Essay: Health Care Conversion Foundations: A Status Report
1997; Project HOPE; Volume: 16; Issue: 6 Linguagem: Inglês
10.1377/hlthaff.16.6.228
ISSN2694-233X
AutoresStephen L. Isaacs, Dennis F. Beatrice, Willine Carr,
Tópico(s)Nursing Education, Practice, and Leadership
ResumoGrantWatch Health AffairsVol. 16, No. 6 Essay: Health Care Conversion Foundations: A Status ReportStephen L. Isaacs, Dennis F. Beatrice, and Willine Carr AffiliationsCenter for Health and Social Policy, in Pelham, New YorkInstitute for Health Policy, Heller School, Brandeis University, in Waltham, MassachusettsGrantmakers In Health, in Washington, D.C.PUBLISHED:November/December 1997Free Accesshttps://doi.org/10.1377/hlthaff.16.6.228AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSHospital qualitySystems of careEducationHealth maintenance organizationsNonprofit statusElderly careAccess to carePsychiatric hospitalsFor-profit statusPublic healthAlthough conversion foundations are a welcome addition to health care philanthropy, their emergence also raises major challenges to public policy. THE DRAMATIC UPHEAVAL in health care—the shift from physician-run fee-for-service to market-generated managed care— has made headlines. A perhaps more important phenomenon has escaped this level of attention: a shift in control of the system from nonprofit organizations to for-profit corporations. What once was a trend is now a full-scale revolution. Forced to compete with cash-laden commercial insurance companies, for-profit health maintenance organizations (HMOs) have increased their share of the market from 18 percent in 1981 to 71 percent in 1995. 1 Hospital chains gobble up small community hospitals and large medical centers alike; between 1994 and 1996 alone, 155 hospitals and hospital systems shifted from nonprofit to for-profit status. Blue Cross and Blue Shield plans in. five states have shed their nonprofit status, while those in many other states have either applied for for-profit status or are anxiously awaiting their turn. Huge sums of money are being generated by the “conversion,” or change, of nonprofit corporations into for-profits. The conversion of Blue Cross of California in 1996 led to the creation of two foundations that together had assets of $3.2 billion. 2 When corporations merge, personal fortunes can be made. When Health Net, one of California's largest HMOs, converted in 1992, thirty-three executives and directors purchased 20 percent of the company for $1.5 million; four years later, in 1996, their shares were worth $315 million. 3 This shift in the marketplace has altered the nature of health services and created new forces in philanthropy. 4 A side effect of conversions has been the rise of a separate category of foundations, with assets totaling more than $9 billion. The sizes of some of the new “conversion foundations” rival those of more well-known giants such as The Rockefeller and The John D. and Catherine T. MacArthur Foundations. What these new foundations are, how they came about, and what they do with their assets has received comparatively little attention. 5 Yet, their potential for affecting health and health care is as great as the revolution that spawned these funders. A Conversion PrimerWhen a nonprofit corporation is merged, acquired, restructured, or otherwise converted into a for-profit entity, the new owners cannot simply divide up the assets. The law restricts the distribution of assets built up over the years through the benefits of tax exemptions, favorable treatment, and tax-deductible contributions. Conversions of health care organizations trigger two legal doctrines. The first, called “charitable trust” doctrine, requires that the assets of a charitable nonprofit (or public benefit) corporation must always be dedicated to the charitable purposes for which it was established, even if the corporation is dissolved or reorganized. The second is the cypres doctrine (meaning “so near” in Norman French). Under cypres, when the original charitable purposes become impossible or impracticable to fulfill, the assets may be used for purposes similar to those found in the articles of incorporation. 6 Ignored in the past as arcane jurisprudential principles that were of interest mainly to lawyers doing estate planning for wealthy clients, these two doctrines were dusted off by state attorneys general in the 1990s. They now govern conversion transactions in most states. (Although conversions have federal tax and antitrust implications, they fall primarily under state law.) By definition, when a hospital, an HMO, or a Blue Cross plan converts to for-profit status, its original nonprofit, or public benefit, purposes no longer exist. Charitable trust and cypres doctrines then apply to determine how the value of the assets can be used. The final determination may rest with the courts, attorneys general, and state regulators. Most commonly, a new charitable foundation is created. A recent survey conducted by the Center for Health and Social Policy, Grantmakers In Health, and the Institute for Health Policy at Brandeis University identified eighty-one conversion foundations, with another nine in the process of formation as of 1 October 1997. 7 Together these conversion foundations have $9.3 billion in assets, about half of which— $4.5 billion—is concentrated in California. If they gave away 5 percent of their assets a year, as organizations classified by the Internal Revenue Service as “private foundations” are required to do, it would add more than $450 million for philanthropic purposes annually. Conversion foundations range in size from the $4 million Truman Heartland Foundation to the $2.2 billion California HealthCare Foundation. The median asset size is $57 million. Exhibit 1 lists the nation's twenty-five largest conversion foundations, by asset size. Sixty-nine of the eighty-one conversion foundations established to date have resulted from hospital conversions. Ten were created from conversions of managed care companies or HMOs, and two arose from the conversion of Blue Cross of California.Although one conversion foundation was established in 1973, a trend developed in the 1980s, when twenty-two conversion foundations were formed. Between 1990 and 1993, conversion foundations were established at an average rate of one to three a year. In 1994, spurred by an increase in the number of health care conversions and greater vigilance by state regulators and public-interest groups, the number shot up to ten. Nineteen such foundations followed in 1995, and seventeen in 1996. Four had been established through 1 August 1997. Thus, nearly two-thirds of the nation's conversion foundations were established within the past four years. With a few dramatic exceptions (foundations that bought airplanes and uniforms for school marching bands), conversion foundations spend most of their money on health care. 8 Fifty-two (67 percent) of the seventy-eight conversion foundations for which information is available are dedicated exclusively to health care, and nearly all the rest devote a portion of their resources to health care. (Three have not yet determined the breadth of their mission.) Generally, conversion foundations define health care broadly to encompass health promotion, disease prevention, and public health ( Exhibit 2 ). Many give priority to improving children's well-being, discouraging teen pregnancy, preventing violence, and addressing the root causes of poor health. A smaller number fund—or in some cases provide—health services for uninsured and indigent patients or underwrite the costs of sending physicians or medical residents to underserved areas. Where health is not the main or exclusive priority, conversion foundations tend to fund a broad array of community activities. Public Policy ChallengesConversion foundations are a welcome addition to health care philanthropy. Their emergence, however, raises three major public policy challenges. The first is assuring that charitable assets built up over the years are not lost to the public. A growing number of state legislatures are requiring government approval of conversion transactions; public notice and comment on the terms of the transaction; assurance that insiders are not profiting unduly; pricing at fair market value; and/or dedication of an amount equal to the converting entity's assets for the public's benefit.Exhibit 1 The Twenty-Five Largest Conversion Foundations, By Asset AmountFoundation Assets (in millions) aCalifornia Healthcare Foundation$2,200.0California Endowment975.4California Wellness Foundation880.0Kansas Health Foundation377.0Colorado Trust320.0Rose Community Foundation185.0Rapides Foundation175.0Paso del Norte Health Foundation170.0Baptist Community Ministries163.4Presbyterian Health Foundation142.0Arlington Health Foundation140.0 Methodist Health Care Ministries of Southwest Texas b140.0NBI Healthcare Foundation140.0Quantum Foundation140.0Sierra Health Foundation138.0The Memorial Foundation132.0The Assisi Foundation of Memphis130.0Jewish Healthcare Foundation of Pittsburgh120.0St. David's Health Care Foundation118.0Venice Foundation109.0Drs. Bruce and Lee Foundation105.0 Winter Park Health Foundation b105.0Archstone Foundation88.1St. Luke's Charitable Health Trust83.0Sisters of Charity Foundation of South Carolina82.5SOURCE: S.L. Isaacs, W. Carr, and D.F. Beatrice, Health Care Conversion Foundations: 1997 Status Report (Washington: Grantmakers In Health, October 1997). a As of 31 December 1996. b Operating health care organizations/foundations that also provide grants. The second is assuring that the new foundations become effective and professional grant-making organizations. The key to this is an independent board and a capable staff. Board independence is of particular concern. The potential for divided loyalties is particularly strong where members of the former nonprofit, HMO, Blue Cross, or hospital's board form the new foundation's board and, in joint ventures, where the foundation shares the hospital's profits and some of the foundation's trustees sit on the boards of both organizations. The third is assuring that the funds of the new foundations are used for appropriate charitable purposes. Among the important public policy considerations is the extent to which new foundations should fund medical care for indigent and uninsured patients; adopt a broader approach encompassing health promotion, disease prevention, and public health; or support a wide range of civic activities. An educated and involved community and a well-selected board with ongoing public accountability will help to ensure that the foundation plays an appropriate role. 9Exhibit 2 Conversion FoundationsName and locationYear establishedEntity converted Assets(in millions) aGrant-making areasAlleghany Foundation Covington, VA1995Hospital or health system$40.0Quality of life, “worthy activities,” school nurses, and dental servicesAlliance Healthcare Foundation San Diego, CA1994HMO60.0Care for medically underserved and indigent; programs relating to substance abuse, communicable diseases, violence, mental health, and environmentArchstone (formerly FHP)Foundation Long Beach, CA1985HMO88.1Senior citizens and aging: policy, research, and servicesArlington Health Foundation Arlington, VA1996Hospital or health system140.0Access to health services; prevention and treatment of substance abuse; frail elderlyAssisi Foundation of Memphis Memphis, TN1994Hospital or health system130.0Health and human services, education, ethics, religion, and humanitiesBarberton (OH) Community Foundation1997Hospital or health system75.0 (1997)Charitable, educational, public health, and recreational programsMary Black Foundation Spartanburg, SC1996Hospital or health system62.0Primary health care, disease prevention, and wellnessBlowitz-Ridgeway Foundation Northfield, IL1984Hospital or health system21.9100% mental health-related: health care, social service, and researchByerly Foundation Hartsville, SC1995Hospital or health system25.0Health care, education, economic development, and quality of lifeCalifornia Endowment Woodland Hills, CA1996Blue Cross975.4Serving medically underserved; services, public health, and community health; strengthening health careCalifornia HealthCare Foundation Oakland, CA1996Blue Cross2,200.0Access to care, underinsured and uninsured, public health, and community healthCalifornia Wellness Foundation Woodland Hills, CA1992HMO880.050% direct services, violence prevention, population health improvement, work and health, community health, and teenage pregnancy preventionCape Fear Memorial Foundation Wilmington, NC1996Hospital or health system50.0Guidelines not availableChoiceCare Foundation Cincinnati, OH1995HMO50.0Health care delivery, community health, and physician educationChristy-Houston Foundation Murfreesboro, TN1986Hospital or health system; sale to a nonprofit company78.0Health care, education, and charitable activitiesColorado Springs (CO) Osteopathic Foundation1984Hospital or health system13.4Indigent care clinic; medical residency for osteopathic doctors in rural areasColorado Trust Denver, CO1985Hospital or health system320.0Services, disease prevention, research, strengthening families, and accessColumbus (OH) Medical Association Foundation1992HMO56.0Health care delivery, education, innovative health care projects, and researchCommunity Health Corporation Riverside, CA1997Hospital or health system21.0 (1997)Services for underinsured or uninsured patients; prevention and public healthCommunity Memorial Foundation Hinsdale, IL1995Hospital or health system62.0Youth, older adults, strengthening family, creating community cohesiveness, and specific health needsConsumer Health Foundation Washington, DC1994HMO$20.0Public health, improving access to care, and enabling people to be actively involved in their own health careDakota Medical Foundation Fargo, ND1994Hospital or health system17.0Community health, clinical research, community and patient education, and medical educationDrs. Bruce and Lee Foundation Florence, SC1995Hospital or health system105.0Health, human services, education, arts, religion, civic affairs; historical, cultural, and environmental preservationFederation of Independent School Alumnae Pittsburgh, PA1996Hospital or health system22.0Physical rehabilitation, underserved/disadvantaged women, drug abuse services, and mental retardationFoundation for Seacoast Health Portsmouth, NH1984Hospital or health system53.1Health promotion, women's health, scholarships, infant/child/adolescent, and medical financial assistanceGeorgia Osteopathic Institute Tucker, GA1986Hospital or health system5.0Statewide training program for third- and fourth-year medical students working in underserved areasGood Samaritan Charitable Trust San Jose, CA1996Hospital or health system71.0Health research, education, and servicesGood Samaritan Foundation Lexington, KY1982Hospital or health system15.0Primary/preventive health care access, delivery of care, and health education in underserved areas; training of health care professionalsGrotta Foundation for Senior Care Maplewood, NJ1993Hospital or health system8.0Services for elderly peopleGroup Health Foundation St. Louis, MO1985HMO4.9Promote health and prevent illness; grants to health care providersGulf Coast Medical Foundation Wharton, TX1983Hospital or health system16.0Primarily medical-related, such as local emergency medical services and primary careHealth Foundation of Central Massachusetts Worcester, MA1997HMO50.0 (1997)Guidelines in preparationHealth Foundation of Greater Indianapolis (IN)1985HMO28.0Adolescent programs, HIV/AIDS programs, and miscellaneous programsHealth Foundation of South Florida Miami, FL1993Hospital or health system80.0Indigent care and social services; medical, health, and nursing research; health education; health promotion/disease preventionHealth Future Foundation Omaha, NE1984Hospital or health system70.0Indigent care, research, and health-related projects at Creighton University HealthOne b Denver, CO 1995Hospital or health system20.5 (1995)Health care research and medical student training; adult day care; community grantsHill Crest Foundation Bessemer, AL1984Hospital or health system28.0Primarily mental health; also arts and educationHilton Head Island (SC) Foundation1994Hospital or health system26.0Arts/culture, community development, education, environment, and health/human servicesIrvine (CA) Health Foundation1985Hospital or health system25.0Health services, research, and education; preventionJackson Foundation Dickson, TN1995Hospital or health system$80.0Education and arts; technology training; Eagle flying squadronAnnabella R.Jenkins Foundation Richmond, VA1995Hospital or health system25.5Quality health care and effective health care programs; a supporting organization of the Community Foundation Serving Richmond and Central VirginiaJewish Healthcare Foundation of Pittsburgh Pittsburgh, PA1990Hospital or health system; sale to a nonprofit company120.0Services; health education; research for elderly, underprivileged, and indigent; priority areas: aging and chronic care, women's health, children's health, AIDS, and nutritionKansas Health Foundation Wichita, KS1985Hospital or health system377.0Primary care education, rural health, health promotion and disease prevention, public health, and health policy and researchDr. John T. MacDonald Foundation Coral Gables, FL1992Hospital or health system22.0Health education; prevention and early detection of diseases; children and economically disadvantaged; and medical rehabilitationMemorial Foundation GoodlettsviIle, TN1994Hospital or health system132.0Senior citizens, youth, children, and teens; human services related to drug and alcohol abuse and domestic violence, health, rehabilitation, and education Methodist Health Care Ministries of Southwest Texas b San Antonio, TX 1996Hospital or health system140.0Two clinics serving underserved populations; community outreach through churches in rural areasMid-Iowa Health Foundation Des Moines, IA1984Hospital or health system15.5Prevention, health education, and direct services for children, elderly, handicapped, indigent, at-risk groups, and chronically or terminally illMt. Sinai Health Care Foundation Cleveland, OH1996Hospital or health system70.0Health; priorities are child development, services for elderly, organizational development, and community programsNBI Healthcare Foundation Livingstone, NJ1996Hospital or health system; sale to a nonprofit company140.0Health care services, health care education, and medical and scientific researchNorth Dade (FL) Medical Foundation1997Hospital or health system25.0 (1997)Community education and health careNorthwest Osteopathic Medica Foundation Portland, OR1984Hospital or health system7.2Wellness and prevention, research, medical equipment, health education for families and children, and scholarships and loans to osteopathic studentsPaso del Norte Health Foundation El Paso, TX1995Hospital or health system170.0Health education; preventionPortsmouth (VA) General Hospital Foundation1988Hospital or health system; sale to a nonprofit company15.2Health education and preventive health programs, substance abuse prevention, research and coordination of indigent care, health and family, teen pregnancy prevention, community and humanitarian concernsPresbyterian Health Foundation Oklahoma City, OK1985Hospital or health system$142.0Medical research; medical education;clinical pastoral education; community health-related programs, primarily through University of OklahomaQuad City Osteopathic Foundation Davenport, IA1985Hospital or health system4.4Grants, loans, scholarships to advance quality and availability of osteopathic health care professionals and paraprofessionalsQuantum Foundation Atlantis, FL1996Hospital or health system140.0Health and educationJohn Randolph Foundation Hopewell, VA1995Hospital or health system25.0Mental health, social services, substance abuse services, family and child agencies, specialized care for elderly and disabled, educational institutions and scholarships, treatment services, child development and youth services, women's services, homeless, hospice, prevention of teen pregnancy, sexual assault and domestic violence prevention, health education, and prevention and wellness programsRapides Foundation Alexandria, LA1994Hospital or health system175.0Health science, education, arts, and human caringMichael Reese Health Trust Chicago, IL1991Hospital or health system58.0Health care, health education, and health research. Programs target medically indigent and underserved, immigrants, refugees, elderly persons, mentally and physically disabled persons, children, and youthRose Community Foundation Denver, CO1995Hospital or health system185.0Children and families, education, elderly, health of community, and Jewish continuitySt. Ann Foundation Cleveland, OH1973Hospital or health system28.0Improved quality of life for women, children, and youth; religious community ministriesSt. David's Health Care Foundation Austin, TX1996Hospital or health system118.0Access and prevention programs, behavioral health, parenting, life skills, prevention of violence and teen pregnancy, and medical education and researchSt. Luke's Charitable Health Trust Phoenix, AZ1995Hospital or health system83.0Disease prevention programs for children, youth, and families; delivery of health services to underserved; health care capacity buildingSt. Luke's Foundation Bellingham, WA1983Hospital or health system8.7Improve quality of health careSan Angelo (TX) Health Foundation1995Hospital or health system50.0A wide range of community projects Share Foundation b El Dorado, AR 1996Hospital or health system40.0Service, health, arts, research, and education (SHARE); clinic for indigent patients; hospice and chaplaincy programsSierra Health Foundation Sacramento, CA1984HMO138.0Improve health care delivery; expand use and availability of health care resources; health needs of underserved populations, using a broad, community-based approachJ. Marion Sims Foundation Lancaster, SC1994Hospital or health system60.0Health and wellness: prevention, education, and therapySisters of Charity Foundation of Canton (OH)1995Hospital or health system$72.5Health, education, and social services; root causes of poverty, outreach to families affected by welfare reform, and job trainingSisters of Charity Foundation of Cleveland (OH)1995Hospital or health system46.0Health education and social services, including substance abuse services, services for frail elderly, care of dependent family members, elementary and secondary education, safe and affordable housing, early childhood education, and personal and family development programs leading to employmentSisters of Charity Foundation of South Carolina Columbia, SC1996Hospital or health system82.5Poverty-related programs, including education, crime prevention, health care, and jobsSisters of Mercy of North Carolina Charlotte, NC1995Hospital or health system; sale to a non profit companyNot reportedAssists Sisters of Mercy of North Carolina by supporting systemic change, empowerment of women, children, and elderlySisters of St. Joseph Charitable Fund Parkersburg, WV1996Hospital or health system20.0Guidelines not availableSouth Lake County Foundation Clermont, FL1995Hospital or health system; joint venture with a nonprofit company10.0Education, youth and family services, health and wellness, arts and cultural development, and community developmentTruman Heartland Foundation Independence, MO1994Hospital or health system4.0Community programs, including health, education, stronger neighborhoods, seniors, youth development, arts, culture, and historic preservation; supporting organization of Kansas City Community FoundationTucson (AZ) Osteopathic Medical Foundation1986Hospital or health system9.0Osteopathic medical education, understanding of osteopathic medicine, health and well-being of communityVenice (FL) Foundation1995Hospital or health system109.0Health and human services, education, arts and culture, and civic affairsWashington Square Foundation health system Chicago, IL1985Hospital or health system32.0Health CareWilliamsburg (VA) Community Hospital Foundation1996Hospital or health system; sale to a nonprofit company61.0Improve health; priorities are disease prevention, primary health care services for underserved children and young families, improvement of elderly persons' health, support of community health initiatives Winter Park (FL) Health Foundation b1994Hospital or health system105.0Wellness and adult day-care centers;grants for community healthSOURCE: S.L Isaacs, W. Carr, and D.F. Beatrice, Health Care Conversion Foundations: 1997 Status Report (Washington: Grantmakers In Health, October 1997). NOTES: HMO is health maintenance organization. HIV/AIDS is human immunodeficiency virus/acquired immunodeficiency syndrome.a As of 31 December 1996, unless otherwise noted. b Operating health care organization that also provides grants. The magnitude of the additional resources available to philanthropy offers the potential for a significant beneficial effect on the health and well-being of communities. Against this must be weighed concerns about the for-profit corporations' commitment to health. 10 These concerns raise a fourth, more global, challenge: assuring that investor-owned health care systems, which are the force driving conversions and the establishment of conversion foundations, maintain a commitment to high-quality services for people regardless of their ability to pay. ACKNOWLEDGMENTSThe authors thank Alix Grubel, Jennifer Radin, and Barbara Stearns of the Center for Health and Social Policy and Mary Backley of Grantmakers In Health (G1H) for their research and clerical assistance; Catherine McDermott, former president of GIH, for her guidance throughout the course of this research; and The Robert Wood Johnson Foundation and The Henry]. Kaiser Family Foundation for their generous financial support.NOTES1. Claxton G. , et al. , “Public Policy Issues in Nonprofit Conversions: An Overview,” Health Affairs (March/April 1997 ): 9 - 28 . Go to the article, Google Scholar 2. See Schaeffer L.D. , “Health Plan Conversions: The View from Blue Cross of California,” Health Affairs (Winter 1996 ): 183 - 187 ; and Go to the article, Google Scholar Fox D.M. , Isenberg P. , “Anticipating the Magic Moment: The Public Interest in Health Plan Conversions in California,” Health Affairs ( Spring 1996 ): 202 - 209 . Go to the article, Google Scholar 3. Bell J. , “Saving Their Assets: How to Stop Plunder at Blue Cross and Other Nonprofits,” The American Prospect ( May/June 1996 ): 62 . Google Scholar 4. Jaffe G. , Langley M. , “Generous to a Fault? Fledgling Charities Get Billions from the Sales of Nonprofit Hospitals,” The Wall Street journal, 6 November 1996 ,1; and Google Scholar Lewin T. , Gottlieb M. , “In Hospital Sales, an Overlooked Side Effect,” The New York Times, 27 April 1997 , 1 . Google Scholar 5. Articles on conversion foundations include Kane N.M. , “Some Guidelines for Managing Charitable Assets from Conversions,” Health Affairs (March/April 1997 ): 229 - 237 ; Go to the article, Google Scholar Grantmakers In Health , “The New ‘Conversion’ Health Foundations: Preliminary Results of GIH Survey” ( Grantmakers In Health Research Initiative, paper presented at Council on Foundations Annual Conference , Atlanta, Georgia , 23 April 1996 ); Go to the article, Google Scholar Bader B. , “The Conversion Foundations: A Pot of Gold or Pandora's Box for Communities?” Health System Leader ( October 1996 ): 4 - 18 ; and Go to the article, Google Scholar Greenberg L.G. , “Foundations Formed through Nonprofit Hospitals' Sales,” Health Affairs ( Spring 1991 ): 180 - 183 . Go to the article, Google Scholar 6. Peregrine M. , “Charitable Trust Laws and the Evolving Nature of the Nonprofit Hospital Corporation,” Journal of Health and Hospital Law (March 1997 ): 11 - 20 . Medline, Google Scholar 7. Isaacs S.L. , Carr W. , Beatrice D.F. , Health Care Conversion Foundations: 1997 Status Report (Washington: Grantmakers In Health , October 1997 ). Google Scholar The survey reviewed annual reports, grant guidelines, and, where they were available, Internal Revenue Service Form 990s of all conversion foundations associated with and known to Grantmakers In Health; those listed in the October 1996 issue of Health System Leader, which was devoted to conversions; those mentioned in Modern Healthcare and The Health Law Reporter, both of which track health care conversions; and those that came up in Lexis-Nexis searches. The review of written materials was followed by telephone interviews with a key person from ninety-eight of the 110 organizations that were thought to be conversion foundations. In this process, the authors eliminated those foundations established by the gift of a wealthy individual or a corporation and those that were fund-raising arms of a hospital rather than grant-making organizations. This left a total of eighty-one conversion foundations. (The eighty-one foundations include eight that originated from the sale of a nonprofit hospital to another nonprofit hospital or hospital system and that are identical in all respects to those established from the transfer of assets to a for-profit corporation.) The assets are reported as of 31 December 1996, except for those foundations established in 1997 whose assets are reported as of 1 August 1997 . Google Scholar 8. Jaffe , Langley , “Generous to a Fault?” and Google Scholar Lewin , Gottlieb , “In Hospital Sales, an Overlooked Side Effect.” Google Scholar 9. Kane , “Some Guidelines for Managing Charitable Assets from Conversions,” 236 . Google Scholar 10. See, for example , Meyerson A.R. , “When Healing Collides with the Drive for Profits,” The New York Times , 27 July 1997 , 14 ; Crossref, Medline, Google Scholar Kassirer J.P. , “The New Health Care Game,” The New England journal of Medicine ( 8 August 1996 ): 433 ; and Crossref, Medline, Google Scholar Snow C. , “For-Profits Spurned,” Modern Healthcare ( 13 January 1997 ): 30 . Crossref, Medline, Google Scholar Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article MetricsCitations: Crossref 4 History Published online 1 November 1997 InformationCopyright © by Project HOPE: The People-to-People Health Foundation, Inc.ACKNOWLEDGMENTSThe authors thank Alix Grubel, Jennifer Radin, and Barbara Stearns of the Center for Health and Social Policy and Mary Backley of Grantmakers In Health (G1H) for their research and clerical assistance; Catherine McDermott, former president of GIH, for her guidance throughout the course of this research; and The Robert Wood Johnson Foundation and The Henry]. Kaiser Family Foundation for their generous financial support.PDF downloadCited bySocial Entrepreneurship in Communities11 January 2016 | Nonprofit Management and Leadership, Vol. 26, No. 3Hospital Conversion FoundationsJONA's Healthcare Law, Ethics, and Regulation, Vol. 3, No. 1Health Care Organizations: For-profit and NonprofitHospital ConsolidationJONA: The Journal of Nursing Administration, Vol. 29, No. 3
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