Dialysis Clinic, Inc. v. Levin, 127 Ohio St. 3d 215

DCI sought a charitable-use property exemption for its West Chester dialysis facility; the tax commissioner denied it, and the BTA affirmed the denial.
DCI is a Tennessee nonprofit organized as a 501(c)(3) entity whose charter prohibits profit and directs excess revenue to kidney research and subsidy of services.
West Chester facility is 9,846 square feet; DCI treats predominantly Medicare/Medicaid patients and writes off some bad debt; DCI’s indigency policy states it is not a charity and reserves the right to refuse treatment to those unable to pay.
Medicare/Medicaid payments cover most patient costs; the record shows most patients have some pay source, with write-offs constituting a small fraction of charges nationwide.
The BTA concluded DCI did not qualify as a charitable institution under R.C. 5709.121(A)(2) and that the West Chester facility was not used exclusively for charitable purposes under R.C. 5709.12(B); the court affirmed the BTA’s decision.
The dissent would have reversed, finding charity based on non-discrimination and actual treatment of indigent patients, but the majority affirmed the BTA.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether DCI qualifies as a charitable institution under R.C. 5709.121(A)(2).	DCI argues nonprofit medical care fulfills charity; 501(c)(3) status supports charitable status.	BTA concluded owner’s charitable status must be based on activities, not solely 501(c)(3) status, and DCI’s indigency policy undermines nondiscrimination.	No; DCI not a charitable institution under 5709.121(A)(2).
Whether the West Chester facility’s use is exclusively charitable under R.C. 5709.12(B).	West Chester provides care to those in need and should be used exclusively for charitable purposes.	Facility operates with market charges and lacks unreimbursed care evidence; indigency reservation undermines exclusivity.	No; West Chester not used exclusively for charitable purposes.
Whether a minimum unreimbursed care threshold is required for exemption.	No fixed threshold is required; charity can be shown by nondiscriminatory care and overall charitable activities.	Some unreimbursed care is required to demonstrate charity; the record shows minimal unreimbursed care.	No minimum threshold required; however, record supports denial based on overall factors.
What is the proper standard of review for BTA’s charitable-use determination?	Review should assess charity status and use on the property, not defer to BTA on every factual point.	Review is for reasonableness and lawfulness of BTA’s determinations.	Affirmed; BTA acted reasonably and lawfully.

First Baptist Church of Milford v. Wilkins, 110 Ohio St.3d 496 (2006-Ohio-4966) (expands on the intent behind 5709.121; ownership and use need not coincide)
OCLC Online Computer Library Ctr., Inc. v. Kinney, 11 Ohio St.3d 198 (1984) (rejects vicarious exemptions; use of property must be charitable)
Church of God in N. Ohio, Inc. v. Levin, 124 Ohio St.3d 36 (2009-Ohio-5939) (set standard: charitable services in nonprofit healthcare to those in need qualify)
Northeast Ohio Psych. Inst. v. Levin, 121 Ohio St.3d 292 (2009-Ohio-583) (reiterates charitable-use standards tied to owner’s activities)
O’Brien v. Physicians’ Hosp. Assn., 96 Ohio St.1 (1917) (recognizes indigent access without denying usual indigent patients; context for healthcare exemption)
Cleveland Osteopathic Hosp. v. Zangerle, 153 Ohio St.222 (1950) (discusses non-profit vs. for-profit use of hospital property)
Bethesda Healthcare, Inc. v. Wilkins, 101 Ohio St.3d 420 (2004-Ohio-1749) (distinguishes exclusive public access versus restricted exemptions)