INNOVATIONS IN TAX-EXEMPT INSTRUMENTS AND TRANSACTIONS

This chapter examines the Internal Revenue Code’s treatment of religious entities. The federal tax statute embodies three diverse approaches to taxing and exempting sectarian organizations and activities. Some provisions of the Code—the charitable deduction, the general income tax exemption for eleemosynary institutions, the federal unemployment tax—exempt religious entities and other charitable, educational, and philanthropic institutions. Other provisions of the Code narrowly target churches for tax exemption. For example, the Code relieves churches of filing requirements with which nonchurch religious entities and other eleemosynary organizations must comply. Similarly, churches’ retirement plans receive lenient treatment under the Code. Churches receive procedural protections from IRS audits.Yet other provisions of the Code tax churches as for secular entities. Churches generally pay FICA taxes—Social Security and Medicare payroll taxes—on the compensation paid to nonclerical employees. These payroll taxes can be considerable. Churches also pay federal income taxes on their unrelated business incomes.

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The Conversion Conundrum: The State and Federal Response to Hospitals’ Changes in Charitable Status

American Journal of Law & Medicine ◽

10.1017/s0098858800010716 ◽

1997 ◽

Vol 23 (2-3) ◽

pp. 221-250

Author(s):

Lawrence E. Singer

Keyword(s):

Joint Venture ◽

Low Cost ◽

State Level ◽

The State ◽

Nonprofit Hospitals ◽

For Profit ◽

Tax Exempt ◽

Federal Response ◽

Profit Status ◽

Hospital Conversions

The pressures encountered by hospitals in the current era of reimbursement declines and stiffened competition are well known. As the “ultimate” payors—primarily employers and government—aggressively continue to seek low cost care, the response of the hospital industry has been to move toward consolidation and efficiency-enhancing mechanisms.Increasingly, nonprofit, tax-exempt hospitals have come to believe that they are at a significant disadvantage vis-á-vis their for-profit brethren in their ability to attract the capital needed to compete in the market. A growing trend among nonprofit hospitals, therefore, is to sell to or enter into a joint venture with a proprietary organization, or alternatively to convert to for-profit status. In 1995, fifty-eight nonprofit hospitals became for-profit; hospital conversions to for-profit status in 1996 are projected to outstrip the pace established the prior year.The conversion trend has not gone unnoticed at the state level. Recently, several states have proposed or enacted laws regulating sales and conversions of nonprofit hospitals, and many more states are contemplating such legislation.

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