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Tax-Exempt Status and Integrated Delivery Systems

Published online by Cambridge University Press:  01 January 2021

Lisa C. Choi
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Extract

Within the health care industry, the move from regulatory cost controls to market competition has generated rapid and dramatic restructuring of providers. To enhance their competitive positions in the evolving market, many health care organizations are pursuing the ownership and integration of all elements and stages of health care delivery and payment, with the goal of increasing access to capital and lowering costs through administrative efficiencies and economies of scale. As of July 1994, 24 percent of hospitals were members of an integrated delivery system (IDS), and 47 percent were involved in IDS development.

IDSs pose a singular challenge to the Internal Revenue Service (IRS). The IRS recognizes that its traditional policies for granting tax exempt status are not flexible enough for the competitive and rapidly changing health care market. In recent years, the IRS has taken a more active role in scrutinizing emerging health care institutions seeking taxexempt status.

Type
Recent Developments in Health Law
Information
Journal of Law, Medicine & Ethics , Volume 23 , Issue 4 , Winter 1995 , pp. 403 - 406
Copyright
Copyright © American Society of Law, Medicine and Ethics 1995

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References

“Integrated Delivery Systems,” Health News Daily, July 26, 1994.Google Scholar
I.R.C. § 501(a) (Supp. 1995).Google Scholar
I.R.C. §§ 141, 145 (Supp. 1995).Google Scholar
I.R.C. § 170 (Supp. 1995).Google Scholar
Revenue rulings, general counsel memoranda, IRS educational texts published, and private letter rulings may not be cited as precedent under I.R.C. § 6110(j)(3), though they may provide guidance.Google Scholar
Treas. Reg. § 1.501(c)(3)-1 (as amended in 1990).Google Scholar
Rev. Rul. 69-545, 1969–2 C.B. 117.CrossRefGoogle Scholar
Rev. Rul. 83-157, 1983-2 C.B. 94.CrossRefGoogle Scholar
See Kaiser, C.F. Reilly, J.F., “Integrated Delivery Systems,” in Exempt Organizations Continuing Professional Education Technical Instruction Program Textbook (IRS Exempt Orgs. Technical Div., 1993 (for FY 1994)): At 224.Google Scholar
Treas. Reg. § 1.501(c)(3)-1(d)(1) (as amended in 1990).Google Scholar
Gen. Counsel Mem. 39,670 (June 17, 1987).Google Scholar
This 20 percent “safe harbor” rule was arbitrarily chosen by the IRS for “ease of administration” and for compliance with tax-exempt bond financing requirements. See Kaiser, Reilly, , supra note 9, at 227. Rev. Proc. 93-19, 1993-11 I.R.B. 52 states that the for-profit provider must not have more than 20 percent control on the board of an exempt organization issuing tax-exempt bonds.Google Scholar
See Kaiser, Reilly, , supra note 9; and Kaiser, C.F. Reilly, J.F., Exempt Organizations Continuing Professional Education Technical Instruction Program Textbook (IRS Exempt Orgs. Technical Div., 1994 (for FY 1995)).Google Scholar
Priv. Ltr. Rul. (Sept. 29, 1994) in Exempt Orgs. Tax Rev., June 1994, at 1323. See generally Exempt Orgs. Tax Rev., May 1995, at 1015.Google Scholar
This venture fell apart shortly after the ruling was issued, apparently due to the lack of physician board representation and control. See Hosfeld, V.N., “Integrated Delivery Systems—The ‘Promised Land’ of Health Care: Obtaining a Federal Income Tax Exemption as a Nonprofit Organization Under Section 501(c)(3) of the Internal Revenue Code,” Univ. Dayton L. Rev., 20 (1994): 203–42.Google Scholar
Priv. Ltr. Rul. (Jan. 29, 1993) in Exempt Orgs. Tax Rev., Mar. 1993, at 490.Google Scholar
See Exempt Orgs. Tax Rev., May 1993, at 828 for the Facey ruling; and see Exempt Orgs. Tax Rev., Mar. 1994, at 719 for the Harriman Jones ruling.Google Scholar
See Hosfeld, , supra note 15.Google Scholar
Id.Google Scholar
Boisture, R., “Health Reform Speeds Shift to Tax-Exempt Integrated Managed Care Plans,” HealthSpan, 11, no. 5 (1994): At 3.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Castro, A.I., “Overview of the Tax Treatment of Nonprofit Hospitals and Their For-Profit Subsidiaries: A Short-Sighted View Could Be Very Bad Medicine,” Pace L. Rev., 15 (1995): 501–38.Google Scholar
Exempt Orgs. Tax Rev., June 1994, at 1307 (The IRS revoked the § 501(c)(3) status of LAC Facilities, Inc., a Miami hospital. The revocation was based on private inurement to insiders).Google Scholar
See generally, Boisture, , supra note 20, at 3.Google Scholar