Despite consistent evidence that religious congregations provide health-related programs for their members and residents of the local community, little is known about the distribution of congregation-based health programs across the United States. Using a nationally representative sample of US congregations (n=1230) we employ bivariate analysis and logistic regression to identify patterns in the sponsorship of health-related programs by religious congregations; we then propose and test various explanations for these observed patterns. Our findings contradict the impressions given by case studies and the program evaluation literature and suggest: a) that congregation-based health programs may not be serving the neediest communities; and b) that congregations are not taking advantage of mechanisms intended to facilitate the provision of health-related services by religious congregations.