"Many decisions are made for what is going to maximize profits for the private equity company, rather than what is best for the patient, what is best for the community.". Furthermore, some nonprofit hospitals also spend money on marketing, because they recognize that they have to compete in the marketplace, regardless of their nonprofit status. Figures are based on CMS cost report data analyzed by American Hospital Directory. Baptist Medical Center, Jackson's other nonprofit hospital, does sue patients. Although we have grown to a 247-bed hospital to meet the needs of the community today, the buildings and grounds are still owned by the citizens of Iredell County and all revenue is reinvested in medical technology and staff. Surprise emergency care medical bills have also emerged as a problem at private equity-run Envision. Representatives of every firm identified in this article declined to respond to broad criticisms of private equity in the health care arena. A non-profit hospital is a hospital that does not make profits for owners of the hospital from the funds collected for patient services. Last fall, United Healthcare, the giant insurer, canceled coverage at 500 hospitals with TeamHealth-run emergency rooms, largely because of high costs, a company spokeswoman said. ", Download the NBC News app for breaking news and politics. A class-action case involving a patient in California has a final settlement hearing scheduled for June. Fast Facts on U.S. A nonprofit organization is not "owned" by the people who start it, nor their successors in leadership. Do the activities performed by nonprofit hospitals that are exempt from paying taxes because of their nonprofit status, truly qualify as charitable activities that provide a broad public benefit & are consistent with exempt purposes? Generally, a nonprofit cannot be sold to another individual or organization. For example, if your hospital system owns an urgent care center, any care you received there may not be covered by the hospital system's FAP. As such, the hospital will have a board of trustees on whose shoulders the final say and ultimate responsibility will lie. "They're not going to do a single thing that doesn't benefit them first and foremost. for-profit hospitals has declined by half 1 Investor-owned for-profit corporations are . In 2019, there were around 5,141 community hospitals in the United States. In 2016, the country's for-profit hospital trade association, the Washington, DC-based Federation of American Hospitals, represented a dozen health systems that owned about 635 hospitals. Conflicting theories of the nonprofit firm have existed for several decades yet empirical research has not resolved these debates, partly because the theories are not easily testable but also because empirical research generally considers ... Found inside – Page 158We welcome the opportunity to serve as spokesmen along with Mr. Dunn , for the affected voluntary nonprofit hospitals as well as the publicly owned institutions in our State . In Iowa , there are 67 hospitals licensed by the State as ... What are the Duties of Nonprofit Directors? Found inside – Page 295In short , Mr. Chairman , hospitals , including nonprofit hospitals , are , today , big business . They are engaged in interstate commerce ... Colleges and universities privately owned and operated ; Second . Radio stations operated by ... For-profit hospitals don't get these tax benefits. The American health care system is undergoing a rapid socioeconomic revolution. What are nonprofit minutes? Gretchen Morgenson is the senior financial reporter for the NBC News Investigative Unit. Private equity's laser focus on cost cutting and operational efficiencies can benefit consumers, economists say, if lower costs are passed on to end users. OhioHealth has been recognized as one of the top five large health systems in America by IBM Watson Health™, an honor we have received six times. Found inside – Page 281Other Financial Relationships The Director has been an executive officer or an employee , or a family member has been an executive officer , of a company that receives payments from , or makes payments to , the organization for ... IE 11 is not supported. Looking at data from 2000 to 2017 from over 18,000 nursing homes, the academics found "robust evidence of declines in patient health and compliance with care standards" after private equity concerns bought facilities. The largest portion of these hospitals were non-profit, while . "We should not be running our health care system as a profit-making operation on steroids," said Eileen Appelbaum, an authority on private equity and co-director of the Center for Economic and Policy Research, a left-leaning think tank in Washington, D.C. "Health care is not so much anymore about taking care of patients. The 10 most profitable for profit hospitals in America provide top-notch healthcare to a wide array of patients, especially in urban areas, as well as substantial returns to their shareholders . United Healthcare provided NBC News with examples of TeamHealth costs far exceeding median charges for specific emergency department procedures. As one might expect, nonprofit hospitals on average provide more uncompensated care than for-profit hospitals do. A nonprofit organization is not "owned" by the people who start it, nor their successors in leadership. Aliese Polk, a spokeswoman for Envision, said the company is experiencing the same financial problems that many other health care providers are and is "focused on fighting the COVID-19 pandemic, deploying significant resources to front-line clinicians caring for sick patients." But they've always been hybrids—part social-welfare organization, part business. Nonprofit hospitals, viewed as charities by the IRS (assuming they comply with guidelines governing nonprofits, like providing certain benefits to the community), don’t pay federal income or state and local property taxes. Anybody that needed ICU care, we didn't have one, we couldn't keep you. During the 1900s, most hospitals were owned either by nonprofit entities with religious affiliations or by states and cities, with ties to medical schools. Nonprofit hospitals pay virtually no local, state or federal income tax. Doctor Patient Unity funded a $28 million media blitz against the bill, the report said, which didn't pass. Envision Healthcare is a physician staffing, emergency medicine and billing services company bought for almost $10 billion by KKR in 2018. Sprague said she is proud to serve patients in the same hospital where her grandmother was a nurse. Across the southeast, we're here for you. One example: the use of so-called physician extenders, like nurse practitioners, to see patients instead of actual doctors. Com-munity hospitals can be private nonprofit (3,175, or almost 60 percent of all community hospitals in 1991), private for-profit (738 in 1991), or owned by state and local governments (1,429 in 1991) (6) (table 8-2). Under typical medical industry practice, Lin's case would have been subject to peer review, experts said. Additionally, the assets acquired by a nonprofit usually were acquired with the understanding that they will be used to further the mission of that organization. The patient recovered. And while they don’t own the nonprofit, they do have significant legal and ethical duties that cannot be delegated to others. Cullinane Law Group | Legal Counsel for Nonprofits + Associations | Austin Texas. He required intubation — the insertion of a breathing tube down his throat — but the doctor was unable to perform the procedure and had to call in local paramedics for help. Hospitals, 2021. Number of hospitals in the U.S. 2010-2019, by ownership. Make a Donation. The TeamHealth spokesman didn't respond to a question from NBC News about why it sued patients. In response to the laws, private equity firms have structured their health care investments with physicians as owners, but in name only, McNamara said. INTEGRIS Health is Transforming. Currently, Connecticut has 28 nonprofit hospitals and one for-profit (Sharon Hospital, which became for-profit before the current restriction was created). Geithner is now president of Warburg Pincus, which owns Modernizing Medicine. Most of those who head major private equity firms are reported to be billionaires, like the two men atop Blackstone: Stephen Schwarzman, a close adviser to President Donald Trump, and Hamilton "Tony" James, a major donor to Democrats. View history of Beacon Health System (PDF) Headquartered in South Bend, Indiana, with 20 specialized partners and over 7,000 associates throughout the region, Beacon connects you with the care you . In keeping with their charitable purpose and community focus, nonprofit hospitals are often affiliated with a particular religious denomination. Henderson Hospital is owned and operated by a subsidiary of Universal Health Services, Inc. (UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation.. Ownership is the major difference between a for-profit business and a nonprofit organization. Can nonprofit hospitals be bought and sold? Corporate Compliance. . Once incorporated, the newly created nonprofit organization is a separate legal entity from its incorporators, directors, officers, and employees. The government in most cases should own the hospitals as …. Copyright © 2021 The George Washington University, Learn More About the Healthcare MBA Program at GW, How Hospital Management Affects Patient Care, George Washington University Healthcare MBA Program, http://www.modernhealthcare.com/article/20121215/SUPPLEMENT/312159997, http://in-training.org/profit-non-profit-hospitals-differences-7352, http://health.usnews.com/best-hospitals/rankings. A patient visiting an emergency department with chest pains, for example, would face a median charge of $340, United Healthcare said, versus a TeamHealth bill for $976. Investor-owned hospitals also tend to provide a narrower range of services, sending patients with complex needs to nonprofit systems that have the facilities to handle their care. As a nonprofit organization, it also receives a tax break. We are a locally owned, not-for-profit health system with medical teams and hospitals caring for our neighbors right here in Indiana and Michigan. Join our list to get helpful tips for nonprofits and social enterprises. ChristianaCare is a nonprofit teaching health system with more than 260 residents and fellows. Northwest Specialty Hospital is proudly owned and operated by a team of local physicians. No one person or group of people can own a nonprofit organization. To finance the purchases, private equity owners typically load the companies they buy with debt. But in the years leading up to COVID-19, the laws were rarely enforced. Dan W. Brock and Allen Buchanan . Translate. The nonprofit corporation generally owns assets of the business and is entitled to receive the revenue from its operation. A unit of Envision is a defendant in three of the cases. And to private equity, that's like putting dollar bills on a shelf. She helps nonprofits, foundations, and trade associations that seek to create positive change. Assessing the impact of private equity on the overall quality of care has been difficult, in part because ownership by the firms is relatively new. Within a general environment of heightening competition, the number of investor-owned for-profit hospitals has more than doubled in the past 10 years, while the number of independent proprietary. Found inside – Page 9selectively with hospitals (Gruber (1994)). Prior to 1987, California's CON regulation affected both hospital entry and hospital size. Ownership The data we use classifies hospitals into four categories based on ownership: nonprofit, ... It suspended intensive care unit admissions at Nashoba Valley Medical Center, a hospital in rural northeastern Massachusetts, and redeployed equipment and staff elsewhere to meet COVID-19 demand, according to a memo from the president of the facility. Nonprofit hospitals may qualify for favored tax treatment under federal--as well as a variety of state and local income . hospital's patients are admitted to units where the average length of stay is less than 30 days. Note: The hospital total patient revenues reported here are reported to CMS by the hospitals in their most recent cost reports and, in some cases, may include patient revenue . October 30, 2018; Becker's Hospital Review Beginning on January 1, according to The Nonprofit Times, MaineHealth will become a single nonprofit entity and will have nearly 19,000 employees and over $3 billion in annual revenue.Hospitals that make up MaineHealth join a long list of independent hospitals around the nation merging with other entities to form large . Because we are a nonprofit hospital, our focus is on promoting health and wellness in our community, not on the bottom line. Found inside – Page 129The model also tests whether operating margins differ by the interaction of hospital ownership and market type, holding all else equal. The results confirm that nonprofit hospitals in high for-profit markets are more likely to offer ... Since July 1997, The George Washington University Hospital has been jointly owned and operated by a partnership between George Washington University and a subsidiary of Universal Health Services Inc. (UHS), a King of Prussia, PA-based company that is one of the nation's largest healthcare management companies. Complete the form to download the brochure. Here are the 50 largest non-profit hospitals in America, listed by number of beds. Let's be clear about one thing. Frustrated by their response, Lin took to social media, criticizing the hospital's operations in a series of posts. She said that the facility had previously been owned by a private company but that patient safety and staff treatment had worsened since Steward took over. Other funding types for hospitals include public hospitals and for-profit hospitals. Doctor Patient Unity didn't respond to an email seeking comment. Nonprofit Law Basics: Who Owns a Nonprofit? Again, this the duties of boards of directors are set out by each state. In a press release, Anderson indicated that "the system is broken when nonprofit hospitals are . Found inside – Page 3Many nonprofit medical centers have three-tiered nonprofit programs including educational, medical treatment, and research. But hospitals are far from the only medical-related nonprofit organizations. Most medical associations like the ... No one owns a nonprofit corporation. Before the acquisition, Envision acknowledged in a 2014 securities filing that its contracts with physician groups might run afoul of laws barring the corporate practice of medicine, as well as fee-sharing arrangements between doctors and companies. It's about doing everything in our power to keep our friends . But nonprofit organizations do not have private owners and they do not issue stock or pay dividends. Whether publicly traded or owned by private . Many nonprofits are managed by boards, others may be managed by voting members, some are managed by a combination of those. Number of hospitals in the U.S. 2010-2019, by ownership. A Voluntary hospital typically functions under the auspices of a particular religion or other non-profit body. She had a hard time getting help from Community Health Systems Inc., the for . They are owned, directly or indirectly, by the tax-exempt nonprofit parent organization. Can the Executive Director Serve on the Board of Directors? She provides risk management and offers practical solutions for sound governance. Cullinane Law Group: What are the Duties of Nonprofit Directors? In general, employing three extenders equals the cost of one physician, said Robert McNamara, professor and chairman of emergency medicine at Temple University and chief medical officer of Temple Faculty Physicians. Found inside – Page 43California hospitals, there was some evidence of an increase in price for for-profit hospitals, some evidence of an ... The more specific question that I wish to address today is whether the form of hospital ownership — nonprofit or ... Referring to the American Academy of Emergency Medicine, Lee said the company has prevailed while facing judicial scrutiny "initiated or funded by AAEM, where Dr. McNamara has made identical charges.". As the nonprofit grows, the board may begin hiring staff members to develop and lead programs as the board and/or voting members continue to oversee the organization. Warburg Pincus, overseen by former Treasury Secretary Timothy Geithner, owns Modernizing Medicine, an information technology company that helps health care providers ramp up profits through medical billing and, to a lesser degree, debt collections. Often times the founder will serve on the initial board of directors, which manages the nonprofit. Abstract: Roughly one half of hospitals in the U.S. are in rural areas, yet researchers have largely studied the effects of hospital ownership in the urban context. Non-Profit: For-profit organizations are owned by private individuals and are allowed to generate profits for shareholders. Non-profit Ascension Health in St. Louis increased their net assets by 1,211 percent in one year. That was true at some hospitals owned by major systems including Sanford Health and Yale New Haven Health System. As for PeaceHealth St. Joseph Medical Center, spokeswoman Bev Mayhew said it removed Ming Lin from the emergency department rotation because "his actions were disruptive, compromised collaboration in the midst of a crisis and contributed to the creation of fear and anxiety among staff and the community." When a private staffing firm teams up with a hospital, the right to due process can disappear. But none of these individuals or groups have any ownership rights in the organization. Whether a hospital is nonprofit or for-profit should be of interest to its staff and to the community it serves, so that they can understand how the hospital operates and allocates resources. hospital's patients are admitted to units where the average length of stay is less than 30 days. Nonprofit Hospitals Usually nonprofit hospitals are structured in health systems, with a parent organization, a subsidiary to operate the hospital, a subsidiary foundation, and other subsidiaries to operate other providers. What to Consider Before Starting a Nonprofit. The American Medical Association recently reported that 2018 was the first year in which more physicians were employees — 47.4 percent — than owners of their practices — 45.9 percent. TeamHealth is charging six times, he said. As a point of reference, the most highly compensated executive in the for . What Should Be Included in a Nonprofit Annual Report? The data below, from the 2019 AHA Annual Survey, are a sample of what you will find in AHA Hospital Statistics, 2021 edition.The definitive source for aggregate hospital data and trend analysis, AHA Hospital Statistics includes current and historical data on . Carrying $7.5 billion in debt, the company recently hired restructuring advisers and may file for bankruptcy. The information on this website is provided as general health guidelines and may not be applicable to your particular health condition. Of the nation's 4,840 non-federal, general hospitals, 2,849 are nonprofit, 1,035 are for-profit and 956 are owned by state or local governments, according to the American Hospital Association. Nonprofit hospitals are . First, health care drives a huge part of the nation's economic output — almost 20 percent of gross domestic product. It’s important for patients and administrators alike to understand that there is no indication of any difference in the environment, operational efficiency, or standard of care between nonprofit and for-profit hospitals. Found inside – Page 6359In general , however , nonprofit hospitals ranked higher than chain - operated for - profit hospitals in the ... The introduction of public stock corporation ownership of hospitals has brought new sources of capital into the hospital ... Private equity-owned firms also use practitioners with less experience or training to save money, say doctors associated with the American College of Emergency Physicians and the American Academy of Emergency Medicine. Finally, some medical professionals say, private equity's growing involvement in health care in recent years has contributed to shortages of ventilators, masks and other equipment needed to combat COVID-19, because keeping such goods on hand costs money. Found insideGreening Health Care examines the intersections of health care and environmental health, both in terms of traditional failures and the revolution underway to fix them. This is a key question because those who hold the power to select board members retain the ultimate authority over the corporation. The Key To Saving Your Hospital It is continually ranked by U.S. News & World Report as a Best Hospital. Ever on the hunt for efficiencies, private equity has brought changes to traditional health care practices, experts say. While for-profit hospitals tend to get dinged by the public for being bottom-line-driven or owned by big, faceless corporations or investor groups, nonprofit hospitals aren't simply owned by an . Most of Canada's approximately 850 hospitals are owned and operated by non-profit, voluntary organizations. For the total nonprofit sector, healthcare accounts for 60% of the revenue and expenses generated, 42% of the total assets, and employ s 57% of all nonprofit jobs (Anheier 2014). As a non-profit hospital, CHOC treats over 150,000 children annually, regardless of their ability to pay. A major misconception about nonprofit organizations concerns ownership of a nonprofit. These stories force us to reconsider what happens when the medical system does us harm. The average net asset growth over the last year was 23.6 percent. McHenry Lee, TeamHealth's spokesman, said the company's "organizational structure is fully compliant with long established laws and precedents." In 2019, there were around 5,141 community hospitals in the United States. About. Can the Executive Director Serve on the Board? OhioHealth is a nationally recognized, not-for-profit, charitable, healthcare outreach of the United Methodist Church. As a point of reference, the most highly compensated executive in the for . Found inside – Page 239Mr. Ihm . I also serve as administrator of Skiff Memorial Hospital in Newton , Iowa , a city - owned institution of 125 ... for those voluntary nonprofit hospitals affected , as well as the publically owned institutions in our State . The hospitals investigated in the report had combined net assets of $203.1 billion. Leadership. Lin's case was never heard. But medicine isn't always about caring for the sick. Found inside – Page 1229Also , nonprofit hospitals usually have provided a somewhat higher percentage of their care to charity patients than ... Tosterud , who owns Northwest Medical Laboratories of Portland , has challenged the tax exemptions of the medical ... Many times, when a nonprofit first begins operating, the board members, along with the founder(s), may perform many of the tasks of the organization. Some argue, however, that investments in new technologies might be just as wasteful for hospitals that serve low-income communities, as patients likely would not be able to afford the more advanced (and more expensive) treatment they offer. Its headquarters are located in the China Basin Landing building in San Francisco. "This is particularly evident with private equity-backed physician staffing companies like TeamHealth.". Some people believe that " no one owns a nonprofit corporation," because nonprofits are owned by something nebulous called "the community at large" or a religious order. What is a 990. The board safeguards the public’s interest to ensure that the organization operates in accordance with its mission and the purpose for which it was granted tax-exempt status and protects the assets of the nonprofit. Our mission is to provide world-class healthcare - every time, every touch - to each person in every community we have the privilege to serve. Nonprofit hospitals are . In that same study, the majority of 3,000 health systems profiled lost . Learn more about directors’ duties. Full coverage of the coronavirus outbreak, Mark Reiter is residency program director of emergency medicine for the University of Tennessee and past president of American Academy of Emergency Medicine, an advocacy group for practitioners. Small nonprofit or city-owned hospitals seem like public assets, like roads or a sewer system. He had worked at PeaceHealth for 17 years. Found inside – Page 165The Federation of American Hospitals is a national non - profit association representing nearly 600 investor - owned ( proprietary ) hospitals through its members and affiliated state organizations . Our member hospitals range from ... Cerberus Capital Management, a $42 billion investment firm run by Steve Feinberg, owns Steward Health Care; it runs 35 hospitals and a swath of urgent care facilities in 11 states. Found inside – Page 5VHA represents about 28 percent of the nation's community-owned, nonprofit hospitals. In 2006, CHA and VHA jointly released a set of detailed community benefit guidelines—A Guide for Planning and Reporting Community Benefit.18 HFMA ... Some nonprofit hospitals are finding other ways to improve their finances, like the joint venture launched in 2011 between Ascension, the United States’ largest network of Catholic hospitals, and the private equity firm, Oak Hill Capital Partners. While for-profit hospitals have traditionally been located in southern states, the economic collapse of the early 2000s catalyzed the acquisition of nonprofit hospitals by for-profit companies. Non-profit hospitals are required to provide community benefits that include charity care, community health improvement efforts, medical training and research and the assessment of community . Over the past 20 years, demand for acute care hospital services has declined more rapidly than has hospital capacity. The doctrine and the laws hold that only individual physicians should be licensed to practice medicine, not corporations. We are a family of 35,000 associates, physicians and volunteers, and a network . About Riverview Health. The largest portion of these hospitals were non-profit, while . The founder usually does not own the nonprofit. This was the average. Private equity firms are buying up hospitals, nursing homes and ER operations. For more than a century, company ownership of doctors' practices was barred under the Corporate Practice of Medicine doctrine, which was enshrined in most state laws. In March, as the coronavirus gripped the nation, veteran emergency room doctor Ming Lin was growing concerned. Representatives from TeamHealth and Envision accused insurance companies of causing problems for patients seeking emergency care and said they didn't support the legislation because it would have benefited insurers at the expense of patients. Hospitals, 2021. Over the past decade, private equity firms like Blackstone, Apollo Global Management, The Carlyle Group, KKR & Co. and Warburg Pincus have deployed more than $340 billion to buy health care-related operations around the world. Dr. David Himmelstein, the co-founder of an organization that advocates a universal, single-payer health system in the U.S, argues that these are wasteful expenditures that divert patient dollars from things like equipment and training that could improve quality of care. While a founder may feel closer to the organization that she helped to form, a founder usually has no ownership rights regarding the nonprofit corporation. Novant Health is a not-for-profit integrated system of 15 medical centers and more than 2,300 physicians in nearly 800 locations, as well as numerous outpatient surgery centers, medical plazas, rehabilitation programs, diagnostic imaging centers and community health outreach programs. 100% (1 rating) In most cases, if the private get more hospitals, it would cause the overcharging and exploitation of normal consumers. Hospitals aren't supposed to close such units without first notifying state authorities and holding community hearings. Found inside – Page 239Mr. Ihm . I also serve as administrator of Skiff Memorial Hospital in Newton , Iowa , a city - owned institution of 125 ... for those voluntary nonprofit hospitals affected , as well as the publically owned institutions in our State . That can be especially harmful in health care, in which patients' lives are on the line and it is difficult for consumers to comparison shop by analyzing quality of care. Data are for short term acute . PeaceHealth St. Joseph Medical Center in Bellingham, Wash. President Barack Obama pats outgoing Treasury Secretary Timothy Geithner on the back in January 2013. Days later, the hospital removed Lin from the rotation in the emergency department. For-profit hospitals existed, but it wasn't until recently that they became nearly ubiquitous. Both exist on lists of the best hospitals in the country, and among the worst. In Bai's and Anderson's study, 59% of the hospitals were nonprofit, 25% for-profit and 16% public. Cullinane Law Group: Can the Executive Director Serve on the Board? ", Grubb called Sprague's view a "baseless, selective, hyper-generalized claim.". Each state has particular rules regarding sale of assets of a charitable organization and you should check with your state. That the assets, investments and bank accounts at these but they & # x27 ; ve always hybrids—part. Be sold to another individual or organization with physicians ``, Grubb called 's! And a nonprofit teaching health system generally, a finance giant health and wellness in our to! Donations helps kids heal by a combination of those may feel closer to the negative income pressures by! Next to St. Dominic surprise emergency care medical bills have also emerged as a nonprofit under the of... Today, Envision 's business has collapsed, again a result of private equity has had on employees customers. Questions I ask when forming a new nonprofit corporation is how board members private owners and do... 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United healthcare provided NBC News cullinane Law Group: nonprofit corporation generally owns assets of the Best hospitals in same! Be licensed to practice medicine, which became for-profit before the COVID-19 crisis, private equity brought. At the facility, said the company 's `` organizational structure is compliant! Physician Group charges three to four times the founder will serve on the board trustees! And for doctors, who owns nonprofit hospitals she said range from small rural facilities to large urban suburban! Mollie 's work focuses on setting up and managing strong and legally compliant nonprofits have! Provincial legislation 95 % operate on a minor cut would be $ 200 at the facility, said the ``... To help tailor the curriculum to your particular health condition as well as a point of reference the. Local income emergency department procedures allocate more resources to advertising and Marketing may! 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Basics: do nonprofits File tax Returns carrying $ 7.5 billion in debt the! Happens when the medical system does us harm nonprofit community hospitals struggling reach... These individuals or groups have any ownership rights in the health care, owned by physicians nonprofit,. Hospital donations are more than 260 residents and fellows a typical emergency room McNamara. Vary substantially in voting members, some are managed by a combination those... Fully compliant with long established laws and precedents. hospital typically functions under the auspices a... 'S business has collapsed, again a result of private equity firms acquire nursing homes, the deal would 100... Precedents. but it was TeamHealth, a physician staffing, emergency medicine and billing services company bought for $! Practitioners, to see patients instead of actual doctors corporation Vs. 501 ( r ) ( 1.. 35,000 associates, physicians and volunteers, and among the nearly 3,000 nonprofit hospitals pay virtually no local, or.
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