Information Collection Request

Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

ICR 201206-1545-013 · OMB 1545-0047 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
Form 990 Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Form Unchanged Repair queued
Form Schedule R (F 990) Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Form Unchanged Available
Form Schedule N (Form 9 Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Form Unchanged Repair queued
Form Schedule M (F 990) Schedule M - Non-Cash Contributions Form Unchanged Repair queued
Form Schedule L (Form 9 Schedule L - Transactions with Interested Persons Form Unchanged Repair queued
Form Schedule K (Form 9 Schedule K - Supplemental Information on Tax Exempt Bonds Form Unchanged Repair queued
Form Schedule J (F 990) Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Form Unchanged Repair queued
Form Schedule I (Form 9 Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Form Unchanged Repair queued
Form Schedule H (F 990) Schedule H - Hospitals Form Unchanged Available
Form Schedule G (Form 9 Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Form Unchanged Repair queued
Form Schedule F (Form 9 Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Form Unchanged Repair queued
Form Schedule E (F 990) Schedule E - Schools Form Unchanged Available
Form Schedule D (Form 9 Schedule D - Supplemental Financial Statements Form Unchanged Available
Form 990 Sch. C Schedule C - Political Campaign and Lobbying Activities Form Unchanged Repair queued
Form Schedule B (Form 9 Schedule B - Schedule of Contributors Form and Instruction Unchanged Repair queued
Form Schedule A (Form 9 Schedule A - Public Charity Status and Public Support Form Unchanged Available
IRS Schedule H letter (#3 final).pdf Supplementary Document Uploaded 2012-05-15 Available
990 sch. H (2010).pdf Supplementary Document Uploaded 2012-05-15 Repair queued
Supporting Statement (6-20-12).doc Supporting Statement A Uploaded 2012-06-25 Available
Expiration Explanation.rtf Supplementary Document Uploaded 2010-07-22 Available
IC Document Collections
IC IDCollectionTypeStatusForm
39403 Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Form Unchanged
202829 REG-130266-11 (NPRM) Section 501(r)--Additional Requirements for Certain Hospitals New
184772 Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Form Unchanged
184771 Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Form Unchanged
184770 Schedule M - Non-Cash Contributions Form Unchanged
184769 Schedule L - Transactions with Interested Persons Form Unchanged
184768 Schedule K - Supplemental Information on Tax Exempt Bonds Form Unchanged
184767 Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Form Unchanged
184765 Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Form Unchanged
184764 Schedule H - Hospitals Form Unchanged
184763 Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Form Unchanged
184762 Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Form Unchanged
184753 Schedule E - Schools Form Unchanged
184752 Schedule D - Supplemental Financial Statements Form Unchanged
184751 Schedule C - Political Campaign and Lobbying Activities Form Unchanged
184750 Schedule B - Schedule of Contributors Form and Instruction Unchanged
184749 Schedule A - Public Charity Status and Public Support Form Unchanged
ICR Details
1545-0047 201206-1545-013
Historical Inactive 201205-1545-005
TREAS/IRS EC-1545-0047-061
Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)
Revision of a currently approved collection   No
Regular
Withdrawn and continue 04/11/2013
Retrieve Notice of Action (NOA) 06/26/2012
  Inventory as of this Action Requested Previously Approved
11/30/2012 36 Months From Approved 04/30/2014
403,068 0 403,068
25,766,156 0 25,766,156
0 0 0

Form 990 is needed to determine that IRC section 501(a) tax-exempt organizations fulfill the operating conditions within the limitations of their tax exemption. REG-130266-11(NPRM) These regulations describe the requirements that charitable hospitals must satisfy under Section 501(r) of the Internal Revenue Code.

US Code: 26 USC 501 Name of Law: Exemption from tax on corporations, certain trusts, etc.
   US Code: 26 USC 527 Name of Law: Political organizations
   US Code: 26 USC 6033 Name of Law: Returns by exempt organizations
   US Code: 26 USC 4947 Name of Law: Application of taxes to certain nonexempt trusts
  
US Code: 26 USC 501(r) Name of Law: Additional Requirements for Certain Hospitals

1545-BK57 Proposed rulemaking 77 FR 38147 06/26/2012

No

17
IC Title Form No. Form Name
Schedule C - Political Campaign and Lobbying Activities 990 Sch. C Polical Campaign and Lobbying Activities
Schedule N - Liquidation, Termination, Dissolution or Significant Disposition of Assets; Schedule N-1 - Continuation Sheet of Schedule N Schedule N-1, Schedule N (Form 990 or 990-EZ) Liquidation, Termination, Dissolution or Significant Disposition of Assets ,   Continuation Sheet of Schedule N
Schedule H - Hospitals Schedule H (F 990) Hospitals
Schedule I - Grants and Other Assistance to Organizations...; Schedule I-1- Continuation Sheet for Schedule I Schedule I (Form 990), Schedule I-I (Form 990) Grants and Other Assistance to Organizations, Governments and Individuals in the U.S. ,   Continuation Sheet for Schedule I (Form 990)
Schedule F - Statement of Activities Outside the United States; Schedule F-1 - Continuation Sheet for Schedule F Schedule F (Form 990), Schedule F-1 (Form 990) Statement of Activities Outside the United States ,   Continuation Sheet for Schedule F
Schedule R - Related Organizations and Unrelated Partnerships; Schedule R-1 - Continuation Sheet for Schedule R Schedule R (F 990), Schedule R-1 (F 990) Related Organizations and Unrelated Partnerships ,   Continuation Sheet for Schedule R
Schedule K - Supplemental Information on Tax Exempt Bonds Schedule K (Form 990) Supplemental Information on Tax Exempt Bonds
Schedule L - Transactions with Interested Persons Schedule L (Form 990 or 990-EZ) Transactions with Interested Persons
Schedule M - Non-Cash Contributions Schedule M (F 990) Non-Cash Contribution
Schedule J - Compensation Information; Schedule J-1 - Continuation Sheet for Sch J-1; Schedule J-2 - Continuation Sheet for Form 990 Schedule J (F 990), Schedule J-1 (F 990), Schedule J-2 (F 990) Compensation Information ,   Continuation Sheet for Sch J ,   Continuation Sheet for Form 990
Schedule A - Public Charity Status and Public Support Schedule A (Form 990 or 990EZ) Public Charity Status and Public Support
Schedule B - Schedule of Contributors Schedule B (Form 990) Schedule of Contributors
Schedule E - Schools Schedule E (F 990) Schools
Return of Organization Exempt From Income Tax ...; Schedule O - Supplemental Information to Form 990 Schedule O, 990 Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ,   Supplemental Information to Form 990
Schedule G - Supplemental Information Regarding Fundraising or Gaming Activities Schedule G (Form 990 or 990-EZ) Supplemental Information Regarding Fundraising or Gaming Activities
Schedule D - Supplemental Financial Statements Schedule D (Form 990) Supplemental Financial Statements
REG-130266-11 (NPRM) Section 501(r)--Additional Requirements for Certain Hospitals

No
No
There is an increase in total burden hours due to requirements under The Affordable Care Act of 2010 as further described in the proposed regulations in §§1.501(r)-4 and 501(r)-6(c). The collection of information flows from section 501(r)(4) of the Internal Revenue Code (Code), which requires hospital organizations to establish a written financial assistance policy and a written policy related to care for emergency medical conditions, and section 501(r)(6), which requires a hospital organization to make reasonable efforts to determine whether an individual is eligible for assistance under a financial assistance policy before engaging in extraordinary collection actions against that individual. The expected recordkeepers are hospital organizations described in sections 501(c)(3) and 501(r)(2).

$20,000
No
No
Yes
No
No
Uncollected
Bruce Lewis 2022830662 ext. 0662

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/26/2012