Enter the amount on Part I, Line 12g, Row D, Column (v).
(22) EIN E 12G(II)E <ENTER> Enter the EIN in Part I, Line 12g, Row E, Column (ii).
(23) Type of Org E 12G(III)E <ENTER> Enter the type of organization in Part I, Line 12g, Row E, Column (iii).
(24) Listed in Governing Doc E 12G(IV)E <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row E, Column (iv).
(25) Amount of Support E 12G(V)E $ <ENTER> Enter the amount on Part I, Line 12g, Row E, Column (v).
(26) Filling Field     Blank field generated on output.
(27) Total Number of Organizations 12G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 12g, Column (i), Total Line.
(28) Total Amount of Support GVTOT $ <ENTER> Enter the amount on Part I, Line 12g, Total, Column (v).
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-77

Form 990 - Section 12, Schedule A (2018)

Form 990 - Section 12 Schedule A (2018)
3.24.12 - 77 SECTION 12
Source Document or Record: Forms 990 - Section 12, Schedule A (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 12.
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Filling Field     Generates a blank field on output.
(29) Excess Distributions C PTVE3C $ <ENTER> Enter the amount from Part V, Section E, Line 3c.
(30) Excess Distributions D PTVE3D $ <ENTER> Enter the amount from Part V, Section E, Line 3d.
(31) Excess Distributions E PTVE3E $ <ENTER> Enter the amount from Part V, Section E, Line 3e.
(32) Excess Distributions Breakdown B PTVE8B $ <ENTER> Enter the amount from Part V, Section E, Line 8b.
(33) Excess Distributions Breakdown C PTVE8C $ <ENTER> Enter the amount from Part V, Section E, Line 8c.
(34) Excess Distributions Breakdown D PTVE8D $ <ENTER> Enter the amount from Part V, Section E, Line 8d.
(35) Excess Distributions Breakdown E PTVE8E $ <ENTER> Enter the amount from Part V, Section E, Line 8e.
Exhibit 3.24.12-78

Form 990 - Section 13, Schedules C & D (2018)

Form 990 - Section 13, Schedules C & D (2018)
3.24.12 - 78 SECTION 13
Source Document or Record: Forms 990 - Section 13, Schedules C & D (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Political Expenditures SCHIAL2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Total Number at EOY SCHDL1(A) <ENTER> Enter the number shown on Schedule D, Part I, Line 1, Column (a).
(4) Contributions To L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 2, Column (a).
(5) Grants From L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 3, Column (a).
(6) Aggregate Value L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 4, Column (a).
(7) Inform All Donors Checkbox L5 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 5.
(8) Inform All Grantees Checkbox L6 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 6.
Exhibit 3.24.12-79

Form 990 - Section 31, Schedule H (2018)

Form 990 - Section 31, Schedule H (2018)
3.24.12 - 79 SECTION 31
Source Document or Record: Form 990 - Section 31, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 31.
(2) Financial Assistance L1A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1a: 1 = yes 2 = no.
(3) Written Policy L1B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1b: 1 = yes 2 = no.
(4) Best Describes L2 <ENTER> Enter the following:
1 = Applied Uniformly to all. 2 = Applied Uniformly to most.
3 = Generally tailored.
(5) FPG Used L3A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3a: 1 = yes 2 = no.
(6) FPG% L3A% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3a percent:
1 = 100%
2 = 150%
3 = 200%
4 = Other.
(7) FPG Discounted Care L3B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3b: 1 = yes
2 = no.
(8) FPG Discounted Care % L3B% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3b percent:
1 = 200%
2 = 250%
3 = 300%
4 = 350%
5 = 400%
6 = Other
If more than one box is checked, enter the number for the largest percent..
(9) Applied to Largest Number of Patients L4 <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 4: 1 = yes
2 = no.
(10) Budget Amounts for Free or Discounted L5A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5a: 1 = yes
2 = no.
(11) Exceed Budget Amount L5B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5b: 1 = yes
2 = no.
(12) Unable to Provide Free or Discounted Care L5C <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5c: 1 = yes
2 = no.
(13) Prepare A Community Benefit Report L6A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6a: 1 = yes
2 = no.
(14) Available to Public L6B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6b: 1 = yes
2 = no.
(15) Financial Assistance C L7AC $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (c).
(16) Financial D L7AD $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (d).
(17) Financial Assistance at Cost Net Community SCHH 7A(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7a, Column (e).
(18) Financial Assistance at Cost Percent 7A(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7a, Column (f).
(19) Medicaid C L7BC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (c).
(20) Medicaid D L7BD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (d).
(21) Unreimbursed Medicaid Net Community 7B(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (e).
(22) Unreimbursed Medicaid Percent 7B(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7b, Column (f).
(23) Cost of Other Means Tested C L7CC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (c).
(24) Cost of Other Means Tested D L7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (d).
(25) Unreimbursed Costs - Other Net Community 7C(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (e).
(26) Unreimbursed Costs - Other Percent 7C(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7c, Column (f).
(27) Financial Assistance Total C 7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (c).
(28) Financial Assistance Total D 7DD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (d).
(29) Total Financial Assistance Net Community 7D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (e).
(30) Total Financial Assistance Percent 7D(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7d, Column (f).
Exhibit 3.24.12-80

Form 990 - Section 32, Schedule H (2018)

Form 990 - Section 32, Schedule H (2018)
3.24.12 - 80 Section 32
Source Document or Record: Forms 990 - Section 32, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 32.
(2) Community Health Improvement C 7EC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (c).
(3) Community Health Improvement D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (d).
(4) Community Health Improvement E 7EE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (e).
(5) Community Health Improvement Percent 7EF% <ENTER> Enter the percent from Schedule H, Part I, Line 7e, Column (f).
(6) Health Professions C 7FC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (c).
(7) Health Professions D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (d).
(8) Health Professions E 7FE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (e).
(9) Health Professions Percent 7FF% <ENTER> Enter the percent from Schedule H, Part I, Line 7f, Column (f).
(10) Subsidized Health Services C 7GC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (c).
(11) Subsidized Health Services D 7GD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (d).
(12) Subsidized Health Services E 7GE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (e).
(13) Subsidized Health Services Percent 7GF% <ENTER> Enter the percent from Schedule H, Part I, Line 7g, Column (f).
(14) Research C 7HC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (c).
(15) Research D 7HD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (d).
(16) Research E 7HE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (e).
(17) Research F Percent 7HF% <ENTER> Enter the percent from Schedule H, Part I, Line 7h, Column (f).
(18) Cash & Contributions C 7IC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (c).
(19) Cash & Contributions D 7ID $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (d).
(20) Cash & Contributions E 7IE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (e).
(21) Cash & Contributions % 7IF% <ENTER> Enter the percent from Schedule H, Part I, Line 7i, Column (f).
(22) Total Other Benefits C 7JC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (c).
(23) Total Other Benefits D 7JD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (d).
(24) Total Other Benefits E 7JE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (e).
(25) Total Other Benefits Percent 7JF% <ENTER> Enter the percent from Schedule H, Part I, Line 7j, Column (f).
(26) Total C 7KC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (c).
(27) Total D 7KD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (d).
(28) Total E 7KE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (e).
(29) Total Percent 7KF% <ENTER> Enter the percent from Schedule H, Part I, Line 7k, Column (f).
Exhibit 3.24.12-81

Form 990 - Section 33, Schedule H (2018)

Form 990 - Section 33, Schedule H (2018)
3.24.12 - 81 SECTION 33
Source Document or Record: Forms 990 - Section 33, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 16.
(2) Total Net Community PIII0E $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part II, Line 10, Column (e).
(3) Total Percent of Expense 10F% <ENTER> Enter the percent from Schedule H, Part II, Line 10 Column (f).
(4) Report Bad Debt Expense PT3L1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part III, Line 1.
(5) Bad Debt Expense Amount L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 2.
(6) Estimated Bad Debt Expense Amount L3 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 3.
(7) Revenue from Medicare L5 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 5.
(8) Medicare Allowable Costs L6 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 6.
(9) Medicare Surplus or Shortfall L7 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 7.
(10) Costing Methodology or Source Code L8CD <ENTER> Enter the edited code from the right of the boxes from Schedule H, Part III, Line 8.
(11) Written Debt Collection Policy L9A <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9a.
(12) Collection Policy Contain Provision L9B <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9b.
(13) Part IV Code PIVCD <ENTER> Enter the edited digit from Schedule H, Part IV, right margin.
(14) Part V How Many Hospital Facilities Did Organization Operate SECATOP <ENTER> Enter the number shown in the Hospital Facilities area in the top left portion of Schedule H, Part V, Section A.
(15) Part V Section C Indicator Code SECCRM <ENTER> Enter the indicator code from Schedule H, Part V, Section C, right margin.
(16) Part V How Many Non-Hospital Facilities Did Organization Operate SECCTOP <ENTER> Enter the number from the non-hospital health care benefits line.
(17) Part V Section D Indicator Code SECTDRM <ENTER> Enter the edited code from Schedule H, Part V, Section D, right margin.
Exhibit 3.24.12-82

Form 990 - Section 34, Schedule H (2018)

Form 990 - Section 34, Schedule H (2018)
3.24.12 - 82 SECTION 34
Source Document or Record: Forms 990 - Section 34, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-83

Form 990 - Section 35, Schedule H (2018)

Form 990 - Section 35, Schedule H (2018)
3.24.12 - 83 SECTION 35
Source Document or Record: Forms 990 - Section 35, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-84

Form 990 - Section 36, Schedule H (2018)

Form 990 - Section 36, Schedule H (2018)
3.24.12 - 84 SECTION 36
Source Document or Record: Forms 990 - Section 36, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19d is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-85

Form 990 - Section 37, Schedule H (2018)

Form 990 - Section 37, Schedule H (2018)
3.24.12 - 85 SECTION 37
Source Document or Record: Forms 990 - Section 37, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-86

Form 990 - Section 38, Schedule H (2018)

Form 990 - Section 38, Schedule H (2018)
3.24.12 - 86 SECTION 38
Source Document or Record: Forms 990 - Section 38, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(25) Other Similar Actions 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(26) None of These Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
Exhibit 3.24.12-87

Form 990 - Section 39, Schedule H (2018)

Form 990 - Section 39, Schedule H (2018)
3.24.12 - 87 SECTION 39
Source Document or Record: Forms 990 - Section 39, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-88

Form 990 - Section 40, Schedule H (2018)

Form 990 - Section 40, Schedule H (2018)
3.24.12 - 88 SECTION 40
Source Document or Record: Forms 990 - Section 40, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-89

Form 990 - Section 41, Schedule H (2018)

Form 990 - Section 41, Schedule H (2018)
3.24.12 - 89 SECTION 41
Source Document or Record: Forms 990 - Section 41, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-90

Form 990 - Section 42, Schedule H (2018)

Form 990 - Section 42, Schedule H (2018)
3.24.12 - 90 SECTION 42
Source Document or Record: Forms 990 - Section 42, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-91

Form 990 - Section 43, Schedule H (2018)

Form 990 - Section 43, Schedule H (2018)
3.24.12 - 91 SECTION 43
Source Document or Record: Forms 990 - Section 43, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-92

Form 990 - Section 44, Schedule H (2018)

Form 990 - Section 44, Schedule H (2018)
3.24.12 - 92 SECTION 44
Source Document or Record: Forms 990 - Section 44, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-93

Form 990 - Section 45, Schedule H (2018)

Form 990 - Section 45, Schedule H (2018)
3.24.12 - 93 SECTION 45
Source Document or Record: Forms 990 - Section 45, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-94

Form 990 - Section 46, Schedule H (2018)

Form 990 - Section 46, Schedule H (2018)
3.24.12 - 94 SECTION 46
Source Document or Record: Forms 990 - Section 46, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-95

Form 990 - Section 47, Schedule H (2018)

Form 990 - Section 47, Schedule H (2018)
3.24.12 - 95 SECTION 47
Source Document or Record: Forms 990 - Section 47, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-96

Form 990 - Section 48, Schedule H (2018)

Form 990 - Section 48, Schedule H (2018)
3.24.12 - 96 SECTION 48
Source Document or Record: Forms 990 - Section 48, Schedule H (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-97

Form 990 - Section 49, Schedules L and R (2018)

Form 990 - Section 49 Schedules L and R (2018)
3.24.12 - 97 SECTION 49
Source Document or Record: Forms 990 - Section 49, Schedules L & R (2018)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 49.
(2) Excess Benefit Transactions PT1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part 1.
(3) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
(4) Interest, Annuities, Royalties, Yes/No Box SCHR PT51A <ENTER> Enter a yes or a no from the yes/no box from Schedule R, Part V, Line 1a.
Exhibit 3.24.12-98

Form 990 - Section 01 (2019 and Subsequent)

3.24.12-98 Section 01
Source Document or Record: Forms 990 - Section 01 (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section 01 always generates. No entry required.
(2) Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generated the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5 for procedures.
(3a) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5 for procedures.
(4) E.I.N. EIN <ENTER>
★★★★★★		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) For a CP 425–431 & 259A-259H, underlined to the right of the Employer ID Number.
(b) See standard rules in IRM 3.24.38.
(c) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(5) Address Check ADDRESS CHECK? <ENTER> Enter Y or N as appropriate.
(6) Street Key STREET KEY <ENTER> See IRM 3.24.38
(7) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38
(8) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under title of form.
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) For a CP 425–431 & 259A-259H, edited in the area around the Tax Period.
(9) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.
(10) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(11) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a G Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(12) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country code.
(13) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(14) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(15) Group Code H(b) BOXHB <ENTER> Enter a 1 or 2 from the yes/no box from the entity area of the return, Line H(b). For a CP425–431 & 259A-259H, press <ENTER> only.
(16) Tax Exempt Status BOXI <ENTER> Enter the edited two digit code from the blank space of Box I.
(17) Type of Organization BOXK RT <ENTER> Enter the edited code from the blank space of Box K. For a CP 425–431 & 259A-259H always enter a 9.
(18) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 2–7b. For a 420–431 & 259A-259H, enter the edited characters as shown in the center of the return. If a Condition Code is illegible, enter a # in its place.
(19) Return Processing Code 01RPC <ENTER> Enter the edited codes on Page 1, in the right margin next to line 1.
(20) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a G Condition Code is present and the return is non-remittance, end the document after this element.
(c) If a CP 425–431 & 259A-259H, end the document after this element.
(21) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(22) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(23) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
(24) Preparer Telephone # TEL# <ENTER> Enter the preparer phone number.
(a) If the Type of Organization is a 9, and the "9" is underlined, don't end the document. Continue transcribing the return.
(b) If Type of Organization is a 9, and the 9 is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If present, continue to that element and follow the instructions there.
(25) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the 600 series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the 600 series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a G Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
9 from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
9, and the 9 is NOT underlined, press <F6> and end the document after this element.
Exhibit 3.24.12-99

Form 990 - Section 02 (2019 and Subsequent)

Form 990- Section 02 (2019 and Subsequent)
3.24.12 - 99 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800 - Edit Sheet (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 02.
(2) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(3) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(4) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(5) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(6) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-100

Form 990 - Section 03 (2019 and Subsequent)

Form 990 - Section 03 (2019 and Subsequent)
3.24.12 - 100 SECTION 03
Source Document or Record: Forms 990 - Section 03, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 03.
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return, ONLY if underlined in green.
(3) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(4) Undertake New Activities Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2.
(5) Make Significant Changes Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3.
(6) Exempt Purpose Code 1 L4A <ENTER> Press Enter only. Don't transcribe a code.
(7) Exempt Purpose Code 2 L4B <ENTER> Press Enter only. Don't transcribe a code.
(8) Exempt Purpose Code 3 L4C <ENTER> Press Enter only. Don't transcribe a code.
(9) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.

Note:

If a "D1" is edited and underlined, pick up as an alpha "D" and numeric "1" . Don't confuse with an alpha "D" and alpha "I" .
(10) 501(c)(3) or 4947(a)(1) Y/N L1 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 1.
(11) Required to Complete Sch B Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 2.
(12) Engage in Direct or Indirect Political Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 3.
(13) Engage in Lobbying Activities Y/N L4 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 4.
(14) Subject to Sec 6033(c) Notice L5 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 5.
(15) Maintain Donor Advised Y/N L6 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 6.
(16) Receive or Hold Conservation Y/N L7 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 7.
(17) Maintain Collections of Works of Art Y/N L8 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 8.
(18) Provide Credit Counseling Y/N L9 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 9.
(19) Hold Assets in Term/Permanent Y/N L10 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 10.
(20) Land, Buildings, Equipment 11A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11a.
(21) Investments Other Securities 11B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11b.
(22) Investments Program Related 11C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11c.
(23) Other Assets 11D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11d.
(24) Other Liabilities 11E <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11e.
(25) Separate or Consolidated Financial Statements 11F <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11f.
(26) Separate Independent Audited Financial 12A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12a.
(27) Consolidated Independent Financial 12B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12b.
(28) School Described in 170(b)(1)(A)(ii) L13 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 13.
(29) Maintain an Office, etc Outside U.S. 14A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14a.
(30) Have Aggregate Revenues/Expenses 14B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14b.
(31) Report > $5000 on Part IX Organizations L15 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 15.
(32) Report > $5000 on Part IX Individuals L16 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 16.
(33) Report > $15,000 on Part IX, Line 11e L17 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 17.
(34) Report > $15,000 on Part VIII, Line 1c/8a L18 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 18.
(35) Report > $15,000 on Part VIII, Line 9a L19 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 19.
(36) Operate Hospitals 20A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20a.
(37) Attach Audited Financial Statements 20B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20b.
Exhibit 3.24.12-101

Form 990 - Section 04 (2019 and Subsequent)

Form 990 - Section 04 (2019 and Subsequent)
3.24.12 - 101 SECTION 04
Source Document or Record: Forms 990 - Section 04, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 04.
(2) Report > $5000 on Part IX, Line 1 L21 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 21.
(3) Report > $5000 on Part IX, Line 2 L22 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 22.
(4) Answer Yes to Questions 3, 4, 5 L23 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 23.
(5) Any Tax-Exempt Bond with Outstanding Principal 24A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24a.
(6) Invest Any Proceeds 24B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24b.
(7) Maintain an Escrow Account 24C <ENTER> Enter a yes or no from the yes/box from Part IV, Line 24c.
(8) Act as On Behalf Of Issuer 24D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24d.
(9) 501(c)(3) / 501(c)(4) Organizations 25A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25a.
(10) Become Aware it Engaged in Excess 25B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25b.
(11) Loan to/by Current/Former Officer L26 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 26.
(12) Provide Grant or Other Assistance L27 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 27.
(13) Business Transaction with Current or Former Officer 28A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28a.
(14) Business Transaction with Family Member 28B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28b.
(15) Business Transaction with Entity of Current/ Former Officer 28C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28c.
(16) Receive or Accrue > $25,000 in Non-Cash L29 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 29.
(17) Receive or Accrue Contributions of Art L30 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 30.
(18) Liquidate, Terminate, Dissolve L31 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 31.
(19) Sell, Exchange, Dispose L32 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 32.
(20) Own 100% of an Entity L33 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 33.
(21) Related to Tax-Exempt / Taxable Entity L34 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 34.
(22) Controlled Entity Within 512(b)(13) L35A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35a.
23 Receive Payment or Engage Transaction Within 35B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35b.
(24) Make Any Transfers L36 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 36.
(25) Conduct More than 5% L37 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 37.
(26) Complete Schedule O L38 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 38.
Exhibit 3.24.12-102

Form 990 - Section 05 (2019 and Subsequent)

Form 990 - Section 05 (2019 and Subsequent)
3.24.12 - 102 SECTION 05
Source Document or Record: Forms 990 - Section 05, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 05.
(2) Part V Number of Forms/1096 PTVL1A <ENTER> Enter the number shown on Part V, Line 1a.
(3) Number of Forms W-2G L1B <ENTER> Enter the number shown on Part V, Line 1b.
(4) Comply with Backup Withholding Rules L1C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 1c.
(5) Number of Employees / W-3 L2A <ENTER> Enter the number shown on Part V, Line 2a.
(6) File All Required Federal Employment Returns L2B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 2b.
(7) Unrelated Business Income > $1000 L3A <ENTER> Enter a yes or no from the yes/box from Part V, Line 3a.
(8) If Yes, Has Filed a 990-T L3B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 3b.
(9) Interest in or a Signature L4A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 4a.
(10) Party to a Prohibited Tax Shelter L5A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5a.
(11) Taxable Party Notify Organization L5B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5b.
(12) If Yes, Did Organization File 8886-T L5C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5c.
(13) Annual Gross Receipts Normally >$100,000 L6A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6a.
(14) If Yes, Did Organization Include L6B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6b.
(15) >$75 Partly Contribution/Goods/Services L7A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7a.
(16) If Yes, Did Organization Notify Donor L7B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7b.
(17) Sell, Exchange, Otherwise Dispose L7C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7c.
(18) Number of Forms 8282 L7D <ENTER> Enter the number shown on Part V, Line 7d.
(19) Receive Any Funds L7E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7e.
(20) Pay Premiums L7F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7f.
(21) Contributions of Qualified Intellectual Property L7G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7g.
(22) Contributions of Cars, Boats, Airplanes L7H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7h.
(23) Sponsoring Orgs, 509(a)(3) Excess Business Holdings L8 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 8.
(24) Make Taxable Distributions Under 4966 L9A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9a.
(25) Make Distribution to Donor L9B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9b.
(26) Initiation Fees/Capital Contributions 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10a.
(27) Gross Receipts for Public Use of Facilities 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10b.
(28) Gross Income/Members/Shareholders 11A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11a.
(29) Gross Income from Other Sources 11B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11b.
(30) 4947(a)(1) Filing 990 in Lieu of 1041 12A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 12a.
(31) Amount of Tax Exempt Interest 12B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 12b.
(32) Licensed to Issue Qualified Health Plans 13A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 13a.
(33) Aggregate Amount of Reserves to Maintain 13B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13b.
(34) Aggregate Amount of Reserves on Hand 13C $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13c.
(35) Receive Payments for Indoor Tanning 14A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14a.
(36) Filed Form 720 to Report Payments 14B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14b.
(37) Subject to Section 4960 Tax on Payments of More Than $1,000,000 15 <ENTER> Enter 1 for yes and 2 for no Part V, Line 15.
(38) Education Institution Subject to 4968 Excise Tax 16 <ENTER> Enter 1 for yes and 2 for no Part V, Line 16.
Exhibit 3.24.12-103

Form 990 - Section 06 (2019 and Subsequent)

Form 990 - Section 06 (2019 and Subsequent)
3.24.12 - 103 SECTION 06
Source Document or Record: Forms 990 - Section 06, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 06.
(2) Voting Members of Governing Body PG6L1A <ENTER> Enter the number shown on Part VI, Section A, Line 1a.
(3) Independent Voting Members L1B <ENTER> Enter the number shown on Part VI, Section A, Line 1b.
(4) Officer, Director, Trustee Family/Relationship L2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 2.
(5) Delegate Control Over Management L3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 3.
(6) Make Significant Changes L4 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 4.
(7) Become Aware of Material Diversion L5 <ENTER> Enter a yes or no from the yes/box from Part VI, Section A, Line 5.
(8) Members of Stockholders L6 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 6.
(9) Members, Stockholders, Other Persons 7A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7a.
(10) Members Subject to Approval 7B <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7b.
(11) Determining Compensation for CEO, Exec Director 15A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section B, Line 15a.
(12) Reportable Compensation from the Organization 1 PTVII1D $ <ENTER> Enter the amount from Part VII Section A, Line 1, Column (d).
(13) Reportable Compensation from Related Organizations 1 PTVII1E $ <ENTER> Enter the amount from Part VII Section A, Line 1, Column (e).
(14) Estimated Amount of Other Compensation 1 PTVII1F $ <ENTER> Enter the amount from Part VII Section A, Line 1, Column (f).
(15) Reportable Compensation from the Organization 2 PTVII2D $ <ENTER> Enter the amount from Part VII Section A, Line 2, Column (d).
(16) Reportable Compensation from Related Organizations 2 PTVII2E $ <ENTER> Enter the amount from Part VII Section A, Line 2, Column (e).
(17) Estimated Amount of Other Compensation 2 PTVII2F $ <ENTER> Enter the amount from Part VII Section A, Line 2, Column (f).
(18) Reportable Compensation from the Organization 3 PTVII3D $ <ENTER> Enter the amount from Part VII Section A, Line 3, Column (d).
(19) Reportable Compensation from Related Organizations 3 PTVII3E $ <ENTER> Enter the amount from Part VII Section A, Line 3, Column (e).
(20) Estimated Amount of Other Compensation 3 PTVII3F $ <ENTER> Enter the amount from Part VII Section A, Line 3, Column (f).
(21) Reportable Compensation from the Organization 4 PTVII4D $ <ENTER> Enter the amount from Part VII Section A, Line 4, Column (d).
(22) Reportable Compensation from Related Organizations 4 PTVII4E $ <ENTER> Enter the amount from Part VII Section A, Line 4, Column (e).
(23) Estimated Amount of Other Compensation 4 PTVII4F $ <ENTER> Enter the amount from Part VII Section A, Line 4, Column (f).
(24) Reportable Compensation from the Organization 5 PTVII5D $ <ENTER> Enter the amount from Part VII Section A, Line 5, Column (d).
(25) Reportable Compensation from Related Organizations 5 PTVII5E $ <ENTER> Enter the amount from Part VII Section A, Line 5, Column (e).
(26) Estimated Amount of Other Compensation 5 PTVII5F $ <ENTER> Enter the amount from Part VII Section A, Line 5, Column (f).
(27) Total Reportable Compensation from Organization PG8L1D(D) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column D.
(28) Total Reportable Compensation from Related Organization 1D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column E.
(29) Total Compensation from Organization & Related Organizations 1D(F) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column F.
(30) Total Individuals who Received > $100,000 SECTAL2 <ENTER> Enter the number shown on Part VII, Section A, Line 2.
(31) Total Independent Contractors Received > $100,000 SECTBL2 <ENTER> Enter the number shown on Part VII, Section B, Line 2.
Exhibit 3.24.12-104

Form 990 - Section 07 (2019 and Subsequent)

Form 990 - Section 07 (2019 and Subsequent)
3.24.12 - 104 SECTION 07
Source Document or Record: Forms 990 - Section 07, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise always enter 07.
(2) Total Contributions/
Gifts/Grants		 PG9L1H $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 1h, Column (A).
(3) Program Service Business Code 2A 2ACODE <ENTER> Enter the number shown on Part VIII, Line 2a.
(4) 2a Program Service Revenue Col. A 2A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2a, Column (A).
(5) Program Service Business Code 2B 2BCODE <ENTER> Enter the number shown on Part VIII, Line 2b.
(6) 2b Program Service Revenue Col. A 2B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2b, Column (A).
(7) Program Service Business Code 2C 2CCODE <ENTER> Enter the number shown on Part VIII, Line 2c.
(8) 2c Program Service Revenue Col. A 2C(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2c, Column (A).
(9) Program Service Business Code 2D 2DCODE <ENTER> Enter the number shown on Part VIII, Line 2d.
(10) 2d Program Service Revenue Col. A 2D(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2d, Column (A).
(11) Program Service Business Code 2E 2ECODE <ENTER> Enter the number shown on Part VIII, Line 2e.
(27) 2e Program Service Revenue Col. A 2E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2e, Column (A).
(28) 2f Program Service Revenue Col. A 2F(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2f, Column (A).
(29) 2g Program Service Revenue Total Col. A 2GTOT $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 2g, Column (A).
(15) Investment Income Col. A 3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 3, Column (A).
(16) Tax-Exempt Bond Proceeds Col. A 4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 4, Column (A).
(17) Royalties Col. A 5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 5, Column (A).
(18) Gross Rents Real 6(A)I $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (i).
(19) Gross Rents Personal 6(A)II $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (ii).
(20) Rental Expenses Real 6(B)(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (i).
(21) Rental Expenses Personal 6(B)(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (ii).
(22) Rental Income/Loss Real 6C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (i).
(23) Rental Income/Loss Personal 6C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (ii).
(24) Net Rental Income/Loss Col. A 6D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6d, Column (A).
Exhibit 3.24.12-105

Form 990 - Section 08 (2019 and Subsequent)

Form 990 - Section 08 (2019 and Subsequent)
3.24.12 - 105 SECTION 08
Source Document or Record: Forms 990 - Section 08, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08..
(2) Gross Amount from Sales of Assets - Securities PG9L7A(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (i).
(3) Gross Amount from Sales of Assets - Other 7A(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (ii).
(4) Cost or Other Basis/Sales - Securities 7B(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (i).
(5) Cost or Other Basis/Sales - Other 7B(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (ii).
(6) Gain/Loss - Securities 7C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (i).
(7) Gain/Loss - Other 7C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (ii).
(8) Net Gain/Loss Col. A 7D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7d, Column (A).
(9) Gross Income from Fundraising 8A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8a.
(10) Less Direct Expenses 8b 8B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8b.
(11) Net Income/Loss from Fundraising Col. A 8C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8c, Column (A).
(12) Gross Income from Gaming 9A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9a.
(13) Less Direct Expenses 9b 9B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9b.
(14) Net Income/Loss from Gaming 9C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9c, Column (A).
(15) Gross Sales of Inventory 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10a.
(16) Less Cost of Goods Sold 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10b.
(17) Net Income/Loss from Sales Col. A 10C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10c, Column (A).
(18) Misc. Revenue Business Code 11a 11ACODE <ENTER> Enter the number shown on Part VIII, Line 11a.
(19) Misc. Revenue Total (A) Col. A 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11a, Column (A).
(20) Misc. Revenue Business Code 11b 11BCODE <ENTER> Enter the number shown on Part VIII, Line 11b.
(21) Misc. Revenue Total 11B(A) Col. A 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11b, Column (A).
(22) Misc. Revenue Business Code 11c 11CCODE <ENTER> Enter the number shown on Part VIII, Line 11c.
(23) Misc. Revenue Total 11C(A) Col. A 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11c, Column (A).
(24) Misc. Revenue Total 11D(A) Col. A 11D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11d, Column (A).
(25) Misc. Revenue Total 11E Col. A 11ETOT $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11e, Column (A).
(26) Total Revenue 12(A) Col. A 12(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 12, Column (A).
Exhibit 3.24.12-106

Form 990 - Section 09 (2019 and Subsequent)

Form 990 - Section 09 (2019 and Subsequent)
3.24.12 - 106 SECTION 09
Source Document or Record: Forms 990 - Section 09, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 09..
(2) Gross to Government / Organizations in U.S. PG10L1(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 1, Column (A).
(3) Grants / Other Assistance in U.S. L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 2, Column (A).
(4) Grants / Other Assistance Outside U.S. L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 3, Column (A).
(5) Benefits Paid to / for Members L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 4, Column (A).
(6) Compensation of Current Officers / Directors L5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 5, Column (A).
(7) Compensation to Disqualified Persons L6(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 6, Column (A).
(8) Other Salaries / Wages L7(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 7, Column (A).
(9) Pension Plan Contributions L8(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 8, Column (A).
(10) Other Employee Benefits L9(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 9, Column (A).
(11) Payroll Taxes 10(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 10, Column (A).
(12) Fees for Services / Management 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11a, Column (A).
(13) Fees for Services / Legal 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11b, Column (A).
(14) Fees for Services / Accounting 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11c, Column (A).
(15) Fees for Services / Lobbyists 11D(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11d, Column (A).
(16) Fees for Services / Professional Fundraising 11E(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11e, Column(A).
(17) Fees for Services / Investment Management 11F(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11f, Column (A).
(18) Fees for Services / Other 11G(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from shown on Part IX, Line 11g, Column (A).
(19) Advertising / Promotion 12(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 12, Column (A).
(20) Office Expenses 13(A) $ <ENTER>
MINUS (-)		 Enter the amount from on Part IX, Line 13, Column (A).
(21) Information Technology 14(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 14, Column (A).
(22) Royalties 15(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 15, Column (A).
(23) Occupancy 16(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 16, Column (A).
(24) Travel 17(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 17, Column (A).
(25) Payments of Travel / Entertainment 18(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 18, Column (A).
(26) Conferences, Conventions / Meetings 19(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 19, Column (A).
(27) Interest 20(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 20, Column (A).
(28) Payments to Affiliates 21(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 21, Column (A).
(29) Depreciation / Depletion 22(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 22, Column (A).
(30) Insurance 23(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 23, Column (A).
(31) Other Expenses a 24A(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 24a, Column (A).
(32) Other Expenses b 24B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24b, Column (A).
(33) Other Expenses c 24C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24c, Column (A).
(34) Other Expenses d 24D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24d, Column (A).
(35) Other Expenses e 24E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24e, Column (A).
(36) NA 24F(A) $ <ENTER> Enter only.
(37) Total Functional Expenses 25(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part IX, Line 25, Column (A).
Exhibit 3.24.12-107

Form 990 - Section 10 (2019 and Subsequent)

Form 990 - Section 10 (2019 and Subsequent)
3.24.12 - 107 SECTION 10
Source Document or Record: Forms 990 - Section 10, (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 10.
(2) Cash EOY PG11L1(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 1, Column (B).
(3) Savings / Temporary Investments EOY L2(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 2, Column (B).
(4) Pledges / Grants Receivable EOY L3(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 3, Column (B).
(5) Accounts Receivable EOY L4(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 4, Column (B).
(6) Receivables from Current / Former EOY L5(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 5, Column (B).
(7) Receivables from Disqualified Persons EOY L6(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 6, Column (B).
(8) Notes / Loans Receivable EOY L7(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 7, Column (B).
(9) Inventories for Sale EOY L8(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 8, Column (B).
(10) Prepaid Expenses EOY L9(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 9, Column (B).
(11) Land / Buildings Less Accumulated EOY 10C(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 10c, Column (B).
(12) Investments Publicly Traded Securities EOY 11(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 11, Column (B).
(13) Investments Other Securities EOY 12(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 12, Column (B).
(14) Investments Program Related EOY 13(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 13, Column (B).
(15) Intangible Assets EOY 14(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 14, Column (B).
(16) Other Assets EOY 15(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 15, Column(B).
(17) Total Assets BOY 16(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 16, Column (A).
(18) Total Assets EOY 16(B) $ <ENTER>
MINUS (-)		 Enter the amount from shown on Part X, Line 16, Column (B).
(19) Accounts Payable EOY 17(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 17, Column (B).
(20) Grants Payable EOY 18(B) $ <ENTER>
MINUS (-)		 Enter the amount from on Part X, Line 18, Column (B).
(21) Deferred Revenue EOY 19(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 19, Column (B).
(22) Tax-Exempt Bond Liabilities EOY 20(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 20, Column (B).
(23) Escrow Liability EOY 21(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 21, Column (B).
(24) Payable to Current / Former Officers EOY 22(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 22, Column (B).
(25) Secured Mortgages / Notes EOY 23(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 23, Column (B).
(26) Unsecured Notes / Loans EOY 24(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 24, Column (B).
(27) Other Liabilities EOY 25(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 25, Column (B).
(28) Total Liabilities BOY 26(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 26, Column (A).
(29) Total Liabilities EOY 26(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 26, Column (B).
(30) Net Assets Without Restrictions 27(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 27, Column (B).
(31) Net assets with donor restrictions 28(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 28, Column (B).
(32) N/A 29(B) $ N/A Press enter only.
(33) Capital Stock / Trust EOY 30(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 30, Column (B).
(34) Paid-In / Capital Surplus EOY 31(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 31, Column (B).
(35) Retained Earnings, Endowment EOY 32(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 32, Column (B).
(36) Total Net Assets or Fund Balances BOY 33(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 33, Column (A).
(37) Total Net Assets or Fund Balances EOY 33(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 33, Column (B).
(38) N/A 34(B) $ N/A Press enter only.
Exhibit 3.24.12-108

Form 990 - Section 11, Schedule A (2019 and Subsequent)

Form 990 - Section 11 Schedule A (2019 and Subsequent)
3.24.12 - 108 SECTION 11
Source Document or Record: Form 990 - Section 11, Schedule A (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 11.
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter one of the following from Line 12:
1 = Type I, 2 = Type II, 3 = Type III – Functionally integrated
4 = Type III – Non-functionally integrated Blank <ENTER>.
If more than one box is checked, enter the corresponding number for the first box checked.
(4) Type I, II or III Supporting Organization 11E <ENTER> Enter a 1 if the box is checked on Schedule A, Part I, Line 12e.
(5) Number of Supported Organizations 11F <ENTER> Enter the number from Line 12f.
(6) EIN A 12G(II)A <ENTER> Enter the EIN in Part I, Line 12g, Row A, Column (ii).
(7) Type of Org A 12G(III)A <ENTER> Enter the type of organization in Part I, Line 12g, Row A, Column (iii).
(8) Listed in Governing Doc A 12G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row A, Column (iv).
(9) Amount of Support A 12G(V) A $ <ENTER> Enter the amount on Part I, Line 12g, Row A, Column (v).
(10) EIN B 12G(II)B <ENTER> Enter the EIN in Part I, Line 12g, Row B, Column (ii).
(11) Type of Org B 12G(III)B <ENTER> Enter the type of organization in Part I, Line 12g, Row B, Column (iii).
(12) Listed in Governing Doc B 12G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row B, Column (iv).
(13) Amount of Support B 12G(V)B $ <ENTER> Enter the amount Part I, Line 12g, Row B, Column (v).
(14) EIN C 12G(II)C <ENTER> Enter the EIN in Part I, Line 12g, Row C, Column (ii).
(15) Type of Org C 12G(III)C <ENTER> Enter the type of organization in Part I, Line 12g, Row C, Column (iii).
(16) Listed in Governing Doc C 12G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row C, Column (iv).
(17) Amount of Support C 12G(V)C $ <ENTER> Enter the amount on Part I, Line 12g, Row C, Column (v).
(18) EIN D 12G(II)D <ENTER> Enter the EIN in Part I, Line 12g, Row D, Column (ii).
(19) Type of Org D 12G(III)D <ENTER> Enter the type of organization in Part I, Line 12g, Row D, Column (iii).
(20) Listed in Governing Doc D 12G(IV)D <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row D, Column (iv).
(21) Amount of Support D 12G(V)D $ <ENTER> Enter the amount on Part I, Line 12g, Row D, Column (v).
(22) EIN E 12G(II)E <ENTER> Enter the EIN in Part I, Line 12g, Row E, Column (ii).
(23) Type of Org E 12G(III)E <ENTER> Enter the type of organization in Part I, Line 12g, Row E, Column (iii).
(24) Listed in Governing Doc E 12G(IV)E <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row E, Column (iv).
(25) Amount of Support E 12G(V)E $ <ENTER> Enter the amount on Part I, Line 12g, Row E, Column (v).
(26) Filling Field     Blank field generated on output.
(27) Total Number of Organizations 12G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 12g, Column (i), Total Line.
(28) Total Amount of Support GVTOT $ <ENTER> Enter the amount on Part I, Line 12g, Total, Column (v).
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-109

Form 990 - Section 12, Schedule A (2019 and Subsequent)

Form 990 - Section 12 Schedule A (2019 and Subsequent)
3.24.12 - 109 SECTION 12
Source Document or Record: Forms 990 - Section 12, Schedule A (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 12.
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Filling Field     Generates a blank field on output.
(29) Excess Distributions C PTVE3C $ <ENTER> Enter the amount from Part V, Section E, Line 3c.
(30) Excess Distributions D PTVE3D $ <ENTER> Enter the amount from Part V, Section E, Line 3d.
(31) Excess Distributions E PTVE3E $ <ENTER> Enter the amount from Part V, Section E, Line 3e.
(32) Excess Distributions Breakdown B PTVE8B $ <ENTER> Enter the amount from Part V, Section E, Line 8b.
(33) Excess Distributions Breakdown C PTVE8C $ <ENTER> Enter the amount from Part V, Section E, Line 8c.
(34) Excess Distributions Breakdown D PTVE8D $ <ENTER> Enter the amount from Part V, Section E, Line 8d.
(35) Excess Distributions Breakdown E PTVE8E $ <ENTER> Enter the amount from Part V, Section E, Line 8e.
Exhibit 3.24.12-110

Form 990 - Section 13, Schedules C & D (2019 and Subsequent)

Form 990 - Section 13, Schedules C & D (2019 and Subsequent)
3.24.12 - 110 SECTION 13
Source Document or Record: Forms 990 - Section 13, Schedules C & D (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Political Expenditures SCHIAL2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Total Number at EOY SCHDL1(A) <ENTER> Enter the number shown on Schedule D, Part I, Line 1, Column (a).
(4) Contributions To L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 2, Column (a).
(5) Grants From L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 3, Column (a).
(6) Aggregate Value L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 4, Column (a).
(7) Inform All Donors Checkbox L5 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 5.
(8) Inform All Grantees Checkbox L6 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 6.
Exhibit 3.24.12-111

Form 990 - Section 31, Schedule H (2019 and Subsequent)

Form 990 - Section 31, Schedule H (2019 and Subsequent)
3.24.12 - 111 SECTION 31
Source Document or Record: Form 990 - Section 31, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 31.
(2) Financial Assistance L1A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1a: 1 = yes 2 = no.
(3) Written Policy L1B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 1b: 1 = yes 2 = no.
(4) Best Describes L2 <ENTER> Enter the following:
1 = Applied Uniformly to all. 2 = Applied Uniformly to most.
3 = Generally tailored.
(5) FPG Used L3A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3a: 1 = yes 2 = no.
(6) FPG% L3A% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3a percent:
1 = 100%
2 = 150%
3 = 200%
4 = Other.
(7) FPG Discounted Care L3B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 3b: 1 = yes
2 = no.
(8) FPG Discounted Care % L3B% <ENTER> Enter the percent that is next to the marked box from Schedule H, Part I, Line 3b percent:
1 = 200%
2 = 250%
3 = 300%
4 = 350%
5 = 400%
6 = Other
If more than one box is checked, enter the number for the largest percent..
(9) Applied to Largest Number of Patients L4 <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 4: 1 = yes
2 = no.
(10) Budget Amounts for Free or Discounted L5A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5a: 1 = yes
2 = no.
(11) Exceed Budget Amount L5B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5b: 1 = yes
2 = no.
(12) Unable to Provide Free or Discounted Care L5C <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 5c: 1 = yes
2 = no.
(13) Prepare A Community Benefit Report L6A <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6a: 1 = yes
2 = no.
(14) Available to Public L6B <ENTER> Enter the following from the checkbox Schedule H, Part I, Line 6b: 1 = yes
2 = no.
(15) Financial Assistance C L7AC $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (c).
(16) Financial D L7AD $ <ENTER> Enter the amount from Schedule H, Part I, Line 7a, Column (d).
(17) Financial Assistance at Cost Net Community SCHH 7A(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7a, Column (e).
(18) Financial Assistance at Cost Percent 7A(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7a, Column (f).
(19) Medicaid C L7BC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (c).
(20) Medicaid D L7BD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (d).
(21) Unreimbursed Medicaid Net Community 7B(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (e).
(22) Unreimbursed Medicaid Percent 7B(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7b, Column (f).
(23) Cost of Other Means Tested C L7CC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (c).
(24) Cost of Other Means Tested D L7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (d).
(25) Unreimbursed Costs - Other Net Community 7C(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (e).
(26) Unreimbursed Costs - Other Percent 7C(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7c, Column (f).
(27) Financial Assistance Total C 7DC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (c).
(28) Financial Assistance Total D 7DD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (d).
(29) Total Financial Assistance Net Community 7D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (e).
(30) Total Financial Assistance Percent 7D(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7d, Column (f).
Exhibit 3.24.12-112

Form 990 - Section 32, Schedule H (2019 and Subsequent)

Form 990 - Section 32, Schedule H (2019 and Subsequent)
3.24.12 - 112 Section 32
Source Document or Record: Forms 990 - Section 32, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 32.
(2) Community Health Improvement C 7EC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (c).
(3) Community Health Improvement D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (d).
(4) Community Health Improvement E 7EE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7e, Column (e).
(5) Community Health Improvement Percent 7EF% <ENTER> Enter the percent from Schedule H, Part I, Line 7e, Column (f).
(6) Health Professions C 7FC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (c).
(7) Health Professions D 7ED $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (d).
(8) Health Professions E 7FE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7f, Column (e).
(9) Health Professions Percent 7FF% <ENTER> Enter the percent from Schedule H, Part I, Line 7f, Column (f).
(10) Subsidized Health Services C 7GC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (c).
(11) Subsidized Health Services D 7GD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (d).
(12) Subsidized Health Services E 7GE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7g, Column (e).
(13) Subsidized Health Services Percent 7GF% <ENTER> Enter the percent from Schedule H, Part I, Line 7g, Column (f).
(14) Research C 7HC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (c).
(15) Research D 7HD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (d).
(16) Research E 7HE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7h, Column (e).
(17) Research F Percent 7HF% <ENTER> Enter the percent from Schedule H, Part I, Line 7h, Column (f).
(18) Cash & Contributions C 7IC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (c).
(19) Cash & Contributions D 7ID $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (d).
(20) Cash & Contributions E 7IE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7i, Column (e).
(21) Cash & Contributions % 7IF% <ENTER> Enter the percent from Schedule H, Part I, Line 7i, Column (f).
(22) Total Other Benefits C 7JC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (c).
(23) Total Other Benefits D 7JD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (d).
(24) Total Other Benefits E 7JE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (e).
(25) Total Other Benefits Percent 7JF% <ENTER> Enter the percent from Schedule H, Part I, Line 7j, Column (f).
(26) Total C 7KC $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (c).
(27) Total D 7KD $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (d).
(28) Total E 7KE $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (e).
(29) Total Percent 7KF% <ENTER> Enter the percent from Schedule H, Part I, Line 7k, Column (f).
Exhibit 3.24.12-113

Form 990 - Section 33, Schedule H (2019 and Subsequent)

Form 990 - Section 33, Schedule H (2019 and Subsequent)
3.24.12 - 113 SECTION 33
Source Document or Record: Forms 990 - Section 33, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 16.
(2) Total Net Community PIII0E $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part II, Line 10, Column (e).
(3) Total Percent of Expense 10F% <ENTER> Enter the percent from Schedule H, Part II, Line 10 Column (f).
(4) Report Bad Debt Expense PT3L1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part III, Line 1.
(5) Bad Debt Expense Amount L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 2.
(6) Estimated Bad Debt Expense Amount L3 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 3.
(7) Revenue from Medicare L5 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 5.
(8) Medicare Allowable Costs L6 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 6.
(9) Medicare Surplus or Shortfall L7 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 7.
(10) Costing Methodology or Source Code L8CD <ENTER> Enter the edited code from the right of the boxes from Schedule H, Part III, Line 8.
(11) Written Debt Collection Policy L9A <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9a.
(12) Collection Policy Contain Provision L9B <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9b.
(13) Part IV Code PIVCD <ENTER> Enter the edited digit from Schedule H, Part IV, right margin.
(14) Part V How Many Hospital Facilities Did Organization Operate SECATOP <ENTER> Enter the number shown in the Hospital Facilities area in the top left portion of Schedule H, Part V, Section A.
(15) Part V Section C Indicator Code SECCRM <ENTER> Enter the indicator code from Schedule H, Part V, Section C, right margin.
(16) Part V How Many Non-Hospital Facilities Did Organization Operate SECCTOP <ENTER> Enter the number from the non-hospital health care benefits line.
(17) Part V Section D Indicator Code SECTDRM <ENTER> Enter the edited code from Schedule H, Part V, Section D, right margin.
Exhibit 3.24.12-114

Form 990 - Section 34, Schedule H (2019 and Subsequent)

Form 990 - Section 34, Schedule H (2019 and Subsequent)
3.24.12 - 114 SECTION 34
Source Document or Record: Forms 990 - Section 34, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-115

Form 990 - Section 35, Schedule H (2019 and Subsequent)

Form 990 - Section 35, Schedule H (2019 and Subsequent)
3.24.12 - 115 SECTION 35
Source Document or Record: Forms 990 - Section 35, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-116

Form 990 - Section 36, Schedule H (2019 and Subsequent)

Form 990 - Section 36, Schedule H (2019 and Subsequent)
3.24.12 - 116 SECTION 36
Source Document or Record: Forms 990 - Section 36, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19d is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-117

Form 990 - Section 37, Schedule H (2019 and Subsequent)

Form 990 - Section 37, Schedule H (2019 and Subsequent)
3.24.12 - 117 SECTION 37
Source Document or Record: Forms 990 - Section 37, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-118

Form 990 - Section 38, Schedule H (2019 and Subsequent)

Form 990 - Section 38, Schedule H (2019 and Subsequent)
3.24.12 - 118 SECTION 38
Source Document or Record: Forms 990 - Section 38, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-119

Form 990 - Section 39, Schedule H (2019 and Subsequent)

Form 990 - Section 39, Schedule H (2019 and Subsequent)
3.24.12 - 119 SECTION 39
Source Document or Record: Forms 990 - Section 39, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-120

Form 990 - Section 40, Schedule H (2019 and Subsequent)

Form 990 - Section 40, Schedule H (2019 and Subsequent)
3.24.12 - 120 SECTION 40
Source Document or Record: Forms 990 - Section 40, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-121

Form 990 - Section 41, Schedule H (2019 and Subsequent)

Form 990 - Section 41, Schedule H (2019 and Subsequent)
3.24.12 - 121 SECTION 41
Source Document or Record: Forms 990 - Section 41, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-122

Form 990 - Section 42, Schedule H (2019 and Subsequent)

Form 990 - Section 42, Schedule H (2019 and Subsequent)
3.24.12 - 122 SECTION 42
Source Document or Record: Forms 990 - Section 42, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-123

Form 990 - Section 43, Schedule H (2019 and Subsequent)

Form 990 - Section 43, Schedule H (2019 and Subsequent)
3.24.12 - 123 SECTION 43
Source Document or Record: Forms 990 - Section 43, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-124

Form 990 - Section 44, Schedule H (2019 and Subsequent)

Form 990 - Section 44, Schedule H (2019 and Subsequent)
3.24.12 - 124 SECTION 44
Source Document or Record: Forms 990 - Section 44, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-125

Form 990 - Section 45, Schedule H (2019 and Subsequent)

Form 990 - Section 45, Schedule H (2019 and Subsequent)
3.24.12 - 125 SECTION 45
Source Document or Record: Forms 990 - Section 45, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-126

Form 990 - Section 46, Schedule H (2019 and Subsequent)

Form 990 - Section 46, Schedule H (2019 and Subsequent)
3.24.12 - 126 SECTION 46
Source Document or Record: Forms 990 - Section 46, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 34.
(2) Name of Facility Section B BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Licensed Registered State Y/N PVL1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 1.
(5) Hospital Acquired in Current Year Y/N P2VL <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 2.
(6) Conduct Community Health Needs Assessment L3 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part V, Section B Line 3.
(7) Definition of Community Served L3A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3a is checked.
(8) Demographics of a Community L3B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3b is checked.
(9) Existing Health Care and Resources L3C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3c is checked.
(10) How Data Was Obtained L3D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3d is checked.
(11) Health Needs of a Community L3E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3e is checked.
(12) Primary and Chronic Disease Needs L3F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3f is checked.
(13) Identifying and Prioritizing Health Needs L3G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3g is checked.
(14) Consulting With Persons Representing L3H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3h is checked.
(15) Information Gaps That Limit L3I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3i is checked.
(16) Other L3J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 3j is checked.
(17) Tax Year CHNA Conducted L4 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 4.
(18) Hospital Facility Take Into Account Input L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(19) Conducted With One or More Other Hospitals Facilities L6A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6a.
(20) CHNA Conducted With One or More Organizations Other Than Hospital Facilities L6B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 6b.
(21) Widely Available to Public L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(22) Hospital Website L7A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7a is checked.
(23) Other Website L7B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7b is checked.
(24) Paper Copy Available Without Charge L7C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7c is checked.
(25) Other L7D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 7d is checked.
(26) Adopt Implementation Strategy L8 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8.
(27) Tax Year Strategy Implemented L9 <ENTER> Enter the year from Schedule H, Part V, Section B, Line 9.
(28) Strategy Posted on Website L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(29) URL Present L10A <ENTER> Enter a 1 if a url is present on Schedule H, Part V, Section B, Line 10a.
(30) Strategy Attached L10B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10b.
(31) Excise Tax Under 4959 L12A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12a.
(32) Did Organization File 4720 L12B <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 12b.
(33) 4959 Tax Reported L12C $ <ENTER>
MINUS (-)		 Enter the amount on Schedule H, Part V, Section B, Line 12c.
(34) Explained Eligibility Requirement L13 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(35) Uses Federal Poverty Guidelines Free Care L13A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13a is checked.
(36) Free Care % 13A1% <ENTER> Enter the first percent on Schedule H, Part V, Section B, Line 13a.
(37) Discounted Care % 13A2% <ENTER> Enter the second percent on Schedule H, Part V, Section B, Line 13a.
(38) Income Level Other Than FPG L13B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13b is checked.
(39) Asset Level L13C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13c is checked.
(40) Medical Indigency 13D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13d is checked.
(41) Insurance Status 13E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13e is checked.
(42) Underinsurance Status 13F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13f is checked.
(43) Residency 13G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13g is checked.
(44) Other 13H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 13h is checked.
Exhibit 3.24.12-127

Form 990 - Section 47, Schedule H (2019 and Subsequent)

Form 990 - Section 47, Schedule H (2019 and Subsequent)
3.24.12 - 127 SECTION 47
Source Document or Record: Forms 990 - Section 47, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 35.
(2) Calculating Amounts Charged to Patients 14 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(3) Explained the Method for Applying Financial Assistance 15 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(4) Information Hospital Required on Application 15A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15a is checked.
(5) Supporting Information Required on Application 15B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15b is checked.
(6) Contact Information 15C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15c is checked.
(7) Contact Information Sources of Financial Assistance 15D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15d is checked.
(8) Other 15E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 15e is checked.
(9) Publicize the Policy 16 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 16.
(10) FAP Available on Website 16A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16a is checked.
(11) FAP Application on Website 16B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16b is checked.
(12) Plain Language Summary 16C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16c is checked.
(13) FAP Available on Request 16D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16d is checked.
(14) FAP Application Form Available Upon Request 16E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16e is checked.
(15) Plain Language FAP Available 16F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16f is checked.
(16) FAP Conspicuously Displayed 16G <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16g is checked.
(17) Notified Customers 16H <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16h is checked.
(18) FAP Translated into Primary Language of LEP 16I <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16i is checked.
(19) Other 16J <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 16j is checked.
(20) Separate Billing and Collections Billing 17 <ENTER> Enter a a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(21) Reporting to Credit Agency 18A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18a is checked.
(22) Selling an Individuals Debt 18B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18b is checked.
(23) Deferring, Denying or Requesting a Payment 18C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18c is checked.
(24) Actions That Require Legal or Judicial Process 18D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18d is checked.
(25) Other Similar Actions 18E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18e is checked.
(26) None of These Actions 18F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 18f is checked.
Exhibit 3.24.12-128

Form 990 - Section 48, Schedule H (2019 and Subsequent)

Form 990 - Section 48, Schedule H (2019 and Subsequent)
3.24.12 - 128 SECTION 48
Source Document or Record: Forms 990 - Section 48, Schedule H (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 36.
(2) Individuals Availability Under Facilities FAP 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(3) Reporting to Credit Agency 19A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19a is checked.
(4) Selling an Individuals Debt 19B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19b is checked.
(5) Deferring, Denying or Requesting a Payment 19C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19c is checked.
(6) Actions That Require Legal or Judicial Process 19D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19dc is checked.
(7) Other Similar Actions 19E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 19e is checked.
(8) Provided a Written Notice 20A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20a is checked.
(9) Reasonable Effort to Orally Notify 20B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20b is checked.
(10) Processed Complete and Incomplete FAP 20C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20c is checked.
(11) Made Presumptive Eligibility Determinations 20D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20d is checked.
(12) Other 20E <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20e is checked.
(13) None of These Efforts 20F <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 20f is checked.
(14) Written Policy to Emergency Medical Dare Policy 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(15) Did Not Provide Care for Emergency Medical Conditions 21A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21a is checked.
(16) Did Not Have Policy Relating to Emergency Medical Care 21B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21b is checked.
(17) Limited Who Was Eligible 21C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21c is checked.
(18) Other 21D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 21d is checked.
(19) Look Back Method Allowed by a Medicare Fee 22A <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22a is checked.
(20) Look Back Method Allowed by a Medicare Fee and Private Insurance 22B <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22b is checked.
(21) Look Back Method Allowed by Medicaid Either Alone or Combination of Medicare 22C <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22c is checked.
(22) Prospective Medicaid or Medicare Method 22D <ENTER> Enter a 1 if the box on Schedule H, Part V, Section B, Line 22d is checked.
(23) Charge Any of Its Patients 23 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 23.
(24) Amount Equal to the Gross Charge 24 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 24.
Exhibit 3.24.12-129

Form 990 - Section 49 Schedules L and R (2019 and Subsequent)

Form 990 - Section 49 Schedules L and R (2019 and Subsequent)
3.24.12 - 129 SECTION 49
Source Document or Record: Forms 990 - Section 49, Schedules L & R (2019 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 49.
(2) Excess Benefit Transactions PT1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part 1.
(3) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
(4) Interest, Annuities, Royalties, Yes/No Box SCHR PT51A <ENTER> Enter a yes or a no from the yes/no box from Schedule R, Part V, Line 1a.
Exhibit 3.24.12-130

Form 990 - Section 01 (2008 - 2013) CP 425–431 & 259A-259H

Form 990 - Section 01 (2008 - 2013) CP425–431 & 259A-259H
3.24.12 - 130 SECTION 01
Source Document or Record: Forms 990 - Section 01 (2008 - 2013) CP411–414, 420–430 & 259A - 259G
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
★★★★★★		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) For a CP 425–431 & 259A-259H, underlined to the right of the "Employer ID Number" .
(b) See standard rules in IRM 3.24.38.
(c) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) For a CP 425–431 & 259A-259H, edited in the area around the Tax Period.
(10) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.
(11) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(12) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(13) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country code.
(14) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(15) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(16) Group Code H(b) BOXHB <ENTER> Enter a "1" or "2" from the yes/no box from the entity area of the return, Line H(b). For a CP425–431 & 259A-259H, press <ENTER> only.
(17) Tax Exempt Status BOXI <ENTER> Enter the edited two digit code from the blank space of Box I.
(18) Type of Organization BOXK RT <ENTER> Enter the edited code from the blank space of Box K. For a CP 425–431 & 259A-259H enter a "9" .
(19) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 2–7b. For a 420–431 & 259A-259H, enter the edited characters as shown in the center of the return. If a Condition Code is illegible, enter a "#" in its place.
(20) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a "G" Condition Code is present and the return is non-remittance, end the document after this element.
(c) If a CP 425–431 & 259A-259H, end the document after this element.
(21) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(22) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(23) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
(24) Preparer Telephone # TEL# <ENTER> Enter the preparer phone number.
(a) If the Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(b) If Type of Organization is a "9" , and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(25) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
"9" from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
"9" , and the "9" is NOT underlined, press <F6> and end the document after this element.
Exhibit 3.24.12-131

Form 990 - Section 02, Form 5800 - Edit Sheet (2008 - 2013)

Form 990 - Section 02, Form 5800 - Edit Sheet (2008 - 2013)
3.24.12 - 131 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800 - Edit Sheet (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(3) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(4) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(5) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(6) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-132

Form 990 - Section 03 (2008 - 2013)

Form 990 - Section 03 (2008 - 2013)
3.24.12-132 SECTION 03
Source Document or Record: Forms 990 - Section 03, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return, ONLY if underlined in green.
(3) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(4) Undertake New Activities Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2.
(5) Make Significant Changes Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3.
(6) Exempt Purpose Code 1 L4A <ENTER> Press Enter only. Don't transcribe a code.
(7) Exempt Purpose Code 2 L4B <ENTER> Press Enter only. Don't transcribe a code.
(8) Exempt Purpose Code 3 L4C <ENTER> Press Enter only. Don't transcribe a code.
(9) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.

Note:

If a "D1" is edited and underlined, pick up as an alpha "D" and numeric "1" . Don't confuse with an alpha "D" and alpha "I" .
(10) 501(c)(3) or 4947(a)(1) Y/N L1 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 1.
(11) Required to Complete Sch B Y/N L2 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 2.
(12) Engage in Direct or Indirect Political Y/N L3 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 3.
(13) Engage in Lobbying Activities Y/N L4 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 4.
(14) Subject to Sec 6033(c) Notice L5 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 5.
(15) Maintain Donor Advised Y/N L6 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 6.
(16) Receive or Hold Conservation Y/N L7 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 7.
(17) Maintain Collections of Works of Art Y/N L8 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 8.
(18) Provide Credit Counseling Y/N L9 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 9.
(19) Hold Assets in Term/Permanent Y/N L10 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 10.
(20) Land, Buildings, Equipment 11A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11a.
(21) Investments Other Securities 11B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11b.
(22) Investments Program Related 11C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11c.
(23) Other Assets 11D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11d.
(24) Other Liabilities 11E <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11e.
(25) Separate or Consolidated Financial Statements 11F <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 11f.
(26) Separate Independent Audited Financial 12A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12a.
(27) Consolidated Independent Financial 12B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 12b.
(28) School Described in 170(b)(1)(A)(ii) L13 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 13.
(29) Maintain an Office, etc Outside U.S. 14A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14a.
(30) Have Aggregate Revenues/Expenses 14B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 14b.
(31) Report > $5000 on Part IX Organizations L15 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 15.
(32) Report > $5000 on Part IX Individuals L16 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 16.
(33) Report > $15,000 on Part IX, Line 11e L17 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 17.
(34) Report > $15,000 on Part VIII, Line 1c/8a L18 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 18.
(35) Report > $15,000 on Part VIII, Line 9a L19 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 19.
(36) Operate Hospitals 20A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20a.
(37) Attach Audited Financial Statements 20B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 20b.
Exhibit 3.24.12-133

Form 990 - Section 04 (2008 - 2013)

Form 990 - Section 04 (2008 - 2013)
3.24.12 - 133 SECTION 04
Source Document or Record: Forms 990 - Section 04, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "04" .
(2) Report > $5000 on Part IX, Line 1 L21 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 21.
(3) Report > $5000 on Part IX, Line 2 L22 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 22.
(4) Answer Yes to Questions 3, 4, 5 L23 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 23.
(5) Any Tax-Exempt Bond with Outstanding Principal 24A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24a.
(6) Invest Any Proceeds 24B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24b.
(7) Maintain an Escrow Account 24C <ENTER> Enter a yes or no from the yes/box from Part IV, Line 24c.
(8) Act as "On Behalf Of" Issuer 24D <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 24d.
(9) 501(c)(3) / 501(c)(4) Organizations 25A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25a.
(10) Become Aware it Engaged in Excess 25B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 25b.
(11) Loan to/by Current/Former Officer L26 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 26.
(12) Provide Grant or Other Assistance L27 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 27.
(13) Business Transaction with Current or Former Officer 28A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28a.
(14) Business Transaction with Family Member 28B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28b.
(15) Business Transaction with Entity of Current/Former Officer 28C <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 28c.
(16) Receive or Accrue > $25,000 in Non-Cash L29 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 29.
(17) Receive or Accrue Contributions of Art L30 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 30.
(18) Liquidate, Terminate, Dissolve L31 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 31.
(19) Sell, Exchange, Dispose L32 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 32.
(20) Own 100% of an Entity L33 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 33.
(21) Related to Tax-Exempt / Taxable Entity L34 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 34.
(22) Controlled Entity Within 512(b)(13) L35A <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35a.
23 Receive Payment or Engage Transaction Within L35B <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 35b.
(24) Make Any Transfers L36 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 36.
(25) Conduct More than 5% L37 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 37.
(26) Complete Schedule O L38 <ENTER> Enter a yes or no from the yes/no box from Part IV, Line 38.
Exhibit 3.24.12-134

Form 990 - Section 05 (2008 - 2013)

Form 990 - Section 05 (2008 - 2013)
3.24.12 - 134 SECTION 05
Source Document or Record: Forms 990 - Section 05, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Part V Number of Forms/1096 PTVL1A <ENTER> Enter the number shown on Part V, Line 1a.
(3) Number of Forms W-2G L1B <ENTER> Enter the number shown on Part V, Line 1b.
(4) Comply with Backup Withholding Rules L1C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 1c.
(5) Number of Employees / W-3 L2A <ENTER> Enter the number shown on Part V, Line 2a.
(6) File All Required Federal Employment Returns L2B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 2b.
(7) Unrelated Business Income > $1000 L3A <ENTER> Enter a yes or no from the yes/box from Part V, Line 3a.
(8) If Yes, Has Filed a 990-T L3B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 3b.
(9) Interest in or a Signature L4A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 4a.
(10) Party to a Prohibited Tax Shelter L5A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5a.
(11) Taxable Party Notify Organization L5B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5b.
(12) If Yes, Did Organization File 8886-T L5C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 5c.
(13) Annual Gross Receipts Normally >$100,000 L6A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6a.
(14) If Yes, Did Organization Include L6B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 6b.
(15) >$75 Partly Contribution/Goods/Services L7A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7a.
(16) If Yes, Did Organization Notify Donor L7B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7b.
(17) Sell, Exchange, Otherwise Dispose L7C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7c.
(18) Number of Forms 8282 L7D <ENTER> Enter the number shown on Part V, Line 7d.
(19) Receive Any Funds L7E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7e.
(20) Pay Premiums L7F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7f.
(21) Contributions of Qualified Intellectual Property L7G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7g.
(22) Contributions of Cars, Boats, Airplanes L7H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 7h.
(23) Sponsoring Orgs, 509(a)(3) Excess Business Holdings L8 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 8.
(24) Make Taxable Distributions Under 4966 L9A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9a.
(25) Make Distribution to Donor L9B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 9b.
(26) Initiation Fees/Capital Contributions 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10a.
(27) Gross Receipts for Public Use of Facilities 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 10b.
(28) Gross Income/Members/Shareholders 11A $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11a.
(29) Gross Income from Other Sources 11B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 11b.
(30) 4947(a)(1) Filing 990 in Lieu of 1041 12A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 12a.
(31) Amount of Tax Exempt Interest 12B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 12b.
(32) Licensed to Issue Qualified Health Plans 13A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 13a.
(33) Aggregate Amount of Reserves to Maintain 13B $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13b.
(34) Aggregate Amount of Reserves on Hand 13C $ <ENTER>
MINUS (-)		 Enter the amount from Part V, Line 13c.
(35) Receive Payments for Indoor Tanning 14A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14a.
(36) Filed Form 720 to Report Payments 14B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 14b.
Exhibit 3.24.12-135

Form 990 - Section 06 (2008 - 2013)

Form 990 - Section 06 (2008 - 2013)
3.24.12 - 135 SECTION 06
Source Document or Record: Forms 990 - Section 06, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "06" .
(2) Voting Members of Governing Body PG6L1A <ENTER> Enter the number shown on Part VI, Section A, Line 1a.
(3) Independent Voting Members L1B <ENTER> Enter the number shown on Part VI, Section A, Line 1b.
(4) Officer, Director, Trustee Family/Relationship L2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 2.
(5) Delegate Control Over Management L3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 3.
(6) Make Significant Changes L4 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 4.
(7) Become Aware of Material Diversion L5 <ENTER> Enter a yes or no from the yes/box from Part VI, Section A, Line 5.
(8) Members of Stockholders L6 <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 6.
(9) Members, Stockholders, Other Persons 7A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7a.
(10) Members Subject to Approval 7B <ENTER> Enter a yes or no from the yes/no box from Part VI, Section A, Line 7b.
(11) Determining Compensation for CEO, Exec Director 15A <ENTER> Enter a yes or no from the yes/no box from Part VI, Section B, Line 15a
(12) Total Reportable Compensation from Organization PG8L1D(D) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column D.
(13) Total Reportable Compensation from Related Organization 1D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column E.
(14) Total Compensation from Organization & Related Organizations 1D(F) $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Section A, Line 1d, Column F.
(15) Total Individuals who Received > $100,000 SECTAL2 <ENTER> Enter the number shown on Part VII, Section A, Line 2.
(16) Total Independent Contractors Received > $100,000 SECTBL2 <ENTER> Enter the number shown on Part VII, Section B, Line 2.
Exhibit 3.24.12-136

Form 990 - Section 07 (2008 - 2013)

Form 990 - Section 07 (2008 - 2013)
3.24.12 - 136 SECTION 07
Source Document or Record: Forms 990 - Section 07, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "07" .
(2) Total Contributions/Gifts/Grants PG9L1H $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 1h, Column (A).
(3) Program Service Business Code 2A 2ACODE <ENTER> Enter the number shown on Part VIII, Line 2a.
(4) 2a Program Service Revenue Col. A 2A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2a, Column (A).
(5) Program Service Business Code 2B 2BCODE <ENTER> Enter the number shown on Part VIII, Line 2b.
(6) 2b Program Service Revenue Col. A 2B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2b, Column (A).
(7) Program Service Business Code 2C 2CCODE <ENTER> Enter the number shown on Part VIII, Line 2c.
(8) 2c Program Service Revenue Col. A 2C(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2c, Column (A).
(9) Program Service Business Code 2D 2DCODE <ENTER> Enter the number shown on Part VIII, Line 2d.
(10) 2d Program Service Revenue Col. A 2D(A) $ <ENTER>
MINUS (-)		 Enter amount shown on Part VIII, Line 2d, Column (A).
(11) Program Service Business Code 2E 2ECODE <ENTER> Enter the number shown on Part VIII, Line 2e.
(12) 2e Program Service Revenue Col. A 2E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2e, Column (A).
(13) 2f Program Service Revenue Col. A 2F(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 2f, Column (A).
(14) 2g Program Service Revenue Total Col. A 2GTOT $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 2g, Column (A).
(15) Investment Income Col. A 3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 3, Column (A).
(16) Tax-Exempt Bond Proceeds Col. A 4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 4, Column (A).
(17) Royalties Col. A 5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 5, Column (A).
(18) Gross Rents Real 6(A)I $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (i).
(19) Gross Rents Personal 6(A)II $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6a, Column (ii).
(20) Rental Expenses Real 6(B)(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (i).
(21) Rental Expenses Personal 6(B)(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6b, Column (ii).
(22) Rental Income/Loss Real 6C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (i).
(23) Rental Income/Loss Personal 6C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6c, Column (ii).
(24) Net Rental Income/Loss Col. A 6D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 6d, Column (A).
Exhibit 3.24.12-137

Form 990 - Section 08 (2008 - 2013)

Form 990 - Section 08 (2008 - 2013)
3.24.12 - 137 SECTION 08
Source Document or Record: Forms 990 - Section 08, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "08" .
(2) Gross Amount from Sales of Assets - Securities PG9L7A(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (i).
(3) Gross Amount from Sales of Assets - Other 7A(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7a, Column (ii).
(4) Cost or Other Basis/Sales - Securities 7B(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (i).
(5) Cost or Other Basis/Sales - Other 7B(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7b, Column (ii).
(6) Gain/Loss - Securities 7C(I) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (i).
(7) Gain/Loss - Other 7C(II) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7c, Column (ii).
(8) Net Gain/Loss Col. A 7D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 7d, Column (A).
(9) Gross Income from Fundraising 8A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8a.
(10) Less Direct Expenses 8b 8B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8b.
(11) Net Income/Loss from Fundraising Col. A 8C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 8c, Column (A).
(12) Gross Income from Gaming 9A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9a.
(13) Less Direct Expenses 9b 9B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9b.
(14) Net Income/Loss from Gaming 9C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 9c, Column (A).
(15) Gross Sales of Inventory 10A $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10a.
(16) Less Cost of Goods Sold 10B $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10b.
(17) Net Income/Loss from Sales Col. A 10C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 10c, Column (A).
(18) Misc. Revenue Business Code 11a 11ACODE <ENTER> Enter the number shown on Part VIII, Line 11a.
(19) Misc. Revenue Total (A) Col. A 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11a, Column (A).
(20) Misc. Revenue Business Code 11b 11BCODE <ENTER> Enter the number shown on Part VIII, Line 11b.
(21) Misc. Revenue Total 11B(A) Col. A 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11b, Column (A).
(22) Misc. Revenue Business Code 11c 11CCODE <ENTER> Enter the number shown on Part VIII, Line 11c.
(23) Misc. Revenue Total 11C(A) Col. A 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11c, Column (A).
(24) Misc. Revenue Total 11D(A) Col. A 11D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11d, Column (A).
(25) Misc. Revenue Total 11E Col. A 11ETOT $ <ENTER>
MINUS (-)		 Enter the amount from Part VIII, Line 11e, Column (A).
(26) Total Revenue 12(A) Col. A 12(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from Part VIII, Line 12, Column (A).
Exhibit 3.24.12-138

Form 990 - Section 09 (2008 - 2013)

Form 990 - Section 09 (2008 - 2013)
3.24.12 - 138 SECTION 09
Source Document or Record: Forms 990 - Section 09, (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "09" .
(2) Gross to Government / Organizations in U.S. PG10L1(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 1, Column (A).
(3) Grants / Other Assistance in U.S. L2(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 2, Column (A).
(4) Grants / Other Assistance Outside U.S. L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 3, Column (A).
(5) Benefits Paid to / for Members L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 4, Column (A).
(6) Compensation of Current Officers / Directors L5(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 5, Column (A).
(7) Compensation to Disqualified Persons L6(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 6, Column (A).
(8) Other Salaries / Wages L7(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 7, Column (A).
(9) Pension Plan Contributions L8(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 8, Column (A).
(10) Other Employee Benefits L9(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 9, Column (A).
(11) Payroll Taxes 10(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 10, Column (A).
(12) Fees for Services / Management 11A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11a, Column (A).
(13) Fees for Services / Legal 11B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11b, Column (A).
(14) Fees for Services / Accounting 11C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 11c, Column (A).
(15) Fees for Services / Lobbyists 11D(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11d, Column (A).
(16) Fees for Services / Professional Fundraising 11E(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11e, Column(A).
(17) Fees for Services / Investment Management 11F(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 11f, Column (A).
(18) Fees for Services / Other 11G(A) $ <ENTER>
MINUS (-) ★★★★★★		 Enter the amount from shown on Part IX, Line 11g, Column (A).
(19) Advertising / Promotion 12(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 12, Column (A).
(20) Office Expenses 13(A) $ <ENTER>
MINUS (-)		 Enter the amount from on Part IX, Line 13, Column (A).
(21) Information Technology 14(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 14, Column (A).
(22) Royalties 15(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 15, Column (A).
(23) Occupancy 16(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 16, Column (A).
(24) Travel 17(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 17, Column (A).
(25) Payments of Travel / Entertainment 18(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 18, Column (A).
(26) Conferences, Conventions / Meetings 19(A) $ <ENTER>
MINUS(-)		 Enter the amount from Part IX, Line 19, Column (A).
(27) Interest 20(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 20, Column (A).
(28) Payments to Affiliates 21(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 21, Column (A).
(29) Depreciation / Depletion 22(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 22, Column (A).
(30) Insurance 23(A) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part IX, Line 23, Column (A).
(31) Other Expenses a 24A(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24a, Column (A).
(32) Other Expenses b 24B(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24b, Column (A).
(33) Other Expenses c 24C(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24c, Column (A).
(34) Other Expenses d 24D(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24d, Column (A).
(35) Other Expenses e 24E(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24e, Column (A).
(36) Other Expenses f 24F(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IX, Line 24f, Column (A).
(37) Total Functional Expenses 25(A) $ <ENTER>
MINUS (-)★★★★★★		 Enter the amount from Part IX, Line 25, Column (A).
Exhibit 3.24.12-139

Form 990 - Section 10 (2008 - 2013)

Form 990 - Section 10 (2008 - 2013)
3.24.12 - 139 SECTION 10
Source Document or Record: Forms 990 - Section 10, (2008- 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "10" .
(2) Cash EOY PG11L1(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 1, Column (B).
(3) Savings / Temporary Investments EOY L2(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 2, Column (B).
(4) Pledges / Grants Receivable EOY L3(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 3, Column (B).
(5) Accounts Receivable EOY L4(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 4, Column (B).
(6) Receivables from Current / Former EOY L5(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 5, Column (B).
(7) Receivables from Disqualified Persons EOY L6(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 6, Column (B).
(8) Notes / Loans Receivable EOY L7(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 7, Column (B).
(9) Inventories for Sale EOY L8(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 8, Column (B).
(10) Prepaid Expenses EOY L9(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 9, Column (B).
(11) Land / Buildings Less Accumulated EOY 10C(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 10c, Column (B).
(12) Investments Publicly Traded Securities EOY 11(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 11, Column (B).
(13) Investments Other Securities EOY 12(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 12, Column (B).
(14) Investments Program Related EOY 13(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 13, Column (B).
(15) Intangible Assets EOY 14(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 14, Column (B).
(16) Other Assets EOY 15(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 15, Column(B).
(17) Total Assets BOY 16(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 16, Column (A).
(18) Total Assets EOY 16(B) $ <ENTER>
MINUS (-)		 Enter the amount from shown on Part X, Line 16, Column (B).
(19) Accounts Payable EOY 17(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 17, Column (B).
(20) Grants Payable EOY 18(B) $ <ENTER>
MINUS (-)		 Enter the amount from on Part X, Line 18, Column (B).
(21) Deferred Revenue EOY 19(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 19, Column (B).
(22) Tax-Exempt Bond Liabilities EOY 20(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 20, Column (B).
(23) Escrow Liability EOY 21(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 21, Column (B).
(24) Payable to Current / Former Officers EOY 22(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 22, Column (B).
(25) Secured Mortgages / Notes EOY 23(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 23, Column (B).
(26) Unsecured Notes / Loans EOY 24(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 24, Column (B).
(27) Other Liabilities EOY 25(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 25, Column (B).
(28) Total Liabilities BOY 26(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 26, Column (A).
(29) Total Liabilities EOY 26(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 26, Column (B).
(30) Unrestricted Net Assets EOY 27(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 27, Column (B).
(31) Temporarily Restricted Net Assets EOY 28(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 28, Column (B).
(32) Permanently Restricted Net Assets EOY 29(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 29, Column (B).
(33) Capital Stock / Trust EOY 30(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 30, Column (B).
(34) Paid-In / Capital Surplus EOY 31(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 31, Column (B).
(35) Retained Earnings, Endowment EOY 32(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 32, Column (B).
(36) Total Net Assets or Fund Balances BOY 33(A) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Part X, Line 33, Column (A).
(37) Total Net Assets or Fund Balances EOY 33(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 33, Column (B).
(38) Total Liabilities / Net Assets Fund Balances EOY 34(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part X, Line 34, Column (B).
Exhibit 3.24.12-140

Form 990 - Section 11, Schedule A (2008 - 2013)

Form 990 - Section 11, Schedule A (2008 - 2013)
3.24.12 - 140 SECTION 11
Source Document or Record: Forms 990 - Section 11, Schedule A (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Total Number of Organizations 11H(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 11h, Column (i), Total Line.
(4) Total Amount of Support HVIITOT $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 11h, Column (vii), Total Line.
(5) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(6) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(7) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(8) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(9) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(10) Public Support 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(11) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(12) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(13) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(14) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(15) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(16) Receipts from Related Activities L12 $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 12.
(17) First 5 Years Checkbox 13CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 13 is checked.
(18) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16a is checked.
(19) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16b is checked.
(20) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17a is checked.
(21) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17b is checked.
(22) Private Foundation Checkbox 18CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-141

Form 990 - Section 12, Schedule A (2008 - 2013)

Form 990 - Section 12, Schedule A (2008 - 2013)
3.24.12 - 141 SECTION 12
Source Document or Record: Forms 990 - Section 12, Schedule A (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 20 is checked.
Exhibit 3.24.12-142

Form 990 - Section 13, Schedules C & D (2008 - 2013)

Form 990 - Section 13, Schedules C & D (2008 - 2013)
3.24.12 - 142 SECTION 13
Source Document or Record: Forms 990 - Section 13, Schedules C & D (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "13" .
(2) Political Expenditures SCHIAL2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Total Number at EOY SCHDL1(A) <ENTER> Enter the number shown on Schedule D, Part I, Line 1, Column (a).
(4) Contributions To L2(A)$ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 2, Column (a).
(5) Grants From L3(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 3, Column (a).
(6) Aggregate Value L4(A) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule D, Part I, Line 4, Column (a).
(7) Inform All Donors Checkbox L5 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 5.
(8) Inform All Grantees Checkbox L6 <ENTER> Enter a yes or no from the yes/no box from Schedule D, Part I, Line 6.
Exhibit 3.24.12-143

Form 990 - Section 14, Schedule H (2008 - 2013)

Form 990 - Section 14, Schedule H (2008 - 2013)
3.24.12 - 143 SECTION 14
Source Document or Record: Forms 990 - Section 14, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "14" .
(2) Financial Assistance at Cost Net Community SCHH 7A(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7a, Column (e).
(3) Financial Assistance at Cost Percent 7A(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7a, Column (f).
(4) Unreimbursed Medicaid Net Community 7B(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7b, Column (e).
(5) Unreimbursed Medicaid Percent 7B(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7b, Column (f).
(6) Unreimbursed Costs - Other Net Community 7C(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7c, Column (e).
(7) Unreimbursed Costs - Other Percent 7C(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7c, Column (f)
(8) Total Financial Assistance Net Community 7D(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7d, Column (e).
(9) Total Financial Assistance 7D(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7d, Column (f).
(10) Total Other Benefits Net Community 7J(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7j, Column (e).
(11) Total Other Benefits Percent 7J(F) <ENTER> Enter the percent from Schedule H, Part I, Line 7j, Column (f).
(12) Total Financial Assistance and Other Benefits Net Community 7K(E) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part I, Line 7k, Column (e).
(13) Total Financial Assistance and Other Benefits Percent 7K(F) $ <ENTER> Enter the percent from Schedule H, Part I, Line 7k, Column (f).
(14) Report Bad Debt Expense PT3 L1 <ENTER> Enter a yes or no from the yes/no box on Sch H, Part III, Line 1.
(15) Bad Debt Expense Amount L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 2.
(16) Estimated Bad Debt Expense Amount L3 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 3.
(17) Revenue from Medicare L5 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 5.
(18) Medicare Allowable Costs L6 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 6.
(19) Medicare Surplus or Shortfall L7 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule H, Part III, Line 7.
(20) Costing Methodology or Source Code L8CD <ENTER> Enter the edited code from the right of the boxes from Schedule H, Part III, Line 8.
(21) Written Debt Collection Policy L9A <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9a.
(22) Collection Policy Contain Provisions L9B <ENTER> Enter a yes or no from the yes/no box on Schedule H, Part III, Line 9b.
Exhibit 3.24.12-144

Form 990 - Section 15, Schedule H (2008 - 2013)

Form 990 - Section 15, Schedule H (2008 - 2013)
3.24.12 - 144 SECTION 15
Source Document or Record: Forms 990 - Section 15, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "15" .
(2) How Many Hospital Facilities Did Organization Operate SECATOP <ENTER> Enter the number shown in the Hospital Facilities area in the top left portion of Schedule H, Part V, Section A.
(3) How Many Non-Hospital Facilities Did Organization Operate SECCTOP <ENTER> Enter the number shown in the Other Facilities area in the top portion of Schedule H, Part V, Section C.
(4) Name of Facility BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(5) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Section B.
(6) Facility Line Number LN#HOSP <ENTER> Enter the number shown on the Line Number of Hospital Facility area on the top portion of Schedule H, Part V, Section B.
(7) Conduct Community Health Needs Assessment L1 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 1.
(8) Definition of Community Served L1A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(9) Demographics of Community L1B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1b is checked.
(10) Existing Health Care Facilities and Resources L1C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1c is checked.
(11) How Data was Obtained L1D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1d is checked.
(12) Health Needs of Community L1E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1e is checked.
(13) Primary and Chronic Disease Needs L1F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1f is checked.
(14) Identifying and Prioritizing Health Needs L1G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1g is checked.
(15) Consulting with Persons Representing L1H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1h is checked.
(16) Information Gaps the Limit L1I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1i is checked.
(17) Other L1J <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1j is checked.
(18) Needs Assessment: 20XX L2 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 2.
(19) Hospital Facility Take Into Account Input L3 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 3.
(20) Conducted with one or More Other Hospital L4 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 4.
(21) Widely Available to Public L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(22) Hospital Website L5A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5a is checked.
(23) Available Upon Request L5B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5b is checked.
(24) Other L5C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5c is checked.
(25) Adoption of Implementation Strategy L6A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6a is checked.
(26) Execution of Implementation Strategy L6B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6b is checked.
(27) Development of Community-Wide Community Benefit Plan L6C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6c is checked.
(28) Execution of Community-Wide Community Benefit Plan L6D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6d is checked.
(29) Inclusion of Community Benefit Section L6E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6e is checked.
(30) Adoption of Budget for Provision of Services L6F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6f is checked.
(31) Prioritization of Health Needs L6G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6g is checked.
(32) Prioritization of Services L6H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6h is checked.
(33) Other L6I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6i is checked.
(34) Hospital Facility Address All Needs Identified L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(35) Excise Tax under Section 4959 L8A <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8a.
36 Did Organization File Form 4720 L8B ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8b.
37 4959 Tax Reported L8C ENTER Enter the amount from Part V, Section B, Line 8c.
38 Eligibility Criteria for Financial Assistance L9 Enter Enter a yes or no from the yes/no box form Schedule H, Part V, Section B, Line 9.
(39) Uses Federal Policy Guidelines (FPG) Free Care L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(40) Free Care Percent 10% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 10, percent line.
Exhibit 3.24.12-145

Form 990 - Section 16, Schedule H (2008 - 2013)

Form 990 - Section 16, Schedule H (2008 - 2013)
3.24.12 - 145 SECTION 16
Source Document or Record: Forms 990 - Section 16, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "16" .
(2) FPG Discounted Care SCHH PTV SECB11 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 11.
(3) Discounted Care Percent 11% <ENTER> Enter the 3-digit percent from Sch H, Part V, Section B, Line 11.
(4) Basis for Calculating Amounts Charged 12 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 12.
(5) Income Level 12A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12a is checked.
(6) Asset Level 12B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12b is checked.
(7) Medical Indigency 12C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12c is checked.
(8) Insurance Status 12D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12d is checked.
(9) Uninsured Discount 12E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12e is checked.
(10) Medicaid/medicare 12F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12f is checked.
(11) State Regulation 12G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12g is checked.
(12) Other 12H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12h is checked.
(13) Method for Applying for Financial Assistance 13 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(14) Measures to Publicize the Policy 14 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(15) Policy Posted on Hospital Web Site 14A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14a is checked.
(16) Policy Attached to Billing Invoices 14B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14b is checked.
(17) Policy Posted in Emergency or Waiting Rooms 14C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14c is checked.
(18) Policy Posted in Admissions Office 14D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14d is checked.
(19) Policy Provided in Writing Upon Admission 14E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14e is checked.
(20) Policy Available Upon Request 14F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14f is checked.
(21) Other 14G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14g is checked.
(22) Separate Billing and Collections Policy 15 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(23) Actions Against Patient Reporting to Credit Agency 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(24) Patient Lawsuits 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(25) Patient Liens on Residences 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(26) Patient Body Attachments 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(27) Patient Other 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
Exhibit 3.24.12-146

Form 990 - Section 17, Schedule H (2008 - 2013)

Form 990 - Section 17, Schedule H (2008 - 2013)
3.24.12 - 146 SECTION 17
Source Document or Record: Forms 990 - Section 17, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "17" .
(2) Third Party Collection Actions 17 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(3) Third Party Reporting to Credit Agency 17A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17a is checked.
(4) Third Party Lawsuits 17B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17b is checked.
(5) Third Party Liens on Residences 17C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17c is checked.
(6) Third Party Body Attachments 17D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17d is checked.
(7) Third Party Other 17E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17e is checked.
(8) Notified Financial Assistance Upon Admission 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(9) Notified Financial Assistance Prior to Discharge 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(10) Notified Financial Assistance in Bills 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(11) Documented its Determination 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(12) Other 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
(13) Written Policy to Emergency Medical Dare Policy 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(14) Did Not Provide Care for Emergency Medical Conditions 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(15) Did Not Have Policy Relating to Emergency Medical Care 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(16) Limited Who Was Eligible 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(17) Other 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(18) Negotiated Commercial Insurance Rate 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(19) Average of the Three Lowest Negotiated Commercial Insurance Rates 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(20) Medicare Rate 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(21) Other 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(22) Charge Any of Its Patients 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(23) Amount Equal to the Gross Charge 22 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 22.
Exhibit 3.24.12-147

Form 990 - Section 18, Schedule H (2008 - 2013)

Form 990 - Section 18, Schedule H (2008 - 2013)
3.24.12 - 147 SECTION 18
Source Document or Record: Forms 990 - Section 18, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "18" .
(2) Name of Facility BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Section B.
(4) Facility Line Number LN#HOSP <ENTER> Enter the number shown on the Line Number of Hospital Facility area on the top portion of Schedule H, Part V, Section B.
(5) Conduct Community Health Needs Assessment L1 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 1.
(6) Definition of Community Served L1A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(7) Demographics of Community L1B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1b is checked.
(8) Existing Health Care Facilities and Resources L1C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1c is checked.
(9) How Data was Obtained L1D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1d is checked.
(10) Health Needs of Community L1E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1e is checked.
(11) Primary and Chronic Disease Needs L1F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1f is checked.
(12) Identifying and Prioritizing Health Needs L1G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1g is checked.
(13) Consulting with Persons Representing L1H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1h is checked.
(14) Information Gaps the Limit L1I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1i is checked.
(15) Other L1J <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(16) Needs Assessment: 20XX L2 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 2.
(17) Hospital Facility Take Into Account Input L3 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 3.
(18) Conducted with one or More Other Hospital L4 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 4.
(19) Widely Available to Public L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(20) Hospital Website L5A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5a is checked.
(21) Available Upon Request L5B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5b is checked.
(22) Other L5C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5c is checked.
(23) Adoption of Implementation Strategy L6A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6a is checked.
(24) Execution of Implementation Strategy L6B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6b is checked.
(25) Development of Community-Wide Community Benefit Plan L6C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6c is checked.
(26) Execution of Community-Wide Community Benefit Plan L6D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6d is checked.
(27) Inclusion of Community Benefit Section L6E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6e is checked.
(28) Adoption of Budget for Provision of Services L6F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6f is checked.
(29) Prioritization of Health Needs L6G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6g is checked.
(30) Prioritization of Services L6H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6h is checked.
(31) Other L6I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6i is checked.
(32) Hospital Facility Address All Needs Identified L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
33 Excise Tax Under Section 4959 L8A ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8a.
34 Did Organization File Form 4720 L8B ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8b.
35 4959 Tax Reported L8C ENTER Enter the amount from Schedule H, Part V, Section B, Line 8c.
(36) Eligibility Criteria for Financial Assistance L9 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 9.
(37) Uses Federal Policy Guidelines (FPG) Free Care L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(38) Free Care Percent 10% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 10, percent line.
Exhibit 3.24.12-148

Form 990 - Section 19, Schedule H (2008 - 2013)

Form 990 - Section 19, Schedule H (2008 - 2013)
3.24.12 -148 SECTION 19
Source Document or Record: Forms 990 - Section 19, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "19" .
(2) FPG Discounted Care SCHH PTV SECB11 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 11.
(3) Discounted Care Percent 11% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 11.
(4) Basis for Calculating Amounts Charged 12 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 12.
(5) Income Level 12A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12a is checked.
(6) Asset Level 12B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12b is checked.
(7) Medical Indigency 12C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12c is checked.
(8) Insurance Status 12D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12d is checked.
(9) Uninsured Discount 12E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12e is checked.
(10) Medicaid/medicare 12F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12f is checked.
(11) State Regulation 12G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12g is checked.
(12) Other 12H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12h is checked.
(13) Method for Applying for Financial Assistance 13 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(14) Measures to Publicize the Policy 14 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(15) Policy Posted on Hospital Web Site 14A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14a is checked.
(16) Policy Attached to Billing Invoices 14B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14b is checked.
(17) Policy Posted in Emergency or Waiting Rooms 14C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14c is checked.
(18) Policy Posted in Admissions Office 14D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14d is checked.
(19) Policy Provided in Writing Upon Admission 14E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14e is checked.
(20) Policy Available Upon Request 14F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14f is checked.
(21) Other 14G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14g is checked.
(22) Separate Billing and Collections Policy 15 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(23) Actions Against Patient Reporting to Credit Agency 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(24) Patient Lawsuits 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(25) Patient Liens on Residences 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(26) Patient Body Attachments 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(27) Patient Other 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
Exhibit 3.24.12-149

Form 990 - Section 20, Schedule H (2008 - 2013)

Form 990 - Section 20, Schedule H (2008 - 2013)
3.24.12 - 149 SECTION 20
Source Document or Record: Forms 990 - Section 20, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "20" .
(2) Third Party Collection Actions 17 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(3) Third Party Reporting to Credit Agency 17A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17a is checked.
(4) Third Party Lawsuits 17B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17b is checked.
(5) Third Party Liens on Residences 17C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17c is checked.
(6) Third Party Body Attachments 17D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17d is checked.
(7) Third Party Other 17E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17e is checked.
(8) Notified Financial Assistance Upon Admission 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(9) Notified Financial Assistance Prior to Discharge 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(10) Notified Financial Assistance in Bills 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(11) Documented its Determination 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(12) Other 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
(13) Written Policy to Emergency Medical Dare Policy 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(14) Did Not Provide Care for Emergency Medical Conditions 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(15) Did Not Have Policy Relating to Emergency Medical Care 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(16) Limited Who Was Eligible 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(17) Other 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(18) Negotiated Commercial Insurance Rate 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(19) Average of the Three Lowest Negotiated Commercial Insurance Rates 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(20) Medicare Rate 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(21) Other 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(22) Charge Any of Its Patients 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(23) Amount Equal to the Gross Charge 22 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 22.
Exhibit 3.24.12-150

Form 990 - Section 21, Schedule H (2008 - 2013)

Form 990 - Section 21, Schedule H (2008 - 2013)
3.24.12 - 150 SECTION 21
Source Document or Record: Forms 990 - Section 21, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "21" .
(2) Name of Facility BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Sec B.
(4) Facility Line Number LN#HOSP <ENTER> Enter the number shown on the Line Number of Hospital Facility area on the top portion of Schedule H, Part V, Section B.
(5) Conduct Community Health Needs Assessment L1 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 1.
(6) Definition of Community Served L1A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(7) Demographics of Community L1B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1b is checked.
(8) Existing Health Care Facilities and Resources L1C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1c is checked.
(9) How Data was Obtained L1D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1d is checked.
(10) Health Needs of Community L1E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1e is checked.
(11) Primary and Chronic Disease Needs L1F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1f is checked.
(12) Identifying and Prioritizing Health Needs L1G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1g is checked.
(13) Consulting with Persons Representing L1H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1h is checked.
(14) Information Gaps the Limit L1I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1i is checked.
(15) Other L1J <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(16) Needs Assessment: 20XX L2 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 2.
(17) Hospital Facility Take Into Account Input L3 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 3.
(18) Conducted with one or More Other Hospital L4 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 4.
(19) Widely Available to Public L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(20) Hospital Website L5A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5a is checked.
(21) Available Upon Request L5B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5b is checked.
(22) Other L5C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5c is checked.
(23) Adoption of Implementation Strategy L6A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6a is checked.
(24) Execution of Implementation Strategy L6B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6b is checked.
(25) Development of Community-Wide Community Benefit Plan L6C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6c is checked.
(26) Execution of Community-Wide Community Benefit Plan L6D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6d is checked.
(27) Inclusion of Community Benefit Section L6E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6e is checked.
(28) Adoption of Budget for Provision of Services L6F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6f is checked.
(29) Prioritization of Health Needs L6G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6g is checked.
(30) Prioritization of Services L6H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6h is checked.
(31) Other L6I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6i is checked.
(32) Hospital Facility Address All Needs Identified L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
33 Excise Tax Under Section 4959 L8A ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8a.
34 Did Organization File Form 4720 L8B ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8b.
35 4959 Tax Reported L8C ENTER Enter the amount from Schedule H, Part V, Section B, Line 8c.
(36) Eligibility Criteria for Financial Assistance L9 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 9.
(37) Uses Federal Policy Guidelines (FPG) Free Care L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(38) Free Care Percent 10% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 10, percent line.
Exhibit 3.24.12-151

Form 990 - Section 22, Schedule H (2008 - 2013)

Form 990 - Section 22, Schedule H (2008 - 2013)
3.24.12 - 151 SECTION 22
Source Document or Record: Forms 990 - Section 22, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "22" .
(2) FPG Discounted Care SCHH PTV SECB11 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 11.
(3) Discounted Care Percent 11% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 11.
(4) Basis for Calculating Amounts Charged 12 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 12.
(5) Income Level 12A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12a is checked.
(6) Asset Level 12B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12b is checked.
(7) Medical Indigency 12C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12c is checked.
(8) Insurance Status 12D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12d is checked.
(9) Uninsured Discount 12E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12e is checked.
(10) Medicaid/medicare 12F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12f is checked.
(11) State Regulation 12G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12g is checked.
(12) Other 12H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12h is checked.
(13) Method for Applying for Financial Assistance 13 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(14) Measures to Publicize the Policy 14 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(15) Policy Posted on Hospital Web Site 14A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14a is checked.
(16) Policy Attached to Billing Invoices 14B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14b is checked.
(17) Policy Posted in Emergency or Waiting Rooms 14C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14c is checked.
(18) Policy Posted in Admissions Office 14D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14d is checked.
(19) Policy Provided in Writing Upon Admission 14E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14e is checked.
(20) Policy Available Upon Request 14F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14f is checked.
(21) Other 14G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14g is checked.
(22) Separate Billing and Collections Policy 15 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(23) Actions Against Patient Reporting to Credit Agency 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(24) Patient Lawsuits 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(25) Patient Liens on Residences 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(26) Patient Body Attachments 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(27) Patient Other 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
Exhibit 3.24.12-152

Form 990 - Section 23, Schedule H (2008 - 2013)

Form 990 - Section 23, Schedule H (2008 - 2013)
3.24.12 - 152 SECTION 23
Source Document or Record: Forms 990 - Section 23, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "23" .
(2) Third Party Collection Actions 17 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(3) Third Party Reporting to Credit Agency 17A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17a is checked.
(4) Third Party Lawsuits 17B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17b is checked.
(5) Third Party Liens on Residences 17C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17c is checked.
(6) Third Party Body Attachments 17D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17d is checked.
(7) Third Party Other 17E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17e is checked.
(8) Notified Financial Assistance Upon Admission 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(9) Notified Financial Assistance Prior to Discharge 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(10) Notified Financial Assistance in Bills 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(11) Documented its Determination 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(12) Other 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
(13) Written Policy to Emergency Medical Dare Policy 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(14) Did Not Provide Care for Emergency Medical Conditions 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(15) Did Not Have Policy Relating to Emergency Medical Care 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(16) Limited Who Was Eligible 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(17) Other 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(18) Negotiated Commercial Insurance Rate 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(19) Average of the Three Lowest Negotiated Commercial Insurance Rates 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(20) Medicare Rate 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(21) Other 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(22) Charge Any of Its Patients 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(23) Amount Equal to the Gross Charge 22 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 22.
Exhibit 3.24.12-153

Form 990 - Section 24, Schedule H (2008 - 2013)

Form 990 - Section 24, Schedule H (2008 - 2013)
3.24.12 - 153 SECTION 24
Source Document or Record: Forms 990 - Section 24, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "24" .
(2) Name of Facility BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Section B.
(4) Facility Line Number LN#HOSP <ENTER> Enter the number shown on the Line Number of Hospital Facility area on the top portion of Schedule H, Part V, Section B.
(5) Conduct Community Health Needs Assessment L1 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 1.
(6) Definition of Community Served L1A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(7) Demographics of Community L1B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1b is checked.
(8) Existing Health Care Facilities and Resources L1C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1c is checked.
(9) How Data was Obtained L1D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1d is checked.
(10) Health Needs of Community L1E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1e is checked.
(11) Primary and Chronic Disease Needs L1F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1f is checked.
(12) Identifying and Prioritizing Health Needs L1G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1g is checked.
(13) Consulting with Persons Representing L1H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1h is checked.
(14) Information Gaps the Limit L1I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1i is checked.
(15) Other L1J <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(16) Needs Assessment: 20XX L2 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 2.
(17) Hospital Facility Take Into Account Input L3 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 3.
(18) Conducted with one or More Other Hospital L4 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 4.
(19) Widely Available to Public L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(20) Hospital Website L5A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5a is checked.
(21) Available Upon Request L5B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5b is checked.
(22) Other L5C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5c is checked.
(23) Adoption of Implementation Strategy L6A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6a is checked.
(24) Execution of Implementation Strategy L6B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6b is checked.
(25) Development of Community-Wide Community Benefit Plan L6C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6c is checked.
(26) Execution of Community-Wide Community Benefit Plan L6D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6d is checked.
(27) Inclusion of Community Benefit Section L6E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6e is checked.
(28) Adoption of Budget for Provision of Services L6F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6f is checked.
(29) Prioritization of Health Needs L6G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6g is checked.
(30) Prioritization of Services L6H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6h is checked.
(31) Other L6I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6i is checked.
(32) Hospital Facility Address All Needs Identified L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
(33) Excise Tax Under Section 4959 L8A ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8a.
(34) Did Organization File Form 4720 L8B ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8b.
(35) 4959 Tax Reported L8C ENTER Enter the amount from Schedule H, Part V, Section B, Line 8c.
(36) Eligibility Criteria for Financial Assistance L9 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 9.
(37) Uses Federal Policy Guidelines (FPG) Free Care L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(38) Free Care Percent 10% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 10, percent line.
Exhibit 3.24.12-154

Form 990 - Section 25, Schedule H (2008 - 2013)

Form 990 - Section 25, Schedule H (2008 - 2013)
3.24.12 - 154 SECTION 25
Source Document or Record: Forms 990 - Section 25, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "25" .
(2) FPG Discounted Care SCHH PTV SECB11 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 11.
(3) Discounted Care Percent 11% <ENTER> Enter the 3-digit percent from Sch H, Part V, Section B, Line 11.
(4) Basis for Calculating Amounts Charged 12 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 12.
(5) Income Level 12A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12a is checked.
(6) Asset Level 12B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12b is checked.
(7) Medical Indigency 12C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12c is checked.
(8) Insurance Status 12D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12d is checked.
(9) Uninsured Discount 12E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12e is checked.
(10) Medicaid/medicare 12F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12f is checked.
(11) State Regulation 12G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12g is checked.
(12) Other 12H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12h is checked.
(13) Method for Applying for Financial Assistance 13 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(14) Measures to Publicize the Policy 14 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(15) Policy Posted on Hospital Web Site 14A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14a is checked.
(16) Policy Attached to Billing Invoices 14B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14b is checked.
(17) Policy Posted in Emergency or Waiting Rooms 14C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14c is checked.
(18) Policy Posted in Admissions Office 14D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14d is checked.
(19) Policy Provided in Writing Upon Admission 14E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14e is checked.
(20) Policy Available Upon Request 14F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14f is checked.
(21) Other 14G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14g is checked.
(22) Separate Billing and Collections Policy 15 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(23) Actions Against Patient Reporting to Credit Agency 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(24) Patient Lawsuits 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(25) Patient Liens on Residences 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(26) Patient Body Attachments 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(27) Patient Other 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
Exhibit 3.24.12-155

Form 990 - Section 26, Schedule H (2008 - 2013)

Form 990 - Section 26, Schedule H (2008 - 2013)
3.24.12 -155 SECTION 26
Source Document or Record: Forms 990 - Section 26, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "26" .
(2) Third Party Collection Actions 17 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(3) Third Party Reporting to Credit Agency 17A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17a is checked.
(4) Third Party Lawsuits 17B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17b is checked.
(5) Third Party Liens on Residences 17C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17c is checked.
(6) Third Party Body Attachments 17D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17d is checked.
(7) Third Party Other 17E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17e is checked.
(8) Notified Financial Assistance Upon Admission 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(9) Notified Financial Assistance Prior to Discharge 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(10) Notified Financial Assistance in Bills 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(11) Documented its Determination 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(12) Other 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
(13) Written Policy to Emergency Medical Dare Policy 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(14) Did Not Provide Care for Emergency Medical Conditions 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(15) Did Not Have Policy Relating to Emergency Medical Care 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(16) Limited Who Was Eligible 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(17) Other 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(18) Negotiated Commercial Insurance Rate 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(19) Average of the Three Lowest Negotiated Commercial Insurance Rates 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(20) Medicare Rate 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(21) Other 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(22) Charge Any of Its Patients 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(23) Amount Equal to the Gross Charge 22 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 22.
Exhibit 3.24.12-156

Form 990 - Section 27, Schedule H (2008 - 2013)

Form 990 - Section 27, Schedule H (2008 - 2013)
3.24.12 - 156 SECTION 27
Source Document or Record: Forms 990 - Section 27, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "27" .
(2) Name of Facility BNAME <ENTER> Enter the name as shown on the top portion of Schedule H, Part V, Section B.
(3) Section B Facility Identification Number Code BCODE <ENTER> Enter the edited code from the right of Name of Hospital Facility on Schedule H, Part V, Section B.
(4) Facility Line Number LN#HOSP <ENTER> Enter the number shown on the Line Number of Hospital Facility area on the top portion of Schedule H, Part V, Section B.
(5) Conduct Community Health Needs Assessment L1 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 1.
(6) Definition of Community Served L1A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(7) Demographics of Community L1B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1b is checked.
(8) Existing Health Care Facilities and Resources L1C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1c is checked.
(9) How Data was Obtained L1D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1d is checked.
(10) Health Needs of Community L1E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1e is checked.
(11) Primary and Chronic Disease Needs L1F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1f is checked.
(12) Identifying and Prioritizing Health Needs L1G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1g is checked.
(13) Consulting with Persons Representing L1H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1h is checked.
(14) Information Gaps the Limit L1I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1i is checked.
(15) Other L1J <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 1a is checked.
(16) Needs Assessment: 20XX L2 <ENTER> Enter the two-digit year field from Schedule H, Part V, Section B, Line 2.
(17) Hospital Facility Take Into Account Input L3 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 3.
(18) Conducted with one or More Other Hospital L4 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 4.
(19) Widely Available to Public L5 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 5.
(20) Hospital Website L5A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5a is checked.
(21) Available Upon Request L5B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5b is checked.
(22) Other L5C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 5c is checked.
(23) Adoption of Implementation Strategy L6A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6a is checked.
(24) Execution of Implementation Strategy L6B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6b is checked.
(25) Development of Community-Wide Community Benefit Plan L6C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6c is checked.
(26) Execution of Community-Wide Community Benefit Plan L6D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6d is checked.
(27) Inclusion of Community Benefit Section L6E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6e is checked.
(28) Adoption of Budget for Provision of Services L6F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6f is checked.
(29) Prioritization of Health Needs L6G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6g is checked.
(30) Prioritization of Services L6H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6h is checked.
(31) Other L6I <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 6i is checked.
(32) Hospital Facility Address All Needs Identified L7 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 7.
33 Excise Tax Under Section 4959 L8A ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8a.
34 Did Organization File Form 4720 L8B ENTER Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 8b.
35 4959 Tax Reported L8C ENTER Enter the amount from Schedule H, Part V, Section B, Line 8c.
(33) Eligibility Criteria for Financial Assistance L9 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 9.
(34) Uses Federal Policy Guidelines (FPG) Free Care L10 <ENTER> Enter a yes or a no from the yes/no box from Schedule H, Part V, Section B, Line 10.
(35) Free Care Percent 10% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 10, percent line.
Exhibit 3.24.12-157

Form 990 - Section 28, Schedule H (2008 - 2013)

Form 990 - Section 28, Schedule H (2008 - 2013)
3.24.12 - 157 SECTION 28
Source Document or Record: Forms 990 - Section 28, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "28" .
(2) FPG Discounted Care SCHH PTV SECB11 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 11.
(3) Discounted Care Percent 11% <ENTER> Enter the 3-digit percent from Schedule H, Part V, Section B, Line 11.
(4) Basis for Calculating Amounts Charged 12 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 12.
(5) Income Level 12A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12a is checked.
(6) Asset Level 12B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12b is checked.
(7) Medical Indigency 12C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12c is checked.
(8) Insurance Status 12D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12d is checked.
(9) Uninsured Discount 12E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12e is checked.
(10) Medicaid/medicare 12F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12f is checked.
(11) State Regulation 12G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12g is checked.
(12) Other 12H <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 12h is checked.
(13) Method for Applying for Financial Assistance 13 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 13.
(14) Measures to Publicize the Policy 14 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 14.
(15) Policy Posted on Hospital Web Site 14A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14a is checked.
(16) Policy Attached to Billing Invoices 14B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14b is checked.
(17) Policy Posted in Emergency or Waiting Rooms 14C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14c is checked.
(18) Policy Posted in Admissions Office 14D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14d is checked.
(19) Policy Provided in Writing Upon Admission 14E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14e is checked.
(20) Policy Available Upon Request 14F <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14f is checked.
(21) Other 14G <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 14g is checked.
(22) Separate Billing and Collections Policy 15 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 15.
(23) Actions Against Patient Reporting to Credit Agency 16A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16a is checked.
(24) Patient Lawsuits 16B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16b is checked.
(25) Patient Liens on Residences 16C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16c is checked.
(26) Patient Body Attachments 16D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16d is checked.
(27) Patient Other 16E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 16e is checked.
Exhibit 3.24.12-158

Form 990 - Section 29, Schedule H (2008 - 2013)

Form 990 - Section 29, Schedule H (2008 - 2013)
3.24.12 - 158 SECTION 29
Source Document or Record: Forms 990 - Section 29, Schedule H (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "29" .
(2) Third Party Collection Actions 17 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 17.
(3) Third Party Reporting to Credit Agency 17A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17a is checked.
(4) Third Party Lawsuits 17B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17b is checked.
(5) Third Party Liens on Residences 17C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17c is checked.
(6) Third Party Body Attachments 17D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17d is checked.
(7) Third Party Other 17E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 17e is checked.
(8) Notified Financial Assistance Upon Admission 18A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18a is checked.
(9) Notified Financial Assistance Prior to Discharge 18B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18b is checked.
(10) Notified Financial Assistance in Bills 18C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18c is checked.
(11) Documented its Determination 18D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18d is checked.
(12) Other 18E <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 18e is checked.
(13) Written Policy to Emergency Medical Dare Policy 19 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 19.
(14) Did Not Provide Care for Emergency Medical Conditions 19A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19a is checked.
(15) Did Not Have Policy Relating to Emergency Medical Care 19B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19b is checked.
(16) Limited Who Was Eligible 19C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19c is checked.
(17) Other 19D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 19d is checked.
(18) Negotiated Commercial Insurance Rate 20A <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20a is checked.
(19) Average of the Three Lowest Negotiated Commercial Insurance Rates 20B <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20b is checked.
(20) Medicare Rate 20C <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20c is checked.
(21) Other 20D <ENTER> Enter a "1" if the box on Schedule H, Part V, Section B, Line 20d is checked.
(22) Charge Any of Its Patients 21 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 21.
(23) Amount Equal to the Gross Charge 22 <ENTER> Enter a yes or no from the yes/no box from Schedule H, Part V, Section B, Line 22.
Exhibit 3.24.12-159

Form 990 - Section 30, Schedules L & R (2008 - 2013)

Form 990 - Section 30, Schedules L & R (2008 - 2013)
3.24.12 - 159 SECTION 30
Source Document or Record: Forms 990 - Section 30, Schedules L & R (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "30" .
(2) Excess Benefit Transactions PT1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part 1.
(3) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
(4) Interest, Annuities, Royalties, Yes/No Box SCHR PT51A <ENTER> Enter a yes or a no from the yes/no box from Schedule R, Part V, Line 1a.
Exhibit 3.24.12-160

Form 990 - Section 01 (2007 and Prior)

Form 990 - Section 01 (2007 and Prior)
3.24.12 - 160 SECTION 01
Source Document or Record: Forms 990 - Section 01 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
★★★★★★		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(c) CP 411–414, 420–429, edited in the area around the "Tax Period" .
(10) Type of Organization BOXF RT <ENTER> Enter the edited digit from the right margin of box F.
(11) Group Code BOXH RT <ENTER> Enter the edited code from the right margin of box H.
(12) Computer Condition Codes CCC <ENTER> Enter the edited characters as shown on dotted portion of Lines 1a —- 1c. If a Condition Code is illegible, enter a "#" in its place.
(13) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If the Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(c) If Type of Organization is a "9" , and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(d) If a "G" Condition Code is present in Section 01 E-12 and the return is non-remittance, end the document after this element.
(14) Box J 501(c) # 501C# <ENTER> Enter the edited 2 digit code from the lower right corner of the entity portion.
(15) Box M Checkbox M RTMAR <ENTER> Enter the edited code from the right margin of Line 1d.
(16) In Care of Name Line C/O NAME <ENTER> Enter the in-care-of name, if shown.

Note:

Downstream processing generates the (%) sign.
(17) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown.
See IRM 3.24.38 for additional instructions.
(18) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(19) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(20) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(21) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-161

Form 990 - Section 02, Form 5800 - Edit Sheet (2007 and Prior)

Form 990 - Section 02, Form 5800 - Edit Sheet (2007 and Prior)
3.24.12 - 161 SECTION 02
Source Document or Record: Forms 990 - Section 02, Form 5800-Edit Sheet (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and the return is a remittance, Press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is
"9" from Section 01 E–10 and the " 9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is
"9" , and the "9" is NOT underlined, press <F6> and end the document after this element.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(7) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-162

Form 990 - Section 03 (2007 and Prior)

Form 990 - Section 03 (2007 and Prior)
3.24.12 - 162 SECTION 03
Source Document or Record: Form 990 - Section 03 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a "G" Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the "600" series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Contributions, Gifts/Grants L1E $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1e.
(4) Program Service Revenue LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(5) Membership Dues and Assessments LN3 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3.
(6) Interest on Savings LN4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(7) Dividends and Interest LN5 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5.
(8) Gross Rents L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a.
(9) Minus Rental Expenses L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(10) Net Rental Income (Loss) L6C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6c.
(11) Other Investment Income LN7 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7.
(12) Gross Amt Sale of Assets (Securities) 8A LF $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8a, Securities.
(13) Gross Amt Sale of Assets (Other) 8A RT $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8a, Other.
(14) Cost or Other Basis (Securities) 8B LF $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8b, Securities.
(15) Minus Cost or Other Basis (Other) 8B RT $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8b, Other.
(16) Gain/Loss Sale of Assets (Securities) 8C LF $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8c, Securities.
(17) Gain/Loss Sale of Assets (Other) 8C RT $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8c, Other.
(18) Special Events/Gaming 9CKBX <ENTER> Enter a "1" if the box is checked on Part I, Line 9.
(19) Gross Revenue (Fundraising) 9A RT $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 9a.
(20) Minus Direct Expenses L9B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 9b.
(21) Net Income (Fundraising) L9C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 9c.
(22) Gross Sales Minus Returns 10A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10a.
(23) Minus Cost of Goods Sold 10B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10b.
(24) Gross Profit (Loss) 10C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10c.
(25) Other Revenue L11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
(26) Total Revenue L12 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part I, Line 12.
(27) Program Services L13 $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 13.
(28) Fundraising L15 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 15.
(29) Payments to Affiliates L16 $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 16.
(30) Total Expenses L17 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 17.
(31) Excess for Year L18 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 18.
(32) Other Changes in Net Assets L20 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 20.
(33) Net Assets or Fund Balances (EOY) L21 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 21.
Exhibit 3.24.12-163

Form 990 - Section 04 (2007 and Prior)

Form 990 - Section 04 (2007 and Prior)
3.24.12 - 163 SECTION 04
Source Document or Record: Form 990 - Section 04 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "04" .
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of page 2.
(3) Grants From Donor Advised Funds 22AA $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 22A, Column (A).
(4) Donor Advised Funds Checkbox 22ACKBX <ENTER> Enter a "1" if the box on Line 22a is checked.
(5) Other Grants & Allocations 22BA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 22b, Column (A).
(6) Other Foreign Grants Checkbox 22BCKBX <ENTER> Enter a "1" if the box on Line 22b is checked.
(7) Specific Assistance 23A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 23, Column (A).
(8) Benefits To/For Members 24A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 24, Column (A).
(9) Compensation of Current Officers 25AA $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25a, Column (A).
(10) Compensation of Former Officers 25BA $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25b, Column (A).
(11) Compensation and Other Distributions 25CA $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25c, Column (A).
(12) Other Salaries and Wages 26A $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 26, Column (A).
(13) Pension Plan Contributions 27A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (A).
(14) Other Employee Benefits 28A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 28, Column (A).
(15) Payroll Taxes 29A $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 29, Column (A).
(16) Professional Fund Raising Fees 30AD $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 30, Column (A) or Column (D).
(a) If both are present, enter the amount from Column (A).
(17) Accounting Fees 31A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 31, Column (A).
(18) Legal Fees 32A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 32, Column (A).
(19) Supplies 33A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 33, Column (A).
(20) Telephone 34A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 34, Column (A).
(21) Postage & Shipping 35A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 35, Column (A).
(22) Occupancy 36A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 36, Column (A).
(23) Equipment Rental and Maintenance 37A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 37, Column (A).
(24) Printing & Publications 38A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 38, Column (A).
(25) Travel 39A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 39, Column (A).
(26) Conferences, Conventions & Meetings 40A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 40, Column (A).
(27) Interest 41A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 41, Column (A).
(28) Depreciation, Depletion 42A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 42, Column (A).
(29) Other Expenses a 43AA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 43a, Column (A).
(30) Other Expenses b 43BA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 43b, Column (A).
(31) Other Expenses c 43CA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 43c, Column (A).
(32) Other Expenses d 43DA $ <ENTER>
MINUS (-).		 Enter the amount from Part II, Line 43d, Column (A).
(33) Other Expenses e 43EA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 43e, Column (A).
(34) Total Expenses 44A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 44, Column (A).
Exhibit 3.24.12-164

Form 990 - Section 05 (2007 and Prior)

Form 990 - Section 05 (2007 and Prior)
3.24.12 - 164 SECTION 05
Source Document or Record: Form 990 - Section 05 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Cash (BOY) 45A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 45, Column (A).
(3) Cash (EOY) 45B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 45, Column (B).
(4) Savings/Temporary Investments (BOY) 46A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 46, Column (A).
(5) Savings/Temporary Investments (EOY) 46B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 46, Column (B).
(6) Accounts Receivable (BOY) 47CA $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 47c, Column (A).
(7) Accounts Receivable (EOY) 47CB $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 47c, Column (B).
(8) Pledges Receivable (BOY) 48CA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 48c, Column (A).
(9) Pledges Receivable (EOY) 48CB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 48c, Column (B).
(10) Grants Receivable (BOY) 49A $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 49, Column (A).
(11) Grants Receivable (EOY) 49B $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 49, Column (B).
(12) Current and Former Receivables (BOY) 50AA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 50a, Column (A).
(13) Current and Former Receivables (EOY) 50AB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 50a, Column (B).
(14) Receivables From Disqualified Persons (BOY) 50BA $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 50b, Column (A).
(15) Receivables From Disqualified Persons (EOY) 50BB $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 50b, Column (B).
(16) Other Notes/Loans (BOY) 51CA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 51c, Column (A).
(17) Other Notes/Loans (EOY) 51CB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 51c, Column (B).
(18) Inventories for Sale (BOY) 52A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 52, Column (A).
(19) Inventories For Sale (EOY) 52B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 52, Column (B).
(20) Prepaid Expenses (BOY) 53A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 53, Column (A).
(21) Prepaid Expenses (EOY) 53B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 53, Column (B).
(22) Investments - Publicly Traded Securities (BOY) 54AA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 54a, Column (A).
(23) Investments - Publicly Traded Securities (EOY) 54AB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 54a, Column (B).
(24) Investments - Other Securities (BOY) 54BA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 54b, Column (A).
(25) Investments - Other Securities (EOY) 54BB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 54b, Column (B).
(26) Investments-Land (BOY) 55CA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 55c, Column (A).
(27) Investments-Land (EOY) 55CB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 55c, Column (B).
(28) Other Investments (BOY) 56A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 56, Column (A).
(29) Other Investments (EOY) 56B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 56, Column (B).
(30) Land/Buildings (BOY) 57CA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 57c, Column (A).
(31) Land/Buildings (EOY) 57CB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 57c, Column (B).
(32) Other Assets (BOY) 58A $ <ENTER>
MINUS (-).		 Enter the amount from Part IV, Line 58, Column (A).
(33) Other Assets (EOY) 58B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 58, Column (B).
(34) Total Assets (BOY) 59A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 59, Column (A).
(35) Total Assets (EOY) 59B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 59, Column (B).
Exhibit 3.24.12-165

Form 990 - Section 06 (2007 and Prior)

Form 990 - Section 06 (2007 and Prior)
3.24.12 - 165 SECTION 06
Source Document or Record: Form 990 - Section 06 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "06" .
(2) Accounts Payable (BOY) 60A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 60, Column (A).
(3) Accounts Payable (EOY) 60B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 60, Column (B).
(4) Grants Payable (BOY) 61A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 61, Column (A).
(5) Grants Payable (EOY) 61B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 61, Column (B).
(6) Deferred Revenue (BOY) 62A $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 62, Column (A).
(7) Deferred Revenue (EOY) 62B $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 62, Column (B).
(8) Loans (BOY) 63A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 63, Column (A).
(9) Loans (EOY) 63B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 63, Column (B).
(10) Tax-Exempt Bond Liabilities (BOY) 64AA $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 64a, Column (A).
(11) Tax-Exempt Bond Liabilities (EOY) 64AB $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 64a, Column (B).
(12) Mortgages/Other Notes (BOY) 64BA $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 64b, Column (A).
(13) Mortgages/Other Notes (EOY) 64BB $ <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 64b, Column (B).
(14) Other Liabilities (BOY) 65A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 65, Column (A).
(15) Other Liabilities (EOY) 65B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 65, Column (B).
(16) Total Liabilities (BOY) 66A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 66, Column (A).
(17) Total Liabilities (EOY) 66B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 66, Column (B).
(18) Retained Earnings (BOY) 72A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 72, Column (A).
(19) Retained Earnings (EOY) 72B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 72, Column (B).
(20) Total Fund Balance/Net Assets (BOY) 73A $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 73, Column (A).
(21) Total Fund Balance/Net Assets (EOY) 73B $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 73, Column (B).
Exhibit 3.24.12-166

Form 990 - Section 07 (2007 and Prior)

Form 990 - Section 07 (2007 and Prior)
3.24.12 - 166 SECTION 07
Source Document or Record: Form 990 - Section 07 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "07" .
(2) Total Voting Officers 75A <ENTER> Enter the number from Part V-A, Line 75a.
(3) Are there Relationships? 75B <ENTER> Enter a yes or no from the yes/no box from Part V-A, Line 75b.
(4) Was Compensation Received? 75C <ENTER> Enter a yes or no from the yes/no box from Part V-A, Line 75c.
(5) Compensation/Benefits Code VBRTMAR <ENTER> Enter the edited code from the bottom right margin of Part V-B.
(6) Did you Make Changes to Activities/Methods? 76 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 76.
(7) Were any change made? 77 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 77.
(8) Did you have unrelated business? 78A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 78a.
(9) If yes, did you file Form 990-T? 78B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 78b.
(10) Was there a liquidation? 79 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 79.
(11) Are you related? 80A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 80a.
(12) Political Expenditures 81A $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 81a.
(13) Did you file Form 1120-POL? 81B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 81b.
(14) Section 501(c)(5) or (6) Organization? 85A <ENTER> Enter a yes or no from te yes/no box from Part VI, Line 85a.
(15) Did the Organization Make Lobbying Expenditures? 85B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 85b.
(16) Dues/Assessments & Similar Amounts 85C $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 85c.
(17) Section 162(e) Lobbying 85D $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 85d.
(18) Aggregate Non-deductible 85E $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 85e.
(19) Taxable Amount/Lobbying 85F $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 85f.
(20) Does the Organization Elect? 85G <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 85g.
(21) If Section 6033(e)(1)(A) 85H <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 85h.
(22) 501(c)(7) Initiation Fees 86A $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 86a.
(23) Gross Receipts Amount 86B $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 86b.
(24) Gross Income/Members 87A $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 87a.
(25) Gross Income/Other Sources 87B $ <ENTER>
MINUS (-)		 Enter the amount from Part VI, Line 87b.
(26) At Any Time During the Year 88A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 88a.
(27) Did You Have Interest in Controlled Entity? 88B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 88b.
(28) 501(c)(3) and 501(c)(4) 89B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 89b.
(29) Did You Acquire Direct/Indirect Interest? 89F <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 89f.
(30) Did you have Foreign Bank Accounts? 91B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 91b
(31) Did you have a Foreign Office? 91C <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 91c.
(32) Section 4947(a)(1) Trust Filing 990? 92 <ENTER> Enter the code edited to the right of Part VI, Line 92.
Exhibit 3.24.12-167

Form 990 - Section 08 (2007 and Prior)

Form 990 - Section 08 (2007 and Prior)
3.24.12 - 167 SECTION 08
Source Document or Record: Form 990 - Section 08 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "08" .
(2) Program Service a (D) 93AD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93a, Column (D).
(3) Program Service a (E) 93AE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93a, Column (E).
(4) Program Service b (D) 93BD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93b, Column (D).
(5) Program Service b (E) 93BE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93b, Column (E).
(6) Program Service c (D) 93CD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93c, Column (D).
(7) Program Service c (E) 93CE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93c, Column (E).
(8) Program Service d (D) 93DD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93d, Column (D).
(9) Program Service d (E) 93DE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93d, Column (E).
(10) Program Service e (D) 93ED $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93e, Column (D).
(11) Program Service e (E) 93EE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93e, Column (E).
(12) Medicare/Medicaid (D) 93FD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93f, Column (D).
(13) Medicare/Medicaid (E) 93FE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93f, Column (E).
(14) Fees and Contracts (D) 93GD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93g, Column (D).
(15) Fees and Contracts (E) 93GE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 93g, Column (E).
(16) Membership Dues (D) 94D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 94, Column (D).
(17) Membership Dues (E) 94E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 94, Column (E).
(18) Interest on Savings (D) 95D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 95, Column (D).
(19) Interest on Savings (E) 95E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 95, Column (E).
(20) Dividends and Interest (D) 96D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 96, Column (D).
(21) Dividends & Interest (E) 96E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 96, Column (E).
(22) Debt-Financed Property (D) 97AD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 97a, Column (D).
(23) Debt-Financed Property (E) 97AE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 97a, Column (E).
(24) Non Debt-Financed (D) 97BD $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 97b, Column (D).
(25) Non Debt-Financed (E) 97BE $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 97b, Column (E).
(26) Non Rental Income/Loss (D) 98D $ <ENTER>
MINUS (-).		 Enter the amount from Part VII, Line 98, Column (D)
(27) Non Rental Income/Loss (E) 98E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 98, Column (E).
(28) Other Investments (D) 99D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 99, Column (D).
(29) Other Investments (E) 99E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 99, Column (E).
(30) Gain/Loss From Sales (D) 100D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 100, Column (D).
(31) Gain/Loss From Sales (E) 100E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 100, Column (E).
(32) Net Income/Loss Property (D) 101D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 101, Column (D).
(33) Net Income/Loss Property (E) 101E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 101, Column (E).
(34) Gross Profit/Loss Sales (D) 102D $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 102, Column D.
(35) Gross Profit/Loss Sales (E) 102E $ <ENTER>
MINUS (-)		 Enter the amount from Part VII, Line 102, Column (E).
(36) Did the Organization Receive any Funds? X(A) <ENTER> Enter a yes or no from the yes/no box from Part X, Line (a).
(37) Did the Organization Pay any Premiums? X(B) <ENTER> Enter a yes or no from the yes/no box from Part X, Line (b).
(38) Did the Organization Make Any Transfers to a Controlled Entity? XI106 <ENTER> Enter a yes or no from the yes/no box from Part XI, Line 106.
(39) Did the Organization Receive Any Transfers From a Controlled Entity? 107 <ENTER> Enter a yes or no from the yes/no box from Part XI, Line 107.
(40) Did the Organization Have a Binding Contract as of 08/17/2006? 108 <ENTER> Enter a yes or no from the yes/no box from Part XI, Line 108.
(41) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN Line.
(42) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(43) Preparer's EIN PEIN <ENTER> Enter the preparer's EIN.
Exhibit 3.24.12-168

Form 990 - Section 09, Schedule A (2007 and Prior)

FORM 990-Section 09, Schedule A (2007 and Prior)
3.24.12 - 168 SECTION 09
Source Document or Record: Form 990 - Section 09, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "09" .
(2) Question 1 Part III LN1 <ENTER> Enter the edited digit to the right of Part III, Line 1.
If un-edited, enter a yes or no from the yes/no box from Part III, Line 1.
(3) Legislative Activities LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part III, Line 1, next to the $.
(4) Was there a Sale, Exchange or Lease of Property? L2A <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2a.
(5) Did you Lend Money or Other Credit? L2B <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2b.
(6) Did you Furnish Goods, Services or Facilities? L2C <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2c.
(7) Did you make Payment Compensation? L2D <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2d.
(8) Did you Transfer Income or Assets? L2E <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2e.
(9) Do you Make Grants/Scholarships? L3A <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3a.
(10) Did you Have a Section 403(b) Annuity Plan? L3B <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3b.
(11) Did you Receive or Hold Easement - Section 170(h)? L3C <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3c.
(12) Do you Provide Credit Counseling? L3D <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3d.
(13) Did you Maintain any Donor Advised Funds? L4A <ENTER> Enter a yes or no from the yes/no box from Part III, Line 4a.
(14) Did you Make any Taxable Distributions? L4B <ENTER> Enter a yes or no from the yes/no box from Part III, Line 4b.
(15) Did you Make a Distribution – Section 4967? L4C <ENTER> Enter a yes or no from the yes/no box from Part III, Line 4c.
(16) Enter the Total Number of Donor Advised Funds L4D <ENTER> Enter the number from Part III, Line 4d.
(17) Enter the Aggregate Value of Assets L4E $ <ENTER> Enter the amount from Part III, Line 4e.
(18) Part IV Non-Private Foundation IVRTMAR <ENTER> Enter the edited code from the RIGHT margin of Part IV.
(19) Total Amount of Support 13E $ <ENTER> Enter the amount from Part IV, Line 13, Column (e).
(20) Gifts, Contributions, Grants 15E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 15, Column (e).
(21) Membership Fees 16E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 16, Column (e).
(22) Gross Receipts/Admissions 17E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 17, Column (e).
(23) Gross Income/Interest/Dividends 18E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 18, Column (e).
(24) Tax Revenues Levied 20E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 20, Column (e).
(25) Value of Services/Facilities Furnished 21E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 21, Column (e).
(26) Total Lines 15–22 23E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 23, Column (e).
(27) Line 23 Minus 17 24E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 24, Column (e).
Exhibit 3.24.12-169

Form 990 - Section 10, Schedule A (2007 and Prior)

Form 990 - Section 10, Schedule A (2007 and Prior)
3.24.12 - 169 SECTION 10
Source Document or Record: Form 990 - Section 10, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: If a large edited "X" is present through Part V or Part V is blank, don't enter this section.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "10" .
(2) Do you have a racially? V29 <ENTER> Enter a yes or no from the yes/no box on Part V, Line 29.
(3) Do you include? 30 <ENTER> Enter a yes or no from the yes/no box on Part V, Line 30.
(4) Have you publicized? 31 <ENTER> Enter a yes or no from the yes/no box on Part V, Line 31.
(5) Records indicating? 32A <ENTER> Enter a yes or no from the yes/no box on Part V, Line 32a.
(6) Records documenting? 32B <ENTER> Enter a yes or no from the yes/no box on Part V, Line 32b.
(7) Copies of all catalogues? 32C <ENTER> Enter a yes or no from the yes/no box on Part V, Line 32c.
(8) Copies of all material? 32D <ENTER> Enter a yes or no from the yes/no box on Part V, Line 32d.
(9) Students' rights? 33A <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33a.
(10) Admission Policies? 33B <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33b.
(11) Employment of faculty? 33C <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33c.
(12) Scholarships? 33D <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33d.
(13) Educational policies? 33E <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33e.
(14) Use of facilities? 33F <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33f.
(15) Athletic programs? 33G <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33g.
(16) Other extracurricular activities? 33H <ENTER> Enter a yes or no from the yes/no box on Part V, Line 33h.
(17) Does Organization Certify? 35 <ENTER> Enter a yes or a no from the yes/no box on Part V, Line 35.
(18) Signature Code SIGN <ENTER> Enter the code edited in the lower right margin of page 5, Schedule A.
Exhibit 3.24.12-170

Form 990 - Section 11, Schedule A (2007 and Prior)

Form 990 - Section 11, Schedule A (2007 and Prior)
3.24.12 - 170 SECTION 11
Source Document or Record: Form 990 - Section 11, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Total (Grass Roots) Expenditures 36B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 36, Column (b).
(3) Total Lobbying Expenses 37B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 37, Column (b).
(4) Other Exempt Purposes Expenses 39B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 39, Column (b).
(5) Lobbying Nontaxable Amount 41B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 41, Column (b).
(6) Grass Roots Nontaxable Amount 42B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 42, Column (b).
(7) Excess of Line 36 over Line 42 43B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 43, Column (b).
(8) Excess of Line 38 over Line 41 44B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 44, Column (b).
(9) Part VI-B, Line i, Total VIBLNI $ <ENTER>
MINUS (-)		 Enter the amount from Part VI-B, Line i.
Exhibit 3.24.12-171

Form 990 - Section 12, Schedule A (2007 and Prior)

Form 990 - Section 12, Schedule A (2007 and Prior)
3.24.12 - 171 SECTION 12
Source Document or Record: Form 990 - Section 12, Schedule A, (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Cash transfers? 51AI <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51a(i).
(3) Other assets? AII <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51a(ii).
(4) Sales of assets? 51BI <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51b(i).
(5) Purchases of assets? BII <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51b(ii).
(6) Rental? BIII <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51b(iii).
(7) Reimbursement? BIV <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51b(iv).
(8) Loans? BV <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51b(v).
(9) Performance of services? BVI <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51b(vi).
(10) Sharing? 51C <ENTER> Enter a yes or no from the yes/no box on Part VII, Line 51c.
Exhibit 3.24.12-172

Form 990-EZ - Section 01 (2018 and Subsequent)

Form 990-EZ - Section 01 (2018 and Subsequent)
3.24.12 - 172 SECTION 01
Source Document or Record: Form 990-EZ - Section 01 (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section 01 always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter Y or N as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under title of form.
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Type of Organization BOXGRT <ENTER> Enter the edited code from right margin of box F. If the edit sheet isn't present, enter the Type of Organization from the right margin of Lines C, D or E.
(11) Computer Condition Codes CCC <ENTER> Enter the edited characters from the dotted portion of Lines 1–3. If a Condition Code is illegible, enter a # in its place.
(12) Return Processing Code 01RPC <ENTER> Enter the edited codes on Page 1, in the right margin next to line 1.
(13) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If Type of Organization is a 9, and the "9" is underlined, don't end the document. Continue transcribing the return.
(c) If the Type of Organization is a 9 and the 9 is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(d) If a G Condition Code is present and the return is a non-remittance, end the document after this element.
(14) Box J 501(c) # 501C# <ENTER> Enter the edited 2 digit code from the lower right corner of the entity portion.
(15) Box H Checkbox H RTMAR <ENTER> Enter the edited code from the right margin of Line 1.
(16) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates a (%) sign.
(17) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(18) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a G Condition Code is present, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(19) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(20) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(21) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-173

Form 990-EZ - Section 02 (5800, Edit Sheet) (2018 and Subsequent)

Form 990-EZ - Section 02, Form 5800-Edit Sheet (2018 and Subsequent)
3.24.12 - 173 SECTION 02
Source Document or Record: Form 990-EZ - Section 02 (5800, Edit Sheet) (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 02.
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the 600 series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the 600 series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a G Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is a 9 from Section 01 E-10, and the "9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is a 9 from Section 01 E-10, and the 9 is NOT underlined, press <F6> and end the document after this element.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800.
(a) For special instructions, see IRM 3.24.38.
(7) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-174

Form 990-EZ - Section 03 (2018 and Subsequent)

Form 990-EZ - Section 03 (2018 and Subsequent)
3.24.12 - 174 SECTION 03
Source Document or Record: Form 990-EZ - Section 03 (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 03.
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a G Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the 600 series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Contributions, Gifts, Grants LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1.
(4) Program Service Revenue LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(5) Membership Dues and Assessments LN3 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3.
(6) Investment Income LN4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(7) Gross Amount from Sale of Assets L5A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5a.
(8) Less Cost or Other Basis L5B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5b.
(9) Gain/Loss Other L5C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5c.
(10) Gross Income from Gaming L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a.
(11) Gross Income from Fundraising L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(12) Less Direct Expenses L6C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6c.
(13) Net Income/Loss L6D $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6d.
(14) Gross Sales Less Returns and Allowances L7A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7a.
(15) Less Cost of Goods Sold L7B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7b.
(16) Gross Profit/Loss L7C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7c.
(17) Other Revenue LN8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(18) Total Revenue LN9 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part I, Line 9.
(19) Grants & Other Similar Amounts L10 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10.
(20) Benefits Paid to Members L11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
(21) Salaries & Other Compensation L12 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12.
(22) Total Expenses L17 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 17.
(23) Excess (Deficit) for the Year L18 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 18.
(24) Other Changes in Net Assets L20 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 20.
(25) Net Assets at (EOY) L21 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 21.
Exhibit 3.24.12-175

Form 990-EZ - Section 05 (2018 and Subsequent)

Form 990-EZ - Section 05 (2018 and Subsequent)
3.24.12 - 175 SECTION 05
Source Document or Record: Form 990-EZ - Section 05 (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 05.
(2) Total Assets (BOY) 25A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 25, Column (A).
(3) Total Assets (EOY) 25B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25, Column (B).
Exhibit 3.24.12-176

Form 990-EZ - Section 06 (2018 and Subsequent)

Form 990-EZ - Section 06 (2018 and Subsequent)
3.24.12 - 176 SECTION 06
Source Document or Record: Forms 990-EZ - Section 06 (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 06.
(2) Total Liabilities - BOY 26A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (A).
(3) Total Liabilities - EOY 26B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (B).
(4) Net Assets - BOY 27A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (A).
(5) Net Assets - EOY 27B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (B).
Exhibit 3.24.12-177

Form 990-EZ - Section 07 (2018 and Subsequent)

Form 990-EZ - Section 07 (2018 and Subsequent)
3.24.12 - 177 SECTION 07
Source Document or Record: Form 990-EZ - Section 07 (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 07.
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top margin of Page 2.
(3) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.
(4) Did you Engage in any Activity? 33 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33.
(5) Were any Changes Made? 34 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 34.
(6) Did you have Unrelated Business? 35A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35a.
(7) If Yes, Did you File 990–T? 35B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35b.
8 Was organization 501(c)(4), (c)(5) or (c)(6) 35C ENTER Enter a yes or no from the yes/no box from Part V, Line 35c.
(9) Was there a Liquidation? 36 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 36.
(10) Amount of Political Expenditures 37A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 37a.
(11) Did You File 1120–POL? 37B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 37b.
(12) Borrow Money From or Make Loans 38A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 38a.
(13) Enter Amount Involved 38B $ <ENTER>
<MINUS (-)>		 Enter the amount from Part V, Line 38b.
(14) Section 501(c)(7) Initiation Fees 39A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39a.
(15) Gross Receipts Amount 39B $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39b.
(16) 501(c)(3) and 501(c)(4) 40B <ENTER> Enter the yes or no from the yes/no box from Part V, Line 40b.
(17) Party to a Prohibited Tax Shelter 40E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 40e.
(18) Did you have Foreign Bank Accounts? 42B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42b.
(19) Did you have a Foreign Office? 42C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42c.
(20) Section 4947(a)(1) Trusts Filing 990EZ? 43 <ENTER> Enter the code edited to the right of Part V, Line 43.
(21) Maintain Any Donor Advised Funds 44A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44a.
(22) Operate One or More Hospital Facilities 44B <ENTER>` Enter a yes or no from the yes/no box from Part V, Line 44b.
(23) Receive Payments for Indoor Tanning 44C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44c.
(24) Filed Form 720 to Report Payments 44D <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44d.
(25) Controlled Entity Within 512(b)(13) 45A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 45a.
26 Received any payment from or engaged in transaction 45B ENTER Enter a yes or no from the yes/no box from Part V, Line 45b
(26) Engage in Direct/Indirect Political Activities 46 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 46.
(27) Engage in Lobbying Activities 47 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 47.
(28) Operating a School 48 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 48.
(29) Make Any Transfers to an Exempt 49A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49a.
(30) Section 527 Organization 49B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49b.
Exhibit 3.24.12-178

Form 990-EZ - Section 08 (2018 and Subsequent)

Form 990-EZ - Section 08 (2018 and Subsequent)
3.24.12 - 178 SECTION 08
Source Document or Record: Form 990 - EZ - Section 08 (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08.
(2) Preparation Code PREP <ENTER> Enter the edited digits from the right margin of the return next to the PTIN.
(3) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(4) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
(5) Preparer Telephone # TEL# <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-179

Form 990-EZ - Section 11, Schedule A, (2018 and Subsequent)

Form 990-EZ - Section 11, Schedule A, (2018 and Subsequent)
3.24.12 - 179 SECTION 11
Source Document or Record: Forms 990-EZ - Section 11, Schedule A (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 11.
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter one of the following from Line 12:
1 = Type I
2 = Type II
3= Type III- Functionally integrated
4 = Type III Non-functionally integrated
Blank - <ENTER>
(4) Type I, II or III Supporting Organization L11E <ENTER> Enter a “1” if the box is checked on Schedule A, Part I, Line 12e.
(5) Number of Supported Organizations 11F <ENTER>
MINUS (-)		 Enter the amount from Line 12f.
(6) EIN A 12G(II)A <ENTER> Enter the EIN in Part I, Line 12g, Row A, Column (ii).
(7) Type of Org A 12G(III)A <ENTER> Enter the type of organization in Part I, Line 12g, Row A, Column (iii). If more than one digit, pick up the first digit only.
(8) Listed in Governing Doc A 12G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row A, Column (iv).
(9) Amount of Support A 12G(V)A $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row A, Column (v).
(10) EIN B 12G(II)B <ENTER> Enter the EIN in Part I, Line 12g, Row B, Column (ii).
(11) Type of Org B 12G(III)B <ENTER> Enter the type of organization in Part I, Line 12g, Row B, Column (iii). If more than one digit, pick up the first digit only.
(12) Listed in Governing Doc B 12G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row B, Column (iv).
(13) Amount of Support B 12G(V)B $ <ENTER>
MINUS (-)		 Enter the amount Part I, Line 12g, Row B, Column (v).
(14) EIN C 12G(II)C <ENTER> Enter the EIN in Part I, Line 12g, Row C, Column (ii).
(15) Type of Org C 12G(III)C <ENTER> Enter the type of organization in Part I, Line 12g, Row C, Column (iii). If more than one digit, pick up the first digit only.
(16) Listed in Governing Doc C 12G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row C, Column (iv).
(17) Amount of Support C 12G(V)C $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row C, Column (v).
(18) EIN D 12G(II)D <ENTER> Enter the EIN in Part I, Line 12g, Row D, Column (ii).
(19) Type of Org D 12G(III)D <ENTER> Enter the type of organization in Part I, Line 12g, Row D, Column (iii). If more than one digit, pick up the first digit only.
(20) Listed in Governing Doc D 12G(IV)D <ENTER> Enter 1 for yes and 2 for no from check box in Part I, Line 12g, Row D, Column (iv).
(21) Amount of Support D 12G(V)D $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row D, Column (v).
(22) EIN E 12G(II)E <ENTER> Enter the EIN in Part I, Line 12g, Row E, Column (ii).
(23) Type of Org E 12G(III)E <ENTER> Enter the type of organization in Part I, Line 12g, Row E, Column (iii). If more than one digit, pick up the first digit only.
(24) Listed in Governing Doc E 12G(IV)E <ENTER> Enter 1 for yes and 2 for no from check box in Part I, Line 12g, Row E, Column (iv).
(25) Amount of Support E 12G(V)E $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row E, Column (v).
(26) Filling Field     Generates blank on output.
(27) Total Number of Organizations 12G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 12h, Column (i), Total Line.
(28) Total Amount of Support G(V) TOT $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Total, Column (v).
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-180

Form 990-EZ - Section 12, Schedule A (2018 and Subsequent)

Form 990-EZ - Section 12, Schedule A (2018 and Subsequent)
3.24.12 - 180 SECTION 12
Source Document or Record: Forms 990-EZ - Section 12, Schedule A (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 12.
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Filling Field     Generates a blank field on output.
(29) Excess Distributions C PTVE3C$ <ENTER> Enter the amount from Part V, Section E, Line 3c.
(30) Excess Distributions D PTVE3D$ <ENTER> Enter the amount from Part V, Section E, Line 3d.
(31) Excess Distributions E PTVE3E$ <ENTER> Enter the amount from Part V, Section E, Line 3e.
(32) Excess Distributions Breakdown B PTVE8B$ <ENTER> Enter the amount from Part V, Section E, Line 8b.
(33) Excess Distributions Breakdown C PTVE8C$ <ENTER> Enter the amount from Part V, Section E, Line 8c.
(34) Excess Distributions Breakdown D PTVE8D$ <ENTER> Enter the amount from Part V, Section E, Line 8d.
(35) Excess Distributions Breakdown E PTVE8E$ <ENTER> Enter the amount from Part V, Section E, Line 8e.
Exhibit 3.24.12-181

Form 990-EZ - Section 13, Schedules C & L (2018 and Subsequent)

Form 990-EZ - Section 13, Schedules C & L (2018 and Subsequent)
3.24.12 - 181 SECTION 13
Source Document or Record: Forms 990-EZ - Section 13, Schedules C & L (2018 and Subsequent)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Political Expenditures SCHC L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Excess Benefit Transactions SCHL1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part I.
(4) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
Exhibit 3.24.12-182

Form 990-EZ - Section 01 (2016 and 2017)

Form 990-EZ - Section 01 (2016 and 2017)
3.24.12 - 182 SECTION 01
Source Document or Record: Form 990-EZ - Section 01 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section 01 always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter Y or N as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under title of form.
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Type of Organization BOXGRT <ENTER> Enter the edited code from right margin of box F. If the edit sheet isn't present, enter the Type of Organization from the right margin of Lines C, D or E.
(11) Computer Condition Codes CCC <ENTER> Enter the edited characters from the dotted portion of Lines 1–3. If a Condition Code is illegible, enter a # in its place.
(12) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If Type of Organization is a 9, and the "9" is underlined, don't end the document. Continue transcribing the return.
(c) If the Type of Organization is a 9 and the 9 is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(d) If a G Condition Code is present and the return is a non-remittance, end the document after this element.
(13) Box J 501(c) # 501C# <ENTER> Enter the edited 2 digit code from the lower right corner of the entity portion.
(14) Box H Checkbox H RTMAR <ENTER> Enter the edited code from the right margin of Line 1.
(15) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates a (%) sign.
(16) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(17) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a G Condition Code is present, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(18) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(19) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(20) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-183

Form 990-EZ - Section 02 (5800, Edit Sheet) (2016 and 2017)

Form 990-EZ - Section 02, Form 5800- Edit Sheet (2016 and 2017)
3.24.12 - 183 SECTION 02
Source Document or Record: Form 990-EZ - Section 02 (5800, Edit Sheet) (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 02.
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the 600 series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the 600 series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a G Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is a 9 from Section 01 E-10, and the "9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is a 9 from Section 01 E-10, and the 9 is NOT underlined, press <F6> and end the document after this element.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800.
(a) For special instructions, see IRM 3.24.38.
(7) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-184

Form 990-EZ - Section 03 (2016 and 2017)

Form 990-EZ - Section 03 (2016 and 2017)
3.24.12 - 184 SECTION 03
Source Document or Record: Form 990-EZ - Section 03 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 03.
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a G Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the 600 series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Contributions, Gifts, Grants LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1.
(4) Program Service Revenue LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(5) Membership Dues and Assessments LN3 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3.
(6) Investment Income LN4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(7) Gross Amount from Sale of Assets L5A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5a.
(8) Less Cost or Other Basis L5B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5b.
(9) Gain/Loss Other L5C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5c.
(10) Gross Income from Gaming L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a.
(11) Gross Income from Fundraising L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(12) Less Direct Expenses L6C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6c.
(13) Net Income/Loss L6D $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6d.
(14) Gross Sales Less Returns and Allowances L7A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7a.
(15) Less Cost of Goods Sold L7B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7b.
(16) Gross Profit/Loss L7C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7c.
(17) Other Revenue LN8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(18) Total Revenue LN9 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part I, Line 9.
(19) Grants & Other Similar Amounts L10 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10.
(20) Benefits Paid to Members L11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
(21) Salaries & Other Compensation L12 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12.
(22) Total Expenses L17 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 17.
(23) Excess (Deficit) for the Year L18 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 18.
(24) Other Changes in Net Assets L20 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 20.
(25) Net Assets at (EOY) L21 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 21.
Exhibit 3.24.12-185

Form 990-EZ - Section 05 (2016 and 2017)

Form 990-EZ - Section 05 (2016 and 2017)
3.24.12 - 185 SECTION 05
Source Document or Record: Form 990-EZ - Section 05 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 05.
(2) Total Assets (BOY) 25A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 25, Column (A).
(3) Total Assets (EOY) 25B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25, Column (B).
Exhibit 3.24.12-186

Form 990-EZ - Section 06 (2016 and 2017)

Form 990-EZ - Section 06 (2016 and 2017)
3.24.12 - 186 SECTION 06
Source Document or Record: Forms 990-EZ - Section 06 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 06.
(2) Total Liabilities - BOY 26A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (A).
(3) Total Liabilities - EOY 26B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (B).
(4) Net Assets - BOY 27A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (A).
(5) Net Assets - EOY 27B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (B).
Exhibit 3.24.12-187

Form 990-EZ - Section 07 (2016 and 2017)

Form 990-EZ - Section 07 (2016 and 2017)
3.24.12 - 187 SECTION 07
Source Document or Record: Form 990-EZ - Section 07 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 07.
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top margin of Page 2.
(3) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.
(4) Did you Engage in any Activity? 33 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33.
(5) Were any Changes Made? 34 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 34.
(6) Did you have Unrelated Business? 35A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35a.
(7) If Yes, Did you File 990–T? 35B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35b.
8 Was organization 501(c)(4), (c)(5) or (c)(6) 35C ENTER Enter a yes or no from the yes/no box from Part V, Line 35c.
(9) Was there a Liquidation? 36 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 36.
(10) Amount of Political Expenditures 37A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 37a.
(11) Did You File 1120–POL? 37B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 37b.
(12) Borrow Money From or Make Loans 38A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 38a.
(13) Enter Amount Involved 38B $ <ENTER>
<MINUS (-)>		 Enter the amount from Part V, Line 38b.
(14) Section 501(c)(7) Initiation Fees 39A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39a.
(15) Gross Receipts Amount 39B $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39b.
(16) 501(c)(3) and 501(c)(4) 40B <ENTER> Enter the yes or no from the yes/no box from Part V, Line 40b.
(17) Party to a Prohibited Tax Shelter 40E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 40e.
(18) Did you have Foreign Bank Accounts? 42B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42b.
(19) Did you have a Foreign Office? 42C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42c.
(20) Section 4947(a)(1) Trusts Filing 990EZ? 43 <ENTER> Enter the code edited to the right of Part V, Line 43.
(21) Maintain Any Donor Advised Funds 44A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44a.
(22) Operate One or More Hospital Facilities 44B <ENTER>` Enter a yes or no from the yes/no box from Part V, Line 44b.
(23) Receive Payments for Indoor Tanning 44C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44c.
(24) Filed Form 720 to Report Payments 44D <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44d.
(25) Controlled Entity Within 512(b)(13) 45A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 45a.
26 Received any payment from or engaged in transaction 45B ENTER Enter a yes or no from the yes/no box from Part V, Line 45b
(26) Engage in Direct/Indirect Political Activities 46 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 46.
(27) Engage in Lobbying Activities 47 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 47.
(28) Operating a School 48 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 48.
(29) Make Any Transfers to an Exempt 49A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49a.
(30) Section 527 Organization 49B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49b.
Exhibit 3.24.12-188

Form 990-EZ - Section 08 (2016 and 2017)

Form 990-EZ - Section 08 (2016 and 2017)
3.24.12 - 188 SECTION 08
Source Document or Record: Form 990 - EZ - Section 08 (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08.
(2) Preparation Code PREP <ENTER> Enter the edited digits from the right margin of the return next to the PTIN.
(3) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(4) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
(5) Preparer Telephone # TEL# <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-189

Form 990-EZ - Section 11, Schedule A, (2016 and 2017)

Form 990-EZ - Section 11, Schedule A, (2016 and 2017)
3.24.12 - 189 SECTION 11
Source Document or Record: Forms 990-EZ - Section 11, Schedule A (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 11.
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization L11 <ENTER> Enter the following:
1 = Type I
2 = Type II
3= Type III- Functionally integrated
4 = Type III Non-functionally integrated
Blank - <ENTER>
(4) Type I, II or III Supporting Organization L11E <ENTER> Enter a “1” if the box is checked on Schedule A, Part I, Line 11e.
(5) Number of Supported Organizations 11F <ENTER>
MINUS (-)		 Enter the amount from Line 11f.
(6) EIN A 12G(II)A <ENTER> Enter the EIN in Part I, Line 12g, Row A, Column (ii).
(7) Type of Org A 12G(III)A <ENTER> Enter the type of organization in Part I, Line 12g, Row A, Column (iii). If more than one digit, pick up the first digit only.
(8) Listed in Governing Doc A 12G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row A, Column (iv).
(9) Amount of Support A 12G(V)A $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row A, Column (v).
(10) EIN B 12G(II)B <ENTER> Enter the EIN in Part I, Line 12g, Row B, Column (ii).
(11) Type of Org B 12G(III)B <ENTER> Enter the type of organization in Part I, Line 12g, Row B, Column (iii). If more than one digit, pick up the first digit only.
(12) Listed in Governing Doc B 12G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row B, Column (iv).
(13) Amount of Support B 12G(V)B $ <ENTER>
MINUS (-)		 Enter the amount Part I, Line 12g, Row B, Column (v).
(14) EIN C 12G(II)C <ENTER> Enter the EIN in Part I, Line 12g, Row C, Column (ii).
(15) Type of Org C 12G(III)C <ENTER> Enter the type of organization in Part I, Line 12g, Row C, Column (iii). If more than one digit, pick up the first digit only.
(16) Listed in Governing Doc C 12G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 12g, Row C, Column (iv).
(17) Amount of Support C 12G(V)C $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row C, Column (v).
(18) EIN D 12G(II)D <ENTER> Enter the EIN in Part I, Line 12g, Row D, Column (ii).
(19) Type of Org D 12G(III)D <ENTER> Enter the type of organization in Part I, Line 12g, Row D, Column (iii). If more than one digit, pick up the first digit only.
(20) Listed in Governing Doc D 12G(IV)D <ENTER> Enter 1 for yes and 2 for no from check box in Part I, Line 12g, Row D, Column (iv).
(21) Amount of Support D 12G(V)D $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row D, Column (v).
(22) EIN E 12G(II)E <ENTER> Enter the EIN in Part I, Line 12g, Row E, Column (ii).
(23) Type of Org E 12G(III)E <ENTER> Enter the type of organization in Part I, Line 12g, Row E, Column (iii). If more than one digit, pick up the first digit only.
(24) Listed in Governing Doc E 12G(IV)E <ENTER> Enter 1 for yes and 2 for no from check box in Part I, Line 12g, Row E, Column (iv).
(25) Amount of Support E 12G(V)E $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Row E, Column (v).
(26) Filling Field     Generates blank on output.
(27) Total Number of Organizations 12G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 12h, Column (i), Total Line.
(28) Total Amount of Support GVTOT <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 12g, Total, Column (v).
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a 1 if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-190

Form 990-EZ - Section 12, Schedule A (2016 and 2017)

Form 990-EZ - Section 12, Schedule A (2016 and 2017)
3.24.12 - 190 SECTION 12
Source Document or Record: Forms 990-EZ - Section 12, Schedule A (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 12.
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a 1 if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Filling Field     Generates a blank field on output.
(29) Excess Distributions C PTVE3C$ <ENTER> Enter the amount from Part V, Section E, Line 3c.
(30) Excess Distributions D PTVE3D$ <ENTER> Enter the amount from Part V, Section E, Line 3d.
(31) Excess Distributions E PTVE3E$ <ENTER> Enter the amount from Part V, Section E, Line 3e.
(32) Excess Distributions Breakdown B PTVE8B$ <ENTER> Enter the amount from Part V, Section E, Line 8b.
(33) Excess Distributions Breakdown C PTVE8C$ <ENTER> Enter the amount from Part V, Section E, Line 8c.
(34) Excess Distributions Breakdown D PTVE8D$ <ENTER> Enter the amount from Part V, Section E, Line 8d.
(35) Excess Distributions Breakdown E PTVE8E$ <ENTER> Enter the amount from Part V, Section E, Line 8e.
Exhibit 3.24.12-191

Form 990-EZ - Section 13, Schedules C & L (2016 and 2017)

Form 990-EZ - Section 13, Schedules C & L (2016 and 2017)
3.24.12 - 191 SECTION 13
Source Document or Record: Forms 990-EZ - Section 13, Schedules C & L (2016 and 2017)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Political Expenditures SCHC L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Excess Benefit Transactions SCHL1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part I.
(4) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
Exhibit 3.24.12-192

Form 990-EZ - Section 01 (2014 and 2015)

3.24.12 - 192 SECTION 01
Source Document or Record: Form 990-EZ - Section 01 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Type of Organization BOXGRT <ENTER> Enter the edited code from right margin of box F. If the edit sheet isn't present, enter the Type of Organization from the right margin of Lines C, D or E.
(11) Computer Condition Codes CCC <ENTER> Enter the edited characters from the dotted portion of Lines 1–3. If a Condition Code is illegible, enter a "#" in its place.
(12) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(c) If the Type of Organization is a "9" and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(d) If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
(13) Box J 501(c) # 501C# <ENTER> Enter the edited 2 digit code from the lower right corner of the entity portion.
(14) Box H Checkbox H RTMAR <ENTER> Enter the edited code from the right margin of Line 1.
(15) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates a (%) sign.
(16) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(17) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(18) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(19) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(20) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-193

Form 990-EZ - Section 02, Form 5800 Edit - Sheet (2014 and 2015)

3.24.12 - 193 SECTION 02
Source Document or Record: Form 990-EZ - Section 02 (5800, Edit Sheet) (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is a "9" from Section 01 E-10, and the "9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is a "9" from Section 01 E-10, and the "9" is NOT underlined, press <F6> and end the document after this element.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800.
(a) For special instructions, see IRM 3.24.38.
(7) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-194

Form 990-EZ - Section 03 (2014 and 2015)

3.24.12 - 194 SECTION 03
Source Document or Record: Form 990-EZ - Section 03 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a "G" Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the "600" series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Contributions, Gifts, Grants LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1.
(4) Program Service Revenue LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(5) Membership Dues and Assessments LN3 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3.
(6) Investment Income LN4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(7) Gross Amount from Sale of Assets L5A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5a.
(8) Less Cost or Other Basis L5B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5b.
(9) Gain/Loss Other L5C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5c.
(10) Gross Income from Gaming L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a.
(11) Gross Income from Fundraising L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(12) Less Direct Expenses L6C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6c.
(13) Net Income/Loss L6D $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6d.
(14) Gross Sales Less Returns and Allowances L7A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7a.
(15) Less Cost of Goods Sold L7B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7b.
(16) Gross Profit/Loss L7C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7c.
(17) Other Revenue LN8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(18) Total Revenue LN9 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part I, Line 9.
(19) Grants & Other Similar Amounts L10 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10.
(20) Benefits Paid to Members L11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
(21) Salaries & Other Compensation L12 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12.
(22) Total Expenses L17 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 17.
(23) Excess (Deficit) for the Year L18 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 18.
(24) Other Changes in Net Assets L20 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 20.
(25) Net Assets at (EOY) L21 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 21.
Exhibit 3.24.12-195

Form 990-EZ - Section 05 (2014 and 2015)

3.24.12 - 195 SECTION 05
Source Document or Record: Form 990-EZ - Section 05 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Total Assets (BOY) 25A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 25, Column (A).
(3) Total Assets (EOY) 25B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25, Column (B).
Exhibit 3.24.12-196

Form 990-EZ - Section 06 (2014 and 2015)

3.24.12 - 196 SECTION 06
Source Document or Record: Forms 990-EZ - Section 06 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "06" .
(2) Total Liabilities - BOY 26A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (A).
(3) Total Liabilities - EOY 26B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (B).
(4) Net Assets - BOY 27A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (A).
(5) Net Assets - EOY 27B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (B).
Exhibit 3.24.12-197

Form 990-EZ - Section 07 (2014 and 2015)

3.24.12 - 197 SECTION 07
Source Document or Record: Form 990-EZ - Section 07 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "07" .
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top margin of Page 2.
(3) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.
(4) Did you Engage in any Activity? 33 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33.
(5) Were any Changes Made? 34 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 34.
(6) Did you have Unrelated Business? 35A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35a.
(7) If Yes, Did you File 990–T? 35B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35b.
8 Was organization 501(c)(4), (c)(5) or (c)(6) 35C ENTER Enter a yes or no from the yes/no box from Part V, Line 35c.
(9) Was there a Liquidation? 36 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 36.
(10) Amount of Political Expenditures 37A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 37a.
(11) Did You File 1120–POL? 37B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 37b.
(12) Borrow Money From or Make Loans 38A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 38a.
(13) Enter Amount Involved 38B $ <ENTER>
<MINUS (-)>		 Enter the amount from Part V, Line 38b.
(14) Section 501(c)(7) Initiation Fees 39A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39a.
(15) Gross Receipts Amount 39B $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39b.
(16) 501(c)(3) and 501(c)(4) 40B <ENTER> Enter the yes or no from the yes/no box from Part V, Line 40b.
(17) Party to a Prohibited Tax Shelter 40E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 40e.
(18) Did you have Foreign Bank Accounts? 42B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42b.
(19) Did you have a Foreign Office? 42C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42c.
(20) Section 4947(a)(1) Trusts Filing 990EZ? 43 <ENTER> Enter the code edited to the right of Part V, Line 43.
(21) Maintain Any Donor Advised Funds 44A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44a.
(22) Operate One or More Hospital Facilities 44B <ENTER>` Enter a yes or no from the yes/no box from Part V, Line 44b.
(23) Receive Payments for Indoor Tanning 44C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44c.
(24) Filed Form 720 to Report Payments 44D <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44d.
(25) Controlled Entity Within 512(b)(13) 45A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 45a.
26 Received any payment from or engaged in transaction 45B ENTER Enter a yes or no from the yes/no box from Part V, Line 45b
(26) Engage in Direct/Indirect Political Activities 46 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 46.
(27) Engage in Lobbying Activities 47 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 47.
(28) Operating a School 48 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 48.
(29) Make Any Transfers to an Exempt 49A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49a.
(30) Section 527 Organization 49B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49b.
Exhibit 3.24.12-198

Form 990-EZ Section 08 (2014 and 2015)

3.24.12 - 198 SECTION 08
Source Document or Record: Form 990 - EZ - Section 08 (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "08" .
(2) Preparation Code PREP <ENTER> Enter the edited digits from the right margin of the return next to the PTIN.
(3) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(4) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
(5) Preparer Telephone # TEL# <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-199

Form 990-EZ - Section 11, Schedule A (2014 and 2015)

3.24.12 - 199 SECTION 11
Source Document or Record: Forms 990-EZ - Section 11, Schedule A (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Type of Organization 11 <ENTER> Enter the following:
1 = Type I
2 = Type II
3= Type III- Functionally integrated
4 = Type III Non-functionally integrated
Blank - <ENTER>
(4) Type I, II or III Supporting Organization L11E <ENTER> Enter a “1” if the box is checked on Schedule A, Part I, Line 11e.
(5) Number of Supported Organizations 11F <ENTER>
MINUS (-)		 Enter the amount from Line 11f.
(6) EIN A 11G(II)A <ENTER> Enter the EIN in Part I, Line 11g, Row A, Column (ii).
(7) Type of Org A 11G(III)A <ENTER> Enter the type of organization in Part I, Line 11g, Row A, Column (iii). If more than one digit, pick up the first digit only.
(8) Listed in Governing Doc A 11G(IV)A <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row A, Column (iv).
(9) Amount of Support A 11G(V)A $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 11g, Row A, Column (v).
(10) EIN B 11G(II)B <ENTER> Enter the EIN in Part I, Line 11g, Row B, Column (ii).
(11) Type of Org B 11G(III)B <ENTER> Enter the type of organization in Part I, Line 11g, Row B, Column (iii). If more than one digit, pick up the first digit only.
(12) Listed in Governing Doc B 11G(IV)B <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row B, Column (iv).
(13) Amount of Support B 11G(V)B $ <ENTER>
MINUS (-)		 Enter the amount Part I, Line 11g, Row B, Column (v).
(14) EIN C 11G(II)C <ENTER> Enter the EIN in Part I, Line 11g, Row C, Column (ii).
(15) Type of Org C 11G(III)C <ENTER> Enter the type of organization in Part I, Line 11g, Row C, Column (iii). If more than one digit, pick up the first digit only.
(16) Listed in Governing Doc C 11G(IV)C <ENTER> Enter 1 for yes and 2 for no from checkbox in Part I, Line 11g, Row C, Column (iv).
(17) Amount of Support C 11G(V)C $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 11g, Row C, Column (v).
(18) EIN D 11G(II)D <ENTER> Enter the EIN in Part I, Line 11g, Row D, Column (ii).
(19) Type of Org D 11G(III)D <ENTER> Enter the type of organization in Part I, Line 11g, Row D, Column (iii). If more than one digit, pick up the first digit only.
(20) Listed in Governing Doc D 11G(IV)D <ENTER> Enter 1 for yes and 2 for no from check box in Part I, Line 11g, Row D, Column (iv).
(21) Amount of Support D 11G(V)D $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 11g, Row D, Column (v).
(22) EIN E 11G(II)E <ENTER> Enter the EIN in Part I, Line 11g, Row E, Column (ii).
(23) Type of Org E 11G(III)E <ENTER> Enter the type of organization in Part I, Line 11g, Row E, Column (iii). If more than one digit, pick up the first digit only.
(24) Listed in Governing Doc E 11G(IV)E <ENTER> Enter 1 for yes and 2 for no from check box in Part I, Line 11g, Row E, Column (iv).
(25) Amount of Support E 11G(V)E $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 11g, Row E, Column (v).
(26) Total Number of Organizations 11G(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 11h, Column (i), Total Line.
(27) Total GVTOT $ <ENTER>
MINUS (-)		 Enter the amount on Part I, Line 11g, Total, Column (v).
(28) Filling Field     Blank field generates on output.
(29) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(30) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(31) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(32) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(33) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(34) Public Support 6(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(35) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(36) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(37) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(38) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(39) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(40) Receipts from Related Activities L12 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part II, Line 12.
(41) First 5 Years Checkbox 13CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 13 is checked.
(42) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16a is checked.
(43) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16b is checked.
(44) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17a is checked.
(45) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17b is checked.
(46) Private Foundation Checkbox 18CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-200

Form 990-EZ - Section 12, Schedule A (2014 and 2015)

3.24.12 - 200 SECTION 12
Source Document or Record: Forms 990-EZ - Section 12, Schedule A (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 20 is checked.
(23) Part IV Section A Data Present Indicator PTIVA <ENTER> Enter a 1 if data is present in Part IV, Section A.
(24) Part IV Section B Data Present Indicator PTIVB <ENTER> Enter a 1 if data is present in Part IV, Section B.
(25) Part IV Section C Data Present Indicator PTIVC <ENTER> Enter a 1 if data is present in Part IV, Section C.
(26) Part IV Section D Data Present Indicator PTIVD <ENTER> Enter a 1 if data is present in Part IV, Section D.
(27) Part IV Section E Data Present Indicator PTIVE <ENTER> Enter a 1 if data is present in Part IV, Section E.
(28) Part V Data Present Indicator PTV <ENTER> Enter a 1 if data is present in Part V.
Exhibit 3.24.12-201

Form 990-EZ - Section 13, Schedules C & L (2014 and 2015)

3.24.12 - 201 SECTION 13
Source Document or Record: Forms 990-EZ - Section 13, Schedules C & L (2014 and 2015)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "13" .
(2) Political Expenditures SCHC L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Excess Benefit Transactions SCHL1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part I.
(4) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
Exhibit 3.24.12-202

Form 990-EZ - Section 01 (2008 - 2013)

Form 990-EZ - Section 01 (2008 - 2013)
3.24.12 - 202 SECTION 01
Source Document or Record: Form 990-EZ - Section 01 (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Type of Organization BOXGRT <ENTER> Enter the edited code from right margin of box F. If the edit sheet isn't present, enter the Type of Organization from the right margin of Lines C, D or E.
(11) Computer Condition Codes CCC <ENTER> Enter the edited characters from the dotted portion of Lines 1–3. If a Condition Code is illegible, enter a "#" in its place.
(12) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(c) If the Type of Organization is a "9" and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(d) If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
(13) Box J 501(c) # 501C# <ENTER> Enter the edited 2 digit code from the lower right corner of the entity portion.
(14) Box H Checkbox H RTMAR <ENTER> Enter the edited code from the right margin of Line 1.
(15) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates a (%) sign.
(16) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(17) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(18) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(19) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(20) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-203

Form 990-EZ - Section 02 Form 5800-Edit Sheet (2008 - 2013)

Form 990-EZ - Section 02 (5800, Edit Sheet) (2008 - 2013)
3.24.12 - 203 SECTION 02
Source Document or Record: Form 990-EZ - Section 02 (5800, Edit Sheet) (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is a "9" from Section 01 E-10, and the "9" is underlined, don’t end the document. Continue processing the return.
(e) If the Type of Organization is a "9" from Section 01 E-10, and the "9" is NOT underlined, press <F6> and end the document after this element.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800.
(a) For special instructions, see IRM 3.24.38.
(7) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-204

Form 990-EZ - Section 03 (2008 - 2013)

Form 990-EZ - Section 03 (2008 - 2013)
3.24.12 - 204 SECTION 03
Source Document or Record: Form 990-EZ - Section 03 (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a "G" Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the "600" series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Contributions, Gifts, Grants LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1.
(4) Program Service Revenue LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(5) Membership Dues and Assessments LN3 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3.
(6) Investment Income LN4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(7) Gross Amount from Sale of Assets L5A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5a.
(8) Less Cost or Other Basis L5B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5b.
(9) Gain/Loss Other L5C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5c.
(10) Gross Income from Gaming L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a.
(11) Gross Income from Fundraising L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(12) Less Direct Expenses L6C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6c.
(13) Net Income/Loss L6D $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6d.
(14) Gross Sales Less Returns and Allowances L7A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7a.
(15) Less Cost of Goods Sold L7B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7b.
(16) Gross Profit/Loss L7C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7c.
(17) Other Revenue LN8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(18) Total Revenue LN9 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part I, Line 9.
(19) Grants & Other Similar Amounts L10 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10.
(20) Benefits Paid to Members L11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
(21) Salaries & Other Compensation L12 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12.
(22) Total Expenses L17 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 17.
(23) Excess (Deficit) for the Year L18 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 18.
(24) Other Changes in Net Assets L20 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 20.
(25) Net Assets at (EOY) L21 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 21.
Exhibit 3.24.12-205

Form 990-EZ - Section 05 (2008 - 2013)

Form 990-EZ - Section 05 (2008 - 2013)
3.24.12 - 205 SECTION 05
Source Document or Record: Form 990 - EZ - Section 05 (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Total Assets (BOY) 25A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 25, Column (A).
(3) Total Assets (EOY) 25B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25, Column (B).
Exhibit 3.24.12-206

Form 990-EZ - Section 06 (2008 - 2013)

Form 990-EZ - Section 06 (2008 - 2013)
3.24.12 - 206 SECTION 06
Source Document or Record: Forms 990-EZ - Section 06 (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "06" .
(2) Total Liabilities - BOY 26A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (A).
(3) Total Liabilities - EOY 26B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 26, Column (B).
(4) Net Assets - BOY 27A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (A).
(5) Net Assets - EOY 27B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 27, Column (B).
Exhibit 3.24.12-207

Form 990-EZ - Section 07 (2008 - 2013)

Form 990-EZ - Section 07 (2008 - 2013)
3.24.12 - 207 SECTION 07
Source Document or Record: Form 990-EZ - Section 07 (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "07" .
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top margin of Page 2.
(3) Schedule Indicator Codes PG3TOP <ENTER> Enter the edited codes from the top of page 3.
(4) Did you Engage in any Activity? 33 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33.
(5) Were any Changes Made? 34 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 34.
(6) Did you have Unrelated Business? 35A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35a.
(7) If Yes, Did you File 990–T? 35B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35b.
8 Was organization 501(c)(4), (c)(5) or (c)(6) 35C ENTER Enter a yes or no from the yes/no box from Part V, Line 35c.
(9) Was there a Liquidation? 36 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 36.
(10) Amount of Political Expenditures 37A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 37a.
(11) Did You File 1120–POL? 37B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 37b.
(12) Borrow Money From or Make Loans 38A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 38a.
(13) Enter Amount Involved 38B $ <ENTER>
<MINUS (-)>		 Enter the amount from Part V, Line 38b.
(14) Section 501(c)(7) Initiation Fees 39A $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39a.
(15) Gross Receipts Amount 39B $ <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 39b.
(16) 501(c)(3) and 501(c)(4) 40B <ENTER> Enter the yes or no from the yes/no box from Part V, Line 40b.
(17) Party to a Prohibited Tax Shelter 40E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 40e.
(18) Did you have Foreign Bank Accounts? 42B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42b.
(19) Did you have a Foreign Office? 42C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42c.
(20) Section 4947(a)(1) Trusts Filing 990EZ? 43 <ENTER> Enter the code edited to the right of Part V, Line 43.
(21) Maintain Any Donor Advised Funds 44A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44a.
(22) Operate One or More Hospital Facilities 44B <ENTER>` Enter a yes or no from the yes/no box from Part V, Line 44b.
(23) Receive Payments for Indoor Tanning 44C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44c.
(24) Filed Form 720 to Report Payments 44D <ENTER> Enter a yes or no from the yes/no box from Part V, Line 44d.
(25) Controlled Entity Within 512(b)(13) 45A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 45a.
26 Received any payment from or engaged in transaction 45B ENTER Enter a yes or no from the yes/no box from Part V, Line 45b
(26) Engage in Direct/Indirect Political Activities 46 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 46.
(27) Engage in Lobbying Activities 47 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 47.
(28) Operating a School 48 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 48.
(29) Make Any Transfers to an Exempt 49A <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49a.
(30) Section 527 Organization 49B <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 49b.
Exhibit 3.24.12-208

Form 990-EZ - Section 08 (2008 - 2013)

Form 990-EZ - Section 08 (2008 - 2013)
3.24.12 - 208 SECTION 08
Source Document or Record: Form 990-EZ - Section 08 (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "08" .
(2) Preparation Code PREP <ENTER> Enter the edited digits from the right margin of the return next to the PTIN.
(3) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(4) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
(5) Preparer Telephone # TEL# <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-209

Form 990-EZ - Section 11, Schedule A (2008 - 2013)

Form 990-EZ - Section 11, Schedule A (2008 - 2013)
3.24.12 - 209 SECTION 11
Source Document or Record: Form 990-EZ - Section 11, Schedule A (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Non-Private Foundation Code SCHAPT1 <ENTER> Enter the edited code to the right margin of Part I.
(3) Total Number of Organizations 11H(I)TOT <ENTER> Enter the number from Schedule A, Part I, Line 11h, Column (i), Total Line.
(4) Total Amount of Support HVIITOT $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 11h, Column (vii), Total Line.
(5) Gifts / Grants / Contributions PTII 1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (f).
(6) Tax Revenues Levied 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 2, Column (f).
(7) Value of Services 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 3, Column (f).
(8) Total 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 4, Column (f).
(9) Amounts Included on Line 1 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 5, Column (f).
(10) Public Support 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 6, Column (f).
(11) Amount from Line 4 7(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 7, Column (f).
(12) Gross Income from Interest 8(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 8, Column (f).
(13) Net Income from Unrelated Business 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 9, Column (f).
(14) Other Income 10(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 10, Column (f).
(15) Total Support 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part II, Line 11, Column (f).
(16) Receipts from Related Activities L12 $ <ENTER>
MNUS (-)
☆☆☆☆☆☆		 Enter the amount from Schedule A, Part II, Line 12.
(17) First 5 Years Checkbox 13CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 13 is checked.
(18) 33 1/3% Test Current Year Checkbox 16ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16a is checked.
(19) 33 1/3% Test Prior Year Checkbox 16BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 16b is checked.
(20) 10% Facts & Circumstances Current 17ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17a is checked.
(21) 10% Facts & Circumstances Prior 17BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 17b is checked.
(22) Private Foundation Checkbox 18CKBX <ENTER> Enter a "1" if the box on Schedule A, Part II, Line 18 is checked.
Exhibit 3.24.12-210

Form 990-EZ - Section 12, Schedule A (2008 - 2013)

Form 990-EZ - Section 12, Schedule A (2008 - 2013)
3.24.12 - 210 SECTION 12
Source Document or Record: Forms 990-EZ - Section 12, Schedule A (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Part III Gifts / Grants / Contributions PT3L1(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 1, Column (f).
(3) Gross Receipts from Admissions 2(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 2, Column (f).
(4) Gross Receipts from Activities 3(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 3, Column (f).
(5) Tax Revenues Levied 4(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 4, Column (f).
(6) Value of Services / Facilities 5(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 5, Column (f).
(7) Total 509(a)(2) 6(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 6, Column (f).
(8) Received from Disqualified Persons 7A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7a, Column (f).
(9) Received from Other than Disqualified 7B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7b, Column (f).
(10) Total of 7a & 7b 7C(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 7c, Column (f).
(11) Public Support 8(F) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Schedule A, Part III, Line 8, Column (f).
(12) Amounts from Line 6 9(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 9, Column (f).
(13) Gross Income from Interest 10A(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10a, Column (f).
(14) Unrelated Business Taxable Income 10B(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 10b, Column (f).
(15) Total of 10a & 10b 10C(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 10c, Column (f).
(16) Net Income / Unrelated Business Activity 11(F) $ <ENTER>
MNUS (-)		 Enter the amount from Schedule A, Part III, Line 11, Column (f).
(17) Other Income 12(F) $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part III, Line 12, Column (f).
(18) Total Support 13(F) $ <ENTER>
MINUS (-)
☆☆☆☆☆☆		 Enter the amount from Schedule A, Part III, Line 13, Column (f).
(19) First 5 Years Checkbox 14CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 14 is checked.
(20) 33 1/3% Test Current Year Checkbox 19ACKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19a is checked.
(21) 33 1/3% Test Prior Year Checkbox 19BCKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 19b is checked.
(22) Private Foundation Checkbox 20CKBX <ENTER> Enter a "1" if the box on Schedule A, Part III, Line 20 is checked.
Exhibit 3.24.12-211

Form 990-EZ - Section 13, Schedules C & L (2008 - 2013)

Form 990-EZ - Section 13, Schedules C & L (2008 - 2013)
3.24.12 - 211 SECTION 13
Source Document or Record: Forms 990-EZ - Section 13, Schedules C & L (2008 - 2013)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "13" .
(2) Political Expenditures SCHC L2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule C, Part I-A, Line 2.
(3) Excess Benefit Transactions SCHL1 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part I.
(4) Approved by Board or Committee PT2 RTMAR <ENTER> Enter the edited digit from the right margin of Schedule L, Part II.
Exhibit 3.24.12-212

Form 990-EZ - Section 01 (2007 and Prior)

Form 990-EZ-Section 01 (2007 and Prior)
3.24.12 - 212 SECTION 01
Source Document or Record: Form 990-EZ, Section 01 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number as shown on the preprinted label or in the E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For the error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Type of Organization BOXGRT <ENTER> Enter the edited code from right margin of box F. If the edit sheet isn't present, enter the Type of Organization from the right margin of Lines C, D or E.
(11) Computer Condition Codes CCC <ENTER> Enter the edited characters from the dotted portion of Lines 1–3. If a Condition Code is illegible, enter a "#" in its place.
(12) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If Type of Organization is a "9" , and the "9" is underlined, don't end the document. Continue transcribing the return.
(c) If the Type of Organization is a "9" and the "9" is NOT underlined, press <F6> and end the document unless an ERS Action Code is present. If an Action Code is present, continue to that element and follow the instructions there.
(d) If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
(13) Box J 501(c) 501C# <ENTER> Enter the edited 2 digit code from the lower right corner of the entity portion.
(14) Box H Checkbox H RTMAR <ENTER> Enter the edited code from the right margin of Line 1.
(15) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates a (%) sign.
(16) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(17) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(18) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(19) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(20) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-213

Form 990-EZ - Section 02, Form 5800 - Edit Sheet (2007 and Prior)

Form 990-EZ - Section 02, Form 5800 - Edit Sheet (2007 and Prior)
3.24.12 - 213 SECTION 02
Source Document or Record: Form 990-EZ - Section 02, Form 5800 -Edit Sheet (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(d) If the Type of Organization is a "9" from Section 01 E-10, and the "9" is underlined, do NOT end the document. Continue processing the return.
(e) If the Type of Organization is a "9" from Section 01 E-10, and the "9" is NOT underlined, press <F6> and end the document after this element.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800.
(a) For special instructions, see IRM 3.24.38.
(7) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-214

Form 990-EZ - Section 03 (2007 and Prior)

Form 990-EZ - Section 03 (2007 and Prior)
3.24.12 - 214 SECTION 03
Source Document or Record: Form 990-EZ, Section 03 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a "G" Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the "600" series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Contributions, Gifts, Grants LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1.
(4) Program Service Revenue LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(5) Membership Dues and Assessments LN3 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3.
(6) Investment Income LN4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(7) Gross Amount from Sale of Assets L5A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5a.
(8) Less Cost or Other Basis L5B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5b.
(9) Gain/Loss Other L5C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5c.
(10) Special Events/Gaming 6CKBX <ENTER> Enter a "1" if the check box from Part I, Line 6 is checked.
(11) Gross Revenue L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a.
(12) Less Direct Expenses L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(13) Net Income L6C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6c.
(14) Gross Sales Less Returns and Allowances L7A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7a.
(15) Less Cost of Goods Sold L7B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7b.
(16) Gross Profit/Loss L7C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7c.
(17) Other Revenue LN8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(18) Total Revenue LN9 $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part I, Line 9.
(19) Grants & Other Similar Amounts L10 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10.
(20) Benefits Paid to Members L11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
(21) Salaries & Other Compensation L12 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12.
(22) Total Expenses L17 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 17.
(23) Excess (Deficit) for the Year L18 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 18.
(24) Other Changes in Net Assets L20 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 20.
(25) Net Assets at (EOY) L21 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 21.
Exhibit 3.24.12-215

Form 990-EZ - Section 05 (2007 and Prior)

Form 990-EZ- Section 05 (2007 and Prior)
3.24.12 - 215 SECTION 05
Source Document or Record: Form 990-EZ, Section 05 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Total Assets (BOY) 25A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 25, Column (A).
(3) Total Assets (EOY) 25B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 25, Column (B).
Exhibit 3.24.12-216

Form 990-EZ - Section 06 (2007 and Prior)

Form 990-EZ-Section 06 (2007 and Prior)
3.24.12 - 216 SECTION 06
Source Document or Record: Form 990-EZ - Section 06 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "06" .
(2) Total Liabilities (BOY) 26A $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 26, Column (A).
(3) Total Liabilities (EOY) 26B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 26, Column (B).
(4) Net Assets (BOY) 27A $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 27, Column (A).
(5) Net Assets (EOY) 27B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 27, Column (B).
Exhibit 3.24.12-217

Form 990-EZ - Section 07 (2007 and Prior)

Form 990-EZ-Section 07 (2007 and Prior)
3.24.12 - 217 SECTION 07
Source Document or Record: Form 990-EZ, Section 07 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "07" .
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top margin of Page 2.
(3) Did you Engage in any Activity? 33 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33.
(4) Were any Changes Made? 34 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 34.
(5) Did you have Unrelated Business? 35A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35a.
(6) If Yes, Did you File 990–T? 35B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35b.
(7) Was there a Liquidation? 36 <ENTER> Enter a yes or no from the yes/no box from Line 36.
(8) Amount of Political Expenditures 37A $ <ENTER>
MINUS (−)		 Enter the amount from Line 37a.
(9) Did You File 1120–POL? 37B <ENTER> Enter a yes or no from the yes/no box from Line 37b.
(10) Section 501(c)(7) Initiation Fees 39A $ <ENTER>
MINUS (−)		 Enter the amount from Line 39a.
(11) Gross Receipts Amount 39B $ <ENTER>
MINUS (−)		 Enter the amount from Line 39b.
(12) 501(c)(3) and 501(c)(4) 40B <ENTER> Enter the yes or no from the yes/no box from Part V, Line 40b.
(13) Did you have Foreign Bank Accounts? 42B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42b.
(14) Did you have a Foreign Office? 42C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 42c.
(15) Section 4947(a)(1) Trusts Filing 990EZ? 43 <ENTER> Enter the code edited to the right of Part V, Line 43.
Exhibit 3.24.12-218

Form 990-EZ - Section 08 (2007 and Prior)

Form 990-EZ - Section 08 (2007 and Prior)
3.24.12 - 218 SECTION 08
Source Document or Record: Form 990-EZ - Section 08 (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "08" .
(2) Preparation Code PREP <ENTER> Enter the edited digits from the right margin of the last page of the return next to the PTIN.
(3) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(4) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
Exhibit 3.24.12-219

Form 990-EZ - Section 09, Schedule A (2007 and Prior)

Form 990-EZ - Section 09, Schedule A, (2007 and Prior)
3.24.12 - 219 SECTION 09
Source Document or Record: Form 990-EZ - Section 09, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "09" .
(2) Question 1 Part III LN1 <ENTER> Enter the edited digit to the right of Part III, Line 1.
If un-edited, enter a yes or no from the yes/no box from Part III, Line 1.
(3) Legislative Activities LN1 $ <ENTER>
MINUS (−)		 Enter the amount from Part III, Line 1, next to the $.
(4) Was there a Sale, Exchange or Lease of Property? L2A <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2a.
(5) Did you Lend Money or Other Credit? L2B <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2b.
(6) Did you Furnish Goods, Services or Facilities? L2C <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2c.
(7) Did you make Payment Compensation? L2D <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2d.
(8) Did you Transfer Income or Assets? L2E <ENTER> Enter a yes or no from the yes/no box from Part III, Line 2e.
(9) Do you Make Grants/Scholarships? L3A <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3a.
(10) Did you Have a Section 403(b) Annuity Plan? L3B <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3b.
(11) Did you Receive or Hold Easement - Section 170(h)? L3C <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3c.
(12) Do you Provide Credit Counseling? L3D <ENTER> Enter a yes or no from the yes/no box from Part III, Line 3d.
(13) Did you Maintain any Donor Advised Funds? L4A <ENTER> Enter a yes or no from the yes/no box from Part III, Line 4a.
(14) Did you Make any Taxable Distributions? L4B <ENTER> Enter a yes or no from the yes/no box from Part III, Line 4b.
(15) Did you Make a Distribution – Section 4967? L4C <ENTER> Enter a yes or no from the yes/no box from Part III, Line 4c.
(16) Enter the Total Number of Donor Advised Funds L4D <ENTER> Enter the number from Part III, Line 4d.
(17) Enter the Aggregate Value of Assets L4E $ <ENTER> Enter the amount from Part III, Line 4e.
(18) Part IV Non-Private Foundation IVRTMAR <ENTER> Enter the edited code from the RIGHT margin of Part IV.
(19) Total Amount of Support 13E $ <ENTER> Enter the amount from Part IV, Line 13, Column (e).
(20) Gifts, Contributions, Grants 15E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 15, Column (e).
(21) Membership Fees 16E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 16, Column (e).
(22) Gross Receipts/Admissions 17E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 17, Column (e).
(23) Gross Income/Interest/Dividends 18E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 18, Column (e).
(24) Tax Revenues Levied 20E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 20, Column (e).
(25) Value of Services/Facilities Furnished 21E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 21, Column (e).
(26) Total Lines 15–22 23E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 23, Column (e).
(27) Line 23 Minus 17 24E $ <ENTER>
MINUS (−)		 Enter the amount from Part IV-A, Line 24, Column (e).
Exhibit 3.24.12-220

Form 990-EZ - Section 10, Schedule A (2007 and Prior)

Form 990-EZ - Section 10, Schedule A (2007 and Prior)
3.24.12 - 220 SECTION 10
Source Document or Record: Form 990-EZ - Section 10, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: If a large edited "X" is present through Part V or Part V is blank, don't enter this section.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "10" .
(2) Do you have a racially? V29 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 29.
(3) Do you include? 30 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 30.
(4) Have you publicized? 31 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 31.
(5) Records indicating? 32A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 32a.
(6) Records documenting? 32B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 32b.
(7) Copies of all catalogues? 32C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 32c.
(8) Copies of all material? 32D <ENTER> Enter a yes or no from the yes/no box from Part V, Line 32d.
(9) Students' rights? 33A <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33a.
(10) Admission Policies? 33B <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33b.
(11) Employment of faculty? 33C <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33c.
(12) Scholarships? 33D <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33d.
(13) Educational policies? 33E <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33e.
(14) Use of facilities? 33F <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33f.
(15) Athletic programs? 33G <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33g.
(16) Other extracurricular activities? 33H <ENTER> Enter a yes or no from the yes/no box from Part V, Line 33h.
(17) Does Organization Certify? 35 <ENTER> Enter a yes or no from the yes/no box from Part V, Line 35.
(18) Signature Code SIGN <ENTER> Enter the edited code from the bottom right hand portion of Schedule A, page 5.
Exhibit 3.24.12-221

Form 990-EZ - Section 11, Schedule A (2007 and Prior)

Form 990-EZ - Section 11, Schedule A (2007 and Prior)
3.24.12 - 221 SECTION 11
Source Document or Record: Form 990-EZ - Section 11, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Total (Grass Roots) Expenditures 36B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 36, Column (b).
(3) Total Lobbying Expenses 37B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 37, Column (b).
(4) Other Exempt Purposes Expenses 39B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 39, Column (b).
(5) Lobbying Nontaxable Amount 41B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 41, Column (b).
(6) Grass Roots Nontaxable Amount 42B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 42, Column (b).
(7) Excess of Line 36 over Line 42 43B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 43, Column (b).
(8) Excess of Line 38 over Line 41 44B $ <ENTER>
MINUS (−)		 Enter the amount from Part VI-A, Line 44, Column (b).
(9) Part VI-B, Line i, Total VIBLNI $ <ENTER>
MINUS (-)		 Enter the amount from Part VI-B, Line i.
Exhibit 3.24.12-222

Form 990-EZ - Section 12, Schedule A (2007 and Prior)

Form 990-EZ - Section 12, Schedule A (2007 and Prior)
3.24.12 - 222 SECTION 12
Source Document or Record: Form 990-EZ - Section 12, Schedule A (2007 and Prior)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Cash transfers? 51AI <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51a(i).
(3) Other assets? AII <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51a(ii).
(4) Sales of assets? 51BI <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51b(i).
(5) Purchases of assets? BII <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51b(ii).
(6) Rental? BIII <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51b(iii).
(7) Reimbursement? BIV <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51b(iv).
(8) Loans? BV <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51b(v).
(9) Performance of services? BVI <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51b(vi).
(10) Sharing? 51C <ENTER> Enter a yes or no from the yes/no box from Part VII, Line 51c.
Exhibit 3.24.12-223

Form 990-PF - Section 01

Form 990-PF - Section 01
3.24.12 - 223 SECTION 01
Source Document or Record: Form 990-PF - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I. Number EIN <ENTER>
★★★★★★		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Type of Organization Code C RTMAR <ENTER> Enter the edited code from right margin of box C/D.
(11) Foundation Code LN H <ENTER> Enter the edited digits from Line H.
(12) Termination Code F RTMAR <ENTER> Enter the edited code from right margin of box F.
(13) Line 2 Checkbox LN2 <ENTER> Enter the code if edited from the right margin of Line 1a.
(14) Computer Condition Codes CCC <ENTER> Enter the codes shown on the dotted portion of Lines 8–9. If a condition code is illegible, enter a "#" in its place.
(15) Return Processing Code 01RPC <ENTER> For 2018 and subsequent tax periods enter the edited codes on Page 1, in the right margin next to line 2.
(16) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
(b) See IRM 3.24.38 for special instructions.
(17) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates an (%) sign.
(18) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(19) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present on the return, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(20) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(21) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(22) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
Exhibit 3.24.12-224

Form 990-PF - Section 02, Form 5800 - Edit Sheet

Form 990-PF - Section 02, Form 5800 - Edit Sheet
3.24.12 - 224 SECTION 02
Source Document or Record: Form 990-PF - Section 02, Form 5800 - Edit Sheet
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from Bottom Left Margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3 then proceed to Section 03.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800, in MMDDYY format.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800.
(a) For special instructions, see IRM 3.24.38.
(7) Penalty and Interest Code LN6 <ENTER> Enter the edited digit from Line 6, Form 5800.
(8) Daily Delinquency Penalty LN7 <ENTER> Enter the edited amount exactly as shown on Line 7, Form 5800.
Exhibit 3.24.12-225

Form 990-PF - Section 03

Form 990-PF - Section 03
3.24.12 - 225 SECTION 03
Source Document or Record: Form 990-PF - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE: ENTER DOLLARS ONLY EXCEPT FOR E–(2).
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance RMT <ENTER> Enter the edited DOLLARS AND CENTS amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a "G" Condition Code is present, end the document after this element.
(c) If the ERS Action Code is in the "600" series, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Fair Market Value of Assets (EOY) BOXI $ <ENTER>
MINUS (−)		 Enter the amount from Box I, top portion of the return.
(4) Contributions, Gifts, Etc. L1A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1, Column (a).
(5) Interest on Savings L3A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 3, Column (a).
(6) Dividends & Interest L4A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4, Column (a).
(7) Gross Rents 5AA $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5a, Column (a).
(8) Net Gain or Loss L6A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6a, Column (a).
(9) Gross Sales Price on Line 6a L6B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6b.
(10) Cost of Goods Sold 10B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10b.
(11) Gross Profit from Business 10CA $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10c, Column (a).
(12) Other Income 11A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11, Column (a).
(13) Total Revenue per Book 12A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12, Column (a).
(14) Total Net Investment Income 12B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12, Column (b).
(15) Total Adjusted Net Income 12C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 12, Column (c).
(16) Compensation of Officers 13A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 13, Column (a).
(17) Pension Plan Employee Benefits 15A $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 15, Column (a).
(18) Legal Fees 16AA $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 16a, Column (a).
(19) Accounting Fees 16BA $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 16b, Column (a).
(20) Interest 17A $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 17, Column (a).
(21) Depreciation 19A $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 19, Column (a).
(22) Occupancy 20A $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 20, Column (a).
(23) Travel/Conferences and Meetings 21A $ <ENTER>
MINUS (-)		 Enter the amount form Part I, Line 21, Column (a).
(24) Printing and Publications 22A $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 22, Column (a).
(25) Total Operating & Admin. Expenses Col. A 24A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 24, Column (a).
(26) Total Operating & Admin. Expenses Col. B 24B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 24, Column (b).
(27) Total Operating and Admin. Expenses Col. D 24D $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 24, Column (d).
(28) Contributions, Gifts, Grants Paid 25A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 25, Column (a).
(29) Total Expenses Per Books 26A $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 26, Column (a).
(30) Total Expenses Net Investment 26B $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 26, Column (b).
(31) Total Expenses Adjusted Net 26C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 26, Column (c).
(32) Total Expenses Disbursements 26D $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 26, Column (d).
(33) Excess of Revenue 27AA $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 27a, Column (a).
(34) Net Investment Income 27BB $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 27b, Column (b).
(35) Adjusted Net Income 27CC $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 27c, Column (c).
Exhibit 3.24.12-226

Form 990-PF - Section 04

Form 990-PF - Section 04
3.24.12 - 226 SECTION 04
Source Document or Record: Form 990-PF - Section 04
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS ONLY.
NOTE 2: If the return is for a prior year, "04" will be edited to the left of the Part Number that is to be entered. The line items remains the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "04" .
(2) IRI Codes PG2TOP <ENTER> Enter the edited digits from the top of Page 2 or the return.
(3) Cash Non Interest (BOY) L1A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 1, Column (a).
(4) Cash Non Interest (EOY) L1B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 1, Column (b).
(5) Accounts Receivable Less Allowances (BOY) L3A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 3, Column (a).
(6) Accounts Receivable Less Allowance (EOY) L3B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 3, Column (b).
(7) Pledges Receivable Less Allowances (BOY) L4A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 4, Column (a).
(8) Pledges Receivable Less Allowances (EOY) L4B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 4, Column (b).
(9) Grants Receivable (BOY) L5A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 5, Column (a).
(10) Grants Receivable (EOY) L5B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 5, Column (b).
(11) Receivables Due From Officers (BOY) L6A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 6, column (a).
(12) Receivables Due From Officers (EOY) L6B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 6, Column (b).
(13) Other Notes and Loans (BOY) L7A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 7, Column (a).
(14) Other Notes and Loans (EOY) L7B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 7, Column (b).
(15) Inventories for Sale (BOY) L8A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 8, Column (a).
(16) Inventories for Sale (EOY) L8B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 8, Column (b).
(17) Prepaid Expenses (BOY) L9A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 9, Column (a).
(18) Prepaid Expenses (EOY) L9B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 9, Column (b).
(19) Investments-Government (BOY) 10AA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 10a, Column (a).
(20) Investments-Government (EOY) 10AB $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 10a, Column (b).
(21) Investment Stock (BOY) 10BA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 10b, Column (a).
(22) Investment Stock (EOY) 10BB $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 10b, Column (b).
(23) Investment Bonds (BOY) 10CA $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 10c, Column (a).
(24) Investment Bonds (EOY) 10CB $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 10c, Column (b).
(25) Investment Mortgage Loans (BOY) 12A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 12, Column (a).
(26) Investment Mortgage Loans (EOY) 12B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 12, Column (b).
(27) Investment Other (BOY) 13A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 13, Column (a).
(28) Investment Other (EOY) 13B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 13, Column (b).
(29) Land, Buildings and Equipment (BOY) 14A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 14, Column (a).
(30) Land, Buildings and Equipment (EOY) 14B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 14, Column (b).
(31) Other Assets (BOY) 15A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 15, Column (a).
(32) Other Assets (EOY) 15B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 15, Column (b).
(33) Total Assets (EOY) 16B $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 16, Column (b).
(34) FMV of Assets (EOY) 16C $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 16, Column (c).
Exhibit 3.24.12-227

Form 990-PF - Section 05

Form 990-PF - Section 05
3.24.12 - 227 SECTION 05
Source Document or Record: Form 990-PF - Section 05
Elem Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS AND CENTS.
NOTE 2: If the return is for a prior year, "05" will be edited to the left of the Part Number that is to be entered. The Line items remains the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Accounts Payable (BOY) 17A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 17, Column (a).
(3) Accounts Payable (EOY) 17B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 17, Column (b).
(4) Grants Payable (BOY) 18A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 18, Column (a).
(5) Grants Payable (EOY) 18B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 18, Column (b).
(6) Mortgages and Notes (EOY) 21B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 21, Column (b).
(7) Other Liabilities (BOY) 22A $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 22, Column (a).
(8) Other Liabilities (EOY) 22B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 22, Column (b).
(9) Total Liabilities (EOY) 23B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 23, Column (b).
(10) Total Net Assets/Fund Balances 29B $ <ENTER>
MINUS (-)		 Enter the amount from Part II, Line 29, Column (b).
(11) 4940 Code PG4TOP <ENTER> Enter the edited code from the top center margin of page 4 of the return.
(12) Excise Tax LN1 <ENTER> Enter the amount from Part V, Line 1.
(13) Section 511 Tax LN2 <ENTER> Enter the amount from Part V, Line 2.
(14) Subtitle A Tax LN4 <ENTER> Enter the amount from Part V, Line 4.
(15) Tax on Investment Income LN5 <ENTER> Enter the amount from Part V, Line 5.
(16) ES Credit L6A <ENTER> Enter the amount from Part V, Line 6a.
(17) Tax Withheld at Source L6B <ENTER> Enter the amount from Part V, Line 6b.
(18) Tax Paid from Form 8868 L6C <ENTER> Enter the amount from Part V, Line 6c.
(19) Erroneous Backup Withholding L6D <ENTER> Enter the amount from Part V, Line 6d.
(20) ES Penalty LN8 <ENTER> Enter the amount from Part V, Line 8.
(21) Tax Due/Overpayment L9/10 <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 9 followed by pressing <ENTER>.
(a) If no amount on Line 9, enter the amount from Part VI, Line 10 with a MINUS (−).
(b) If entries on both lines, enter the amount from Part VI, Line 9 followed by pressing <ENTER>.
(22) Credit Elect 11 CT <ENTER> Enter the amount from Part V, the center portion of Line 11.
Exhibit 3.24.12-228

Form 990-PF - Section 06

Form 990-PF - Section 06
3.24.12 - 228 SECTION 06
Source Document or Record: Form 990-PF - Section 06
Elem Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "06" .
(2) During this tax year? VIIA1A <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 1a.
(3) Have you engaged in? LN2 <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 2.
(4) Have you made any changes? LN3 <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 3.
(5) If yes, have you? L4B <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 4b.
(6) Was there a liquidation? LN5 <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 5.
(7) If you answered yes? L8B <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 8b.
(8) Are you claiming? LN9 <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 9.
(9) Did any Persons Become? L10 <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 10.
(10) Is the Foundation a Controlling Organization? L11 <ENTER> Enter a yes or no from the yes/no box on Part VI-A, Line 11.
(11) Did you Acquire Direct/Indirect Interest? L12 <ENTER> Enter a yes or no from the yes/no box from Part VI-A, Line 12.
(12) Did the Organization Comply with Public? L13 <ENTER> Enter a yes or no from the yes/no box from Part VI-A, 1 Line 13.
(13) Section 4947(a)(1) Trusts L15 <ENTER> Enter a "1" if the box is checked on Part VI-A, Line 15.
14 Did the foundation have any interest income L16 ENTER Enter a yes or no from the yes/no box on Part VI-A, Line 16.
(15) Engage in the sale? VIIB1A1 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1a(1).
(16) Borrow money from? 1A2 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1a(2).
(17) Furnish goods? 1A3 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1a(3).
(18) Pay compensation? 1A4 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1a(4).
(19) Transfer any of? 1A5 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1a(5).
(20) Agree to pay money? 1A6 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1a(6).
(21) If you answered yes? 1B <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1b.
(22) Did you engage in? 1C <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 1c.
(23) Taxes on failure to? 2A <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 2a.
(24) If 2a is yes? 2B <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 2b.
(25) Did you hold more? 3A <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 3a.
(26) If yes, did you? 3B <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 3b.
(27) Did you invest during? 4A <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 4a.
(28) Did you make any? 4B <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 4b.
(29) Carry on propaganda? 5A1 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 5a(1).
(30) Influence the outcome? 5A2 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 5a(2).
(31) Provide a grant? 5A3 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 5a(3).
(32) Provide grant to an organization? 5A4 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 5a(4).
(33) Provide for any? 5A5 <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 5a(5).
(34) If you answered yes? 5B <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 5b.
(35) Did the Organization Receive any Funds? 6A <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 6a.
(36) Did the Organization Pay any Premiums? 6B <ENTER> Enter a yes or no from the yes/no box on Part VI-B, Line 6b.
(37) Subject to Section 4960 Tax on Payments of More Than $1,000,000 8 <ENTER> Enter 1 for yes and 2 for no Part VI-B, Line 8.
Exhibit 3.24.12-229

Form 990-PF - Section 07

Form 990-PF - Section 07
3.24.12 - 229 SECTION 07
Source Document or Record: Form 990-PF - Section 07
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS ONLY.
NOTE 2: If the return is for a prior year, "07" will be edited to the left of the Part Number that is to be entered. The line items remains the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "07" .
(2) Reportable Compensation 1 PTVIII1C $ <ENTER> Enter the amount from Part VII Section 1, Line 1, Column (c).
(3) Reportable Contributions to Employee Benefits Plans 1 PTVIII1D $ <ENTER> Enter the amount from Part VII Section 1, Line 1, Column (d).
(4) Reportable Compensation 2 PTVIII2C $ <ENTER> Enter the amount from Part VII Section 1, Line 2, Column (c).
(5) Reportable Contributions to Employee Benefits Plans 2 PTVIII2D $ <ENTER> Enter the amount from Part VII Section 1, Line 2, Column (d).
(6) Reportable Compensation 3 PTVIII3C $ <ENTER> Enter the amount from Part VII Section 1, Line 3, Column (c).
(7) Reportable Contributions to Employee Benefits Plans 3 PTVIII3D $ <ENTER> Enter the amount from Part VIII Section 1, Line 3, Column (d).
(8) Reportable Compensation 4 PTVIII4C $ <ENTER> Enter the amount from Part VII Section 1, Line 4, Column (c).
(9) Reportable Contributions to Employee Benefits Plans 4 PTVIII4D $ <ENTER> Enter the amount from Part VII Section 1, Line 4, Column (d).
(10) Five Highest Paid Employees Compensation 1 PTVIII21C $ <ENTER> Enter the amount from Part VII Section 2, Line 1, Column (c).
(11) Five Highest Paid Contributions to Employee Benefits Plans 1 PTVIII21D $ <ENTER> Enter the amount from Part VII Section 2, Line 1, Column (d).
(12) Five Highest Paid Employees Compensation 2 PTVIII22C $ <ENTER> Enter the amount from Part VII Section 2, Line 2, Column (c).
(13) Five Highest Paid Contributions to Employee Benefits Plans 2 PTVIII22D $ <ENTER> Enter the amount from Part VII Section 2, Line 2, Column (d).
(14) Five Highest Paid Employees Compensation 3 PTVIII23C $ <ENTER> Enter the amount from Part VII Section 2, Line 3, Column (c).
(15) Five Highest Paid Contributions to Employee Benefits Plans 3 PTVIII23D $ <ENTER> Enter the amount from Part VII Section 2, Line 3, Column (d).
(16) Five Highest Paid Employees Compensation 4 PTVIII24C $ <ENTER> Enter the amount from Part VII Section 2, Line 4, Column (c).
(17) Five Highest Paid Contributions to Employee Benefits Plans 4 PTVIII24D $ <ENTER> Enter the amount from Part VII Section 2, Line 4, Column (d).
(18) Five Highest Paid Employees Compensation 5 PTVIII25C $ <ENTER> Enter the amount from Part VII Section 2, Line 5, Column (c).
(19) Five Highest Paid Contributions to Employee Benefits Plans 5 PTVIII25D $ <ENTER> Enter the amount from Part VII Section 2, Line 5, Column (d).
(20) Total X1D $ <ENTER>
MINUS (−)		 Enter the amount from Part IX, Line 1d.
(21) Net Value/Noncharitable-Use Assets LN5 $ <ENTER>
MINUS (−)		 Enter the amount from Part IX, Line 5.
(22) Minimum Investment Return LN6 $ <ENTER>
MINUS (−)		 Enter the amount from Part IX, Line 6.
(23) Distributable Amount XI7 $ <ENTER>
MINUS (−)		 Enter the amount from Part X, Line 7.
(24) Undistributed Income XIII6F $ <ENTER>
MINUS (−)		 Enter the amount from Part XII, Line 6f.
Exhibit 3.24.12-230

Form 990-PF - Section 08

Form 990-PF - Section 08
3.24.12 - 230 SECTION 08
Source Document or Record: Form 990-PF - Section 08
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS ONLY.
NOTE 2: If the return is for a prior year, "08" edits to the left of the lines to be entered. The line items remain the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "08" .
(2) Adjusted Net Income Column (a) 2AA $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2a, Column (a).
(3) Adjusted Net Income Column (b) 2AB $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2a, Column (b).
(4) Adjusted Net Income Column (c) 2AC $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2a, Column (c).
(5) Adjusted Net Income Column (d) 2AD $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2a, Column (d).
(6) Adjusted Net Income Total 2AE $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 2a, Column (e).
(7) Qualifying Distribution Column (a) 2EA $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2e, Column (a).
(8) Qualifying Distribution Column (b) 2EB $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2e, Column (b).
(9) Qualifying Distribution Column (c) 2EC $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2e, Column (c).
(10) Qualifying Distribution Column (d) 2ED $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 2e, Column (d).
(11) Qualifying Distribution Total 2EE $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 2e, Column (e).
Exhibit 3.24.12-231

Form 990-PF - Section 09

Form 990-PF - Section 09
3.24.12 - 231 SECTION 09
Source Document or Record: Form 990-PF - Section 09
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS ONLY.
NOTE 2: If the return is for a prior year, "09" edits to the left of the lines to be entered. The line items remain the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "09" .
(2) Value of Assets Column (a) 3A1A $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(1), Column (a).
(3) Value of Assets Column (b) 3A1B $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(1), Column (b).
(4) Value of Assets Column (c) 3A1C $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(1), Column (c).
(5) Value of Assets Column (d) 3A1D $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(1), Column (d).
(6) Value of Assets Total 3A1E $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 3a(1), Column (e).
(7) Value of Assets Qualifying Column (a) 3A2A $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(2), Column (a).
(8) Value of Assets Qualifying Column (b) 3A2B $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(2), Column (b).
(9) Value of Assets Qualifying Column (c) 3A2C $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(2), Column (c).
(10) Value of Assets Qualifying Column (d) 3A2D $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3a(2), Column (d).
(11) Value of Assets Qualifying Total 3A2E $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 3a(2), Column (e).
Exhibit 3.24.12-232

Form 990-PF - Section 10

Form 990-PF - Section 10
3.24.12 - 232 SECTION 10
Source Document or Record: Form 990-PF - Section 10
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS ONLY.
NOTE 2: If the return is for a prior year, "10" edits to the left of the lines to be entered. The line items remain the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "10" .
(2) Alternative Test Endowment, Column (a) 3BA $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3b, Column (a).
(3) Alternative Test Endowment, Column (b) 3BB $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3b, Column (b).
(4) Alternative Test Endowment, Column (c) 3BC $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3b, Column (c).
(5) Alternative Test Endowment, Column (d) 3BD $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3b, Column (d).
(6) Alternative Test Endowment, Total 3BE $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 3b, Column (e).
(7) Total Support, Column (a) 3C1A $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(1), Column (a).
(8) Total Support, Column (b) 3C1B $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(1), Column (b).
(9) Total Support, Column (c) 3C1C $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(1), Column (c).
(10) Total Support, Column (d) 3C1D $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(1), Column (d).
(11) Total Support, Total 3C1E $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 3c(1), Column (e).
Exhibit 3.24.12-233

Form 990-PF - Section 11

Form 990-PF - Section 11
3.24.12 - 233 SECTION 11
Source Document or Record: Form 990-PF - Section 11
Elem. Data Element Name Prompt Fld. Term. Instructions
        NOTE 1: ENTER DOLLARS ONLY.
NOTE 2: If the return is for a prior year, "11" edits to the left of the lines to be entered. The line items remain the same.
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "11" .
(2) Support from General Public Column (a) 3C2A $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(2), Column (a).
(3) Support from General Public Column (b) 3C2B $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(2), Column (b).
(4) Support from General Public Column (c) 3C2C $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(2), Column (c).
(5) Support from General Public Column (d) 3C2D $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(2), Column (d).
(6) Support from General Public Total 3C2E $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 3c(2), Column (e).
(7) Gross Investment Income Column (a) 3C4A $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(4), Column (a).
(8) Gross Investment Income Column (b) 3C4B $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(4), Column (b).
(9) Gross Investment Income Column (c) 3C4C $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(4), Column (c).
(10) Gross Investment Income Column (d) 3C4D $ <ENTER>
MINUS (−)		 Enter the amount from Part XIII, Line 3c(4), Column (d).
(11) Gross Investment Income Total 3C4E $ <ENTER>
MINUS (-)
★★★★★★		 Enter the amount from Part XIII, Line 3c(4), Column (e).
(12) Future Grants, 3b Total XV3B $ <ENTER> Enter the amount from Part XIII, Line 3b, Total line.
Exhibit 3.24.12-234

Form 990-PF - Section 12

Form 990-PF - Section 12
3.24.12 - 234 SECTION 12
Source Document or Record: Form 990-PF - Section 12
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "12" .
(2) Program Services Revenue a, Column (d) XVIA1AD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1a, Column (d).
(3) Program Service Revenue a, Column (e) 1AE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1a, Column (e).
(4) Program Service Revenue b, Column (d) 1BD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1b, Column (d).
(5) Program Service Revenue b, Column (e) 1BE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line l b, Column (e).
(6) Program Service Revenue c, Column (d) 1CD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1c, Column (d).
(7) Program Service Revenue c, Column (e) 1CE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1c, Column (e).
(8) Program Service Revenue d, Column (d) 1DD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1d, Column (d).
(9) Program Service Revenue d, Column (e) 1DE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1d, Column (e).
(10) Program Service Revenue e, Column (d) 1ED $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1e, Column (d).
(11) Program Service Revenue e, Column (e) 1EE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1e, Column (e).
(12) Program Service Revenue f, Column (d) 1FD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1f, Column (d).
(13) Program Service Revenue f, Column (e) 1FE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1f, Column (e).
(14) Fees and Contracts from Government g, Column (d) 1GD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1g, Column (d).
(15) Fees and Contracts from Government g, Column (e) 1GE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 1g, Column (e).
(16) Membership Dues Column (d) 2D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 2, Column (d).
(17) Membership Dues Column (e) 2E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 2, Column (e).
(18) Interest on Savings Column (d) 3D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 3, Column (d).
(19) Interest on Savings Column (e) 3E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 3, Column (e).
(20) Dividends and Interest Column (d) 4D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 4, Column (d).
(21) Dividends and Interest Column (e) 4E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 4, Column (e).
(22) Debt-Financed Property Column (d) 5AD $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 5a, Column (d).
(23) Debt-Financed Property Column (e) 5AE $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 5a, Column (e).
(24) Net Rental Income/Loss Column (d) 6D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 6, Column (d).
(25) Net Rental Income/Loss Column (e) 6E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 6, Column (e).
(26) Other Investment Income Column (d) 7D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 7, Column (d).
(27) Other Investment Income Column (e) 7E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 7, Column (e).
(28) Gain/Loss From Sales Column (d) 8D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 8, Column (d).
(29) Gain/Loss From Sales Column (e) 8E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 8, Column (e).
(30) Net Income/Loss Special Events Column (d) 9D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 9, Column (d).
(31) Net Income/Loss Special Events Column (e) 9E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 9, Column (e).
(32) Gross Profit/Loss From Sales Column (d) 10D $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 10, Column (d).
(33) Gross Profit/Loss From Sales Column (e) 10E $ <ENTER>
MINUS (-)		 Enter the amount from Part XV-A, Line 10, Column (e).
Exhibit 3.24.12-235

Form 990-PF - Section 13

Form 990-PF - Section 13
3.24.12 - 235 SECTION 13
Source Document or Record: Form 990-PF - Section 13
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "13" .
(2) Cash Transfer From? XVII1A1 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1a(1).
(3) Other Assets? 1A2 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1a(2).
(4) Sales of Assets? 1B1 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1b(1).
(5) Purchase of Assets? 1B2 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1b(2).
(6) Rental? 1B3 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1b(3).
(7) Reimbursement? 1B4 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1b(4).
(8) Loans? 1B5 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1b(5).
(9) Performance of Services? 1B6 <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1b(6).
(10) Sharing of? L1C <ENTER> Enter a yes or no from the yes/no box from Part XVI, Line 1c.
(11) Preparer PTIN PTIN <ENTER> Enter the Prepare's PTIN.
(12) Preparer EIN PEIN <ENTER> Enter the preparer's EIN.
(13) Preparer Telephone # TEL# <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-236

Form 990-PF - Section 20, Form 965

Form 990-PF, Section 20, Form 965-B
3.24.12 - 236 Section 20
Source Document or Record: Form 990-PF - Section 20, Form 965-B
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 20.
(2) Net 965 Tax Liability D1 TAX $ <ENTER> Enter the amount from Part I column (d) line 1.
(3) Form 965-B Part I Indicator IND <ENTER> Enter "1" if additional information is present in Part I.
Exhibit 3.24.12-237

Form 990-T - Section 01

Form 990 - T Section 01
3.24.12 - 237 SECTION 01
Source Document or Record: Form 990-T - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Section 01 always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I. Number EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter Y or N as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under title of form.
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Condition Codes CCC <ENTER> Enter the edited codes from the dotted portion of Line 2–4a. If a Condition Code is illegible, enter a # in its place.
(11) Filling Field (VIN Portal Information Field)     Generate blank
(11) Return Processing Code 01RPC <ENTER> Enter the edited codes on Page 1, in the right margin next to line 1.
(12) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a G Condition Code is present and the return is a non-remittance, end the document after this element.
(13) Exempt Sub Section BOXB <ENTER> Enter the edited 2-digit code from Box B.
(14) Organization Code ORGCD <ENTER> Enter the edited code from the right margin of box F/G.
(15) In Care of Name Line C/O NAME <ENTER> Enter the in care of name as shown.

Note:

Downstream processing generates a (%) sign.
(16) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(17) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a G Condition Code is present, do NOT enter any of the address information, even if prompted to do so. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(18) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(19) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(20) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(21) Number of Organizations Trade or Business NOTB <ENTER> Enter the amount Item H, first question.

Note:

Enter for prior year only.
Exhibit 3.24.12-238

Form 990-T - Section 02, Form 5800 - Edit Sheet

Form 990-T - Section 02, Form 5800 - Edit Sheet
3.24.12 - 238 SECTION 02
Source Document or Record: Form 990-T - Section 02, Form 5800 - Edit Sheet
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 02.
(2) ERS Action Code LN1 <ENTER> Enter the edited digits from the bottom left margin of the return.
(a) If a G Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Indicator/Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digit from Line 4, Form 5800.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(7) Penalty/Interest Code LN6 <ENTER> Enter the edited digit from Line 6, Form 5800.
(8) Installment Sales Indicator LN7 <ENTER> Enter the edited digit from Line 7, Form 5800.
(9) Missing Schedule Code LN8 <ENTER> Enter the edited digits from Line 8, Form 5800.
(10) F2439 Regulated Investment Company Credit LN9 <ENTER> Enter the edited amount from Line 9, Form 5800.
(11) F5735 Possessions Credit L10 <ENTER> Enter the edited amount from Line 10, Form 5800.
(12) F8586 Low Income Housing Credit L11 <ENTER> Enter the edited amount from Line 11, Form 5800.
Exhibit 3.24.12-239

Form 990-T - Section 03

Form 990-T - Section 03
3.24.12 - 239 SECTION 03
Source Document or Record: Form 990-T - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 03.
(2) Remittance RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(b) If a G Condition Code is present, end the document after this element.
(c) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(d) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Was Corporation a Subsidiary Member ?IY/N <ENTER> Enter a yes or no from the yes/no box from Line K.
(4) Parent Corporation Name Control ?INC <ENTER> Enter the edited or underlined Name Control from Line K.
(5) Parent Corporation EIN ?IEIN <ENTER> Enter the EIN from Line K.
(6) Gross Receipts Less Returns & Allowances L1C $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1c, Column A. (2019 and prior revisions only)
(7) Cost of Goods Sold LN2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2, Column A. (2019 and prior revisions only)
(8) Investment Income 501(c) L9(C) $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 9, Column (C). (2019 and prior revisions only)
(9) Dispose of Any Investments 12...$ <ENTER> Enter the amount from the dotted portion of line 12. (2019 and prior revisions only)
(10) Total Unrelated Trade or Business Income 13(A) $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 13, Column (A). (2019 and prior revisions only)
(11) Total Expenses 13(B) $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 13, Column (B). (2019 and prior revisions only)
(12) Total Net 13(C) $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 13, Column (C). (2019 and prior revisions only)
(13) Total Deductions L29 $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 28. (2019 and prior revisions only)
(14) Net Operating Loss L31 $ <ENTER>
MINUS (−)		 Enter the amount from Part II, Line 31. (2019 and prior revisions only)
(15) Taxable Income Computed From all Unrelated Trades or Businesses LI1 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 1.
(16) Amount Disallowed Fringes LI2 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 2.
(17) Charitable Contributions LI4 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 4.
(18) Total of Unrelated Tax pre NOLS LI5 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 5.
(19) Deduction for Net Operating Loss LI6 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 6.
(20) Unrelated Business Taxable Income LI7 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 7.
(21) Specific Deduction LI8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(22) Section 199A Deduction LI9 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 9.
(23) Total Deductions 2020 and Subsequent LI10 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 10.
(24) Unrelated Business Taxable Income LI11 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 11.
Exhibit 3.24.12-240

Form 990-T - Section 04

Form 990-T - Section 04
3.24.12 -240 SECTION 04
Source Document or Record: Form 990-T - Section 04
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 04.
(2) Controlled Group Code L39 RT <ENTER> Enter the edited digit to the right of Part IV, Line 40 check box. (2019 and prior revision only)
(3) 1st Income Bracket 1STINCA1$ <ENTER> Enter the amount from Part III, Line 35a(1). Enter Only for 2017 and prior tax periods.
(4) 2nd Income Bracket 2NDINCA2$ <ENTER> Enter the amount from Part III, Line 35a(2).Enter Only for 2017 and prior tax periods.
(5) 3rd Income Bracket 3RDINCA3$ <ENTER> Enter the amount from Part III, Line 35a(3). Enter Only for 2017 and prior tax periods.
(6) Additional 5% Tax 5%TAXB1$ <ENTER> Enter the amount from Part III, Line 35b(1). Enter Only for 2017 and prior tax periods.
(7) Additional 3% Tax 3%TAXB2$ <ENTER> Enter the amount from Part III, Line 35b(2). Enter Only for 2017 and prior tax periods.
(8) Corp. Income Tax Taxpayer LII1 $ <ENTER>
★★★★★★		 Enter the amount from Part II, Line 1.
(9) Trust Income Tax LII2 $ <ENTER> Enter the amount from Part II, Line 2.
(10) Proxy Tax LII3 $ <ENTER> Enter the amount from Part II, Line 3.
(11) Other Additions to Tax LII4 $ <ENTER> Enter the amount from Part II, Line 4.
(12) Alternative Minimum Tax LII5 $ <ENTER> Enter the amount from Part II, Line 5.
(13) Non Compliant Hospital Facility Income LII6 $ <ENTER> Enter the amount from Part II, Line 6.
(14) Total (Gross Tax) LII7 $ <ENTER> Enter the amount from Part II, Line 7.
(15) Foreign Tax Credit III1A $ <ENTER> Enter the amount from Part III, Line 1a.
(16) Other Tax Credits III1B $ <ENTER> Enter the amount from Part III, Line 1b.
(17) General Business Credit III1C $ <ENTER> Enter the amount from Part III, Line 1c.
(18) Credit Prior Year Minimum Tax III1D $ <ENTER> Enter the amount from Part III, Line 1d.
(19) Total Statutory Credits III1E $ <ENTER> Enter the amount from Part III, Line 1e.
(20) Recapture Taxes III3F $ <ENTER> Enter the amount from Part III, Line 3f.
(21) Total Tax III4 <ENTER>
★★★★★★		 Enter the amount from Part III, Line 4.
(22) Net 965 Tax Liability III5 <ENTER> Enter the amount from Part III, Line 5.
(23) Prior Year Overpayment Credit III6A <ENTER> Enter the amount from Part III, Line 6a.
(24) ES Payments III6B <ENTER> Enter the amount from Part III, Line 6b.
(25) Tax Deposited—Form 8868 III6C <ENTER> Enter the amount from Part III, Line 6c.
(26) Tax Withheld at Source III6D <ENTER> Enter the amount from Part III, Line 6d.
(27) Backup Withholding III6E <ENTER> Enter the amount from Part III, Line 6e.
(28) Small Business Health Care Tax Credit III6F <ENTER> Enter the amount from Part III, Line 6f.
(29) Deemed payment election III6G <ENTER> Enter the amount from Part III, Line 6g.
30 Credit from a RIC or REIT III6H <ENTER> Enter the amount from Part III, Line 6h.
31 Credit for federal tax paid on fuels III6I <ENTER> Enter the amount from Part III, Line 6i.
32 Other Payments and Credits III6J <ENTER> Enter the amount from Part III, Line 6j.
(33) ES Penalty III8 <ENTER> Enter the amount from Part III, Line 8.
(34) Tax Due/Overpayment 9/10 <ENTER>
MINUS (−)
★★★★★★		 Enter amount shown on Part III, Line 9 followed by pressing <ENTER>.
(a) If no amount present on Line 9, enter the amount from Line 10 with a MINUS (−).
(b) If both lines have entries, enter the amount from Line 10 and press <ENTER>.
(35) Credit Elect L11 <ENTER> Enter the amount from the first box, Part III, Line 11.
(36) Discuss with Preparer Checkbox CKBX <ENTER> Enter a 1 if the Yes box is checked. <ENTER> only, if No or none of the box's are checked.
(37) Preparer's /PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(38) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN from the Preparer's EIN box.
(39) Preparer's Telephone Number TEL# <ENTER> Enter the Preparer's phone number from the Preparer's phone number box.
Exhibit 3.24.12-241

Form 990-T - Section 07, Form 1041 - Schedule I

Form 990-T - Section 07, Form 1041 - Schedule I
3.24.12 - 241 SECTION 07
Source Document or Record: Form 1041 - Section 07, Form 1041 - Schedule I
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 07.
(2) Alternative Tax NOLD L22 $ <ENTER>
MINUS (−)		 Enter the amount from Schedule I, Part I, Line 22.
(3) Total Adjustments and Tax Preference L23 $ <ENTER>
MINUS (−)		 Enter the amount from Schedule I, Part I, Line 23.
Exhibit 3.24.12-242

Form 990-T - Section 08, Form 1041 - Schedule D

3.24.12 - 242 SECTION 08
Source Document or Record: Form 1041 - Section 08, Form 1041 - Schedule D, Form 4952
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 08.
(2) Schedule D Net Short-Term Gain/Loss Estates/Trusts D17(2) $ <ENTER>
MINUS (−)		 Enter the amount from Schedule D, Part III, Line 17, Column (2).
(3) Net Long-Term Gain/Loss for Year 18A(2) $ <ENTER>
MINUS (−)		 Enter the amount from Schedule D, Part III, Line 18a, Column (2).
(4) Unrecaptured Section 1250 Estates/Trusts 18B(2) $ <ENTER> Enter the amount from Schedule D, Part III, Line 18b, Column (2).
(5) 28% Rate Gain/Loss 18C(2) $ <ENTER>
MINUS (−)		 Enter the amount from Schedule D, Part III, Line 18c, Column (2).
(6) Total Net Gain/Loss Estates/Trusts 19(2) $ <ENTER>
MINUS (−)		 Enter the amount from Schedule D, Part III, Line 19, Column (2).
(7) Estate/Trust Qualified Dividends L23 $ <ENTER> Enter the amount from Schedule D, Part V, Line 23.
(8) Tax on Taxable Income L45 $ <ENTER> Enter the amount from Schedule D, Part V, Line 45.
(9) Form 4952 Line 4e 4952L4E $ <ENTER> Enter the amount from Form 4952, Part II, Line 4e.
(10) Form 4952 Line 4g 4952L4G $ <ENTER> Enter the amount from Form 4952, Part II, Line 4g.
Exhibit 3.24.12-243

Form 990-T - Section 10, Form 8949???

Form 990-T - Section 10, Form 8949
3.24.12 - 243 Section 10
Source Document or Record: Form 990-T - Section 10, Form 8949
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 10.
(2) Dispose of Any Investments ZCKBX <ENTER> For Form 990-T enter only. Enter the numeric digit from Dispose of Any Investments Checkbox from Schedule D
0 = no
1 = yes
(3) EIN ZPTI 1(A) <ENTER> Enter the EIN from form 8949 Part I Line 1 column (a).

Note:

Enter the underlined data or enter only if there is a "Z" in Column (f).
(4) Date Acquired ZPTI 1(B) <ENTER> Enter the date from Form 8949 Part I Line 1 column (b).

Note:

Enter the underlined data or enter only if there is a Z in Column (f).
(5) Amount of Adjustment ZPTI 1(G) $ <ENTER> Enter the amount from Form 8949 Part I Line 1 column (g).

Note:

Enter the underlined data or enter only if there is a "Z" in Column (f).
(6) Part I 8949 Indicator ZPTI IND <ENTER>
★★★★★★		 Enter "1" if additional information is present in Part I.
(7) EIN YPTI 1(A) <ENTER> Enter the EIN from form 8949 Part I Line 1 column (a).

Note:

Enter the underlined data or enter only if there is a "Y" in Column (f).
(8) Date Sold or Disposed YPTI 1(B) <ENTER> Enter the date from Form 8949 Part I Line 1 column (b).

Note:

Enter the underlined data or enter only if there is a "Y" in Column (f).
(9) Recaptured Deferral YPTI 1(G) $ <ENTER> Enter the amount from Form 8949 Part I Line 1 column (g).

Note:

Enter the underlined data or enter only if there is a "Y" in Column (f).
(10) Part I 8949 Indicator YPTI IND <ENTER>
★★★★★★		 Enter "1" if additional Y information is present in Part I.
(11) EIN ZPTII 1 (A) <ENTER> Enter the EIN from Form 8949 Part II Line 1 column (a).

Note:

Enter the underlined data or enter only if there is a "Z" in Column (f).
(12) Date Acquired ZPTII 1 (B) <ENTER> Enter the date from Form 8949 Part II Line 1 column (b).

Note:

Enter the underlined data or enter only if there is a "Z" in Column (f).
(13) Amount of Adjustment ZPTII 1 (G) $ <ENTER> Enter the EIN from Form 8949 Part II Line 1 column (g).

Note:

Enter the underlined data or enter only if there is a "Z" in Column (f).
14 Part I Form 8949 Indicator ZPTII IND <ENTER> ?? on PRP
(15) EIN YPTII 1 (A) <ENTER> Enter the EIN from Form 8949 Part II Line 1 column (a).

Note:

Enter the underlined data or enter only if there is a "Y" in Column (f).
(16) Date Sold or Disposed YPTII 1(B) V <ENTER> Enter the date from Form 8949 Part II Line 1 column (b).

Note:

Enter the underlined data or enter only if there is a "Y" in Column (f).
(17) Recaptured Deferral YPTII 1(G) $ <ENTER> Enter the amount from Form 8949 Part II Line 1 column (g).

Note:

Enter the underlined data or enter only if there is a "Y" in Column (f).
(18) Part II 8949 Indicator YPTII IND <ENTER> Enter "1" if additional Y information is present in Part II.
Exhibit 3.24.12-244

Form 990-T - Section 13, Form 8995/8995A

Form 990-T - Section 13, Form 8995/8995A
3.24.12 - 244 Section 13
Source Document or Record: Form 990-T - Section 13, Form 8995/8995A
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Part IV Qualified Business Income L5/L27 <ENTER> Enter the amount from Line 5 or Line 27 as follows:

  1. Enter the amount from Form 8995 Line 5, if present and press Enter.

  2. Enter the amount from Form 8995-A, Part IV, Line 27, if present and press Enter.
(3) Part IV REIT/PTP Component L9/L31 <ENTER> Enter the amount from Line 9 or Line 31 as follows:

  1. Enter the amount from Form 8995, Line 9, if present and press Enter.

  2. Enter the amount from Form 8995-A, Part IV, Line 31 if present and press Enter.
(4) Part IV Net Capital Gains L12/L34 <ENTER> Enter the amount from line 12 or line 34 as follows:

  1. Enter the amount from Form 8995 line 12, if present, and press Enter.

  2. Enter the amount from Form 8995-A Part IV line 34, if present, and press Enter.
(5) Part IV Domestic Production Activities Section 199A(g) L38 <ENTER> Enter the amount from Form 8995-A Part IV line 38.
Exhibit 3.24.12-245

Form 990-T - Section 15, Form 4136

Form 990-T - Section 15, Form 4136
3.24.12 - 245 SECTION 15
Source Document or Record: Form 990-T - Section 15, Form 4136
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 15.
(2) Amount of Claim 1 AMT1(D) $ <ENTER> Enter the first amount shown on Form 4136, Column (d).
(3) Credit Reference Number 1 CRN1(E) <ENTER> Enter the CRN from Column (e) that corresponds with the first amount entered.
(4) Amount of Claim 2 AMT2(D) $ <ENTER> Enter the second amount shown on Form 4136, Column (d).
(5) Credit Reference Number 2 CRN2(E) <ENTER> Enter the CRN from Column (e) that corresponds with the second amount entered.
(6) Amount of Claim 3 AMT3(D) $ <ENTER> Enter the third amount shown on Form 4136, Column (d).
(7) Credit Reference Number 3 CRN3(E) <ENTER> Enter the CRN from Column (e) that corresponds with the third amount entered.
(8) Amount of Claim 4 AMT4(D) $ <ENTER> Enter the fourth amount shown on Form 4136, Column (d).
(9) Credit Reference Number 4 CRN4(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fourth amount entered.
(10) Amount of Claim 5 AMT5(D) $ <ENTER> Enter the fifth amount shown on Form 4136, Column (d).
(11) Credit Reference Number 5 CRN5(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fifth amount entered.
(12) Amount of Claim 6 AMT6(D) $ <ENTER> Enter the sixth amount shown on Form 4136, Column (d).
(13) Credit Reference Number 6 CRN6(E) <ENTER> Enter the CRN from Column (e) that corresponds with the sixth amount entered.
(14) Amount of Claim 7 AMT7(D) $ <ENTER> Enter the seventh amount shown on Form 4136, Column (d).
(15) Credit Reference Number 7 CRN7(E) <ENTER> Enter the CRN from Column (e) that corresponds with the seventh amount entered.
(16) Amount of Claim 8 AMT8(D) $ <ENTER> Enter the eighth amount shown on Form 4136, Column (d).
(17) Credit Reference Number 8 CRN8(E) <ENTER> Enter the CRN from Column (e) that corresponds with the eighth amount entered.
(18) Amount of Claim 9 AMT9(D) $ <ENTER> Enter the ninth amount shown on Form 4136, Column (d).
(19) Credit Reference Number 9 CRN9(E) <ENTER> Enter the CRN from Column (e) that corresponds with the ninth amount entered.
(20) Amount of Claim 10 AMT10(D) $ <ENTER> Enter the tenth amount shown on Form 4136, Column (d).
(21) Credit Reference Number 10 CRN10(E) <ENTER> Enter the CRN from Column (e) that corresponds with the tenth amount entered.
(22) Amount of Claim 11 AMT11(D) $ <ENTER> Enter the eleventh amount shown on Form 4136, Column (d).
(23) Credit Reference Number 11 CRN11(E) <ENTER> Enter the CRN from Column (e) that corresponds with the tenth amount entered.
(24) Amount of Claim 12 AMT12(D) $ <ENTER> Enter the twelfth amount shown on Form 4136, Column (d).
(25) Credit Reference Number 12 CRN12(E) <ENTER> Enter the CRN from Column (e) that corresponds with the twelfth amount entered.
(26) Amount of Claim 13 AMT13(D) $ <ENTER> Enter the thirteenth amount shown on Form 4136, Column (d).
(27) Credit Reference Number 13 CRN13(E) <ENTER> Enter the CRN from Column (e) that corresponds with the thirteenth amount entered.
(28) Amount of Claim 14 AMT14(D) $ <ENTER> Enter the fourteenth amount shown on Form 4136, Column (d).
(29) Credit Reference Number 14 CRN14(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fourteenth amount entered.
(30) Amount of Claim 15 AMT15(D) $ <ENTER> Enter the fifteenth amount shown on Form 4136, Column (d).
(31) Credit Reference Number 15 CRN15(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fifteenth amount entered.
(32) Amount of Claim 16 AMT16(D) $ <ENTER> Enter the sixteenth amount shown on Form 4136, Column (d).
(33) Credit Reference Number 16 CRN16(E) <ENTER> Enter the CRN from Column (e) that corresponds with the sixteenth amount entered.
(34) Amount of Claim 17 AMT17(D) $ <ENTER> Enter the seventeenth amount shown on Form 4136, Column (d).
(35) Credit Reference Number 17 CRN17(E) <ENTER> Enter the CRN from Column (e) that corresponds with the seventeenth amount entered.
(36) Amount of Claim 18 AMT18(D) $ <ENTER> Enter the eighteenth amount shown on Form 4136, Column (d).
(37) Credit Reference Number 18 CRN18(E) <ENTER> Enter the CRN from Column (e) that corresponds with the eighteenth amount entered.
(38) Amount of Claim 19 AMT19(D) $ <ENTER> Enter the nineteenth amount shown on Form 4136, Column (d).
(39) Credit Reference Number 19 CRN19(E) <ENTER> Enter the CRN from Column (e) that corresponds with the nineteenth amount entered.
(40) Amount of Claim 20 AMT20(D) $ <ENTER> Enter the twentieth amount shown on Form 4136, Column (d).
(41) Credit Reference Number 20 CRN20(E) <ENTER> Enter the CRN from Column (e) that corresponds with the twentieth amount entered.
Exhibit 3.24.12-246

Form 990-T - Section 17, Form 4626, 2017 and prior years only

3.24.12-246 Section 17
Source Document or Record: Form 990-T - Section 17, Form 4626, 2017 and prior years only
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 17.
(2) Pre-Adjustment AMTI LN3 $ <ENTER>
MINUS (-)		 Enter the amount from Line 3.
(3) Adjusted Current Earnings L4E $ <ENTER>
MINUS (-)		 Enter the amount from Line 4e.
(4) Alternative Tax Net Operating Loss Deduction LN6 $ <ENTER> Enter the amount from Line 6.
(5) Tentative Minimum Tax L12 $ <ENTER> Enter the amount from Line 12.
Exhibit 3.24.12-247

Form 990-T - Section 19, Form 8978

Form 990-T - Section 19, Form 8978
3.24.12 - 247 Section 19
Form 990-T - Section 19, Form 8978
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 19.
(2) BBA Audit and AAR Filing Check Box CHKBX <ENTER> 1 = BBA Audit, 2 = AAR Filing, 3 = both, 0 = default (no box checked or section not present)
(3) Total Additional Reporting Year Tax L14 <ENTER> Enter the amount from Part I, Line 14.
(4) Total Penalties L16 <ENTER> Enter the amount from Part II, Line 16.
(5) Total Interest L18 <ENTER> Enter the amount from Part III, Line 18.
Exhibit 3.24.12-248

Form 990-T - Section 20, Forms 965-A and B

Form 990-T - Section 20, Forms 965-A and B
3.24.12 - 248 SECTION 20
Source Document or Record: Form 990-T - Section 20, Forms 965-A and B
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT <ENTER> Press <ENTER> if already present on the screen; otherwise enter 20.
(2) Election or Transfer Year A1 YEAR <ENTER> Enter the last two positions of the tax year Part I, column (a).
(3) Part I Form 965-A Indicator PTI IND <ENTER>
★★★★★★		 Enter "1" if additional information is present on line 6 Part I.
(4) Net 965 Tax Liability Transferred J1 TAX $ <ENTER> Enter the amount from Part I, column (j).
(5) Tax Identification Number K1 TIN <ENTER> Enter the TIN from Part I, column (k).
(6) Part IV Indicator PTIV IND <ENTER>
★★★★★★		 Enter “1” if additional information is present in Part IV Line 6.
(7) Election or Transfer Year A2 YEAR <ENTER> Enter the last two positions of the tax year Part I, column (a).
(8) Net 965 Tax Liability Transferred J2 TAX $ <ENTER> Enter the amount from Part I, column (j).
(9) Tax Identification Number K2 TIN <ENTER> Enter the TIN from Part I, column (k).
(10) Election or Transfer Year A3 YEAR <ENTER> Enter the last two positions of the tax year from Part I, column (a).
(11) Net 965 Tax Liability Transferred J3 TAX $ <ENTER> Enter the amount from Part I, column (j).
(12) Tax Identification Number K3 TIN <ENTER> Enter the TIN from Part I, column (k).
(13) Election or Transfer Year A4 YEAR <ENTER> Enter the last two positions of the tax year Part I, column (a).
(14) Net 965 Tax Liability Transferred J4 TAX $ <ENTER> Enter the amount from Part I, column (j).
(15) Tax Identification Number K4 TIN <ENTER> Enter the TIN from Part I, column (k).
(16) Election or Transfer Year A5 YEAR <ENTER> Enter the last two positions of the tax year Part I, column (a).
(17) Net 965 Tax Liability Transferred J5 TAX $ <ENTER> Enter the amount from Part I, column (j).
(18) Tax Identification Number K5 TIN <ENTER> Enter the TIN from Part I, column (k).
(19) Net 965 Tax Liability Triggered F1 TAX $ <ENTER> Enter the amount from Part IV, column (f).
(20) Net 965 Tax Liability Triggered F2 TAX $ <ENTER> Enter the amount from Part IV, column (f).
(21) Net 965 Tax Liability Triggered F3 TAX $ <ENTER> Enter the amount from Part IV, column (f).
(22) Net 965 Tax Liability Triggered F4 TAX $ <ENTER> Enter the amount from Part IV, column (f).
(23) Net 965 Tax Liability Triggered F5 TAX $ <ENTER> Enter the amount from Part IV, column (f).
(24) Total I1 TOTAL $ <ENTER> Enter the amount from Part IV, column (i).
(25) Election or Transfer Year A1 YEAR <ENTER> Enter the year from Part I, Line 1, col a.
(26) Net 965 Tax Liability Transferred H1 TAX $ <ENTER> Enter the amount from Part I, Line 1, col h.
(27) Tax Identification Number I1 TIN <ENTER> Enter the TIN from Part I, Line 1, col i.
(28) Election or Transfer Year A2 YEAR <ENTER> Enter the date from Part I, Line 2, col a.
(29) Net 965 Tax Liability Transferred H2 TAX $ <ENTER> Enter the amount from Part I, Line 2, col h.
(30) Tax Identification Number I2 TIN <ENTER> Enter the TIN from Part I, Line 2, col i.
(31) Election or Transfer Year A3 YEAR <ENTER> Enter the year from Part I, Line 3, col a.
(32) Net 965 Tax Liability Transferred H3 TAX $ <ENTER> Enter the amount from Part I, Line 3, col h.
(33) Tax Identification Number I3 TIN <ENTER> Enter the TIN from Part I, Line 3, col i.
(34) Election or Transfer Year A4 YEAR <ENTER> Enter the date from Part I, Line 4, col a.
(35) Net 965 Tax Liability Transferred H4 Tax $ <ENTER> Enter the amount from Part I, Line 4, col h.
(36) Tax Identification Number I4 TIN <ENTER> Enter the TIN from Part I, Line 4, col i.
(37) Election or Transfer Year A5 YEAR <ENTER> Enter the date from Part I, Line 5, col a.
(38) Net 965 Tax Liability Transferred H5 TAX $ <ENTER> Enter the amount from Part I, Line 5, col h.
(39) Tax Identification Number I5 TIN <ENTER> Enter the TIN from Part I, Line 5, col i.
(40) Form 965-B Indicator B IN <ENTER> Enter the edited digit from Form 965-B, Right Margin Part I.
Exhibit 3.24.12-249

Form 990-T - Section 21, Form 8941

Form 990-T - Section 21, Form 8941
3.24.12 - 249 SECTION 21
Source Document or Record: Form 990-T - Section 21, Form 8941
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 21.
(2) Shop Box 21BX <ENTER> Enter a
1 if the Shop Box on Form 8941 is checked yes.
2 if checked no
3 if both boxes are checked
enter if no boxes are checked and the system generates a 0.
(3) EIN 21B <ENTER> Enter the EIN from box b.
(4) Previous Form 8941 Filed 21C <ENTER> Enter a 1 if the previous filed Form 8941 (C) checkbox on Form 8941 is checked yes, 2 if check no, 3 if both boxes checked and default “0” if no boxes are checked.
(5) Number of Employees L1 <ENTER> Enter the number from Line 1.

Note:

If greater than 9999 just enter 9999. If a value is present but less than 1 enter a 1.
(6) Number of Full Time Employees Tax Year L2 <ENTER> Enter the number from Line 2.

Note:

Round to the next lowest whole number if not a whole number. If less than 1 enter a 1.
(7) Average Annual Wages LN3 $ <ENTER> Enter the amount from Line 3.
(8) Health Insurance Premiums Paid LN4 $ <ENTER> Enter the amount from Line 4.
(9) Premiums You Would Have Paid LN5 $ <ENTER> Enter the amount from Line 5.
(10) Smaller office 4 or 5 LN6 $ ENTER Enter the amount from Line 6.
(11) Multiply Line 6 by 25% LN7 $ ENTER Enter the amount from Line 7.
(12) Amount of State Subsidies paid/tax credits L10 $ <ENTER> Enter the amount from Line 10.
(13) If Line 12 is zero L13 <ENTER> Enter the number from Line 13.
(14) Number of Employees you Would Have Entered on Line 2 L14 <ENTER> Enter the number from Line 14.

Note:

If greater than 99 enter 99.
(15) Add Lines 12 and 15 L16 $ <ENTER> Enter the amount from Line 16.
(16) Cooperatives, Estates, Trusts Credit L18 $ <ENTER> Enter the amount from Line 18.
(17) Payroll Taxes L19 $ <ENTER> Enter the amount from Line 19.
(18) Tax Exempt Small Employers L20 $ <ENTER> Enter the amount from Line 20.
Exhibit 3.24.12-250

Form 990-T - Section 22, Form 5884-B

Form 990-T - Section 22, Form 5884-B
3.24.12 - 250 SECTION 22
Source Document or Record: Form 990T - Section 22, Form 5884-B

This Exhibit is reserved for future use.
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 22.
(2) Total of Line 9, Columns (a) through (c) L10 $ <ENTER> Enter the amount from Form 5884-B, Line 10
(3) Number of retained workers L11 <ENTER> Enter the number from Form 5884-B, Line 11.
Exhibit 3.24.12-251

Form 990-T - Section 23, Form 3800

Form 990-T - Section 23, Form 3800
3.24.12 - 251 SECTION 23
Source Document or Record: Form 990T - Section 23, Form 3800
Elem. Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 23.
2 Elective Payment Election or Credit Transfer Registration or other number 1B 1BB <ENTER> Enter the number from Part III, Line 1b, Column b.
3 Credit Transfer Election Amount 1B 1BG$ <ENTER +/-> Enter the amount from Part III, Line 1b, Column g.
4 Gross Elective Payment Election Amount 1B 1BH$ <ENTER> Enter the amount from Part III, Line 1b, Column h.
5 Net Elective Payment Electron Amount Line 1B Total 1BI$ <ENTER> Enter the amount from Part III, Line 1b, Column i.
6 Line 1B Total 1BTOT$ <ENTER> Enter the amount from Part III, Line 1b, Column j.
7 Elective Payment Election or Credit Transfer Registration or other number 1D 1DB <ENTER> Enter the number from Part III, Line 1d, Column b.
8 Credit Transfer Election Amount 1D 1DG$ <ENTER +/-> Enter the amount from Part III, Line 1d, Column g.
9 Gross Section 6417 or 48D(d) Elective Payment Election 1D 1DH$ <ENTER> Enter the amount from Part III, Line 1d, Column h.
10 Net Elective Payment Election Credit Amount 1D 1DI$ <ENTER> Enter the amount from Part III, Line 1d, Column i.
11 Line 1D Total 1DTOT$ <ENTER> Enter the amount from Part III, Line 1d, Column j.
12 Elective Payment Election or Credit Transfer Registration or other number 1F 1FB <ENTER> Enter the number from Part III, Line 1f, Column b.
13 Credit Transfer Election Amount 1F 1FG$ <ENTER +/-> Enter the amount from Part III, Line 1f, Column g.
14 Line 1F Total 1FTOT$ <ENTER> Enter the amount from Part III, Line 1f, Column j.
15 Elective Payment Election or Credit Transfer Registration or other number 1G 1GB <ENTER> Enter the number from Part III, Line 1g, Column b.
16 Credit Transfer Election Amount 1G 1GG$ <ENTER +/-> Enter the amount from Part III, Line 1g, Column g.
17 Gross Section 6417 or 48D(d) Elective Payment Election 1G 1GH$ <ENTER> Enter the amount from Part III, Line 1g, Column i.
18 Net Elective Payment Election Credit Amount 1G 1GI$ <ENTER> Enter the amount from Part III, Line 1g, Column i.
19 Line 1G Total 1GTOT$ <ENTER> Enter the amount from Part III, Line 1g, Column j.
Exhibit 3.24.12-252

Form 990-T - Section 24, Form 3800

Form 990-T - Section 24, Form 3800
3.24.12 - 252 SECTION 24
Source Document or Record: Form 990-T - Section 24, Forms 3800
Elem. Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 24.
2 Elective Payment Election or Credit Transfer Registration or other number 1O 1OB$ <ENTER> Enter the number from Part III, Line 1o, Column b.
3 Reserved/ filler (Credit transfer Election Amount) 1OG$ <ENTER> Enter the number from Part III, Line 1o, Column g.
4 Gross Section 6417 or 48D(d) Elective Payment Election 1O 1OH$ <ENTER> Enter the number from Part III, Line 1o, Column h.
5 Net Elective Payment Election Credit Amount 1O 1OI$ <ENTER> Enter the number from Part III, Line 1o, Column i.
6 Line 1O Total 1OTOT$ <ENTER> Enter the number from Part III, Line 1o, Column j.
7 Reserved/ filler (registration number) 1QB <ENTER> Part III, Line 1q, Column b.
8 Reserved/ filler (Credit transfer Election Amount) 1QG$ <ENTER> Part III, Line 1q, Column g.
9 Reserved/ filler (Gross Elective Payment Election) 1QH$ <ENTER> Part III, Line 1q, Column h.
10 Reserved/ filler (Net elective payment) 1QI$ <ENTER> Part III, Line 1q, Column i.
11 Reserved/ filler (Net GBC) 1QTOT$ <ENTER> Part III, Line 1q, Column j.
12 Elective Payment Election or Credit Transfer Registration or other number 1S 1SB <ENTER> Enter the number from Part III, Line 1s, Column b.
13 Credit Transfer Election Amount 1A 1SG$ <ENTER +/-> Enter the amount from Part III, Line 1s, Column g.
14 Gross Section 6417 or 48D(d) Elective Payment Election 1S 1SH$ <ENTER> Enter the amount from Part III, Line 1s, Column h.
15 Net Elective Payment Election Credit Amount 1S 1SI$ <ENTER> Enter the amount from Part III, Line 1s, Column i.
16 Line 1S Total 1STOT$ <ENTER> Enter the amount from Part III, Line 1s, Column j.
17 Elective Payment Election or Credit Transfer Registration or other number 1U 1UB <ENTER> Enter the number from Part III, Line 1u, Column b.
18 Credit Transfer Election Amount 1U 1UG$ <ENTER +/-> Enter the amount from Part III, Line 1u, Column g.
19 Gross Section 6417 or 48D(d) Elective Payment Election 1U 1UH$ <ENTER> Enter the amount from Part III, Line 1u, Column h.
20 Net Elective Payment Election Credit Amount 1U 1UI$ <ENTER> Enter the amount from Part III, Line 1u, Column i.
21 Line 1U Total 1UTOT$ <ENTER> Enter the amount from Part III, Line 1u, Column j.
22 Reserved/ filler (registration number) 1VB <ENTER> Enter the number from Part III, Line 1v, Column b.
23 Reserved/ filler (Credit transfer Election Amount) 1VG$ <ENTER> Enter the amount from Part III, Line 1v, Column g
24 Reserved/ filler (Gross Elective Payment Election) 1VH$ <ENTER> Enter the amount from Part III, Line 1v, Column h.
25 Reserved/ filler (Net elective payment) 1VI$ <ENTER> Enter the amount from Part III, Line 1v, Column i.
26 Reserved/ filler (Net GBC) 1VTOT$ <ENTER> Enter the amount from Part III, Line 1v, Column j.
27 Elective Payment Election or Credit Transfer Registration or other number 1X 1XB <ENTER> Enter the number from Part III, Line 1x, Column b.
28 Credit Transfer Election Amount 1X 1XG$ <ENTER +/-> Enter the amount from Part III, Line 1x, Column g.
29 Gross Section 6417 or 48D(d) Elective Payment Election 1X 1XH$ <ENTER> Enter the amount from Part III, Line 1x, Column h.
30 Net Elective Payment Election Credit Amount 1X 1XI$ <ENTER> Enter the amount from Part III, Line 1x, Column i.
31 Line 1X Total 1XTOT$ <ENTER> Enter the amount from Part III, Line 1x, Column j.
Exhibit 3.24.12-253

Form 990-T - Section 25, Form 3800

Form 990-T - Section 25, Form 3800
3.24.12 - 253 SECTION 25
Source Document or Record: Form 990-T - Section 25, Form 3800
Elem. Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 25.
2 Elective Payment Election or Credit Transfer Registration or other number 1AA 1AAB <ENTER> Enter the number from Part III, Line 1aa, Column b.
3 Gross Section 6417 or 48D(d) Elective Payment Election 1AA 1AAH$ <ENTER> Enter the amount from Part III, Line 1aa, Column h.
4 Net Elective Payment Election Credit Amount 1AA 1AAI$ <ENTER> Enter the amount from Part III, Line 1aa, Column i.
5 Line 1AA Total 1AATOT$ <ENTER> Enter the amount from Part III, Line 1aa, Column j.
6 Reserved/ filler (registration number) 1GGB <ENTER> Part III, Line 1gg Column b.
7 Reserved/ filler (Credit transfer Election Amount) 1GG$ <ENTER> Part III, Line 1gg Column g.
8 Reserved/ filler (Gross Elective Payment Election) 1GGH$ <ENTER> Part III, Line 1gg Column h.
9 Reserved/ filler (Net elective payment) 1GGI$ <ENTER> Part III, Line 1gg Column i.
10 Reserved/ filler (Net GBC) 1GGTOT$ <ENTER> Part III, Line 1gg Column j.
11 Elective Payment Election or Credit Transfer Registration or other number 4A 4AB <ENTER> Enter the number from Part III, Line 4a, Column b.
12 Credit Transfer Election Amount 4A 4AG$ <ENTER +/-> Enter the amount from Part III, Line 4a, Column g.
13 Gross Section 6417 or 48D(d) Elective Payment Election 4A 4AH$ <ENTER> Enter the amount from Part III, Line 4a, Column h.
14 Net Elective Payment Election Credit Amount 4A 4AI$ <ENTER> Enter the amount from Part III, Line 4a, Column i.
15 Line 4A Total 4ATOT$ <ENTER> Enter the amount from Part III, Line 4a, Column j.
16 Elective Payment Election or Credit Transfer Registration or other number 4E 4EB <ENTER> Enter the number from Part III, Line 4e, Column b.
17 Credit Transfer Election Amount 4E AEG$ <ENTER +/-> Enter the amount from Part III, Line 4e, Column g.
18 Gross Section 6417 or 48D(d) Elective Payment Election 4E AEH$ <ENTER> Enter the amount from Part III, Line 4e, Column h.
19 Net Elective Payment Election Credit Amount 4E AEI$ <ENTER> Enter the amount from Part III, Line 4e, Column i.
20 Line 4E Total 4ETOT$ <ENTER> Enter the amount from Part III, Line 4e, Column j.
21 Part V indicator VIND <ENTER> Enter 1 if any Box in Part V, column c is marked.
Exhibit 3.24.12-254

Form 990-T - Section 31, Form 8936

Form 990-T - Section 31, Form 8936
3.24.12 - 254 SECTION 31
Source Document or Record: Form 990-T - Section 31, Form 8936
Elem. Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 31.
2 Vehicle Identification Number (VIN) 311VI <ENTER> First Schedule A, Part I, Line 2
3 Placed in service date 311DT <ENTER> First Schedule A, Part I, Line 3
4 Tentative credit amount 31109 <ENTER> First Schedule A, Part II, Line 9
5 Credit amount for business use of new clean vehicle 31111 <ENTER> Part II, Line 11
6 Smaller of Line 15 or Line 16 31117 <ENTER> First Schedule A, Part IV, Line 17
7 Smaller of Line 24 or Line 25 31126 <ENTER> First Schedule A, Part V, Line 26
8 Indicator field for results of MeF check of VIN against portal 311IN <ENTER> N/A
9 Vehicle Identification Number (VIN) 312VI <ENTER> Second Schedule A, Part I, Line 2
10 Placed in service date 312DT <ENTER> Second Schedule A, Part I, Line 3
11 Tentative credit amount 31209 <ENTER> Second Schedule A, Part II, Line 9
12 Credit amount for business use of new clean vehicle 31211 <ENTER> Part II, Line 11
13 Smaller of Line 15 or Line 16 31217 <ENTER> Second Schedule A, Part IV, Line 17
14 Smaller of Line 24 or Line 25 31226 <ENTER> Second Schedule A, Part V, Line 26
15 Indicator field for results of MeF check of VIN against portal 312IN <ENTER> N/A
16 Verified field for SUM-REDCD-VIN-CR-VERIFIED-AMT 31RDV <ENTER> N/A
17 Indicator (More than 2 Schedule A’s attached) 313IN <ENTER> Second Form 8936, Schedule A, (edited bottom right margin of Page 2).
Exhibit 3.24.12-255

Form 1041-A - Section 01

Form 1041-A - Section 01
3.24.12 - 255 SECTION 01
Source Document or Record: Form 1041-A - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(3a) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(4) E.I.N EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(5) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(6) Condition Codes CC <ENTER> Enter the edited characters as shown below the OMB Number. If a condition code is illegible, enter a "#" in its place.
(7) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) If a "G" Condition Code is present and return is a non-remittance, end the document after this element.
(b) If a "G" Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–8 then proceed to Section 03.
(c) See IRM 3.24.38 for special instructions.
(8) P & I Indicator P&I <ENTER> Enter the edited digit shown to the right of the EIN.
(9) Correspondence Code CORC <ENTER> Enter the 2 edited digits shown to the right of the City and State.
(10) Correspondence Received Date CRD <ENTER> Enter the edited digits shown to the right of the Correspondence Code. Example: 11–020600. For special instructions, see IRM 3.24.38.
(11) Daily Delinquency Penalty DDP <ENTER> Enter the edited amount shown to the right of Part II title.
(12) ERS Action Code ERS <ENTER> Enter the edited digits from the bottom left margin.
(13) CAF Indicator CAF <ENTER> Enter the edited digit from the bottom right margin.
(14) Preparation Code PREP <ENTER> Enter the edited code from the right of the preparer PTIN line.
(15) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(16) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
(17) Preparer's Telephone PTEL <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-256

Form 1041-A - Section 03

Form 1041-A - Section 03
3.24.12 - 256 SECTION 03
Source Document or Record: Form 1041-A - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance Amount RMT <ENTER> Enter the edited amount shown in the top center margin of the return.
(a) Check the control document (813) for the correct amount in case of illegibility.
(b) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(c) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(d) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Total Income LN9 $ <ENTER>
MINUS (-)		 Enter the amount from Part I, Line 9.
(4) Total Assets (BOY) 38(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 38, Column (a).
(5) Total Assets (EOY) 38(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 38, Column (b).
(6) Total Liabilities (BOY) 42(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 42, Column (a).
(7) Total Liabilities (EOY) 42(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 42, Column (b).
(8) Total Net Assets (BOY) 45(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 45, Column (a).
(9) Total Net Assets (EOY) 45(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 45, Column (b).
(10) Total Liabilities and Net Assets (BOY) 46(A) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 46, Column (a).
(11) Total Liabilities and Net Assets (EOY) 46(B) $ <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 46, Column (b).
Exhibit 3.24.12-257

Form 1120–POL - Section 01

Form 1120–POL - Section 01
3.24.12 - 257 SECTION 01
Source Document or Record: Form 1120–POL - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT:   Section "01" always generates. No entry required.
(2) Serial Number SER#   Enter the last two digits of the 13–digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(3a) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(4) E.I. Number EIN <ENTER>
★★★★★★		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(5) Address Check ADDRESS CHECK?   ENTER Y or N as appropriate.
(6) Street Key STREET KEY <ENTER> See IRM 3.24.38
(7) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38
(8) Tax Period TAXPR <ENTER> Enter in YYMM format the tax period edited to the right of, or underlined under, the form title.
(a) If not edited or underlined, press <ENTER> only.
(b) For standard instructions, see IRM 3.24.38.
(9) In Care of Name Line C/O NAME <ENTER> Enter the in care of name, if shown.

Note:

Downstream processing generates the (%) sign.
(10) Foreign Address FGN ADD <ENTER> Enter the Foreign address, if shown. See IRM 3.24.38 for additional instruction.
(11) Street Address ADD <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.28 for specific instructions.
(b) If a "G" Condition Code is present, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(12) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(13) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(14) ZIP ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(15) Received Date RDATE <ENTER>
★★★★★★		 Enter as stamped on the face of the return or edited on the dotted portion of Line 11, in MMDDYY format.
(a) For standard instructions, see IRM 3.24.38.
(16) Condition Codes CC <ENTER> Enter as shown on the dotted portion of Line 1.
(a) If a Condition Code is illegible, enter a "#" .
(17) Return Processing Code 01RPC <ENTER> For 2018 and subsequent tax periods enter the edited codes on Page 1, in the right margin next to line 1.
(18) Tax Period Beginning YRBEGDT <ENTER> Enter the tax period Beginning in MMDDYY format when edited to the left of form title area at the top of the form.
(18) Principal Campaign Committee PCC <ENTER> Enter the edited 1, 2, or 3 from the right of "Candidates for U.S. Congress Only" line. For 2018 and subsequent, enter only.
(19) ERS Action Code ACTCD <ENTER> Enter the edited digits from the bottom left margin.
(a) If a "G" Condition Code is present or if the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If a "G" Condition Code is present or if the ERS Action Code is in the "600" series and the return is a remittance, Press <ENTER> followed by <F6> and proceed to Section 03.
(c) If no additional data for this or any other sections, end the document.
(20) EOMF Code EOMF <ENTER> Enter the edited "1" shown in the right margin next to the Tax Year.
21 Filling Field (VIN Portal Information Field) N/A <ENTER> N/A
Exhibit 3.24.12-258

Form 1120–POL - Section 02, Form 5800 - Edit Sheet

Form 1120–POL - Section 02, Form 5800 - Edit Sheet
3.24.12 - 258 SECTION 02
Source Document or Record: Form 5800 (Edit Sheet)
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> <ENTER> if already present on the screen; otherwise enter "02" .
(2) Audit Code L2 <ENTER> Enter from Edit Sheet, Line 2.
(3) CAF Indicator/Code L3 <ENTER> Enter from Edit Sheet, Line 3.
(4) Correspondence Received Date L5 <ENTER> Enter from Edit Sheet, Line 5, in MMDDYY format.
(a) For standard instructions, see IRM 3.24.38.
(5) Penalty and Interest Code L6 <ENTER> Enter from Edit Sheet, Line 6.
(6) Missing Schedule Code L8 <ENTER> Enter from Edit Sheet, Line 8.
Exhibit 3.24.12-259

Form 1120–POL - Section 03

Form 1120–POL - Section 03
3.24.12 - 259 SECTION 03
Source Document or Record: Form 1120–POL - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> <ENTER> if already present on the screen; otherwise enter "03" .
(2) Payment Received RMT <ENTER> Enter the green edited amount shown on Line 25.
(a) If a green edited amount isn't present, enter the amount written in green, or the cash register imprint amount shown in the upper right margin.
(b) Check the control document (813, 3893) for correct amount in case of illegibility.
(c) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(d) If a "G" Condition Code is present, end the document after this element.
(e) If the ERS Action Code is in the "600" series, end the document after this element.
(f) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(g) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Dividends L1 $ <ENTER>
MINUS (−)		 Enter the amount from Line 1.
(4) Taxable Interest L2 $ <ENTER>
MINUS (−)		 Enter the amount from Line 2.
(5) Gross Rents L3 $ <ENTER>
MINUS (−)		 Enter the amount from Line 3.
(6) Gross Royalties L4 $ <ENTER>
MINUS (−)		 Enter the amount from Line 4.
(7) Capital Gain L5 $ <ENTER>
MINUS (−)		 Enter the amount from Line 5.
(8) Ordinary Gain or Loss L6 $ <ENTER>
MINUS (−)		 Enter the amount from Line 6.
(9) Other Income L7 $ <ENTER>
MINUS (−)		 Enter the amount from Line 7.
(10) Gross Income L8 <ENTER>
MINUS (−)
★★★★★★		 Enter the amount from Line 8.
Exhibit 3.24.12-260

Form 1120–POL - Section 04

Form 1120–POL - Section 04
3.24.12 - 260 SECTION 04
Source Document or Record: Form 1120–POL - Section 04
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> <ENTER> if already present on the screen; otherwise enter "04" .
(2) Salaries and Wages Deduction L9 $ <ENTER>
MINUS (−)		 Enter the amount from Line 9.
(3) Repairs Deduction 10 $ <ENTER>
MINUS (−)		 Enter the amount from Line 10.
(4) Rent Deduction 11 $ <ENTER>
MINUS (−)		 Enter the amount from Line 11.
(5) Tax Deduction 12 $ <ENTER>
MINUS (−)		 Enter the amount from Line 12.
(6) Interest Deduction 13 $ <ENTER>
MINUS (−)		 Enter the amount from Line 13.
(7) Depreciation Deduction 14 $ <ENTER>
MINUS (−)		 Enter the amount from Line 14.
(8) Other Deduction 15 $ <ENTER>
MINUS (−)		 Enter the amount from Line 15.
(9) Total Deductions 16 <ENTER>
MINUS (−)		 Enter the amount from Line 16.
(10) Specific Deductions 18 $ <ENTER>
★★★★★★		 Enter the amount from Line 18.
(11) Statutory Credits 21 <ENTER> Enter the amount from Line 21.
Exhibit 3.24.12-261

Form 1120–POL - Section 05

Form 1120–POL - Section 05
3.24.12 - 261 SECTION 05
Source Document or Record: Form 1120–POL - Section 05
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> <ENTER> if already present on the screen; otherwise enter "05" .
(2) Total Tax 22 <ENTER> Enter the amount from Line 22.
(3) Total Overpayment and Estimated Tax Credits 22... <ENTER> Enter the amount from the dotted portion of Line 22.
(4) Form 7004 Credits 23A <ENTER> Enter the amount from Line 23a.
(5) Credit From Undistributed Capital Gains (2439) 23B <ENTER> Enter the amount from Line 23b.
(6) Federal Telephone Excise Tax Paid 23SPACE <ENTER> Enter the amount from the space to the right of Line 23c.
(7) Elective payment Election 23D $ <ENTER> Enter the amount from Line 23d
(8) Balance Due/Overpayment 24/25 <ENTER>
MINUS (−)
★★★★★★		 Enter the amount as follows:
(a) From Line 24, followed by <ENTER>.
(b) If no amount Line 24, enter the amount from Line 25, with a MINUS (−).
(c) If there are entries on both lines, enter the amount from Line 24.
(9) Discuss with Preparer Checkbox CKBX <ENTER> Enter a "1" if the "Yes" box is checked. Otherwise, press <ENTER> only if the "No" box is checked or none of the boxes are checked.
(10) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(11) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN.
(12) Preparer's Telephone Number TEL# <ENTER> Enter the Preparer's phone number.
Exhibit 3.24.12-262

Form 1120-POL - Section 15, Form 4136

Form 1120-POL - Section 15, Form 4136
3.24.12 - 262 SECTION 15
Source Document or Record: Form 1120-POL - Section 15, Form 4136
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "15. "
(2) Amount of Claim 1 AMT1(D) <ENTER> Enter the first amount shown on Form 4136, Column (d).
(3) Credit Reference Number 1 CRN1(E) <ENTER> Enter the CRN from Column (e) that correspond with the first amount entered.
(4) Amount of Claim 2 AMT2(D) <ENTER> Enter the second amount shown on Form 4136, Column (d).
(5) Credit Reference Number 2 CRN2(E) <ENTER> Enter the CRN from Column (e) that corresponds with the second amount entered.
(6) Amount of Claim 3 AMT3(D) <ENTER> Enter the third amount shown on Form 4136, Column (d).
(7) Credit Reference Number 3 CRN3(E) <ENTER> Enter the CRN from Column (e) that corresponds with the third amount entered.
(8) Amount of Claim 4 AMT4(D) <ENTER> Enter the fourth amount shown on Form 4136, Column (d).
(9) Credit Reference Number 4 CRN4(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fourth amount entered.
(10) Amount of Claim 5 AMT5(D) <ENTER> Enter the fifth amount shown on Form 4136, Column (d).
(11) Credit Reference Number 5 CRN5(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fifth amount entered.
(12) Amount of Claim 6 AMT6(D) <ENTER> Enter the sixth amount shown on Form 4136, Column (d).
(13) Credit Reference Number 6 CRN6(E) <ENTER> Enter the CRN from Column (e) that corresponds with the sixth amount entered.
(14) Amount of Claim 7 AMT7(D) <ENTER> Enter the seventh amount shown on Form 4136, Column (d).
(15) Credit Reference Number 7 CRN7(E) <ENTER> Enter the CRN from Column (e) that corresponds with the seventh amount entered.
(16) Amount of Claim 8 AMT8(D) <ENTER> Enter the eighth amount shown on Form 4136, Column (d).
(17) Credit Reference Number 8 CRN8(E) <ENTER>☆ Enter the CRN from Column (e) that corresponds with the eighth amount entered.
(18) Amount of Claim 9 AMT9(D) <ENTER> Enter the ninth amount shown on Form 4136, Column (d).
(19) Credit Reference Number 9 CRN9(E) <ENTER> Enter the CRN from Column (e) that corresponds with the ninth amount entered.
(20) Amount of Claim 10 AMT10(D) <ENTER> Enter the tenth amount shown on Form 4136, Column (d).
(21) Credit Reference Number 10 CRN10(E) <ENTER> Enter the CRN from Column (e) that corresponds with the tenth amount entered.
(22) Amount of Claim 11 AMT11(D) <ENTER> Enter the eleventh amount shown on Form 4136, Column (d).
(23) Credit Reference Number 11 CRN11(E) <ENTER> Enter the CRN from Column (e) that corresponds with the eleventh amount entered.
(24) Amount of Claim 12 AMT12(D) <ENTER> Enter the twelfth amount shown on Form 4136, Column (d).
(25) Credit Reference Number 12 CRN12(E) <ENTER> Enter the CRN from Column (e) that corresponds with the twelfth amount entered.
(26) Amount of Claim 13 AMT13(D) <ENTER> Enter the thirteenth amount shown on Form 4136, Column (d).
(27) Credit Reference Number 13 CRN13(E) <ENTER> Enter the CRN from Column (e) that corresponds with the thirteenth amount entered.
(28) Amount of Claim 14 AMT14(D) <ENTER> Enter the fourteenth amount shown on Form 4136, Column (d).
(29) Credit Reference Number 14 CRN14(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fourteenth amount entered.
(30) Amount of Claim 15 AMT15(D) <ENTER> Enter the fifteenth amount shown on Form 4136, Column (d).
(31) Credit Reference Number 15 CRN15(E) <ENTER> Enter the CRN from Column (e) that corresponds with the fifteenth amount entered.
(32) Amount of Claim 16 AMT16(D) <ENTER> Enter the sixteenth amount shown on Form 4136, Column (d).
(33) Credit Reference Number 16 CRN16(E) <ENTER> Enter the CRN from Column (e) that corresponds with the sixteenth amount entered.
(34) Amount of Claim 17 AMT17(D) <ENTER> Enter the seventeenth amount shown on Form 4136, Column (d).
(35) Credit Reference Number 17 CRN17(E) <ENTER> Enter the CRN from Column (e) that corresponds with the seventeenth amount entered.
(36) Amount of Claim 18 AMT18(D) <ENTER> Enter the eighteenth amount shown on Form 4136, Column (d).
(37) Credit Reference Number 18 CRN18(E) <ENTER> Enter the CRN from Column (e) that corresponds with the eighteenth amount entered.
(38) Amount of Claim 19 AMT19(D) <ENTER> Enter the nineteenth amount shown on Form 4136, Column (d).
(39) Credit Reference Number 19 CRN19(E) <ENTER> Enter the CRN from Column (e) that corresponds with the nineteenth amount entered.
(40) Amount of Claim 20 AMT20(D) <ENTER> Enter the twentieth amount shown on Form 4136, Column (d).
(41) Credit Reference Number 20 CRN20(E) <ENTER> Enter the CRN from Column (e) that corresponds with the twentieth amount entered.
Exhibit 3.24.12-263

Form 1120-POL - Section 19, Form 8978

Form 1120-POL Section 19, Form 8978
3.24.12 - 259 Section 19
Source Document or record for Form 1120–POL, Section 19 - Form 8978
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 19.
(2) Source of Review Year Adjustments CKBX <ENTER>- Enter 1 if BBA Audit is checked. Enter 2 if AAR filing is checked.
(3) Total Additional Reporting Year Tax L14 <ENTER> Enter the amount from Part I, Line 14.
(4) Total Penalties L16 <ENTER> Enter the amount from Part II, Line 16.
(5) Total Interest L18 <ENTER> Enter the amount from Part III, Line 18.
Exhibit 3.24.12-264

Form 1120-POL - Section 20, Form 8913

3.24.12 - 264 Section 20
Source Document or record for Form 1120–POL, Section 20 - Form 8913
Elem. Data Element Name Prompt Fld. Term Instructions
(1) Section Number SECT: <ENTER> Press ENTER if already present on the screen; otherwise enter 20.
(2) Tax Refund 15D <ENTER> Enter the amount from Line 15d.
(3) Interest on Tax Refund 15E <ENTER> Enter the amount from Line 15e.
Exhibit 3.24.12-265

Form 1120-POL - Section 23, Form 3800

3.24.12 - 265 SECTION 23
Source Document or Record: Form 1120-POL- Section 23, Form 3800
Elem. Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 23.
2 Elective Payment Election or Credit Transfer Registration or other number 1B 1BB <ENTER> Enter the number from Part III, Line 1b, Column b.
3 Credit Transfer Election Amount 1B 1BG$ <ENTER +/-> Enter the amount from Part III, Line 1b, Column g.
4 Gross Elective Payment Election Amount 1B 1BH$ <ENTER> Enter the amount from Part III, Line 1b, Column h.
5 Net Elective Payment Electron Amount Line 1B Total 1BI$ <ENTER> Enter the amount from Part III, Line 1b, Column i.
6 Line 1B Total 1BTOT$ <ENTER> Enter the amount from Part III, Line 1b, Column j.
7 Elective Payment Election or Credit Transfer Registration or other number 1D 1DB <ENTER> Enter the number from Part III, Line 1d, Column b.
8 Credit Transfer Election Amount 1D 1DG$ <ENTER +/-> Enter the amount from Part III, Line 1d, Column g.
9 Gross Section 6417 or 48D(d) Elective Payment Election 1D 1DH$ <ENTER> Enter the amount from Part III, Line 1d, Column h.
10 Net Elective Payment Election Credit Amount 1D 1DI$ <ENTER> Enter the amount from Part III, Line 1d, Column i.
11 Line 1D Total 1DTOT$ <ENTER> Enter the amount from Part III, Line 1d, Column j.
12 Elective Payment Election or Credit Transfer Registration or other number 1F 1FB <ENTER> Enter the number from Part III, Line 1f, Column b.
13 Credit Transfer Election Amount 1F 1FG$ <ENTER +/-> Enter the amount from Part III, Line 1f, Column g.
14 Line 1F Total 1FTOT$ <ENTER> Enter the amount from Part III, Line 1f, Column j.
15 Elective Payment Election or Credit Transfer Registration or other number 1G 1GB <ENTER> Enter the number from Part III, Line 1g, Column b.
16 Credit Transfer Election Amount 1G 1GG$ <ENTER +/-> Enter the amount from Part III, Line 1g, Column g.
17 Gross Section 6417 or 48D(d) Elective Payment Election 1G 1GH$ <ENTER> Enter the amount from Part III, Line 1g, Column i.
18 Net Elective Payment Election Credit Amount 1G 1GI$ <ENTER> Enter the amount from Part III, Line 1g, Column i.
19 Line 1G Total 1GTOT$ <ENTER> Enter the amount from Part III, Line 1g, Column j.
Exhibit 3.24.12-266

Form 1120-POL - Section 24, Form 3800

3.24.12 - 266 SECTION 24
Source Document or Record: Form 1120-POL- Section 24, Form 3800
Elem Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 24.
2 Elective Payment Election or Credit Transfer Registration or other number 1O 1OB <ENTER> Enter the number from Part III, Line 1o, Column b.
3 Gross Section 6417 or 48D(d) Elective Payment Election 1O 1OH$ <ENTER> Enter the number from Part III, Line 1o, Column h.
4 Net Elective Payment Election Credit Amount 1O 1OI$ <ENTER> Enter the number from Part III, Line 1o, Column i.
5 Line 1O Total 1OTOT$ <ENTER> Enter the number from Part III, Line 1o, Column j.
6 Reserved/ filler (registration number) 1QB <ENTER> Part III, Line 1q, Column b.
7 Reserved/ filler (Credit transfer Election Amount) 1QG$ <ENTER> Part III, Line 1q, Column g.
8 Reserved/ filler (Gross Elective Payment Election) 1QH$ <ENTER> Part III, Line 1q, Column h.
9 Reserved/ filler (Net elective payment) 1QI$ <ENTER> Part III, Line 1q, Column i.
10 Reserved/ filler (Net GBC) 1QTOT$ <ENTER> Part III, Line 1q, Column j.
11 Elective Payment Election or Credit Transfer Registration or other number 1S 1SB <ENTER> Enter the number from Part III, Line 1s, Column b.
12 Credit Transfer Election Amount 1S 1SG$ <ENTER +/-> Enter the amount from Part III, Line 1s, Column g.
13 Gross Section 6417 or 48D(d) Elective Payment Election 1S 1SH$ <ENTER> Enter the amount from Part III, Line 1s, Column h.
14 Net Elective Payment Election Credit Amount 1S 1SI$ <ENTER> Enter the amount from Part III, Line 1s, Column i.
15 Line 1S Total 1STOT$ <ENTER> Enter the amount from Part III, Line 1s, Column j.
16 Elective Payment Election or Credit Transfer Registration or other number 1U 1UB <ENTER> Enter the number from Part III, Line 1u, Column b.
17 Credit Transfer Election Amount 1U 1UG$ <ENTER +/-> Enter the amount from Part III, Line 1u, Column g.
18 Gross Section 6417 or 48D(d) Elective Payment Election 1U 1UH$ <ENTER> Enter the amount from Part III, Line 1u, Column h.
19 Net Elective Payment Election Credit Amount 1U 1UI$ <ENTER> Enter the amount from Part III, Line 1u, Column i.
20 Line 1U Total 1UTOT$ <ENTER> Enter the amount from Part III, Line 1u, Column j.
21 Elective Payment Election or Credit Transfer Registration or other number 1X 1XB <ENTER> Enter the number from Part III, Line 1x, Column b.
22 Credit Transfer Election Amount 1X 1XG$ <ENTER +/-> Enter the amount from Part III, Line 1x, Column g.
23 Gross Section 6417 or 48D(d) Elective Payment Election 1X 1XH$ <ENTER> Enter the amount from Part III, Line 1x, Column h.
24 Net Elective Payment Election Credit Amount 1X 1XI$ <ENTER> Enter the amount from Part III, Line 1x, Column i.
25 Line 1X Total 1XTOT$ <ENTER> Enter the amount from Part III, Line 1x, Column j.
Exhibit 3.24.12-267

Form 1120-POL - Section 25, Form 3800

3.24.12 - 267 SECTION 25
Source Document or Record: Form 1120-POL- Section 25, Form 3800
Elem. Data Element Name Prompt Fld. Term, Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 25.
2 Elective Payment Election or Credit Transfer Registration or other number 1AA 1AAB <ENTER> Enter the number from Part III, Line 1aa, Column b.
3 Gross Section 6417 or 48D(d) Elective Payment Election 1AA 1AAH$ <ENTER> Enter the amount from Part III, Line 1aa, Column h.
4 Net Elective Payment Election Credit Amount 1AA 1AAI$ <ENTER> Enter the amount from Part III, Line 1aa, Column i.
5 Line 1AA Total 1AATOT$ <ENTER> Enter the amount from Part III, Line 1aa, Column j.
6 Reserved/ filler (registration number) 1GGB <ENTER> Part III, Line 1gg Column b.
7 Reserved/ filler (Credit transfer Election Amount) 1GG$ <ENTER> Part III, LIne 1gg Column g.
8 Reserved/ filler (Gross Elective Payment Election) 1GGH$ <ENTER> Part III, Line 1gg Column h.
9 Reserved/ filler (Net elective payment) 1GGI$ <ENTER> Part III, Line 1gg Column i.
10 Reserved/ filler (Net GBC) 1GGTOT$ <ENTER> Part III, Line 1gg Column j.
11 Elective Payment Election or Credit Transfer Registration or other number 4A 4AB <ENTER> Enter the number from Part III, Line 4a, Column b.
12 Credit Transfer Election Amount 4A 4AG$ <ENTER +/-> Enter the amount from Part III, Line 4a, Column g.
13 Gross Section 6417 or 48D(d) Elective Payment Election 4A 4AH$ <ENTER> Enter the amount from Part III, Line 4a, Column h.
14 Net Elective Payment Election Credit Amount 4A 4AI$ <ENTER> Enter the amount from Part III, Line 4a, Column i.
15 Line 4A Total 4ATOT$ <ENTER> Enter the amount from Part III, Line 4a, Column j.
16 Elective Payment Election or Credit Transfer Registration or other number 4E 4EB <ENTER> Enter the number from Part III, Line 4e, Column b.
17 Credit Transfer Election Amount 4E AEG$ <ENTER +/-> Enter the amount from Part III, Line 4e, Column g.
18 Gross Section 6417 or 48D(d) Elective Payment Election 4E AEH$ <ENTER> Enter the amount from Part III, Line 4e, Column h.
19 Net Elective Payment Election Credit Amount 4E AEI$ <ENTER> Enter the amount from Part III, Line 4e, Column i.
20 Line 4E Total 4ETOT$ <ENTER> Enter the amount from Part III, Line 4e, Column j.
21 Part V indicator VIND <ENTER> Enter 1 if any Box in Part V, column c is marked.
Exhibit 3.24.12-268

Form 1120-POL - Section 31, Form 3800

3.24.12 - 268 SECTION 31
Source Document or Record: Form 1120-POL- Section 31, Form 3800
Elem. Data Element Name Prompt Fld. Term. Instructions
1 Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 31.
2 Vehicle Identification Number (VIN) 311VI <ENTER> First Schedule A, Part I, Line 2
3 Placed in service date 311DT <ENTER> First Schedule A, Part I, Line 3
4 Tentative credit amount 31109 <ENTER> First Schedule A, Part II, Line 9
5 Credit amount for business use of new clean vehicle 31111 <ENTER> Part II, Line 11
6 Smaller of Line 15 or Line 16 31117 <ENTER> First Schedule A, Part IV, Line 17
7 Smaller of Line 24 or Line 25 31126 <ENTER> First Schedule A, Part V, Line 26
8 Indicator field for results of MeF check of VIN against portal 311IN <ENTER> N/A
9 Vehicle Identification Number (VIN) 312VI <ENTER> Second Schedule A, Part I, Line 2
10 Placed in service date 312DT <ENTER> Second Schedule A, Part I, Line 3
11 Tentative credit amount 31209 <ENTER> Second Schedule A, Part II, Line 9
12 Credit amount for business use of new clean vehicle 31211 <ENTER> Part II, Line 11
13 Smaller of Line 15 or Line 16 31217 <ENTER> Second Schedule A, Part IV, Line 17
14 Smaller of Line 24 or Line 25 31226 <ENTER> Second Schedule A, Part V, Line 26
15 Indicator field for results of MeF check of VIN against portal 312IN <ENTER> N/A
17 Indicator (More than 2 Schedule A’s attached) 313IN <ENTER> Second Form 8936, Schedule A, (edited bottom right margin of Page 2).
Exhibit 3.24.12-269

Form 4720 - Section 01

Form 4720 - Section 01
3.24.12 - 261 SECTION 01
Source Document or Record: Form 4720 - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3a) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(3a) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(4) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(5) TIN Type TIN <ENTER> Enter the edited 0 or 2 following the TIN.
(6) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(7) Condition Codes CC <ENTER> Enter the edited characters as shown to the right of the printed year. If a condition code is illegible, enter a "#" in its place.
(8) Received Date DATE <ENTER>
★★★★★★		 Enter the six digits for the received date in MMDDYY format from the face of the return.
(a) If a "G" Condition Code is present and return is a non-remittance, end the document after this element.
(b) If a "G" Condition Code is present and return is a remittance, press <ENTER> followed by <F6> after E–8 then proceed to Section 03.
(c) See IRM 3.24.38 for special instructions.
(9) Type Organization Code TYPE <ENTER> Enter the edited digit from the Type of Annual Return box.
(10) Audit Indicator A… <ENTER> Enter the edited digit shown on the dotted portion of Line A.
(11) Question A A RT <ENTER> Enter a Yes or No from the yes/no box from Line A.
(12) Question B B RT <ENTER> Enter a Yes or No from the yes/no box from Line B.
(13) CAF Indicator B… <ENTER> Enter the edited digit shown on the dotted portion of Line B.
(14) Correspondence Code 1… <ENTER> Enter the edited digits shown on the dotted portion of Line 1.
(15) Correspondence Received Date 2… <ENTER> Enter the edited digits shown on the dotted portion of Line 2.
(a)For special instructions, see IRM 3.24.38.
(16) Penalty and Interest Code 3… <ENTER> Enter the edited digit shown on the dotted portion of Line 3.
(17) ERS Action Codes BOTLFMAR <ENTER> Enter the edited ERS Action Code.
(18) Signature Code 01SIG <ENTER> Enter a 1 if the signature is present and 2 if it is not signed.
Exhibit 3.24.12-270

Form 4720 - Section 02

Form 4720 - Section 02
3.24.12 - 262 SECTION 02
Source Document or Record: Form 4720 - Section 02
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) Tax on Undistributed Income LN1 <ENTER> Enter the amount from Part I, Line 1.
(3) Tax on Excess Business Holding LN2 <ENTER> Enter the amount from Part I, Line 2.
(4) Tax on Investments that Jeopardize LN3 <ENTER> Enter the amount from Part I, Line 3.
(5) Tax on Taxable Expenditures LN4 <ENTER> Enter the amount from Part I, Line 4.
(6) Tax on Political Expenditures LN5 <ENTER> Enter the amount from Part I, Line 5.
(7) Tax on Excess Lob Expenditures LN6 <ENTER> Enter the amount from Part I, Line 6.
(8) Tax on Disqualifying Lobbying Expenditures LN7 <ENTER> Enter the amount from Part I, Line 7.
(9) Tax on Premiums Paid... Contracts LN8 <ENTER> Enter the amount from Part I, Line 8.
(10) Tax on Entering Prohibited Tax Shelter Transactions LN9 <ENTER> Enter the amount from Part I, Line 9.
(11) Tax on Taxable Distributions L10 <ENTER> Enter the amount from Part I, Line 10.
(12) Tax on Unrelated Business Taxable Income L11 <ENTER> Enter the amount from Part I, Line 11.
(13) Tax on Failure to Meet Requirements of 501(r)(3) L12 <ENTER> Enter the amount from Part I, Line 12.
(14) Tax on Excess Executive Compensation L13 <ENTER> Enter the amount from Part I, Line 13.
(15) Tax on Private Colleges and Universities L14 <ENTER> Enter the amount from Part I, Line 14.
(16) Total Tax Part I L15 <ENTER> Enter the amount from Part I, Line 15.
(17) Organization EIN (B) EIN <ENTER> Enter the EIN from Part II Column (b)
(18) Tax on Self-Dealing Part II, Line 1 (1) T <ENTER> Enter the amount from Part II, Line 1.
(19) Tax on Investments that Jeopardize Part II, Line 2 (2) T <ENTER> Enter the amount from Part II, Line 2.
(20) Tax on Taxable Expenditures Part II, Line 3 (3) T <ENTER> Enter the amount from Part II, Line 3.
(21) Tax on Political Expenditures Part II, Line 4 (4) T <ENTER> Enter the amount from Part II, Line 4.
(22) Tax on Disqualifying Lobbying Expenditures Part II, Line 5 (5) T <ENTER> Enter the amount from Part II, Line 5.
(23) Tax on Excess Benefits Part II, Line 6 (6) T <ENTER> Enter the amount from Part II, Line 6.
(24) Tax on Prohibited Tax Shelter Transactions Part II, Line 7 (7) T <ENTER> Enter the amount from Part II, Line 7.
(25) Tax on Taxable Distributions Part II, Line 8 (8) T <ENTER> Enter the amount from Part II, Line 8.
(26) Tax on Prohibited Benefits Part II, Line 9 (9) T <ENTER> Enter the amount from Part II, Line 9.
(27) Total Tax Part II, Line 10 (10) T <ENTER> Enter the amount from Part II, Line 10.
(28) Total Tax PTIII1 <ENTER> Enter the amount from Part III, Line 1.
(29) Total Payments PTIII2 <ENTER> Enter the amount from Part III, Line 2.
op(30) Tax Due/Overpayment PTIII3 <ENTER> Enter the amount from Part III, Line 3 or 4.
(31) Excess Grass Roots Expenditures SCHG–1 <ENTER> Enter the amount from Schedule G, Line 1.
(32) Excess Lobbying Expenditures G–2 <ENTER> Enter the amount from Schedule G, Line 2.
(33) Lobby Expenditures Tax G–4 <ENTER> Enter the amount from Schedule G, Line 4.
(34) Preparation Code PREP <ENTER> Enter the edited code from the right of the Preparer PTIN line.
(35) Preparer's PTIN PTIN <ENTER> Enter the Preparer's PTIN.
(36) Preparer's EIN PEIN <ENTER> Enter the Preparer's EIN from the Preparer's EIN box.
(37) Preparer's Telephone Number TEL# <ENTER> Enter the Preparer's phone number from the Preparer's phone number box.
Exhibit 3.24.12-271

Form 4720 - Section 03

Form 4720 - Section 03
3.24.12 - 263 SECTION 03
Source Document or Record: Form 4720 - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if it is already present on the screen; otherwise enter "03" .
(2) Remittance Amount RMT <ENTER> Enter the edited amount shown in the top center margin of the return.
(a) Check the control document (813) for the correct amount in case of illegibility.
(b) Press <ENTER> if Form 3893 is checked "Reprocessable Document" .
(c) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
Exhibit 3.24.12-272

Form 5227 - Section 01

Form 5227 - Section 01
3.24.12 - 267 SECTION 01
Source Document or Record: Form 5227 - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: (auto) Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I. Number EIN <ENTER>
★★★★★★		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK? <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY <ENTER> See IRM 3.24.38.
(8) ZIP Key ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(10) Computer Condition Codes CCC <ENTER> Enter the code(s) from the center portion of the return below the entity section. If a condition code is illegible, enter a "#" in its place.
(11) Received Date RDATE <ENTER>
★★★★★★		 Enter the stamped or edited date in MMDDYY format from the face of the return.
(a) See IRM 3.24.38 for special instructions.
(b) If a "G" Condition Code is present and the return is a non-remittance, end the document after this element.
(12) Type of Organization Code ORGCD <ENTER> Enter the number that correlates with the box 1-5 checked from the Type of Entity box marked in Item C of the entity area.

Example:

If Box (1) is checked, you would enter a "1" . If Box (5) is checked you would enter a "5" . If more than one box is checked or no box is checked, enter either the edited digit or a "2" as a default.
(13) In Care of Name Line C/O NAME <ENTER> Enter the care of name, if shown.

Note:

Downstream processing generates a (%) sign.
(14) Foreign Address FGN ADD <ENTER> Enter the foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(15) Street Address ADDR <ENTER> Enter the street address from the address line.
(a) See IRM 3.24.38 for specific instructions.
(b) If a "G" Condition Code is present on the return, do NOT enter any of the address information even if prompted. This occurs when a Name Control is entered.
(c) If a foreign address, enter the foreign city, province and postal code.
(16) City CITY <ENTER> Enter the city name from the city line or Major City Code, if appropriate.
(a) If a foreign address, enter the edited foreign country's code.
(17) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(b) If a foreign address, enter a period (.).
(18) ZIP Code ZIP <ENTER> Enter the ZIP Code.
(a) If a foreign address, press <ENTER> only.
(19) Preparation Code PREP <ENTER> Enter the edited code from the right of the Preparer PTIN line.
(20) Preparer PTIN PTIN <ENTER> Enter the Preparer's PTIN.
21 Preparer EIN PEIN <ENTER> Enter the Preparer's EIN from the Preparer EIN box.
(22) Preparer Telephone PTEL <ENTER> Enter the Preparer's phone number from the Preparer's phone number box.
Exhibit 3.24.12-273

Form 5227 - Section 02, Form 5800 - Edit Sheet

Form 5227 - Section 02, Form 5800 - Edit Sheet
3.24.12 - 268 SECTION 02
Source Document or Record: Form 5227 - Section 02, Form 5800 - Edit Sheet
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "02" .
(2) ERS Action Code BOTLFMAR <ENTER> Enter the edited digits from the bottom left margin of the return.
(a) If the ERS Action Code is in the "600" series and the return is a non-remittance, end the document after this element.
(b) If the ERS Action Code is in the "600" series and the return is a remittance, press <ENTER> followed by <F6> after this element and proceed to Section 03.
(c) If a "G" Condition Code is present and the return is a remittance, press <ENTER> followed by <F6> after E–3, then proceed to Section 03.
(3) Audit Code LN2 <ENTER> Enter the edited digit from Line 2, Form 5800.
(4) CAF Code LN3 <ENTER> Enter the edited digit from Line 3, Form 5800.
(5) Correspondence Code LN4 <ENTER> Enter the edited digits from Line 4, Form 5800.
(6) Correspondence Received Date LN5 <ENTER> Enter the edited digits from Line 5, Form 5800, in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(7) Penalty and Interest Code LN6 <ENTER> Enter the edited digit from Line 6, Form 5800.
(8) Daily Delinquency Penalty LN7 <ENTER> Enter the amount from Line 7, Form 5800.
Exhibit 3.24.12-274

Form 5227 - Section 03

Form 5227 - Section 03
3.24.12 - 269 SECTION 03
Source Document or Record: Form 5227 - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "03" .
(2) Remittance Amount RMT <ENTER> Enter the edited amount shown in the margin at the top of the return.
(a) Check the control document (813) for correct amount in case of illegibility.
(b) Enter the RPS amount printed on the upper right corner of the return ONLY if underlined in green.
(c) If a "G" Condition Code is present, end the document after this element.
(d) This is a MUST ENTER if Pre-journalized Credit Amount E–(5), Block Header, was entered.
(e) The error message INVALID DATA appears if there is an amount in this field and no entry for Pre-journalized Credit Amount in the Block Header.
(3) Fair Market Value BOXC $ <ENTER>
MINUS (−)		 Enter the amount from Box D.
(4) Gross Income BOXD $ <ENTER>
MINUS (−)		 Enter the amount from Box E.
(5) Total Ordinary Income LN8 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 8.
(6) Total Capital Gain (loss) L13 $ <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 13.
(7) Total Deductions L22 $B <ENTER>
MINUS (−)		 Enter the amount from Part I, Line 22.
(8) Total Distributions of Principal PTIII1 $ <ENTER>
MINUS (−)		 Enter the amount This is a dollar field only from Form 5227, Part III, Section A, Line 4.
(9) Total Distributions of Income PTIII9 $ <ENTER>
MINUS (−)		 Enter the amount This is a dollar field only from Form 5227, Part III, Section B, Line 9.
(10) Total Assets (EOY) PTIV13B <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 13, Column (b).
(11) Total Assets (FMV) PTIV13C <ENTER>
MINUS (-)		 Enter the amount from Part IV, Line 13, Column (c).
(12) Total Liabilities (EOY) PTIV 19B <ENTER>
MINUS (−)		 Enter the amount from Part IV, Line 19, Column (b).
(13) Total Annual Annuity PTIV23B <ENTER>
MINUS (−)		 Enter the amount from Part V, Line 1b.
(14) NICRUT PTVL2 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 1.
(15) NIMCRUT PTVL3 <ENTER> Enter a yes or no from the yes/no box from Part VI, Line 2
(16) Unitrust Amount PTVL5B <ENTER>
MINUS (−)		 Enter the amount from Part VI, Line 4b.
Exhibit 3.24.12-275

Form 5227 - Section 04

Form 5227 - Section 04
3.24.12 - 270 SECTION 04
Source Document or Record: Form 5227 - Section 04
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "04" .
(2) Engage in the Sale? PTVIIA1 <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1a(1).
(3) Borrow Money from? PTVIIA2 <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1a(2).
(4) Furnish Goods? PTVIIA3 <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1a(3).
(5) Pay Compensation? PTVIIA4 <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1a(4).
(6) Transfer any of your Income? PTVIIA5 <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1a(5).
(7) Agree to Pay Money? PTVIIA6 <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1a(6).
(8) Fail to Qualify Under Exceptions? PTVIIIB <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1b.
(9) Engage in Prior Year? PTVIIIC <ENTER> Enter a yes or no from the yes/no box from Part VIII, Line 1d.
(10) Income Interest Expired? PTIX1 <ENTER> Enter a "1" if the box in Part IX, Line 1 is checked.
(11) Making an Election Under Regulation PTIXI2 <ENTER> Enter a yes or no from the yes/no box from Part IX, Section D, Line 12.
(12) Initial Return PTIXI3 <ENTER> Enter a yes or no from the yes/no box from Part IX, Section D, Line13.
(13) Trust Instrument Amended? PTIXI4 <ENTER> Enter a yes or no from the yes/no box from Part IX, Section D, Line 14.
(14) Final Distributions Made? D15a <ENTER> Enter a yes or no from the yes/no box from Part IX, Section D, Line 15a.
Exhibit 3.24.12-276

Form 5227 - Section 05

Form 5227 - Section 05
3.24.12 - 271 SECTION 05
Source Document or Record: Form 5227 - Section 05
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter "05" .
(2) Accum. Dist. from Ordinary Excluded Income 2B(A)1 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 2b, Column (a) ordinary excluded income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(3) Distributions from Ordinary Accumulated NII Income 2B(A)2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 2b, Column (a), ordinary accumulated NII income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(4) Dist. from Capital Gain Excluded Income 2B(B)1 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 2b, Column (b) capital gain excluded income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(5) Distributions form Capital Gain Accumulated NII Income 2B(B)2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 2b, Column (b), capital gain accumulated NII income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(6) Distributions from Nontaxable Excluded Income 2B(C)1 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 2b, Column (c), nontaxable excluded income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(7) Distributions from Nontaxable Accumulated NII Income 2B(C)2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 2b, Column (c), nontaxable accumulated NII income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(8) Undist. Excluded Ordinary Income 3(A)1 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 3, Column (a) ordinary excluded income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(9) Undistributed Accumulated NII Ordinary Income 3A2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 3, Column (a), accumulated NII income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(10) Undist. Capital Gains Excluded Income 3(B)1 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 3, Column (b), capital gains excluded income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(11) Undistributed Capital Gains Accumulated NII Income 3B2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 3, Column (b), capital gains accumulated NII income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(12) Undistributed Nontaxable Excluded Income 3C1 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 3, Column (c), nontaxable excluded income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(13) Undistributed Nontaxable Accumulated NII Income 3C2 $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part I, Line 3, Column (c), nontaxable accumulated NII income. Enter only the money amount in the first excluded column for 2012 and prior year returns.
(14) Simplified Net Investment Income Current Year L4B $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (b), current year NII.
(15) Simplified Net Investment Income Distributions L4C $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (c), distributions.
(16) Simplified Net Investment Ending NII L4D $ <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part II, Line 1, Column (d), ending NII.
(17) Additional Assets Contributed LV1 <ENTER> Enter a yes or no from the yes/no box from Schedule A, Part V, Line 1.
(18) Total Fair Market Value of Assets LV4C <ENTER>
MINUS (-)		 Enter the amount from Schedule A, Part V, Line 4, total.
(19) Early Termination Agreement Signed? LV5 <ENTER> Enter a yes or no from the yes/no box from Schedule A, Part V, Line 5.
Exhibit 3.24.12-277

Form 5227 - Section 13, Form 8995/8995A

Form 5227, Section 13, Form 8995/8995A
3.12.24 - 272 Section 13
Source Document or Record: Form 5227 - Section 13, Form 8995/8995A
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Press <ENTER> if already present on the screen; otherwise enter 13.
(2) Part IV Qualified Business Income L5/L27 <ENTER> Enter the amount from Line 5 or Line 27 as follows:

  1. Enter the amount from Form 8995 Line 5, if present and press Enter.

  2. Enter the amount from Form 8995-A, Part IV, Line 27, if present and press Enter.
(3) Part IV REIT/PTP Component L9/L31 <ENTER> Enter the amount from Line 9 or Line 31 as follows:

  1. Enter the amount from Form 8995, Line 9, if present and press Enter.

  2. Enter the amount from Form 8995-A, Part IV, Line 31 if present and press Enter.
(4) Part IV Net Capital Gains L12/L34 <ENTER> Enter the amount from line 12 or line 34 as follows:

  1. Enter the amount from Form 8995 line 12, if present, and press Enter.

  2. Enter the amount from Form 8995-A Part IV line 34, if present, and press Enter.
(5) Part IV Domestic Production Activities Section 199A(g) L38 <ENTER> Enter the amount from Form 8995-A Part IV line 38.
Exhibit 3.24.12-278

Form 5578 - Section 01

Form 5578 - Section 01
3.24.12 - 273 SECTION 01
Source Document or Record: Form 5578 - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> Section "01" always generates. No entry required.
(2) Serial Number SER# <ENTER> Enter the last two digits of the 13-digit DLN from the upper portion of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1), verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If the Check Digit isn't present, enter the Name Control. See IRM 3.24.12.2.5.
(5) E.I.N. EIN <ENTER>
☆☆☆☆☆☆		 Enter the E.I. Number from the preprinted label or from E.I. Number block.
(a) See standard rules in IRM 3.24.38.
(b) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Tax Period TAXPR <ENTER> Enter in YYMM format the Tax Period edited or underlined under "title of form" .
(a) If not edited or underlined, press <ENTER> only.
(b) See IRM 3.24.38 for special instructions.
(7) Condition Code CC <ENTER> Enter the edited code as shown in the upper right corner of the return. If illegible, enter a "#" .
Exhibit 3.24.12-279

Form 5768 - Section 01 (Program 15502)

Form 5768 - Section 01 (Program 15502)
3.24.12 - 274 SECTION 01
Source Document or Record: Form 5768 - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT:   Section "01" always generates. No entry required.
(2) Serial Number SER# <ENTER> Enter the last 2 digits of the 13 digit DLN from the DLN box, upper right margin or top center margin of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1) verify it matches the document being entered.
(3) Name Control NC <ENTER> Enter the Name Control as follows:
(a) Enter the 4 character Name Control underlined or edited in the first name line area.
(b) If less than 4 characters, enter those shown followed by <ENTER>.
(c) If Name Control is illegible, enter 1 period and <ENTER>.
(4) EIN TIN Auto Enter the 9 digit number from the area labeled "EIN" , or "Employer Identification Number" on the form.
(a) If two account numbers are shown, enter 9 periods.
(b) See standard rules in IRM 3.24.38.
(c) NOTE 1: E–(5) thru (8) must be present for Document 00.
(d) NOTE 2: If E–(5) thru (11) are the same as the previous document, press <F6> after the EIN/SSN.
(5) MFT Code MFT <ENTER> Enter the MFT Code as follows:
(a) Form 5768 - enter "00" .
(b) If illegible or missing, enter a zero (0) and <ENTER>.
(6) Report/Plan Number RPT# <ENTER> Enter the edited 3 digit code shown to the right of the MFT Code.
(a) If MFT is 46 or 76, then "RPT#" is a "MUST ENTER" field.
(b) If not present, enter one zero (0) and press <Enter>.
(7) Tax Period TAXPR <ENTER> Enter the four digits in YYMM format.
(a) Form 5768 - enter "0000" .

(b) For special instructions, see IRM 3.24.38.
(8) Transaction Code CODE <ENTER> Enter the three digit Transaction Code from Line 1 or 2 left margin.
(a) If illegible or missing, enter "000" .
(9) Transaction Date DATE <ENTER> Enter the digits from "Date Received" or "Date" in MMDDYY format. If date isn't present, illegible or incomplete, enter the earlier of today's date or 4/15/19.
(a) For special instructions, see IRM 3.24.38.
(10) Extension to Date EXT DATE <ENTER>
(a) press <ENTER> only.
(d) For special instructions, see IRM 3.24.38.
(11) EO Group Code EOGRP <ENTER> Enter the digit "7" or "8" shown in the right middle margin of the two dots.
(a) Form 5768 - press <ENTER> only.
(12) Lobby Year Code LOB YR <ENTER> Enter the 2 digits
underlined on dotted portion of Line 1 or 2 in YY format.
(a) For special instructions, see IRM 3.24.38.
(13) Account Number (TIN) Prefix ANP <ENTER> Enter the edited zero (0) if present, following the TIN.
(14) ERS Action Code ERSCD <ENTER> Enter the ERS Action Code edited on the bottom left margin of the return.
Exhibit 3.24.12-280

Form 8872 - Section 01 (Program 16010)

Form 8872 - Section 01 (Program 16010)
3.24.12 - 275 SECTION 01
Source Document or Record: Form 8872 - Section 01
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT:   Section "01" always generates. No entry required.
(2) DLN Serial Number SER# <ENTER> Enter the last 2 digits of the 13-digit DLN from the DLN box, upper right margin or top center margin of the form. If the system generates the serial number (see IRM 3.24.38.4.1.1) verify it matches the document being entered.
(3) Check Digit CD <ENTER> Enter the Check Digit if present.
(a) If not present, press <ENTER>.
(b) See IRM 3.24.12.2.5.
(4) Name Control NC <ENTER> If a Check Digit isn't present, enter the Name Control as follows:
(a) Enter the 4 character Name Control underlined or edited in the first name line area.
(b) If less than 4 characters, enter those shown followed by <ENTER>.
(c) If Name Control is illegible, enter 1 period and <ENTER>.

Note:

"ZZZZ" is valid.
(5) EIN EIN <ENTER> Enter the 9-digit number from the area labeled "EIN" , or "Employer Identification Number" on the form.
(a) If two account numbers are shown, enter 9 periods.
(b) See standard rules in IRM 3.24.38.
(c) For error message CHECK DIGIT ERROR, see IRM 3.24.12.2.5.
(6) Address Check ADDRESS CHECK <ENTER> Enter "Y" or "N" as appropriate.
(7) Street Key STREET KEY# <ENTER> See IRM 3.24.28.
(8) ZIP KEY ZIP KEY <ENTER> See IRM 3.24.38.
(9) Tax Period TAXPR <ENTER> Enter in YYMM format the edited digits to the left of the OMB Number.
(a) For special instructions, see IRM 3.24.38.
(10) Condition Codes CCC <ENTER> Enter the edited codes shown on Line B.
(a) If a "G" Condition Code is present and the return is a non-remittance, end the document after the Received Date.
(11) Received Date RDATE <ENTER> Enter in MMDDYY format.
(a) For special instructions, see IRM 3.24.38.
(12) Correspondence Indicator COR <ENTER> Enter the edited digits to the right of the City/State line.
(13) Correspondence Received Date CRD <ENTER> Enter the edited digits to the right of the Correspondence Indicator.
(14) ERS Action Code ERS <ENTER> Enter the edited digits in the lower left margin of the form.
(15) Audit Code AUD <ENTER> Enter from the bottom right margin of the form.
Exhibit 3.24.12-281

Form 8872 - Section 02 (Program 16010)

Form 8872 - Section 02 (Program 16010)
3.24.12 - 276 SECTION 02
Source Document or Record: Form 8872, Section 02
Elem. Data Element Name Prompt Fld. Term. Instructions
       

Note:

1: For good labels with no changes and a solid or broken black line above and to the left of the entity area, see IRM 3.24.38.
(1) Section Number SECT: <ENTER> <ENTER> if already present on the screen; otherwise enter "02" .
(2) Street Address ADD# <ENTER> Enter the street address from the address line - Line 2.
(a) See IRM 3.24.28 for specific instructions.
(b) If a "G" Condition Code or a foreign address is present on the return, do NOT enter any of the address information, even if prompted. This occurs when a Name Control is entered.
(3) Second/Foreign Address ADD2 <ENTER> Enter the second/foreign street address, if shown. See IRM 3.24.38 for additional instructions.
(4) City CITY <ENTER> Enter the city name from the city line, or Major City Code, if appropriate.
(5) State ST <ENTER> Enter the standard state abbreviation from the city/state line (see IRM 3.24.38).
(a) If a Major City Code was entered, press <ENTER> only.
(6) ZIP Code ZIP <ENTER> Enter the ZIP Code.
Exhibit 3.24.12-282

Form 8872 - Section 03 (Program 16010)

Form 8872 - Section 03 (Program 16010)
3.24.12 - 277 SECTION 03
Source Document or Record: FORM 8872 - Section 03
Elem. Data Element Name Prompt Fld. Term. Instructions
(1) Section Number SECT: <ENTER> <ENTER> if already present on the screen; otherwise enter "03" .
(2) Type of Report LN8# <ENTER> Enter the digit edited to the right of Line 8. If missing, enter a "1" through "8" representing the box checked for "a" through "h" on Line 8.
(3) Amount of Reported Contributions LN9 $ <ENTER> Enter amount shown on Line 9.
(4) Amount of Reported Expenditures L10 $ <ENTER> Enter amount shown on Line 10.