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Brown ArrowCommunity Benefit / Community Health Needs Assessment

Not-for-profit hospitals, in order to maintain their tax-exempt, or "charitable," status, under section 501(c)(3) of Federal Internal Revenue Code, have long been required to provide benefit to the community that they serve. Recent changes in legislation now require that such hospitals explicitly and publicly demonstrate community benefit by conducting a community health needs assessment (CHNA) and adopting an implementation strategy to meet the identified community health needs. (IRS).

Section 9007 of the Patient Protection and Affordable Care Act, Public Law 111-148 (the "Affordable Care Act"), created section 501(r) of the Code adding new requirements effective beginning with the first tax year on or after March 23, 2012, that 501(c)(3) hospitals must conduct a CHNA at least once every three years in order to assess community need and annually file information (by means of Schedule H (Form 990)) regarding progress toward addressing identified needs. (IRS). This can involve partnerships with other clinical, public health, and population health focused organizations. Section 9007 furthermore established tax penalties for hospitals that do not comply, as well as reporting requirements regarding national compliance on the IRS. (IRS).
The IRS has provided initial guidance concerning the CHNA requirement (see legislative and tax information); this guidance has been further augmented by individual states to accommodate their state-specific requirements for tax-exempt status (Hilltop). A growing set of tools, examples, and analyses are provided below to assist both those tasked with preparing a CHNA, as well as those interested in reviewing national progress.

Search Queries Using NLM Resources: Community Benefit

News : Community Benefit / Community Health Needs Assessment

  • Health Impact Assessment Can Inform Community Development Decisions--06-APR-2017 - (Pew Charitable Trusts USA)  Details

    This brief presents case studies about three health impact assessments and draws from a review conducted by the Georgia Health Policy Center that summarized the HIA process and findings. It also provides an introduction to HIA for community developers and policymakers and explains how developers can incorporate health considerations into their decisions.

Data, Tools, Statistics

For a broad set of quality sources of data and statistics related to health care, health services and health status, readers are directed to the following resource and topic pages on HSRInfo Central and

  • ACHI Community Health Assessment Toolkit - (Association for Community Health Improvement (ACHI))  Details

    This toolkit was designed to assist in planning, leading and using community health needs assessments to understand and improve health of communities.

  • AHRQ Health Care Innovations Exchange - (Agency for Healthcare Research and Quality (AHRQ))  Details

    The Innovations Exchange offers health professionals and researchers the opportunity to share, learn about, and ultimately adopt evidence-based innovations and tools suitable for a range of health care settings and populations.

  • Assessing and Addressing Community Health Needs - (Catholic Health Association of the United States (CHAUSA) USA)  Details

    This web page assembles a number of different resources to assist hospitals in understanding the IRS requirements that went into effect on December 31, 2014, the differences between the proposed and final regulations, and resources that will assist in the CHNA planning and implementation processes.

  • CDC Community Health Improvement Navigator - (Centers for Disease Control and Prevention (CDC))  Details

    This website is aimed at those who participate in CHI work within hospitals and health systems, public health agencies, and other community organizations. It provides vetted tools and resources for community health improvement.

  • Community Benefit (CHA) - (Catholic Health Association of the United States (CHAUSA) USA)  Details

    This website features a selection of tools, reports and forms to assist organizations in fulfilling the community benefit requirements. News feeds alert users to new data, relevant to the area.

  • Community Health Assessment & Health Improvement Planning - (Center to Reduce Cancer Health Disparities, NCI (CRCHD))  Details

    This site helps state, tribal, local, and territorial (STLT) health departments as they develop community health assessments and health improvement plans, whether for accreditation preparation, nonprofit hospital collaboration, or other reasons.

  • Community Health Assessment Clearinghouse - (New York State Department of Health)  Details

    Intended as a resource for community health planners, practitioners, and policy developers both in counties and hospitals in New York State but relevant to other states and settings, this website contains health data, local health planning, and examples of Community Health Assessments and Hospital Community Service Plans (CHNAs).

  • Community Health Assessment Toolkit - (Association for Community Health Improvement (ACHI))  Details

    The Association for Community Health Improvement's Community Health Assessment Toolkit offers a nine-step pathway for conducting a CHA and developing implementation strategies.

  • Community Health Assessment and Improvement Planning - (National Association of County and City Health Officials (NACCHO))  Details

    This website provides access to resources in support of both assessment of community benefit and accreditation, from from the perspective of Local Health Departments. Included are sections on community benefit, the Community Health Status Indicators Project, and accreditation prerequisites: CHAs and CHIPs.

  • Community Health Needs Assessment Toolkit (2012) images/pdf.gif icon - (Oklahoma State University, National Center for Rural Health Works USA)  Details

    Designed for state level professionals, this toolkit facilitates the community health assessment process in rural hospitals at no or low cost to the hospitals.

  • Community Health Status Indicators (CHSI) - (Centers for Disease Control and Prevention (CDC))  Details

    Interactive web application that produces health profiles for all counties in the United States. Each profile includes key indicators of health outcomes, which describe the population health status of a county and factors that have the potential to influence health outcomes, such as health care access and quality, health behaviors, social factors, and the physical environment.

  • Community Tool Box - (Community Tool Box, Work Group for Community Health and Development, University of Kansas U.S.)  Details

    The Community Tool Box is a global resource for free information on essential skills for building healthy communities. Its goal is to promote community health and development by connecting people, ideas and resources

  • Comprehensive Community Needs Assessment (CCNA) Tool - (University of Missouri-Columbia USA)  Details

    The Center for Applied Research and Environmental Systems (CARES) provides basic data on counties and states through an online data retrieval system and provides you with a downloadable, and editable, Microsoft Word document which can serve as a basis for conducting a more detailed CCNA.

  • County Health Rankings & Roadmaps - (Robert Wood Johnson Foundation (RWJF), University of Wisconsin)  Details

    Provides county-by-county health rankings for each of the 50 states and Washington DC, explanations of each health factor, and actionable strategies to improve the health of communities across the nation.

  • HSRProj - (National Library of Medicine, National Information Center on Health Services Research and Health Care Technology)  Details

    Database of ongoing health services research projects. Search for studies relating to access, cost, and quality of health care, including patient outcomes, health services research methods, community needs assessments, etc.

  • HSRR (Health Services and Sciences Research Resources) - (National Library of Medicine, National Information Center on Health Services Research and Health Care Technology)  Details

    HSRR is a searchable database of information about research datasets, instruments/indices and software employed in Health Services Research, the Behavioral and Social Sciences and Public Health. The database includes brief descriptions of research resources and links to PubMed.

  • Hospital-based Strategies for Creating a Culture of Health (2014) images/pdf.gif icon - (Health Research and Educational Trust (HRET), Robert Wood Johnson Foundation (RWJF))  Details

    This report presents the results of an analysis of the community health needs assessments from 300 tax-exempt hospitals. It outlines the key drivers to community health needs, including: access to care, lack of health insurance, socioeconomic factors, limited preventive and screening services, limited care coordination, and inadequate chronic condition management.

  • Leading Health Indicators - (Department of Health and Human Services (HHS) U.S.)  Details

    Healthy People 2020 provides a comprehensive set of 10-year, national goals and objectives for improving the health of all Americans.

  • Maps and Data - (Kaiser Permanente US)  Details

    This tool will allow you to browse maps created by Community Commons members, or build state specific reports for Community Health Needs Assessment and Vulnerable Populations Footprint.

  • Tools for Community Action - (Centers for Disease Control and Prevention (CDC))  Details

    This website includes links to The Guide to Community Preventive Services, Community Health Resources Database, Community Health Assessment aNd Group Evaluation (CHANGE) Tool and Action Guide, several actions guides, and a series of reports focusing on health education

State and Special Population Resources

  • Tri-State Community Wellness Indicators Details

    This website provides information on demographics, health, and societal risk factors for fourteen counties in southwestern Indiana, southeastern Illinois and northwestern Kentucky.

  • Vermont State Data Center - (University of Vermont)  Details

    A searchable resource created by the University of Vermont. It is divided by Vermont cities, towns, and villages, with information on demographics, transportation, education, and health resources in Vermont.

Legislation / Regulations

Federal Resources

  • Requirement of a Section 4959 Excise Tax Return and Time for Filing the Return images/pdf.gif icon - (Internal Revenue Service (IRS) USA)  Details

    This document contains final and temporary regulations that provide guidance to charitable hospital organizations regarding the requirement of a return to accompany payment of the excise tax, enacted as part of the Patient Protection and Affordable Care Act of 2010, for failure to meet the community health needs assessment requirements for any taxable year.

  • Schedule H (Form 990) - (Internal Revenue Service (IRS) USA)  Details

    Not-for-profit hospitals are required to file this form, which demonstrates their compliance with ACA section 501(r). Link directs to IRS resource pages for form, instructions, notifications and other relevant tax documents,

State Resources

  • State Links - (Internal Revenue Service (IRS) USA)  Details

    The IRS has provided a set of links to the state government web sites, with information related to the tax regulations for tax-exempt organizations.

Selected Articles and Documents

  • Community Health Needs Assessments - (Association of State and Territorial Health Officials (ASTHO))  Details

    Included in this set of resources are several case studies looking at partnerships between hospitals and state public health departments.

  • Hospitals Building Healthier Communities: Embracing the Anchor Mission (2013) images/pdf.gif icon - (University of Maryland)  Details

    The report features a series of case studies, intended to serve as models for other hospitals planning to strengthen their community engagement model. Included in the paper are previous research on anchor institutions, the evolution of the hospital in the U.S. and trends and best practices in community building.

Analyses examining Pre-ACA Community Benefit Practices

Sample Community Health Needs Assessments

This is a list of representative samples of CHNA’s. These have been selected to provide examples of different types of institutions that would be doing CHNA’s. The list is not meant to be exhaustive.

Meetings / Webinars



  • Community Health Status Indicators(CHSI) 2015 Webinar - (Centers for Disease Control and Prevention (CDC), National Library of Medicine (NLM) U.S.)  Details

    This CDC/NLM webinar provides an overview of the new features and redesign of CDC's CHSI online web application. Learn firsthand from experts who developed CHSI 2015 about how best to use this redesigned web application to support community health and health needs assessment and population health improvement. Originally presented on March 24 and March 26, 2015.


  • American Hospital Association Details

    The primary organization for hospitals, AHA's website contains a number of reports, presentations, and case studies relevant to organizations seeking to comply with the community benefit requirement.

  • Centers for Disease Control and Prevention (CDC) Details

    The Centers for Disease Prevention and Control (CDC) is one of the operating components of the U.S. Department of Health and Human Services. CDC's mission is to promote health and quality of life by preventing and controlling disease, injury, and disability.

  • Community Benefit Connect Details

    The purpose of Community Benefit Connect is to support nonprofit hospitals by building a learning community of practitioners who will translate into action community benefit planning, implementation, reporting and evaluation. Included on the website are suggested links, webinars, and a blog.

  • Community Indicators Consortium Details

    The Community Indicators Consortium advances and supports the development, availability and effective use of community indicators for making measurable and sustainable improvements in quality of community life.

  • Hospital Accountability Project - (Community Catalyst USA)  Details

    This website features news related to the CHNA regulations, as well as links to documents useful to organizations needing to comply with the regulations.

  • Hospital Community Benefit Program - (Hilltop Institute USA, University of Maryland)  Details

    This website was developed to assist policymakers in locating the necessary resources to ensure continuation of their tax-exempt status.

  • Public Health Accreditation Board - (Public Health Accreditation Board (PHAB))  Details

    Provides information about a national voluntary accreditation program for state, local, territorial and tribal public health departments. The goal of the accreditation program is to improve and protect the health of every community by advancing the quality and performance of public health departments.

  • W.K. Kellogg Foundation Details

    The Foundation provides grant support for projects that concentrate on early childhood (prenatal to age 8), within the context of families and communities.