Federal Requirements

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

IRS Forms

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