Community Benefit & Other Tax-Exempt Hospital Requirements reference guide
Resources
- CHA Summary of CHNA and Implementation Strategy Requirements
- Advocacy Commitment to Community Benefit
- Policy Brief: Commitment to Community Benefit
- Policy Brief: Social Determinants of Health
- Policy Brief: Health Equity
- Policy Brief: Caring for Creation
- Commonly Asked Questions About Community Benefit (Updated February 2022)
Non-for-profit hospitals like other non-profits are designated as 501(c)(3) tax-exempt charitable organizations and over time there have been additional requirements.
- Revenue Ruling 69-545
- Revenue Ruling 83-157
- Form 990, Schedule H was introduced and required tax-exempt hospitals to annually report community benefit spending and activities by Employer Identification Number (EIN).
- Patient Protection and Affordable Care Act legislation — see sections 4959, 9007 and 10903 for new requirements for tax-exempt hospitals.
- Summary of Provisions Related to Tax Exempt Hospitals in the Affordable Care Act, (March 31, 2010)
- Summary of Legal Requirements for Section 501(c)(3) Hospitals | Congressional Research Service, April, 2024
The Internal Revenue Service Form 990 is used by 501(c)(3) not-for-profit organizations to submit information required by the federal government for tax-exemption. The Form 990 is easily accessed by the public and is often reviewed by community members, policy makers, the media, and consumer advocates. The Schedule H must be completed by tax-exempt hospital organizations and reports compliance with organization-wide community benefit standards, financial assistance and other requirements. Both Form 990 and Schedule H present an opportunity to tell the community benefit story and to document that not-for-profit health care organizations are fulfilling their tax-exempt purpose.
- Revised 990 core form
- Instructions for Form 990
- Schedule H
- Schedule H Instructions and Worksheets
- Governance and Tax-Exempt Organizations – Examination Materials — a checklist and guidesheet used by IRS' Exempt Organizations Examination agents to capture data about governance practices and the related internal controls of organizations being examined.
IRS Rulemaking
- 12/18/15 – IRS Guidance on Reporting Housing Improvements on Schedule H — see December 18, 2015 Update
- 03/10/15 — Revenue Procedure — Guidance regarding correction and disclosure procedures for hospital organizations to follow so that certain failures to meet the requirements of § 501(r) of the Internal Revenue Code will be excused for purposes of § 501(r)(1) and 501(r)(2)(B).
- 12/31/14 — Final Regulations — Additional Requirements for Charitable Hospitals; Community Health Needs Assessments for Charitable Hospitals; Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return
- Hilltop Institute, Community Benefit State Law Profiles — a compilation of each state's community benefit laws and regulations, analyzed in the context of the ACA's community benefit framework
- Legal Requirements for Section 501(c)(3) Hospitals | Congressional Research Service, April 15, 2024
- The U.S. Government Accountability Office (GAO) in October, 2020 released a report on its study of IRS enforcement of hospital tax exemption requirements. The GAO was asked by Congress to review IRS's enforcement of requirements for tax-exempt hospitals. The report assesses IRS oversight of how tax-exempt hospitals provide community benefits and the enforcement of the Affordable Care Act requirements for tax-exempt hospitals. The report makes one recommendation for Congress and four for the Internal Revenue Service.
- IRS issues extension to Dec. 31, 2020 for CHNAs and Implementation Strategies (July 14, 2020)
- Joint Letter to IRS on CHNA Extension (July 7, 2020)
- IRS extends due date for CHNAs and Implementation Strategies (April 9, 2020)
- CHA Requests Extension of Six Months to File 990 (March 31, 2020)
- Charles Rettig Letter to Finance Committee on IRS Section 501(r) (April 11, 2019)
- Report to Congress on Private Tax-Exempt, Taxable, and Government-Owned Hospitals (May 2018)
- Hatch, Grassley Press IRS for Answers on Nonprofit Hospitals, (Feb. 15, 2018)
- Chairman of Senate Judiciary Committee letter to IRS Commissioner calling for greater oversight of tax-exempt hospital billing and collection practices (June 6, 2016)
- Chairman’s letter to Senate Judiciary Committee regarding investigation into hospital billing and collection practices (May 24, 2016)
- Assessing Reality in Healthcare Financial Information, Healthcare Financial Management Association, April 14, 2023
- Healthcare Blame Game: How news outlets mishandled a medical debt study, Healthcare Financial Management Association (April 3, 2023)
- Community Catalyst releases report "Hospitals Investing in Health: Community Benefit in Massachusetts," October 2016
- "Provision of Community Benefits by Tax-Exempt U.S. Hospitals." Gary J. Young, J.D., Ph.D., Chia-Hung Chou, Ph.D., Jeffrey Alexander, Ph.D., Shoou-Yih Daniel Lee, Ph.D., and Eli Raver. New England Journal of Medicine 2013; 368:1519-1527
- Beyond Charity Care: Mission Matters for Tax-Exempt Health Care, J. David Seay, Esquire, The Catholic Health Association, 2007
- Why Nonprofits Matter in American Medicine: A Policy Brief, Nonprofit Sector Research Fund: Working Paper Series, 2005