Assignment: Community Benefit Expenditure
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Joint ventures: Auditors check each joint venture (a relationship established between two business entities—for example, a hospital and radiologist purchasing and operating a computed tomography scanner together) to determine whether the venture violates prohibitions on private benefit, inurement, or kickbacks.
◆ Independent contractors: Auditors check hospital contracts to determine whether contractors should be treated as contractors or employees for tax purposes.
In 2009, the IRS released its final report on a study of nonprofit hospitals that began in 2006 (IRS 2009). The report was based on a survey sent to 500 nonprofit hospitals in four community settings: high-population urban, other urban and suburban, critical access hospitals, and other rural hospitals. The community benefit findings included substantial variation in the amount of community benefit provided by nonprofit hospitals. For instance, the report found that 20 percent of the survey hospitals accounted for 78 percent of the aggregate community benefit:
◆ There is considerable diversity in the demographics, community benefit activities, and financial resources among the hospitals in the sample.
◆ The average and median percentages of total revenues reported spent on community benefit activities were 9 percent and 6 percent, respectively, with the lowest percentages reported among the rural hospitals.
Uncompensated care was the largest reported community benefit expenditure, accounting for 56 percent, followed by medical education and training at 23 percent, research at 15 percent, and community programs at 6 percent.
◆ The average excess profit margin for the sample was 5 percent, though 21 percent of the sample reported losses.
◆ The average and median total compensation amounts paid to the top management official were $490,000 and $377,000, respectively. Nearly all of the amounts were determined to be reasonable compensation by the IRS.
legIslAtIve cHAllenges to tAx-exemPt stAtus At the federal level, significant activity related to the tax privileges of tax-exempt organiza- tions has taken place in the late twentieth and early twenty-first centuries. Representative Brian Donnelly (D-MA), who served from 1979 to 1993, led legislative efforts to require tax-exempt hospitals to provide specific levels of charity care.
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