Amends GS 105-278.8 to define the property tax exemption for nonprofit hospitals as the total actual cost of qualified charity care provided during the most recent fiscal year by the hospital on the parcel for which the exemption is claimed. This amount is calculated by applying the hospital’s cost-to-charge ratio to the gross charges of hospital services provided on the parcel. Defines “qualified charity care.” Provides that the difference between taxes due with this exemption and without this is due and payable under Subchapter II of GS Chapter 105. Sets out time frame and method by which hospitals may apply for this exemption. Effective and applicable for taxable years beginning on or after July 1, 2027.

Amends GS 105-282.1(a)(2)a to remove GS 105-278.8 from list of exceptions to annual application requirement. Effective and applicable for taxable years beginning on or after July 1, 2027.

Amends GS 105-164.14(b) to add subsection (1a) to provide that a nonprofit hospital’s aggregate annual refund shall not exceed the lesser of $31.7 million or the total actual cost of qualified charity care calculated pursuant to new GS 105-278.8(d). Effective July 1, 2027 and applies to purchases made on or after that date.