Financial information about nonprofit hospitals

• Highlights of IRS Form 990

AHCJ has obtained information on the finances of nonprofit hospitals across the country from GuideStar, which compiles and disseminates financial documents for most U.S. nonprofits. This information is broken into two sets of data - from tax years 2009 and 2010. AHCJ hopes to update this information annually.

GuideStar asks to be identified in news reports as "the leading source of nonprofit information." If you intend to reproduce more than 50 lines of this data, you must obtain advanced permission from GuideStar. Email Lindsay Nichols at lnichols@guidestar.org or call her at 202-637-7614 (direct) or 757-634-2198 (cell).

Below are some questions and answers about 990s and this data set.

What is a 990? 
The 990 is a public tax return. It is filed by nonprofits to justify their mostly tax-free status. For more, check here.   By law, the nonprofit must give anyone who requests it the most recent 990 form in a timely way. Generally this means if you show up there, they must give it to you the same day. Or if you file an email request, they must give it to you within 30 days.  

Where did this overall list come from?
The list was compiled by GuideStar, a group that focuses on collecting 990s from U.S. nonprofits.  Specifically, these are organizations from fiscal year 2009 or 2010 (more on that later) that answered yes to question 20 in Part IV: Did the organization operate one or more hospitals? You can find this question on the bottom of Page 3 in most 990s. 

Is every nonprofit hospital in here?
No. For example, chains such as Kaiser Foundation Hospitals file as a chain and not as individual hospitals. Sometimes hospitals have multiple entities, especially older ones, and the 990 may be listed under the older names. For example, the Fox Chase Cancer Center is listed here by its old name, the American Oncologic Hospital. (Note: Fox Chase also submits a separate 990 for its non-hospital operations, but that is not included in this spreadsheet. ) And some entities run more than just hospitals. The University of Pennsylvania, Vanderbilt University, the University of Southern California and other large universities include their health care systems in their institutional 990s instead of filing separately.

What data are in the spreadsheets?
AHCJ president Charles Ornstein and vice president Karl Stark, along with Modern Healthcare reporter Melanie Evans, selected certain key fields from the 990 that capture a hospital’s financial standing and are most likely to yield story ideas.

Can I use this stuff in a story?
Yes, but you should attribute the information (for instance how a hospital ranks in comparison to its peers) to GuideStar data and doublecheck any 990 from which you intend to quote specific figures. Never run a document without checking on its accuracy and context with the hospital and other sources. And please alert AHCJ if you find an error or omission.

Why do a story on 990s right now?
The 990s have recently been upgraded; they have more information than ever before on issues ranging from compensation to marketing, charity care to lobbying. The 2009 was the first year that the changes were mandatory. So this is the best time in the history of the document to take a look at the 990s of institutions that you cover.   

What does the year mean on the 990?
Of course it refers to the year, but not all 990s cover the same time period. Some are based on the calendar year and some are based on fiscal years, meaning that they start on July 1 and end on June 30 of the next year. There are yet other variations. See the columns labeled TAXYEARBEGIN AND TAXYEAREND for what 2009 or 2010 means for the particular institution you cover. Important note: Some, but not all, organizations have filed later 990s and they are or will be available on GuideStar. You can also request them from the organization itself.

What are some issues I might want to look at?

• Compensation. 990s have been a consistent source of compensation stories for reporters. Now that the 990s have gotten more detailed, you can also see if anyone got first-class charter travel, travel for companions, a housing allowance, a residence for personal use, health or social club dues and discretionary spending accounts. (AHCJ’s website has many good story examples.)

• Charity care figures. This was the original reason why the 990 was updated to include Schedule H. The old 990 did a poor job of showing what nonprofit hospitals were doing for the public, aka “community benefit.” Now there is an equation that everyone agrees on. (It’s essentially charity care plus the hospital’s loss on Medicaid). The form also includes other payments that hospitals believe are part of community benefit, such as Medicare underpayments. It’s now much easier to make comparisons among hospitals.  A big change in the new 990 was requiring hospitals to count their charity care and other losses in real costs, not inflated charges.        

• Lobbying. You can tell what your hospitals are spending in this crucial area and then do some reporting on what concessions they are winning. Remember that if the hospital is part of a larger institution (i.e. university) that files a single 990, the lobbying expenses might not all involve health care.

• Profit/loss/reserves. These are all on the 990, but newer figures may well be available on bond disclosures and financial statements.

• “Family business relationship-officer business relationships” might be a tip to major conflicts of interest. If the hospital answers yes to these questions, it would be wise to check out. If they respond yes, hospitals must disclose later in the forms the nature of these relationships. Be sure to look for that in the form itself.

• “Interested persons transactions” on Schedule L of specific 990s. These are cases in which the nonprofit's money goes to a board member or that person's family. This is very common in nonprofits and a huge potential area for reporters. These transactions were not included in this data but may be very interesting to look at and can lead to powerful stories. The columns labeled OFFICER_BUSINESS_REL_CBX and FAMILY_BUSINESS_REL_CBX
  of the main spreadsheet can tell you if the hospital conducted business with companies controlled by officers, board members or their families. If so, seek out the Schedule L for additional details.

• Number of board members and the number of independent board members may be significant. Governance experts say the bigger the board, the less the oversight. And board members aren’t independent if they work for the nonprofit and therefore have a stake in current leadership.

If you are interested in nonprofit compensation, GuideStar has an annual compensation report that gives the lay of the land when it comes to nonprofit compensation, as well as a white paper about IRS rules when it comes to compensation. Lindsay Nichols at GuideStar said she’s willing to make these reports available to reporters for free. Her contact information is at the top of this page.

Here is a guide to the spreadsheet GuideStar compiled (AHCJ_GuideStar_990_2009 and AHCJ_GuideStar_990_2010) column by column, including the place in the 990 form that the information came from:

xml_document_id - GuideStar's own unique row ID

EIN - From Header Block D, Employer Identification Number (EIN)

ORGNAME - From Header block C, Organization name

CITY - From Header block C, Organization address city

STATE - From Header block C, Organization address state

TAX_YEAR - From Header Block B, Per GuideStar convention, Tax Year = year from tax year ending

TAXYEARBEGIN - From Header Block A, Tax year beginning date

TAXYEAREND - From Header Block B, Tax year ending date

TOT_REV_CURRENT - From Part 1 - Line 12, Total revenue 

INFLUENCE_CBX - From Part IV - Line 4, Did the organization engage in lobbying activities? Y means filer must complete Schedule C, Part II (Y/N)

OFFICER_LOAN_OUTSTANDING_CBX - From Part IV - Line 26, Did the organization have an outstanding loan to person at end of yr? Y means filer must complete Schedule L, Part II (Y/N)

OFFICER_LOAN_PROVIDED_CBX - From Part IV - Line 27, Did the organization provide a grant or other assistance to a person related to the org? Y means filer must complete Schedule L, Part III (Y/N)

OFFICER_BUSINESS_REL_CBX - From Part IV - Line 28a, Did any current or former officer, director,etc: Have a direct business relationship with the organization? If Y, filer must complete Schedule L, Part IV (Y/N)

FAMILY_BUSINESS_REL_CBX - From Part IV - Line 28b, Did any current or former officer, director,etc: Have a family member who had any business relationship with the organization? If Y, filer must complete Schedule L, Part IV (Y/N)

OFFICER_IN_2ORGS_CBX - From Part IV - Line 28c, Did any current or former officer, director,etc: Serve as an officer, director, etc., of an entity doing business with the organization? If Y, filer must complete Schedule L, Part IV (Y/N)

ALL_YEAR_EMPLOYEES - From Part V-Line2a, Number of employees reported on Form W-3.

TOTAL_OFFICERS - From Part VI - Line 1a, Number of voting members in governing body

VOTING_MEMBERS - From Part VI - Line 1b, Number of voting members independent

ASSET_DIVERSION_CBX - From Part VI - Line 5, Material diversion of assets (Y/N)

TOTAL_PERSONS_100000 - From Part VII-Line 2, Total number of individuals who received more than $100,000 in compensation

SERVICE_REVENUE - From Part VIII-Line 2g, Total program service revenue

INCOME_INVESTMENT - From Part VIII-Line 3, Investment income 

INCOME_BONDS - From Part VIII-Line 4, Investment income from bonds

NET_SALES - From Part VIII-Line 7d, Net gain or loss on sale of assets

FEES_LOBBYING - From Part IX - Line 11d (A), Fees for services (non-employees): Lobbying

ADS_PROMO - From Part IX - line 12 (A), Advertising and promotion

EXPENSES_TOTAL - From Part IX - line 25 (A), Total functional expenses

ASSETS_TOTAL_BOY - From Part X - Line 16 (A), Total assets: beginning of year

ASSETS_TOTAL_EOY - From Part X - Line 16 (B), Total assets: end of year

LIABILITY_TOTAL_BOY - From Part X - Line 26 (A), Total liabilities: beginning of year

LIABILITY_TOTAL_EOY - From Part X - Line 26 (B), Total liabilities: end of year

CHARITY_CARE_COST_e - From Sched H Part I - Line 7a(e), Net charity care expense

CHARITY_CARE_COST_f - From Sched H Part I - Line 7a(f), Charity care as a percent of total expenses (as %)

CHARITY_CARE_UNREIMBURSED_MEDICAID_c - From Schedule H Part I - Line 7b(c), Total Medicaid expenses 

CHARITY_CARE_UNREIMBURSED_MEDICAID_e - From Schedule H Part I - Line 7b(e), Net Medicaid expense attributable to community benefit (i.e. Medicaid shortfall or surplus)

CHARITY_CARE_UNREIMBURSED_MEDICAID_f - From Schedule H Part I - Line 7b(f), Medicaid shortfall as a percent of total expenses (as %)

BENEFITS_OTHER_e - From Schedule H Part I - Line 7j(e), Total "other" community benefit expenses

BENEFITS_OTHER_f - From Schedule H Part I - Line 7j(f), Total other community benefit expenses as a percent of expenditures (as %)

BENEFITS_TOTAL_e - From Schedule H Part I - Line 7k(e), Net community benefit expenses, all categories

BENEFITS_TOTAL_f - From Schedule H Part I - Line 7k(f), Net community benefit expenses as a percent of total expenses (total community benefit spending) (as %)

BAD_DEBT_EXPENSE - From Schedule H Part III - Line 2, Bad debt at cost 

BAD_DEBT_PATIENTS - From Schedule H Part III - Line 3, Bad debt attributable to patients qualifying for charity care (i.e. "bad charity care") 

MEDICARE_TOTAL_REVENUE - From Schedule H Part III - Line 5, Medicare revenue 

MEDICARE_ALLOWABLE_COSTS - From Schedule H Part III - Line 6, Medicare allowable costs 

MEDICARE_SURPLUS - From Schedule H Part III - Line 7, Medicare shortfall or surplus

GROUP_EXEMPTION - If form Header H(a) indicates that the 990 includes information for affiliates under a group exemption, then this four-digit number assigned by the IRS to organizations holding group exemption letters. It's entered in Header H(c). Leading zeros have been truncated.

In addition to the main spreadsheet, you should review an additional spreadsheets with compensation information.

Personnel Pay

This file provides the names and compensation of officers, trustees, key personnel and the five most highly paid employees as outlined in Part VII, Section A of the 990. Review that document to confirm the information. Some individuals are listed multiple times because they are both officers and also board members. Some, like university presidents, may not have a direct hands-on role in the operations of the hospital. This figure does not include deferred compensation or nontaxable benefits.

Here are the column names, the specific source from Guidestar or the 990 form, and a brief description:

xml_document_id - From Guidestar, matches organization data file

EIN - From Header Block D, Employer Identification Number (EIN)

ORGNAME - From Header block C, Organization name

TAX_YEAR - From Header Block B, Per GuideStar convention, Tax Year = year from tax year ending

PERSON_ID - GuideStar unique row ID

NAME - From Part VII-Section A (A), Name of officer or trustee

TITLE - From Part VII-Section A (A), Title of officer or trustee

POSITION_OFFICER_CBX - From Part VII-Section A (C), Position-officer

COMP_ORG - From Part VII-Section A (D), Compensation of employee

COMP_RELATED_ORG - From Part VII-Section A (E), Compensation from related organization

COMP_OTHER - From Part VII-Section A (F), Estimated amount of other compensation from the organization and related organization

TOTAL_COMP  - Calculated by GuideStar: sum of the 3 compensation fields