FHA Survey on Hospital Community Benefit Impact | 2021

Highlighting hospital activities to improve the health of the communities served is an important way to "tell the hospital story" and quantify the financial contributions of hospitals to local communities.

To support our state and federal advocacy efforts, we are collecting the most current data on hospital community benefit activities. Please provide the information below which aligns with annual IRS reporting requirements for 501(c)(3) hospitals. For hospitals who do not complete a 990 Schedule H form, please use the definitions and descriptions outlined by the IRS, www.irs.gov/forms-pubs/about-schedule-h-form-990. For information on what can be counted as community benefit by category, please consult the Catholic Health Association's What Counts Resources, https://www.chausa.org/communitybenefit/what-counts.

Please complete the survey no later than November 15, 2021. No individual hospital data will be released, only aggregate statewide numbers. If you have questions regarding the survey, please contact Kim Streit at kims@fha.org or (407) 841-6230.

Question Title

* 1. Please complete:

Hospital/Health System: *

Name: *

Title:

Email Address: *

Phone Number: *

Question Title

* 2. If you are a health system or part of a health system, do these answers represent the entire health system?

Yes

N/A

If no, please identify which hospitals are included in this response.

Question Title

* 3. We are requesting 2020 data submitted to the IRS. If you do not have 2020 data, please note what time period you are using:

Question Title

* 4. Please list the name and contact information for the individual in your hospital leading community benefits initiatives.

Name:

Title:

Email Address:

Phone Number: