PRESS RELEASE: U.S. nonprofit hospitals get billions more in tax breaks than they spend on charity care and community investment

Many hospital systems with large fair share deficits also received millions in CARES Act funding

Boston, MA: Nonprofit hospital systems are expected to give back to their communities in amounts that justify their massive tax breaks. But a new report from the Lown Institute, a healthcare think tank, shows this is rarely the case. They determined that 227 of the 275 systems studied had fair share deficits, meaning they spent less on charity care and community investment than the value of their tax exemption. Adding the fair share deficits of all hospital systems together reveals $18.4 billion in stranded dollars that could have been used to advance health equity, housing, food insecurity, and other local needs.

The 10 private nonprofit hospital systems with the largest fair share deficits (FYE 2019):

  1. Providence Saint Joseph Health – $705M
  2. Trinity Health – $671M
  3. Mass General Brigham (FYE 2018) – $625M 
  4. The Cleveland Clinic Health System – $611M
  5. University of Pittsburgh Medical Center – $601M
  6. University of Pennsylvania Health System – $571M
  7. Catholic Health Initiatives – $515M
  8. Advocate Aurora Health – $498M
  9. Dignity Health – $456M
  10. Ascension Health – $388M

These 10 systems account for $5.6 billion of the $18.4 billion total fair share deficit.

“Would half a billion in taxpayer dollars be better spent by directly funding addiction, food insecurity, or homelessness efforts?” said Vikas Saini, MD, president of the Lown Institute. “We should all be asking those types of questions given the vastness of these sums and the significant public health crises many communities are facing.”

Hospitals claim additional taxpayer funds through CARES Act

Many systems with fair share deficits had their strong financial positions further supplemented with CARES Act funding, according to Lown Institute’s experts. For example, the Cleveland Clinic Health System accepted $423 million in funds while posting $1.33 billion in surplus revenues in 2020. The University of Pittsburgh Medical Center accepted $761 million in COVID funds as they posted $1.1 billion in surplus revenues. And the University of Pennsylvania Health System accepted $213 million from the CARES Act while ending the year with $387 million in excess revenue. 

“At the end of the day, some of these hospital systems are walking away with over a billion in government funds,” said Dr. Saini. “Taxpayers should be seeing a better return on their investments and demanding greater accountability.”


Lown Institute calculated fair share spending based on 2019 IRS Form 990. For systems in which 2019 data were not available, data from 2018 were used. Fair share deficits and surpluses for each system were calculated by balancing the estimated value of hospital systems’ tax exemptions against the amount systems spent on charity care and community investment— including community health improvement activities, contributions to community groups, community building activities, and subsidized healthcare services. Only private nonprofit hospitals with available IRS data were included in the analysis. More information is available on the project landing page

The full 2022 Lown Institute Hospitals Index for Social Responsibility, including rankings across more than 50 metrics, will be released in late June.



Panel Discussion: Join us April 12, 2022 at 1 p.m. ET for a live event as we discuss our fair share rankings with special guests:

  • Dale Folwell, CPA – North Carolina State Treasurer
  • Paul Hattis, MD, JD – Senior Fellow, Lown Institute
  • Jennifer Valenzuela, MPH, MSW Chief People and Equity Officer at Health Leads

About the Lown Institute 

Founded in 1973 by Nobel Peace Prize winner Bernard Lown, MD, developer of the defibrillator and cardioverter, the Lown Institute believes that a radically better system of health is possible and generates bold ideas towards that goal. The Lown Institute Hospitals Index for Social Responsibility is a signature project of the Institute and features measures never used before like racial inclusivity, avoidance of overuse, and pay equity.


Aaron Toleos, Lown Institute, (978) 821-4620,