In the early 1990's, during Memorial's reevaluation of their role in the community, the Board of Trustees participated in an annual Board forum and retreat to discuss the concept of a "healthy community." Forum speaker, Leland Kaiser, an internationally known health care futurist, discussed the concept of "tithing" as a means for generating funds to support innovative community health projects. This planted the seed in the minds of hospital Board members and administrative staff.

According to Phil Newbold, Memorial Health System CEO, "the first time the concept of tithing was brought to the Board - the seed did not take hold. We did not have a specific committee designated to discuss the issue. We needed a group to act as the gardener - to take the seed, plant it, water it, and nourish it."

As a result of the retreat, an ad hoc committee was formed from the Board of Trustees of both Memorial Hospital and Health System specifically to discuss this concept of "community health" and a tithing policy. This ad hoc committee, which later became known as the Community Health Enhancement committee (CHE), was chaired by Janet Thompson, a member of Memorial Hospital's Board of Trustees. The ad hoc committee was charged with the task of defining a "healthy community" - just what does that mean? Once again, Leland Kaiser provided direction to the committee, including the idea of tithing. The concept of a tithing policy challenged Memorial to designate 10 percent of their net revenues every year to new innovative health initiatives. Not all the Board members or hospital staff were supportive of the concept of "community health" or tithing at first.

One of the issues that the committee discussed revolved around rate reduction. Several members asked why the hospital, if able to contribute to the community in this way, could not reduce rates for its patients? Mark Chambers, Memorial Hospital and Health Foundation Vice President, explained, " there are three reasons why we should tithe and not reduce rates for our customers; first, the establishment of a rate structure is highly complex due to the selling of contracts for health services and is therefore not meaningful; second, the hospital needs to generate cash reserves in order to be able to make capital investments (equipment, land, etc.), if you give something away, the chances of getting it back are slim; and lastly, the availability of funds assures accountability in community stewardship and the community benefits through these funds."

Historically, excess revenues for community-owned institutions like Memorial Hospital have been reinvested in the community by creating new health-care facilities and new health-care services. This was new ground. These discussions were about doing something that was new and different, maybe even radical in the governance function. But offering prospective benefits that could have greater impact on the health status of our community.

According to Janet Thompson, CHE Chairperson, "the committee got into several conflicting discussions about whether to be focusing on 'the forest' or 'the trees.' We needed to decide whether to fund lots of different projects or focus our efforts on specific initiatives geared toward our definition of community health." There were several strong personalities on the ad hoc committee. Sometimes the conversation would get diverted, the committee would get off track, but with persistence they would eventually return to the task of defining and setting policy related to community health and tithing.

After many meetings and much discussion the committee agreed that tithing was a good idea. However, there was a great deal of deliberation about how to structure the tithing policy. Janet Thompson, described some of the committee's examination: "We struggled between a set amount of money versus a percentage. We talked about what would happen if we had a bad year and were using a set amount and couldn't meet program expectations. We definitely did not want to fund projects one year and then not be able to follow through on commitments." The questions raised during these meetings led the committee to create a Community Benefit Policy. The original Community Benefit Policy set the tithing concept down on paper. It outlined a purpose, definition of programs, criteria, methodology and assessment mechanisms.

Throughout initial discussions regarding "community health" and tithing there were several individuals who persisted in asking why - why does Memorial want to tithe? Hospital President and Health System CEO, Phil Newbold believes that, "Tithing is the greatest accelerant (to becoming really involved in improving community health) you can do, it gives you the resources and commitment you can't get any other way. I tell people as soon as you do this, you're absolutely going to take off!" He asserts that tithing will do the following for an organization:

1. It converts it from an idea, "a nice thing to do," into a board approved policy. It formalizes the idea into something that can be implemented and accounted for. If it is not a policy it ends up being something that sounds nice and that you may "get around to" later.

2. It takes away all the arguments about how much you should be doing - it fixes a number (a percentage). It creates something that is controllable.

3. It is pre-funded from the year before. Therefore you always have the funds available and set aside and don't get into budget competition with current operating needs.

4. It forces you to adopt criteria for how to invest those new tithing dollars. It obligates you to think through the implementation of the policy, to target your investment and create a mechanism for reporting results back to the Board

In 1993, when the tithing concept was accepted and used to create the Community Benefit Policy, the ad hoc committee formally evolved into the Community Health Enhancement committee (CHE). It was from this point forward that the seed began to sprout into the Community Benefit Fund, a "giving tree" of resources designated to partner with those projects deemed Community Health Enhancement Initiatives. These initiatives would be specifically and consciously directed toward new, innovative and never-been-tried-before initiatives. Clearly, this was going to require getting back in touch with the community we serve, on a scale that no one back in 1993 could fully appreciate.