Worksheet 4

Community Health Improvement Services and Community Benefit Operations (Part I, line 7e)

Use Worksheet 4 to report the net cost of community health improvement services and community benefit operations.

"Community health improvement services" means activities or programs carried out or supported for the express purpose of improving community health that are subsidized by the health care organization. Such services do not generate inpatient or outpatient bills, although there may be a nominal patient fee or sliding scale fee for these services.

"Community benefit operations" means activities associated with community health needs assessments as well as community benefit planning and administration. Community benefit operations also include the organization's activities associated with fundraising or grant-writing for community benefit programs.

Activities or programs may not be reported if they are provided primarily for marketing purposes and the program is more beneficial to the organization than to the community; for instance, if the activity or program is designed primarily to increase referrals of patients with third-party coverage, required for licensure or accreditation, or restricted to individuals affiliated with the organization.

To be reported, community need for the activity or program must be established. Community need may be demonstrated through the following.
 - A community needs assessment developed or accessed by the organization.
 - Documentation that demonstrated community need or a request from a public agency or community group was the basis for initiating or continuing the activity or program.
 - The involvement of unrelated, collaborative tax-exempt or government organizations as partners in the activity or program.

Community benefit activities or programs also seek to achieve objectives, including improving access to health services, enhancing public health, advancing generalizable knowledge, and relief of government burden. This includes activities or programs that do the following.

 - Are available broadly to the public and serve low-income consumers.
 - Reduce geographic, financial, or cultural barriers to accessing health services, and if ceased to exist would result in access problems (for example, longer wait times or increased travel distances).
 - Address federal, state, or local public health priorities such as eliminating disparities in health care among different populations.
 - Leverage or enhance public health department activities such as childhood immunization efforts.
 - Otherwise would become the responsibility of government or another tax-exempt organization.
 - Advance generalizable knowledge through education or research that benefits the public.

Lines 1a-j, column (A). Enter the name of each reported community health improvement activity or program and total community benefit expense for each. Include both direct costs and indirect costs in total community benefit expense. Use additional worksheets if the organization reports more than 10 community health improvement activities or programs.

Lines 3a-d, column (A). Enter the name of each reported community benefit operations activity or program and total community benefit expense for each. Include both direct costs and indirect costs in total community benefit expense. Use additional worksheets if the organization reports more than four community benefit operations activities or programs.

Report total community benefit expense, direct offsetting revenue, and net community benefit expense for each line item.

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