Summary
What do they do? The YMCA’s work spans SF, San Mateo and Marin. Its actual services include fitness access, mental-health care, family resource centers, diabetes prevention, youth programs and aquatics. Public funding, fees and existing partnerships already support much of this work. More
Why this approach interests us
- YMCA provides real clinical care, supported activity, family services and diabetes prevention that can improve health when donations expand access.
Our main reservations
- The next gift’s allocation, additional service access, complete costs and local health effects are largely analyst judgments. Educational and community value is not fully captured in QALYs.
What do you get for your dollar?
The same unrestricted gift yields an estimated $6.18 million per 10 Bay Area QALYs, including SF. This portfolio model replaces the narrower diabetes-prevention view. It counts the entire gift while leaving 30% of spending without quantified health benefits. Inspect the whole-gift model. Earlier diabetes-prevention-only model.
- sf estimate
- $9.50M / 10 QALYs — Central donor-cash estimate with a judgmental 65% SF residence share.
- bay estimate
- $6.18M / 10 QALYs — Includes SF; not an additional pool of benefits to add to it.
- gift coverage
- 100% of cash counted — 30% allocated to youth, aquatics and camp/capital/other has unquantified health.
- evidence
- Mixed trials and judgments — One external integrated QALY anchor; no observed organization-wide donor effect.
1. What do they do?
The YMCA’s work spans SF, San Mateo and Marin. Its actual services include fitness access, mental-health care, family resource centers, diabetes prevention, youth programs and aquatics. Public funding, fees and existing partnerships already support much of this work.
Allocate one unrestricted gift
Assumed shares: fitness 20%, mental health 25%, family support 20%, diabetes prevention 5%, youth enrichment 15%, aquatics 5%, and camp/capital/other 10%.
Change access beyond existing provision
Only additional provision earns health credit; replacing fees, public payments or other donors may create little incremental health.
Count distinct health changes
Supported exercise, therapy, short hardship relief and delayed diabetes are modeled separately, assuming distinct health increments; overlapping benefits must be excluded.
Scope of this review. All allocation weights are analyst priors, not audited marginal spending. Complete offered-course allowances include failed participation and shared costs once. Unquantified services are not assumed valueless. Food-bank partner outcomes are not added again.
2. Monitoring and information sharing
Wales NERS; 798 economic-study participants, 55% of the trial
Randomized exercise-referral economic evaluation. .027 incremental QALYs integrated over months 6–12; baseline EQ-5D was not collected.
Our assessment. A 16-week supported referral program is not an ordinary YMCA membership. The economic sample had greater adherence; transfer factors address selection and delivery mismatch without a second adherence multiplier or later tail.
YMCA mental-health services and family resource centers
Primary service documentation; modeled health judgments. Actual clinical and hardship-support pathways exist, alongside DPH, school and Medi-Cal funding.
Our assessment. Local incremental response, utility and duration are not measured here. Workshops, referrals and delivered therapy are not interchangeable.
RAPID trial and YMCA high-risk adult prevention course
Randomized community adaptation plus current program documentation. Community delivery is supported; local DPP excludes diagnosed diabetes and may be covered by employers or insurers.
Our assessment. RAPID is not a local incidence/QALY estimate. The model uses finite analyst diabetes-delay assumptions, not the intensive DPP trial’s lifetime benefits.
YMCA of Greater San Francisco, FY2024–25
Audited financial statements and annual report. Broad health, human-service, youth and camp operations and mixed financing are documented.
Our assessment. Accounting categories and participant counts do not measure the next gift’s allocation, additional health or beneficiary residence.
3. Qualitative assessment
YMCA provides real clinical care, supported activity, family services and diabetes prevention that can improve health when donations expand access.
Key reservations
- The entire gift is costed, but only selected health pathways are quantified; this is not a complete social-value estimate.
- Local response, funding, course-price and geography assumptions dominate the result.
- Fitness, therapy, family support and DPP must not duplicate the same health increment.
- Existing public funding and fees can substitute for donations; extra service capacity is unverified.
- Even the joint favorable scenario remains above $100,000 per 10 QALYs.
Benefits not included in our estimate
- Unquantified youth education, employment, caregiver and community benefits.
- Aquatics, drowning prevention, camping and capital benefits without a verified incremental health bridge.
- Food-bank partnership benefits already credited to the supplying organizations.
- Lifetime diabetes prevention, long-run exercise tails and duplicated therapy effects.
- Unreconciled healthcare savings or financial transfers treated as health.
4. What do you get for your dollar?
A $100,000 gift yields an estimated 0.105 SF QALYs, or 0.162 across the Bay.
We estimate four finite health pathways rather than extrapolate diabetes prevention to the whole YMCA. Fitness contributes .072 Bay QALYs, mental health .066667, family support .016 and diabetes prevention .007215. Geography is then allocated by residence judgment.
A better life is our comparison unit of 10 additional quality-adjusted life years (QALYs), potentially spread across people. These are uncertain estimates, not measured returns or verified donation offers.
How we calculate the estimate
Central portfolio model: (.072 fitness + .066667 mental health + .016 family support + .007215 diabetes prevention) × .65 SF share
.105223 SF QALYs; $100,000 × 10 / .105223 = $9,503,647
Model inputs and assumptions
- Unrestricted-gift allocation
- 70% quantified pathways; 30% unquantified (range: Fixed in these scenarios). All $100,000 remains in the numerator. Actual prospective allocation may differ sharply. Judgment.
- Supported-activity course
- $600; .027 Q × 20% transfer (range: $300–$1,000; 2–75% transfer). External .027 Q is integrated over months 6–12, not annual utility or lifetime benefit. Membership assistance alone does not establish a matched coached course. Trial anchor; judgmental transfer.
- Mental-health course
- $1,500; 20% response × .10 utility × .5 integrated years (range: $1,000–$2,500; bounded first-year effects). Response is incremental versus usual care and includes noncompletion. Utility includes shared treatment burdens; no symptom-scale mapping is claimed. Judgment.
- Short family hardship support
- $500; 20% response × .02 utility × .25 integrated years (range: $250–$1,000; .1–.5 integrated years). Short-lived health relief only, not a major housing transition or duplicated therapy/food-bank benefit. Weakest quantified bridge. Judgment.
- Diabetes-prevention course
- $600; 8% three-year risk × 30% reduction (range: $350–$1,000; 3–15% risk; 10–50% reduction). Central cases are delayed two years, with .05 annual utility relief discounted in years 3–4. No lifelong diabetes avoidance or duplicate fitness benefit. Judgment, informed by trials.
- Additional provision from funding
- 40% in each quantified pathway (range: 0–80%, depending on pathway). Access beyond public, private and household financing. Separate from response to that changed provision; not another completion multiplier. Judgment.
- SF share of modeled Bay health
- 65% (range: 40–75%). Unverified beneficiary-residence prior, not a branch-location ratio. Model assumes no material non-Bay share; outside-Bay benefits must be separately allocated if present. Judgment.
How much could the estimate change?
- Joint favorable: $447,276 / 10 SF QALYs. $335,457 per 10 Bay QALYs. Demanding combination of cheaper courses and stronger effects; neither meets the target.
- Pessimistic positive: $1.91 billion / 10 SF QALYs. $764.85 million per 10 Bay QALYs.
- Additional-resource stress: Central ratios double. A hypothetical extra $100,000 of induced resources gives $19.01M SF and $12.35M Bay. This is not a measured full-resource comparison.
- No additional provision or clinical benefit: No finite positive ratio. Donor cash remains spent while modeled health is zero.
- Independent donor-harm stress: Bay health can become negative. Subtracting .1 Q in SF and .1 elsewhere in the Bay leaves .005223 SF Q but −.038119 Bay Q centrally. Under no additional provision, both regions have net harm. These are diagnostic assumptions, not observed harm rates.
Uncertainty. Scenarios are joint analyst judgments, not confidence limits or a calibrated expected-value distribution. Exercise-referral EQ-5D already includes mental health: fitness and therapy increments must be from separate cohorts or exclude the same distress improvement in the same person and period. Shared people may have genuinely distinct gains, but full overlapping generic utilities cannot be added. Remove family credit if it duplicates therapy or partner-food health. DPP participants do not also earn the modeled fitness benefit.
5. Funding and previous grants
Neither central nor favorable modeled health yield meets $100,000 per 10 QALYs. Better evidence on marginal services and sustained health change is needed.
FY2025 audited expenses were $117.87M. Revenue included $51.16M of government fees/grants; membership and program fees are also substantial. These document baseline financing, not marginal allocation or course prices. General campaign giving does not identify extra treatment places. Course allowances include staff, facilities and allocated overhead; the favorable mental-health price requires low-intensity/group delivery, not guaranteed full clinical therapy. Public reimbursement, displaced payments, volunteer and participant time, travel and savings are not reconciled, so donor cash is not comprehensive societal cost. Unquantified youth, aquatics and capital benefits remain possible, positive or negative.
This review does not establish a verified marginal funding offer or a complete history of grants.
Opens the organization’s giving page. A general donation may not fund the specific activity modeled here; confirm allocation with the recipient.
6. Sources
- FY2025 audited financial statements. YMCA of Greater San Francisco. Primary audited finances. Published: October 24, 2025; year ended June 30, 2025; retrieved: September 8, 2026.
- FY2024–25 annual report. YMCA of Greater San Francisco. Primary portfolio report. Published: December 2025; retrieved: September 8, 2026.
- Annual campaign. YMCA of Greater San Francisco. Primary general-giving route. Published: Current page; retrieved: September 8, 2026.
- Financial assistance. YMCA of Greater San Francisco. Primary access description. Published: Current page; retrieved: September 8, 2026.
- Mental-health services. YMCA of Greater San Francisco. Primary clinical-service description. Published: Current page; retrieved: September 8, 2026.
- Family resource centers. YMCA of Greater San Francisco. Primary service description. Published: Current page; retrieved: September 8, 2026.
- Diabetes Prevention Program. YMCA of Greater San Francisco. Primary eligibility and payer context. Published: Current page; retrieved: September 8, 2026.
- NERS randomized economic evaluation. Edwards et al., BMC Public Health. Primary randomized-trial economic evaluation. Published: 2013; retrieved: September 8, 2026.
- Community YMCA diabetes-prevention trial. RAPID investigators. Primary randomized trial; indexed abstract provenance. Published: 2015; retrieved: September 8, 2026.
- Ten-year cost-effectiveness of lifestyle intervention. Diabetes Prevention Program Research Group. Primary trial economic evaluation; context only. Published: 2012; retrieved: September 8, 2026.
Annual expenses: years and sources
Average annual expenses (three consecutive fiscal years): $111,533,309. Organization size is separate from the modeled cost-effectiveness of a donation.
Young Men's Christian Association of San Francisco
IRS Form 990 whole-entity total expenses, Part I line 18; fiscal years ending June 30
Original current-year figures used consistently. FY2024's comparative reports FY2023 as $106,179,745 rather than the original $105,626,717; the difference is unreconciled.