Many U.S. hospitals are hurting this year from falling numbers of elective surgeries and a rising tide of uninsured patients. The economic downturn has also savaged investment income, which can buffer finances in lean years. Experts say the burden is falling hardest on smaller rural and urban hospitals such as the 189-bed Northeastern Hospital in Philadelphia. Northeastern has been hurt by falling patient admissions and rising charity care. The latter has surged 33% over the last four years, reaching a projected $19.2 million in charges in 2009.