Has St. Jude's percentage to patient care changed over the past five years and why?
Executive summary
St. Jude’s share of total dollars going to “patient care and research” has been the subject of competing narratives: the hospital and its charity ALSAC report a high combined percentage (commonly cited as ~82% toward patient care, research, and future needs), while independent reporting and analyses of IRS filings show that, over roughly the past five fiscal years, about half of donations went to patient care and research, with roughly 30% to fundraising and ~20% to reserves — a meaningful shift driven by large fundraising operations, explicit reserve-building for a multibillion-dollar strategic plan, and accounting differences between ALSAC and the hospital [1] [2] [3] [4].
1. What the numbers say: two competing pictures
Public-facing St. Jude materials and its finance pages emphasize a high percentage of dollars supporting patient care, research, and future needs and highlight a multiyear strategic plan that commits $12.9 billion to expand care and research through FY22–27 [5] [6], whereas investigative reporting that parsed IRS filings concluded that since about 2017 roughly half of contributions went to hospital care and research, about 30% to fundraising, and about 20% to reserves — including a spike in reserves that saw billions accumulated by 2021 [2] [3] [7].
2. Has the percentage changed over the last five years?
Yes — when measured the way ProPublica and other analyses did (donor dollars raised by ALSAC allocated to immediate patient care/research at the hospital), the proportion dedicated to those categories fell to about half of total contributions in the five-year window analyzed, rather than the much higher percentages asserted in some of St. Jude’s broader-year messaging; this decline reflects both growing fundraising spends and a substantial build-up in reserves by the charity and hospital system [2] [3] [7].
3. Why fundraising and reserves grew: campaigns, celebrity events and strategy
Fundraising surged — record single-year gifts, large celebrity- and corporate-backed campaigns (for example, high-profile private spaceflight and influencer fundraising drove huge revenue spikes) — and ALSAC’s fundraising apparatus returned a persistent share of revenue to fundraising costs, which independent analyses put near 30% on average; simultaneously St. Jude and ALSAC intentionally grew reserve accounts to fund an expensive FY22–27 strategic plan and capital projects, a rationale the hospital publicly cites as prudent against market swings and future capital needs [1] [3] [5].
4. Accounting lines and the “who’s counting what” problem
Part of the apparent divergence is methodological: St. Jude often aggregates “patient care, research and future needs” in public percentages and counts ALSAC transfers to the hospital alongside hospital operating receipts, while reporters who examined IRS Form 990s and ALSAC’s own filings separated ALSAC fundraising and reserve growth from immediate program spending, producing a lower percentage for current patient care/research [1] [2].
5. The hospital’s response and subsequent changes
St. Jude has defended its reserve strategy as prudent and tied to long-term capital and program needs and publicly noted adjustments to family benefits and disclosures after scrutiny; independent coverage records the hospital increasing some family supports following the reporting, and St. Jude continues to publish its financial statements and strategic commitments as context for reserves and spending plans [3] [6] [5].
6. What remains uncertain or contested
Precise year-to-year percentage swings depend on which financial source and accounting boundary one uses (ALSAC vs. hospital operations, donations vs. total revenue including insurance reimbursements), and publicly available summaries do not fully reconcile donor-facing claims with the granular allocations reporters derived from tax filings; therefore, while independent reporting documents a drop to about half for direct patient-care/research from contributions over the multi-year span, that finding coexists with St. Jude’s framing that much of its revenue is earmarked for future program expansion and capital investment [2] [1] [3].
7. Bottom line for donors and observers
Donors should understand that St. Jude’s reported percentage to immediate patient care and research has effectively been lower in recent years when measured by independent analyses of ALSAC-driven contributions — largely because fundraising costs and reserve accumulation have grown — but the hospital argues those funds are being marshaled for a defined long-term strategic expansion and to buffer economic uncertainty; both the reporters’ methodological critiques and the hospital’s stated stewardship goals are documented in the public record [2] [3] [5].