GiveBetter x USA

Surgery on Sunday

Free medically necessary outpatient surgery for uninsured and underinsured residents near Lexington

Research time: ~5 min on GPT-6 Astra Light + ~14 min on GPT-6 Astra Medium + ~6 min on GPT-6.1 Sol
  • Research — reviewed programs, finances and impact evidence.
  • Modeling — estimated costs, QALYs and uncertainty.
  • Source audit — checked claims, assumptions and calculations.

Updated: 2026-10-02

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Summary

What do they do? Surgery on Sunday is the Lexington, Kentucky charity coordinating free outpatient surgery and associated assessment for eligible uninsured or underinsured people, not the separate Louisville organization. Its volunteer surgeons, anesthesia teams and donated facilities support procedures ranging from cataracts and hernias to gallbladder, tonsil and orthopedic surgery; a donation pays the recipient’s support costs rather than buying a standardized operation. The modeled benefit is additional relief of pain, impaired vision and functional limitations over a finite period, after allowing for alternative treatment, operating constraints and surgical harm.

Why we’re interested in this organization:

  • The service has a direct clinical pathway and screens patients for medical necessity; clinicians may choose less invasive care rather than operate.

  • Original returns now provide all recipient expenses, including separately netted fundraising-event costs, and a matched FY2023 benchmark of $2,943 per surgical patient.

  • A December 2025 medical-society account corroborates continuing volunteer-based operations; donated professional and facility inputs can make modest cash support useful when both patient need and clinical capacity are available.

Our main reservations:

  • Our working estimate is about $120K per DALY, combining health and household-resource equivalents; clinical persistence, targeting, cash costs and donation-driven surgery remain judgments.

  • No current procedure mix, severity distribution, complication series or donation-funded case queue was found; newer filings change patient counts while retaining an old narrative date.

  • Substantial historical unrestricted assets and volunteer bottlenecks leave the next gift’s effect uncertain. Cash costs omit donated and external resources, and the fiscal transition prevents a comparable consecutive three-year expense mean.

What do you get for your dollar? $124K per DALY in USA. DALY is our one-year comparison unit. QALY-based health gains and income-welfare equivalents retain their original assumptions; they are not measured clinical DALYs. Conditional partial donation-dollar comparison including signed household resources; no verified marginal surgery offer..

Per $10,000: 3.33 nominal patient equivalents, 1.67 additional equivalents, 1.5 nonbuyer clinical equivalents, 0.08 health years, −0.003239 resource equivalents and 0.08 combined equivalents. These are conditional model outputs, not observed services per dollar.

1. What do they do?

The recipient is Surgery on Sunday, EIN 20-3187452, in Lexington. The official donation route leads to a Charityproud form naming this charity and offering general giving; no transaction was made. Its clinical menu covers several outpatient specialties, not only unusually cost-effective cataract surgery. The FAQ describes monthly volunteer operating lists, eligibility near Lexington, low income and lack of usable insurance. Residence within 250 miles, with limited exceptions, supports attribution to the USA’s 50 states and DC regardless of citizenship. Dental care is currently excluded despite the broader wording in the tax-return mission. Patients needing overnight admission are outside the routine service. The separate Louisville program’s research and outputs are not attributed to this recipient.

2. Monitoring and information sharing

The FY2022 return reports 78 surgical patients in its dated year and the FY2023 return reports 86. Recipient costs per such patient are $2,845 and $2,943 after event-cost addbacks; these are average support benchmarks, not marginal operation prices. One person may have multiple procedures, while assessment and nonsurgical care also consume resources. The transition filing and 2024 filing retain a June 2023 narrative date beside changing counts of 46 and 93, so neither supplies a reliable matched current denominator. A December 2025 partner account supports continued operations, not a 2026 volume estimate. The public surgery-date page still lists 2024 dates. Priority monitoring is dated unique patients and procedures, clinical indications and baseline severity, complications, follow-up utility, alternative-care waiting time, cancellations and cash-funded extra slots. Testimonials are not a controlled health-outcome series. A May 2026 partner fundraising notice again names the charity among supported services; it reports no new grant amount or completed-case count.

The October 2026 source check still finds calendar 2024 as the latest original filing, with the same stale June 2023 narrative beside93 patients. Current FAQ timing is30–60days after approval, conditional on surgeon availability, not a measured gift-to-surgery latency. The May 2026 nonclinical-volunteer capacity banner does not measure surgeon or operating-room slots. Actual recipient purchases, unpaid leave, net travel after assistance, recovery earnings and volunteer expenses remain unobserved.

3. Qualitative assessment

Trials establish that benefits depend on clinical selection, not that every free operation creates the same QALYs. Earlier first-eye cataract surgery added 0.06 QALYs over one year in older women compared with a waiting-list strategy; that is a timing comparison, not evidence of perpetual untreated blindness. Minimally symptomatic hernia repair added 0.03 QALYs over two years. The 24-month C-GALL analysis found a small, statistically uncertain 0.02 QALY advantage for cholecystectomy over conservative management in uncomplicated symptomatic disease. NATTINA found an adjusted, multiple-imputation 0.12 QALY advantage over two years for tonsillectomy in adults meeting UK recurrent-tonsillitis thresholds; its safety report also recorded 52 postoperative bleeding episodes among 231 operated participants and 47 readmissions. Those risks must not be assigned to every outpatient specialty. Trial QALYs already reflect their trial comparators and measured treatment burden: we do not add them together or deduct a second harm allowance from them. Instead, our independent utility-duration prior is discounted for alternative care and charged an explicit perioperative loss. There is no measured Surgery on Sunday case mix with which to transport these effects. Selection of more impaired patients could support greater relief; mild disease and eventual access elsewhere could produce much less.

The current estimate separates purchaser replacement from clinical additionality, considers signed economic effects and retains both the historical clinical model and independent sensitivity cases. One- to two-year trial findings do not identify the current three-year utility prior or local procedure mix. Scientific acceptance verifies the declared conditional arithmetic and boundaries, not measured marginal effectiveness or a current funding offer.

4. What do you get for your dollar?

Our working estimate is about $120K per DALY in the USA, counting ten combined health and household-resource equivalents. Surgery on Sunday can turn donated professional and facility capacity into relief of impaired vision, pain and functional limitations at relatively modest recipient cash cost. We charge the full gift, including assessment and other work whose separate benefits are not quantified. This is a conditional research comparison, not a quoted surgical slot or measured donation return.

What does a donation enable? A $10,000 normalization funds 3.33 nominal patient-treatment equivalents at $3,000 comprehensive recipient support cost each. That allowance includes administration, fundraising, assessment and unsuccessful referrals; it is anchored to the matched FY2023 average of $2,943 per surgical patient, not the narrower, undated $1,000–$1,500 public illustrations. A judged 50% funding and operating response produces 1.67 additional patient equivalents, or $6,000 donor cash per added equivalent. Clinician schedules, facilities, other donors and reserves may limit that response. Neither the normalization nor the five-patient mathematical cap verifies current capacity.

Why should surgery improve health? We model 10% of added patients as otherwise buying equivalent care: their matching surgical benefit and burden occur in both worlds, so they receive no added clinical credit. For the other 1.5 patient equivalents, a separately judged annual utility improvement of 0.04 lasts three years, adjusted for 1% annual mortality, a quarter-year intervention delay and 3% discounting. After retaining 60% of relief relative to alternative free care, later treatment or conservative management, and subtracting a full 0.01 QALY treatment burden, each nonbuyer gains 0.06 QALYs. Total health is 0.08 USA QALYs per $10,000, or $119K per DALY. These are not measured Surgery on Sunday outcomes. Trials described below show why indication and severity matter; their net QALYs are not inserted as gross utility and charged harm again.

What happens to household resources? Ten percent are assumed to avoid an actual $600 own payment for equivalent care, less $30 incremental travel. This is not a waived hospital bill or insurance payment. Nonbuyers incur $30 residual travel, $150 actual lost disposable pay and $20 medication cost beyond their without-gift alternative, after any support or paid leave. Together these one-off recipient flows are −$205. All purchase probabilities, cash amounts and the $30,000 household-resource baseline are judgments; eligibility is not measured disposable income.

Functional recovery may improve work. Among nonbuyers, 25% are assumed to be work-limited in a way that can improve, with the same 60% clinical additionality discount. The resulting 0.225 patient equivalents earn a judged $500 of extra disposable income per year for two years. These are patients alive in both counterfactual worlds, not ordinary earnings of newly surviving people. Applying yearly mortality gives $221.64 expected raw earnings. Only 25% of its welfare-equivalent score is credited independently of health utility, which can already reflect role limitations and worry; this overlap adjustment does not erase real cash.

Restored earnings are survival-adjusted year-end flows. The first annual log increment uses resources after the contemporaneous $200 burden; the next uses the unburdened baseline. One-off costs and avoided payments are valued at the quarter-year delay. Five volunteer-person equivalents per added patient each incur a judged $10 actual unreimbursed cash cost, or −$83.33 per gift; unpaid leisure is not lost wages. These signed pathways, using the Coefficient Giving resource-to-health crosswalk, yield −0.003239 household-resource equivalents. Health plus resources is 0.08 combined equivalents per $10,000, giving $124K per DALY. Resource equivalents are welfare comparisons, not observed clinical QALYs.

Why did the estimate change? The preserved earlier health-only price was $41K. The new model shortens assumed relief from five to three years, lowers annual gross utility from 0.05 to 0.04, lowers funding response from 60% to 50%, and explicitly separates purchasers and intervention timing. These are reconsidered priors, not newly measured effects. Restoring the old clinical assumptions reproduces the old health result; cash and timing alternatives are inspectable separately. One- and two-year relief, zero funding, absent capacity, greater harms, negative earnings, no purchase savings and unknown components challenge the central. No scenario range is a confidence interval.

The institutional gross-resource companion adds a judged $5,000 of donated labor/facility/supply opportunity cost and $200 expected external complication resources per added patient, making $18,666.67 per gift and $231K per DALY. It is not a net societal estimate: displaced alternative care and other institutional effects are unknown. Recipient and volunteer cash losses already in welfare are not charged again, and donated professional time is not credited as household income. Screening, referral, survival and other unquantified effects remain unknown rather than observed zero. Gifts above the model's $25,000 domain cannot be linearly extrapolated into a delivery promise.

Model, assumptions and sensitivity

Full donor gift retained with judged $3000 comprehensive recipient cost per nominal patient-equivalent. Separate gross institutional resources per added case. Household and volunteer cash affect welfare, not a repeated donor charge.

Routine 250-mile Lexington residency eligibility supports USA residents. Central g=1; pessimistic .99 allows exceptional nonresident cases. Citizenship is not residency. Independent affiliates are excluded. Actual residence extract is not available.

N=min(G/cashCase*funding,capacity); nonbuyer=N*(1-purchaseShare); health=g*[nonbuyer*(clinicalAdditionality*du*sum finite survival/discount minus acute h)-donorHarm]. Signed recipient, survival-adjusted year-end restored earnings, and volunteer cash each use separate logarithmic crosswalks. Price=10*G/(health+resources) only when positive.

FY2023 surgical patients
86 patients (observed). Matched year-ending June 2023 original filing; do not use later stale-date counts. [sos-fy23]
FY2023 full expense
253116 USD (observed). Original Part IX $239,269 plus Part VIII event direct expense $13,847. All reported recipient expenses; reported depreciation retained. [sos-fy23]
Historical expense per surgical patient
2943.2093023255816 USD/patient (observed). Derived arithmetic from observed gross recipient expense divided by 86 surgical patients in the matched year; not a procedure count or observed marginal price. [sos-fy23]
2023 transition expense
125061 USD / six months (observed). Original July–December 2023 six-month period, separately shown. Used only in the explicit 42-month bridge, not as a full year. [sos-transition]
Current procedure mix and marginal funded queue
null cases/severity/funding (unknown). Exact key diligence gap; no inferred mix from the service menu. [sos-types] [sos-2024]
G
10000 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
cashCase
3000 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
funding
0.5 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
capacity
5 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
g
1 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
delay
0.25 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
discount
0.03 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
purchaseShare
0.1 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
du
0.04 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
T
3 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
mortality
0.01 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
clinicalAdditionality
0.6 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
h
0.01 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
donorHarm
0 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
purchaseCash
600 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
recipientIncome
30000 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
nonbuyerTravel
30 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
nonbuyerLostPay
150 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
nonbuyerMedication
20 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
buyerIncrementalBurden
30 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
recoveryShare
0.25 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
earningsGain
500 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
incomeYears
2 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
incomeIndependent
0.25 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
volunteersPerCase
5 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
volunteerCash
10 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
volunteerIncome
60000 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
volunteerIndependent
1 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
donatedResourcePerAddedCase
5000 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.
complicationResourcePerAddedCase
200 declared parameter; units and ledger in cost section (judgment). Finite hypothesis, not a measured marginal organizational effect; independent acceptance/source memo preserves causal and timing boundaries.

Conditional donor health and household resources: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

prior utility .05: Cost: $10K; USA health QALYs: 0.11; all-population health QALYs: 0.11. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

prior funding .6: Cost: $10K; USA health QALYs: 0.10; all-population health QALYs: 0.10. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

no purchaser partition: Cost: $10K; USA health QALYs: 0.09; all-population health QALYs: 0.09. Income-equivalent healthy years: -0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

no procedure delay: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

prior clinical assumptions: Cost: $10K; USA health QALYs: 0.25; all-population health QALYs: 0.25. Income-equivalent healthy years: -0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

favorable severe selection: Cost: $10K; USA health QALYs: 2.67; all-population health QALYs: 2.67. Income-equivalent healthy years: 0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

mild delayed access downside: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

zero funding: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

zero capacity: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

zero gift: Cost: $0; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

clinical null with treatment harm: Cost: $10K; USA health QALYs: -0.01; all-population health QALYs: -0.01. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

equivalent benefit elsewhere harm: Cost: $10K; USA health QALYs: -0.01; all-population health QALYs: -0.01. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

all purchased equivalent care: Cost: $10K; USA health QALYs: 0.00; all-population health QALYs: 0.00. Income-equivalent healthy years: 0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

no actual purchase savings: Cost: $10K; USA health QALYs: 0.09; all-population health QALYs: 0.09. Income-equivalent healthy years: -0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

one year relief: Cost: $10K; USA health QALYs: 0.02; all-population health QALYs: 0.02. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

two year relief: Cost: $10K; USA health QALYs: 0.05; all-population health QALYs: 0.05. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

five year relief: Cost: $10K; USA health QALYs: 0.14; all-population health QALYs: 0.14. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

ten year relief: Cost: $10K; USA health QALYs: 0.27; all-population health QALYs: 0.27. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

higher treatment harm: Cost: $10K; USA health QALYs: 0.02; all-population health QALYs: 0.02. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

negative functional cash: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: -0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

no independent earnings: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

full independent earnings: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

no recipient burden: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

cash positive purchaser heavy: Cost: $10K; USA health QALYs: 0.07; all-population health QALYs: 0.07. Income-equivalent healthy years: 0.01. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

volunteer paid work displacement stress: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: -0.02. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

independent harm no activity: Cost: $10K; USA health QALYs: -0.01; all-population health QALYs: -0.01. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

survival .03: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

discount .05: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

domestic share .99: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

lower cash cost: Cost: $10K; USA health QALYs: 0.13; all-population health QALYs: 0.13. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

higher cash cost: Cost: $10K; USA health QALYs: 0.06; all-population health QALYs: 0.06. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

no donated resource opportunity cost: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

higher donated resource cost: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

income unknown: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

clinical unknown: Cost: $10K; USA health QALYs: unknown; all-population health QALYs: unknown. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

institutional resource unknown: Cost: $10K; USA health QALYs: 0.08; all-population health QALYs: 0.08. Income-equivalent healthy years: 0.00. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

whole route unknown: Cost: $10K; USA health QALYs: unknown; all-population health QALYs: unknown. Explicit judged parameters and typed component status below; purchasers have matching clinical care in both worlds, other care discount conditional on nonbuyers; earnings include yearly survival and year-end timing.

Historical USA clinical-only estimate: Cost: $10K; USA health QALYs: 0.25; all-population health QALYs: 0.25. Preserved original clinical model; not current result. G=10000, c=3000, b=0.6, s=0.6, Δu=0.05, T=5, m=0.01, h=0.01, g=1. Gross QALY=0.22; net per added patient-treatment equivalent=0.12340321460253671; additional equivalents=2. Full harm retained; judgment stress, not an empirical bound.

Counterfactual: Purchased equivalent care has matching benefits and surgical burden in both worlds; no additional clinical or restored-wage credit. Other clinical relief discount is conditional on nonbuyers. Common-alive patients may regain function, not ordinary wages of newly surviving people. Actual cash after support and paid leave, not retail bills.

Attribution: No procedure-mix weights inferred from menu or stale counts; all dose/cost/funding/capacity/clinical/economic parameters explicit judgments. Recovered wage cohort includes annual mortality and year-end receipts; full one-off burdens retained regardless earnings overlap discount.

Conditional partial judgment comparison, not identified expected unrestricted return or verified capacity; typed unknowns remain different from zero, and negative welfare has no favorable price. Year3 relief and all income parameters are unmeasured.

Sensitivity

  • Current donor combined$124K versus historic clinical$41K; donor clinical$119K. Changed priors are not observed effects.
  • Restored utility/funding/duration/purchaser/timing assumptions and zero/negative income are separate cases. Finite utility horizon and delayed recovery income remain judgments.
  • Institutional companion$2,305,588 is gross, not net societal spending. Household cash and donated opportunity costs have separate ledgers.
  • Unknown clinical propagates to recovery earnings; known direct cash stays inspectable. Zero gifts/capacity/funding preserve genuine zeros, independent harms remain.

Unresolved inputs

  • Dated 2024–2026 completed cases and surgical patients by procedure, plus reconciliation of changing patient counts with stale 2023 narrative dates.
  • Baseline utility/severity, follow-up utility and complications by procedure, and evidence for duration of additional relief.
  • Next unrestricted gift's funded case queue, cash bottleneck, clinician/facility slots, current budget and reserve deployment policy.
  • Alternative public/charitable/private care and waiting time for eligible patients without this service.
  • Actual donated labor/facility opportunity costs, downstream complication costs and patient travel/time costs.
  • Residence by patient, particularly exceptional out-of-area admissions.
  • Actual otherwise-paid treatment, net recipient and volunteer cash, earnings/benefit offsets and independent health-income overlap. Mathematical capacity bounds are not delivery offers.

Health and income breakdown

For the modeled $10K: 0.08 health QALYs + 0.00 income-equivalent healthy years in USA: $124K per DALY. Income equivalents are welfare comparisons, not observed QALYs or DALYs.

Method and caveats.

5. Funding and previous grants

The 2024 original filing reports $250,740 in Part IX expenses and $12,073 of event costs netted against revenue. Reconstructing gross recipient spending gives $262,813: $186,178 program, $50,794 administration and $25,841 fundraising including the addback. Gross receipts similarly rise from $250,470 to $262,543, leaving the same $270 deficit. Payroll, benefits and payroll taxes total $119,697; patient care is $70,833 and interpreter/credentialing costs $16,570. Cash and savings were $352,026, with $108,363 securities and $459,108 unrestricted net assets at year end—not a current cash-shortfall finding. The FY2022 and FY2023 returns classify $21,218 and $95,407 as government grants. Their programs are unidentified, but these entries contradict an unqualified claim of no government assistance. A 2023 founder appeal identified volunteers as the greatest need; it is not evidence of today’s bottleneck. A 2022 direct account describes nominal facility rent, per-patient supplies, donated ancillary care and some travel support. Public evidence does not show what extra cash now unlocks. The 50% response factor is a judgment covering donor replacement, reserves and operating constraints once, not a measured expansion promise. Appendix: corrected full-period expenses are $221,875 for July 2021–June 2022, $253,116 for July 2022–June 2023, and $262,813 for calendar 2024. These are not consecutive periods. Adding the intervening six-month $125,061 return produces $862,865 over 42 months, an annualized historical rate of $246,533—not the standard consecutive three-year mean, which remains unavailable.

The October 2026 original-source refresh reproduces all four expense/event-cost reconciliations. The latest three contiguous filings span 30 months and $640,990 gross expense, annualized $256,396; this is a separate historical rate, not a consecutive three-year mean. Current unrestricted cash-funded surgical capacity remains unresolved.

Annual expenses

Organization-level spending, including programs, administration and fundraising. The research list averages three comparable, consecutive full fiscal years when available.

  • FY 2022: $222K; Surgery on Sunday, EIN 20-3187452, 12-month period, Original cash-basis Form 990, 2021-07-01 through 2022-06-30; Part IX plus separately netted event costs. Reported depreciation retained. Full-year windows are not consecutive across the transition; no standard three-year mean.. Source
  • FY 2023: $253K; Surgery on Sunday, EIN 20-3187452, 12-month period, Original cash-basis Form 990, 2022-07-01 through 2023-06-30; Part IX plus separately netted event costs. Reported depreciation retained. Full-year windows are not consecutive across the transition; no standard three-year mean.. Source
  • FY 2024: $263K; Surgery on Sunday, EIN 20-3187452, 12-month period, Original cash-basis Form 990, 2024-01-01 through 2024-12-31; Part IX plus separately netted event costs. Reported depreciation retained. Full-year windows are not consecutive across the transition; no standard three-year mean.. Source

6. Sources

  1. About Surgery on Sunday. Surgery on Sunday. Published: not stated; retrieved: 2026-10-02.
  2. Types of surgeries. Surgery on Sunday. Published: not stated; retrieved: 2026-10-02.
  3. Frequently asked questions. Surgery on Sunday. Published: not stated; retrieved: 2026-10-02.
  4. Donate. Surgery on Sunday. Published: not stated; retrieved: 2026-09-14.
  5. Supported by the LMS Foundation: Surgery on Sunday. Lexington Medical Society. Published: 2025-12-04; retrieved: 2026-10-02.
  6. Original Form 990, July 2022–June 2023. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-10-02.
  7. Original Form 990, July–December 2023. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-10-02.
  8. Original Form 990, calendar 2024. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-10-02.
  9. First-eye cataract surgery economic evaluation alongside randomized trial. Sach et al. / British Journal of Ophthalmology. Published: not stated; retrieved: 2026-10-02.
  10. Tension-free repair versus watchful waiting economic evaluation. Stroupe et al. / Journal of the American College of Surgeons. Published: 2006-08-24; retrieved: 2026-10-02.
  11. C-GALL randomized trial of conservative management versus cholecystectomy. Ahmed et al. / BMJ. Published: 2023-12-06; retrieved: 2026-09-14.
  12. Original Form 990, July 2021–June 2022. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-10-02.
  13. General giving form identifying Lexington Surgery on Sunday. Surgery on Sunday / Charityproud. Published: not stated; retrieved: 2026-09-14.
  14. Surgery on Sunday needs volunteers. Andrew Moore / Lexington Medical Society. Published: 2023-06-14; retrieved: 2026-09-14.
  15. The Power of Teamwork: Nonprofit Changes Lives Through Free Surgery Model. Health Progress / Catholic Health Association. Published: not stated; retrieved: 2026-10-02.
  16. Volunteer FAQ: reported malpractice arrangement. Surgery on Sunday. Published: not stated; retrieved: 2026-09-14.
  17. Physician volunteers: preoperative and postoperative care. Surgery on Sunday. Published: not stated; retrieved: 2026-09-14.
  18. Surgery dates: dated 2024 schedule. Surgery on Sunday. Published: not stated; retrieved: 2026-10-02.
  19. C-GALL within-trial economic analysis, 24 months. Ahmed et al. / NIHR Health Technology Assessment. Published: not stated; retrieved: 2026-10-02.
  20. NATTINA economic evaluation, Table 24. Wilson et al. / NIHR Health Technology Assessment. Published: not stated; retrieved: 2026-10-02.
  21. NATTINA trial report and safety summary. Wilson et al. / NIHR Health Technology Assessment. Published: not stated; retrieved: 2026-09-14.
  22. May 2026 foundation fundraising notice naming supported services. Lexington Medical Society. Published: not stated; retrieved: 2026-10-02.
  23. General volunteer capacity notice. Original organization, IRS record or primary research publication. Published: not stated; retrieved: 2026-10-02.
  24. Clinical volunteer onboarding. Original organization, IRS record or primary research publication. Published: not stated; retrieved: 2026-10-02.
  25. Original IRS filing index. Original organization, IRS record or primary research publication. Published: not stated; retrieved: 2026-10-02.
  26. Original C-GALL economic analysis. Original organization, IRS record or primary research publication. Published: not stated; retrieved: 2026-10-02.
  27. NATTINA adjusted QALY comparison, Table24. Original organization, IRS record or primary research publication. Published: not stated; retrieved: 2026-10-02.
  28. Health and income cost-effectiveness reference. Coefficient Giving. Published: not stated; retrieved: 2026-09-30.