West Virginia Code of State Rules
Agency 110 - Tax
Title 110 - LEGISLATIVE RULE STATE TAX DEPARTMENT
Series 110-03 - Exemption Of property from ad valorem property taxation
Section 110-3-24 - Charitable Hospitals

Universal Citation: 110 WV Code of State Rules 110-3-24

Current through Register Vol. XLI, No. 38, September 20, 2024

24.1. In general.

24.1.1. These regulations as they relate to hospitals shall become effective on July 1, 1990: Provided, That subsection 24.9.4.5 shall become effective six (6) months after passage of the bill authorizing this rule, 110 C.S.R. 3 (1988). Prior to the July 1, 1990 effective date, any exemption currently in existence shall continue for so long as the existing charitable activities of such hospitals continue.

24.1.2. Section 11-3-9 of the West Virginia Code provides:

All property, real and personal, described in this section, and to the extent herein limited, shall be exempt from taxation, that is to say: . . . property belong to any . . .hospital not held or leased out for profit . . .

24.1.3. Except as otherwise provided in these regulations, health care organizations and hospitals will not qualify for exemption from property tax if they are operated, in any way, for the private gain of physicians, officers, or members of the board of a hospital or other private individuals. For purposes of this regulation, private gain is any significant economic benefit accruing to any individual or entity other than the charitable hospital: Provided, That economic benefit does not include payments for the receipt of reasonable goods and services which are furnished to the hospital under valid arms-length contracts, as that phrase is generally defined.

24.1.4. Payment by a hospital of salaries to administrative and medical staff, or the realization of a surplus or positive net earnings does not necessarily constitute such disqualifying private gain. Payment of salaries commensurate with services rendered is simply a cost of operating a charitable organization. As long as any surplus of the organization is used to continue its charitable activities, no disqualifying gain can be said to inure to the benefit of any private individual. For purposes of these regulations, surplus is the excess of the net earnings over the expenditures incurred producing such net earnings.

24.2. Key determinants of charitable use. A hospital to be eligible for ad valorem property tax exemption may attain such exemption by using property owned or leased in a charitable manner. For purposes of this Section 24, charitable use is defined as any one of the following or combination of elements listed below:

24.2.1. The provision of health services on an inpatient or outpatient basis to individuals who cannot afford to pay for such services in a volume and frequency determined by the hospital board of trustees, as articulated in the charity care plan of the hospital.

24.2.2. The provision of activities which promote the health of the community served by the hospital and/or decrease the burdens of state, county and municipal governments, as provided in Section 24.10 of these regulations.

24.3. Restriction of beneficiaries.

24.3.1. Hospital administration policies that discriminate on the basis of race, color, sex, or national origin will disqualify a hospital from tax exempt status.

24.3.2. The effect of other kinds of beneficiary restrictions on a hospital's tax exempt status depends on the particular restriction. Certain types of restrictions on patient admissions are permissible because of the specialized nature of the medical care provided by some hospitals. For example, children's hospital provide care exclusively for children, and the Shriners' Hospital specializes in the care of burn victims. Such restrictions rarely threaten a hospital's tax exempt status, if they are applied in a nondiscriminatory manner, because their purpose is to provide better patient care.

24.3.3. Restrictions that limit admissions to members of a society, religious order, or association that founded the hospital or to paying patients are not acceptable. The West Virginia statute exempts only institutions that are "pure public charity" or those that fulfill "charitable purposes."

24.4. Ownership of property.

24.4.1. Section 11-3-9 of the West Virginia Code requires that property belonging to the hospital not be held or leased out for profit.

24.4.2. In West Virginia, a lease of real estate is a chattel real that is taxed as personal property. If a lease has a separately determinable market value, it is proper to assess the value of the lease to the lessee and the value of the remainder to the lessor.

24.4.3. A leasehold interest held by a charity as the lessee would constitute personal property exempt from ad valorem taxation as to that charity if the leasehold interest were separately assessable.

24.5. Office space for staff physicians.

24.5.1. For purposes of Section 24, "staff physicians" are physicians who may be employed by the hospital on more than a half-time basis, radiologists, pathologist, anesthesiologists and similar positions, or, if the hospital is a teaching hospital, are members of the teaching faculty or administration; i.e., dean of the faculty, department head, etc. Physicians who do not qualify to be classified as a staff physician are classified as "affiliated physicians."

24.5.2. Hospitals may provide space for use by physicians in connection with hospital related responsibilities such as medical staff and committee meetings, medical record keeping and charting, locker room for changing clothes, or similar activities.

24.5.3. A hospital may provide free office space to members of its staff an an enticement to qualified medical personnel. The hospital may not provide free office space to some of its staff members and charge others. Furthermore, if office space is available, a hospital may not deprive some staff physicians of office space when others receive free office space. Such offices may not be so used as to cause the primary and immediate use of the hospital property to be other than charitable. For instance, staff physicians holding office space on an exempt hospital tract may examine and treat paying, for profit patients in such offices, but such use of the property may not be so extensive as to make the primary and immediate use of the tract as a whole a profit making operation rather than a charitable one in accordance with Section 19 of these regulations.

24.5.4. Hospitals frequently make part of their property available for staff physicians's offices. Such office space may be rented to a physician at nominal commercial rates, or provided free, or it may be considered compensation for administrative duties such a physician performs in the hospital.

24.5.5. The private use of hospital office space by affiliated physicians is not viewed favorably. Such offices are primarily for the convenience or profit of the physician. The exclusive use of a hospital office for a physician's own private gain is inconsistent with the charitable use requirement of the Constitution and the exemption statute. Rental of office space to a physician at a market rate is a strong indication that the property is being used for the sole benefit of the physician.

24.6. Recreational facilities.

24.6.1. Use of charitable property for tennis courts, playgrounds, parks and similar facilities may be considered reasonably necessary or incidental to the primary functions of a hospital provided certain conditions are met. Recreation may be recognized for its therapeutic value to patients, the main beneficiary of the hospital's services. Additionally, use of recreational facilities by any person or group of people who has or have been identified as high risk for any disease, condition or malady or recovering from such disease, condition or malady, (e.g., pre or post heart attack, stroke recovery, or weight reduction) will not jeopardize the exempt status of hospitals provided such programs constitute preventative or rehabilitative health care. In such instances, the hospital may charge for the use of such facilities by inpatients and outpatients without danger to its exempt status.

24.6.2. Mere incidental use of such recreational facilities by hospital personnel will not destroy the charitable nature of such instrumentalities.

24.6.3. The primary and repeated use of facilities for mere recreational reasons by the general public, charged for such utilization, is not consistent with charitable use.

24.7. Categories of hospitals.

24.7.1. General. There are three generally recognized categories of hospitals: for profit, governmental, and nonprofit or not-for-profit.

24.7.2. Taxability.
24.7.2.1. For-profit hospital. A hospital held or operated for profit is not exempt from ad valorem property taxes.

24.7.2.2. Government owned hospital.
(a) A hospital owned and operated by the United States (or an agency or instrumentality thereof) is exempt from ad valorem property taxes on its real and personal property unless federal law permits it to be taxed in accordance with Section 8 of those regulations.

(b) A hospital owned and operated by the State of West Virginia (or one of its agencies or institutions) is exempt from ad valorem property taxes on its real and personal property in accordance with Section 9 of these regulations.

(c) A hospital owned and operated by any county, municipality or other political subdivision of this State is exempt from ad valorem property taxes if the hospital is used for public purposes in accordance with Section 10 of these regulations.

(d) A hospital owned by any county, municipality or other political subdivision of the State but operated as a separate corporation pursuant to a lease may be taxable depending upon the nature of the lessor and whether the property is being used for charitable purposes.

24.7.2.3. Nonprofit or not-for-profit hospital. A hospital owned and operated, or leased and operated, by a nonprofit or not-for-profit corporation may be exempt from ad valorem property taxation if the primary and immediate use of the property is for charitable purposes. If in the situation where the hospital is leased to such a corporation and the lease is not a below-market lease, the leaseholder would not be taxable but the fee interest would be taxable to the lessor.

24.8. Hospitals.

24.8.1. The term "hospital," does not include institutions regularly licensed by the West Virginia Department of Human Services (formerly Department of Welfare), such as child caring institutions, day nurseries, child-care centers and foster boarding homes. However, institutions having dual functions, one of which is clearly subject to hospital licensure by the West Virginia Department of Health, are "hospitals" within the meaning of these regulations, if such institutions are so licensed.

24.8.2. The term "hospital" as used in these regulations does not include homes or institutions regularly licensed by the West Virginia Nursing Home Licensing Board.

24.8.3. The term "hospital" as used in these regulations, does not include first aid stations and emergency care facilities or other facilities which do not provide reception and care of persons for a continuous period longer than twenty-four (24) hours, for the purpose of providing room, board, nursing service and hospital facilities for use in diagnosis and treatment of medical conditions or informities: Provided, That such a facility may be included under the term "hospital" if it is actually owned or leased by a hospital, is operated on a charitable basis, and is primarily used for patient care activities such as: Outpatient surgery, physical therapy and rehabilitation, drug and alcohol abuse counseling, and mental health counseling.

24.8.4. Under the Constitution of this State, property used for charitable purposes may be exempted from taxation. Property used for a hospital cannot be exempted from taxation under the Constitution of this State unless it is used or charitable purposes. West Virginia Constitution Article X, '1. Reynolds Memorial Hospital et al. v. County Court of Marshall County 78 W. Va. 685, 90 S.E. 238 (1916); State ex rel. Cook v. Rose, 299 S.E.2d 3 (W.Va. 1982).

24.8.5. Hospital property, in order to be exempt from ad valorem property taxation, must not be held or leased out for profit. W. Va. Code '11-3-9.

24.8.6. Under West Virginia Constitution Article X, '1, the exemption of property from taxation depends on its use. To warrant such exemption, the use must be primary and immediate, not secondary or remote. State ex rel. Farr v. Martin, 105 W. Va. 600, 143 S.E. 356 (1928).

24.8.7. The fact that a hospital is incorporated as a nonstock, nonprofit hospital does not make it charitable, even though some operating funds are derived from private, voluntary contributions; only the nature of its activities can determine if it is operated in a charitable manner.

24.8.8. Any Internal Revenue Service determination as to exemption of a hospital from federal taxation under Section 501(c)(3) or Section 501(c)(4) of the Internal Revenue Code (26 U.S.C. ''501(c)(3) or 501(c)(4)) shall not be determinative of the issue of whether property is exempt for ad valorem property tax purposes.

24.8.9. If the hospital ceases to be used for charitable purposes, it will lose its tax exempt status.

24.9. Admissions and ability to pay.

24.9.1. The charitable purpose of a hospital shall be determined by an examination of several factors. The primary factor is the provision of charity care consistent with the standard contained in Section 24.2 and the definitions contained in Section 24.9.7. Promotion of health, relief of burdens of government, and volunteer and community services, as described in Section 24.10 of these regulations, shall be considered in determining charitable use of hospital property.

24.9.2. The provision of charity care by a charitable hospital on a below cost or free basis to those who are financially unable to pay for those services is limited by the economic health of the institution. It is essential that such hospitals continue to provide quality health care and entirely unrealistic to expect that federal or state governments fill the void which would exist in their absence. In order to so continue, these hospitals must be able to maintain and promote their own financial and economic health. The quantity of free and below cost health care which a hospital can provide, therefore, is necessarily limited to the amount which can reasonably be provided consistent with the maintenance of the economic well-being and fiscal soundness of the hospital.

24.9.3. Each hospital which intends to establish charitable use of its facilities by use of this section shall develop, by July 1, 1990, a charity care plan which must be approved by the hospital board of trustees. Such plan, once approved, must be reviewed by each board of trustees not less than every two (2) years to ascertain its effectiveness and respond to changing financial conditions of the institution and needs of the community.

24.9.4. The charity care plan must reflect the following minimum criteria:
24.9.4.1. The hospital may not arbitrarily restrict the provision of health services to certain individuals or groups.

24.9.4.2. Restriction may be based upon any rationale which reflects a definite benefit to the general public interest, e.g., restricting admission to a general class of indefinite number such as children, burn victims, or heart patients.

24.9.4.3. No hospital may insist that patients provide assurance that all of their bills will be paid as a condition for obtaining emergency medical care or medical care for the treatment of a life threatening condition.

24.9.4.4. A hospital must develop reasonable rules and regulations which may require that those patients who are financially able to do so pay the charges incurred for the care provided. However, emergency medical care may not be withheld until a patient or person seeking such care, demonstrates that charges incurred will be paid. Deliberate failure to provide such emergency medical care due to lack of assured payment may be sufficient cause to deny tax exempt status to the hospital.

24.9.4.5. Governmental or nonprofit hospitals must establish procedures and maintain records which demonstrate compliance with the provisions of this Section 24.9.4.5. Such hospitals shall plainly post in the emergency and admitting areas a notice containing a statement of the existence of their obligation to provide free and below cost care and of the criteria and mechanism for receiving such care. Such hospitals shall provide written notification of the existence, criteria and mechanism for receiving such care, at a minimum, to each person admitted or treated who does not demonstrate payment coverage under governmental programs or private insurance. Such hospitals shall create and maintain records demonstrating that such required criteria and mechanisms are established, that such required policies have been posted and distributed, and which record any and all requests for free or below cost care, the disposition of such request, the rationale for such disposition and the dollar amount of charity care provided: Provided, That in all instances, patient confidentiality shall be protected and maintained. Aggregate data reflecting the number of requests for charity care, the dispositions of such requests and the dollar amount of charity care provided shall be made available to the general public annually. To the extent the specific required information is on file with the West Virginia Health Care Cost Review Authority, it is unnecessary for hospitals to maintain separate records for purposes of the Section 24.9.4.5.

24.9.5. A hospital may also develop reasonable rules and regulations which allow persons (including infants who are referred by a court to a hospital) to be given a priority for receiving hospital services over those hospital services to be provided to indigent or charity patients, based upon criteria articulated in subsection 24.9.8 of these regulations.

24.9.6. A hospital in formulating a charity care plan may take into consideration the overall financial condition of the institution, including but not limited to:
24.9.6.1. Days outstanding of accounts receivable.

24.9.6.2. Cash flow problems encountered by the hospital.

24.9.6.3. Amount of profit or loss on operations in preceding fiscal years.

24.9.6.4. The amount of charity care and bad debts previously generated from operations.

24.9.6.5. Any other financial restraint or limitation, including legislatively mandated assessments, placed on the hospital which would effect a limitation on its ability to provide free or below cost care.

24.9.7. Accounting classification: charity care and bad debts. For purposes of this section 24.9, the following definitions shall govern accounting classifications and the charity care plan:
24.9.7.1. Charity care. That care rendered by a hospital or nonprofit subsidiary or affiliate which is free care to individuals who do not have the ability to pay for such care. Charity care does not include bad debts as that term is defined in subsection 24.9.7.2 of these regulations.

24.9.7.2. Bad debts. Unpaid accounts of any individual who has received medical care or is financially responsible for the payment for medical care, has the ability to pay and refuses to do so.

24.9.8. A hospital, to be charitable under this Section 24, must provide an amount of free and below cost necessary medical services as determined by its board of trustees, consistent with other provisions herein, to those who are unable to pay therefore: Provided, That at the time free or below cost service is sought, in the judgment of the hospital, its medical staff and ancillary health professionals:
24.9.8.1. The hospital routinely provides such medical services.

24.9.8.2. Capability presently exists within the hospital to safely render the service requested.

24.9.8.3. The care requested is medically appropriate.

24.9.8.4. The hospital in providing such care will not be sanctioned or penalized by a professional standards review organization.

24.9.8.5. The rendering of such medical services is consistent with the charity care policy of the hospital.

24.10. Promotion of health and relief of burdens of government. Providing charitable medical care is accepted as assisting in the relief of the burdens of government. In addition to providing charitable medical care, a hospital may provide other volunteer and community services which also assist in relieving the burdens of government. The reasonable value of such volunteer and community services, as well as the short fall between charges for services as approved by the West Virginia Health Care Cost Review Authority and payments received from Medicaid, Public Employees Insurance Agency and similar governmental programs, may be used to demonstrate charitable use of property: Provided, That such volunteer and community services, short falls, or promotion of health shall not occur to the neglect or detriment of the provision of charity care. The volunteer and community services which may be utilized for this purpose include, but are not necessarily limited to, the following:

24.10.1. Public education programs relating to preventive medicine or the public health of the community.

24.10.2. Donations of medical supplies, equipment and manpower to support groups for the promotion of health and the provision of medical care.

24.10.3. Free, at-cost or below-cost health screenings and assessments.

24.10.4. Social services assistance/counseling.

24.10.5. Free or reduced charge medical clinics.

24.10.6. Operation of poison control centers.

24.10.7. Free or below-cost blood banking services.

24.10.8. Free or below-cost assistance, material, equipment and training to EMS and ambulance services.

24.10.9. Disaster planning.

24.10.10. Unreimbursed costs for education and training of medical, nursing and allied health profession students.

24.11. Private gain or benefit.

24.11.1. Unless certain conditions are met, no property or activity of a hospital which is exempt from taxation shall cause any economic benefit to inure to any private individuals or businesses other than the charitable hospital. No economic benefit shall inure to any employee, staff member, trustee, director or other person associated with the hospital: Provided, That economic benefit does not include payments for the receipt of reasonable goods and services, which are provided to the hospital under valid arms-length contracts, as that phrase is generally defined.
24.11.1.1. Provided such an agreement is entered into on an arms length basis, as that phrase is generally defined, a hospital may lease a portion of its space to private business for the purpose of furnishing necessary segments of the normal hospital operation; e.g., leasing space to a third party to operate a for-profit pharmacy. Total leased areas shall not be more than ten percent (10%) of the available floor space of the hospital; available floor space shall be all floor space exclusive of maintenance areas or common areas such as hallways and stairways.

24.11.1.2. A hospital complex may include more than one building or structure. If the primary use of one or more structures is for nonexempt purposes, such structures and the land upon which they are situated must be divided from the remaining structures in order for the remaining structures to continue as exempt property. The division of property shall be accomplished in accordance with W. Va. Code '11-4-18.

24.11.2. A hospital may pay salaries to its employees and staff. The salaries paid may be commensurate with the value of the services rendered. The salaries and benefits paid to employees and staff members must not be excessive when compared with other salaries and benefits for the same services in the community. For the purpose of these regulations and because of the rural nature of West Virginia, "community" may be determined on a state-wide basis: Provided, That when developing salary and benefit comparisons, those salaries and benefits paid at hospitals outside of West Virginia may be used so long as such hospitals are not in excess of one hundred (100) miles from the borders of West Virginia.

24.11.3. A hospital may accumulate and aggregate a surplus of revenue over expenses.
24.11.3.1. A hospital may not pay out any surplus operating funds to any individual or organization. This prohibition applies to payments in the form of dividends and excessive salaries; bonuses and similar employee incentive plans are not necessarily inconsistent with the charitable use basis for the exemption where it is shown that such plans are not merely a device for diverting profits and that they contribute to the charitable purpose of the hospital.

24.11.3.2. Any excess operating funds shall be used for the hospital's exempt purposes. Such purposes must include the hospital's charitable activities and also may include other activities. By way of illustration and not limitation, other activities may include the payment of reasonable salaries, purchase of new or replacement equipment and the cost of capital improvements which carry out those charitable activities. A hospital may enter into other activities which will provide additional revenues so long as such activities are accomplished in accordance with a plan approved by the hospital's board of directors; however, if such other activities are performed on a for-profit basis, such as owning and operating a doctor's office building or a medical laboratory apart from the hospital's own laboratory, it is presumed that a separate corporation will be formed for those purposes and that the hospital will receive a reasonable rate of return on the revenues it provides.

24.11.4. If a hospital is transferred from proprietary ownership to ownership which will operate the hospital as a charitable hospital, no economic benefit shall inure to any of the former owners, directors, trustees, staff members, or any other persons subsequent to the time of transfer as a direct or indirect result of the transfer, unless such benefit is the result of an arms length negotiation for services rendered to the hospital in accordance with another provision contained with subsection 24.11.1.

24.11.5. When a hospital is transferred from proprietary ownership to an ownership for charitable operation, and the former owners are the only members or a substantial number of the members of the medical staff, the hospital may be exempt from ad valorem property tax. However, the hospital will be subject to close scrutiny so as to determine whether or not it is operating in the interest of the former owners.

24.12. Medical staff.

24.12.1. A hospital may restrict access to the use of hospital facilities to qualified physicians and dentists who, in the discretion of the hospital, are competent and qualified to practice: Provided, That such restriction or the question of competency and qualification is determined by the hospital in accordance with published by-laws and policies. A hospital may restrict its medical staff to a limited number of members, based upon the service needs of the hospital.

24.12.2. A hospital may not arbitrarily deny access to use of hospital facilities in order to operate for the private gain of its active medical staff; access may be denied in accordance with subsection 24.12.1.

24.13. Charges and fees.

24.13.1. A hospital may charge reasonable fees for the services that it provides to a patient. These charges may include a reasonable amount above the actual cost of service for the future use of the hospital.

24.13.2. Any revenue that the hospital realizes from its charges shall be used solely for the maintenance and support of the hospital: Provided, That a hospital may accumulate and aggregate a surplus of revenues over expenses in accordance with the procedures authorized in subsection 24.11.3 of these regulations.

24.13.3. If a hospital's expenses exceed its revenue, voluntary contributions may be used to make up the difference.

24.14. Voluntary contributions and other revenue.

24.14.1. Any hospital is permitted to receive donations which are either restricted or nonrestricted. Restricted donations shall be used in such a manner as to respect the wishes of the donor. In appropriate cases, cypress proceedings may be initiated in any court having jurisdiction. Unrestricted gifts may be used for any charitable purpose: Provided, That such purpose is approved by the board of trustees of the hospital and in some way furthers the charitable activity of the hospital. For the purposes of this Section 24.14, and by way of illustration and not limitation, charitable activity may include any of the following:
24.14.1.1. The promotion of health; such as, the acquisition and use of major medical equipment.

24.14.1.2. Improvement of the quality of care of medical services rendered to the community.

24.14.1.3. The provision of free and below cost services.

24.14.1.4. The purchase of real estate for capital expansion.

24.14.1.5. The offset of cost of construction of capital improvements, as that term is generally defined, so long as such improvements are related to the provision of medical services or the promotion of health.

24.14.1.6. Retirement of pre-existing debt of the hospital.

24.15. Ancillary functions.

24.15.1. A hospital may engage in certain non-medical activities, so long as these activities are designed to serve hospital staff, employees, patients and visitors, and are not such as to cause the primary and immediate use of the property to be other than charitable use in accordance with Section 19 of these regulations. These activities include, but are not limited to:
24.15.1.1. The operation of a parking facility,

24.15.1.2. The operation of a pharmacy,

24.15.1.3. The operation of a cafeteria or coffee shop, and

24.15.1.4. The operation of a gift shop.

24.16. Leasing.

24.16.1. A hospital may lease part of a tract out for an legal use and retain the tax exemption described under this section so long as the primary and immediate use of the tract is charitable in accordance with Section 19 of these regulations and other restrictions in these regulations are not violated.

24.17. Vacant land and construction.

24.17.1. When a hospital purchases land which it intends to use for capital improvements, which will be used for charitable purposes, the land shall not be exempt so long as the land is vacant. So long as the land is vacant, it can be sold and used for noncharitable purposes.

24.17.2. Vacant tracts owned by a hospital will remain subject to taxation, even if plans are made which show that the land will be used for tax exempt purposes.

24.17.3. If construction is begun on a tract for the purpose of making improvements to be used for hospital purposes, such property shall not be exempt under this section until it has been put to such actual use as to make the primary and immediate use of the property charitable in accordance with Section 19 of these regulations.

24.17.4. If construction is begun on a tract exempt under this section from ad valorem taxation at the time construction is initiated, such construction shall not void the pre-existing exemption if the proposed use of the improvements so constructed is to be a charitable use consistent with the provisions of this section.

24.17.5. Construction of improvements, the proposed use of which is not charitable, shall not void a pre-existing exemption under this section until such time as the primary and immediate use of the property is not longer charitable in accordance with this section and Section 19 of these regulations.

24.18. Hospital owned housing.

24.18.1. Property which a hospital owns and uses for housing for doctors, nurses, interns, technicians and other hospital personnel may be exempt from ad valorem tax. It is necessary for the housing to be located on or near the same tract of property as the hospital. Also, it is incumbent upon the hospital to show that the housing is being used in a way which directly and immediately relates to the charitable purposes, such as housing medical personnel in an actual "on call" status, as that phrase is generally defined. Otherwise, such housing would be used for purposes which would put it in competition with generally available commercial housing; a commercial use would not be primarily and immediately charitable in such an instance.

24.19. Education facilities on hospital property.

24.19.1. Possession by a hospital of property used as a place of education shall not void the exemption provided under this section so long as the primary and immediate use of the property is for charitable purposes under Section 19 of these regulations. If education is the primary and immediate use of the property, then the exemption provided under this section will typically no longer apply. However, the exemption provided under Section 16 of these regulations may apply.

24.19.2. Any property owned by a hospital which is used as a place of residence for medical or nursing students, or other students who are studying in a medical related field at the hospital shall not be exempt from ad valorem property tax unless such property is exempt under Section 21 of these regulations.

24.19.3. Recreational facilities shall not be considered property used primarily and immediately for charitable purposes unless such facilities are designed for and primarily and immediately used by patients of the hospital.

24.20. Hospital service corporations, medical service corporations, dental service corporations and health service corporations.

24.20.1. Hospital service corporations, medical service corporations, dental service corporations and health service corporations are exempt from ad valorem property taxation. See W. Va. Code '33-24-4. See Section 35.40 of these regulations.

24.21. Health care corporations.

24.21.1. All health care corporations are exempt from ad valorem property tax. See W. Va. Code '33-25-3. See Section 35.41 of these regulations.

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