Pinnacle Health Hospitals v. Dauphin County Board of Assessment Appeals

708 A.2d 1284, 1998 Pa. Commw. LEXIS 43
Commonwealth Court of Pennsylvania·Decided January 26, 1998·No. 2087 and 2166 C.D. 1996·Published·Cited by 8 cases

Opinion

DOYLE, Judge.

Before this Court are the consolidated cross-appeals of the Pinnacle Health Hospitals, successor by merger to Harrisburg Hospital (Hospital), 1 and the County of Dauphin, School District of Harrisburg, and the City of Harrisburg (collectively, the County) from two orders of the Court of Common Pleas of Dauphin County. The first order, issued on March 23, 1995, granted the Hospital’s petition to remove its properties from the tax assessment rolls for calendar year 1993 and fiscal year 1993-1994, but denied the Hospital’s request for further reinstatement of its tax exemption for 1994 and subsequent years. The second order, entered on June 24, 1996, likewise denied the Hospital’s petition to have its tax-exempt status restored. The Hospital appeals from both the March 23, 1995 order and the June 24, 1996 order. The County appeals from the March 23,1995 order only.

FACTUAL BACKGROUND

The Common Pleas Court made extensive findings of fact in its decision in Harrisburg Hospital v. Dauphin County Board of Assessment Appeal, 116 Dauph. 193 (C.P.Pa.1996), which may be generally summarized as follows.

Histoiy and Community Services

The Hospital is a Pennsylvania non-profit corporation and is a tax exempt charity for federal tax purposes. 2 It was founded in 1873 through a combination of public contributions and private charity, and has evolved from a single building and medical treatment center into a multi-structure acute-care teaching hospital with more than 471 beds. Historically, the Hospital has always enjoyed a charitable exemption from local real estate taxes.

The evolution of the Hospital into a modem medical facility was financed largely through public and private contributions. In recent years, the Hospital has received substantial donations from the community in the form of contributions, gifts, grants and volun *1287 teer services in the following amounts: $1,744,076 in 1992; $1,659,850 in 1993; and $2,224,887 in 1994.

The Hospital’s corporate by-laws state that the Hospital is to provide healthcare services to individuals without regard to their ability to pay. Accordingly, the Hospital has always maintained an open admissions policy, under which it treats persons regardless of their race, color, or economic resources. No person has ever been denied care or admission to the Hospital because he or she could not afford to pay. The Hospital makes every effort to identify persons who qualify for charity care at the earliest possible time in the treatment process, and the cost of medical services provided to such persons is charged to direct charity care or written off as a bad debt. The Hospital will pursue collection efforts only against patients who have the ability to pay for the provided medical services. However, if the Hospital later determines that such a patient is, in fact, eligible for charity care, the Hospital will make no further effort to collect the debt. Each year the Hospital forgives charges rendered to patients unable to pay their bills.

The Hospital also operates a clinic, which provides extensive primary care to an average of 20,000 indigent walk-in patients each year. Further, through its twenty-four hour emergency room, the Hospital treats, on average, an additional 35,000 persons each year. There is no government agency that operates a community hospital, primary care clinic for the indigent, or an emergency room, that services the same population as is treated by the Hospital.

Corporate Organization and Financial Status

The various entities comprising the Hospital’s corporate organization became collectively known as the Capital Health System (System) in 1983. The System is an integrated system for the delivery of health care services, 3 and includes the following corporate entities:

• Capital Area Health Foundation (Foundation): the parent corporation and owner of the System through the Foundation’s ownership of Capital Health Systems Services (CHSS); this entity is specifically charged with furthering the purposes of the Hospital through fund raising and acceptance of community donations.

• Capital Health Systems Services (CHSS): a non-profit corporation which exercises supervision over the financial condition, financial operation and financial needs of the entire System, including the Hospital. Excess cash from all of the related entities is periodically transferred to CHSS.

• Controlled Affiliates (Subsidiaries) of CHSS:

• Harrisburg Hospital (Hospital).
• Seidel Memorial Hospital. 4
• Capital Extended Care, a non-profit entity that operates an assisted-living facility known as Harrisfield.
• Health Reach Home Care, a non-profit home health care agency that also operates as a hospice.
• Harrisburg Systems Services (HSS), a tax exempt agency that employs physicians to operate family medicine centers.
• Harrisburg Medical Management, Inc. (HMMI), a for-profit corporation that engages in various business ventures.

The system’s organizational structure is illustrated in the following organization chart:

*1288 Figure 1

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The Board of Directors of the Foundation is composed of members of the community, and they elect the Board of Directors of CHSS; the Board of directors of CHSS, in turn, elects the Board of Directors of the Hospital. The System’s top executives are employed by CHSS. Although the Common Pleas Court did not make a specific finding on this point, the record indicates that the Board of Directors of CHSS and the executives employed by CHSS have de facto control over the System and make decisions on behalf of the entire System.

As mentioned above, CHSS receives the excess cash flow from all entities in the System. The Hospital’s excess cash flow is the primary source of funds which CHSS transfers to the System’s subsidiary corporations, including for-profit HMMI. From 1990 through 1994, the Hospital contributed or loaned nearly $28,700,000 to CHSS. That amount includes a capital contribution in excess of $14,000,000, and a transfer to CHSS of $1,700,000 on an account receivable from HMMI.

In the mid-1980s, the System, through CHSS, created HMMI, a for-profit subsidiary corporation. HMMI engages in a variety of for-profit businesses including the operation of a magnetic resonance imaging facility, real estate acquisition and leasing, sales of medical supplies, and, until 1992, the practice of medicine through family medical practices. Further, HMMI operates a paint treatment center, is part owner of certain medical office buildings, runs a nurse staffing agency, and is engaged in joint ventures with other businesses and non-profit entities.

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Pinnacle Health Hospitals v. Dauphin County Board of Assessment Appeals, 708 A.2d 1284, 1998 Pa. Commw. LEXIS 43 (Pa. Ct. App. 1998).

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