The Law of Tax-Exempt Healthcare Organizations. Bruce R. Hopkins

insurance described in the Code and it did not provide insurance substantially below cost or limit the insurance to a class of charitable recipients. With regard to the question of substantiality, the IRS noted that the entity planned to devote 100 percent of its efforts toward establishing and marketing its insurance program in its first year of operations, and would spend 50 percent of its total activities on its insurance program in the second through fourth years of operation. Even after it was established, the entity planned to spend 30 percent of its total activities on its insurance program. Based on applicable case law, the IRS concluded that these amounts are substantial. Furthermore, 94 percent of the entity's revenue was slated to come from insurance sales and 94 percent of its expenses were planned for payments for the healthcare expenses of its insureds. Accordingly, the provision of commercial‐type insurance was deemed substantial, which precluded the entity from securing exemption as a charitable organization.

NOTES

      1 ^145.1 EO Update, October 13, 2017.

      2 ^145.2 “Audit Technique Guide—Other 501(c)(3) Organizations,” https://www.irs.gov/pub/irs-tege/atg_hmo.pdf.

      3 ¹⁴⁹ Priv. Ltr. Rul. 201538027.

      4 ¹⁵⁰ See § 24.24.

      5 ¹⁵¹ See IRC § 501(c)(29).

      6 ¹⁵² Priv. Ltr. Rul. 201451033.

      7 ¹⁵³ Priv. Ltr. Rul. 202015035.