Glossary · Forms & Certificates
Form 5000HC — Transaction Privilege Tax Healthcare Exemption Certificate
In short
The exemption certificate a qualifying healthcare organization gives out. A contractor may receive one and still not be the party who hands it to the vendor.
In full
Form 5000HC is the Transaction Privilege Tax Healthcare Exemption Certificate. It documents a tax-exempt transaction where the purchaser is one of four kinds of qualifying organization: a qualifying hospital, a qualifying health care organization, a qualifying rehabilitation program for mentally or physically disabled persons, or a qualifying community health center.
It is prescribed under A.R.S. § 42-5009 and works like Form 5000 in shape — completed by the purchaser, furnished to the vendor, only one category of exemption per certificate. What differs is what the vendor must hold: the certificate is retained together with a copy of the organization's exemption letter, and the form directs vendors to review that letter carefully.
Two of the four categories carry a use restriction. Where the purchaser is a qualifying health care organization, or an organization running a specialized program for disabled persons, the items purchased must be used solely to provide health and medical related educational and charitable services or for the organization's programs, and the reason must be stated on the certificate.
A contractor working for one of these organizations may be handed both the exemption letter and a Form 5000HC, and that is where the confusion starts. The certificate establishes the organization's status; it is not the document the contractor gives the materials vendor. ADOR's answer for an unlicensed contractor on an MRRA project for a qualified hospital is that a statutory deduction is available for the hospital's materials purchase, so the contractor completes and submits a Form 5000M to the vendor — because the contractor has no TPT license and a vendor could not accept an incomplete Form 5000 in good faith.
So the organization's status creates the deduction, and the contractor's own license status decides which certificate reaches the vendor. Those are two separate questions and the answer to the first does not settle the second. The certificate does not say this; ADOR's Contracting FAQs do.
Section C identifies the facility by name and location; a purchaser claiming the exemption for more than one location attaches a list.
Arizona Form 5000HC, Transaction Privilege Tax Healthcare Exemption Certificate (ADOR 11228, 02/26); A.R.S. § 42-5009; ADOR Contracting FAQs