The St. Jude controversy centers on a gap between the hospital’s famous promise that families “never receive a bill” and the financial reality many families face: the pledge covers direct medical costs, travel, housing, and food at the hospital, but not the lost wages, mortgage payments, car payments, and household bills that pile up during a child’s cancer treatment. A 2021 ProPublica investigation reported that while families drained savings and turned to GoFundMe, St. Jude held billions in reserves it was adding to each year. Separate reporting has criticized the charity for suing donors’ families over bequests, and an affiliated fundraising vehicle run by Eric Trump drew a New York Attorney General investigation.
What the “No-Billing” Promise Actually Covers
St. Jude’s marketing is built on a single, powerful line: families never receive a bill. ProPublica found that this is technically true for the medical side and for travel, housing, and food provided through the hospital, but it leaves families exposed to the indirect costs that don’t stop when a child gets sick.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
Those indirect costs are substantial. Parents quit jobs or take unpaid leave. Rent, mortgage, utilities, and car payments keep coming. ProPublica identified more than 100 St. Jude families who turned to GoFundMe to cover living expenses, with half of those campaigns launched in the two years before the November 2021 report. Scores of other families organized yard sales and benefit concerts to stay afloat.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
Individual stories drove the point home. Jason Burt, a father earning $20,000 a year, slept in his pickup truck in the hospital parking lot because St. Jude provided free housing for only one parent and he couldn’t afford a hotel; his credit score dropped and he faced vehicle repossession from missed work. Kelly Edwards spent her entire $10,000 savings, money set aside for a home down payment, on living expenses during her son’s treatment, and eventually stopped returning to St. Jude because she could no longer afford the associated costs. The Murphy family ran up $20,000 in debt from lost income and relied on donations from outside sources, including a UFC fighter, to pay credit card bills. Catherine Rainey, a single mother and nurse who left her job to care for her child, was berated by a hospital representative when she challenged how St. Jude calculated mileage reimbursements.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
Families and critics said the hospital’s marketing created a public perception of a “totally free ride” that undercut their own crowdfunding efforts. Donors kept asking why they needed money if St. Jude was paying for everything.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
Billions in Reserves While Families Crowdfund
The money question is the loudest part of the controversy. ProPublica reported that as of 2021, St. Jude held $5.2 billion in reserves, enough to run the hospital for four and a half years with no new donations. That reserve had grown 58% over the prior five fiscal years.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings A June 2022 follow-up found the reserve had grown to $7.6 billion, with the hospital adding $886 million in unspent revenue in a single fiscal year on more than $2 billion in total revenue.2ProPublica. St. Jude Stashed Away $886 Million in Unspent Revenue Last Year By fiscal year 2024, combined financial statements showed total net assets of about $11.3 billion and total investments above $9.2 billion, against total revenues and gains of roughly $3.8 billion and fundraising expenses of about $420 million.3St. Jude Children’s Research Hospital. ALSAC/St. Jude Combined Financial Statement, Fiscal Year 2024
How that money gets spent is the other half of the dispute. ProPublica’s analysis of the five fiscal years through 2020 found that roughly 50% of the $7.3 billion in contributions went to research and patient care, about 30% went to fundraising operations, and 20% was added to reserves. Spending on food, travel, and housing for families came to about 2% of funds raised, or roughly $40 million. Ge Bai, a professor of accounting and health policy at Johns Hopkins University, told ProPublica the hospital “should be spending the money as aggressively as they raise it, but they seem to be hoarding.” Laura Otten of LaSalle University called the reserve size “staggering,” noting that a typical nonprofit keeps one to two years of operating expenses in reserve.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
St. Jude frames the numbers differently. The hospital states that 82 cents of every dollar received from donations, grants, insurance recoveries, and investment returns supports the current and future needs of St. Jude.4St. Jude Children’s Research Hospital. How Much of What I Donate Actually Benefits the Children It points to a $12.9 billion strategic plan covering fiscal years 2022 through 2027 that includes adding 2,300 jobs, $2.3 billion in new construction and capital projects, expanded clinical research, new technology centers, and global pediatric cancer initiatives.5St. Jude Children’s Research Hospital. St. Jude Strategic Plan 2022-27 Hospital officials have defended the reserves by noting that St. Jude is “highly donor-dependent” and vulnerable to economic downturns.
A related criticism focuses on where St. Jude raises its money. ALSAC, the hospital’s dedicated fundraising arm, operates 36 regional offices across the country, including in cities with their own top-tier pediatric cancer centers. ProPublica reported that in fiscal year 2019 a single ALSAC vice president’s West Coast team raised $300 million, which was $100 million more than either Children’s Hospital Los Angeles or Seattle Children’s Hospital received in total donations that year. David Clark, a pediatrician and former chairperson of pediatrics at Albany Medical Center, said St. Jude “raises tens of thousands of dollars in his region that does little to benefit the children with cancer in his area since almost all are treated locally,” and alleged that the hospital “thinks of every way they can to make money and the least amount of ways to spend it.”1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
Suing Donors’ Families Over Bequests
A March 2022 ProPublica report examined St. Jude’s practices around bequests. ALSAC cultivates potential donors through home visits, restaurant dinners, personal notes, birthday cards, and what the organization internally calls “love calls.” When donors die and families alter or contest the terms of bequests, St. Jude has gone to court for its share.6ProPublica. St. Jude Fights Donors’ Families in Court for Share of Estates
ALSAC attorney Fred Jones acknowledged in 2017 that the charity was involved in over 100 legal disputes regarding estates, though he said it litigated less than 1% of the thousands of estate donations received each year. ProPublica documented several cases:
- After J.D. Harris reduced St. Jude’s inheritance by roughly $2.5 million before his death, the hospital contested his revised estate plan in court. St. Jude lost, and the family received their share in 2020 after years of litigation.
- Vance Lanier spent $50,000 in legal fees fighting a St. Jude claim for $100,000 from the sale of a home. Both the trial court and the state Supreme Court ruled against St. Jude.
- In the Scheide estate, St. Jude sought the entirety of a $2.6 million estate after the original will was lost. The case raised questions about potential conflicts of interest involving an attorney who drafted the will while also doing work for St. Jude. The Nevada Supreme Court ruled in 2020 that St. Jude had met the legal requirements for probating a copy of the lost will.6ProPublica. St. Jude Fights Donors’ Families in Court for Share of Estates7FindLaw. In Re: The Estate of Theodore Ernest Scheide, Jr.
Estate attorney Cary Colt Payne alleged that St. Jude “promotes the disinheritance of children or families.” One person who prevailed against the hospital asked: “Think of all the fees for lawyers that didn’t go to St. Jude, not one child, not one cancer patient. Where is the sanity in all this?”8KFF Health News. St. Jude Uses Donations to Cultivate Bequests, Challenge Wills
The Eric Trump Foundation Investigation
A separate scandal involved the Eric Trump Foundation, a charity established in 2007 to fund St. Jude through annual golf tournaments at Trump family properties. The foundation raised over $16.3 million for the hospital and helped fund a $20 million surgery and ICU center.9CNBC. Trump Organization Charged Eric Trump’s Cancer Charity for Golf Events
In June 2017, Forbes reported that despite Eric Trump’s claims that the Trump Organization provided its golf courses for free, the foundation actually paid over $1.2 million to Trump properties for event costs. The report also alleged that more than $500,000 was redirected to other charities connected to Trump family interests, and that the Donald J. Trump Foundation funneled $100,000 in donations through the Eric Trump Foundation into revenue for the Trump Organization.9CNBC. Trump Organization Charged Eric Trump’s Cancer Charity for Golf Events Former Trump National Westchester marketing director Ian Gillule told Forbes that Donald Trump ordered that “everybody gets billed” after discovering the course wasn’t charging the charity.10Forbes. How Eric Trump Created a Myth Around His Kids’ Cancer Charity
The New York Attorney General opened an investigation in June 2017, identifying financial statements that failed to comply with accepted accounting principles, disregard for self-dealing rules, and misleading marketing materials, and threatened to revoke the charity’s registration. The foundation restated three years of financial statements, the board retroactively approved golf course transactions, and Eric Trump and all Trump Organization employees stepped down from the board. The charity rebranded as Curetivity.10Forbes. How Eric Trump Created a Myth Around His Kids’ Cancer Charity By late 2018, the AG’s office said the probe was “more about compliance than enforcement.” Curetivity continues to operate and describes itself as one of St. Jude’s “largest non-corporate fundraising partners,” claiming to have raised over $50 million to date; in 2023 it reported granting roughly $2.95 million to St. Jude.11CauseIQ. The Curetivity Foundation
How St. Jude Responded
Following ProPublica’s initial inquiry in 2021, St. Jude announced what it called a “dramatic expansion” of family assistance, effective November 15, 2021. Travel benefits now cover two parents instead of one, regular trips for siblings and other loved ones are covered, hotel stays are reimbursed for families living more than 400 miles away (reduced from the prior 500-mile threshold), and daily food stipends were increased to $25 per family member.1ProPublica. St. Jude Hoards Billions While Many of Its Families Drain Their Savings
Lawyers for St. Jude and ALSAC rejected the investigation’s framing, saying “ProPublica should be celebrating St. Jude and ALSAC for their commitment to finding cures, saving children’s lives, and optimizing patient outcomes.”12Deadline. Celebrity-Backed St. Jude Children’s Hospital Slammed in ProPublica Report The hospital acknowledged it cannot cover all financial obligations families experience during a child’s illness but said its model is designed to remain compliant with federal anti-kickback statutes that restrict what hospitals can offer to patients.
The charity continues to earn high marks from watchdogs. Charity Navigator gives ALSAC/St. Jude a four-star rating with a 99% Beacon Score and a 100% score for accountability and finance.13Charity Navigator. ALSAC – St. Jude Children’s Research Hospital The BBB Wise Giving Alliance reports the organization meets all 20 Standards for Charity Accountability, with a program expense ratio of 70%, a fundraising expense ratio of 17%, and an administrative expense ratio of 13%.14BBB Wise Giving Alliance. ALSAC St. Jude Children’s Research Hospital
One Boundary Worth Noting
The financial hardship that families face at St. Jude is not unique to St. Jude. Family Reach, which provides free wrap-around financial services to cancer patients nationwide, argued that the burden of housing, lost wages, and out-of-pocket expenses is a pervasive problem across hospitals, not one confined to one charity. CEO Carla Tardif said the ProPublica coverage felt like “someone handed me a megaphone and said ‘here’s your chance to show the world what cancer really does to a family.'”15Family Reach. The St. Jude’s Controversy: A Look at Why Family Reach Welcomed the Spotlight The specific critique of St. Jude is not that families struggle, but that a charity marketing a “no bill” promise while sitting on billions in reserves could choose to do more about the costs it already knows families carry.