1. (a) Any health care charitable trust for which compliance with the annual community benefits plan reporting requirement would be a financial or administrative burden may request that the director grant an exemption for 3 years by completing and filing Form NHCT-32 “Community Benefits Plan Application for Exemption,” effective September 2022, available online at www.doj.nh.gov/charitable-trusts/forms.htm.

2. (b) The director shall grant an exemption from the annual community benefits plan reporting requirement for 3 years if the health care charitable trust demonstrates that it meets the following criteria:

   1. (1) The health care charitable trust serves a specifically defined and very limited segment of the population and provides no health care services to the community at large;

   2. (2) The cash assets of the health care charitable trust are valued at less than $100,000.00, and:

      1. a. The financial resources of the health care charitable trust would be negatively impacted by the obligation to prepare annual community benefits plans; and
      2. b. It is not possible to enter into a collaboration with another health care charitable trust for the purpose of preparing a community benefits plan; or

   3. (3) The health care charitable trust does not have sufficient paid staff, volunteers, or other resources available to prepare the community benefits plan, and:

      1. a. It does not have sufficient financial resources available to engage the services of an outside entity for the purposes of preparing the community benefits plan; and
      2. b. It is not possible to enter into a collaboration with another health care charitable trust for the purpose of preparing a community benefits plan.

3. (c) Any health care charitable trust seeking an exemption under Jus 415.04(a) shall supply with Form NHCT-32 “Community Benefits Plan Application for Exemption” the following:

   1. (1) If the health care charitable trust seeks an exemption under Jus 415.04(b)(1), copies of the health care charitable trust’s mission statement, articles of agreement, bylaws, and other governing documents;

   2. (2) If the health care charitable trust seeks an exemption under Jus 415.04(b)(2):

      1. a. Copies of the health care charitable trust’s mission statement, articles of agreement, bylaws, and other governing documents; and
      2. b. Copy of the health care charitable trust’s Internal Revenue Service Form 990, Internal Revenue Service Form 990-EZ, audited financial statement, or other financial report for the most recent accounting period;

   3. (3) If the health care charitable trust seeks an exemption under Jus 415.04(b)(3):

      1. a. Copies of the health care charitable trust’s mission statement, articles of agreement, bylaws, and other governing documents;
      2. b. Copy of the health care charitable trust’s Internal Revenue Service Form 990, Internal Revenue Service Form 990-EZ, audited financial statement, or other financial report for the most recent accounting period; and
      3. c. An organizational chart showing all paid full- and part-time positions.
4. (d) Form NHCT-32 “Community Benefits Plan Application for Exemption” shall be signed by the presiding officer or treasurer of the governing board under penalty of false written statement in accordance with RSA 641:3 and RSA 641:8.
5. (e) Form NHCT-32 “Community Benefits Plan Application for Exemption” shall be submitted to the charitable trusts unit online at www.doj.nh.gov/charitable-trusts/forms.htm.

Source. #13455, eff 10-7-22; ss by #14162, eff 12-27-24