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The Community Benefit information reported through this Web site is used for several reports that the Health System prepares for reporting our contributions to the community.  Some of these reports ask for very detailed information about our community benefit event, and we are trying to improve our data collection efforts so that we can accurately report our contributions.  We encourage you to use this form to provide us with detailed information about your activities.

The Community Benefit reporting form is available as a PDF.

To fill out the Community Benefit Reporting form:

  1. Click here to open the Community Benefit reporting form.
  2. Save the reporting form to your desktop.
  3. Enter your event information into the form.
    • Please note that directions for some commonly asked questions are included as foot notes at the bottom of the reporting form. Additional questions can be directed to the Community Benefit Committee at communitybenefit@med.umich.edu.
    • If you need to gather additional information, or are waiting for an answer to a question, you can save the reporting form to your computer (even if it has not been completed) and complete it at a later time.
  4. After entering information into the reporting form:
    • Select “File” in the upper right corner of the document.
    • Then select “Save As” and rename the file with an identifier for your event. (Example: Meals on Wheels = MOW.pdf)
    • Save the file to your computer.
  5. Email the completed Community Benefit reporting form to the Community Benefit Committee at communitybenefit@med.umich.edu.

To submit your completed form:

  1. Attach your completed form to an email addressed to communitybenefit@med.umich.edu
  2. Enter “Community Benefit Report” in the subject line.
  3. Send the email.
    • Please note that you can send separate emails as you complete your reports or attach multiple reports to a single email.

Please Note:
It is possible, and you are encouraged to submit several forms for the same community event if the program consists of various different types of activities.  For example, a department, program or individual should submit:

Submitting several forms will provide us with more detailed information about each type of activity.  If you are submitting various forms, please avoid double-counting activities, expenses or revenues by allocating these data as appropriately as possible.

Questions?
Please refer to our Community Benefit Glossary for help with the terms used in our form.  Any other questions related to reporting Community Benefits can be directed to the Community Benefit Committee through our email address communitybenefit@med.umich.edu.