This study focuses on how medical foundations use legal loopholes to manipulate effective tax rates. In the paper, we investigate whether medical foundations manipulate effective tax rates through capital expenditures and medical care income allotments. For purposes of the study, we classify medical foundations into three types: business-supported, religiously-supported, and other foundations that are neither business nor religiously supported. Our results show that business-supported medical foundations are more likely to manipulate effective tax rates through capital expenditures and medical care income allotments. Conversely, religiously-supported and other foundations that are more focused on social services are less likely to manipulate effective tax rates.