Conversion from nonprofit to for-profit legal status: Why does it happen and should anyone care?

Abstract

The conversion of a nonprofit firm to the for-profit form is commercialism carried to an extreme. Conversion is increasingly common, most notably in health care. We seek to advance understanding of why nonprofit conversions occur and what public policy should be toward them. A transfer of control—the essence of a conversion—over nonprofit assets can be accomplished in various ways. Thus, it would be a public policy mistake to focus narrowly on formal legal conversions or outright sales. We explore the possible motives for conversion, and speculate about the reasons for the flurry of conversion activity in hospitals and health maintenance organizations (HMOs). We conclude that there are three central public policy questions raised by conversions: (1) under what circumstances is conversion appropriate—when does it represent an efficient reallocation of resources and when only a redistribution of wealth?; (2) how should the nonprofit's assets be valued?; and (3) what should happen to the financial assets that remain after a conversion?