Community benefit is a well-defined set of activities articulated by the Internal Revenue Service. The IRS has identified specific categories of community benefit with detailed definitions and specific accounting guidelines. The IRS requires that to be reported, a community benefit must respond to an identified community need and meet a community benefit objective, such as improving community health, increasing access to health services, enhancing public health, educating health professionals, or relieving the government burden to improve health.
Integral to the mission of Catholic and other not-for-profit health care organizations, community benefit is an extension of not-for-profit hospitals' historic mission to meet the needs of the time in their communities, especially the needs of vulnerable and disenfranchised members in their communities.
Not-for-profit health care organizations demonstrate their commitment to community service through organized and sustainable community benefit programs providing:
- Free and discounted care to those unable to afford health care.
- Care to low-income beneficiaries of Medicaid and other indigent care programs.
- Services designed to improve community health and increase access to health care.
Community benefit is also the basis of the tax-exemption of not-for-profit hospitals. The Internal Revenue Service (IRS), in its Revenue Ruling 69–545, describes the community benefit standard for charitable tax-exempt hospitals. Since 2008, tax-exempt hospitals have been required to report their community benefit and other information related to tax-exemption on the IRS Form 990 Schedule H.
The Affordable Care Act, passed in 2010, added new requirements for tax-exempt hospitals regarding:
- Community health needs assessment and planning.
- Financial assistance.
- Charges.
- Billing and collections.
Sept. 2023 Legislative Briefing – Community Benefit and Tax Exemption
Learn More About Community Benefit
Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. They increase access to health care and improve community health.
A community benefit must respond to an identified community need and meet at least one of the following criteria:
- Improve access to health care services.
- Enhance health of the community.
- Advance medical or health knowledge.
- Relieve or reduce the burden of government or other community efforts.
A program or activity should not be reported as community benefit if it is:
- Provided for marketing purposes.
- Restricted to hospital employees and physicians.
- Required of all health care providers by rules or standards.
- Questionable as to whether it should be reported.
- Unrelated to health or the mission of the organization.
The Catholic Health Association recommends that health care organizations implement a comprehensive framework for planning, delivering and reporting their community benefit efforts. This framework includes the following elements:
- Build a sustainable infrastructure — Create a culture that supports the organization's community benefit mission and put in place operational elements that sustain community benefit programs such as qualified staff, sufficient budgets, and supportive policies and procedures.
- Plan for community benefit — Work with public health experts and community partners to assess and prioritize community health needs and develop programs based on goals, measurable outcomes and evidence-based interventions.
- Account for community benefit — Adopt standardized principles and practices to account for community benefit and establish effective administrative and accounting processes to accurately account for and report community benefit to various stakeholders, including the IRS and state/local agencies.
- Evaluate community benefit programs — Assess the quality and effectiveness of the overall program and individual programs and activities.
- Tell the community benefit story — Report the organization's community benefit efforts as required to regulatory bodies (such as the IRS or state/local agencies) and to communities and other important constituencies such as hospital staff, physicians and donors.
- Hospital community benefit programs are increasingly accountable to their communities, boards, employees and to organizations granting tax-exemption.
- Community benefit programs are more public health oriented, using tools and expertise from professional and academic public health.
- Most community benefit programs strategically focus on a few issues where they are likely to make an impact rather than scattering scarce resources on multiple "random act of kindness."
- While community benefit programs of the past tended to be planned and carried out by the hospital itself, today's community benefit programs work with a wide range of community partners to improve community health and increase access to services.
Not-for-profit hospitals are important partners for improving the health and well-being of communities. In alignment with their mission and their community benefit requirements, not-for-profit hospitals are working with their communities to address health equity and improve health outcomes. Successful efforts start by developing key relationships for collaboration and partnerships. This resource provides tips for getting started in aligning and partnering with your local not-for-profit hospital.