This study draws from a sample of not-for-profit hospitals in Taiwan to investigate the influence of debt using and community benefit service expenditure on financial manipulation. The results indicate that debt using and community benefit service expenditure have significant positive correlation with financial manipulation. This implies that the majority of not-for-profit hospitals raise the capital by loan and that the hospitals’ CEOs have the incentive to avoid the violation of debt covenants when they face the pressure of the enormous costs of debt and creditors. At the same time, the study's results indicate hospitals’ CEOs have the incentive to use financial manipulation to adjust to a range that is just above zero by increasing or decreasing the community benefit service expenditure.
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