By the Everything-PR Research Team  |  Published on Everything-PR.com

For the first time, a structured industry-focused analysis of communications and advertising spending across the largest U.S. tax-exempt organizations, drawing on publicly disclosed IRS Form 990 filings, NACUBO endowment data, and the hospital and higher-education financial disclosures that nonprofits are required to make. The data reveals that America’s most prominent nonprofits — Harvard, Yale, Stanford, the Kaiser Permanente system, the Cleveland Clinic, United Way, Salvation Army, Feeding America, and peer institutions — operate communications functions that are systemically under-scaled relative to the reputational exposure their size and visibility generate.

Key Statistics and Takeaways

Why this study exists

Every nonprofit executive in the country can describe their organization’s mission. Most can recite their program-service expense ratio to the nearest percentage point. But ask what America’s largest nonprofits actually spend on public relations, advertising, and strategic communications — as a percentage of revenue, as a function of reputational exposure, as a benchmark against comparable private-sector institutions — and the numbers become scattered, comparatively uncollected, and functionally invisible to the donors, trustees, and beneficiaries who fund them.

Unlike most categories of nonprofit spending, communications expense is disclosed by federal tax law. IRS Form 990 Part IX, Line 12 requires every filing nonprofit to report “Advertising and promotion expenses” broken out across Program Services, Management and General, and Fundraising columns. Line 11e discloses “Professional fundraising expenses.” Schedule J discloses compensation for highest-paid officers and contractors. Schedule G discloses fundraising activities in detail. Schedule H requires hospital community-benefit reporting. The data is fully public, available through the IRS Tax Exempt Organization Search, ProPublica’s Nonprofit Explorer, and Cause IQ.

The data is public. Almost no one in the commercial PR industry or the nonprofit trustee community systematically aggregates it. This study is an attempt to change that — drawing on IRS Form 990 filings for the top 100 U.S. nonprofits by revenue, NACUBO endowment data, Forbes charity rankings, Becker’s Hospital Review health-system revenue analysis, and the extraordinary natural experiment of the December 2023–January 2024 Ivy League crisis — to produce a structured picture of where the nonprofit sector stands oncommunications preparedness.

“The December 2023–January 2024 Ivy League crisis was not a random event. It was the predictable consequence of institutions that manage $50 billion in assets while resourcing their communications function as if they were mid-sized regional nonprofits. The Form 990 data tells this story every year; the congressional hearing simply made it visible.”

Methodology & data sources

This study draws on five independent data sources, triangulated to produce sector-level, institution-level, and comparative estimates:

IRS Form 990 Part IX — Statement of Functional Expenses: Every U.S. tax-exempt organization with gross receipts of $200,000 or total assets of $500,000 must file Form 990 annually and disclose 26 expense line items split across Program Services (column B), Management and General (column C), and Fundraising (column D). Line 12 is “Advertising and promotion.” Line 11e is “Professional fundraising expenses.” Line 11a through 11g itemize management, legal, accounting, lobbying, investment management, and other professional services. Forms are public and retrievable through IRS.gov, ProPublica Nonprofit Explorer, Cause IQ, and Candid’s GuideStar.

NACUBO-Commonfund Study of Endowments: The National Association of College and University Business Officers, in partnership with Commonfund, publishes an annual endowment study capturing market value, returns, and payouts across more than 650 U.S. higher-education institutions. FY 2024 aggregate endowment market value was $837.7 billion, with a median of $244.4 million and extreme concentration at the top (Harvard, Yale, Stanford, Princeton, and MIT alone hold more than $180 billion in endowment assets).

Health-system revenue rankings: Becker’s Hospital Review, Fierce Healthcare, Hospitalogy, and Modern Healthcare publish annual rankings of U.S. nonprofit health systems by total operating revenue. The FY 2024 top-five nonprofit health systems by total revenue were Kaiser Permanente ($115.8B), CommonSpirit Health ($38.4B), Advocate Health ($34.8B), Providence ($30.7B), and UPMC ($29.9B).

Forbes 100 Largest U.S. Charities and Chronicle of Philanthropy 400: Annual rankings of charitable organizations by private donations and total revenue, capturing mega-charities including United Way Worldwide, The Salvation Army, Feeding America, St. Jude Children’s Research Hospital, American National Red Cross, Habitat for Humanity, Goodwill Industries International, Task Force for Global Health, YMCA of the USA, and peer organizations.

December 2023–January 2024 Ivy League crisis documentation: Public reporting by NPR, PBS NewsHour, Axios, the Associated Press, The Harvard Crimson, and the House Committee on Education and the Workforce covering the December 5, 2023 testimony of Harvard President Claudine Gay, Penn President Liz Magill, and MIT President Sally Kornbluth, and the subsequent resignation timeline (Magill, December 9, 2023; Gay, January 2, 2024; Penn Board Chair Scott Bok, December 2023).

A note on limitations: Form 990 Line 12 captures advertising and promotion specifically, not the full communications operation. In-house communications staff compensation is reported in Lines 5–7 (salaries) rather than Line 12, and is not separately broken out by function. Contracted PR agency fees may appear in Line 11g (“Other” professional services) rather than Line 12 depending on how the nonprofit’s accounting function categorizes the relationship. These figures therefore capture disclosed external-facing spend; they understate the full communications function.

The benchmark: what the data actually shows

Based on the triangulated dataset, the U.S. nonprofit communications market is defined by five structural features:

1. Scale concentration is extreme. The largest single U.S. nonprofit health system (Kaiser Permanente) reports 2024 total revenue of $115.8 billion — larger than the GDP of many countries. The top 10 nonprofit health systems combined exceed $400 billion in total revenue. The top five university endowments exceed $180 billionin assets. The top 10 charities by private donations exceed $20 billion in giving annually. This is an institutional segment with commercial-scale financial resources.
2. Communications spending does not scale proportionally with institutional size. Form 990 Line 12 disclosures across the largest U.S. nonprofits consistently show advertising and promotion expense at a small fraction of total revenue, typically ranging from under 0.1% at the largest health systems to roughly 0.5–1.5% at consumer-facing charities. These ratios are well below commercial-sector benchmarks for comparably exposed institutions. The 2026 PR Spend Transparency Study published by Everything-PR established a median Fortune 500 PR-to-revenue ratio of 0.25%; the median commercial marketing-to-revenue ratio sits at roughly 7.7%. Even against the narrower PR benchmark, most large nonprofits fall below the commercial median despite materially higher reputational exposure.
3. Reputational exposure is structurally higher than the spending suggests. Nonprofit institutions face reputational risks that commercial corporations generally do not: federal regulatory scrutiny of tax-exempt status, donor-driven crisis cascades (a single large donor can materially damage the institution by publicly withdrawing support), congressional testimony obligations that create viral-video risk, state attorney general investigations, accreditation risk, and unique categories of media coverage (university campus protests, hospital patient-safety events, charity accountability audits).
4. Form 990 disclosure creates asymmetric transparency. Nonprofit communications spending is more disclosed than commercial PR spending. A donor, a journalist, a trustee, or a competitor can pull any U.S. nonprofit’s Form 990 and read Line 12 directly. This transparency is underutilized by the nonprofit sector itself — trustees frequently have no systematic benchmark for what peer institutions spend on communications.
5. The December 2023–January 2024 Ivy League crisis is the clearest public illustration. Within 28 days of the December 5, 2023 congressional testimony on campus antisemitism, University of Pennsylvania President Liz Magill resigned (December 9, 2023), Penn lost a $100 million pledged donation from Ross Stevens within days, Harvard President Claudine Gay resigned (January 2, 2024, the shortest Harvard presidency in history), Penn Board Chair Scott Bok resigned, and Harvard and Penn together saw multi-billion–dollar pledged giving impairment. All three institutions involved have endowments over $20 billion, communications staffs in the hundreds, and established relationships with external communications counsel. The crisis revealed not absence of capability but absence of preparation for the specific risk category that materialized.

The largest U.S. nonprofits by total revenue or assets

Source: Everything-PR Research Team analysis of Becker’s Hospital Review, Hospitalogy, NACUBO FY 2024 endowment data, Forbes 100 Largest U.S. Charities, and Form 990 filings.

Spending tier benchmarks: disclosed communications spend across the nonprofit sector

Tier 4 — Below-benchmark

Disclosed advertising and promotion under 0.1% of revenue

Typical of large nonprofit health systems, where the institutional posture is that direct-patient communications is a separately-categorized function and external PR is deliberately minimized. Exposes the institution to elevated risk when a patient-safety, labor, billing, or regulatory event occurs with limited pre-existing media relationships or crisis infrastructure.

Tier 3 — Baseline

Disclosed advertising and promotion at 0.1–0.5% of revenue

Typical of major universities, research institutions, and older mega-charities. Sufficient for standard institutional media relations, alumni and donor communications, and recurring program outreach. Typically insufficient for sustained crisis response, congressional oversight preparation, or rapid-cycle digital response.

Tier 2 — Competitive

Disclosed advertising and promotion at 0.5–1.5% of revenue

Typical of consumer-facing charities (Salvation Army, Red Cross, St. Jude, Feeding America), which rely heavily on direct-response fundraising and therefore carry structurally higher advertising and promotion expense. Also typical of hospital systems with deliberate consumer-marketing strategies (Cleveland Clinic, Mayo Clinic) where brand premium is a core institutional asset.

Tier 1 — Direct-response heavy

Disclosed advertising and promotion above 1.5% of revenue

Typical of direct-response fundraising charities and cause-marketing-heavy organizations where the advertising spend directly drives the revenue. Ratios can exceed 5% at organizations with television and direct-mail acquisition models. Typically does not correlate with superior crisis preparedness, as the spend is concentrated on fundraising rather than strategic communications or reputation management.

The reputational exposure categories nonprofits face

Unlike commercial institutions, which primarily manage customer, regulatory, investor, and employee stakeholder communications, large nonprofit institutions face an additional layer of exposure categories that have no direct private-sector analog:

• Tax-exempt status scrutiny — congressional committees, IRS determinations, and state attorneys general have the legal authority to examine and in extreme cases revoke 501(c)(3) status. Communications missteps during examinations can materially increase enforcement risk.
• Donor cascades — a single large donor withdrawing support publicly can trigger cascading withdrawals across the donor community. The Ross Stevens $100 million withdrawal from Penn within days of the Magill testimony is the paradigmatic modern example, but similar dynamics have played out at numerous universities, hospital systems, and museums.
• Congressional and state-legislative testimony — nonprofit executives, unlike most corporate executives, are frequently called to testify before federal and state legislative bodies. The viral-video risk of such testimony is high, the preparation burden is extensive, and the downside asymmetry is severe.
• Accreditation and regulatory relationships — hospital systems face Joint Commission accreditation, CMS conditions of participation, and state department of health oversight. Universities face regional accreditors, federal Title IX and Title VI compliance, NCAA oversight. Communications failures can trigger formal reviews.
• Tax-policy exposure — the 2017 Tax Cuts and Jobs Act imposed a 1.4% endowment tax on institutions with at least 500 tuition-paying students and net assets of at least $500,000 per student. A 2026 expansion introduces tiered rates of 4–8% for the wealthiest institutions (Princeton, Yale, MIT at 8%; Stanford, Harvard, Notre Dame, Dartmouth, Rice, Vanderbilt, Richmond at 4%). Tax-policy shifts create direct communications obligations to alumni, donors, and legislative audiences.
• Philanthropic-competition dynamics — large nonprofits compete for a finite donor pool. Competitor organizations’ communications successes directly constrain an institution’s fundraising upside.
• Patient, student, beneficiary, and community safety events — hospital systems face patient-safety incidents, universities face student-safety and campus-climate events, charities face beneficiary-protection concerns. Each carries reputational tail risk that standard commercial crisis frameworks do not fully address.

The two surprises

Surprise #1: The Ivy League crisis was foreseeable from the disclosed data. Harvard, Penn, and MIT all disclose Form 990 filings and had for years before the December 2023 testimony. The ratio of disclosed communications spend to institutional scale was, in each case, below what would be expected for institutions of comparable size, visibility, and reputational exposure. The rapid cascade of events — Magill’s resignation within four days, Harvard losing Gay within 28 days, Penn losing a $100 million pledge within a week, multi-billion–dollar pledged-giving impairment, Board Chair Scott Bok’s resignation — reflected not just the testimony itself but the absence of the preparation, rapid-response capability, and donor-management infrastructure that the institutions’ scale would have supported. The crisis was a natural experiment in what happens when a Form 990 Line 12 ratio meets a Fortune-500-scale reputational event.

Surprise #2: Hospital systems are the most exposed nonprofit category and the least benchmarked. Of the 16 U.S. nonprofit institutions with more than $20 billion in annual revenue, 14 are health systems. These institutions face patient-safety exposure, labor-relations exposure (nursing strikes at Kaiser, Mount Sinai, and peer systems have produced sustained national coverage cycles), charity-care and community-benefit scrutiny (elevated under the 2022 IRS Schedule H reforms), vertical integration and antitrust attention, and the ongoing consolidation-driven M&A disclosure environment. Yet hospital-system communications spending is, on a revenue-ratio basis, the lowest of any major nonprofit category. The structural gap between exposure and preparedness in the U.S. nonprofit hospital sector is larger than in any other nonprofit segment.

“Fourteen of the 16 largest U.S. nonprofits by revenue are hospital systems. The communications-spend-to-revenue ratio of this category is the lowest of any nonprofit segment. It is also the segment with the broadest exposure surface. The disconnect is the single largest structural reputational risk in the U.S. nonprofit sector.”

The December 2023–January 2024 timeline: a natural experiment in nonprofit crisis exposure

The compressed timeline of the Ivy League crisis is worth documenting in detail because it demonstrates how quickly the reputational asymmetries in the nonprofit sector can compound:

• December 5, 2023: House Committee on Education and the Workforce hearing. Harvard President Claudine Gay, Penn President Liz Magill, and MIT President Sally Kornbluth testify. Rep. Elise Stefanik (R-NY) poses hypothetical questions about whether calls for genocide of Jewish students would violate campus conduct codes. All three presidents respond with legalistic answers that become viral clips within hours.
• December 7, 2023: Penn Wharton Board calls publicly for Magill’s resignation. Pennsylvania Governor Josh Shapiro publicly criticizes the testimony.
• December 7–8, 2023: Ross Stevens, through attorneys, notifies Penn of intent to withdraw a pledged $100 million gift unless Magill is replaced.
• December 9, 2023: Magill resigns. Penn Board Chair Scott Bok resigns shortly thereafter.
• Mid-December 2023: Harvard Corporation initially reaffirms support for Gay. Conservative media and opposition–research efforts surface plagiarism allegations in Gay’s published academic work.
• Late December 2023: Harvard Corporation acknowledges additional plagiarism instances. Major donors including hedge-fund manager Bill Ackman escalate public calls for Gay’s removal. Rabbi David Wolpe resigns from Gay’s antisemitism advisory committee.
• January 2, 2024: Gay resigns, the shortest Harvard presidency in the institution’s history. Harvard Provost Alan Garber becomes interim president.
• Post-crisis: House committee opens formal investigation. Multi-billion–dollar pledged giving impairment reported across both institutions. MIT President Kornbluth survives, supported by her board and faculty.

The compressed 28-day window produced the forced departure of two Ivy League presidents, the loss of a single nine-figure pledge, and material ongoing damage to both institutions’ donor bases. It is not possible to model this outcome as the product of a single decision at a single moment; it was the aggregate product of a preparation posture that had been set across years of communications-spend decisions reflected in each institution’s Form 990 filings.

The 2026 environment: why this matters now

Three 2026-specific dynamics make nonprofit communications preparedness more consequential than at any point in the past decade:

The 2026 federal endowment-tax expansion introduces tiered rates of 4–8% on the wealthiest institutions, producing a direct revenue impact on Princeton, Yale, MIT, Stanford, Harvard, Notre Dame, Dartmouth, Rice, Vanderbilt, and the University of Richmond. This creates sustained public communications obligations around institutional use of endowment funds, student financial aid, and research commitments.

Congressional oversight of universities, hospital systems, and mega-charities has structurally intensified. The House Committee on Education and the Workforce, the Ways and Means Committee, and the Senate Finance Committee have all signaled expanded investigatory posture toward 501(c)(3) organizations through 2026. Campus antisemitism hearings, hospital billing and consolidation hearings, and charity accountability hearings are now a standard legislative calendar feature rather than an exceptional event.

The Trump administration’s 2025–2026 higher-education funding posture — including threatened withdrawal of federal research funds from Columbia and other institutions, expanded scrutiny of university DEI programs, and accelerated endowment-tax enforcement — has shifted the federal regulatory environment materially. Nonprofit institutions now face federal-government communications counterparties that operate with much more compressed timelines and more public posturing than in prior administrations.

What this means for nonprofit trustees, CFOs, and communications leaders

1. Form 990 Line 12 should be an explicit board-level benchmark. The data is public, the peer-institutioncomparison is easy to produce, and the ratio relative to total revenue is a meaningful indicator of preparedness. Trustees who do not systematically benchmark their institution’s communications spend against peers are making an implicit decision to accept whatever level the current administration has inherited.
2. Crisis preparation is a separate capability from communications staffing. The Ivy League crisis demonstrated that institutions with hundreds of communications staff can still fail under specific-event stress. Scenario planning for congressional testimony, donor-cascade response, patient-safety or student-safety events, and regulatory enforcement actions requires dedicated investment distinct from day-to-day institutional communications. The disclosed spending data suggests this investment is not widespread.
3. Donor communications infrastructure is now a core institutional asset. The $100 million Ross Stevens withdrawal from Penn took place within days of Magill’s testimony. The compression between a major event and donor reaction has materially shortened. Institutions that cannot brief their top 20 donors within 24 hours of a significant event face cascade risk. The infrastructure to do this — donor-communications CRM systems, pre-drafted event-response templates, rehearsed leadership-briefing protocols — is itself a category of communications investment that does not appear on Line 12 but materially affects institutional resilience.

This study was produced by the Everything-PR Research Team and is available for republication with attribution. For inquiries: everything-pr.com.

Methodology note: All figures derive from publicly disclosed sources including IRS Form 990 filings (IRS.gov Tax Exempt Organization Search, ProPublica Nonprofit Explorer, Cause IQ, Candid/GuideStar), NACUBO-Commonfund Study of Endowments (FY 2024), Becker’s Hospital Review and Hospitalogy health-system revenue rankings (FY 2024), Forbes 100 Largest U.S. Charities, and public reporting on the December 2023–January 2024 Ivy League crisis by NPR, PBS NewsHour, Associated Press, Axios, The Harvard Crimson, and the House Committee on Education and the Workforce. All disclosed figures traceable to primary-source filings; all modeled estimates labeled as such.