Not an allegation. Not an investigation. These hospitals checked the box themselves on their federal tax filing. Read the question carefully, because it is narrower and sharper than it first appears: Schedule H asks what a hospital did before making reasonable efforts to determine whether the patient qualified for financial assistance. Federal law — 26 U.S.C. §501(r)(6) — prohibits exactly that. These ten reported doing it anyway.
Two things this does not mean. It does not mean the other 1,703 filers never sue patients — the form does not ask that, and a hospital may sue after screening someone and still correctly answer “none.” And because the form groups lawsuits, liens and wage garnishment together, a hospital that places liens but never sues answers the same way as one that sues.
About 40% as much free care — while their bad debt runs higher (median 4.3% of expenses vs 2.5%). Bad debt is unpaid patient bills; charity care is bills forgiven. Both figures point the same way, on ten filers. Whether that is a pattern or a coincidence of a small group is a fair question, and one this page cannot settle. Bad-debt medians rest on slightly different denominators: bad debt is not reported by 80 of the 1,703 filers attesting none, and by none of the ten.
They are also small: about $82M in average annual expenses against $620M for hospitals attesting to no collection actions. Rural and small-town, mostly — places where the hospital is the only one for an hour in any direction, and where the person being sued has nowhere else to go next time.
Ten hospitals is a small group, and small groups move on little — the same comparison on means rather than medians gives a different multiple, which is why we state the method. An attestation is also not a finding of conduct: it is what the hospital told the IRS. Read this as a pattern worth asking about, not a law of nature — and see what the percentage can and can’t tell you.
Salem Community Hospital in Salem, Ohio filed $0 in net charity care for three consecutive years — FY2019, FY2020, FY2021 — in filings where it also attested to using legal or judicial process against patients. In those same years it reported roughly $100M+ in annual expenses.
A filed zero is not automatically a lie: it happens when offsetting revenue equals or exceeds the gross cost of assistance, which is a legitimate accounting outcome. We label it, we never rank it, and we never call it charity that vanished. But it is a fair question for a board to ask: how were we pursuing patients through the courts in a year we recorded no net free care?
1,759 hospitals checked “no collection actions.” We cannot yet tell you which of them are telling the truth, and we will not pretend otherwise.
So this section is empty, and it stays empty until the work is done. Ohio’s courts are the pilot. Here is what it takes:
Until every one of those steps is done for a given hospital, this site says exactly what it knows: they attested to this; nobody has checked. That sentence is the difference between a truth instrument and a weapon.
Where it comes from. Every figure is taken from a hospital’s own IRS Form 990, Schedule H, and links to the filing it came from. We report what hospitals reported. Where a hospital reported nothing, we say “not reported” — we never estimate, impute, or fill a gap.
What it is not. Where we say a hospital “attests” to something, that describes what it told the IRS. It is not a finding about its actual conduct, and it is not a court record. Figures are as filed for the fiscal year shown and may not reflect current policy or practice.
Draw your own conclusions — from the filings. This site exists so you can read the record yourself. It is published for general information only. It is not legal, medical, tax, or financial advice, it is not a recommendation about where to seek care, and it should not be relied on for any decision without confirming the underlying filing and checking with the hospital directly.
Corrections. If a figure here does not match the filing it links to, we want to know and we will correct it. cashpaymed.org