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Topical Resource Lists

Health Conversion Foundations:
A Resource List

Conversions of traditional nonprofit hospital and health facilities to for-profit status have had a substantial impact on the field of health care delivery and on philanthropy. A number of new foundations have been created from the sale of nonprofit assets, and many of these are now among the largest philanthropies. Their grantmaking activities and policies are generating interest and concern in the sector.

This selected reading list contains citations to selected works from the Foundation Center's bibliographic database on the topic of health conversion foundations. Materials cited are journal articles and books. For a complete bibliography on this topic, use Catalog of Nonprofit Literature, entering the subject heading "health conversion foundations" in the subject search field box.

Bell, Judith E.; Harry M. Snyder; and Christine Tien. The Public Interest in Conversions of Nonprofit Health Charities. New York, NY: Milbank Memorial Fund, 1997. vi, 52 p.
Explains the market forces driving the transformation of health nonprofits; regulators' interests in health services that remain after conversions; valuation of a nonprofit's assets and who receives them; and missions of the newly-created foundations. Nine case studies are presented.

Building and Maintaining Strong Foundations: Creating Community Responsive Philanthropy in Nonprofit Conversions. San Francisco, CA: Consumers Union of U. S., Inc., 2004. 44 p.
The book is a primer offering guidance for the establishment of health conversion foundations when nonprofit hospitals change status to for-profit. More information is available through the publisher's Web site:

Cohen, Mary B. The Sale of Nonprofit Hospital Assets to For-Profit Corporations: Philanthropic Options for Community Decision Makers. Grand Haven, MI: Council of Michigan Foundations, 1996. 22 p.
Provides a concise overview of philanthropic options for hospital and community decision makers considering a change from nonprofit to for-profit status. Describes the types of philanthropic organizations; gives the pros and cons of each type; and gives examples of health care organizations that formed each type. Includes bibliographic references.

Connecting to Community and Building Accountability. Washington, DC: Grantmakers in Health, 2007. iii, 49 p.
Data presented is based on a 2006 survey completed by 104 health conversion foundations, and is a follow-up to the 2005 report, "The Business of Giving." Topics addressed include foundation structure and governance, community engagement, and succession planning. The appendix contains brief profiles of health conversion foundations identified by Grantmakers in Health. Survey reports from prior years are available from GIH's Web site (see publications area, "Tracking the Field"):

Conover, Christopher J.; Mark A. Hall; and Jan Ostermann. "The Impact of Blue Cross Conversions on Health Spending and the Uninsured." Health Affairs, vol. 24 (March-April 2005): p. 473-82.
The researchers sought to determine if there were significant increases in health care costs and coverage after a conversion of a nonprofit to a for-profit agency. Their methodology and study results are presented.

Corbett, Christopher. "Stewardship of Public Assets Under Nonprofit Conversion Models: New York's Empire Blue Cross Blue Shield Case Study." Nonprofit Management & Leadership, vol. 16 (Winter 2005): p. 153-69.
Report on the progress of the controversial conversion of Empire Blue Cross Blue Shield in New York from nonprofit to for-profit status. At issue are the disposition of assets and the formula devised by the state legislature, which are studied in this article.

DeLucia, Michael. "Creating New Health Care Foundations." Nonprofit and Voluntary Sector Quarterly, vol. 30 (March 2001) p. 130-6.
A status report on new health care foundations—those 122 foundations established from the conversion of health care institutions.

Fox, Charles D. IV; and Charlene Kelly. "Sales of Not-for-Profit Hospitals to For-Profit Corporations." Trusts & Estates, vol 137, (October 1998): p.38-46.
Examines the impact of the sales of nonprofit hospitals to for-profit entities.

Garigan, Margaret Health Conversion Foundations. Washington, DC: Georgetown University. Center for Public & Nonprofit Leadership, 2004. 33 p.
An analysis of the magnitude of the conversion trend and implications of the effects for the American health consumer.

Goddeeris, John H. and Burton A. Weisbrod. Conversion From Nonprofit to For-Profit Legal Status: Why Does It Happen and Should We Care? Evanston, IL: Northwestern University. Institute for Policy Research, 1997. 38 p.
Examines recent activity in health care conversions, options for the transfer of assets from a nonprofit to a for-profit, possible motives for such a conversion, and resulting public policy implications. With bibliographic references.

Health Affairs: Hospital and Health Plan Conversions. Milkwood, VA: Project HOPE, 1997. 270 p. (Special Issue of Health Affairs; No. 16:2).
Covers many topics concerning the conversion of nonprofit health care organizations to for-profit organizations. Articles give an overview, discuss the effects of state politics and policy making, and provide strategic and economic considerations of the issue. Includes perspectives from state attorneys general, hospitals, health maintenance organizations, and consumer advocates. Many articles include bibliographic references.

Isaacs, Stephen L.; Dennis F. Beatrice; and Willine Carr. "Health Care Conversion Foundations: A Status Report." Health Affairs, vol. 16 (November-December 1997): p. 228-36.
Discusses three major challenges to public policy raised by health care conversion foundations. Also includes a list of the twenty-five largest conversion foundations by asset amount and a list of conversion foundations.

Marchetti, Domenica. "Redefining Health Philanthropy." Chronicle of Philanthropy, vol. 9 (24 July 1997): p. 1, 12, 14-5.
As more foundations are created through the conversion of nonprofit health care institutions to for-profit status, a debate is growing about whether the new philanthropies should be required to devote themselves entirely to health care or be allowed to make grants to a diverse array of causes. Includes a list of health conversion foundations and their 1996 assets.

Marchetti, Domenica. "Rich New Health Funds Cause Reshuffling of Philanthropic Pecking Order." Chronicle of Philanthropy, vol. 9 (24 July 1997): p. 14.
At least seventy-nine foundations have been established through the sale of hospitals and the change to for-profit status of Blue Cross plans and other health-care organizations. With combined assets of $9.3 billion, those foundations are making their presence felt both locally and nationally.

New Foundations in Health: Six Stories. New York, NY: Milbank Memorial Fund, 1999. ix, 157 p.
Describes how six new health foundations were created, as well as how the foundations fit into the social and economic characteristics of their communities. In chronological order by year of conversion, the foundations profiled are: Sierra Health Foundation, The Colorado Trust, Jewish Healthcare Foundation, The California Wellness Foundation, Health Foundations of South Florida, and The Venice Foundation. Full text is available at:

Owen, John R., III. "Sale of Non-Profit Hospitals Creates New Benefits and New Risks." Fund Raising Management, vol. 28 (February 1998): p. 18, 37.
Provides a list of questions asked by state attorneys general and the Internal Revenue Service of those who are considering selling nonprofit hospital assets.

Rubin, Kyna. "Making the Most Out of Community Advisory Committees." GIH Inside Stories, (Winter 2007): p. 1-8.
Explores lessons learned from health conversion foundations that have established community advisory committees to understand needs at the grassroots level. The article examines the experience of the Missouri Foundation for Health.

Schwartz, James R. and Chester H. Horn, Jr. Health Care Alliances and Conversions: A Handbook for Nonprofit Directors and Trustees. San Francisco, CA: Jossey-Bass, 1999. 198 p.
A description of fiduciary responsibility related to hospital and health facility conversions. With numerous conversions of nonprofit hospital and health institutions to for-profit status, a board's early need is to determine whether a hospital can be converted at all. If the decision is made to convert, offers goals for planning the post-conversion charity (legal structure, creating a charitable spending plan, educating the community, and creating a management and investment structure for the proceeds). Details about the sale process are provided, but joint ventures are also discussed in depth.

Spotlight on Ohio's New Health Foundations. Cleveland, OH: Foundation Center-Cleveland, 2004.
This is a report providing vital information on 22 foundations in Ohio formed by mergers, sales, or other transactions involving hospitals and other health organizations. The report includes a mini-directory with facts on the foundations' formation and giving, a list of representative grants, and excerpts from a conversation with foundation staff that afford a personal glimpse into their grantmaking activities.

Tien, Christine. "Asset Storm." Foundation News & Commentary, vol. 38 (July-August 1997): p. 29-33.
Inspired by the merger-and-acquisition mania in the for-profit sector, nonprofit hospitals have begun to convert to for-profit institutions in droves. What is at stake is a massive loss of charitable assets.

Volunteer Trustees Foundation for Research and Education. The Sale and Conversion of Not-for-Profit Hospitals: A State-by-State Analysis of New Legislation. Washington, DC: Volunteer Trustees Foundation for Research and Education, 1998. 38 p.
Compares and details hospital sale and conversion legislation across fourteen states: Arizona, California, Connecticut, District of Columbia, Georgia, Louisiana, Nebraska, New Hampshire, Ohio, Oregon, Rhode Island, South Dakota, Virginia, and Washington.

When Your Community Hospital Goes Up for Sale: A Guide to Understanding the Sale and Conversion of Not-for-Profit Hospitals to For-Profit Corporations and What You Can Do About It. Washington, DC: Volunteer Trustees Foundation for Research and Education, 1996. 42 p.
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