Internal Revenue Service Form Research Articles

Extremes of Emergency Department Boarding are Associated With Poorer Financial Performance Among Hospitals.

Boarding emergency department (ED) patients is associated with reductions in quality of care, patient safety and experience, and ED operational efficiency. However, ED boarding is ultimately reflective of inefficiencies in hospital capacity management. The ability of a hospital to accommodate variability in patient flow presumably affects its financial performance, but this relationship is not well studied. We investigated the relationship between ED boarding and hospital financial performance measures. Our objective was to see if there was an association between key financial measures of business performance and limitations in patient progression efficiency, as evidenced by ED boarding. Cross-sectional ED operational data were collected from the Emergency Department Benchmarking Alliance, a voluntarily self-reporting operational database that includes 54% of EDs in the United States. Freestanding EDs, pediatric EDs and EDs with missing boarding data were excluded. The key operational outcome variable was boarding time. We reviewed the financial information of these nonprofit institutions by accessing their Internal Revenue Service Form 990. We examined standard measures of financial performance, including return on equity, total margin, total asset turnover, and equity multiplier (EM). We studied these associations using quantile regressions of added ED volume, ED admission percentage, urban versus nonurban ED site location, trauma status, and percentage of the population receiving Medicare and Medicaid as covariates in the regression models. Operational data were available for 892 EDs from 31 states. Of those, 127 reported a Form 990 in the year corresponding to the ED boarding measures. Median boarding time across EDs was 148min (interquartile range [IQR]: 100-216). A significant relationship exists between boarding and the EM, along with a negative association with the hospital's total profit margin in the highest-performing hospitals (by profit margin percentage). After adjusting for the covariates in the regression model, we found that for every 10min above 90min of boarding, the mean EM for the top quartile increased from 245.8% to 249.5% (p <.001). In hospitals in the top 90th percentile of total margin, every 10min beyond the median ED boarding interval led to a decrease in total margin of 0.24%. Using the largest available national registry of ED operational data and concordant nonprofit financial reports, higher boarding among the highest-profitability hospitals (i.e., top 10%) is associated with a drag on profit margin, while hospitals with the highest boarding are associated with the highest leverage (i.e., indicated by the EM). These relationships suggest an association between a key ED indicator of hospital capacity management and overall institutional financial performance.

Creeping COVID catastrophe: the impact of COVID-19 on nonprofits by sector

PurposeThis study aims to provide a timely “first look” at the impact of COVID-19 lockdown restrictions on the financial distress of nonprofits.Design/methodology/approachThis study uses Internal Revenue Service Form 990 returns, US census information, and Oxford COVID-19 workplace restriction data and utilizes logistic regression to analyze results.FindingsNonprofits with greater COVID-19 lockdown restrictions are more likely to experience financial distress, whether measured by a 30% reduction in total, program, management and general, or fundraising expenses. This paper also examines results by subsector using National Taxonomy of Exempt Entities data and finds that the Human Services and Public and Society subsectors drive the full sample results when the authors use total, program, or managerial and general expenses in the measure of financial distress, and the Education and Environment and Animals subsectors drive the results when using fundraising expenses in the measure of financial distress.Originality/valueBroadly speaking, this paper contributes to the limited research stream examining the impact of crises on nonprofits. More specifically, this study is among the earliest to rely on quantitative data to investigate such effects.

Text Analysis of Trends in Health Equity and Disparities From the Internal Revenue Service Tax Documentation Submitted by US Nonprofit Hospitals Between 2010 and 2019: Exploratory Study.

Many US hospitals are classified as nonprofits and receive tax-exempt status partially in exchange for providing benefits to the community. Proof of compliance is collected with the Schedule H form submitted as part of the annual Internal Revenue Service Form 990 (F990H), including a free-response text section that is known for being ambiguous and difficult to audit. This research is among the first to use natural language processing approaches to evaluate this text section with a focus on health equity and disparities. This study aims to determine the extent to which the free-response text in F990H reveals how nonprofit hospitals address health equity and disparities, including alignment with public priorities. We used free-response text submitted by hospital reporting entities in Part V and VI of the Internal Revenue Service Form 990 Schedule H between 2010 and 2019. We identified 29 main themes connected to health equity and disparities, and 152 related key phrases. We tallied occurrences of these phrases through term frequency analysis, calculated the Moran I statistic to assess geographic variation in 2018, analyzed Google Trends use for the same terms during the same period, and used semantic search with Sentence-BERT in Python to understand contextual use. We found increased use from 2010 to 2019 across all the 29 phrase themes related to health equity and disparities. More than 90% of hospital reporting entities used terms in 2018 and 2019 related to affordability (2018: 2117/2131, 99.34%; 2019: 1620/1627, 99.57%), government organizations (2018: 2053/2131, 96.33%; 2019: 1577/1627, 96.93%), mental health (2018: 1937/2131, 90.9%; 2019: 1517/1627, 93.24%), and data collection (2018: 1947/2131, 91.37%; 2019: 1502/1627, 92.32%). The themes with the largest relative increase were LGBTQ (lesbian, gay, bisexual, transgender, and queer; 1676%; 2010: 12/2328, 0.51%; 2019: 149/1627, 9.16%) and social determinants of health (958%; 2010: 68/2328, 2.92%; 2019: 503/1627, 30.92%). Terms related to homelessness varied geographically from 2010 to 2018, and terms related to equity, health IT, immigration, LGBTQ, oral health, rural, social determinants of health, and substance use showed statistically significant (P<.05) geographic variation in 2018. The largest percentage point increase was for terms related to substance use (2010: 403/2328, 17.31%; 2019: 1149/1627, 70.62%). However, use in themes such as LGBTQ, disability, oral health, and race and ethnicity ranked lower than public interest in these topics, and some increased mentions of themes were to explicitly say that no action was taken. Hospital reporting entities demonstrate an increasing awareness of health equity and disparities in community benefit tax documentation, but these do not necessarily correspond with general population interests or additional action. We propose further investigation of alignment with community health needs assessments and make suggestions for improvements to F990H reporting requirements.

Provision of Social Care Services by US Hospitals.

Despite growing interest in identifying patients' social needs, little is known about hospitals' provision of services to address them. We identify social care services offered by US hospitals and determine whether hospital spending or state policies toward community benefits are associated with the provision of these services by tax-exempt hospitals. National secondary data about hospitals were collected from the American Hospital Association Annual Survey, with additional Internal Revenue Service (IRS) Form 990 data on community benefits spending from CommunityBenefitInsight.org and state-level community benefits policies from HilltopInstitute.org. Descriptive statistics for types of social care services and hospital characteristics were calculated, with bivariate chi-square and t-tests comparing for-profit and tax-exempt hospitals. Multivariable Poisson regression was used to estimate associations between hospital characteristics and types of services offered and among tax-exempt hospitals to estimate associations between social care services and community benefits spending and policies. Multivariable logistic regressions modeled associations between community benefits spending/policies and each type of social care services. Private US hospitals offered an average of 5.7 types of social care services in 2018. Tax-exempt hospitals offered about 36% more social care services than for-profit hospitals. Larger number of beds, health system affiliation, and having community partnerships are associated with more social care services, whereas rural hospitals and those managed under contract offered fewer social care services. Among tax-exempt hospitals, greater community benefits spending is associated with offering more total (incidence rate ratio [IRR] = 1.10, p < 0.01) and patient-focused social care services (IRR = 1.16, p < 0.01). Hospitals in states with minimum community benefits spending requirements offered significantly fewer social care services. Although tax-exempt status and increased community benefits spending were associated with increased social care services provision, the observation that certain hospital characteristics and state minimum community benefits spending requirements were associated with fewer social care services suggests opportunities for policy reform to increase social care services implementation.

Trends in the Provision of Community-Building Activities by Nonprofit Hospitals, 2010-2019.

As part of their annual tax report, nonprofit hospitals are asked to report their community-building activities (CBAs); yet, little is known to date about hospitals' spending on such activities. CBAs are activities that improve community health by addressing the upstream factors and social determinants that impact health. Using data from Internal Revenue Service Form 990 Schedule H, this study used descriptive statistics to examine trends in the provision of CBAs by nonprofit hospitals between 2010 and 2019. While the number of hospitals reporting any CBA spending remained relatively stable at around 60%, the share of total operating expenditures that hospitals contributed to CBAs decreased from 0.04% in 2010 to 0.02% in 2019. Despite the increasing attention paid by policy makers and the public to the contributions that hospitals make to the health of their communities, nonprofit hospitals have not made corresponding efforts to increase their spending on CBAs.

The Role of Gender, Race/Ethnicity, and Other Factors in Influencing Top Executive Compensation in American Environmental Nonprofits

The article reports the findings of a pathbreaking national study that examines executive compensation in American environmental nonprofits. This article seeks to accomplish two goals: (1) examine the gender disparities in the pay of chief executive officers (CEOs), executive directors, and presidents in environmental organizations; and (2) analyze the ethnic/racial differences in the wages of the top executive in said nonprofits. The study uses financial information from Internal Revenue Service Form 990 to examine top executive salaries in 2,703 organizations. The author collected data from tax forms filed between 2018 and 2020. The article examines how gender and race/ethnicity are associated with compensation. It also analyzes how region, organizational type, urbanization, organizational revenue, staff size, the board size, the receipt of bonuses and incentives, the size of the bonuses/incentives, and the size of the base wages are related to overall compensation. Men occupied 51.2% (1,383) and women 48.8% (1,320) of the top executive positions in the organizations studied. Whites dominate the CEO position, that is, 92% or 2,488 of the CEOs were White, and 8% (215) were people of color. The study found significant gender pay gaps. While the median compensation for men was $117,468, it was $88,568.50 for women. Hence, women CEOs earned 75.4% of what men were paid. There was also an ethnic/racial pay gap. The study found that White CEOs earned a median income of $102,801. The median wage for Asian CEOs was 97.6%, Black CEOs was 96%, Latinx CEOs was 80.8%, and Native American CEOs was 73.4% of what White CEOs earned. White men obtained the highest median compensation of all gender, and racial/ethnic groups studied. The total compensation also varied by region, organizational revenues, organizational type, level of urbanization, staff size, board size, receipt of bonuses and incentives, the size of bonuses/incentives, and size of base wages. The size of the organization’s revenue, whether a CEO received bonuses/incentives, region, the CEO’s race/ethnicity, the CEO’s gender, and size of the staff were significant factors in the multivariate regression model.

A Guide to the Canadian T3010 for Users of the U.S. Form 990

This research note introduces nonprofit researchers accustomed to the U.S. Form 990 to the Canadian data captured on the T3010 financial form that will soon be available to researchers on a broad scale. Similar to the Internal Revenue Service (IRS) Form 990, the Canada Revenue Agency (CRA) T3010 is an annual information filing required of every Canadian charity that meets certain requirements. However, several elements in the data are unique to the Canadian context, while others are similar to the Form 990 but must be interpreted with attention to differences in definition and accounting practice that might otherwise complicate attempts at cross-national comparisons. Once these elements and the data’s limitations are understood, however, the forthcoming datasets will allow rich analysis for researchers and practitioners in areas that are yet unexplored with large data sources.

What Constitutes a Competitive Environment? A Case Study of the FQHCs Industry In California

Objective: This study aims to identify competitive forces in the FQHCs environment using Porter’s Five Force model. Data Sources: The study utilized various secondary data sources. The Health Resources and Services Administration (HRSA) requires FQHCs to submit a performance report using the measures defined in the Uniform Data System (UDS). The UDS provides data such as the scope and volume of services provided by FQHCs, staffing, number of delivery sites, and finances. The UDS consider being a census of aggregate level health center data for FQHCs. Secondly, the American Hospital Association Annual Survey (AHA), which provides organizational details regarding hospitals. The third dataset is the Area Health Resources File (AHRF). It includes county-level data about health services volume, demographics, and health professional supply. The fourth dataset is the Internal Revenue Service (IRS) Form 990, which was used was used to calculate FQHCs’ total margin. The fifth dataset is the California Health and Human Services Open Data Portal (CHHS), which includes county-level data such as the number of Medicaid eligible populations and the number of primary care clinics. Finally, the study used the U.S. Department of Housing and Urban Development (HUD) United States Postal Service Zip Code Crosswalk Files. The Crosswalk Files was used to allocate both FQHC’s and FQHC’s sites Zip-Codes to counties. Method: this was a descriptive study. Descriptive statistics included frequencies and percentages to describe categorical variables. In addition, means (standard deviations, SD) will describe continuous variables. The study utilized bivariate analysis, including the chi-square test and ANOVA test, to find differences regarding the competitive forces variables among counties that had a new established FQHCs and counties that did not have newly established FQHCs in California for the years 2014 and 2015. Result: the study found that the number of FQHCs sites and primary care clinics in a county is statistically different between counties that had a newly established FQHC compared to counties that did not have a newly established FQHC. Counties that had newly established FQHCs had on an average a lower number of FQHCs sites and primary care clinics. Competition for FQHCs might arise when more FQHCs exist in a market. More research can be conducted to understand how FQHCs behave in a competitive environment.

State Regulation and Hospital Community Benefit Spending in Medicaid Expansion States.

Previous studies show that nonprofit hospital spending on charity care declined in Medicaid expansion states. We test whether state community benefit regulations mitigated the decline in charity care spending. We use a fixed effects model to evaluate the association between state regulations and nonprofit hospital community benefit spending and its subcategories as a share of total expenses in Medicaid expansion states. We obtained community benefit spending data from the Internal Revenue Service Form 990 Schedule H filings of 1,738 hospitals in 44 states and the District of Columbia from 2010 to 2017. We determine the stringency of state regulations by comparing the provisions of state and federal requirements based on regulation information compiled by the Hilltop Institute. State minimum community benefit requirements are associated with increased community benefit and charity care spending by nonprofit hospitals in Medicaid expansion states. States that imposed minimum community benefit requirements on nonprofit hospitals did not experience a decline in charity care spending after Medicaid expansion. The results suggest state minimum community benefit rules may expand the provision of community benefit and charitable care spending.

The Impact of Medicaid Expansion on the Self-Sustainability of Federally Qualified Health Centers

Federally Qualified Health Centers (FQHCs) have been struggling to diversify their revenue sources to reduce their reliance on government grant funding. States’ decisions to expand Medicaid would make most low-income uninsured people eligible for Medicaid coverage and could help FQHCs increase their financial viability by reducing their grant to total revenue ratio. We extracted a national sample of 729 FQHCs from the Uniform Data System and the Internal Revenue Service Form 990 in 2009-2018. The dependent variable was the grant to revenue ratio and the independent variable was the states’ Medicaid expansion status. Mixed-effects regression was applied controlling for organizational, patient, and community factors. FQHCs operating in Medicaid expansion states had lower grant ratios (ß=-4.51, p<.01). As the past decade’s funding volatilities have shown, overreliance on one revenue source can be risky. Medicaid expansion can help FQHCs improve their short-term and long-term sustainability.

How Do Government Grants Affect Nonprofit Financial Effectiveness? The Mediation Role of Process Accountability

This study examines the role of process accountability in the association between government grants and nonprofit financial effectiveness. Using the Internal Revenue Service Form 990 from 2013 to 2017, our mediation analyses find that government grants make nonprofits accountable for their processes. However, process accountability can reduce nonprofit financial effectiveness and suppress the positive relationship between government grants and nonprofit financial effectiveness. We uncover the underlying mechanism by which government grants affect nonprofit financial efficacy and suggest that too much emphasis on process accountability may hamper the benefits of government support of nonprofit service provision and financial effectiveness.

Research Implications of Electronic Filing of Nonprofit Information: Lessons from the United States’ Internal Revenue Service Form 990 Series

Research Implications of Electronic Filing of Nonprofit Information: Lessons from the United States’ Internal Revenue Service Form 990 Series

Estimated Revenue of the Nonprofit Homeless Shelter Industry in the United States: Implications for a More Comprehensive Approach to Unmet Shelter Demand

ABSTRACT This study merged data from the 2015 Housing Inventory Count, a list of temporary housing programs serving homeless persons nationally, and the Internal Revenue Service Form 990 tax filings for nonprofit organizations that same year. Matching records were used to develop estimates of various organizational measures per bed, adjusting for outliers, including revenues by source, expenditures by type, number of employees, employee compensation, and number of volunteers. Average values of these measures per bed by program type and by target population were extrapolated to the overall inventory to generate sector-wide estimates. Based on various measures of central tendency and after addressing outliers, a best guess of total revenues for nonprofit temporary housing providers is estimated at approximately $8.5 billion in 2015. As many as 160,000 people are employed by nonprofit shelters, or 0.4 persons per bed, with average annual compensation of approximately $24,000. Universal bed coverage for unsheltered persons is estimated to cost an additional $3.3–$4.5 billion annually.

Does Mandatory Disclosure Matter? The Case of Nonprofit Fundraising

Do donors seek out potentially adverse information about organizations making fundraising appeals? Do they react when it is readily available? Do they draw negative inferences when critical information is not available? To answer these questions, we consider previously unexamined large-scale natural experiments involving U.S. charitable organizations—tax-exempt organizations that file Internal Revenue Service (IRS) Form 990. Using standard difference-in-differences designs, we find that donors penalize organizations with high fundraising costs when there is mandatory disclosure or involuntary disclosure by a third-party reporter. Organizations with lower fundraising costs fundraise more successfully in the presence of these disclosures. The contrast with donors’ behavior when such information is not available suggests that donors do not draw correct inferences when potentially consequential information is not disclosed. Disclose-on-request requirements, in contrast, apparently do not have any significant impact on donors’ or organizations’ behavior. We then sketch implications for the regulation of donations to charities and their modern cousins, such as crowdfunding and social enterprise organizations.

A multilevel mixed-effects regression analysis of the association between hospital, community and state regulatory factors, and family income eligibility limits for free and discounted care among U.S. not-for-profit, 501(c)(3), hospitals, 2010 to 2017

BackgroundNot-for-profit hospitals are facing an uncertain financial future, especially following the COVID-19 pandemic. Nevertheless, they are legally obligated to provide free and discounted health care services to communities. This study investigates the hospital, community, and state regulatory factors and whether these factors are associated with family income eligibility levels for free and discounted care.MethodsData were sourced from Internal Revenue Service Form 990, several data files from the Centers for Medicare and Medicaid, demographic and community factors from the Census Bureau, supplemental files from The Hilltop Institute, Community Benefit Insight, and Kaiser Family Foundation. The study employs multilevel mixed-effects linear and ordered logit regressions to estimate the association between the hospital, community, state policies, and the hospital’s family income eligibility limit for free and discounted care.ResultsA plurality of hospitals (49.96%) offered a medium level of family income eligibility limit (160–200% of the federal poverty level (FPL)) for free care. In comparison, about 53% (52.94%) offered a low level (0–300 of FPL) eligibility limit for discounted care. Holding all else equal, hospitals designated as critical access, safety net, those in rural areas or located in disadvantaged areas were associated with an increased probability of offering low eligibility limits for free and discounted care. Hospitals in a joint venture, located in highly concentrated markets or states with minimum community benefits requirements, were associated with an increased probability of offering high eligibility limits.ConclusionState and community factors appear to be associated with the eligibility level for free and discounted care. Hospitals serving low-income or rural communities seem to offer the least relief. The federal and state policymakers might need to consider relief to these hospitals with a requirement for them to provide a specific set of minimum community benefits.

The impact of Maryland's payment reforms on hospital community benefit efforts.

In 2014, Maryland established a global budget policy for all hospitals in the state. Under this policy, hospitals are incentivized to not only provide clinical care services to individual patients but also address the health needs of their broader patient population through prevention efforts and investment in the upstream social and economic factors that determine health. To better understand the incentives created for hospitals under this policy, our study assessed whether the implementation of global budgets changed the levels and patterns of Maryland hospitals' investments in community benefits. Data on hospital community benefit spending from the Internal Revenue Service Form 990 Schedule H for the years 2010-2016 were utilized for this study. We found that Maryland hospitals' total spending on community benefits decreased under the global budget policy. Unlike hospitals in similar states without a global budget policy, Maryland hospitals did not experience any increases in Medicaid shortfalls between 2014 and 2016. Although Maryland hospitals provided more subsidized health services, their investment in broader community health improvement activities remained unchanged. Our analysis suggests that Maryland hospitals have shifted strategies because of the implementation of the global budget policy. The ability to report community benefit in a way that accurately considers the context and constraints of a state's policies would provide hospitals better means of communicating these efforts to stakeholders. Our results suggest that global budgets impact the levels and patterns of hospitals' community benefit investments.

Disclosures in Equity

While one might expect that the nonprofit sector is an equitable space where generosity and social justice are the norms, the sector suffers from funding inequalities. Despite corporations’ and private foundations’ pledges to fund nonprofit organizations that are led by members of, or that serve, communities of color, there are racial disparities in nonprofit funding. Research reveals that in comparison to White-led nonprofit organizations, organizations led by or serving communities of color are chronically underfunded. These disparities in funding mean that organizations that serve communities of color are more likely to go defunct or lack resources. Increased funding for minority-led or serving organizations can have a profound positive impact on the criminal justice system, healthcare, environmental justice, housing, labor, and employment. Indeed, it would be difficult to fight mass incarceration without the work of nonprofit charities like Bryan Stevenson’s preeminent organization, Equal Justice Initiative. This Article proposes two novel remedies to address this issue. The first is for charities to publicly disclose their institutional donors in Schedule B of Internal Revenue Service (“IRS”) Form 990. The second is for IRS Form 990 to include information on the race and ethnicity of top managers, directors, and the communities an organization serves. Mandating these disclosures would allow the public to assess whether pledges to support racial justice come with funding rather than empty promises. While the Supreme Court’s recent case, Americans for Prosperity Foundation v. Bonta (“AFPF”) struck down California’s donor disclosure requirements, this Article makes an important distinction between individual and institutional donors that the AFPF case ignores. As the disclosures would only apply to institutional donors and would include an opt out provision for controversial organizations, they would protect the right to freedom of association while promoting transparency in nonprofit funding and racial justice. By using mandatory disclosures to address racial inequities in not-for-profit law, the nonprofit sector might finally contend with persistent racial disparities in funding that leave communities of color underserved.

How Do Payment Reforms Affect Hospitals’ Community Benefit Decisions?

In 2014, Maryland established a global budget policy, setting limits on hospitals’ spending and regulating reimbursement amounts. This study assesses whether the implementation of the policy changed the nature of hospitals’ community benefit activities. Using data from the Internal Revenue Service Form 990 Schedule H, we compared the community benefit trends of Maryland hospitals with those of a state control group and found some key differences. Maryland hospitals increased their spending on clinical services but not on broader community health improvement. Payment reform does have the potential to affect hospital investments to improve health, but more focused policies may be required for greater hospital involvement in nonmedical drivers of health.

Association of State Medicaid Expansion With Hospital Community Benefit Spending

Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities. To examine changes in nonprofit hospital spending on community benefit activities after Medicaid expansion. This cohort study used difference-in-differences analysis of 1666 US nonprofit hospitals that filed Internal Revenue Service Form 990 Schedule H detailing their community benefit expenditures between 2011 and 2017. The analysis was conducted from February to September 2019. State Medicaid expansion between 2011 and 2017. Percentage of hospital operating expenditures attributable to charity care and subsidized care, bad debt (ie, unreimbursed spending for care of patients who did not apply for charity care), unreimbursed Medicaid spending, noncare direct community spending, and total community benefit spending. Of 1478 hospitals in the sample in 2011, nearly half (653 [44.2%]) were small hospitals with fewer than 100 beds, and nearly 70% of hospitals (1023 [69.2%]) were in urban areas. Among the 1666 nonprofit hospitals, Medicaid expansion was associated with a decrease in spending on charity care and subsidized care (-0.68 [95% CI, -0.99 to -0.37] percentage points from a baseline mean [SD] of 3.6% [4.0%] of total hospital expenditures; P < .001) and in bad debt (-0.17 [95% CI, -0.32 to -0.01] percentage points). There was an increase in unreimbursed spending attributable to caring for Medicaid patients (0.85 [95% CI, 0.60 to 1.10] percentage points; P = .04), which canceled out uncompensated care savings from the expansion. Noncare direct community expenditures decreased overall (-0.24 [95% CI, -0.48 to 0.00] percentage points; P = .049). Direct community expenditures remained more stable in small hospitals (-0.07 [95% CI, -0.20 to 0.05] percentage points; P =.26) compared with large hospitals (-0.37 [95% CI, -0.86 to 0.12] percentage points; P = .14) and in nonurban hospitals (0.02 [95% CI, -0.09 to 0.14] percentage points; P = .70) compared with urban hospitals (-0.36 [95% CI, -0.73 to 0.01] percentage points; P = .06). In this study, Medicaid expansion was associated with a decrease in nonprofit hospitals' burden of providing uncompensated care, but this financial relief was not redirected toward spending on other community benefits.

Transnational Nonprofits’ Social Media Use: A Survey of Communications Professionals and an Analysis of Organizational Characteristics

In response to rapid changes in the communication environment, nonprofits are increasingly relying on digital technologies to achieve their communication goals. We examine factors influencing nonprofits’ digital-based external communication based on a survey of communications directors at transnational nonprofits, with an analysis of each organization’s characteristics as described on its Internal Revenue Service (IRS) Form 990 and website. Our results show that, at the organizational level, nonprofits with stronger leadership support concerning social media activities were more likely to use different digital platforms and value more various functions of social media for external communication as compared with those lacking such support. At the individual level, communications directors’ perceived ease of social media use and time in their current position significantly influenced their emphasis on different functions of social media. This research fills a gap in the literature by analyzing both organizational characteristics and individual communications director’s attributes in assessing nonprofits’ social media use.