Given the tax advantages afforded to nonprofit hospitals, including the ability to issue tax-exempt debt, hospital managers encounter institutional pressure to provide community benefits. When nonprofits issue debt, they also face economic pressure to meet creditors' financial performance...

This study examines the relationship between institutional pressures to provide social benefits and the discretionary accrual behavior of nonprofit firms. I examine this issue within the context of US nonprofit hospitals, an economically significant and politically rich setting where firms face...