Requirements for 501(c)(3) Hospitals Under the Affordable Care Act – Section 501(r)


The Patient Protection and Affordable Care Act (the ACA), enacted March 23, 2010, added new requirements codified under Section 501(r) for organizations that operate one or more hospital facilities (hospital organizations) to be described in Section 501(c)(3), as well as new reporting requirements and a new excise tax.

A hospital facility is a facility that is required by a state (including only the 50 states and the District of Columbia) to be licensed, registered, or similarly recognized as a hospital.  Multiple buildings operated under a single state license are considered to be a single hospital facility.

In addition to the general requirements for tax exemption under Section 501(c)(3) and Revenue Ruling 69-545 PDF, hospital organizations must meet the requirements imposed by Section 501(r) on a facility-by-facility basis in order to be treated as an organization described in Section 501(c)(3). These additional requirements are:

  1. Community Health Needs Assessment (CHNA) - Section 501(r)(3),
  2. Financial Assistance Policy and Emergency Medical Care Policy - Section 501(r)(4),
  3. Limitation on Charges - Section 501(r)(5), and 
  4. Billing and Collections - Section 501(r)(6).

These provisions apply to taxable years beginning after the date of enactment of the ACA, except for the CHNA requirements, which apply to taxable years beginning after March 23, 2012.

Final regulations were released on December 29, 2014. For the requirements under Section 501(r), the regulations apply to tax years beginning after December 29, 2015, and this publication reflects those rules. For tax years beginning on or before December 29, 2015, the final regulations provide that a hospital facility may rely on a reasonable, good faith interpretation of Section 501(r). A hospital will be deemed to have operated in accordance with a reasonable, good faith interpretation of Section 501(r) if it complied with provisions of previously issued proposed regulations or the final regulations.

In general, a hospital organization’s failure to meet the requirements of Section 501(r) with respect to one or more hospital facilities it operates may result in revocation of the organization’s tax-exempt status as an organization described in Section 501(c)(3). See Consequence of Non-compliance with Section 501(r) for more information.

A hospital organization uses Form 990, Schedule H, Hospitals, to provide information on the activities and policies of, and community benefit provided by, its hospital facilities and other non-hospital health care facilities that it operated during the tax year. See Section 501(r) Reporting for more information on the reporting requirements of hospital organizations and government hospital organizations.