Part III. Enter in column (a) the names of all fund managers

who agreed to make the distribution conferring the prohibited benefit. If more than one fund manager is listed in column (a) for one distribution, each is individually liable for the entire tax for that distribution. However, the fund managers who are liable for the tax may prorate the payment among themselves. Enter in column (c) the tax each donor advisor, or related person will pay for each distribution for which such donor, donor advisor, or related person owes a tax.

A fund manager filing this Form 4720 should carry the total amount in Schedule L, Part III, column (d) to Part II, line 9.

General Instructions

Requirements. Section 4959 imposes an excise tax on hospital organizations that fail to meet the section 501(r)(3) requirements in any tax year.

Section 501(r)(3) requirements pertain to a hospital organization conducting a community health needs assessment (CHNA). The requirements, which apply separately to each hospital facility the hospital organization operates, are as follows.

1. To conduct a CHNA this tax year, or in either of the 2 prior tax years. The CHNA must take into account input from persons who represent the broad interests of the community served by the hospital facility, including people with special knowledge of or expertise in public health. The CHNA must be made widely available to the public.

2. To adopt an implementation strategy to meet the community health needs identified through the CHNA.

Instructions for Form 4720 (2025) 19

See Notice 2011-52, 2011-30 I.R.B. 60; Final Regulations, T.D. 9708, 79 Fed. Reg. 78954 (Dec. 31, 2014), 2012-32 I.R.B. 126; Notice 2014-2, 2014-3 I.R.B. 407; Notice 2014-3, 2014-3 I.R.B. 408; as well as any future related guidance for details. For additional information on the CHNA requirements, see Schedule H (Form 990), Hospitals, Part V, Section B.

Specific Instructions