In 2024, the Legislature directed the Office of Financial Management (OFM) in coordination with the Department of Revenue (DOR) to conduct a study of costs to the state related to nonprofit health care providers, facilities, and insurers focused on state and federal tax preferences such as tax-preferred capital financing and other public reimbursement streams outside of health care claims payments. (Section 23, Chapter 376, Laws of 2024.) Many of these deductions are not specific to health care operations and are applicable to a broad range of businesses or nonprofits. OFM contracted with Western Washington University’s Center for Economic and Business Research in the College of Business and Economics to conduct this study. In collaboration with DOR, this report was prepared with a focus on nonprofit health care entities (NHCEs).