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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. Also available is a search strategy on "community benefit" and "CHNA" that will assist in finding relevant articles in PubMed. Other search databases can be of use in your research – please talk to your local librarian about unique resources available to you.

Data, Tools, Statistics

  • AHRQ Health Care Innovations Exchange - (Agency for Healthcare Research and Quality (AHRQ))  - 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.
  • CHNA Data Platform - (Kaiser Permanente US)  - Registration is required to use this web-based tool, which includes a focused set of community health indicators to assist in the CHNA process.
  • Community Benefit - (National Association of County and City Health Officials (NACCHO))  - NACCHO provides a section devoted to information on community benefit.
  • Community Benefit (CHA) - (Catholic Health Association of the United States (CHAUSA) USA)  - 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))  - 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 and Improvement Planning - (National Association of County and City Health Officials (NACCHO))  - This website provides access to resources in support of both assessment of community benefit and accreditation, from from the perspective of Local Health Departments.
  • Community Health Assessment Clearinghouse - (New York State Department of Health)  - 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 Needs Assessment (CHNA) - (Community Commons USA, Institute for People, Place & Possibility (IP3))  - Web-based platform designed to assist hospitals, non-profit organizations, state and local health departments, and other organizations seeking to identify assets and potential disparities in their communities.
  • Community Health Needs Assessment Toolkit (2012) images/pdf.gif icon - (Oklahoma State University, National Center for Rural Health Works USA)  - 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 Needs Assessment Online Tool - (University of Missouri-Columbia USA)  - 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.
  • Community Tool Box - (Community Tool Box, Work Group for Community Health and Development, University of Kansas U.S.)  - 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
  • County Health Rankings & Roadmaps - (Robert Wood Johnson Foundation (RWJF), University of Wisconsin)  - 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.
  • Health Indicators Warehouse (HIW) - (National Center for Health Statistics, CDC (NCHS))  - The Health Indicators Warehouse serves as the data hub for the HHS Community Health Data Initiative by providing a single source for national, state, and community health indicators.
  • Hospital-based Strategies for Creating a Culture of Health images/pdf.gif icon - (Health Research and Educational Trust (HRET), Robert Wood Johnson Foundation (RWJF))  - 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.
  • HSRProj - (National Library of Medicine, National Information Center on Health Services Research and Health Care Technology)  - 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)  - 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.
  • Public Health Quality Improvement Exchange (PHQIX) - (RTI International, Robert Wood Johnson Foundation (RWJF))  - Searchable site for public health professionals interested in learning and sharing information about quality improvement (QI) in public health.
  • Tools for Community Action - (Centers for Disease Control and Prevention (CDC))  - 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

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)  - 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)  - 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)  - 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))  - 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)  - 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

  • Hospitals and Community Benefit - Interim "Hospital Compliance" Report - (Internal Revenue Service (IRS) USA)  - This 2007 report examined implementation of the community benefit standard by hospitals and found lack of uniformity in definitions and reporting. It called for a separate schedule for hospitals on Form 990, the annual return filed by tax-exempt organizations, and proposed creation of Schedule H, where hospitals would report how they provide community benefit

Sample Community Health Needs Assessments

  • Rural Community Health and Needs Assessments - The Center for Rural Health at the Mel and Enid Zuckerman College of Public Health of the University of Arizona has assembled examples of the CHNAs for rural Arizona counties and hospitals.

Meetings / Webinars



  • Community Benefit and Anchor Institutions: Linkages and Opportunities - (University of Maryland)  - This webinar from December of 2013 looks at the community benefit requirements as a powerful and effective framework to drive community economic development. Also included are links to webinar slides and to slides that supplement the webinar information.
  • Healthy People 2020 and Community Benefit - (National Association of County and City Health Officials (NACCHO))  - The meeting goals and objects and selected presentations from this April 9, 2013 meeting are available.


  • American Hospital Association - 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) - 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 - 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 Health Improvement - (National Network of Public Health Institutes (NNPHI))  - NNPHI has assembled a series of their own resources, as well as those from other organizations, aimed at supporting organizations in their Community Health Assessment and Community Health Improvement efforts.
  • Community Indicators Consortium - 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 Program - (Community Catalyst USA)  - 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)  - 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))  - 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.
  • Robert Wood Johnson Foundation - (Robert Wood Johnson Foundation (RWJF))  - RWJF's mission is to improve the health and health care of all Americans.
  • W.K. Kellogg Foundation - The Foundation provides grant support for projects that concentrate on early childhood (prenatal to age 8), within the context of families and communities.