Erlanger Health System awarded $1.7 million in executive bonuses but had to absorb $82 million in uncompensated care costs in fiscal 2010.
Now the hospital is making a last push to get its usual slice of public funding.
Since 1976, Erlanger has received money from the Chattanooga-Hamilton County sales tax agreement to treat indigent county residents. For years, the annual allotment has been $3 million.
That changed when the agreement expired in May. County Mayor Jim Coppinger's proposed 2012 budget has only $1.5 million for Erlanger.
Now the public hospital, which turned a profit the last two years, potentially faces a $1.5 million budget hole if the city won't make up the difference.
But Chattanooga Mayor Ron Littlefield and the City Council have expressed reluctance to include Erlanger in the list of quasi-governmental agencies it will support now.
Doug Fisher, vice president of governmental and community affairs for the hospital, criticized what he saw as a lack of initiative from local officials.
"It's a game of chicken between the city and the county," he said. "We're the ones that lose."
Chattanooga City Council Chairwoman Pam Ladd said funding from the city is "pretty much off the table."
"[Erlanger has] been successful," she said. "Perhaps they can look at scaling back some, like we're all having to do."
A total of 110 management-level Erlanger employees split $1.7 million in bonus payments in October 2009. Last December, total bonuses rose to $1.9 million.
But the government funding game isn't over. City and county lawmakers have yet to approve their budgets, and those deliberations typically take a few weeks - plenty of time for Fisher to make his case to local elected officials, he said.
"We're not giving up yet," he said. "We're not taking it lightly."
Fisher said it's difficult to pinpoint exactly how the hospital's indigent program would be affected by a lack of funding, which covers everything from "the working poor" to gang members with gunshot wounds.
"I'm not sure that really matters because the reality is, we continue with our mission," he said, adding that Erlanger hasn't begun considering how to pool extra money if local governments don't pony up.