Partners for a Healthier Community, or PHC, conducted an HIA to inform the Massachusetts Gaming Commission, local municipalities, and the public about the location of a casino in the four-county region of western Massachusetts. Legislation passed in November 2011 allows for as many as three destination resort casinos in three regions of the state, with one being slotted for western Massachusetts. The HIA informed such decisions as the siting of the facility, licensing and regulation by the gaming commission, and a ballot initiative in which voters indicate whether they favor a casino in their community. Health risks the HIA addressed include problems linked to pathological gambling (family violence, alcohol and substance abuse, mental health, and injury). Potential health benefits that were analyzed include new employment opportunities and revenue to support city and state services important to health. With support from the gaming commission, PHC conducted the HIA in partnership with the local health department, the regional economic development council and regional employment board, and social service agencies.