“Pay to all what is due them, taxes to whom taxes are due, revenue to whom revenue is due, respect to whom respect is due, honor to whom honor is due.”
Romans 13:7
Dear Kingdom Builders,
In 1872, five Franciscan sisters arrived in St. Louis with $5 between them. This month, the healthcare ministry they started raised $1.8 billion in institutional capital.
A few days later, another Christian health system received approval to borrow up to $1.9 billion.
And a third Catholic hospital stopped paying its bondholders.
Welcome to the multibillion-dollar bond market behind Christian healthcare. This is BIG nonprofit business.
The $1.8B Bond Sale
Those five sisters came to care for the sick. Today, SSM (Sisters of St. Mary) Health operates 24 hospitals, employs 40,000 people and generates roughly $12.7 billion in annual revenue.
Its mission: “reveal the healing presence of God.” In today’s medical world, revealing God’s healing presence at that scale requires a lot of capital.
SSM recently completed a $1.8 billion bond sale supporting major investments, including a new children’s hospital in St. Louis.
Not donated. Borrowed in the bond market.
Institutional investors buy the bonds. They scrutinize SSM’s finances, management, liquidity and ability to repay them.
BUT they will never own the hospital. And they will never own its mission.
SSM’s Catholic sponsor retains authority over its mission, board, and major corporate decisions.
And SSM is not alone.
Days later, a California agency approved up to $1.9 billion in tax-exempt bonds for Loma Linda University Health, a Seventh-day Adventist system whose mission is “to continue the teaching and healing ministry of Jesus Christ.”
This is not uncommon for nonprofit hospitals. Nonprofit healthcare organizations issued more than $48 billion of municipal bonds in 2025 alone.
That money builds hospitals, buys equipment, refinances debt and keeps enormous institutions functioning.
But It’s NOT a Guarantee
Redeemer Health, a Catholic system near Philadelphia, recently missed a required bond payment after years of financial strain.
Its interim CEO described the choice starkly: continue paying institutional bondholders, or preserve resources to continue caring for people.
Redeemer chose the latter.
Complicated Infrastructure. Simple Mission.
The structures behind these bonds are complicated. Taxable bonds, tax-exempt bonds, philanthropy, and layers of institutional oversight. But the mission is remarkably simple.
“I was sick and you looked after me.” (Mt. 25:36)
As healthcare is wrestling with enormous financial pressure, new technology, and challenging ethical questions, Christian healthcare has a unique role. Not just providing care for bodies, but ensuring that caring for the body never comes at the expense of caring for the soul.
That’s why the mission matters.
Christian healthcare has grown from small ministries into some of the largest healthcare institutions in the world. That scale requires institutional capital.
But it only lasts as long as the money serves the mission. Not the other way around.
Have a blessed week.
Matt
Christian Investment Access
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WHAT CHRISTIANS NEED TO DO TO CREATE REAL KINGDOM IMPACT
Matt Johns spoke with Lions Den DFW this week about how to create real Kingdom impact through business, investing, and giving by thinking like nonprofits:
Why $35 trillion in impact investing may have produced far less impact than expected
What nonprofits understand about impact that businesses often miss
How Christian businesses are already creating Kingdom impact
ICYMI: Christian Business & Financial News
Chick-fil-A will open its first Scottish restaurant and the UK’s first Chick-fil-A drive-thru near Glasgow on October 29, part of the Christian-founded company’s planned $100 million UK expansion.
Abilene Christian University’s roughly $1 billion endowment has produced returns competitive with, and in some periods better than, far larger Ivy League portfolios by leaning into private markets and opportunities too small for mega-endowments to pursue meaningfully.
30-Second Financial Terms and Strategies
Qualified 501(c)(3) Bonds
Qualified 501(c)(3) bonds allow nonprofit organizations like hospitals and universities to borrow through the tax-exempt municipal bond market even though they aren't governments themselves.
What it is: A state or local government entity typically issues the bonds as a conduit, then lends the proceeds to the nonprofit, which is responsible for repaying the debt.
What it looks like: A nonprofit hospital can use this structure to finance major facilities and other qualifying capital projects. A special subset called a qualified hospital bond requires at least 95% of net proceeds to be used to finance a hospital.
Why it matters: Because the bonds can qualify for tax-exempt interest, investors may accept lower interest rates than they would on comparable taxable debt—giving nonprofit health systems access to potentially cheaper long-term capital.
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