(1) The operation of an emergency room open to all members of the community without regard to ability to pay
(2) A governance board composed of community members
(3) The use of surplus revenue for facilities improvement, patient care, and medical training, education, and research
(4) The provision of inpatient hospital care for all persons in the community able to pay, including those covered by Medicare and Medicaid
(5) An open medical staff with privileges available to all qualifying physicians.
Case Where State Law Superseded Federal Law
City of Richmond v. Richmond Memorial Hospital. In City of Richmond v. Richmond Memorial Hospital, 202 Va. 86, 116 S.E. 2d 79 (1960), the issue was whether the right to exemption “depends solely upon the extent to which free service is rendered.” The court rejected that standard and concluded that the exemption depends not upon the number of patients who are treated free of charge, but upon the nature of the institutions and the purpose of the operations. The constitution of Virginia did not require that services be rendered for free as the basis for exemption.