Tax-exempt health system · 501(c)(3) · Chicago, Illinois

CommonSpirit Health

Lost $687 million on operations, made $944 million anyway, and paid its CEO $14.2 million. For every dollar of free care, it takes in nearly ten dollars in subsidies and write-offs.

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Hospital facilities

142

Revenue, FY2025

$39.1B

Net assets

$23.6B

CEO compensation

$14.2M

Long-term debt

$17.2B

Where the money sits

As of June 30, 2025, from the audited statements and Form 990

$20.5B

in cash and investments on the balance sheet.

Cash $2.01B, short-term $0.26B, long-term $18.20B. FY2025 annual report, consolidated balance sheet (Ernst & Young).

$1.94B

held in Cayman Islands insurance companies it controls.

First Initiatives Insurance Ltd, Grand Cayman: $1.89B in assets, $525M in income. Strategic and Physicians Insurance Ltd, Grand Cayman: $48.8M. Form 990 Schedule R, FY2025.

$430.9M

sent abroad for investments in one year.

Caribbean $339.7M, Europe $91.1M. Form 990 Schedule F, CommonSpirit Health and Dignity Health, FY2025.

33 years

of free care its cash and investments could pay for at today's level.

$20.46B ÷ $616.2M of charity care a year (Schedule H 7a, all hospital filers).

The Fair Share Test

$9.99

At least. Eleven of nineteen ledger lines filled so far.

in subsidies and write-offs for every $1 of free care a patient actually received.

Subsidies & write-offs (so far)$6.16B

Free care actually delivered$616.2M

Free care is financial assistance at cost, net, as CommonSpirit's own hospital filers report it (Schedule H Line 7a, FY2025). The system's Medicare cost reports put it higher, at $864.9M (Worksheet S-10); on that basis the ratio is $7.12. The ratio only rises as the open ledger lines fill.

The Subsidy Ledger

Fiscal year 2025, every line sourced

Federal programs
The 340B program: drug discount spread (89 registrations, 811 contract pharmacy arrangements)¹	Drug manufacturers	Pending
Graduate medical education: direct GME²	Medicare	Pending
Graduate medical education: indirect (IME)³	Medicare	$123.0M
Medicare DSH adjustment⁴	Medicare	$108.7M
Medicare uncompensated care payments (71 hospitals)⁵	Medicare	$174.3M
Medicaid DSH⁶	Federal and state Medicaid	Pending
Medicare bad debt reimbursement⁷	Medicare	Pending
Tax exemptions
Federal income tax exemption (21% of $931M audited excess)⁸	U.S. taxpayers	$195.5Mest.
Tax-exempt bond financing on $4.95B of bonds (interest savings)⁹	U.S. and state taxpayers	Pending
Property tax exemption ($14.8B of land and buildings; range $204.1M to $218.4M)¹⁰	County and school district	$204.1Mest.
State income tax exemption (California rate; sales and use tax not estimated)¹¹	State taxpayers	$82.3Mest.
Charitable contribution deduction¹²	U.S. taxpayers	Pending
State Medicaid financing
Medicaid supplemental and state-directed payments¹³	Federal and state Medicaid	Pending
Provider tax: net gain after tax paid¹⁴	Federal Medicaid match	Pending
The community benefit write-off
Charity care, as claimed¹⁵	Patients and taxpayers	$616.2M
Medicaid shortfall claimed as community benefit¹⁶	Taxpayers	$1,999.1M
Medicare shortfall touted as community benefit¹⁷	Taxpayers	$1,065.4M
Bad debt written off¹⁸	Patients and payers	$1,008.5M
Events, education, research, sponsorships and contributions¹⁹	Taxpayers	$580.0M
Total subsidies and write-offs		$6,157.0M+
For comparison: free care actually delivered to patients, at cost		$616.2M

“est.” marks a figure calculated by The Rojas Report; the method is on the methodology page. A dash marks a line still being built from source filings.

Sources

HRSA 340B OPAIS covered entity export of September 29, 2026 (89 participating parent registrations, 306 child sites, 811 active contract pharmacy arrangements); spread estimate pending a method decision
CMS Medicare cost report, Worksheet E-4; pending the HCRIS download
CMS Hospital Provider Cost Report (CostReport_2024_Final.csv, data.cms.gov), latest report per CCN, sum of Total IME Payment over the 128 cost-report hospitals: $122,958,063
CMS Hospital Provider Cost Report (CostReport_2024_Final.csv, data.cms.gov), latest report per CCN, sum of Disproportionate Share Adjustment over the 128 cost-report hospitals: $108,669,789
CMS FY2027 IPPS correction notice, Medicare DSH supplemental data file, Total Uncompensated Care Payment summed over the 71 CommonSpirit hospitals projected to receive DSH in FY2027: $174,256,404
State Medicaid DSH audit reports (medicaid.gov), 19 states; pending the download
CMS Medicare cost report, Worksheet E Part A, reimbursable bad debts; pending the HCRIS download
Rojas Report estimate: excess of revenues over expenses attributable to CommonSpirit Health $944M less the $13M gain on early extinguishment of debt (FY2025 audited statements) = $931M, at the 21% federal corporate rate
Form 990 FY2025 Part X Line 20, tax-exempt bond liabilities at year end: CommonSpirit Health $4,121.6M, Dignity Health $732.6M, Yavapai Community Hospital Association $94.0M; interest savings pending a sourced taxable-to-tax-exempt yield spread (MSRB EMMA)
Rojas Report estimate: land, land improvements and buildings at gross historical cost, $14,792,897,912 (CMS cost reports, latest per hospital), times each state's published rural commercial property tax rate (Lincoln Institute of Land Policy, 50-State Property Tax Comparison Study); low case $204,077,112, high case $218,425,834
Rojas Report estimate: the same $931M base at California's 8.84% corporation franchise tax rate (Cal. Rev. & Tax. Code section 23151), the headquarters-state rate without apportionment
Form 990 Schedule B contribution totals, all filers; pending a donor tax-rate assumption
CMS state-directed payment approvals and state supplemental payment (UPL) reports, 19 states; pending the download
State hospital provider tax program reports (California Hospital Quality Assurance Fee first); pending the download
IRS Form 990 Schedule H Part I Line 7a column (e), financial assistance at cost, net, summed over the 61 hospital filers, FY2025: $616,247,940
IRS Form 990 Schedule H Part I Lines 7b and 7c column (e), unreimbursed Medicaid and other means-tested programs, net, summed over the 61 hospital filers, FY2025: $1,999,128,447
IRS Form 990 Schedule H Part III Line 7, Medicare surplus or shortfall, summed over the 61 hospital filers, FY2025: a shortfall of $1,065,404,951
IRS Form 990 Schedule H Part III Line 2, bad debt expense, summed over the 61 hospital filers, FY2025: $1,008,450,448
IRS Form 990 Schedule H Part I Line 7k column (e), total community benefit $3,195,357,545, less Lines 7a to 7c ($616,247,940 and $1,999,128,447), summed over the 61 hospital filers, FY2025: $579,981,158

Leadership & pay

Wright Lassiter III, CEO$14.2M

Tammara Wilcox, SVP Payer Strategy$9.2M

Terika Richardson, COO$8.3M

Form 990, Schedule J

Lobbying & politics

Federal lobbying, four quarters$240K

State lobbyingPending

AHA & state association duesPending

Senate LDA filings · state ethics filings · Form 990

Market power

CON objections filedPending

Practices acquired, 5 yrsPending

Aircraft registeredPending

State CON dockets · press & filings · FAA registry

Take the numbers with you.

The full dataset for CommonSpirit Health: every subsidy line by hospital and year, plus the source documents. And a board-ready brief you can hand to a lawmaker, an attorney general or your own partners.

This system's datasetPrice pending This system's hospitals, by statePrice pending Every system, all-accessPrice pending

Sources: IRS Form 990 and Schedule H, CMS Medicare cost reports (HCRIS), HRSA 340B OPAIS, CMS DSH and GME data, MSRB EMMA bond disclosures, county assessor records, state Medicaid filings. Methodology · Report a correction