20 hospitals, systems where charity care lags behind tax breaks

A Lown Institute report found 80% of nonprofit hospitals' charity care falls behind tax breaks, with some short by hundreds of millions of dollars.

The independent healthcare think tank used 2021 IRS data from 2,425 nonprofit hospitals across the U.S. to calculate private nonprofit hospitals' "fair share spending." It compared the estimated value of hospital tax exemptions to the amount spent on meaningful community investments. The analysis included five IRS Schedule H categories: financial assistance, community health improvement services, cash and in-kind contributions, community building activities, and subsidized health services. Three categories — Medicaid shortfall, health professions education, and research — were excluded as they did not provide direct or meaningful benefit to communities, according to the Institute. Lown considered hospitals that dedicated at least 5.9 percent of overall expenditures to charity care and meaningful community investment as spending their fair share. Read the full methodology here.

The yearly report included 652 more hospitals than last year and added five large systems that were not included last year: Renton, Wash.-based Providence; Oakland, Calif.-based Kaiser Permanente; Somerville, Mass.-based Mass General Brigham; Cleveland Clinic and Rochester, Minn.-based Mayo Clinic.

More than 1,900 hospitals pay less than their "fair share" — meaning the value of their meaningful community contribution falls short of the value of their tax breaks. The combined fair share deficits totaled $25.7 billion.

Five Catholic health systems were among the 10 systems with the greatest fair share deficits, which accounted for 15% of the fair share deficit: Providence ($1 billion deficit), CommonSpirit ($923 million), Trinity ($784 million), Ascension ($614 million) and Bon Secours Mercy ($488 million). 

Here are the 10 hospitals and systems with the greatest fair share deficits:


Kaiser Permanente (Oakland, Calif.) — $1.2 billion

Providence (Renton, Wash.) — $1 billion

CommonSpirit Health (Chicago) — $923 million

Trinity Health (Livonia, Mich.) — $784 million

Ascension Healthcare (St. Louis) — $614 million

UPMC (Pittsburgh) — $578 million

Bon Secours Mercy Health System (Cincinnati) — $448 million

Advocate Health (Charlotte, N.C.) — $479 million

Mayo Clinic (Rochester, Minn.) — $478 million

Mass General Brigham (Somerville, Mass.) — $461 million



NewYork-Presbyterian Hospital (New York City) — $274 million

UPMC Presbyterian (Pittsburgh) — $268 million

NYU Langone Hospitals (New York City) — $222 million

Cleveland Clinic Main Campus — $212 million

Massachusetts General Hospital (Boston) — $194 million

Stanford (Calif.) Hospital — $181 million

Mayo Clinic Hospital (Rochester, Minn.) — $165 million

Hospital of the University of Pennsylvania (Philadelphia) — $163 million

Vanderbilt University Medical Center (Nashville, Tenn.) — $156 million

Brigham and Women's Hospital (Boston) — $149 million

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