{"edition":"boston","organization":"Community Servings","organizationId":"org:community-servings","boundaryVersion":"OMB-23-01-2023-07-21","updated":"2026-09-29","display":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":31378922.98495234,"canonicalPriceUSDPerTenEquivalentYears":313789229.8495234,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"listDisplay":{"metric":{"id":"daly-equivalent","years":1,"label":"DALY","priceLabel":"$ / DALY"},"priceUSD":31378922.98495234,"canonicalPriceUSDPerTenEquivalentYears":313789229.8495234,"conversion":"display only; QALYs and income equivalents are not measured clinical DALYs"},"model":{"version":"community-servings-boston-alpha-mental-health-v1","costScope":"Entire legal recipient gross FY 2025 Form 990 expense; noncash/depreciation retained. Does not subtract healthcare savings; not full social cost including unrecognized volunteer opportunity cost.","geographicAttribution":"Boston-Cambridge-Newton MA-NH CBSA 14460 under OMB 23-01. Numerator county clients: Middlesex 1294+ Essex 1102+ Suffolk 2468+ Norfolk 828+ Plymouth 447=6139. Denominator 7973 total individuals; mapped counties sum 7893, leaving 80 unresolved. No assumed New Hampshire benefit. Applying client share to diabetes meal health is a transfer judgment. Rockingham and Strafford are the two New Hampshire counties in the MSA; no verified clients there are credited.","formula":"N=min(M*primaryMealShare*diabetesShare/(mealsPerWeek*weeks),people*diabetesShare)*courseRealization; Q_all=financialAdditionality*(N*mentalDaysDifference/30*utilityPerAffectedDay*(benefitWeeks*7/365.25)*transfer+otherQalys); Q_metro=g*Q_all; price10=10*C/Q_metro only for positive net health. benefitWeeks=12 centrally.","counterfactual":"RCT contrast already includes usual care and brochure; do not apply a second ordinary-care subtraction. Transfer covers current population/trial uncertainty. Financing additionality separately discounts replacement by insurance/contracts/donors. Courses are annual-flow equivalents; no lifetime or repeated-year credit.","attribution":"Primary-patient allocation, disease-dose allocation and course realization are unverified; count-based geography is not directly health-weighted. Utility-day prior is not an observed utility gain. Central other portfolio 0 is neither total-health estimate nor proven lower bound.","uncertainty":"Very weak-confidence deterministic scenarios, not probability-weighted expectation or confidence limits. Source evidence supports native outcomes more strongly than the QALY price. Independent review accepts conditional alpha publication with these scope limits; donor status remains HOLD.","nativeOutcomes":"FY 25: 1,221,750 meals; 7,973 individuals; 15% primary diabetes diagnosis. Trial: 3.94 fewer days when mental health interfered with quality of life per 30 days during 12-week on/off periods. These populations and denominators are not interchangeable.","inputs":[{"name":"C","value":22289498,"unit":"USD","basis":"observed","rationale":"Whole legal-recipient FY 2025 Part IX 21,894,207 plus 395,291 direct event expense. Includes capital planning and affiliate transfer; no meal-program cost carveout.","sourceIds":["irs25"]},{"name":"M","value":1221750,"unit":"meals/year","basis":"observed","rationale":"FY 2025 meals prepared/delivered, not people or a disease-specific dose count.","sourceIds":["annual25"]},{"name":"people","value":7973,"unit":"individuals/year","basis":"observed","rationale":"Reported total individuals; not assumed all primary diabetes patients.","sourceIds":["annual25"]},{"name":"primaryMealShare","value":0.5,"unit":"fraction","basis":"judgment","rationale":"Half of meals assigned to primary patients. Family delivery share does not identify this fraction; leaves caregiver/dependent and ambiguous meal allocation uncredited.","sourceIds":["annual25","irs25"]},{"name":"diabetesShare","value":0.15,"unit":"fraction","basis":"judgment","rationale":"15% primary-diagnosis diabetes observed; applying the person mix to meal exposure is a separate unverified allocation assumption.","sourceIds":["annual25"]},{"name":"mealsPerWeek","value":10,"unit":"meals/week","basis":"observed","rationale":"Trial intervention dose, not evidence of dose completion by current clients.","sourceIds":["rct"]},{"name":"weeks","value":12,"unit":"weeks","basis":"observed","rationale":"Trial intervention duration; model credits at most 12 weeks and no residual benefit.","sourceIds":["rct"]},{"name":"courseRealization","value":0.8,"unit":"fraction","basis":"judgment","rationale":"80% of dose-equivalent capacity assumed to represent adequate continuous trial-like courses; no current patient-duration distribution.","sourceIds":[]},{"name":"mentalDaysDifference","value":3.94,"unit":"days per 30 days","basis":"observed","rationale":"9.59 minus 5.65 days when mental health interfered with quality of life per 30 days in the 12-week randomized crossover on/off periods; secondary self-report endpoint, not generic mentally unhealthy days.","sourceIds":["rct"]},{"name":"utilityPerAffectedDay","value":0.2,"unit":"utility decrement per affected day","basis":"judgment","rationale":"Explicit .20 prior: a day no longer experiencing mental-health interference with quality of life gains .20 of a full-health day. Not measured EQ-5 D or a validated application of a CDC crosswalk; test 0,.05,.4.","sourceIds":[]},{"name":"transfer","value":0.5,"unit":"fraction","basis":"judgment","rationale":"50% replication/current-severity transfer, including secondary-outcome uncertainty, small historical trial and different current diabetes severity/food insecurity.","sourceIds":[]},{"name":"financialAdditionality","value":0.5,"unit":"fraction","basis":"judgment","rationale":"50% effective activity survives replacement by insurance, contracts, other donors and reserves. Waitlist indicates demand but does not identify this elasticity.","sourceIds":["funding","audit25"]},{"name":"g","value":0.7699736611062336,"unit":"fraction","basis":"judgment","rationale":"6139/7973 client-count anchor: five Boston MSA MA counties; unallocated 80 and NH counties get no credit. Assumes diabetes exposure and health yield have same residence mix; actual health share unknown.","sourceIds":["annual25"]},{"name":"otherQalys","value":0,"unit":"net QALYs before financing","basis":"judgment","rationale":"All other portfolio net health set to 0 for a partial pathway, not a claim of no benefit or a proven lower bound.","sourceIds":[]}],"scenarios":[{"id":"central","label":"Weak-confidence diabetes mental-health pathway","costUSD":22289498,"allPopulationQalys":0.9225425051334701,"editionQalys":0.7103334302037343,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=313789229.8495234; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"utility-low","label":"Utility prior .05","costUSD":22289498,"allPopulationQalys":0.23063562628336753,"editionQalys":0.17758335755093357,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.05,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=1255156919.3980937; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"utility-high","label":"Utility prior .4","costUSD":22289498,"allPopulationQalys":1.8450850102669403,"editionQalys":1.4206668604074686,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.4,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=156894614.9247617; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"no-health","label":"No causal mental-health change","costUSD":22289498,"allPopulationQalys":0,"editionQalys":0,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":0,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=null; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"no-capacity","label":"Gift replaces existing funding","costUSD":22289498,"allPopulationQalys":0,"editionQalys":0,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=null; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"adverse","label":"Two additional days/month of mental-health interference with quality of life","costUSD":22289498,"allPopulationQalys":-0.46829568788501036,"editionQalys":-0.3605753452810835,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":-2,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=null; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"other-harm","label":"Five other-portfolio QALYs harm","costUSD":22289498,"allPopulationQalys":-1.5774574948665299,"editionQalys":-1.2146007225618496,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":-5}; realized 12-week course equivalents=610.875; price10=null; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"low-dose","label":"Only one quarter of equivalent courses realize trial exposure","costUSD":22289498,"allPopulationQalys":0.2882945328542095,"editionQalys":0.221979196938667,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.25,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=190.8984375; price10=1004125535.5184749; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"geography-low","label":"Only half health accrues in metro","costUSD":22289498,"allPopulationQalys":0.9225425051334701,"editionQalys":0.46127125256673507,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.5,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=483218884.245886; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"geography-high","label":"90% metro health","costUSD":22289498,"allPopulationQalys":0.9225425051334701,"editionQalys":0.8302882546201231,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.9,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=268454935.6921589; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"low-funding","label":"Only 10% financing additionality","costUSD":22289498,"allPopulationQalys":0.18450850102669403,"editionQalys":0.14206668604074685,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.1,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=1568946149.2476172; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"favorable","label":"Higher allocation, realization and transfer","costUSD":22289498,"allPopulationQalys":12.3620695687885,"editionQalys":9.51846796473004,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.67,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":1,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.4,\"transfer\":1,\"financialAdditionality\":1,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=1023.215625; price10=23417106.70518832; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"shorter-benefit","label":"Effect only last four weeks","costUSD":22289498,"allPopulationQalys":0.30751416837782336,"editionQalys":0.2367778100679114,"assumptions":"{\"C\":22289498,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0,\"benefitWeeks\":4}; realized 12-week course equivalents=610.875; price10=941367689.5485704; no post-service persistence, hospital/mortality credit or cost savings offset."},{"id":"higher-cost","label":"25% additional uncounted resource cost","costUSD":27861872.5,"allPopulationQalys":0.9225425051334701,"editionQalys":0.7103334302037343,"assumptions":"{\"C\":27861872.5,\"M\":1221750,\"people\":7973,\"primaryMealShare\":0.5,\"diabetesShare\":0.15,\"mealsPerWeek\":10,\"weeks\":12,\"courseRealization\":0.8,\"mentalDaysDifference\":3.94,\"utilityPerAffectedDay\":0.2,\"transfer\":0.5,\"financialAdditionality\":0.5,\"g\":0.7699736611062336,\"otherQalys\":0}; realized 12-week course equivalents=610.875; price10=392236537.3119043; no post-service persistence, hospital/mortality credit or cost savings offset."}],"sensitivity":["Utility prior .05 quadruples price versus .20; .4 halves it. Zero utility or no gift response eliminates a finite positive price.","A reversal to two additional affected days/month yields negative health; negative results are retained.","Halving metro health share does not halve expense. Unknown 80 residents and unequal diabetes/meal distribution create additional geographic uncertainty.","One 12-week course maximum is credited per modeled person; dose-equivalent caps prevent treating meals or recurring courses as independent beneficiaries.","A 5-QALY other-portfolio harm before financing reverses the central sign. Uncredited clinical benefits could substantially increase value; the central pathway cannot rank the whole portfolio.","Four-week duration credits only a third of central health; 25% additional resource costs raises price 25%. No long-term persistence is assumed."],"missingInputs":["Current primary diabetes patient count, meals delivered/consumed, continuous 12-week course completion and county-linked dose.","Preference-based utility measurements or valid patient-level crosswalk inputs, replication and adverse outcomes.","Current dated waiting list, costed unfunded capacity plan, financing replacement, and uptake per incremental gift.","Whole-portfolio health and harms, volunteer opportunity costs and metro-specific disease/utility shares."]},"sources":[{"id":"irs25","title":"FY2025 original Form 990 (tax year 2024)","publisher":"Community Servings / IRS","url":"https://www.servings.org/wp-content/uploads/2026/07/2024-Form-990-for-CS-Public-Copy.pdf","published":null,"retrieved":"2026-09-29"},{"id":"irs24","title":"FY2024 original Form 990 (tax year 2023)","publisher":"Community Servings / IRS","url":"https://www.servings.org/wp-content/uploads/2025/06/2023-Form-990-for-CS-Public-Copy.pdf","published":null,"retrieved":"2026-09-29"},{"id":"audit25","title":"FY2025 audited consolidating financial statements, FY2024 comparative","publisher":"Community Servings and affiliate / independent auditor","url":"https://www.servings.org/wp-content/uploads/2026/02/FY25-Financials.pdf","published":null,"retrieved":"2026-09-29"},{"id":"annual25","title":"FY2025 annual report","publisher":"Community Servings","url":"https://www.servings.org/wp-content/uploads/2025/11/FY25-Annual-Report-Community-Servings-Pages-reduced-1.pdf","published":null,"retrieved":"2026-09-29"},{"id":"rct","title":"Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: Randomized Cross-over Trial","publisher":"Berkowitz et al. / Journal of General Internal Medicine","url":"https://link.springer.com/article/10.1007/s11606-018-4716-z","published":null,"retrieved":"2026-09-29"},{"id":"medicaid","title":"Medically tailored meals receipt and healthcare utilization and costs in Massachusetts Medicaid demonstration","publisher":"Hager et al. / Nature Medicine","url":"https://www.nature.com/articles/s41591-026-04407-5","published":null,"retrieved":"2026-09-29"},{"id":"fame","title":"Designing Medically Tailored Meal Interventions: FAME-F Factorial Randomized Clinical Trial","publisher":"Berkowitz et al. / Circulation Cardiovascular Quality and Outcomes","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13045650/","published":null,"retrieved":"2026-09-29"},{"id":"mapping","title":"Diabetes State Burden Toolkit Technical Report","publisher":"US Centers for Disease Control and Prevention","url":"https://www.cdc.gov/diabetes/burden-toolkit/docs/technical_documentation.pdf","published":null,"retrieved":"2026-09-29"},{"id":"funding","title":"Update: Growing Demand Amid Funding Challenges","publisher":"Community Servings","url":"https://www.servings.org/blog/update-growing-demand-amid-funding-challenges/","published":null,"retrieved":"2026-09-29"},{"id":"reach","title":"Who We Serve","publisher":"Community Servings","url":"https://www.servings.org/who-we-serve/","published":null,"retrieved":"2026-09-29"},{"id":"gift","title":"Donate","publisher":"Community Servings","url":"https://www.servings.org/donate/","published":null,"retrieved":"2026-09-29"}]}