An Empirical Investigation of Joint Ventures Between For-Profit and Tax-Exempt Nonprofit Hospitals

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.