tell their financial story. It is a narrative carefully plated for public consumption: billions in
“community benefits,” selfless care for the underserved, and a moral justification for
billions more in tax exemptions. On paper, it looks like altruism at scale. In practice, it often
looks like creative accounting.
The latest analysis of New York City’s not-for-profit hospitals provides a perfect case study.
According to the report, these institutions delivered $9.5 billion in “community benefits” in
2023, rising to $11.3 billion when additional categories are included. Against roughly $2.2
billion in tax exemptions, the conclusion seems obvious: hospitals give far more than they
receive.
Case closed—right? Not quite.
Because what counts as a “community benefit” is less a measure of generosity than a
masterclass in definitional elasticity. And when you pair that elasticity with how these
same institutions compensate their leadership, the question becomes harder to ignore: are
we measuring charity—or just cooking the books?
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