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Annual Statement of Community Benefits Standard

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The 2013 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

 

2013 ASCBS form for Nonprofit Hospitals:

Nonprofit Part I (PDF 720kb) Nonprofit Part II (PDF 160kb)

 

2013 ASCBS form for Public Hospitals and For-Profit Disproportionate Share Hospitals:

Public and For-Profit Dispro Part I (PDF 398kb)

Lists of hospitals required to report and hospitals exempt from reporting charity care
and community benefits information for the 2013 reporting period:

 Required - 2013 (PDF 205kb) Exempt - 2013 (PDF 286kb)
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Last updated April 15, 2014