ASC

ASC 220-954

Health Care Entities

220 Income Statement—Reporting Comprehensive Income

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In brief

IntermediatePresentationNot-for-profitIndustry-specificDisclosure

This Subtopic governs how not-for-profit, business-oriented health care entities present their statement of operations and statement of changes in net assets. Its central requirement is a clearly labeled "performance indicator" (e.g., revenues over expenses) reported in a statement that also shows total changes in net assets without donor restrictions, with a specified list of items — such as equity transfers, donor-restricted contributions, other comprehensive income items, and unrealized gains/losses on non-trading debt securities — required to be reported outside that indicator.

Key points (7)
  • The guidance applies only to not-for-profit, business-oriented health care entities (220-954-15-2), and the statement of operations may be combined with the statement of changes in equity (net assets) (220-954-45-1).
  • The statement of operations must include a performance indicator that is clearly labeled with a descriptive term such as revenues over expenses or performance earnings, presented in a statement that also shows total changes in net assets without donor restrictions (220-954-45-5).
  • Paragraph 220-954-45-8 lists items reported separately from (outside) the performance indicator, including owner transactions, equity transfers with controlled/controlling/common-control entities, receipt of donor-restricted contributions, contributions of and assets released for long-lived assets, other comprehensive income items under 220-10-45-10A, donor- or law-restricted investment returns, inherent contributions increasing net assets with donor restrictions, and instrument-specific credit risk changes under 825-10-45-5.
  • Unrestricted investment return inside the performance indicator includes dividend and interest income, realized gains and losses, unrealized gains/losses on trading debt securities, credit loss expense, and unrealized gains/losses and impairments on Topic 321 equity investments; unrealized gains and losses on non-trading debt securities are excluded (220-954-45-9).
  • Increases in net assets from services received from personnel of an affiliate that are not charged to the recipient are reported as equity transfers regardless of the affiliate's status, while the related expense or asset is reported like other such expenses or assets (220-954-45-3); equity transfers are excluded from the performance indicator and create no step-up in basis (220-954-45-2).
  • Functional expense classification groups costs by purpose into program services and supporting activities, with the extent of subclassification depending on the entity's nature and complexity, and allocations based on full cost allocations (220-954-45-4).
  • The notes must describe the nature and composition of the performance indicator (220-954-50-1), and if an intermediate measure of operations is reported and its use is not apparent, the notes must describe the measure or the items excluded from operations (220-954-50-2).

For students. The performance indicator is the NFP health care analogue of "net income," and exam questions almost always test which items fall outside it; the most common error is treating all unrealized gains as excluded — unrealized gains on trading debt securities and on Topic 321 equity investments are inside the indicator, only non-trading debt security unrealized gains are outside.

performance indicatornot-for-profit business-oriented health care entityequity transfernet assets without donor restrictionsfunctional expense classificationtrading debt securitiesintermediate measure of operationsinvestment return

Machine-generated study aid for ASC 220-954. Check the source paragraphs below.

220-954-00Status

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220-954-00-1
The following table identifies the changes made to this Subtopic.
ParagraphActionAccounting Standards UpdateDate
AffiliateAmendedMaintenance Update 2018-12 (PDF)09/10/2018
AffiliateAddedMaintenance Update 2017-19 (PDF)11/15/2017
Conditional ContributionAddedAccounting Standards Update No. 2018-0806/21/2018
ContributionAmendedAccounting Standards Update No. 2018-0806/21/2018
ContributionAddedMaintenance Update 2017-19 (PDF)11/15/2017
Donor-Imposed ConditionAddedAccounting Standards Update No. 2018-0806/21/2018
Donor-Imposed RestrictionAddedMaintenance Update 2017-19 (PDF)11/15/2017
Equity TransferAddedMaintenance Update 2017-19 (PDF)11/15/2017
Functional Expense ClassificationAddedMaintenance Update 2017-19 (PDF)11/15/2017
Inherent ContributionAddedMaintenance Update 2017-19 (PDF)11/15/2017
Net Assets with Donor RestrictionsAddedMaintenance Update 2017-19 (PDF)11/15/2017
Net Assets without Donor RestrictionsAddedMaintenance Update 2017-19 (PDF)11/15/2017
Performance IndicatorAddedMaintenance Update 2017-19 (PDF)11/15/2017
Promise to GiveAddedAccounting Standards Update No. 2018-0806/21/2018
954-220-05-1AddedMaintenance Update 2017-19 (PDF)11/15/2017
954-220-15-1AddedMaintenance Update 2017-19 (PDF)11/15/2017
954-220-15-2AddedMaintenance Update 2017-19 (PDF)11/15/2017
954-220-45-1 through 45-11
AddedMaintenance Update 2017-19 (PDF)11/15/2017
954-220-45-6AmendedAccounting Standards Update No. 2025-1212/17/2025
954-220-50-1AddedMaintenance Update 2017-19 (PDF)11/15/2017
954-220-50-2AddedMaintenance Update 2017-19 (PDF)11/15/2017
954-220-55-1 through 55-6
AddedMaintenance Update 2017-19 (PDF)11/15/2017

220-954-05Overview and Background

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220-954-05-1
This Subtopic provides guidance on the presentation of a statement of operations and a statement of changes in net assets by not-for-profit, business-oriented health care entities.

220-954-15Scope and Scope Exceptions

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Overall Guidance

220-954-15-1
This Subtopic follows the same Scope and Scope Exceptions as outlined in the Overall Subtopic (see Section 954-10-15), with specific entity qualifications noted below.

Entities

220-954-15-2
The guidance in this Subtopic applies only to not-for-profit, business-oriented health care entities.

220-954-45Other Presentation Matters

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Statement of Activities

220-954-45-1
For not-for-profit, business-oriented health care entities, the statement of operations may be combined with the statement of changes in equity (net assets).

Equity Transfers

220-954-45-2
Equity transfers are reported separately as changes in net assets, are excluded from the performance indicator, and do not result in any step-up in basis of the underlying assets transferred. Paragraph 958-720-30-3 provides guidance on services received from personnel of an affiliate that directly benefits the recipient not-for-profit, business-oriented health care entity and for which the affiliate does not charge the recipient entity. Paragraph 958-20-55-2B describes the difference between an equity transfer and an equity transaction.
220-954-45-3
The increase in net assets associated with services received from personnel of an affiliate that directly benefit the recipient not-for-profit, business-oriented health care entity and for which the affiliate does not charge the recipient entity shall be reported as an equity transfer, regardless of whether those services are received from personnel of a not-for-profit affiliate or any other affiliate. The corresponding decrease in net assets or the creation or enhancement of an asset resulting from the use of services received from personnel of an affiliate shall be reported similar to how other such expenses or assets are reported.

Functional Allocations

220-954-45-4
Functional expense classification is a method of grouping expenses according to the purpose for which costs are incurred. The primary functional expense classifications are program services and supporting activities. The extent of classification and subclassification of expenses depends on many factors, such as the nature and complexity of the health care entity. For example, in complying with the requirements of paragraphs 958-205-45-6, 958-720-05-4, and 958-720-45-2, some not-for-profit health care entities may present only two categories: health services (including inpatient services, outpatient procedures, home health services, and so forth) and general and administrative. Others may present additional distinctions such as physician services, research, and teaching. Functional allocations shall be based on full cost allocations.

Performance Indicator and Intermediate Operating Measures

220-954-45-5
The statement of operations for not-for-profit, business-oriented health care entities shall include a performance indicator. Because of the importance of the performance indicator, it shall be clearly labeled with a descriptive term such as revenues over expenses, revenues and gains over expenses and losses, recognized income, or performance earnings. Not-for-profit, business-oriented health care entities shall report the performance indicator in a statement that also presents the total changes in net assets without donor restrictions. Other changes in net assets may be presented separately or in the same statement.
220-954-45-6
Classifying revenues, expenses, gains, and losses within classes of net assets does not preclude incorporating additional classifications within the performance indicator. For example, within a class or classes of changes in net assets, an NFP may classify items as operating and nonoperating, expendable and nonexpendable, recognized and unrecognized, recurring and nonrecurring, or in other ways.
Transition date:(P) December 16, 2026; (N) December 16, 2026Transition guidance:
105-10-65-10Classifying revenues, expenses, gains, and losses within classes of net assets does not preclude incorporating additional classifications within the performance indicator. For example, within a class or classes of changes in net assets, an NFP may classify items as operating and nonoperating, expendable and nonexpendable, recurring and nonrecurring, or in other ways.
220-954-45-7
This guidance neither requires nor precludes reporting such intermediate measures or subtotals. Guidance on the use of an intermediate measure of operations is discussed in paragraphs
958-220-45-11 through 45-12
.
220-954-45-8
Health care entities shall report the following items separately from the performance indicator:
  1. a
    Transactions with owners acting in that capacity.
  2. b
    Equity transfers involving other entities that control the reporting entity, are controlled by the reporting entity, or are under common control with the reporting entity.
  3. c
    Receipt of donor-restricted contributions.
  4. d
    Contributions of, and assets released from donor restrictions related to, long-lived assets.
  5. e
    Items that are required to be reported in or reclassified from other comprehensive income in accordance with paragraph 220-10-45-10A, which includes, but is not limited to, gains or losses, prior service costs or credits, and transition assets or obligations recognized in accordance with Topic 715; foreign currency translation adjustments; the portion of the gain or loss on derivative instruments designated and qualifying as cash flow hedging instruments included in the assessment of effectiveness, and for all qualifying hedging relationships amounts excluded from the assessment of effectiveness and recognized in earnings through an amortization approach in accordance with paragraph 815-20-25-83A.
  6. f
    Items that are required to be reported separately under specialized not-for-profit standards.
  7. g
    Unrealized gains and losses on investments on other than trading debt securities, in accordance with paragraph 954-220-45-9.
  8. h
    Investment returns restricted by donors or by law.
  9. i
    Subparagraph superseded by Accounting Standards Update No. 2016-14.
  10. j
    Subparagraph superseded by Accounting Standards Update No. 2016-14.
  11. k
    An inherent contribution (see paragraph 958-805-25-31) that increases net assets with donor restrictions, as described in paragraph 954-805-45-2.
  12. l
    The portion of the total change in the fair value of the liability resulting from a change in the instrument-specific credit risk, in accordance with paragraph 825-10-45-5.
220-954-45-9
Investment return (including realized and unrealized gains and losses) not restricted by donors or by law shall be classified as changes in net assets without donor restrictions as follows:
  1. a
    Included in the performance indicator are:
    1. 1
      Dividend, interest, and other similar investment income
    2. 2
      Realized gains and losses
    3. 3
      Unrealized gains and losses on trading debt securities (trading securities are defined in Topic 320)
    4. 4
      Credit loss expense (see Topic 326)
    5. 5
      Unrealized gains and losses and impairments on equity investments accounted for under Topic 321.
  2. b
    Excluded from the performance indicator are unrealized gains and losses on debt securities, unless the debt security is a trading debt security.
220-954-45-10
If gains and investment income that are limited to specific uses by donor-imposed restrictions are reported as increases in net assets without donor restrictions in accordance with paragraph 958-220-45-6, classification of those gains and investment income should be consistent with the previous paragraph.
220-954-45-11
See paragraphs
958-220-45-23 through 45-24
for additional guidance on reporting investment gains, losses, and income.

220-954-50Disclosure

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Performance Indicator and Intermediate Operating Measures

220-954-50-1
The notes to the financial statements shall include a description of the nature and composition of the performance indicator.
220-954-50-2
Pursuant to paragraph 958-220-50-1, because terms such as operating income are used with different meanings, if an intermediate measure of operations is reported and its use is not apparent from the details provided on the face of the statement, a note to the financial statements shall describe the nature of the reported measure of operations or the items excluded from operations.

220-954-55Implementation Guidance and Illustrations

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Illustrations

220-954-55-2
This Example illustrates the accounting treatment and financial statement presentation for other-than-trading debt securities of a not-for-profit health care entity.
220-954-55-3
Other-than-trading debt securities are purchased in Year 1 at a cost of $100. At the end of Year 1, the fair value of the securities is $300. In Year 2, the securities are sold for $400.
220-954-55-4
The journal entries are as follows:
  • Entry at the end of Year 1 to adjust the recorded value of the securities to fair value.
    • Investments $200 Change in net unrealized gains and losses on investments $200
  • Entry at the end of Year 2 to record the sale of the securities.
    • Cash $400 Realized gain $300 Investments 100 Change in net unrealized gains and losses on investments 200 Investments 200
220-954-55-5
As discussed in paragraph 954-220-45-9, unrealized gains and losses on debt securities (except for trading debt securities) are reported in the statement of operations outside of the performance indicator and realized gains and losses are reported in the statement of operations within the performance indicator.
220-954-55-6
Two possible presentations of net investment return on the statement of operations of a not-for-profit health care entity that presents a performance indicator in accordance with the information and illustration in paragraphs
954-220-55-3 through 55-5
are as follows.
  • Format 1: Year 1 Presentation of Net Investment Return Revenue " $ X,XXX " Expenses XXX Excess of revenues over expenses XXX "Investment return, net" XXX Less: Unrealized gains (losses) on other than trading debt securities excluded from performance indicator (200) Performance indicator XXX Add: Unrealized gains (losses) on other than trading debt securities excluded from performance indicator 200 Change in net assets without donor restrictions $ XXX
  • Format 2: Year 1 Presentation of Net Investment Return Revenue " $ X,XXX " Expenses XXX Excess of revenues over expenses XXX "Investment return, net, excluding unrealized gains (losses) on debt securities (other than trading)" XXX Performance indicator XXX Unrealized gains (losses) on other than trading debt securities excluded from performance indicator 200 Change in net assets without donor restrictions $ XXX

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