Attachment_C_-_Tax_Exemption.pdf

STATE OF ARIZONA

Department of Revenue

Douglas A. Ducey Governor

David Briant

Director www.azdor.gov 1600 West Monroe Street – Mail Code 1300, Phoenix AZ 85007-2650

December 12, 2017

Ms. Verna Kuwanhoyioma Department of Health & Human Services Phoenix Area Indian Health Service

Email: verna.kuwanhoyioma@ihs.gov

EXEMPTION LETTER FOR A QUALIFYING HOSPITAL

ORGANIZATION: DEPARTMENT OF HEALTH & HUMAN SERVICES, U.S. PUBLIC HEALTH SERVICE,

PHOENIX AREA INDIAN HEALTH SERVICE

EXEMPTION PERIOD: JANUARY 1, 2018 – DECEMBER 31, 2018

Based on a review of the information you provided, the Arizona Department of Revenue grants this Exemption Letter to Phoenix Area Indian Health Service. As a Qualifying Hospital, Phoenix Area Indian Health Service is entitled to an exemption from the Arizona Transaction Privilege Tax and the Use Tax for the period of January 1, 2018 through December 31, 2018 for the following business classifications only:

Code Exempt Classification Statutory Reference 4 Utilities A.R.S. §42-5063(C)(3)(a) 8 Pipeline A.R.S. §42-5067(B)(1) 9 Publication A.R.S. §42-5065(B)(2)(a)

10 Job Printing A.R.S. §42-5066(B)(3)(a) 11 Restaurant A.R.S. §42-5074(B)(7) 14 Personal Property Rental A.R.S. §42-5071(B)(2)(a) 17 Retail A.R.S. §42-5061(A)(25)(a) 29 Use Tax A.R.S. 42-5159(A)(13)(a), (b), (c)

The organization is also entitled to an exemption from the Cities Privilege Tax and the Use Tax for the following business classifications only:

Code Exempt Classification Statutory Reference 4 Utilities M.C.T.C.§ Sec. __-480(e) 9 Publication M.C.T.C.§ Sec. __-435(f)

10 Job Printing M.C.T.C.§ Sec. __-425(b)(5) 11 Restaurant M.C.T.C.§ Sec. __-455(c)

17 Retail M.C.T.C.§ Sec. __-465(p)

Use Tax Jet Fuel Tax Jet Fuel Use Tax (Local Option #LL) Restaurants & Bars (add tax) Short Term Motor Vehicle Rental (PHX) Commercial Lease(Model Option#4) Rental/ Lease/ License of TPP Wastewater Utility Service

M.C.T.C.§ Sec. __-660(p) M.C.T.C.§ Sec. __-422(e) M.C.T.C.§ Sec. __-422(f) Local City Code M.C.T.C.§ Sec. 14-452 M.C.T.C § Sec. __-445(e) M.C.T.C.§ Sec. __-450(c)(5) M.C.T.C.§ Sec. __-485(b)

All locations claimed to be exempt by this organization are listed in Appendix “A” to this Exemption Letter.

mailto:verna.kuwanhoyioma@ihs.gov

Ms. Verna Kuwanhoyioma Department of Health & Human Services Phoenix Area Indian Health Service December 12, 2017

This Exemption Letter is good only for the dates listed above. The Department may rescind this Exemption Letter if any of the information relied upon in granting this Letter is found to be inaccurate or if your organization ceases to qualify as an exempt entity under Arizona law.

The Department does not issue exemption numbers. An Arizona Department of Revenue Transaction Privilege Tax Exemption Certificate (Arizona Form 5000HC) is used to document the applicability of exemptions from tax. Present a copy of this Exemption Letter to your vendors to substantiate your exempt status along with a properly completed Arizona Form 5000HC for the Appendix “A” location for which your organization is claiming an exemption.

Your organization must reapply to the Department annually, at least thirty (30) days before the expiration of this Exemption Letter, in order to avoid any lapse in your exempt status.

Information about the procedure and required documentation for obtaining an Exemption Letter can be found in Arizona Transaction Privilege Tax Procedure (TPP) 15-1 on the Department’s website. If you have any further questions, contact the Department at (602) 716-6803 or visit our website at www.azdor.gov. Please submit all renewal requests or written inquiries to:

Arizona Department of Revenue TRA Healthcare -1300

1600 West Monroe Street Phoenix, AZ 85007-2650

Sincerely, LC Heugly Len Heugly Tax Analyst Tax Policy

U:\Teams\TaxResearch\HEALTHCARE\2017 Healthcare Letters\HOSPITAL EXEMPTION\Hospital - DHHS Phoenix Area IHS.doc

Ms. Verna Kuwanhoyioma Department of Health & Human Services Phoenix Area Indian Health Service December 12, 2017

Appendix A

Phoenix Area Indian Health Service

Dba Phoenix Indian Medical Center 4212 North 16th Street Phoenix, Arizona 85016

Dba Colorado River Service Unit 12033 Agency Road Parker, Arizona 85344

Dba Peach Springs Health Center P.O. Box 190 Peach Springs, Arizona 86434

Dba Havasupai Indian Health Station Supai, Arizona 86435

Dba Whiteriver Service Unit P.O. Box 860 Whiteriver, Arizona 85941

Dba Desert Vision Youth Wellness Center P.O. Box 458 Sacaton, Arizona 85247

Dba Cibecue Health Center P.O. Box 37 Cibecue, Arizona 85941

Dba Desert Vision Youth Wellness Center 198 South Skill Center Road Sacaton, Arizona 85147

Dba Hopi Health Care Center P.O. Box 4000 Polacca, Arizona 86042

Dba Fort Yuma Service Unit P.O. Box 1368 Yuma, Arizona 85366

ADOR 11228 (10/15)

Arizona Form

5000HC

Transaction Privilege Tax

Healthcare Exemption Certificate

I. Qualifying Hospitals or

II. Qualifying Health Care Organizations or

III. Qualifying Rehabilitation Programs for Mentally or Physically Disabled Persons or

IV. Qualifying Community Health Centers

This Exemption Certificate is prescribed by the Department of Revenue pursuant to A.R.S. § 42-5009. The purpose of the Certificate is to document tax-exempt transactions with qualified purchasers. It is to be filled out completely by the purchaser and furnished to the vendor. The vendor shall retain this Certificate along with a copy of the organization’s annual “Exemption Letter” for single transactions or for specified periods as indicated below. Incomplete Certificates are not considered to be accepted in good faith. Only one category of exemption may be claimed on a Certificate.

A. Purchaser’s Name and Address: B. Check Applicable Box:

Name

Single Transaction Certificate Address

Period From Through City State ZIP Code

(You must choose specific dates for which certificate will be valid, not to exceed the annual period stated in the Department’s Exemption Letter.)Vendor’s Name

C. Facility:

Name of Facility* Facility Location*

*(If the purchaser is claiming an exemption for more than one facility location, reference and attach a list of the locations to the Form 5000HC.)

D. Reason for Exemption:

I. Qualifying Hospital (check appropriate box):

Hospital - The above location or satellite facility provides through an organized medical staff, inpatient beds, medical services, and continuous nursing services for the diagnosis and treatment of patients.

Licensed Nursing Care Institution - The above location is a health care institution providing inpatient beds or resident beds and nursing services to persons who need nursing services on a continuing basis but who do not require hospital care or direct daily care from a physician.

Licensed Residential Care Institution - The above location is a health care institution other than a hospital or a nursing care institution that provides resident beds or residential units, supervisory care services, personal care service, directed care services or health-related services for persons.

Residential Care Facility Operated in Conjunction with a Licensed Nursing Care Institution - The above location provides medical, nursing, or health-related services for residents of the residential units and is operated in conjunction with a licensed Nursing Care Institution.

Licensed Kidney Dialysis Center - The above location provides medical, nursing or health-related services and is not used or held for profit.

Continued on page 2

ADOR 11228 (10/15)

II. Qualifying Health Care Organization (“QHCO”) (check appropriate box):

Tangible personal property purchased or leased by a QHCO when the property is to be solely used to provide health and medical related educational and charitable services. The above location must provide educational or charitable services that are health and medical related.

Any tangible personal property purchased or leased by a QHCO dedicated to providing educational, therapeutic, rehabilitative and family medical education training for blind and visually impaired children and children with multiple disabilities from time of birth to age twenty-one.

III. Programs for Mentally or Physically Disabled Persons:

Tangible personal property purchased or leased by a nonprofit charitable organization that engages in and uses such property exclusively in programs for persons with mental or physical disabilities if the programs are exclusively for training, job placement, rehabilitation or testing.

IV. Qualifying Community Health Centers The tangible personal property purchased or leased is used by the community health center that is either: 1) the sole provider of primary care in the community, 2) a nonhospital affiliated clinic that is located in a federally designated medically underserved area in this state, or 3) a clinic that is being constructed as a qualifying community health center.

E. Describe the tangible personal property* purchased or leased and its use below.

(Use additional pages if needed)

*(which may include utilities, job printing or restaurant purchases for certain purchasers. See Department Exemption Letter.)

F. Certification

A vendor that has reason to believe that the Certificate is not accurate or complete will not be relieved of the burden of proving entitlement to the exemption. A vendor that accepts a Certificate in good faith will be relieved of the burden of proof and the purchaser may be required to establish the accuracy of the claimed exemption. If the purchaser cannot establish the accuracy and completeness of the information provided in the Certificate, the purchaser is liable for an amount equal to the transaction privilege tax, penalty and interest which the vendor would have been required to pay if the vendor had not accepted the Certificate. Misuse of this Certificate will subject the purchaser to payment of the A.R.S. § 42-5009 amount equal to any tax, penalty or interest. Willful misuse of this Certificate will subject the purchaser to criminal penalties of a felony pursuant to A.R.S. § 42-1127(B).

I, (print full name) , hereby certify that these transaction(s) are exempt from Arizona transaction privilege tax and that the information on this Certificate is true, accurate and complete.

Further, if purchasing or leasing as an agent or officer, I certify that I am authorized to execute this Certificate on behalf of the purchaser named above.

SIGNATURE OF PURCHASER REPRESENTATIVE DATE TITLE