Nashville’s 2 big nonprofit hospital systems rank 7th and 9th of Tennessee’s 9 biggest on charity care, measured as a share of what each one spends. Vanderbilt University Medical Center put 2.8 percent of its spending into it and Ascension Saint Thomas 2.4. St. Jude in Memphis put in 7.5 percent and Erlanger in Chattanooga 5.7.
VUMC gave the most dollars of the 9, $233M, out of $8.3B in spending. Between its fiscal 2018 return, the first with a full year of its chief executive’s pay, and its fiscal 2025 return, its charity care grew 2.5 times and his pay grew 3.4 times.
Vanderbilt University, a separate nonprofit from the medical center, has had the same best paid person for 4 years running, its chief investment officer, Anders Hall. He made $8.4M for 2024, $2.1M of it deferred pay reported on earlier returns. The endowment his office invests earned $5.1B over 5 years, and $3.9B of it came in 1 of them.
Charity care, ranked
Charity care here is line 7a of Schedule H, the hospital schedule of each system’s federal tax return. It is the free and discounted care a hospital gives under its own financial assistance policy, counted at what that care cost the hospital. The share is that cost over the system’s total spending on the same returns. Nonprofit hospitals are exempt from federal income tax, and this line is where they report the care they gave to patients who qualified for help paying.
Every nonprofit hospital system headquartered in Tennessee with more than $1B in revenue on its latest public returns is on the list. Each system’s sum includes the hospitals it runs in other states, Baptist’s in Mississippi and Arkansas, Ballad’s in Virginia, Erlanger’s Murphy Medical Center in North Carolina and Methodist’s Olive Branch hospital in Mississippi. A system that runs several hospital companies is summed across every one of its returns that carries Schedule H, 18 for Baptist, 9 for Covenant and 7 for Ballad.
- St. Jude Children’s Research Hospital, Memphis, 7.5 percent, $142.7M
- Erlanger, Chattanooga, 5.7 percent, $92.7M
- Methodist Le Bonheur Healthcare, Memphis, 4.7 percent, $107.4M
- Baptist Memorial Health Care, Memphis, 4.5 percent, $174.3M
- Covenant Health, Knoxville, 3.5 percent, $56.5M
- University of Tennessee Medical Center, Knoxville, 2.9 percent, $46.3M
- Vanderbilt University Medical Center, Nashville, 2.8 percent, $233.1M
- Ballad Health, Johnson City, 2.6 percent, $65.6M
- Ascension Saint Thomas, Nashville, 2.4 percent, $45.7M
Hospitals also report a wider measure, total community benefit on line 7k, which adds Medicaid shortfalls, research, training and community programs. That measure counts research, and on it VUMC still ranks 7th and Saint Thomas 8th. VUMC’s 7th place on charity care is close to 6th. It trails UT Medical Center by 0.06 of a point, and UT’s year ends 6 months earlier.
Saint Thomas Midtown is counted, inside the Saint Thomas West return, which says it covers both hospitals. Saint Thomas’s returns also list the highest free care limit of the 8 systems that bill patients, free care for a family earning up to 250 percent of the federal poverty line, level with Erlanger.
Regional One in Memphis files the same schedule and comes in under the line, at $809M in revenue. HCA’s TriStar hospitals and the other for profit chains file no such return.
VUMC’s chief executive
Jeffrey Balser is president and chief executive on every VUMC return since its first, for fiscal 2016. The fiscal 2025 return puts his pay for calendar 2024 at $16.5M. VUMC says in the same return that $6.0M of that was a 4 year payout of deferred pay already reported on earlier returns, so it is left out here. That leaves $10.4M for 2024. For calendar 2017, on the fiscal 2018 return, his pay was $3.1M. That is the first full year of his pay on any VUMC return. The fiscal 2017 return covers only April 30 to December 31, 2016, because the university paid him until VUMC split from it.
Over the same returns VUMC’s revenue grew 2.1 times, from $4.1B to $8.7B. Its charity care grew 2.5 times, from $93.2M to $233.1M, and went from 2.3 percent of spending to 2.8. His pay grew 3.4 times.
Vanderbilt University
Anders Hall is Vanderbilt’s vice chancellor for investments and chief investment officer, and he is the best paid person on each of the university’s last 4 returns. He made $8.4M for 2024, and $2.1M of that was deferred pay already reported on earlier returns. Without it he is still first, at $6.3M.
Head football coach Clark Lea was third on the same return at $4.4M, which is $4.3M in reportable pay plus other compensation. Second was Jerry Stackhouse at $4.8M, $3.46M of it severance after his time as men’s basketball coach ended in 2024. Hall’s $8.4M, Lea’s $4.4M and Stackhouse’s $4.8M are each the return’s total, other compensation included.
The endowment earned $5.1B over the 5 fiscal years to June 2025, by Schedule D of the university’s own returns, which counts the gains and income its investments made each year. $3.9B of that came in the year to June 2021. The 4 years since earned $1.2B on a fund that started them at $10.9B.
Hall told the Vanderbilt Hustler the endowment returned 12.1 percent a year over those 5 years and beat its policy benchmark by more than 2 points a year. Each year’s earnings over the balance it started the year with compound to about 12 percent a year across the same 5, close to his figure. Leave out fiscal 2021 and the other 4 compound to about 3 percent a year.
What cuts against this
A system that treats more uninsured patients will spend more on charity care, and the returns do not report how many each one treats. That is the open question on the ranking.
The systems close their books on different dates. The latest public year ends June 2025 for 5 of them, December 2024 for Methodist Le Bonheur, Covenant and UT Medical Center, and September 2025 for Baptist, whose year began in October 2024.
St. Jude bills no family for care, and its revenue includes transfers from its fundraising arm, ALSAC, so it sits apart from the other 8. Without it Erlanger leads, and the bottom 3 stay where they are.
The $6.0M payout is left out on VUMC’s word. We could not match all of it to deferred pay VUMC showed for Balser on earlier returns, so $10.4M is the low end of his 2024 pay.
Vanderbilt’s 12.1 percent is its own investment return. The 12 and the 3 here come from a simpler yardstick, each year’s earnings over the starting balance, which leaves out money moving in and out during the year.