The Patient Protection and Affordable Care Act of 2010 (PPACA) imposes several new mandates on § 501(c)(3) organizations that operate hospital facilities. One is the requirement that, every three years, the organization perform a "community health needs assessment" (CHNA) and adopt an implementation strategy to meet the needs identified in the CHNA. The CHNA and implementation strategy must be done for each hospital facility operated by the organization, must take into account input from persons representing the broad interests of the community and must be made widely available to the public. The mandate is effective for taxable years beginning after March 23, 2012. Thus, affected § 501(c)(3) organizations with a calendar year must satisfy the mandate by December 31, 2013.

In Notice 2011-52 (Notice), released July 7, 2011, the Treasury Department and Internal Revenue Service give interim guidance on the CHNA mandate and related implementation strategy in advance of the release of proposed regulations. The guidance covers several topics, such as (1) how and when a CHNA is considered conducted; (2) who are persons representing the broad interests of the community; and (3) what it means to make the CHNA widely available to the public. Taxpayers are permitted to rely on the guidance in the Notice with respect to any CHNA made widely available to the public and any implementation strategy adopted on or before the date that is six months after the time at which additional guidance is issued. The Notice also seeks comments on the guidance offered in the Notice to be used in crafting the proposed regulations.

The charitable hospital community has been anxiously awaiting this type of guidance, as there is a $50,000 excise tax for each failure of a hospital facility to meet the CHNA mandate. The Notice makes clear that this means an organization with multiple hospital facilities can face multiple excise taxes for a given year.