METHOD, IN ONE PAGE

Source. Every nonprofit hospital files IRS Form 990 with Schedule H. The IRS publishes every e-filed return as XML. This report reads the 2025 and 2026 releases, keeps the 19,245 filings that include Schedule H, and takes the latest fiscal year for each of 2,306 filers.

CEO pay. Form 990 Part VII lists officers and the highest-paid employees with three compensation columns: from the organization, from related organizations, and other (deferred pay and benefits). CEO pay is the sum. The chief executive is the person whose title says CEO or chief executive and is not marked former; where the filing is ambiguous it was read by hand and the decision recorded with its reason.

Charity care. Schedule H Part I line 7a: free or discounted care under the hospital's own financial assistance policy, at cost, net of payments received for it. The IRS does not accept charges (list price). Bad debt and Medicaid shortfall are separate lines and are not counted.

Systems. Filings reporting the same chief executive are one system; revenue, expenses and charity care are summed and the executive counted once. Where a system's hospitals file under local presidents, a shared system officer in Part VII is the test for membership. Every combination over $1 billion was checked by hand.

The headline count. General hospital systems with revenue over $100 million where CEO pay exceeded charity care. Children's hospitals (Medicaid covers most low-income children) and specialty hospitals are excluded and listed with reasons. Each of the 73 was checked against its filing, including the Part VI narrative, for charity care reported on another line; none was found.

Independent check. CEO pay was compared against CEO Paycheck, which reads the same filings with its own method: 121 of 129 shared systems agree to the dollar; the eight differences are explained in the reproduction manual.

What the report does not do. It does not estimate the value of the tax exemption, does not count public hospitals (they file no Form 990), and does not say whether anyone is overpaid. It puts two of the hospital's own numbers beside each other.

Full manual, every rule and every manual decision: https://everythingisbroken.org/reports/hospital-ceo-pay/manual.html
