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Nonprofit hospitals and health systems

Caring for our communities -
a charge to keep

Every day of every year, America’s hospitals are on the very frontlines of care—serving the health needs of our communities—and, without exception—our poor, our disabled and our uninsured. It’s a charge that Premier’s more than 1,500 not-for-profit hospital and healthcare systems take to heart. Hospitals allied in Premier are an integral and vital part of community life, providing services and benefits that extend well beyond the campuses and clinics themselves—and well beyond necessary point-of-site care. Not-for-profit hospitals have a historic commitment to and proven track record of tending to the healthcare needs of the uninsured, as well as providing unparalleled charity care and community benefit. Premier stands in steadfast support of its member hospitals’ development of fair and compassionate policies for uninsured care—as well as their demonstrated dedication to enhancing the quality of life and health of the communities they serve.

Nonprofit Hospital Status, Charity Care/
Community Benefit: A Resource-based Toolkit


IRS issues guidance on community health needs assessment requirements (7/15/11)

IRS releases new Form 990 Schedule H instructions and delays filing for certain hospitals (3/4/11)

IRS requests comments on nonprofit hospital provisions in healthcare reform law—due July 22 (6/12/10)

IRS releases findings on nonprofit hospital community benefit and executive compensation; Grassley calls for more complete report

GAO finds variation in standards and guidance on hospitals’ community benefit

IRS releases final Form 990 instructions

Grassley releases GAO report on Medicaid DSH payments; Suggests nonprofit hospitals fail to earn public subsidies

Grassley targets nonprofit hospitals during committee hearing

IRS releases draft Form 990 instructions for comment by June 1

IRS releases Form 990 Redesign for Tax Year 2008

Senator Grassley discusses changes to Form 990 and Schedule H

Premier urges IRS to revise and delay implementation of draft Schedule H for hospitals

2007 Policy position statement

IRS releases interim report on tax-exempt hospitals and community benefit project; Senator Grassley releases staff discussion draft of non-profit hospital reforms for public comment

Baucus and Grassley call for revisions to Form 990 tailored to nonprofit hospitals

Treasury IG recommends that IRS report address community benefit

Grassley requests GAO study on nonprofit hospitals' community benefit

IRS finds widespread disclosure errors for tax-exempt sector in the area of executive compensation

CBO report says nonprofit hospitals provide more charity care than for-profits; HFMA revises guidance on reporting charity care and bad debt

GAO releases report on executive compensation practices of nonprofit hospitals

Senate Finance Committee Chairman Grassley seeks timeline for tax guidance on nonprofit hospitals

Grassley seeks increased IRS oversight of nonprofit healthcare organizations

IRS continues probe of tax-exempt hospitals

Congress passes tax reconciliation conference report without harmful nonprofit hospital provisions

Hospitals provided $27 billion in charity care in 2005; Grassley asks hospital groups to weigh in on nonprofit hospital reforms

Nonprofit hospitals under increased scrutiny: Communicating key messages to legislators and the media

Owner Initiatives

Advancing the State of the Art in Community Benefit: A Texas Health Resources (THR) Demonstration Project

Associations/Advocacy Organizations

Advancing the Alliance for Nonprofit Healthcare 

Association for Community Health Improvement 

Hospitals Caring For Communities
American Hospital Association

Institute for Community Health (see toolkit for Community Benefits Reporting) 

Independent Sector: A Coalition of leading nonprofits, foundations and corporations strengthening not-for-profit initiatives, philanthropy and citizen action

National Database of Nonprofit Organizations 

Patient-friendly Billing Project  - February 2005


GAO Report: Nonprofit Hospitals - Variation in Standards and Guidance Limits Comparison of How Hospital Meet Community Benefit Requirements - October 2008

GAO Report: Medicaid - CMS Needs More Information on the Billions of Dollars Spent on Supplemental Payments - May 2008

My Brother’s Keeper: Growing expectations confront hospitals on community benefits and charity care by PriceWaterhouseCoopers - October 2006

Balancing Margin and Mission: Hospitals Alter Billing and Collection Practices for Uninsured Patients
Center for Studying Health System Change

Tax Exempt and Government Entities Division of the IRS announced new initiatives. May focus on two areas regarding nonprofit hospitals executive compensation and community benefit standards.

Government Accountability Office report: Nonprofit, For-Profit, and Government Hospitals: Uncompensated Care and Other Community Benefits, GAO-05-743T - May 26, 2005

State reports and websites on community benefits reporting laws and requirements Institute for Community Health
Institute for Community Health

Separate charity care from referrals, HHS advises
HHS Office of the Inspector General - November 2004

Healthcare Marketing: Three Steps to Start Marketing the Mission - Dec. 2004

Hospital Care To Indigent Up 12%, Study Shows
Greater Cincinnati Health Council - October 2004 

Research Findings on the Performance of Nonprofit Hospitals
Alliance for Advancing Nonprofit Healthcare - October 2004

The High Cost of Cheap Labor: Illegal Immigration and the Federal Budget
Center for Immigration Studies - August 2004 

A Nation’s Health at Risk II: A Front Row Seat In A Changing Health Care System: Hospital Emergency Departments Treat Increased Number of Uninsured Patients
National Association of Community Health Centers - August 2004 

Centers for Medicare & Medicaid Services/Office of the Inspector General: Summary: Open door forum on hospital billing and collections
American Hospital Association - June 1, 2004

Guidance: Questions On Charges For The Uninsured
Department of Health and Human Services (HHS) - February 2004

Guidance: Hospital Discounts offered to Patients who Cannot Afford to Pay Their Hospital Bills
HHS Office of the Inspector General (OIG) - Feb. 2, 2004

Congressional Materials

Present Law and Background Relating to the Tax-exempt Status of Charitable Hospitals - Prepared by the Congressional Joint Committee on Taxation (.pdf) - September 13, 2006

Senate Finance Committee Chairman Charles Grassley (R-IA) gives speech at 2005 Independent Sector Annual Conference, CEO Summit, and announces his committee will continue looking at tax-exempt hospitals.

House Ways and Means Committee holds hearing on nonprofit hospitals. A witness list and testimony from May 26, 2005 hearing is available on the Ways and Means Committee Web site.

The Tax Exempt and Government Entities Division Strategy for Abusive Tax Avoidance Transactions Needs Further Development
September 2004—Reference Number: 2004-10-190 

Stakeholders, interested parties respond to Senate Finance Committee tax-exempt reform proposals - July 2004

Hearing: A Review of Hospital Billing and Collection Practices
U.S. House of Representatives
Energy and Commerce Subcommittee on Oversight and Investigations - June 24, 2004

Hearing: Pricing Practices of Hospitals
U.S. House of Representatives
Ways and Means Subcommittee on Oversight - June 22, 2004 

Hearing: Charity Oversight and Reform—Keeping Bad Things from Happening to Good Charities
U.S. Senate
Committee on Finance - June 22, 2004 

Bipartisan Finance staff discussion document on proposed reforms of tax-exempt organizations (including hospitals)
U.S. Senate
Committee on Finance - June 2004 


As is the purview of the sources of the following documents/tools, etc., some of the links may no longer be active, or might require paid access to archives. We apologize for any inconvenience.