“Charity” Hospital

Matthew G. Saroff
3 min readJun 10, 2022


All organizations, even allegedly charitable ones, need financial reserves to account for problems as they come up.

Under-capitalization, the lack of sufficient resources to weather something going wrong, is one of the main reasons that new business go bust.

That being said, a number of charities (I discussed Harvard’s outsize endowment here and here over a decade ago) that have an obsession with building up reserves that is so extreme that it runs counter to their basic mission, case in point the St. Jude Hospital system:

In July 2021, St. Jude Children’s Research Hospital announced to fanfare that it had just finished raising $2 billion in donations, a single-fiscal-year record for the nation’s largest health care charity. “Solving pediatric cancer is a global problem — a multi-trillion, multi-year problem,” Rick Shadyac, chief executive of St. Jude’s fundraising arm, told the Associated Press at the time. “The way we look at it is: If not St. Jude, then who?”

Financial disclosures newly released by St. Jude, however, show $886 million of the hospital’s record $2 billion-plus in revenues last fiscal year went unspent. Those surplus dollars instead flowed to the hospital’s reserve fund, which helped it grow to $7.6 billion by the end of June 2021. That’s enough money to run St. Jude’s 77-bed hospital in Memphis at last year’s levels for the next five years without a single additional donation.

I wonder what Danny Thomas would have to say about that.


Last year, ProPublica reported that St. Jude had accumulated billions of dollars while many families of young patients treated at the hospital struggled financially. Parents told ProPublica that they’d exhausted savings and retirement accounts and borrowed from family and friends, despite St. Jude’s much-publicized pledge to alleviate many of the costs associated with treatment “because all a family should worry about is helping their child live.” St. Jude said they provided generous benefits to families, but cannot cover all financial obligations that a family experiences during a child’s illness. In response to the story, St. Jude significantly increased its benefits for families, including more support for travel and housing.

Some researchers, oncologists, health care advocates and families of patients complain that St. Jude’s fundraising makes it more difficult for other pediatric hospitals to raise money for their operations. St. Jude competes for fundraising dollars directly against other children’s hospitals, some of which have significant numbers of patients in clinical trials and their own research divisions focused on pediatric cancer care. To visualize just how much St. Jude outstrips its competitors: In 2020, U.S. News and World Report’s ranked the nation’s best children’s cancer centers. St. Jude’s, ranked tenth, pulled in more than the combined total of the nine hospitals ranked above it , according to financial records filed with the Internal Revenue Service.

Call me a cynic, but my guess is that the metrics used to determine the bonuses for executives at St. Jude are slanted toward fundraising, and not patient care.

Econ 101: If you pay for it, that is what they will give you.

There needs to be more regulation of charities.