Form 4 - Nebraska Exemption Application For Sales And Use Tax Page 2
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3INSTRUCTIONS
WhO MAY FILE. Any qualified nonprofit organization wishing to make tax-exempt purchases of property or
taxable services, to be used by and for the purposes of the exempt facility or activities, or portion of the facility,
of the organization.
WhERE TO FILE. This application and copies of all required documents and licenses, must be mailed to the Nebraska
Department of Revenue, P.O. Box 98903, Lincoln, Nebraska 68509-8903.
QUALIFIED ORGANIZATIONS. Only the following organizations qualify for a sales and use tax exemption:
1. Nonprofit organizations created exclusively for religious purposes (see
Sales and Use Tax Regulation
1-091).
2. Public or nonprofit private Nebraska educational institutions established under
Neb. Rev. Stat. §§ 79-1601
to
79-1607
or
85-1103
to
85-1111
(see
Sales and Use Tax Regulation
1-092).
IMPORTANT NOTE: Nonprofit organizations operating any of the types of health care facilities listed
in 3, 7, and 8 below are only exempt on purchases for use at the facility, or portion of the facility, covered
by the license that is issued for the exempt type of health care provided.
This exemption does not extend to all functions, activities, or purchases for an organization that provides
multiple levels of care. For these types of organizations, this exemption applies only to the purchases for
that portion of the facility that provides the type of health care activities listed in 3,7, and 8 below. This
exemption is not issued to the entire organization, but is issued for the specific type of licensed nonprofit
health care.
Organizations providing multiple levels of care, where a portion of the activities within the facility
are exempt and other activities are not exempt, must provide a list of the other activities they provide.
Organizations providing multiple levels of care must realize that ALL their purchases may not be exempt
from Nebraska sales and use tax.
Example: Purchases are made by a nonprofit organization that operates facilities consisting of
independent living, licensed assisted living, and licensed skilled nursing care. This nonprofit
organization must pay sales and use tax on the purchases related to and used for the independent
living portion of the facility. The sales tax exemption is only on those purchases made for the
assisted living facility and skilled nursing facility, or that portion of the entire facility that is
licensed as an assisted living facility and skilled nursing facility (e.g., a specific wing or number
of beds within a designated area of a facility) (see
Sales and Use Tax Regulation
1-090).
3. The following list identifies the specific types of licensed health care facilities/providers that may apply for
this exemption. The license must be from the Nebraska Department of Health and Human Services.
a. Nebraska licensed hospitals
b. Nebraska licensed skilled nursing facilities
c. Nebraska licensed nursing facilities
d. Nebraska licensed assisted living facilities
e. Nebraska licensed intermediate care facilities
f.
Nebraska licensed intermediate care facilities for the mentally retarded
g. Nebraska organizations certified by the Nebraska Department of Health and Human Services to provide
community-based services to persons with developmental disabilities
4. A nonprofit Nebraska licensed child-caring agency. This type of agency is one which provides 24-hour daily
care, supervision, custody, or control of children in lieu of care or supervision normally exercised by parents
in their own home, and is licensed under
Neb. Rev. Stat. §§ 71-1901
to 71-1904.
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