PRESS RELEASE: U.S. nonprofit hospitals receive billions more in tax breaks than they invest in their communities

“Fair share” deficits could wipe out medical debt of more than 18 million Americans or rescue the finances of every rural hospital at risk of closure

A new report examining the finances of 1,773 nonprofit hospitals in the United States finds that more than three-quarters fall short on expected investments in their communities. 

Nonprofit hospitals are exempted from paying most federal, state, and local taxes in exchange for providing free or discounted care and programs that address community health needs, like substance abuse treatment, affordable housing, or access to healthy foods.

Lown Institute analysts identified more than 1,350 hospitals that have “fair share” deficits, meaning that the value of their community investments fails to equal the value of their tax breaks. The combined deficits of nonprofit hospitals totaled $14.2 billion in 2020, enough to relieve the medical debt of 18 million Americans or prevent 600 at-risk rural hospitals from closing.1

“Americans desperately need hospitals to use their billions in tax breaks as intended: to promote health while relieving the problems of medical debt and access to care,” said Vikas Saini, MD, president of the Lown Institute. “These are charitable organizations and they should do a better job at prioritizing social responsibility over profitability.”

Hospitals with the largest “fair share” deficits in the U.S.

UPMC Presbyterian had the largest “fair share” deficit of any hospital in the country at $246 million in 2020.

Other hospitals with the largest “fair share” deficits in the nation include:

  • NYU Langone Hospitals (New York) 
  • Vanderbilt University Medical Center (Nashville) 
  • Hospital of University of Pennsylvania (Philadelphia)
  • Indiana University Health (Indianapolis) 
  • Spectrum Health Butterworth Campus (Grand Rapids, Mich.) 
  • Cedars-Sinai Medical Center (Los Angeles) 
  • M Health Fairview University of Minnesota Medical Center (Minneapolis) 
  • Umass Memorial Medical Center (Worcester, MA)
  • Arizona General Hospital Mesa (Mesa, AZ)

Many of these hospitals ended the year with net incomes close to or exceeding their “fair share” deficits, suggesting they had the financial means to meet their spending obligations. 

“Nonprofit hospitals are going to need help changing their behavior,” said Saini. “These hospitals are supposed to be accountable to Americans through federal, state, and local authorities—but oversight has been negligible.”


The Lown Institute calculated fair share spending based on 2020 IRS Form 990 by comparing the estimated value of hospitals’ tax exemptions to the amount spent on financial assistance and meaningful community investment—including community health improvement activities, contributions to community groups, community building activities, and subsidized healthcare services. For hospitals that file as a group, expenses, income, and community investment data were prorated across hospitals based on their share of system revenue. For hospitals filing with universities where Schedule E was submitted, financial audit or CMS cost report information was used to calculate expenses and net income.

Hospitals for which 2020 IRS filings were unavailable are not included in this year’s report. This includes some large and well-known health systems like Providence, Kaiser Permanente, Mass General Brigham, Cleveland Clinic, and Henry Ford. 

View the full report on the Lown Hospitals Index website.

Table: Largest “Fair Share” Deficits

Fair share deficit, 2020Net income, 20202 COVID relief funds, 20203Medical debts that could be paid off4
UPMC Presbyterian (Pittsburgh, PA)-$246 M$44 M$56 M167,060
NYU Langone Hospitals (New York, NY)-$173 M$406 M$0.45 M145,745
Vanderbilt University Medical Center (Nashville, TN)-$158 M$177 M$56 M59,163
Hospital of the University of Pennsylvania (Philadelphia, PA)-$151 M$304 M$49 M102,836
Indiana University Health (Indianapolis, IN)-$136 M$1,069 M$135 M66,518
Spectrum Health Butterworth Campus (Grand Rapids, MI)-$134 M$201 M$77 M110,762
Cedars-Sinai Medical Center (Los Angeles, CA)-$126 M$470 M$95 M53,217
M Health Fairview University of Minnesota Medical Center (Minneapolis, MN)-$119 M$67 M$34 M87,521
UMass Memorial Medical Center (Worcester, MA)-$114 M$18 M$116 M116,641
Arizona General Hospital Mesa (Mesa, AZ)-$102 M$57 Mn/a41,373
Northwestern Memorial Hospital (Chicago, IL)-$97 M$67 M$18 M61,253
Strong Memorial Hospital (Rochester, NY)-$91 M$3 M$82 M77,132
Froedtert Hospital (Milwaukee, WI)-$87 M$144 M$18 M35,445
Christiana Care Health Services (Newark, DE)-$85 M$78 M$101 M34,899
Lehigh Valley Hospital (Allentown, PA)-$85 M$118 M$6 M57,430

Launch Event: Join us April 11, 2023 at 1 p.m. ET for a live event as we discuss the results or our report with a panel of policymakers and thought leaders.


1 Sources: The average amount of medical debt on credit reports in 2020 was $739 per tradeline, according to the CFPB (2022). The Center for Healthcare Quality and Payment Reform (2022) estimates there are about 600 rural hospitals at risk of closing and that $4 billion/year in funding would keep them solvent. 

2 Data source is IRS Form 990s, fiscal year 2020

3 Data source is CMS Hospital Cost reports, 2020. Includes both grant and loan amounts in Covid-19 public health emergency funds.

4 Data source is CFPB 2022 report on Medical Debt Burden in the United States, which includes average medical debt amounts on credit reports by state. 


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 Fair Share spending, racial inclusivity, and pay equity.

MEDIA CONTACT: Aaron Toleos, vice president of communications for the Lown Institute,