## Facts

- Federal tax law granted favorable treatment to organizations qualifying as “charitable” under I.R.C. § 501(c)(3), including exemption from federal income tax.
- Nonprofit hospitals could qualify for § 501(c)(3) status, but hospital status alone did not automatically satisfy the “charitable” requirement.
- In 1956, IRS Revenue Ruling 56-185 tied hospital charity status to providing care to those unable to pay “to the extent of [the hospital’s] financial ability,” and not operating exclusively for those able and expected to pay.
- In 1969, IRS Revenue Ruling 69-545 replaced that approach with a “community benefit” approach. Under the new approach, a hospital could qualify even if it provided little or no free care, so long as it, among other things, maintained an emergency room open to all regardless of ability to pay and otherwise served the community, including patients paying directly or through private insurance, Medicare, or Medicaid.
- Indigent individuals and organizations assisting indigent persons alleged that, after the 1969 ruling, some tax-exempt nonprofit hospitals refused non-emergency admissions to patients unable to pay.
- Plaintiffs sued the Secretary of the Treasury and the Commissioner of Internal Revenue in federal district court, seeking declaratory and injunctive relief invalidating Rev. Rul. 69-545.
- The government moved to dismiss on jurisdictional grounds (including sovereign immunity and standing). The district court denied dismissal and, on cross-motions for summary judgment, ruled for plaintiffs, holding that § 501(c)(3) required nonprofit hospitals seeking exemption to provide free or below-cost care to those unable to pay and that Rev. Rul. 69-545 was invalid.
- The government appealed to the U.S. Court of Appeals for the D.C. Circuit.

## Issues

1. Whether indigent individuals and organizations had Article III standing, as non-taxpayers, to challenge an IRS revenue ruling affecting hospitals’ eligibility for § 501(c)(3) exemption.
2. Whether sovereign immunity or tax-related jurisdictional limits barred a suit seeking to invalidate an IRS revenue ruling and restrain its use.
3. Whether Rev. Rul. 69-545 was a lawful interpretation of “charitable” under § 501(c)(3), or whether § 501(c)(3) required hospitals to provide free or reduced-cost care to indigent patients as a condition of exemption.

## Decision

- The D.C. Circuit held the suit was not barred by sovereign immunity in this posture, because plaintiffs alleged the federal officials acted beyond statutory authority in administering the exemption standard.
- The D.C. Circuit held plaintiffs had standing and the case was justiciable.
- On the merits, the D.C. Circuit reversed the district court’s grant of summary judgment to plaintiffs.
- The D.C. Circuit upheld Rev. Rul. 69-545 as a permissible interpretation of “charitable” under § 501(c)(3), concluding Congress had not clearly required hospitals to provide a specific level of free or below-cost care to indigent patients as the price of exemption.

## Legal Principles

- A plaintiff may seek prospective relief against federal officers notwithstanding sovereign immunity when the complaint alleges the officers acted outside their delegated authority or under an unconstitutional grant of authority (the Larson/Dugan framework).
- “Charitable” in § 501(c)(3) is a broad statutory term that can include community-oriented hospital activity grounded in charitable-trust concepts, not solely relief of the poor.
- When Congress has not imposed a clear, specific condition in the statute, the IRS may choose among reasonable constructions of “charitable” for nonprofit hospitals, and courts generally will uphold such a construction absent clear contrary statutory direction.
- A non-taxpayer challenge to an IRS policy may be heard where plaintiffs allege concrete injury connected to the policy and seek review of agency action through generally applicable judicial-review doctrines.

## Conclusion

The D.C. Circuit allowed the non-taxpayer plaintiffs to proceed past jurisdictional objections, but it rejected the district court’s view that § 501(c)(3) compelled an indigent-care requirement and held that IRS Revenue Ruling 69-545’s community-benefit standard for nonprofit hospital exemption was a permissible reading of “charitable,” reversing the summary judgment entered for plaintiffs.


Eastern Kentucky Welfare Rights Organization v. Simon, 506 F.2d 1278 (1974)