How do reserve-to-expense ratios at other major pediatric research hospitals (Boston Children's, Seattle Children's, Nationwide) compare to St. Jude?
Executive summary
St. Jude’s publicly reported reserve has been widely reported at roughly $5 billion—about four years’ worth of operating expenses—drawing scrutiny for what critics call “hoarding” even as families struggle [1] [2] [3]. Available public materials in the reporting provided do not include clear, comparable reserve-to-expense ratios for Boston Children’s, Seattle Children’s or Nationwide Children’s, so direct numeric comparisons are not possible from these sources; what follows explains what is known about St. Jude, summarizes the limits of the public record for peers, and lays out why apples‑to‑apples comparisons often break down [4] [5] [6] [7].
1. St. Jude: a large reserve, a stated rationale, and external criticism
Multiple outlets and institutional histories report that St. Jude had about $5 billion in reserves in the early 2020s—an amount characterized as roughly four years of expenses—which ProPublica and others flagged as unusually large and led to criticism that the charity was “hoarding” donor dollars while broader pediatric cancer research funding is constrained [1] [2] [3]. St. Jude and its fundraising arm ALSAC respond that such reserves are deliberate: the hospital says it costs more than $2 billion annually to sustain and grow operations and that long multi‑year research projects can require multi‑million dollar outlays, which justifies maintaining a sizable reserve to underwrite long time horizons and capital plans [8] [9]. ProPublica’s reporting emphasizes public perceptions and consequences for families and the research ecosystem; St. Jude’s own statements emphasize operational continuity and long‑term research commitments [3] [8].
2. What the sources say — and don’t say — about Boston Children’s, Seattle Children’s and Nationwide
The documents and databases provided include institutional descriptions, an audited report excerpt for Boston Children’s and corporate profile pages for Seattle Children’s and Nationwide, but they do not publish explicit reserve‑to‑expense ratios or headline reserve balances comparable to St. Jude’s $5 billion figure in these excerpts [4] [5] [6] [7]. Boston Children’s consolidated filings and public reports exist [4] and would be the place to find unrestricted net asset levels or board‑designated reserves, but the supplied snippet does not extract a reserve dollar amount or a reserve‑to‑expense calculation. CB Insights and profile pages note services and scale but do not provide the nonprofit reserve metrics needed for a ratio [5] [7] [6]. Therefore, no reliable headline numeric comparison of reserve‑to‑expense ratios between St. Jude and the three named hospitals can be asserted from the material provided here [4] [5] [6].
3. Why direct comparisons are technically tricky and often misleading
Even when numbers exist, nonprofit reserves are reported differently across institutions—board‑designated funds, unrestricted net assets, endowments, and cash reserves can be categorized in diverse ways—so a simple “reserves divided by annual expenses” can mislead unless calculated from standardized line items in audited Form 990s or audited financial statements [10] [11]. St. Jude’s framing ties reserves to multi‑year research projects and capital plans [8], while other hospitals may hold operating liquidity, endowment principal, or donor‑restricted funds in distinct buckets that serve different legal and mission purposes; the provided sources do not resolve those classification differences for Boston Children’s, Seattle Children’s or Nationwide [4] [5] [6].
4. The stakes: transparency, mission tradeoffs and competing narratives
The clash in reporting—ProPublica’s critique that St. Jude’s reserves are excessive versus the institution’s defense that large reserves fund long‑term research and mission continuity—illustrates a broader debate over how health charities balance stewardship, risk management and immediate programmatic need [3] [8]. Peer hospitals are often invoked in these debates because rankings and reputations (U.S. News listings) show multiple centers run major pediatric research programs; the sources show Boston, Seattle and Nationwide as top centers but don’t supply reserve metrics to adjudicate whether St. Jude is an outlier relative to them [12] [13] [5]. That gap fuels interpretations shaped by institutional agendas: watchdog reporting emphasizes donor‑use norms and equity across the pediatric research field, while hospital statements emphasize fiscal prudence for multi‑year scientific investments [3] [8].
5. Bottom line: St. Jude’s ratio is documented; comparable ratios for the three peers are not in the provided reporting
Reporting provided documents St. Jude’s multibillion‑dollar reserve and the institution’s explanation for holding large reserves, but it does not include clear reserve totals or reserve‑to‑expense ratios for Boston Children’s, Seattle Children’s or Nationwide Children’s that would support a direct numeric comparison [1] [2] [8] [4] [5] [6]. Achieving a rigorous comparison would require standardized figures from audited financial statements or Form 990 filings for each hospital—specifically comparable line items for unrestricted and board‑designated reserves and the same annual expense basis—which are not present in the materials supplied here [11] [10].