The 2024 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. 

The following documents are not fully ADA compliant.  

2024 ASCBS form for Nonprofit Hospitals

Please use both forms (Non-Profit, Public, and For-Profit Disproportionate Share Hospitals) as of June 26, 2025, Worksheet 3 (w3c1) has been updated. 

• Texas Nonprofit Hospitals Form I - Revised 6/26/2025
• Texas Nonprofit Hospitals Form II 

2024 ASCBS form for Public Hospitals and For-Profit Disproportionate Share Hospitals 

• Public and For-Profit Dispro Part I - Revised 6/26/2025

Hospitals required & exempt from reporting 2024 charity care and community benefits information:  

• Required Report 2024 
• Exempt Report 2024 

For more information, please contact us for assistance.