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CASE 3: Charitable Contributions and Debt: A Comparison of St. Jude Children’s Research
Hospital/ALSAC and Universal Health Services
Hospitals are an industry in which both not-for-profits and investor-owned facilities operate. The
sources of capital available to the not-for-profits include charitable contributions and debt
offerings—unless they are governmental, in which case, higher taxes are also an alternative.
Debt availability is always, in part, a function of performance, and just as failures have arisen in
both sectors, about one-third of the investor-owned hospitals have been described as losing
money. Of interest is how can one effectively evaluate such an industry, with this type of
diversity in organizational forms and capital availability? A necessary prerequisite to such an
evaluation is to have a firm understanding of how charitable contributions are presented.
St. Jude Children’s Research Hospital/ALSAC has the mission of finding cures for children with
catastrophic diseases through research and treatment. For the fiscal year 1999, this entity
reported total assets of $221,664,232 and income of $177,071,890. A Web site
at http://www.stjude.org, as well as Guidestar’s listing, references a Form 990 (Return of
Organization Exempt from Income Tax) filing, availability of audited financial statements upon
request, and information that the hospital has 2,100 employees and 350 volunteers. Founded in
1962, the organization seeks funds from contributions and grants for unrestricted operating
expenses, specific projects, buildings, and endowments. More than 4,000 patients are seen
annually, with a hospital maintaining 56 beds. The Form 990, Part III states that the hospital
provided 15,231 inpatient days of care during the fiscal year and patients made 40,982 clinic
visits. ALSAC is the American Lebanese Syrian Associated Charities, Inc., the fund-raising arm of
St. Jude Children’s Research Hospital. It reported 1999 total assets of $1,007,699,320 and
income of $274,123,399. This organization reports the number of employees as 565 and the
number of volunteers as 800,000. With its sole focus on the hospital, ALSAC’s self-description
explains that no child has ever been turned away due to an inability to pay for treatment and
explains key accomplishments in the research area achieved by St. Jude’s research and
treatment of children with catastrophic diseases. What is borne out by the example of St. Jude
is the fact that a review of the Form 990 filed for the fiscal year ending 6/30/99 indicates in Part
VI the names of related organizations: ALSAC and St. Jude Hospital Foundation, both of which
are tax exempt. To gain a sense of capital availability to a not-for-profit entity, affiliated entities
must be considered. In addition, the role of volunteers is a source of human capital not
effectively captured within the framework of financial statements for not-for-profits, as
reflected in the Form 990 for the fiscal year ending 6/30/99 for ALSAC, which states in Part VI:
Unpaid volunteers have made significant contributions of their time, principally in fund-raising
activities. The value of these services is not recognized in the financial statements since it is not
susceptible to an objective measurement or valuation and because the activities of these
volunteers are not subject to the operating supervision and control present in an
employer/employee relationship. Hence, as one evaluates capital sources and uses by not-for-profits, care is needed to consider
affiliated organizations’ role, total contributions, and the effect of volunteerism on the
comparability between not-for-profit and investor-owned operations.
Universal Health Services, Inc. filed its 10-K on March 28, 2001, for the calendar year 2000,
which includes comparative information for 1999. Analysts have described the company as the
most aggressive company in the industry over the 1999–2001 time frame in making
acquisitions, particularly of not-for-profit operations and investor-owned operations
experiencing losses. The company is praised for it high operating leverage, the relatively small
number of shareholders relative to the magnitude of total revenue, and stock price as a multiple
of earnings. The company operates 59 hospitals and, as of 1999, had an average number of
licensed beds of 4,806 at acute care hospitals and 1,976 at behavioral health centers, with
patient days of 963,842 and 444,632, respectively. Of interest is a commentary on the
competition found in the company’s filing:
Competition
In all geographical areas in which the Company operates, there are other hospitals which
provide services comparable to those offered by the Company’s hospitals, some of which are
owned by governmental agencies and supported by tax revenues, and others of which are
owned by nonprofit corporations and may be supported to a large extent by endowments and
charitable contributions. Such support is not available to the Company’s hospitals. Certain of
the Company’s competitors have greater financial resources, are better equipped and offer a
broader range of services than the Company. Outpatient treatment and diagnostic facilities,
outpatient surgical centers and freestanding ambulatory surgical centers also impact the
healthcare marketplace. In recent years, competition among healthcare providers for patients
has intensified as hospital occupancy rates in the United States have declined due to, among
other things, regulatory and technological changes, increasing use of managed care payment
systems, cost containment pressures, a shift toward outpatient treatment and an increasing
supply of physicians. The Company’s strategies are designed, and management believes that its
facilities are positioned, to be competitive under these changing circumstances. (Source: 10-K
filed 3/28/2001)
Financial information is provided in Tables 5.3-1 and 5.3-2 for both the not-for-profit and the
investor-owned hospitals. Fiscal Year Ended 1999 Contributions, gifts, grants and similar amounts
received: Direct public support St. Jude Children’s
Research Hospital Form
990* American Lebanese Syrian
Associated Charities, Inc. (ALSAC)
Form 990* $91,978,426 $231,793,748 Indirect public support 2,906,934 Government contributions (grants) 31,469,447 Program service revenue, including government
fees and contracts (i.e., health insurance revenue) 46,034,710 Accounts receivable 24,217,029 Pledges receivable
Allowance for doubtful accounts 23,604,748
9,363,328 Program service expenses 99,282,906 Program service expenses: Research 87,225,830 Program service expenses: Education and training 5,471,186 Program service expenses: Medical Services 93,735,602 Reconciliation of revenue, gains, and other support
to audited numbers: net unrealized gains on 4,230,764 −4,023,815 65,891,269 Fiscal Year Ended 1999 St. Jude Children’s
Research Hospital Form
990* American Lebanese Syrian
Associated Charities, Inc. (ALSAC)
Form 990* investments
Deferred grant revenue 1,857,628 (Statement 5) Support from American Lebanese Syrian Associated
91,978,426 (paid per Statements 4,
91,978,426 (Statement 7)
Charities, Inc.
6)
Excluded contributions 2,746,295 (Statement 1) Excess or (deficit) for the year −10,933,191 120,521,982 Net assets or fund balances at end of year 199,707,440 994,501,910 Temporarily restricted 15,715,890 Permanently restricted 14,000,000 247,147,826 Total liabilities 21,956,792 7,017,192 Schedule of deferred debits & credits by contract
(FAS 116 adjustment noted to result in this
deferred revenue) 157,628 Table 5.3-1: Financial Comparisons of the Not-for-Profit Entities
* The GuideStar.org Web site (http://www.guidestar.org) provides access to Forms 990 in .PDF
format. Table 5.3-2: Universal Health Services, Inc.’s Financial Excerpts*
Income Statements (in thousands) Reported 1999 Calendar Year Net revenues $2,042,380 Operating charges 1,913,346 Components:
Salaries, wages, and benefits 793,529 Provision for doubtful accounts 166,139 Lease and rental expense 49,029 Interest expense, net 26,872 Net income 77,775 Total assets 1,497,973 Total liabilities 856,362 Income Statements (in thousands)
Total retained earnings
Capital stock
Paid-in capital in excess of par Reported 1999 Calendar Year
482,960
306
158,345 * The 10-K filing as of 3/28/2001 at EDGAR (http://www.sec.gov/edgar.shtml) provides financial
statement information for 2000 and 1999.
Requirement A: Recording Revenue
1. What is meant by the reference in Table 5.3-1 to an FAS 116 adjustment? (150 words
maximum)
2. How are contributions recorded? Is there a distinction between pledges receivable and
accounts receivable? (150 words maximum)
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