I. Introduction and Background

On July 16, 1999, Senate Bill 69, an act relative to health care charitable trusts and community benefits, was signed into law by Governor Shaheen. The purpose of the legislation is to ensure that health care charitable trusts provide the communities they serve with benefits in keeping with the charitable purposes for which the trusts were established and in recognition of the advantages the trusts enjoy. The legislation requires each health care charitable trust develop a community benefits plan within 90 days of the start of its fiscal year. Each health care charitable trust is required to:

• submit its community benefits plan to the Director of Charitable Trusts on an annual basis;
• provide notice to the public of the availability and process for obtaining a copy of its community benefits plan; and
• prominently display such notice in its lobby, waiting rooms, or other area of public access.

The effective date of the law for health care charitable trusts with a total value of fund balances of at least $1,000,000 is on January 1, 2000; health care charitable trusts with a total value of fund balances of at least $100,000 must comply effective January 1, 2001; any health care charitable trust with a total value of fund balances of less than $100,000 is exempt from the provisions of this law.

This bill requires that the health care charitable trust the prepare a community needs assessment (RSA 7:32-f), seek input from the public during all phases of the process, including the development of the community benefits plan (RSA 7:32-e IV and VI), and provide notice to the public of the availability of the community benefits plan (RSA 7:32-g).

II. The Role of the Director of Charitable Trusts

The new legislation is an amendment to RSA Chapter 7, Director of Charitable Trusts, and adds a new section to the existing statute: 7:32-c to 7:32-l. Jurisdiction for the administration and enforcement of the new law is under the supervisory authority of the Attorney General, Director of Charitable Trusts. The law requires that within 90 days of the start of its fiscal year every health care charitable trust shall develop a community benefits plan. Every health care charitable trust must submit its community benefits plan to the Director of Charitable Trusts on an annual basis no later than 90 days after the start of the trust's fiscal year. Failure to meet this deadline may result in a fine of not more than $1,000 plus attorneys fees and costs for each violation.

An extension of time for filing the community benefits plan may be granted by the Director upon application made by the health care charitable trust and for good cause shown.

The Director of Charitable Trusts may grant an exemption from the provisions of RSA 7:32-c to 7:32-l to those health care charitable trusts for which compliance would be a financial or administrative burden. An exemption, if granted, shall be valid for a period of three years from the date of issuance unless it is revoked by the Director of Charitable Trusts and written notice of such revocation is provided to the health care charitable trust. The criteria for exemption and application form are contained in this booklet.

III. Definitions

Charity care means health care services provided by a health care charitable trust for which the trust does not expect and has not expected payment and which health care services are not recognized as either a receivable or as revenue in the trust's financial statements.

Community means the service area or patient population for which a health care charitable trust provides services.

Community benefits means a health care charitable trust's activities that are intended to address community health care needs. Community benefits may include the following:

(a) Charity care.

(b) Financial or in-kind support of public health programs even if the programs extend beyond the trust's service area, including support of recommendations in any state health plan developed by the Department of Health and Human Services.

(c) Allocation of funds, property, services, or other resources that contribute to community health care needs identified in a community benefits plan.

(d) Donation of funds, property, services, or other resources which promote or support a healthier community, enhanced access to health care or related services, health education and prevention activities, or services to a vulnerable population.

(e) Support of medical research and education and training of health care practitioners.

Charity care does not include any sums identified as bad debt, a receivable, or revenue by the trust in accordance with generally accepted accounting principles.

Community benefits plan means a written document prepared by a health care charitable trust which identifies health care needs in the area served by the trust and describes the activities the trust has undertaken and will undertake to address the identified needs.

Health care charitable trust means a charitable trust organized to directly provide health care services, including, but not limited to, hospitals, nursing homes, community health services, and medical-surgical or other diagnostic or therapeutic facilities or services. It shall not include any testamentary or inter-vivos trust which is not organized to provide health care services.

Nursing Home or facility means a place which shall provide for 2 or more persons, basic domiciliary services (board, room, and laundry), continuing health supervision under competent professional medical and nursing direction, and continuous nursing care as may be individually required. (source: RSA 151-C:2 XXVI)

Vulnerable population means any population that is at risk of not receiving health services due to medical, financial, or other barriers.

IV. Elements of the Community Benefit Plan

Mission Statement: Each health care charitable trust must adopt a mission statement which must be reaffirmed on an annual basis.

Definition of community and population served: The health care charitable trust must identify the service area and/or patient population for which the trust provides services.

Community Needs Assessment: Each health care charitable trust must complete or update a community needs assessment every three years. Community needs assessments may be conducted in collaboration with other health care charitable trusts. Each assessment must include consultation with members of the public, community organizations, service providers, and local government officials in the trust's service area in identifying and prioritizing community needs for each health care charitable trust to address directly, in collaboration with others, or through other organizational arrangements.

Definition of Community Benefit: Including but not limited to charity care; financial or in-kind support of public health programs even if the programs extend beyond the trust's service area, including support of recommendations in any state health plan developed by the Department of Health and Human Services; allocation of funds, property, services, or other resources that contribute to community health care needs identified in a community benefits plan; donation of funds, property, services, or other resources which promote or support a healthier community, enhanced access to health care or related services, health education and prevention activities, or services to a vulnerable population; support of medical research and education and training of health care professionals.

Public Comment: The process for development of the plan shall include an opportunity for members of the public in the trust's service area to provide input into the development of the plan and comment upon the trusts proposed plan.

Community Benefit Planning and Reporting: Each health care charitable trust must adopt and annually update a community benefit plan responding to the identified community needs describing the results or outcomes of the trust's community benefits activities. The report shall also include the means used to solicit the views of the community served by the trust, identification of community groups, members of the public, and local government officials consulted on the development of the plan, and an evaluation of the plan's effectiveness. To the extent practicable, the plan shall include an estimate of the cost of each activity expected to be undertaken or supported in the ensuing year and a report on the unreimbursed cost of each activity undertaken in the previous year. For reporting purposes, the cost of contributed services shall be determined in accordance with the rates, costs, units of service, or other statistical measures used for general accounting purposes by the health care charitable trust. In addition, each charitable trust shall include in its report the ratio of its gross receipts from operations to its net operating costs, as shown in its final statement of accounts for the preceding fiscal year.

Public Disclosure: The statute requires that a copy of the community benefits plan shall be submitted to the Director of Charitable Trusts within 90 days after the start of the trust's fiscal year and every health care charitable trust shall at least annually provide notice to the public of the availability and process for obtaining a copy of its community benefits plan and shall prominently display such notice in its lobby, waiting rooms, or other areas of public access.

Penalty for Noncompliance: Failure to comply with the public disclosure requirement may carry a fine of $1,000 plus attorneys fees and costs for each violation.

V. Elements of the Community Benefit Plan - Community Mental Health Programs

Community mental health programs are closely regulated by the Department of Health and Human Services and are required to draft and implement various planning activities in conjunction with the communities they serve. These administrative and statutory requirements overlap with several provisions of the community benefit law. In order to eliminate duplicative reporting requirements, community mental health programs may submit a copy of the documentation filed with the Department of Health and Human Services to fulfill a portion of the community benefits plan statutory requirements. In addition to this documentation, the following information must be provided:

• The Community Benefits Plan Reporting Form
• The organization's name, address, federal tax identification number, and state registration number
• A copy of the charitable trust's articles of incorporation, constitution, and by-laws or other instrument of creation.
• A list of the names and addresses of the officers and directors of the organization
• The name, address, and telephone number of the community benefits contact person
• A copy of the mission statement
• Program narrative
• An inventory and valuation of all community benefits
• An annual assessment of community benefits activities

FOR FISCAL YEAR BEGINNING ___________________

The following information and attachments must be included in the community benefits plan filed with the Director of Charitable Trusts:

I. a. General Background Information:

Name and Address of the chief executive officer and board chair:

b. Organizational Structure:

Please attach:

• A copy of the charitable trust's articles of incorporation, constitution, and by-laws, or other instrument of creation.
• A list of the names and addresses of the officers and directors of the organization.
• A brief description of the governance and administrative structure of the health care charitable trust, its parent and subsidiary entities, if any.

II. Community Benefits Contact Person:

• Name and Title:
• Address:
• Telephone Number:

III. Mission Statement:

Statutory reference: RSA 7:32-e I.

The health care charitable trust must provide its most recent mission statement and the date it was adopted. The mission statement must describe the purpose of the health care charitable trust and delineate how the mission statement related to the community benefits reported. The mission statement must be reaffirmed on an annual basis.

Please attach a copy of your mission statement.

IV. a. Program Information

Does your health care charitable trust have a strategic plan that addresses community benefits?

Yes __________ No___________

If yes, please attach a copy of the plan or section(s) of the plan pertaining to community benefits.

b. Program Narrative:

Please provide the following information in a concise statement:

• Who has responsibility for the community benefits programs and activities?
• Who is responsible for their implementation?

If more than one individual is responsible for implementation

(1) please provide a list of the names and the project(s) to which each individual has been assigned or (2) provide the number of individuals assigned to each project.

• How was the health care charitable trust's board involved in development the community benefits program and activities?

V. Definition of Community and Population Served:

Statutory reference: RSA 7:32-d II.

The community may be defined in terms of geographic boundaries, special populations, community groups, demographic characteristics, health status, health resources, healthcare utilization data, etc. A description of the methodology used in identifying and determining the community/population served by the organization must be attached. How does your organization define its community? How was this definition developed? Please be specific.

VI. Community Needs Assessment Information:

Statutory reference: RSA 7:32-f

Following the development of the initial Community Needs Assessment, the assessment must be updated every three years. The charitable trust must consult with members of the public, community organizations, service providers, and local government officials in the trust's service area in order to identify and prioritize the community needs which the health care charitable trust can address directly, or in collaboration with others. The report shall also include the means used to solicit the views of the community served by the trust, identification of community groups, members of the public, and local government officials consulted on the development of the plan, and an evaluation of the plans effectiveness. The Assessment may include, but not be limited to, a description of community demographics, community health indicators, income level of the affected population, specific primary, acute, or chronic health care needs, assessment of the health care charitable trust's capability of responding to identified needs, and the availability of other service providers, both public and private. The Assessment must include a description of the methodology utilized in evaluating and identifying community needs.

• Please describe how community input was solicited and used in developing the community benefits plan.
• Once the needs of the community were identified please describe the process utilized to prioritize the projects chosen.
• Please attach a copy of the most recent Community Needs Assessment

The responses to the following two questions will be used in assessing the overall cost of implementing this law.

• Did the organization hire an outside firm to prepare the Needs Assessment?

Yes___________ No___________

• If the answer is yes, what was the cost of the Needs Assessment?

$_____________

• If the answer is no and the plan was completed internally, how many personnel hours were required to prepare the Needs Assessment? ____________

VII. Collaboration:

Statutory reference: RSA 7:32-f and 7:32-l.

If the community needs assessment is being prepared in collaboration with other health care charitable trusts, please attach a list of the name(s), address(es), and telephone number(s) of the collaborating organization(s) and the relationship, if any, between these organizations. One health care charitable trust should be selected as the contact for the collaborative.

Please Note: One copy of the community needs assessment should be filed for the collaborative. Participating charitable trusts should make reference to this collaborative assessment in preparing their community benefits plans.

What was the beginning date of the fiscal year used for this collaboration?
____________________________

VIII. Community Benefit Plan:

Statutory reference: RSA 7:32-e.

The document filed must include a listing of community benefits or benefit activities planned by the health care charitable trust. Health care charitable trusts working in collaboration with other organizations are required to provide individual information pursuant to RSA 7:32-l. For each community benefit activity, the following information must be included:

• A description of the benefit or benefit activity and how the activity will further the mission of the organization and the objectives of the community needs assessment.
• The need to be addressed and the target/affected population for the benefit
• The goal(s) to be accomplished
• Objectives to be achieved within the target dates and the methodology utilized to measure and assess outcomes.
• If the plan was prepared in collaboration with other health care charitable trusts, please complete Section VII.

IX. Inventory and Valuation of All Community Benefits:

Statutory reference: RSA 7:32-d III and 7:32-e IV and V

Describe in detail the cost of the community benefits planned by the health care charitable trust and the methodology for estimating the cost. The plan shall include an estimate of the cost of each activity expected to be undertaken or supported in the ensuing year and a report on the unreimbursed cost of each activity undertaken in the preceding year. For each quantifiable benefit, the trust should provide an economic valuation which identifies the unreimbursed cost to the trust of providing the benefit and the method for calculating that cost. Nonquantifiable benefits should be identified separately and described in narrative form.

X. Annual Assessment of Community Benefits Activities:

Statutory reference: RSA 7:32-e IV

The plan shall include a report on the community benefit activities undertaken by the trust in the preceding year and information describing the results or outcomes of the trust's community benefit activities. The report shall also include the means used to solicit the views of the community served by the trust, identification of community groups, members of the public, and local government officials consulted on the development of the plan, and an evaluation of the plans effectiveness.

Please be sure the assessment section is included in the plan.

THE COMPLETED COMMUNITY BENEFITS PLAN MUST BE FILED WITH THE ATTORNEY GENERAL WITHIN 90 DAYS OF THE BEGINNING OF THE FISCAL YEAR. FAILURE TO FILE THE PLAN MAY RESULT IN THE IMPOSITION OF CIVIL PENALTIES OF $1,000 PLUS ATTORNEYS FEES AND COSTS (RSA 7:32-g III) EXTENSIONS MAY BE REQUESTED BY FILING THE APPLICATION FOR EXTENSION OF TIME TO FILE COMMUNITY BENEFITS PLAN FORM WITH THE ATTORNEY GENERAL.

NOTE: A copy of RSA 7:32-c - l will be included with the form mailed to health care charitable trusts.

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Department of the Attorney General, Charitable Trusts Unit
33 Capitol Street

Department of the Attorney General, Charitable Trusts Unit
Concord, NH 03301-6397

Telephone: 603-271-3591
Fax: 603-271-2110

APPLICATION FOR EXTENSION OF TIME TO FILE COMMUNITY BENEFITS PLAN

This application for extension of time must be received on or before the due date of the community benefits plan in order to be accepted.

NAME OF ORGANIZATION: ________________________________________

CURRENT ADDRESS:_____________________________________________

STATE REGISTRATION NUMBER:___________________________________

COMPLETE THE FOLLOWING

I REQUEST AN EXTENSION OF TIME UNTIL:__________________________

DATE OF FISCAL YEAR BEGINNING:_________________________________

REASON FOR EXTENSION (attach additional sheets if necessary):

FAILURE TO FILE THE COMMUNITY BENEFITS PLAN WITH THE ATTORNEY GENERAL IN A TIMELY MANNER MAY RESULT IN COURT ACTION AND THE IMPOSITION OF CIVIL PENALTIES OF UP TO $1,000 PER VIOLATION PLUS ATTORNEYS FEES AND COSTS (RSA 7:32-g III)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

FOR CHARITABLE TRUST UNIT USE ONLY:

Request granted and report due on: _______________ Request denied: ______

Copy mailed to organization on ___________________.

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COMMUNITY BENEFITS LAW

CHAPTER 312

SB 69-LOCAL - FINAL VERSION

5/6/99 1103s

22june99.....1647h

1999 SESSION

99-0924

08/01

SENATE BILL 69-LOCAL

AN ACT relative to health care charitable trusts and community benefits.

SPONSORS: Sen. Wheeler, Dist 21; Sen. Squires, Dist 12; Rep. Emerton, Hills 7; Rep. Copenhaver, Graf 10; Rep. M. Fuller Clark, Rock 36

COMMITTEE: Executive Departments and Administration

AMENDED ANALYSIS

This bill requires that health care charitable trusts develop community benefits plans each fiscal year which shall be submitted to the director of charitable trusts and provides what shall be included in such plans.

Health care charitable trusts shall also conduct community needs assessments in order to help determine the activities to be included in the community benefits plans.

Health care charitable trusts with total value of fund balances not exceeding $1,000,000 are exempt from this bill's provisions. Under this bill, the $1,000,000 exemption figure will change to $100,000 on January 1, 2001.

In addition, health care charitable trusts for whom compliance would be a financial or administrative burden may be granted an exemption from the bill's requirements.

The bill also authorizes the director of charitable trusts to assess an administrative fine upon charitable trusts for failure to comply with certain requirements.

STATE OF NEW HAMPSHIRE

In the Year of Our Lord One Thousand Nine Hundred and Ninety-Nine

AN ACT relative to health care charitable trusts and community benefits.

312:1 New Subdivision; Community Benefits. Amend RSA 7 by inserting after section 32-b the following new subdivision:

Community Benefits

7:32-c Purpose. The purpose of this subdivision is to ensure that health care charitable trusts provide the communities they serve with benefits in keeping with the charitable purposes for which the trusts were established and in recognition of the advantages the trusts enjoy. It acknowledges that each community is unique and its particular health care problems and needs should be examined and the community benefits provided by health care charitable trusts which serve it should be directed toward addressing the issues and concerns of that community.

Community involvement in the development of community benefits plans is necessary to make the health care charitable trusts more responsive to the true needs of the community.

State oversight of the planning process and public access to the community benefits plans will assure appropriate use of the resources of health care charitable trusts.

7:32-d Definitions. In this subdivision:

I. "Charity care" means health care services provided by a health care charitable trust for which the trust does not expect and has not expected payment and which health care services are not recognized as either a receivable or as revenue in the trust's financial statements.

II. "Community" means the service area or patient population for which a health care charitable trust provides services.

III. "Community benefits" means a health care charitable trust's activities that are intended to address community health care needs including, but not limited to, any of the following:

(a) Charity care.

(b) Financial or in-kind support of public health programs even if the programs extend beyond the trust's service area, including support of recommendations in any state health plan developed by the department of health and human services.

(c) Allocation of funds, property, services, or other resources that contribute to community health care needs identified in a community benefits plan.

(d) Donation of funds, property, services, or other resources which promote or support a healthier community, enhanced access to health care or related services, health education and prevention activities, or services to a vulnerable population.

(e) Support of medical research and education and training of health care practitioners.

IV. "Community benefits plan" means a written document prepared by a health care charitable trust which identifies health care needs in the area served by the trust and describes the activities the trust has undertaken and will undertake to address the identified needs.

V. "Health care charitable trust" means a charitable trust organized to directly provide health care services, including, but not limited to, hospitals, nursing homes, community health services, and medical-surgical or other diagnostic or therapeutic facilities or services. "Health care charitable trust" shall not include any testamentary or inter vivos trust which is not organized to provide health care services.

VI. "Vulnerable population" means any population that is at risk of not receiving health services due to medical, financial, or other barriers.

7:32-e Community Benefits Plans.

Within 90 days of the start of its fiscal year every health care charitable trust shall develop a community benefits plan. The plan shall be developed in accordance with the following criteria on forms supplied by the attorney general:

I. The trust shall adopt a mission statement which shall be included in its plan and which shall be reaffirmed by the trust on an annual basis.

II. The plan shall take into consideration a community needs assessment conducted in accordance with RSA 7:32-f and shall identify the health care needs that were considered in development of the plan.

III. The plan shall identify the activities the trust expects to undertake or support which address the needs determined through the community needs assessment process or which otherwise qualify as community benefits and shall include all charity care in a discrete category.

IV. The plan shall include a report on the community benefit activities undertaken by the trust in the preceding year and information describing the results or outcomes of the trust's community benefit activities. The report shall also include the means used to solicit the views of the community served by the trust, identification of community groups, members of the public, and local government officials consulted on the development of the plan, and an evaluation of the plan's effectiveness.

V.(a) To the extent practicable, the plan shall include:

(1) An estimate of the cost of each activity expected to be undertaken or supported in the ensuing year; and

(2) A report on the unreimbursed cost of each activity undertaken in the preceeding year.

(b) For reporting purposes, the cost of contributed services shall be determined in accordance with the rates, costs, units of service, or other statistical measures used for general accounting purposes by the health care charitable trust.

In addition, each charitable trust shall include in its report the ratio of its gross receipts from operations to its net operating costs, as shown in its final statement of accounts for the preceeding fiscal year.

VI. The process for development of the plan shall include an opportunity for members of the public in the trust's service area to provide input into development of the plan and comment upon the trust's proposed plan.

7:32-f Community Needs Assessment.

Every health care charitable trust shall, either alone or in conjunction with other health care charitable trusts in its community, conduct a community needs assessment to assist in determining the activities to be included in its community benefits plan. The needs assessment process shall include consultation with members of the public, community organizations, service providers, and local government officials in the trust's service area, in the identification and prioritization of community needs that the health care charitable trust can address directly, or in collaboration with others. The community needs assessment shall be updated at least every 3 years.

7:32-g Notice to Director of Charitable Trusts and Public; Administrative Fine.

I. Every health care charitable trust shall submit its community benefits plan to the director of charitable trusts on an annual basis no later than 90 days after the start of the trust's fiscal year.

II. The trust and the director of charitable trusts shall make all community benefits plans available to the public and, where practicable, shall place the reports on an internet site or web page. Every health care charitable trust shall at least annually provide notice to the public of the availability and process for obtaining a copy of its community benefits plan and shall prominently display such notice in its lobby, waiting rooms, or other area of public access.
An extension of time for filing the community benefits plan may be granted by the director.

III. The director may impose an administrative fine upon a charitable organization that violates any provision of RSA 7:32-g, I, in an amount not to exceed $1,000 plus attorneys fees and costs for each such violation.

7:32-h Charity Care.

The provision of charity care may be included in a community benefits plan by a health care charitable trust only to the extent that it:

I. Does not include any sums identified as bad debt, a receivable, or revenue by the trust in accordance with generally accepted accounting principles.

II. Is provided in accordance with a written policy which is available to the public, which allows any individual to make application and receive a prompt decision on eligibility for and the amount of charity care, and notice of which is prominently displayed in the trust's lobby, waiting rooms, or other area of public access or otherwise is provided to service applicants and recipients who are served in their own homes or in locations other than a facility of the trust.

7:32-i Enforcement.

Nothing in this subdivision shall derogate from authority of the attorney general, or the rights of others, provided by common law or other statute.

7:32-j Exemption.

Effective 1/1/2000

If the total value of the fund balances of a health care charitable trust do not exceed $1,000,000, the trust shall have no obligation to comply with the provisions of this subdivision. In addition, those health care charitable trusts for which compliance would be a financial or administrative burden, according to criteria established and administered by the director of charitable trusts, may request an exemption from the provisions of this subdivision. An exemption, if granted, shall be valid for 3 years from the date of issuance unless it is revoked by the director of charitable trusts and written notice of such revocation is provided to the health care charitable trust.

7:32-k Effect on Eligibility for Property Tax Exemption.

Compliance with this subdivision shall not establish eligibility for a property tax exemption under RSA 72:23, V, but may be considered if relevant to the criteria established in RSA 72:23, RSA 72:23-l, and at common law.

7:32-l Combined Needs Assessments, Planning, Reporting.

Health care charitable trusts may satisfy the requirements of RSA 7:32-e, RSA 7:32-f, and RSA 7:32-g, individually or in a combination with other health care charitable trusts, provided that information required to be reported under RSA 7:32-e, V(a) and (b) shall be specifically reported for each health care charitable trust participating in a combined plan or report.

Reference only: V.(a) To the extent practicable, the plan shall include:

(1) An estimate of the cost of each activity expected to be undertaken or supported in the ensuing year; and

(2) A report on the unreimbursed cost of each activity undertaken in the preceeding year.

(b) For reporting purposes, the cost of contributed services shall be determined in accordance with the rates, costs, units of service, or other statistical measures used for general accounting purposes by the health care charitable trust.

312:2 Prospective Change in Total Equalized Assessed Value Required for Exemption. Amend RSA 7:32-j to read as follows:

Effective 1/1/2001

7:32-j Exemption. If the total value of the fund balances of a health care charitable trust do not exceed [$1,000,000] $100,000, the trust shall have no obligation to comply with the provisions of this subdivision. In addition, those health care charitable trusts for which compliance would be a financial or administrative burden, according to criteria established and administered by the director of charitable trusts, may request an exemption from the provisions of this subdivision. An exemption, if granted, shall be valid for 3 years from the date of issuance unless it is revoked by the director of charitable trusts and written notice of such revocation is provided to the health care charitable trust.

312:3 Legislative Review.

The provisions of this act shall be subject to further legislative review and amendment based on the results of the statewide health plan process to be implemented during the fiscal year ending June 30, 2000 and the initial reports by the health care charitable trusts in compliance with this act.

312:4 Effective Date.

I. Section 2 of this act shall take effect January 1, 2001.

II. The remainder of this act shall take effect January 1, 2000.

(Approved: July 16, 1999)

(Effective Date: I. Section 2 effective January 1, 2001

II. Remainder effective January 1, 2000)

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Office of the Attorney General
Charitable Trusts Unit
33 Capitol Street, Concord, NH 03301-6397
603-271-3591

COMMUNITY BENEFITS PLAN -
CRITERIA FOR EXEMPTION
PURSUANT TO RSA 7:32-j

"those health care charitable trusts for which compliance would be a financial or administrative burden, according to criteria established and administered by the director of charitable trusts, may request an exemption from the provisions of this subdivision. An exemption, if granted, shall be valid for 3 years from the date of issuance unless it is revoked by the director of charitable trusts and written notice of such revocation is provided to the health care charitable trust."

CRITERIA

(1) If the health care charitable trust serves a specifically defined and very limited segment of the population and provides no health care services to the community at large or to individuals not defined in its mission statement, an exemption will be granted by the director of charitable trusts upon receipt of this application and supporting documentation.

Example: The St. Anywhere Nursing Home provides services to retired Catholic priests exclusively and does not provide services to anyone not meeting that criteria.

(2) If the health care charitable trust meets the financial threshold of a $1,000,000 fund balance in the year 2000 or a $100,000 fund balance after January 1, 2001, and seeks an exemption under the "financial burden" test it must prove (1) that its financial resources would be negatively impacted in complying with the community benefits law and (2) that it is not possible to enter into a collaboration with other health care charitable trust(s) for purposes of conducting the community needs assessment and preparation of the community benefits plan.

(3) If the health care charitable trust seeks an exemption under the "administrative burden" test it must prove (1) that it does not have sufficient paid staff, volunteers, or other resources available to prepare the community benefits plan; (2) that it does not have sufficient financial resources available to engage the services of an outside entity for purposes of preparing the community benefits plan; and (3) that it is not possible to enter into a collaboration with other health care charitable trust(s) for purposes of conducting a community needs assessment and preparation of the community benefits plan.

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Office of the Attorney General
Charitable Trusts Unit
33 Capitol Street, Concord, NH 03301-6397
603-271-3591

COMMUNITY BENEFITS PLAN -
APPLICATION FOR EXEMPTION
PURSUANT TO RSA 7:32-j

FOR FISCAL YEAR BEGINNING ________________________

This application has three parts, complete only those part(s) which apply to your request for exemption.

PART I - APPLICATION FOR EXEMPTION PERTAINING TO LIMITED MISSION

(1) Please explain in detail the specific and limited segment of the population which your organization serves. Attach additional pages if necessary.

(2) Attach a copy of your Mission Statement, Articles of Agreement and By-Laws or other instrument of creation.

(3) Attach a list of the names and addresses of the officers and directors of the organization. Please specify the contact person and include his/her telephone number.

(4) Does your organization accept any individual(s) not meeting the criteria listed in response to question

(1)? Yes _______________ No______________

If the answer is Yes, please explain the circumstances under which you accept these individuals.

(5) Does your organization provide any health care services?

Yes ____________ No_______________

If the answer is Yes, please explain the type of health care services provided.

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PART II - APPLICATION FOR EXEMPTION BASED ON FINANCIAL BURDEN

(1) Attach a copy of your Mission Statement, Articles of Agreement and By-Laws or other instrument of creation.

(2) Attach a list of the names and addresses of the officers and directors of the organization. Please specify the contact person and include his/her telephone number.

(3) Attach a copy of your form 990, audited financial statement, or other financial report for your most recent accounting period.

(4) Please explain why complying with the provisions of the community benefits law would result in a negative financial burden for your organization. Be specific. Please feel free to attach additional pages.

(5) Please explain why it is not possible for your organization to collaborate with other health care charitable trust(s) in conducting the community needs assessment and in preparing the community benefits plan. Be specific. Please feel free to attach additional pages.

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PART III - APPLICATION FOR EXEMPTION BASED ON ADMINISTRATIVE BURDEN

(1) Attach a copy of your Mission Statement, Articles of Agreement and By-Laws or other instrument of creation.

(2) Attach a list of the names and addresses of the officers and directors of the organization. Please specify the contact person and include his/her telephone number.

(3) Attach a copy of your form 990, audited financial statement, or other financial report for your most recent accounting period.

(4) Attach a copy of your organizational chart showing all paid positions, whether full or part-time; provide the average number of volunteer hours given to your organization on an annual basis and a summary of the duties performed by these volunteers.

(6) Please explain why complying with the provisions of the community benefits law would result in an administrative burden for your organization. Be specific. Please feel free to attach additional pages.

(7) Please explain why it is not possible for your organization to collaborate with other health care charitable trust(s) in conducting the community needs assessment and in preparing the community benefits plan. Be specific. Please feel free to attach additional pages.

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CERTIFICATION
(MUST BE SIGNED REGARDLESS OF WHICH CATEGORY OF EXEMPTION YOU ARE SEEKING)

I hereby certify that the foregoing information is true to the best of my knowledge and belief.

DATE:______________________ ________________________________________

This form must be submitted to the Department of the Attorney General, Charitable Trusts Unit, 33 Capitol Street, Concord, NH 03301-6397.

For Office Use Only

DEPARTMENT OF ATTORNEY GENERAL
CHARITABLE TRUSTS DIVISION

The foregoing request for exemption from the provisions of the community benefits law is hereby GRANTED/DENIED.

Reason for Denial:

________________________________________
Director of Charitable Trusts

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RESOURCES

The Community Health Assessment - Guidelines for New Hampshire Health Charities

Data for Community Focused Research - Office of Planning and Research, New Hampshire Department of Health and Human Services (December, 1999)

A Community Development Approach to Community Needs Assessment, July 1994, Funded by The New Hampshire Division of Public Health Services under a grant from the Robert Wood Johnson Foundation Practice Sights Initiative (available for review at each of the nonprofit hospitals, the State Library in Concord, the Department of Health and Human Services, Office of Community and Public Health, and the Department of the Attorney General, Charitable Trusts Unit)