Wednesday, December 19, 2018
This year’s Pennies for Charity report includes data from the 964 fundraising campaigns conducted all or in part in 2017 by professional fundraisers in New York. The campaigns raised over $1 billion. Key findings include:
• Over $372 million (31%) of funds raised were paid to fundraisers to cover the costs of conducting the charitable campaigns. Charities received $812+ million overall.
• In 313 campaigns (32%), charities retained less than 50% of funds raised.
• In 156 campaigns (16%), fundraising expenses exceeded charitable revenue. In 2017, this loss totaled over $10 million dollars.
The New York AG's office also provides a database with detailed information for campaigns, searchable by charity or fundraiser name.
Monday, December 3, 2018
From today's NY Times:
NASHVILLE — There’s a meme about charitable giving that makes the rounds in Southern social media circles from time to time. It’s a map of United States counties color-coded by charitable giving, and it purports to demonstrate that people living in red states give a greater percentage of their income to charity than people living in blue states. The caption beneath the map reads, “Those heartless conservatives — am I right?”
The map was created in 2013 from a report in The Chronicle of Philanthropy. “Donors in Southern states,” the report notes, “give roughly 5.2 percent of their discretionary income to charity — both to religious and to secular groups — compared with donors in the Northeast, who give 4.0 percent.”
These are figures that Southerners, accustomed to being thought selfish and cruel by the rest of the country, will happily create a meme to promote.
There are many problems with a map like this, but the biggest is that it’s based on the filings of taxpayers who itemize deductions. The vast majority of American taxpayers — some 70 percent — don’t itemize anyway, so there’s really no way to know how many people actually make charitable donations and how much they give when they do. Even so, it has become a cultural commonplace: People in red states are more generous than everyone else.
The Institute for Policy Studies has issued a report subtitled, "Top-Heavy Philanthropy and Its Perils to the Independent Sector and Democracy." Here is a the executive summary:
What are the risks to the autonomy of the independent nonprofit sector—not to mention our democracy—when a growing amount of philanthropic power is held in fewer hands?
A new Institute for Policy Studies report, Gilded Giving 2018: Top-Heavy Philanthropy and Its Risks to the Independent Sector, takes a close look at the impact of increasing economic inequality on the philanthropic sector. Co-authored by Chuck Collins, Josh Hoxie, and Helen Flannery of the Institute for Policy Studies, the report finds that our charitable sector is currently experiencing a transition from broad-based support across a wide range of donors to top-heavy philanthropy increasingly dominated by a small number of very wealthy individuals and foundations.
As we reported in 2016, growing inequity in charitable giving continues to hold risks not only for nonprofits themselves, but also for the nation. This is truer now than ever, as ever-greater proportions of charitable dollars technically qualifying as tax-deductible donations are diverted into wealth-warehousing vehicles such as private foundations and donor-advised funds, and away from direct nonprofits serving immediate needs.
This updated edition of Gilded Giving focuses on the impact of increasing financial inequality on the philanthropic sector, highlights trends that have either arisen or increased in intensity since the initial publication of our report, puts forward several possible implications of these changes, and suggests some solutions.
- Charitable contributions from donors at the top of the income and wealth ladder have increased significantly over the past decade. In the early 2000s, households earning $200,000 or more made up only 30 percent of all charitable deductions. But by 2017, this group accounted for 52 percent. And the percent of charitable deductions from households making over one million dollars grew from 12 percent in 1995 to 30 percent in 2015.
- There has been a marked increase in mega-gifting. In 2012, the threshold for mega-gifts was $50 million or more; gifts of that size amounted to $1.2 billion and accounted for just one-half of one percent of all individual giving in the United States that year. In 2017, just five years later, the threshold for mega-gifts jumped to $300 million or more; gifts of that size totaled $4.1 billion and accounted for about one and a half percent of all individual giving that year.
- In the past two decades, the number of households that give to charity has declined significantly. From 2000 to 2014, the proportion of households giving to charity dropped from 66 percent to 55 percent.
- The number of donors giving at typical donation levels has been steadily declining. Low-dollar and mid-level donors have declined by about two percent each year for more than fifteen years. These donors traditionally have made up the vast majority of donor files and solicitation lists for most national nonprofits since their inception.
- The number and size of private grant-making foundations and donor-advised funds have shown dramatic growth. The funds held in private foundations grew 62 percent between 2005 and 2015; the number of private foundations chartered in the United States grew 21 percent over that same period.
- Donor-Advised Funds (DAFs) are on the rise. Donations to donor-advised funds increased from just under $14 billion in 2012 to $23 billion in 2016—growth of 66 percent over five years. DAFs, a giving vehicle used primarily by the wealthy, are currently the largest and fastest-growing recipients of charitable giving in the United States.
Our charitable sector is currently experiencing a transition from broad-based support across a wide range of donors to top-heavy philanthropy increasingly dominated by a small number of very wealthy individuals and foundations. This has significant implications for the practice of fundraising, the role of the independent nonprofit sector, and the health of our larger democratic civil society.
- Risks to charitable independent sector organizations include increased volatility and unpredictability in funding, making it more difficult to budget and forecast income into the future; an increased need to shift toward major donor cultivation; and an increased bias toward funding heavily major-donor-directed boutique organizations and projects. The increasing power of a small number of donors also greatly increases the potential for mission distortion.
- Risks to the public include an increasingly unaccountable and undemocratic philanthropic sector; the rise of tax avoidance philanthropy; the warehousing of wealth in the face of urgent needs; self-dealing philanthropy; and the increasing use of philanthropy as an extension of power and privilege protection.
This report calls for an urgent reform of the philanthropic sector to encourage broader giving, protect the health of the independent sector, discourage the warehousing of wealth in private foundations and donor-advised funds, and increase accountability to protect the public interest and the integrity of our tax system.
Changes in the rules governing philanthropy should include:
- Increasing the minimum annual distribution payout for foundations.
- Excluding foundation overhead from the payout percentage.
- Linking the excise tax on foundations to payout distribution amounts.
- Reforming the rules governing donor-advised funds to require distribution of DAF donations within three years.
- Banning gifts from private foundations to DAFs and vice-versa.
- Setting a lifetime cap on tax-deductible charitable giving.
- Establishing a universal charitable deduction to encourage giving by low and middle-income givers.
To fully address the risks of top-heavy philanthropy, however, policymakers will need to not only reform the rules of charitable giving, but also establish policies to reduce, over time, concentrations of wealth and power in our society at large. This would include restoring steeply progressive income and wealth taxation, and closing loopholes.
Tuesday, November 6, 2018
Researches have published a study entitled "The Politics of Donations: Are Red Counties More Donative Than Blue Counties?" one of the interesting conclusions of which indicate that as political competition increases within counties, charitable giving decreases most likely because donors worry that their donations will be used to support causes of which they disapprove along political lines. Here is the summary:
This article integrates parallel literatures about the determinants of redistribution across place. Using regression-based path analysis, we explore how tax burden mediates the relationship between political conditions and charitable contributions. Our analysis indicates that counties with a higher proportion of people voting Republican report higher charitable contributions, and tax burden partially mediates this relationship. However, the effect of political ideology on charitable contributions is nonlinear. As the proportion voting Republican in non-Republican-dominated counties increases, the predicted levels of charitable giving actually decreases. In contrast, as the proportion voting Republican increases in Republican-dominated counties, charitable contributions increase. Higher levels of political competition decrease charitable giving, again with partial mediation by tax burden. We also find that the “crowding in” effect of lower tax burdens on charitable giving only partially compensates for the loss of public revenue. Ultimately, total levels of redistribution—both private and government—are higher in Democratic-leaning counties.
Wednesday, October 17, 2018
Among its findings, 16% of respondents identified as lesbian, gay, or bisexual, and 2% identified as genderqueer, transgender, or gender non-conforming. However, a majority (53%) have not disclosed their LGBTQ identity at work. Those who serve on the board or as CEO are more likely to be "out" than those working as program staff or in other positions, where about 35% of staff have disclosed their identity to colleagues. (As the study notes, for comparison, about half of workers in the corporate sector have disclosed their identity at work.) Additional research may shed light on whether and why LGBTQ workers don't feel comfortable being out at their foundations, and what implications that may have for who serves in those roles and how grantee projects are evaluated.
Monday, May 7, 2018
The Hauser Institute for Civil Society (Harvard) has published The Global Philanthropy Report: Perspectives on the Global Foundation Sector. From the introduction:
Global philanthropy holds immense promise in the 21st century. Global giving is growing, gaining visibility, and creating much-needed change around the world.
Over time and across geographies the world has witnessed a near-universal charitable instinct to help others. Recent years, however, have seen a marked and promising change in charitable giving - wealthy individuals, families, and corporations are looking to give more, to give more strategically, and to increase the impact of their social investments. A growing number of philanthropists are establishing foundations and other giving structures to focus, practice, and amplify their social investments. There appears to be a growing belief that institutional philanthropy can encourage more strategic investment approaches; facilitate collaboration; serve as a role model for others; and, in sum, have greater impact on the economic and social challenges being addressed.
Despite the growing significance and scale of institutionally-based philanthropy, remarkably little is known about the related resources and their deployment at the national, regional, and global levels. In much of the world, publicly available philanthropic data and knowledge are scarce. In most countries, neither governments nor private organizations collect and/or make available important data on social investing. Cultural traditions understandably inhibit the sharing of information about giving, often a very personal act. What information does exist is often anecdotal, incomplete, and sometimes inconsistent. In addition, given the varied definitions and research frameworks employed in existing studies, data are generally not comparable within or across countries; information has not been aggregated or analyzed through a global lens. Until the launch of this effort there has been no ongoing and globally coordinated undertaking to quantify the volume of global giving, classify its purposes, or seek to understand its current and potential impact.
Researchers at the Harvard Kennedy School, in collaboration with colleagues around the world, are beginning to address this knowledge gap. The Global Philanthropy Report: Perspectives on the global foundation sector seeks to develop a knowledge base to address the size, scope, and practice of institutional philanthropy across the globe. This inaugural report represents a first step in an attempt to understand worldwide philanthropic practices and trends; provide comparative analysis across countries and regions; begin to develop a picture of the magnitude of global philanthropic investment; and help create an evidence-based discussion on global philanthropy. We hope to publish the report biennially, adding additional countries and reporting increasingly comprehensive data within countries in future editions. Importantly, national collaborators are publishing more in-depth reports on philanthropy in their individual countries.
Each year the CIVICUS State of Civil Society Report examines the major events that involve and affect civil society around the world. Our report is of, from and for civil society, drawing from a wide range of interviews with people close to the major stories of the day, CIVICUS’ ongoing programme of research and analysis, and findings from the CIVICUS Monitor online platform tracking the space for civil society around the world. We will follow the report with a series of dialogues and conversations on the theme of 'reimagining democracy’ in the coming months.
And here are 10 key trends discussed in the report:
“What is perhaps unusual about this year’s report is the focus on the resistance and the fact that the fightback is on, ” is one of the key findings of the State of Civil Society Report 2018. The report identifies 10 key trends that impacted on civil society in 2017 and are continuing in 2018, including:
- Globalised neoliberalism is failing people all around the world;
- Polarising politics are dividing our societies;
- Personal rule by political leaders is undermining democratic institutions;
- Attacks are increasing on journalists reporting on corruption and public protests;
- Growing surveillance and manipulation of opinion is betraying the promise of social media;
- Uncivil society is claiming civil society space;
- Multilateralism is in the firing line;
- The private sector's growing role in governance demands more scrutiny;
- Patriarchy is now firmly under the spotlight;
- Civil society is fighting back and building resolute resistance.
Giving USA and the Indiana University Lilly Family School of Philanthropy have published a The Data on Donor-Advised Funds: New Insights You Need to Know. Here is a description:
Donor-advised funds are frequently identified as one of the fastest-growing vehicles for charitable giving, but the question of where those donor-advised fund grant dollars go has remained largely unanswered until now. A new report is the first to uncover these answers. Among other findings, it identifies education, religion and public-society benefit organizations as the types of nonprofits that attracted the most donor-advised fund grant dollars, based on a sample of donor-advised fund sponsoring organizations from 2012 to 2015.
And here is a critique by Alex Cantor, published in The Chronicle of Philanthropy.
Cindy M. Lott (Columbia University School of Professional Studies), Mary L. Shelly, Nathan Dietz (Urban Institute), and Marcus Gaddy (Urban institute) have published Bifurcation of State Regulation of Charities: Divided Regulatory Authority Over Charities and Its Impact on Charitable Solicitation Laws (Urban Institute). Here is the abstract:
In 27 United States jurisdictions, the attorney general is the sole state-level regulator of charitable organizations and charitable solicitation. In the other 24 jurisdictions, state-level charity regulation is split between two entities: the state attorney general and another state agency, most commonly the secretary of state. This division of regulatory authority is called “bifurcation.” This paper provides background information and data on bifurcated structures for state charities regulation and illustrates the potential utility of considering bifurcation in research on other state-level areas of charitable regulation. We explore several areas of state-level regulation of charitable solicitation (fundraising) through the lens of bifurcation and identify how bifurcation may affect regulatory patterns using our Index of Charitable Solicitation Regulatory Breadth. These approaches to understanding the regulatory context at the state level may have broad applications for research on charities and for jurisdictions considering different models of oversight.
Thursday, September 14, 2017
- Nonprofit compensation has gone up over the last year, returning to pre-recession levels; and
- A gender gap persists in nonprofit compensation (not that that is particularly shocking to anyone in the sector, but it is nice to have some evidence to that effect)
Friday, June 23, 2017
Mark Blumberg (Blumberg Segal LLP) has put together a list, with relevant links, of all 447 Canadian registered charities that have had their charity status revoked by the Charities Directorate of the Canada Revenue Service over the past 25 years. For anyone interested in seeing what types of activities get Canadian charities into trouble with the federal tax authorities, this list could be invaluable. I am not aware of a similar compilation with respect to the IRS in the United States, although Terri Lynn Helge (Texas A&M) has an article in the Pittsburgh Tax Review (Rejecting Charity: Why the IRS Denies Tax Exemption to 501(c)93) Applicants) that looks at IRS denials of applications for recognition of exemption as a charity under section 501(c)(3).
Hat tip: globalphilanthropy.ca.
Thursday, June 22, 2017
No one knows what is going to happen with tax reform, which means now is the perfect time to speculate wildly about how Congress may help or hurt tax-exempt nonprofits if and when it actually does something.
Tax Simplification: If Congress follows the President's lead and simplifies in part by sharply increasing the standard deduction, it will make the charitable contribution deduction irrelevant to an even greater proportion of U.S. households as the number of itemizers shrinks significantly. According to an Indiana University Lilly Family School of Philanthropy report, this change alone could reduce charitable giving by an estimated $11 million annually, and if combined with a lower top tax rate of 35% they could together reduce charitable giving by $13.1 billion. To put these figures in perspective, the most recent Giving USA report reported $282 billion in donations from individuals for 2016.
Non-Itemizer Deduction: One proposal to counter this effect is a charitable contribution deduction for non-itemizers, as long advocated for by Independent Sector among others. The Lilly Family School of Philanthropy report estimates that allowing non-itemizers to deduct their charitable contributions would more than offset the negative effect on contributions from the standard deduction increase and rate reduction proposals. That said, it is hard to see how this proposal could have much chance of success given both its revenue cost and the administrative and enforcement complexity it introduces, particularly in an era of reduced IRS examinations. For an analysis of some of these issues, see this October 2016 Urban Institute report.
The Ghost of Rep. Camp: While Dave Camp is not dead he is no longer in Congress, which you would think would limit his influence over current tax legislation. But he did something brilliant when he was driving the tax reform bus as Chair of the House Ways & Means Committee several year ago: he went through the laborious process of actually drafting legislative language and having the result analyzed and scored by the Joint Committee on Taxation. This means that both the specific language and revenue effects of each provision of the Tax Reform Act of 2014 is available to be pulled off the shelf and deployed immediately as part of any current tax reform legislation. As detailed on pages 535-598 of the JCT report, this includes numerous provisions relating to tax-exempt organizations, including a number of limitations on the existing charitable contribution deduction. Especially if some revenue raisers are needed to pay for other aspects of tax reform, I expect to see some of Rep. Camp's proposals reappear in current legislation.
The Charities Helping Americans Regularly Throughout the Year Act of 2017: Given the uncertainty about the content, timing, and even liklihood of major tax reform legislation, it is a good idea to have a backup plan. The CHARITY Act (I do not know where they got the "I" from) is a modest, bipartisan attempt to tweak the existing tax laws for tax-exempt charities. Its provisions include simplifying the private foundation investment tax under section 4940, making donor advised funds eligible for IRA rollover contributions, increasing the mileage rate applicable to personal vehicle use for volunteer charitable activities, creating an exception to the private foundation excess business holdings rules under section 4943 (can you say Newman's Own Foundation?), and an electronic return filing requirement for all tax-exempt nonprofits.
I look forward to months if not years of further crystal ball gazing on these topics.
Wednesday, June 21, 2017
While the IRS is underfunded and Congress is deadlocked, this does not mean there is no action by the federal government with respect to tax-exempt nonprofit organizations. For starters, the IRS' continues to report data like clockwork, including the always informative Data Book. Highlights from the FY 2016 Data Book include the miniscule examination rate (only 2,956 annual returns examined, including Forms 990, 990-EZ, 990-N, 990-PF, 1041-A, 1120-POL, and 5227), continued strong closures of exemption applications (92,129 for the year, of which the IRS approved 86,406, disapproved 54, and had another 5,669 closed for other reasons, including withdrawals), and now almost 1.6 million organizations recognized as exempt under section 501(c).
The IRS Advisory Committee on Tax Exempt and Government Entities has also had its charter renewed for two more years, and released its sixteenth Report of Recommendations earlier this month. The Committee has been restructured in a way that many of its current members feel is not helpful, as they shared at length in the report. More specifically, the Committee is now divided into subgroups not based on functional areas but instead on subject areas, specifically FICA Replacement Plans, Online Accounts, and, ironically, Future of the ACT.
Finally, the IRS and other federal authorities continue to pursue the most egregious wrongdoing by actors at tax-exempt nonprofits, including criminally. Recent news reports include two major stories along these lines. One involves a federal indictment against a bank officer and her husband who are alleged to have transferred embezzled funds from Bank of America totalling $1.2 million to a variety of charities, possibly in exchange for return payments or other benefits from those charities, according to reports in the Atlanta Journal-Constitution and the Boston Globe. The other, separate situation involves a search by IRS and U.S. Postal Service investigators at the headquarters of televangelist Benny Hinn, as reported by the Dallas Morning News. No further public information is currently available regarding this investigation.
Tuesday, May 10, 2016
Today's Philanthropy Digest is reporting that while the U.S. high school graduation rate rose to a record high 82.3 percent in 2014, the nation is not on track to reach the goal of achieving a 90 percent rate by 2020. That's according to an annual study from Civic Enterprises and the Everyone Graduates Center at John Hopkins University's School of Education.
Conducted in partnership with America's Promise Alliance and the Alliance for Excellent Education, the report from GradNation, 2016 Building a GradNation: Progress and Challenge in Raising High School Graduation Rates, found that while Iowa has achieved a 90 percent graduation rate and twenty other states are on track to do so by 2020, for the first time in four years the nation as a whole is not on track to meet the goal. According to the study, 2, 397 low-graduation-rate high schools -- defined under the Every Student Succeeds Act as those with at least a hundred students enrolled and an Adjusted Cohort Graduation Rate of 67 percent or lower -- enrolled a total of 1.2 million students nationwide, even as the number of large low-graduation-rate schools with at least three hundred students was halved from 2,000 to 1,000 between 2002 and 2014. In forty-one states, low-income students accounted for more than 40 percent of those enrolled in low-performing schools -- including twelve states where they made up more than 75 percent of the student body. African Americans and Latinos made up more than 40 percent of enrollment in low-graduation rate schools in fifteen and nine states, respectively.
The Digest continues:
The study also found that low-graduation-rate schools account for 7 percent of all district schools (and 41 percent of all low-graduation-rate schools), 30 percent of charter schools (26 percent), 57 percent of alternative schools (28 percent), and 87 percent of virtual schools (7 percent). The report recommends that policy makers set clear definitions and give graduation rates the weight they deserve in ESSA; require all states to report extended-year graduation rates in addition to four-year grad rates; create evidence-based plans to improve low-graduation-rate high schools; and ensure that alternative and virtual schools are included in state accountability and improvement systems.
"As the report points out, raising the graduation rate to 90 percent would require graduating an additional 285,000 students," said America's Promise Alliance president and CEO John Gomperts. "Putting it that way makes the goal appear that much more attainable. But to graduate this additional number of students equitably, the nation will have to focus on getting significantly more low-income students, students of color, students with disabilities, English-language learners, and homeless youth on track to earning a diploma. Persistence is key."
Needless to say, the government -- federal, state and local -- will have to allocate more tax dollars to education, to ensuring that the facilities and personnel are available to guide these students towards earning their graduation diplomas.
Wednesday, June 3, 2015
Let me just be honest about my biases. I think it is absolutely shameful that 19 states, including Florida, have refused to participate in Medicaid expansion. It's free money, for Christ's sake, you idiots! But I digress and I am supposed to be a scholar and speak in cold unemotional logic. So let me restate my opinion in the language of a scholar: Ahem . . . . It's free money, for Christ's sake, you idiots! Anyway, we have previously blogged about the early impact of the affordable care act on hospital charity care costs. A more recent report by the Kaiser Family Foundation confirms the early trend:
Looking at particular cost items, charity care costs decreased 40.1 percent among hospitals in Medicaid expansion states compared to 6.2 percent in non-expansion states. However, another component of cost of care to the poor, Medicaid shortfalls – the difference between what Medicaid pays and the costs of treating Medicaid patients – increased 31.9 percent between 2013 and 2014. Shortfalls increased for hospitals in expansion states but were more than offset by increases in Medicaid revenue. Shortfalls increased more among hospitals in non-expansion states than expansion states and were not offset by increases in Medicaid revenue, possibly due to state cuts in provider reimbursement. Combining the decrease in charity care costs with the increase in Medicaid shortfalls, the net cost of caring for low income patients decreased among hospitals in expansion states, while these costs increased among hospitals in non-expansion states.
So let me get this straight. The feds, using our tax dollars, will pay 90% of the costs of Medicaid expansion -- 100% until 2020. Charitable costs will likely increase without medicaid expansion anyway, meaning we will pay for indigent care one way or the other. But the nefarious nineteen (as I will call them from now on) don't want any of "Obama's stinking money." Yeah, that'll teach us, alright! We should remind the knuckleheads that Obamacare was based entirely on Romneycare!
Tuesday, June 2, 2015
We previously blogged on the efforts of the Bright Lines Project to come up with draft political activity regulations here and here. Bright Lines continues the work with these draft regulations. The latest draft, by the way is dated November 11, 2014. Recent reports suggest the real draft regulations may issue sometime this month.
Friday, May 29, 2015
If I were King of the world, I would allow for only a few majors at the undergraduate level. Literature, Languages, History, Mathematics, Science, Art and Philosophy. I would forbid students from majoring in jobs or careers. On the other hand, I have a daughter going into her junior year in college and three more in line and they all need to get jobs to support me and my old bones one day. Georgetown University's Center on College and the Workforce has an informative study out this month quantifying the economic value of a college education by major. I intend to send this to all four of my daughters phones because they won't hear me unless they get it by text or snapchat or whatever other social media is out these days.
Friday, January 30, 2015
Saturday, January 24, 2015
Kate Cooney (School of Management, Yale), Justin Koushyar (Business School, Emory), Matthew Lee (INSEAD (Singapore)), and Haskell Murray (Belmont) have posted the results of their research titled Benefit Corporation and L3C Adoption: A Survey at the Stanford Social Innovcation Review blog. Here is the introduction:
A major challenge for social enterprises pursuing both a social mission and financial profit has been the absence of clear legal guidance about their responsibilities to investors and other stakeholders. In the United States, a number of new legal forms specific to social enterprise have emerged over the last decade to fill this gap. The two most common, the low-profit limited liability company (L3C) and the benefit corporation, modify traditional business legal structures to clearly enable and mandate the pursuit of social and environmental as a for-profit business enterprise. This is no small matter—the last major legal form to be created in the United States was the LLP in 1991.
The success of a new regulatory infrastructure for social enterprise depends heavily on the extent to which state legislators, then companies, adopt these forms. To date, a lack of good data has made it difficult to evaluate progress. To address this, we worked over the last year with Secretary of State offices and Intersector Partners to develop systematic, nation-wide data on adoption of these forms.
Monday, September 29, 2014
An article last week in the Washington Post (h/t Chronicle of Philanthropy) discussed a report by the Department of Health and Human Services that indicated that hospitals are experiencing significant declines in charity care and bad debt, thanks to expansions in Medicaid and a drop in the number of otherwise uninsured individuals due to the Affordable Care Act. The report projects $5.7 billion (that’s billion, with a “b”) in savings in uncompensated care costs in 2014.
The first thing that I thought was, “Wow, that’s a big number! Great news!” The second thing I thought was, “Gee, I wonder if that will change how we evaluate nonprofit hospitals.” What that might say about my mental state aside, it will be interesting to see how this structural change to the way we pay for health care works its way through the standards for tax exemption.
I note that the HHS report tracks “uncompensated care,” which it treats as the sum of bad debt and charity care. While the HHS report does indicate that there is a difference between “self-pay” patients and “charity care”, the report is quick to note that not all hospitals break down their reporting this way. (See HHS Report, FN 6). Of course, part of the raging debate is whether bad debt is charity care – the Catholic Hospital Association says it isn’t but not all hospitals agree.
Either way, under traditional formulations of the community benefit standard, charity care is not the be-all and end-all of for exempt status – it might not even be necessary. The recent trend, first evident in the Revised 990 Form’s Schedule H and then in the community assessment report requirements of the ACA, appears to lean toward wanting more discussion and disclosure of charity care as component of tax-exemption, even if that doesn’t appear anywhere formally quite yet. It will be interesting to see if a structural reduction in the need for charity care (however defined) changes that conversation.
Then, of course, there are the states. Having practiced in Illinois at the time of the Provena decision (good summary here), I’m particularly curious to see how that might play out. For those of you who weren’t following Provena, Illinois revoked the property tax exemption for a number of nonprofit hospitals, stating that the Illinois property tax charitable exemption provisions (some of which are in the state constitution) require actual charitable use (as in relieving- poverty-charitable-use) of the property. While denying that charitable use is a numbers game (that is, you need to show that there are enough charitable dollars spent to offset the property tax uncollected) – the court then engages in exactly that mathematical exercise.
I’ve moved from Illinois since Provena came down, but I understand there was a legislative fix (SB 2194 and SB 3261, passed in 2012), that partially codifies this math-based analysis. What happens if a hospital doesn’t meet its charity care dollars spent requirement because they are simply not necessary anymore due to ACA?
I might be going out on a limb here, but I’m guessing that Prof. Colombo might have a thought or two on this…