GiveBetter x USA

Surgery on Sunday

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

Research time: ~19 min on GPT-6 Astra Light + GPT-6 Astra Medium
  • Research — reviewed programs, finances and impact evidence.

Updated: 2026-09-14

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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:

  • The working estimate of about $405,000 per 10 USA QALYs is a subjective clinical and funding judgment, not a measured return; shorter-lived or less additional benefits make it much worse, and net harm is possible.

  • 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? $405K per better life: ten additional quality-adjusted life years in USA. Working judgment estimate of incremental USA surgical health from an ordinary unrestricted gift, charging all recipient support costs. It excludes unquantified assessment/referral benefits and unpriced external resources; it is neither a measured whole-portfolio return nor a full societal resource-cost estimate..

Observed FY2023: 86 surgical patients and $253,116 gross recipient expenses, including $13,847 of event costs outside Part IX. Derived average $2,943.21 per surgical patient includes assessment and referral overhead. The model uses 3.33 nominal patient-treatment equivalents per $10,000 and 2 additional equivalents after funding response. Patient-treatment equivalents are an approximation, not an observed count of distinct operations. Gross 0.22234 QALY and net 0.12340 QALY per added equivalent yield 0.24681 USA QALY.

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.

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 0.056 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 0.031 QALYs over two years. The 24-month C-GALL analysis found a small, statistically uncertain 0.019 QALY advantage for cholecystectomy over conservative management in uncomplicated symptomatic disease. NATTINA found an adjusted, multiple-imputation 0.118 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.

4. What do you get for your dollar?

The working donor-cost estimate remains about $405,000 per 10 USA QALYs. Charging the full $10,000 gift, a $3,000 recipient-cost case-equivalent gives 3.33 nominal patient-treatment equivalents. A 60% funding/capacity response leaves 2 additional treatment equivalents, or $5,000 per added equivalent; these are modeled units, not confirmed bookings or distinct observed operations. A 0.05 utility gain over five years, 1% annual mortality and 3% annual discounting gives 0.22234 gross QALY per equivalent. Retaining 60% after alternative-care adjustment and subtracting the full 0.01 QALY perioperative burden leaves 0.12340 net QALY each, or 0.24681 per gift. Five-year persistence is an explicit extrapolation, not a trial result. One-year persistence raises the price to about $2.65 million; the joint favorable stress test is about $19,000, while adverse and zero scenarios have no finite favorable price. The website’s $1,500 illustration and partner’s under-$1,000 claim are not reconciled full recipient costs. Donated clinicians, facilities, malpractice support, downstream treatment and patient time are not valued at zero: they are outside the cash donor price and incompletely measured. An illustrative $5,000 resource allowance per added equivalent raises the central to about $810,000 per 10; charging it to every nominal equivalent raises it to about $1.08 million. Neither is a complete societal estimate, and neither uses waived retail bills as resource cost.

Model, assumptions and sensitivity

Whole ordinary recipient gift including program, administration, fundraising and separately netted event costs. Full reported cash-basis accounting expenses retain reported depreciation; this is not a pure bank-cash-flow measure. The $3,000 case-equivalent is calibrated to $2,943 per FY2023 surgical patient, not a contracted per-operation rate. No restricted best-procedure allocation, retail-bill savings, earnings or public-cost offsets.

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.

q_gross = Δu × sum[t=1..T]((1−m)^t/(1.03)^t). N_add = (G/c)×b. q_net = s×q_gross−h. Q_all = N_add×q_net. Q_USA = Q_all×g. Price per 10 = 10 × scenario costUSD / Q_USA only when Q_USA>0. Scenario costUSD=G for recipient-cash scenarios; the two resource-cost stresses explicitly add their opportunity-cost allowance. b is funding-driven operating/capacity additionality; s discounts gross benefit for equivalent counterfactual care. Perioperative loss h applies to every added patient-treatment equivalent, including s=0, and is not multiplied by s.

G
10000 USD normalization (judgment). Small normalization relative to annual spending; no verified room-for-more-funding tranche.
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]
c
3000 USD/patient-treatment equivalent (judgment). Rounded from corrected matched $2,943 recipient cost per surgical patient. Stress $1,500–$5,000; no inflation update or binding current price is observed. [sos-fy23] [sos-donate] [sos-partner]
b
0.6 gift/capacity additionality (judgment). Discount for reserves, replacement donors and volunteer/OR constraints; stress .2–.9 and zero. [sos-2024] [sos-partner] [sos-volunteer-call]
s
0.6 counterfactual health additionality (judgment). Discount for alternative access, later treatment and conservative management; not a measured untreated share. [sos-faq] [cgall]
Δu
0.05 annual health-utility gain (judgment). Independent annual utility prior for selected heterogeneous surgical patients, not a weighted trial estimate. Trial net QALYs anchor plausibility but are not plugged into the gross-utility formula. [cataract-rct] [hernia-rct] [cgall] [cgall24] [nattina-economic]
T
5 years (judgment). Explicit five-year judgment about relief persistence, not observed trial follow-up. No benefit after year five; stress one to ten years.
m
0.01 annual mortality (judgment). Simplified survival adjustment, not recipient age-specific life table; pessimistic .02.
h
0.01 QALY/added patient-treatment equivalent (judgment). Judgment allowance for pain, complications and rare fatal harm across a treatment episode, including repeated procedures; not an observed adverse-event rate. Retained even when s=0. [nattina-safety]
discount rate
0.03 annual (judgment). Conventional analyst discount choice.
g
1 USA resident health share (judgment). Residency eligibility strongly supports domestic boundary; pessimistic .99. [sos-faq]
Donated resource addition
5000 USD/nominal case-equivalent (judgment). Illustrative opportunity cost, not hospital retail charges; actual shadow cost unknown. [sos-partner]
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]

Working judgment central: Cost: $10K; USA QALYs: 0.24680642920507342; all-population QALYs: 0.24680642920507342. 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=0.22233869100422787; net per added patient-treatment equivalent=0.12340321460253671; additional equivalents=2. Full harm retained; judgment stress, not an empirical bound.

Favorable selection and capacity: Cost: $10K; USA QALYs: 5.185304902355682; all-population QALYs: 5.185304902355682. G=10000, c=1500, b=0.9, s=0.9, Δu=0.12, T=10, m=0.01, h=0.01, g=1. Gross QALY=0.9713527596954966; net per added patient-treatment equivalent=0.864217483725947; additional equivalents=6. Full harm retained; judgment stress, not an empirical bound.

Low additionality and modest relief: Cost: $10K; USA QALYs: -0.0005094734659251579; all-population QALYs: -0.0005146196625506645. G=10000, c=5000, b=0.2, s=0.2, Δu=0.01, T=2, m=0.02, h=0.005, g=0.99. Gross QALY=0.018567254218116693; net per added patient-treatment equivalent=-0.0012865491563766613; additional equivalents=0.4. Full harm retained; judgment stress, not an empirical bound.

Existing resources cover all marginal activity: Cost: $10K; USA QALYs: 0; all-population QALYs: 0. G=10000, c=3000, b=0, s=0.6, Δu=0.05, T=5, m=0.01, h=0.01, g=1. Gross QALY=0.22233869100422787; net per added patient-treatment equivalent=0.12340321460253671; additional equivalents=0. Full harm retained; judgment stress, not an empirical bound.

Equivalent gross benefit elsewhere, full perioperative loss: Cost: $10K; USA QALYs: -0.02; all-population QALYs: -0.02. G=10000, c=3000, b=0.6, s=0, Δu=0.05, T=5, m=0.01, h=0.01, g=1. Gross QALY=0.22233869100422787; net per added patient-treatment equivalent=-0.01; additional equivalents=2. Full harm retained; judgment stress, not an empirical bound.

Only one year of incremental relief: Cost: $10K; USA QALYs: 0.03766990291262136; all-population QALYs: 0.03766990291262136. G=10000, c=3000, b=0.6, s=0.6, Δu=0.05, T=1, m=0.01, h=0.01, g=1. Gross QALY=0.04805825242718447; net per added patient-treatment equivalent=0.01883495145631068; additional equivalents=2. Full harm retained; judgment stress, not an empirical bound.

Equivalent operation otherwise occurs one year later: Cost: $10K; USA QALYs: 0.07611650485436894; all-population QALYs: 0.07611650485436894. G=10000, c=3000, b=0.6, s=1, Δu=0.05, T=1, m=0.01, h=0.01, g=1. Gross QALY=0.04805825242718447; net per added patient-treatment equivalent=0.03805825242718447; additional equivalents=2. Full harm retained; judgment stress, not an empirical bound. Gross relief lasts only until equivalent later care; retaining all current surgical harm without offsetting later harm is deliberately conservative.

Greater short-term burden and complications: Cost: $10K; USA QALYs: 0.1668064292050734; all-population QALYs: 0.1668064292050734. G=10000, c=3000, b=0.6, s=0.6, Δu=0.05, T=5, m=0.01, h=0.05, g=1. Gross QALY=0.22233869100422787; net per added patient-treatment equivalent=0.0834032146025367; additional equivalents=2. Full harm retained; judgment stress, not an empirical bound.

Central plus resource allowance for added equivalents: Cost: $20K; USA QALYs: 0.24680642920507342; all-population QALYs: 0.24680642920507342. Central health unchanged. Cost = $10,000 + $5,000 × 2 added patient-treatment equivalents. Unmeasured opportunity-cost allowance, not retail charges or a complete societal estimate.

Central plus gross nominal resource allowance: Cost: $27K; USA QALYs: 0.24680642920507342; all-population QALYs: 0.24680642920507342. Central health unchanged. Cost = $10,000 + $5,000 × 3.3333333333333335 nominal patient-treatment equivalents. Unmeasured opportunity-cost allowance, not retail charges or a complete societal estimate.

Counterfactual: Without the gift some care may still occur using reserves or other donors (b), and some patients may obtain equivalent care through other charities, insurance, public eligibility or later treatment (s). s is a fractional health-benefit discount, not necessarily a literal permanently untreated patient fraction. Conservative nonoperative care may be sufficient for some cases. No assumption that every billed procedure creates benefit. Even where equivalent benefit occurs elsewhere, this conservative formulation retains the full incremental perioperative burden h for every donation-enabled patient-treatment equivalent; it does not assume that alternative care perfectly offsets that harm.

Attribution: The $3,000 benchmark is per surgical-patient treatment equivalent because the original denominator counts patients, not operations. Repeated procedures per patient are implicitly averaged into the utility and harm assumptions; there is no extra credit for each procedure. Volunteer/facility cooperation complements cash; b discounts its operating response, reserve use and donor replacement once. s separately discounts health relative to alternative care, including later access. No independently measured case mix or funding response is claimed.

A genuine working best judgment, not a probability-weighted measurement or endorsement. The $3,000 cash benchmark survives the cost correction, while the clinical persistence and marginal capacity assumptions remain weak. Five years extrapolates beyond the one- to two-year trials. Gross utility is a new independent prior, not trial net QALYs with duplicate harm deductions. There is no survival benefit or lifetime expansion. Positive, zero and adverse scenarios are judgment stresses, not confidence limits.

Sensitivity

  • Price scales with recipient cost and inversely with funding response. Positive health requires s × gross QALY > h; a procedure can therefore have zero or negative incremental value.
  • Central q_gross is 0.22234. At central s=.6 and h=.01, positive health requires q_gross > .01667. The $100,000 per 10 threshold requires q_gross ≥ .85 at the other central inputs; the $1 million threshold requires ≥ .10.
  • Five years is a persistence judgment, not trial follow-up. With only one year of relief the price is about $2.65 million per 10. The separate timing-only scenario assumes equivalent later care and limits benefit to one year rather than counting lifetime relief.
  • No observed procedure shares exist. A severe visual-impairment mix could exceed the central, while minimally symptomatic hernia or uncomplicated gallstone cases could fall well below it. The menu is not a mix distribution.
  • The adverse low-additionality scenario is net harmful. s=0 with b=.6 retains -.02 QALY of perioperative loss; b=0 gives zero operations and zero harm. Neither has a finite favorable price.
  • An illustrative $5,000 opportunity cost per added treatment equivalent gives about $810,000 per 10. Charging the same allowance to every nominal equivalent gives about $1.08 million. Both omit unresolved external costs and are sensitivities, not measured social returns.

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.

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 60% 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.

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: 2026-09-14.
  2. Types of surgeries. Surgery on Sunday. Published: not stated; retrieved: 2026-09-14.
  3. Frequently asked questions. Surgery on Sunday. Published: not stated; retrieved: 2026-09-14.
  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: 2026-09-14.
  6. Original Form 990, July 2022–June 2023. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-09-14.
  7. Original Form 990, July–December 2023. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-09-14.
  8. Original Form 990, calendar 2024. Surgery on Sunday / IRS via ProPublica. Published: not stated; retrieved: 2026-09-14.
  9. First-eye cataract surgery economic evaluation alongside randomized trial. Sach et al. / British Journal of Ophthalmology. Published: not stated; retrieved: 2026-09-14.
  10. Tension-free repair versus watchful waiting economic evaluation. Stroupe et al. / Journal of the American College of Surgeons. Published: 2006-08-24; retrieved: 2026-09-14.
  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: 2026-09-14.
  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: 2026-09-14.
  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: 2026-09-14.
  19. C-GALL within-trial economic analysis, 24 months. Ahmed et al. / NIHR Health Technology Assessment. Published: not stated; retrieved: 2026-09-14.
  20. NATTINA economic evaluation, Table 24. Wilson et al. / NIHR Health Technology Assessment. Published: not stated; retrieved: 2026-09-14.
  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: 2026-09-14.