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Note: See Alliance resource section Nonprofit Results for research on community benefit and other performance results of nonprofit health care organizations.

To follow are brief descriptions of significant resources available to nonprofit health care organizations on community benefit practices and standards. Included are resources developed by both private and public sector groups to support or otherwise influence the community benefit practices of various types of nonprofit health care organizations.


Whether originally designed for a particular type of nonprofit health care organization of not, the resources in this section should be generally applicable to all types of nonprofit health care organizations. Separate sections are provided for resources application to only nonprofit health care providers and for resources applicable to only nonprofit health plans.

Nonprofit Vs. For-Profit Health Care: Is There a Difference?

Bruce McPherson, Alliance President, answers this question, in an article with this title published in the June 2013 newsletter of the Hudson Valley NY HFMA Chapter.

Maximizing Community Benefit: A Six-Point Program

This position paper approved by the Alliance Board in April 2009 calls on all nonprofit health care organizations to adopt as quickly as possible, if they haven't already, six specific community benefit practices to maximize their community benefit in the current economic crisis.

A Key to Health Care Reform: An Organizated Health Care Coalition in Every Community

This 2011 Alliance position paper calls on every nonprofit health care organizations to help establish, where it doesn’t already exist, and actively participate in, an organized coalition in its community consisting of representatives of all key stakeholders to improve the effectivenss of care provided to low-income and uninsured patients and to reduce the incidence of chronic illness for all population groups.

Great Governance: A Practical Guide for Busy Board Leaders and Executives of Nonprofit Health Care Organizations

This fourteen-page Guide, approved by the Alliance Board in August 2011, is intended to answer the question: Among all of the 50 to 100 best practices permeating the literature, which will make the most difference in achieving great governance? It includes two appendices: one providing a list of resources for additional information and guidance to accomplish the key steps recommended under the seven great-governance benchmarks contained in the Guide, and the other providing two checklists derived from the key steps. A recommended key step, under Benchmark # 5, Effective Board Oversight of Organizational and CEO Performance, is that the board should annually review and approve the enterprise’s operating plan, including quantitative objectives for all key areas of performance, including community benefit.

Advisors in the developing the Guide were: F. Kenneth Ackerman, Jr., Howard J. Berman, Douglas Brown, Richard Chait, John R. Combes, M.D., Sean Murphy, James E. Orlikoff, Lawrence Prybil, PH.D., James Rice, Ph.D., and Michael Roberto. Bruce McPherson, Alliance President, served as facilitator in the Guide’s development.

Federal Health Care Reform Law's New Community Benefit Requirements for Nonprofit Hospitals

This document contains the actual language in the federal health care law that establishes new community benefit requirements for tax-exempt hospitals, as well as three clarifications of those requirements contained in the Joint Committee on Taxation's technical explanations of the reform law.

What Makes a True Leader?

This paper contains excerpts from a book by Rabbi Menachem Mendel Schneerson, who seeks to define real leadership. Among the key attributes he sets forth, he sees a true leader as someone who sees his work as a selfless service toward a higher purpose. This resonates with the missions of nonprofit health care organizations.

Why Nonprofit Enterprises?

This 12-page paper authored by Howard J. Berman, the Alliance's Board Chair, discusses why nonprofit organizations exist and how this "Community" sector of our economy differs from, but interacts with, the "Business" and "Government" sectors.

Is the Mission the Brand? Or is the Brand the Mission?

This August 3, 2012 article asserts that great mission statements are the brand, and that great mission statements must be short and succinct--ideally 8 words or less.

Can You Sum Up Your Charity's Work in One Simple Tag Line?

This January 17, 2013 article recommends that every nonprofit organization have a quick, clear means of articulating what it is or stands for, i.e., a tag line. A few examples are provided. For those readers in nonprofit health care organizations, what would you recommend for your organization? How about something like "For people's health, not for profit"?

Health Care Reform Through Community Benefit Leadership

This Alliance report presents the proceedings of an October 5, 2008 roundtable discussion on this topic co-sponsored by the Alliance and Inquiry. Issues explored included: the importance of community benefit to nonprofit health care organizations and the communities they serve, with or without major federal health care reform legislation; its relationship to health care reform, and the role of the board and CEO in the nonprofit health care organization's community benefit efforts. The panelists for this discussion were: Joe Damore, President and CEO, Mission Health System, Asheville, NC; Tom Royer, M.D., President and CEO, Christus Health System, Dallas, TX; Tom Strauss, President and CEO, Summa Health System, Akron, OH; and Keith Volkmar, Senior Vice President, Excellus BlueCross BlueShield, Rochester, NY. Bruce McPherson, President and CEO of the Alliance for Advancing Nonprofit Health Care, moderated the discussion.

Community Benefit: Overcoming Organizational Barriers and Laying the Foundation for Success

This Alliance report presents the proceedings of a February 11, 2010 roundtable discussion on this topic co-sponsored by the Alliance and Inquiry. Five community benefit leaders who work ‘‘in the trenches’’ of nonprofit health care systems and hospitals share their views on how to overcome any organizational barriers to community benefit and describe the basic infrastructure that any type of nonprofit health care organization, whether health care provider or insurer, should have in place to achieve both successful and sustainable community benefit performance. The panelists for this discussion were: Eileen Barsi, Director, Community Benefit, at Catholic Healthcare West in San Francisco, Calif.; Diane Jones, Vice President, Healthy Communities, at Catholic Health Initiatives, in Denver, Colo.; DawnMarie Kotsonis, Executive Director of Community Benefit and of the Presbyterian Intercommunity Hospital Foundation in Whittier, Calif.; Monica Lowell, Vice President, Community Relations, at UMass Memorial Health Care in Worchester, Mass.; and Carol Paret, Chief Community Benefit Officer at Memorial Hermann Healthcare System in Houston, Tex. Bruce McPherson, President and CEO of the Alliance for Advancing Nonprofit Health Care, in Washington, D.C., moderated this discussion.

Nonprofit Health Care and the Public Trust

This five-page Alliance report is a reprint of an article in Inquiry, presenting the proceedings of a March 2006 roundtable discussion cosponsored by the Alliance and Inquiry exploring: the importance of public trust and its dimensions; how nonprofit health care organizations as a whole have been performing in this regard; whether they should somehow be held to higher or different standards than others; and what individual organizations can do—and avoid doing— to improve the reality, as well as the perception, of public trustworthiness. The panelists for this discussion were: William Foley, president and CEO of Provena Health based in Mokena, IL; David Klein, president and CEO of Lifetime Healthcare Companies headquartered in Rochester, NY; and Mark Schlesinger, professor of public health and fellow at the Institute for Social and Policy Studies at Yale University in New Haven, CT. Bruce McPherson, Alliance president and CEO, moderated the session.

Value of Nonprofit Health Care

This Alliance report briefly describes the history and size of the nonprofit health care sector, its role and differentiation from the governmental and for-profit health care sectors, its relative performance along various dimensions (including community benefit) according to the research literature, and challenges ahead.

Commentary on the Need for Health Care Leadership to Protect Safety-Net Providers

This commentary, entitled “Demonstrate Leadership, Help Safety Nets Now” and presenting the personal views of Howard Berman, Alliance Board Chair and Bruce McPherson, Alliance President, appeared in the October 21 HealthLeaders newsletter.

Rewarding Success in Meeting Community Needs

In this March 2012 commentary, David Bjork, Senior Vice President of Integrated Healthcare Strategies, urges nonprofit boards to tie a portion of executive incentive payment opportunities to success in achieving goals that the boards set for meeting community health needs (March 27, “Rewarding Success at Meeting Community Needs”). David’s position echoes the Alliance’s, as presented in its “Great Governance: A Practical Guide for Busy Board leaders and Executives of Nonprofit Health Care Organizations.”

Protecting the Hospital Safety Net

This Alliance report presents the proceedings of an October 22, 2008 roundtable discussion co-sponsored with the health care journal Inquiry exploring the definition of, and strategies for protecting, safety-net hospitals. The panelists were: Ron Anderson, M.D., MACP, President and CEO, Parkland Health & Hospital System, Dallas, Tex.; Peter Cunningham, Ph.D., Senior Fellow at the Center for Studying Health System Change, Washington, D.C.; Paul Hofmann, Dr.P.H., President of the Hofmann Healthcare Group, Moraga, Calif., and former distinguished visiting scholar at Stanford University's Center for Biomedical Ethics; Wayne Lerner, Dr.P.H., President and CEO of Holy Cross Hospital, Chicago, Ill.; and Kevin Seitz, Executive Vice President, Health Value Enhancement, Blue Cross Blue Shield of Michigan, Detroit, Mich. Bruce McPherson, President and CEO of the Alliance for Advancing Nonprofit Health Care, moderated the discussion.

Profits and Health Care: A Second Opinion

This OP-ED, co-authored by Alliance President Bruce McPherson and Alliance Board Chair Howard Berman and submitted to the New York Times Editor, was in response to a January 8, 2013 Opinion by Eduardo Porter, "Health Care and Profits: A Poor Mix." Porter tried to argue that by simply removing the profit motive in health care, our problems would be the answered. Among other counter-arguments, McPherson and Berman asserted that: nonprofit should not be confused with no profit; while nonprofit health care providers and health plans are driven by the need to maximize their community benefit, not profit, they still must generate at least some level of profits; profits are needed not to line someone's pockets, but to replace buildings and equipment, acquire advancing technology and address growing community needs; profits are not the villain; and it is how profits are pursued and used that can distort performance.

The Governance Imperative for Nonprofit Hospitals

This article, appearing in the January 2010 issue of Trustee magazine and authored by Doug Brown, a member of the Alliance Board and Senior Vive President & General Counsel of UMass Memorial Health Care in Worcester, Mass., is entirely consistent with the Alliance's Six-Point Program and does an excellent job of linking community benefit and quality initiatives.

Examples of Organizations' Community Benefit Policies and Procedures

Overall: Lucille Packard Children's Hospital at Stanford
Overall: Fletcher Allen Health Care
Overall: North Shore-Long Island Jewish Health System
Overall: Middlesex Health System
Mission Imperative: Catholic Healthcare West
Overall: Catholic Healthcare West-Bakersfield
Mission: Presbyterian Intercommunity Hospital
Core Principles: Presbyterian Intercommunity Hospital
Employee Performance Evaluation: Presbyterian
  Intercommunity Hospital
Reporting: Presbyterian Intercommunity Hospital
Governance Responsibilities: Catholic Healthcare

Examples of Organizations' Community Benefit Committees/Councils

Lucille Packard Children's Hospital at Stanford
Catholic Healthcare West-Bakersfield
Presbyterian Intercommunity Hospital
Catholic Healthcare West-St. Bernadine

Examples of Community Benefit Job Descriptions

Hospital Executive Role: Catholic Healthcare West
CEO: Catholic Healthcare West-Bakersfield
Executive Director: Lucille Packard Children's Hospital
CEO/VP/Director Competencies: Presbyterian
  Intercommunity Hospital
Regional Director: Catholic Healthcare West-Bakersfield
Manager: Model Developed in "Advancing the State of the
  Art of Community Benefit" Pilot Project
COO: Catholic Healthcare West-Bakersfield

Examples of Organizations' Community Benefit Incentive Goals

CEO: Catholic Healthcare West-Bakersfield
COO: Catholic Healthcare West-Bakersfield
Organization Scorecard (PowerPoint Description): Lancaster
  General Hospital

Examples of Organizations' Community Health Status/Needs Assessments

St. Joseph Health System-Sonoma County
Gwinnett Hospital System
San Diego Collaborative (PowerPoint)

Examples of Organizations' Criteria for Priority-Setting

Community Needs Index: Catholic Healthcare West
Criteria for Assessing Community Benefit Program
  Investment Priorities: Lucille Packard Children's Hospital
  at Stanford

Example of Organizational Measurement of the Return on Community Benefit Investments

St. John Health and Parent Ascension Health (PowerPoint)

Examples of Organizations' Community Benefit Reports and/or Plans (Plans Include Community Health Status/Needs Assessments)

Report and Plan: Lucille Packard Children's Hospital at Stanford
Report and Plan: Catholic Healthcare West-Bakersfield
Report and Plan: Catholic Healthcare West-California
  Hospital Medical Center
Report and Plan: Presbyterian Intercommunity Hospital
Report: Lifetime Healthcare Companies
Report: Blue Cross Blue Shield of Michigan
Report: St. Joseph Health System-Sonoma County
Report: Memorial Hermann Health System
Report: Blue Cross and Blue Shield of Alabama
Report: Blue Cross and Blue Shield of Florida
Report: Blue Cross Blue Shield of Massachusetts
Report: Kaiser Permanente
Report: Aurora Health Care
Report: East Maine Health System
Report: Lancaster General
Report: St. Jude Medical Center
Report: UMass Memorial Health Care
Plan: Fletcher Allen Health Care

Examples of How Organizations' Community Benefit Practices Have Evolved (PowerPoints)

Middlesex Health System and Lowell General Hospital
Memorial Hermann Health System

Examples of Organizations' Community Health Status Improvement Strategies (PowerPoints)

Chronic Disease Management Consortium in Southern
Kaiser Permanente
San Francisco Community Benefit Partnership
  by Catholic Healthcare West-Saint Francis Hospital
Assessing Avoidable ER and Inpatient Care (Dallas
Catholic Health Care West and CHW-
  Bakersfield (PowerPoint)
Ascension Health and Milwaukee Health
  Care Partnership
Using New County Rankings to Improve
  Community Health

CHA Guide: “Assessing and Addressing Community Health Needs

This detailed guide was developed and made broadly available to the field in January 2012, in anticipation of issuance by the IRS of modifications to Form 990 Schedule H and accompanying instructions for nonprofit hospital reporting on new community health needs assessment requirements contained in the federal healthcare reform law.

Other Resources for Community Health Status/Needs Assessments

As of late 2012, the Healthy Communities Institute is now providing a "one-stop shop" for community health needs assessment, entitled “Community Health Needs Assessment (CHNA) System.” This system provides: dashboard of 75-200+ health and quality indicators for any county or community;1,800+ promising, evidence-based community benefit programs and practices; community engagement and collaboration features such as an event calendar, news, and polls; and evaluation and tracking tools, both a Healthy People 2020 tracker and a customized local tracker. This CHNA System can be found at www.new.healthycommunitiesinstitute.com/hci-chna-system

In an October 2012 Issue Brief (20 pages), "Community Building As a Community Benefit," the Hilltop Institute (based at the University of Maryland-Baltimore County) defines community building, describes the types of community building programs and activities that nonprofit health care organizations and other stakeholders might undertake, discusses their importance in addressing the root causes of poor health, and notes other imporant resources on this issue.

For assessing and prioritizing community health needs, as well as for evaluating the results of community benefit programs, the nonprofit health sector and other stakeholders may wish to access the county health rankings and roadmaps provided by the Population Health Institute at the University of Wisconsin: www.countyhealthrankings.org.

For selecting and implementing evidence-informed policies, programs, and system changes to improve the variety of factors affecting health, the nonprofit health sector and other stakeholders may wish to use of another data base by the same Institute: www.whatworksforhealth.wisc.edu. This data base presents evidence-based programs and activities for addressing each of the key factors affecting health. The Institute asserts that social and economic factors account for about 40% of an individual’s health status.

In June 2010 the U. S. Department of Health and Human Services (HHS) and the Institute of Medicine announced a joint initiative wherein: HHS will be releasing greater amounts of community health data and in more usable formats; software developers will use the data to create new applications to make the information increasingly useful to individuals and communities; and with improved data and applications, individuals and communities will be able to initiate better efforts to prevent disease, promote health and measure health care quality and other performance dimensions. The draft set of indicators is available for review and comment at: http://www.cdc.gov/nchs/data/chdi/health_indicators.pdf.

In January 2009 the U.S. Department of Health and Human Services began publishing on a special website, http://communityhealth.hhs.gov/homepage.aspx, the Community Health Status Indicators Report, which contains health indicator data on over 200 measures for every county (3,141) in the U.S. and offers comparative analysis across communities.

The National Research Corporation (NCR), which also owns the Governance Institute, also offers through its Healthcare Market Guide community health reports. NRC has been surveying consumers on health care through a syndicated study for the past twenty years. Each year they survey over 250,000 households in the largest 250 markets. This data product appears to be a very good complement and more current source of consumer information than the public health and other data available from the above HHS source. Nonprofit health plans in particular may want to consider purchasing this product (on their own or in collaboration with state hospital associations, other state provider associations, state health plan associations, and/or state health departments) for themselves, hospitals and other health care providers, and local health departments in their service areas so that everyone is working from the same data in planning and evaluating their community benefit programs and activities. For more information about this product and its pricing, contact NRC's Director of New Product Development, at 800-388-4264 ext. 2508 or visit http://hcmg.nationalresearch.com.

The Association for Community Health Improvement (ACHI), an AHA personal membership group, offers on its web site (www.communityhlth.org) to paid members a Community Health Assessment Tool Kit, which presents a typical assessment process in six core steps, discusses factors that will make an assessment unique, and addresses potential obstacles and solutions. Case examples are also included.

CHA Guide on Planning and Reporting Community Benefit

In June 2008 the Catholic Health Association published an updated, consolidated guidance document on planning and reporting community benefit. Although some of the specific categories of community benefit are geared toward nonprofit hospitals, other nonprofit health care providers as well as nonprofit health plans should find most of the document useful. Copies of this Guide may be purchased on CHA's web site, www.chausa.org. Quantity discounts are available on request.

CHA Resource: Evaluating Community Benefit Programs

In mid-2009 the Catholic Health Association announced the availability of this new resource, which discusses key concepts and building blocks for conducting effective evaluations of community benefit programs and describes basic steps and tools for such evaluations. Copies may be purchased on CHA's web site, www.chausa.org.

CHA Booklet: IRS Form 990, Schedule H: For Community Benefit and Catholic Health Care Governance Leaders

In mid-2009 the Catholic Health Association also announced this new resource to educate boards of directors about the revised Form 990 and its new Schedule H. This booklet can be downloaded for free on its web site, www.chausa.org

Telling the Hospital Story: Going Beyond Schedule H

While published in June 2009 by the AHA for hospitals, this resource should also be of value to other types of nonprofit health care organizations, such as nursing homes and health plans. It includes: a strategy checklist for CEOs and board members; tools to enhance existing communications efforts to key audiences; examples of organizations working on organizing, assessing, documenting, and reporting their community benefit activities; and actual community benefit reports from a variety of organizations. This document is available at www.communityhlth.org in its Resources section under Community Benefit.

Communicating to the Public About Community Benefits

VHA Mountain States developed a 19-page document, "Messages and Strategies for Community-Owned Health Care Organizations: A Guide to Communicating Value," for marketing and communication leaders and senior strategy executives responsible for communicating the value of tax-exempt, community-owned health care to the communities they serve. This document can also be downloaded from the community benefit component of the resource section of the website of the Association for Community Health Improvement (ACHI), www.communityhlth.org

Hospitals Building Healthier Communities

In May 2013, the Democracy Collaborative at the University of Maryland published this report, which provides programmatic examples of what specific nonpofit hospitals and health systems are going around the country to help build their communities and improve health in the process.

Community Benefit-Related Conferences

CHA and VHA, Inc. co-sponsor conferences for community benefit professionals.

In addition, the Association for Community Health Improvement (ACHI), a personal membership group affiliated with the AHA, sponsors an annual conference.

Information about these conferences are posted on the websites of CHA (www.chausa.org) and ACHI (www.communityhlth.org)

Other Websites for Additional Resources on Community Benefit Practices

• Catholic Health Association: www.chausa.org
• Association for Community Health Improvement: www.communityhlth.org
• "Advancing the State of the art of Community Benefit" Pilot Project: www.asacb.org

Charitable Expectations of Nonprofit Hospitals: Lessons from Maryland

This July 23, 2009 article, published online in Health Affairs and co-authored by Brad Gray and Mark Schlesinger, reports on the results of their study of community benefit spending and reporting by nonprofit hospitals in Maryland. One of their important conclusions was that "if we want hospitals to address community needs through disease prevention and improvement of health status...we should think of how to define, encourage and measure performance on such dimensions, not just count expenditures."

Community Benefit Strategies for a Changing Economy

This February 2009 cover story in HFMA's journal describes three health care systems' strategies and programs to improve health status for vulnerable populations while lowering costs in today's economic climate.

Effective Advocacy a Must for Nonprofit Health Care Organizations: A Case Study on Why Being and Doing Good Isn't Enough

This fourteen page Alliance report is a reprint of a Summer 2006 Inquiry article that presents a case study by William Weissert, professor in the Department of Political Science and research associate at Florida State University, on Alliance member Blue Cross Blue Shield of Michigan's need for, and success in, public advocacy. Lessons are provided for all types of nonprofit health care organizations.

Beyond Charity Care: Mission Matters for Tax-Exempt Health Care

This report, authored by David Seay in 2007 for the Catholic Health Association, provides valuable discussions of community benefit, governance and accountability, volunteerism, philanthropy, staying the course, etc. which can be used in internal and external communications with a variety of audiences.

Governance Role in Community Benefit: Compliance or Leadership

This article, appearing in the Spring 2008 issue of Great Boards, discusses how eight nonprofit hospitals and health systems, representing a range of religious and secular, academic and community-based organizations, don't just collect community benefit data. They use it to both plan and oversee outreach programs, approaching community benefit as a matter of mission-based leadership rather than compliance.

Report on Governance of Nonprofit Community Health Systems

This report, issued in early 2009, presents findings of a study by researchers at the University of Iowa, led by Lawrence Prybil, Ph.D. The study recommendations stress the importance of the board's role in establishing community benefit policy and a community benefit committee, ensuring the conduct of a community needs assessment, adopting a formal community benefit plan, ensuring that reporting and accountability mechanisms are in place, and providing a thorough report on the organization's community benefits to their community.

Accountability for Community Benefit

This May 28, 2008 article by Ellen Barsi, Director of Community Benefit at Catholic Healthcare West, describes how her organization has brought more rigor and effectiveness to community benefit programming by establishing greater accountability among the board, management and staff.

Making Community Benefit Relevant to Senior Leaders: The Diabetes Example

This February 2009 article by consultant Patsy Matheny provides a practical, excellent example of how to help senior leaders understand community benefit and its business value and secure their commitment.

Helping Those Most in Need

This article, by Wayne Lerner, CEO of a safety-net hospital in Chicago, was published in the McNerney Forum of the journal Inquiry in its Winter 2008 issue. The author identifies eight possible strategies, not necessarily mutually exclusive, to help protect the hospital safety net.

Sustaining Community Health: The Experience of Health Care System Leaders

This 22-page white paper was researched and developed by the VHA Health Foundation in partnership with the American Hospital Association's Health Research and Educational Trust. They reviewed the experiences of recipients of the Foster G. McGaw Prize (between 1986 and 1998) and winners of the VHA Community Health Improvement Leadership Award (1996 to 1998) to determine whether they had sustained their commitments to community health and, if so, the factors that promoted sustainability.

In-depth interviews were conducted with a board member, CEO and community health improvement director or vice president at 8 of the 15 sites. The study suggested that commitments had been sustained, even in difficult circumstances. The top factors in sustainability were leadership/board commitment, community partnerships, linkage with a hospital foundation and fiscal health of the organization. This report can be downloaded on the VHA, Inc.website, www.vha.com, under its Foundation's Publications.

Where Do We Go from Here? The Hospital Leader's Role in Community Engagement

This document released in June 2007 by HRET, with funding from the W.K. Kellogg Foundation, presents the proceedings of a roundtable discussion on this topic by several hospital and health system leaders. It has broad applicability to all types of nonprofit health care provider and health plan leaders.

Community Benefits: The Need for Action, An Opportunity for Healthcare Change

This 122-page workbook published by the Access Project is intended to provide guidance to grassroots leaders and community organizations in defining community benefits, evaluating existing community benefit activities, and building coalitions and crafting strategies for improving community benefits. This document can be downloaded from the community benefit component of the resource section of the website of the Association for Community Health Improvement (ACHI), www.communityhlth.org.


Advancing the Public Accountability of Nonprofit Health Plans: Guidelines on Community Benefit Practices

This eight-page document approved in May 2005 by the Alliance's Board of Directors, is intended to motivate and assist nonprofit health plans in planning, implementing, assessing and reporting on their community benefits. Where relevant and appropriate, these guidelines draw upon the excellent guidance already developed for nonprofit hospitals and other health care providers by the Catholic Health Association and VHA, Inc.

Minnesota Health Department Report on Nonprofit Health Plans' Community Benefit

This January 2009 report by the Minnesota health department, prepared under a legislative mandate, provides an overview of the community benefit roles of nonprofit health plans in the state, identifies issues related to defining and reporting community benefit for nonprofit health plans, and discusses a range of options related to health plan community benefit requirements.

State Community Benefit Reporting by HMOs

Massachusetts is one of the few states having a program for community benefit reporting by health plans. Guidance to HMOs and hospitals on community benefit practices and reporting, as well as individual organization reports, are available on the website of the Office of the Massachusetts Attorney General, www.ago.state.ma.us


Hospital Tax Exemption: How Did We Get Here?

This 5-page report is a reprint of an article written by Alliance President Bruce McPherson for the Fall 2012 issue of the health care journal, INQUIRY. The report traces the history of hospital tax exemption in the U.S. and its linkage to community benefit.

Hospital Tax Exemption: Where Do We Go From Here?

This 5-page report, a reprint of a "Dialogue" article also appearing in the Fall 2012 issue of INQUIRY, is the proceedings of a recent roundtable discussion on the future of hospital tax exemption. The panelists were: John Koster, M.D., President and CEO of Providence Health & Services, Seattle, WA; Myles P. Lash, President Emeritus (and founder) of Provenance Health Partners, L.L.C., Doswell, VA; and Wayne M. Lerner, DPH, FACHE, President and CEO of Holy Cross Hospital, Chicago, IL.Alliance President Bruce McPherson moderated the discussion.

Community Events Tracker: Hospital Event Module

Community Benefits Tracker, offered by the Michigan Health and Hospital Association (MHA), is a hosted, Web-based data collection and reporting system that has been developed to streamline the collection of a hospital's community benefit activities. It is designed to help users gather and report community benefit event information quickly and easily. The program contains expected functions, like aligning with IRS Form 990 Schedule H and CHA/VHA guidelines, as well as robust reports, system roll-up capability, and creation of custom fields.

Free training is provided via webinar, with individuals able to attend as many sessions as they would like. Pricing is based on hospital bed-size, with clinics or services added at no additional charge. A 90-day free trial is offered, with no additional fees for set-up, implementation, or software upgrades. More information is available at www.cbtracker.net or by contacting MHA directly.

Integrating Community Benefit and the Organization's Clinical Strategies

This April 2, 2008 article entitled "Two Peas in a Pod: Community Benefit and Clinical Strategies," by Patsy Matheny, a community benefit consultant based in Ohio, provides some excellent practical guidance on how to integrate community benefit into the clinical component of the organization's business strategy.

The Future of Property-Tax Exemption for Nonprofit Health Care Organizations

This nine-page Alliance report is a reprint of an article in Inquiry, presenting the proceedings of an April 2007 roundtable discussion, co-sponsored by the Alliance and Inquiry, exploring the future of property tax exemption for nonprofit health care organizations. The panelists for this discussion were: Evelyn Brody, professor and author on tax and nonprofit law at Chicago-Kent College of Law, Illinois Institute of Technology, Chicago; Doug Hammer, vice president and general counsel of Intermountain Healthcare, headquartered in Salt Lake City, Utah; Oliver "Pudge" Henkel, executive director of government relations at the Cleveland Clinic Health System, based in Cleveland, Ohio; Patsy Matheny, consultant to nonprofit health care organizations on community benefit practices (and former director of health improvement for VHA, Inc.), based in central Ohio; and Alan R. Morse, Ph.D., president and CEO of the Jewish Guild for the Blind, headquartered in New York City. Bruce McPherson, Alliance president and CEO, moderated the discussion.

Community Benefit Categories for Homes and Services for the Aging

This ten-page document is part of the Catholic Health Association/VHA Guide for Planning and Reporting Community Benefit. This component was developed in cooperation with the American Association of Homes and Services for the Aging.

HFMA Principles and Practices Board Revised Statement 15: Valuation and Financial Statement Presentation of Charity Care and Bad Debts

This revised statement was released by HFMA in December 2006.

Alliance Brief: State Tax Exemptions Standards with Quantitative Thresholds for Nonprofit Health Care Organizations

Attached is a special brief by the Alliance which details the tax-exemption standards for nonprofit health care organizations in the three states which include quantitative thresholds for compliance: Utah (1990), Texas (1993), and Pennsylvania (1997).

Senate Finance Committee Minority Staff "Discussion Draft" on Major Reform of the Federal Tax Exemption Requirements for Nonprofit Hospitals

This document, prepared by Senate Finance Committee Minority Staff under Senator Grassley's direction and released in July 2007, calls for sweeping changes in hospital community benefit standards. The recommendations include, but are not limited to, the establishment of a number of quantitative standards, such as: a minimum of 5 percent of annual operating expenses or revenues, whichever is greater, devoted to charity care; a minimum threshold for free care of 100% of the federal poverty level; rates for patients offered discounts to equal the lower of the rate that Medicare or Medicaid would pay or the actual unreimbursed cost to the hospital; and no more than 25 percent of board members being employed by or otherwise financially benefiting from the organization's activities (excluding reasonable compensation for board duties).

Catholic Healthcare West's Patient Financial Assistance Policy

This is a summary of Catholic Healthcare West's June 2008 patient financial assistance policy. Included is a practical tool for assessing patient eligibility for assistance.

Also, please visit the Hospital Billing section of our web site Resources for guidelines and other examples of hospital billing and collection practices.

In addition, you may also wish to review "Free Care Compendium" on the web site of Community Catalyst, www.communitycatalyst.org, for individual state laws regulating these practices.

IRS's Redesigned Form 990

In 2008 the IRS released a variety of new and modified 990 forms, schedules and instructions for tax-exempt health care and other organizations, including a new Schedule H for community benefit reporting by tax-exempt hospitals, which is generally consistent with the Alliance's proposal for reform of the federal tax exemption requirements for nonprofit hospitals. The redesigned core form, schedules, and instructions are available at www.irs.gov/charities.

State Community Benefit Reporting Programs

In March 2013, the Hilltop Institute, based at the University of Maryland-Baltimore, published an Issue Brief, "Hospital Community Benefits after the Affordable Care Act: The State Law Landscape." It summarizes state laws on hospital community benefit practices and reporting requirements.

In September 2006 the Catholic Health Association and VHA, Inc. issued this forty-two page report comparing their community benefit reporting guides with those of voluntary and mandatory community benefit programs.

Also, the community benefit component of the resource section of ACHI's website, www.communityhlth.org, provides direct linkages to the websites of about a dozen state-level community benefit reporting programs, several of which are administered by state hospital associations rather than state government. The types of information vary by state program, such as: guidelines, instructions and/or forms for reporting; individual organization and/or aggregated reports; state-enabling legislation; definitions of terms; or listings of community benefit plans on file.

State Reporting Programs on Hospital Community Benefits

Twenty state hospital associations (including DC) annually report and post on their web sites summaries of their member nonprofit hospitals' community benefits, using definitions recommended by either the Catholic Health Association (does not count bad debts and Medicare payment shortfalls as community benefits) or the American Hospital Association (counts bad debts and Medicare shortfalls as community benefits). Some state associations also have published reports on the economic benefits of hospitals to the communities they serve. In addition, fourteen states have mandated community benefit reporting programs. Details on all of these reporting programs are available on the web site of the Association for Community Health Improvement (ACHI) at www.communityhlth.org/communityhlth/resources/communitybenefit.html