Somewhere in your neighborhood hospital's files is a document that names, in writing, what that hospital has decided your community needs most and what it promised to do about it. It's called a Community Health Needs Assessment, or CHNA, and by federal law, the hospital has to show it to you. Not eventually. Not if you're a journalist or a lawyer. On request, for free, right now.
Almost nobody asks.
That's not an accident. Most people don't know the document exists, and hospitals aren't exactly advertising it. But if you've ever wondered why your local emergency room feels perpetually overwhelmed, why a "community benefit" program never seemed to reach your block, or whether a hospital's public equity pledges match what it's actually funding this is where you go to check.
What a CHNA Actually Is
Under Internal Revenue Code Section 501(r)(3), every nonprofit hospital that wants to keep its tax-exempt status has to complete a Community Health Needs Assessment every three years. The hospital studies its service area, identifies the top health problems facing that community, and publishes an implementation strategy laying out what it plans to do about them.
This isn't a courtesy. It's the price of the tax exemption. A hospital that skips it, buries it, or refuses to provide a copy is exposed to a $50,000 excise tax per facility, per year and that failure is itself a compliance story worth telling.
The report has to be "conspicuously posted" on the hospital's own website, and the hospital must provide a free paper copy to anyone who asks. No subpoena. No records request fee, in most cases. Just a request.
How to Actually Get One
Start with the hospital directly — most of the time, that's all it takes.
Check the hospital's website first, usually under a "Community Affairs" or "Community Benefit" page. Large systems like NewYork-Presbyterian and HSS post theirs directly.
If you can't find it, email or call the hospital and cite the law by name:
"Pursuant to Internal Revenue Code Section 501(r)(3) and its implementing regulations, I am requesting a copy of [Hospital Name]'s most recently completed Community Health Needs Assessment report and adopted implementation strategy. Please confirm whether this facility's most recent CHNA identifies [your neighborhood/ZIP code] as a priority area, and if so, what specific interventions were adopted in response."
They're legally required to comply, at no charge. If they don't write that down. That refusal is itself part of the story.
Public hospital systems require a different tool: FOIL.
Private nonprofit hospitals fall under 501(r)(3). But public systems like NYC Health + Hospitals — are government entities, and getting their records (or related city health data to cross-check a CHNA's claims) goes through New York's Freedom of Information Law instead.
For NYC Health + Hospitals: email hhcfoil@nychhc.org, or mail the Records Access Officer at 125 Worth Street, Room 527, New York, NY 10013. Include your name, address, phone, and email.
For related public health data from the city: recordsaccess@health.nyc.gov (NYC Department of Health & Mental Hygiene). For state-level oversight records: foil@health.ny.gov (NYS Department of Health).
One practical note: the agency only has to hand over records that already exist they don't have to create a new analysis just because you asked. Ask for what's already on file, not for someone to go build something new.
Why This Matters More Than It Looks Like It Does
A hospital's CHNA is where its public promises live on paper — the neighborhoods it says it's prioritizing, the health problems it says it's addressing, the money it says it's putting behind both. That paper trail is exactly what lets you check a hospital's actual behavior against its stated commitments, three years at a time.
If your neighborhood keeps showing up in the "priority area" section of every CHNA cycle with the same problems named again and again, and nothing on the ground has changed that gap between the document and the block is the story.
What You Can Do Right Now
- Search "[your hospital's name] Community Health Needs Assessment" it may already be posted.
- If it isn't easy to find, send the request above. It costs you an email.
- Once you have it, check whether your ZIP code is named as a priority area, and what the hospital said it would do about it.
- If a hospital refuses, stalls, or has nothing posted at all, that's worth reporting to us, or to the IRS directly.
This is the same kind of records work behind MB's ongoing Hospital on Your Block investigation — reading the documents hospitals are required to produce, and checking them against what's actually happening in the neighborhoods they claim to serve.
Have a hospital bill, a CHNA that doesn't match your block, or a hospital that stonewalled a records request? Send it to info@melaninblissmedia.com. Tips are ALWAYS CONFIDENTIAL AND PROTECTED
Sources: Internal Revenue Code Section 501(r)(3); IRS Notice 2011-52; New York Freedom of Information Law, Public Officers Law Article 6; NYC Health + Hospitals FOIL guidance; NYS Department of Health FOIL guidance; HFMA compliance guidance on Section 501(r) excise tax penalties.
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