The Patient Protection and Affordable Care Act (PPACA) put new requirements on not-for-profit (NFP) hospitals to document provision of community benefits, to justify their tax-exempt status. Specific PPACA provisions include requirements that NFP hospitals conduct or participate in a community health needs assessment and work to address the needs identified. Consideration is given to these particular PPACA mandates and to Internal Revenue Service (IRS) actions to implement them. The background of concerns that have been expressed about whether the NFP hospitals’ tax exemption should be continued and a brief history of that exemption is noted. Not-for-profit hospitals have resources that the federal government is requiring them to bring to public health improvement, during a time when the public health agencies at the federal and state level continue to experience reductions in funding. Linking of the NFP hospitals’ compliance activities with the public health agency community health planning activities will help fulfill its PPACA requirements and the regulatory reporting requirements for the IRS.