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The nonprofit sector has historically played a significant role in America’s healthcare and social welfare. Stewardship theory posits that as ethical stewards, nonprofit healthcare organizations will act in the best interest of the community. This paper draws from historical studies to examine the relationship between nonprofit hospital community benefit spending and private donations. Data for this study was collected from the National Center for Charitable Statistics’ (NCCS) IRS Statistics of Income Sample (SOI) Files, in particular, Schedule H data which has not been highlighted in previous research. This research offers considerations for sustainability and competitive advantage to nonprofit hospital leadership.