Date on Master's Thesis/Doctoral Dissertation

5-2015

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Austin, Raymond

Committee Co-Chair (if applicable)

Esterhay, Robert

Committee Member

Wainscott, Barry

Committee Member

Wilson, Richard

Subject

Voluntary hospitals--Accounting; Medical care--Law and legislation--Kentucky; Voluntary hospitals--Taxation

Abstract

Background: This dissertation is the first attempt to elucidate and analyze charitable activity expenditures reported on Internal Revenue Service Form 990 and Schedule H by 501(c)(3) and dual status tax-exempt general acute care hospitals located within the state of Kentucky. The study also represents the first attempt to examine the charitable activity expenditures reported by a constant set of 501(c)(3) tax-exempt hospitals over multiple fiscal years. Purpose: The dissertation’s primary research question: At what level were community benefit and certain other expenses reported on Internal Revenue Service Form 990 and Schedule H by 501(c)(3) and dual status tax-exempt general acute care hospitals located within the state of Kentucky during fiscal years 2009, 2010, 2011, and 2012? Secondary research questions include: How have those reported expenditures changed year-over-year? What is the relative distribution of the expenditures reported? Compared to the results of studies conducted utilizing expenditure data reported by hospitals located in other states and nationwide, did the hospitals located within Kentucky provide more community benefit spending? What portion of the hospitals included in the study population would have qualified for tax-exemption if minimum community benefit and certain other expenses spending policies had been in place during the study period? Methods: A descriptive longitudinal research study utilizing descriptive methods and financial analysis tools was designed to answer the study’s five research questions. Findings: The dissertation is divided into five chapters. Chapter One contains an overview of the history of tax-exemption of hospitals. Chapter Two provides historical and political perspective of the issues related to tax-exemption in the United States of America with specific emphasis on 501(c)(3) tax-exempt hospitals. Chapter Three details the methodology that was used to analyze the charitable activity expenditures reported on Internal Revenue Service Form 990 Schedule H. Chapter Four details the results of the study. Chapter Five discusses the findings; offers recommendations for the use of the results; recommends policy changes, ways to improve the research, and future research topics; and offers concluding remarks. Conclusions: This study showed that most 501(c)(3) and dual status tax-exempt general acute care hospitals located in the state of Kentucky are providing similar amounts of reported community benefit activities as compared to hospitals in other states and nationwide. Another positive sign was the amount of reported expenditures increased over time. As we move forward in time, hospitals should place emphasis on community health needs assessment and community engagement to ensure that community benefit and other charitable activity expenditures provided are promoting population health and meeting the health needs of the community they serve.

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