Title page for ETD etd-04112001-214524

Type of Document Dissertation
Author Smith, Pamela C.
Author's Email Address pcsmith@vt.edu
URN etd-04112001-214524
Title An Empirical Investigation of Joint Ventures Between For-Profit and Tax-Exempt Nonprofit Hospitals
Degree PhD
Department Accounting and Information Systems
Advisory Committee
Advisor Name Title
Seago, W. Eugene Committee Chair
Brown, Robert M. Committee Member
Callihan, Debra S. Committee Member
Major, Raymond L. Committee Member
Yardley, James A. Committee Member
  • For-Profit
  • Joint Venture
  • Hospitals
  • Nonprofit
Date of Defense 2001-04-09
Availability unrestricted
This dissertation examines debt ratios, profitability, and commercial activity of the following hospitals: (i) for-profit hospitals [FP hospitals], (ii) nonprofit hospitals engaging in joint ventures [JV NP hospitals], and (iii) nonprofit hospitals that do not engage in joint ventures [Non-JV NP hospitals]. Financial variables are measured using Form 990 tax return data of nonprofit hospitals and audited financial statements of for-profit hospitals.

The purpose of the study is to compare: (1) JV NP hospitals versus FP hospitals and (2) JV NP hospitals versus Non-JV NP hospitals. Potential similarities between FP and JV NP hospitals may indicate nonprofit partners are becoming indistinguishable from for-profit entities, which may further call into question the applicability of tax-exempt status for these nonprofit hospitals.

Results indicate significant differences exist in debt ratios between FP and JV NP hospitals. A lack of significant differences in profitability lends support to the argument that JV NP hospitals may exhibit similarities in financial characteristics to for-profit hospitals.

Regarding comparisons within the nonprofit sector, significant differences were found in profitability and unrelated business income percentages. Differences in debt ratios were not found between the two groups - which fail to support Internal Revenue Service (IRS) arguments that there is something 'special' about JV NP hospitals. JV NP hospitals reported lower profitability on all measures than Non-JV NP hospitals. Findings of lower profitability are consistent with arguments that JV NP hospitals are attempting to improve their financial condition by partnering with for-profit hospitals. Significant differences were not found in contributions received as a percentage of total revenue between the nonprofit hospital groups.

This dissertation contributes to existing literature that compares nonprofit and for-profit hospitals through reliance on tax return data of nonprofit hospitals. Tax returns serve as a primary source for the public and IRS to scrutinize a nonprofit organization's financial operations. The IRS uses tax return data to evaluate a hospital's activities, measure its charitable activities and scrutinize the organizations' tax-exempt status. Investigating these differences using actual tax return data provides support to the argument that nonprofit hospitals engaging in joint ventures exhibit similarities to for-profit hospitals.

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