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members of the organization s governing body by of cials of one or more state or local governments; The potential for unilateral dissolution by a government with the net assets reverting to a government; or The power to enact and enforce a tax levy Furthermore, organizations are presumed to be governmental if they have the ability to issue directly (rather than through a state or municipal authority) debt that pays interest exempt from federal taxation However, organizations possessing only that ability (to issue tax-exempt debt) and none of the other governmental characteristics may rebut the presumption that they are governmental if their determination is supported by compelling, relevant evidence (d) INVESTOR-OWNED PROVIDERS Investor-owned HCOs may be organized as stock corporations (publicly traded or privately held), partnerships, or sole proprietorships Many investorowned HCOs are publicly traded, and therefore are also subject to Securities and Exchange Commission (SEC) reporting requirements
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(a) GENERALLY ACCEPTED ACCOUNTING PRINCIPLES PRIVATE SECTOR SAS No 69, The Meaning of Present Fairly in Conformity with Generally Accepted Accounting Principles in the Independent Auditor s Report, sets forth the hierarchy of generally accepted accounting procedures (GAAP) for private sector organizations Its applicability to investor-owned and not-forpro t health care providers is discussed in 1 of Health Care Organizations Not-for-pro t providers with tax-exempt debt should consider the de nition of governmental entity discussed at Section 361(c) in determining whether to follow this GAAP hierarchy or the hierarchy established for governmental organizations Generally, not-for-pro t HCOs are required to follow the guidance in effective provisions of Accounting Research Bulletins, APB Opinions, and Financial Accounting Standards Board (FASB) Statements and Interpretations, except for speci c pronouncements that explicitly exempt not-forpro t organizations, do not apply to not-for-pro t organizations by nature of their subject matter, or contain specialized accounting and reporting practices for other industries Appendixes A to E of 1 of Health Care Organizations list all such pronouncements and the applicability/inapplicability of each to not-for-pro t health care entities (b) GENERALLY ACCEPTED ACCOUNTING PRINCIPLES PUBLIC SECTOR Since its inception in 1984, the Governmental Accounting Standards Board (GASB) has issued 39 statements and a number of interpretations of nancial accounting and reporting standards that set forth accounting principles that must be followed by state and local government entities, including governmental HCOs SAS No 69, The Meaning of Present Fairly in Conformity with Generally Accepted Accounting Principles in the Independent Auditor s Report, sets forth the hierarchy of GAAP for governmental organizations Its applicability to governmental health care providers is discussed in 1 of Health Care Organizations
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Most governmental health care providers use enterprise fund accounting and reporting because they are nanced and operated in a manner similar to private-sector entities These organizations are included within the scope of the AICPA audit and accounting guide Health Care Organizations as well as the AICPA audit and accounting guide Audits of State and Local Government Units GASB No 20 states that governmental proprietary organizations should apply all applicable GASB pronouncements as well as any FASB Statements and Interpretations, APB Opinions, and ARBs issued on or before November 30, 1989, that do not con ict with or contradict GASB pronouncements Furthermore, paragraph 7 of GASB No 20 provides that governments operated as enterprise funds may apply all FASB Statements and Interpretations issued after November 30, 1989, that do not con ict with or contradict GASB pronouncements1 The requirements set forth in Health Care Organizations for governmental health care enterprises generally are directed to organizations that apply paragraph 7 of GASB No 20 However, because those entities should not apply FASB Statements and Interpretations whose provisions are limited to not-for-pro t organizations or those that address issues concerning primarily such organizations, they should disregard guidance contained in the Guide that is based on, or provided to implement, FASB Statements Nos 116, 117, 124, and 136 Generally, such discussions are agged with a footnote or statement citing that proscription Other governmental health care facilities (eg, long-term institutional care of individuals with certain chronic conditions or mental impairments) nance their operating needs primarily from government support These facilities often use governmental fund accounting and nancial reporting because they do not meet the criteria requiring the use of enterprise funds and because user fees are not a principal revenue source for the activity Consequently, they may be set us as departments under the umbrella of a city, county, or state government Such organizations are subject to the AICPA audit and accounting guide Audits of State and Local Government Units The guidance in the AICPA audit and accounting guide Health Care Organizations does not apply to these organizations, and 35, rather than this chapter, should be consulted for guidance regarding their accounting and nancial reporting considerations (c) SECURITIES AND EXCHANGE COMMISSION REQUIREMENTS Although many investor-owned HCOs are publicly traded, at this time there are no unique SEC rules pertaining speci cally to investor-owned health care providers While not-for-pro t and governmental health care entities that issue tax-exempt securities are exempt from the registration and reporting requirements of the federal securities laws, they have to make certain disclosures at the time securities are issued and thereafter on an ongoing basis2 In accordance with an SEC rule titled Municipal Securities Disclosure, underwriters agreements require municipal borrowers to provide speci c nancial information for example, annual audited nancial statements and timely notices of material events, such as rating changes or delays in principal and interest payments to repositories of municipal securities information (similar in some ways to the reporting requirements for SEC registrants) The repositories make the information available to bondholders and prospective bondholders Additionally, SEC Interpretive Release No 33-7049, Statement of the Commission Regarding Disclosure Obligations of Municipal Securities Issuers and Others, is intended to assist municipal securities issuers, brokers, and dealers in meeting their obligations under the antifraud provisions of the securities laws These releases are available on the SEC s Web site (wwwsecgov) (d) HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION PRINCIPLES AND PRACTICES BOARD In 1975, the leadership of the Healthcare Financial Management Association (HFMA), a major trade organization that monitors nancial issues related to health care providers,
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The GASB s web site ( wwwgasborg) contains a list of FASB pronouncements issued since November 30, 1989, and their applicability to enterprises that apply paragraph 7 of Statement 20 This is updated periodically 2 The ongoing or continuing disclosure requirements apply to securities for which underwriting commitments were executed on or after July 3, 1995
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