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Using the BSC as the starting point, the purpose of this paper is to present a theory on nonprofit performance management and describes how an overall performance index (OPI) was empirically developed to assess the strategic performance of a nonprofit organisation (NPO).

A conceptual model was developed from the literature. This was refined into a testable theoretical model using case studies. Thereafter, the theoretical model and an accompanying measurement model on OPI were validated using quantitative data (n=223) collected from a sample of healthcare NPOs in Australasia.

The measurement model was found to be a good fit to data. The model parameters (weights) pertaining to the OPI represent six PM dimensions (Mission; Strategy; Organisational Capabilities, Infrastructure and People Development; Financial Health; Processes; and Stakeholder Satisfaction) and 13 sub-dimensions. These parameters provide a tenable scoring system to assess the strategic performance of a NPO.

The parameters (hence the scoring system) were estimated from data collected from a particular sector (healthcare) and a region (Australasia).

The findings can be used for comparative benchmarking (e.g. by managers and major donors) of NPOs, better governance and to initiate major performance improvement initiatives.

This study is the first empirical study that has been undertaken to develop an OPI for NPOs. The findings can be readily used by the practitioners.

In this paper we discuss the potential role capital markets will play in health care restructuring. According to theory, agency costs, asymmetric information and strategic interactions cause the cost of capital for nonprofit entities to slope upward. Freestanding nonprofits are particularly disadvantaged in this regard. We conclude that some organizational forms will be less viable due to problems of capital access. Empirical work examines the capital structure of nonprofit entities. Our results indicate that chain hospitals are able to access more debt, both taxable and tax-exempt, than freestanding hospitals. Capital markets also associate for profit market presence with capital risk. We conclude that freestanding hospitals are at a relative disadvantage is accessing capital markets.

This paper provides a review and synthesis of past research regarding financial disclosure management by nongovernmental nonprofit organizations and suggests directions for future study. The primary purpose of this review is to summarize the evidence on financial disclosure management to help regulators and other stakeholders understand why, how, and to what extent nonprofits engage in this behavior. The paper begins by defining disclosure management in nonprofit organizations and exploring the motivations for why it might occur. Next is a survey of the nongovernmental nonprofit financial reporting environment: objectives, common practices, and the informational needs of users of nonprofit financial reports. Research exploring the motives, methods, and consequences of disclosure management is summarized. The evidence suggests that nongovernmental nonprofit managers have a variety of incentives to manage reported numbers and that they do in fact alter spending decisions, choose accounting methods, and design cost allocations to achieve certain performance benchmarks. Furthermore, this review sheds light on the consequences of disclosure management and what can or should be done to limit it.

The purpose of this paper is to analyze the market for audit services for publicly traded companies operating in the US for-profit (FP) healthcare sector. Complex national and local healthcare laws and regulations suggest the importance of assessing fee effects of joint nationallevel and city-specific expertise among auditors. Using cross-sectional OLS regression analysis, we find that joint expertise significantly affects audit pricing in the healthcare sector. We find a fee premium of 33.6 percent on engagements where auditors are both national and city-specific specialists. We also find that Big-4 auditor reputation is significantly priced over and above the effects of joint auditor expertise, and a significant positive association exists between audit and non-audit service fees-indicating the presence of knowledge spillover effects among healthcare company auditors.

We investigate whether auditor size is associated with the disclosure of internal control exceptions among Circular A-133 audits of nonprofit healthcare organizations. Our analysis is motivated by recent growth and transparency concerns within the sector. Using a sample of 1,180 audit reports from 2004 to 2008, we find evidence that audits performed by Big 4 firms are less likely to disclose internal control weaknesses than those performed by smaller firms. Additional analyses indicate this relation only remains statistically significant for a subsample of small organizations, possibly due to greater selectivity or lower efforts by the Big 4 auditors. We discuss the implications of these findings from an audit quality, market dominance, and client size perspective. The results are relevant to hospital financial managers seeking high quality audits at low cost.

The purpose of this paper is to develop a performance measurement (PM) framework for Australasian nonprofit organisations (NPOs) involved in healthcare, and operational descriptions for each PM dimension within this framework.

Literature relating to the balanced scorecard and other PM frameworks was examined to develop an initial conceptual model, and this model was substantially improved by collecting qualitative data from nine Australian and New Zealand healthcare NPOs using a case study approach.

The study identifies nine causally related PM dimensions: mission, strategy, organisational capabilities, infrastructure and people development (people and information), financial health, processes, and stakeholder satisfaction (clients, people, and donors). The study also recognised that “Mission” and “Strategy” should be PM dimensions and that healthcare NPOs should focus on satisfying its people, not only donors and clients. Additionally, 41 operational descriptions are developed for each of these dimensions and can enable detailed PM items to be derived by organisations.

The study is the first study that has been undertaken to develop a PM framework for the Australasian NPOs to a level that it can be readily used by the practitioners (following customisation to their own specific context). The developed model also serves as a basis for future quantitative academic research aimed at testing and empirical validation of the conceptual model.

This study draws on resource dependence theory (RDT) to explain a board's governance function in the United States (US) nonprofit healthcare industry. Specifically, while various nonprofit research studies have appealed to agency theory (AT) to explain the monitoring role of an outside board, RDT offers an alternative explanation that emphasizes an outside board's resource gathering role.

In drawing on the nonprofit GuideStar database, a fixed effect (FE) panel estimation was conducted on a sample of 230 US Non Profit Healthcare Organizations (NPHCOs). This panel estimation examines the relationship between the composition of an outside board and an NPHCO’s revenue and public support performance.

A key finding of this study is that the composition of an outside board involving its' number, compensation and gender impacts an NPHCO’s revenue and public support.

This study shows that the composition of an outside board impacts an NPHCO’s ability to gain access to external resources. As NPHCOs face increasing pressure to seek external forms of revenue support, this study suggests that boards should favor a larger number, compensation and female representation of outside members.

The composition of an outsider board can offer external sources of revenue support that lower the poor's requirements for financial assistance and thus affirm an NPHCO’s identity as a charitable organization.

As an NPHCO’s identity as a charitable organization is dependent on serving the medical needs of the poor, an outside board not only introduces a resource gathering function that is absent in the monitoring explanations of AT, but that this resource gathering function is important to affirming this identity.

Problems with governance at non-profit (NP) healthcare organizations have recently led to legislative scrutiny of their audit committee practices. Using data from a survey of chief financial officers of NP healthcare organizations and from the GuideStar database, we examine audit committee interactions with external auditors for a sample of 69 NP healthcare organizations. We find that 71% of the audit committees in our sample meet privately with the external auditor and the mean number of such meetings 1.9. Our results also suggest that audit committee interaction with the external auditor varies in response to resource dependencies, existence of debt, audit quality, audit tenure, and organizational size. These findings suggest that NP healthcare organizations respond to monitoring demands by adopting suitable audit committee related interactions.

This study aims to provide a timely “first look” at the impact of COVID-19 lockdown restrictions on the financial distress of nonprofits.

This 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.

Nonprofits 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.

Broadly 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.