Beyond community benefit: Unveiling hospitals' comprehensive efforts to improve community health

Calls for nonprofit hospitals to clearly make their case for tax exemption are increasing. Most published research on nonprofit hospitals' provision of community benefit relies on data reported in Internal Revenue Service (IRS) Form 990 Schedule H. This study leverages insight from hospital leaders to better understand the types of initiatives, beyond community benefit, that hospitals engage in to benefit their communities. We conducted 17 semi-structured interviews with a total of 34 hospital representatives. Three themes were identified: (1) the current IRS Form 990 Schedule H provides only limited insights into hospitals' investments into communities, (2) health systems engage in a variety of diverse activities that benefit communities and address social determinants of health, and (3) health systems use a variety of communication channels outside of Form 990 and Schedule H to raise awareness about their contributions to community health. These findings suggest that IRS reports alone do not fully illustrate the scope of hospital initiatives to benefit communities. Internal changes in hospital practices and procedures, and external policy levers, may provide a more comprehensive picture of benefits and opportunities for improvement.