Annual Statement of Community Benefits Standard

The 2016 blank Annual Statement of Community Benefits Standard (ASCBS) form is used in collecting charity care and community benefits information from Texas nonprofit hospitals, public hospitals and for-profit hospitals participating in the Disproportionate Share Hospital Program.

Survey Forms

 

2016 ASCBS form for Nonprofit Hospitals:

Nonprofit Part I (PDF 230kb) Nonprofit Part II  (PDF 66kb)
2016 ASCBS form for Nonprofit Hospitals

 

2016 ASCBS form for Public Hospitals and For-Profit Disproportionate Share Hospitals:

Public and For-Profit Dispro Part I (PDF 223kb)
2016 ASCBS form for Public Hospitals and For-Profit Disproportionate Share Hospitals

Lists of hospitals required to report and hospitals exempt from reporting charity care
and community benefits information for the 2016 reporting period:

 Required - 2016 (Excel 45kb) Exempt - 2016 (Excel 49kb)
Lists of hospitals required and exempt from reporting charity care and community benefits information for the 2016 reporting period

Please note: The documents provided above are not fully ADA compliant, and may therefore pose problems for some of our readers. We are working toward compliance in our archive and in new reports. In the interim, should you have any accessibility-related problems with these materials, please contact us for assistance. We apologize for any inconvenience this may cause.

Last updated July 27, 2017