While much of the country continues to digest the implications of comprehensive health care reform, as adopted in the Patient Protection and Affordable Care Act (H.R. 3590) and the Health Care and Education Reconciliation Act of 2010 (H.R. 4872), tax-exempt hospitals are realizing that they now face a number of new requirements, violations of which could result in significant economic costs and/or loss of tax-exempt status. The new provisions address concerns voiced in recent years by a number of legislators (most prominently, Sen. Charles Grassley, R-Iowa), to the effect that most tax-exempt hospitals are not functioning in a sufficiently “charitable” manner to merit the benefits and privileges of exempt status. Suddenly, with little more than a whimper (compared to the bang of overall health care reform), our nation’s federal tax laws have been changed to materially heighten the standards to which tax-exempt hospitals will be held accountable.