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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 now available as a Microsoft Word document.
To fill out the Community Benefit Reporting form:
- Open the Community Benefit reporting form by double-clicking here.
- Save the reporting form to your desktop.
- Enter your event information into the form.
- Please note that directions for some commonly asked questions are included as footnotes at the bottom of the reporting form. Additional questions can be directed to the Community Benefit Committee at email@example.com.
- 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.
- After entering information into the reporting form:
- Select “File” in the upper right corner of the word document.
- Then select “Save As” and rename the file with an identifier for your event. (Example: Meals on Wheels = MOW.docx)
- Finally save the file to your computer.
To submit your completed form:
- Attach your completed form to an email addressed to firstname.lastname@example.org
- Enter “Community Benefit Report” in the subject line.
- Send the email.
- Please note that you can send separate emails as you complete your reports or attach multiple reports to a single email.
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:
- one form to report each health screening event,
- one to report each health festival/fair,
- one to report each community educational session, and (unless it is part of a series)
- one to report in-kind staff support for community coalitions.
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.
Some programs or departments have identified contact persons to coordinate their submissions. Please look at the list of Program Contacts (xls) to identify the contact person for your area. You may want to contact this person before submitting to make sure that reports are not being duplicated.
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 email@example.com.