Hospital A

Hospital A is a mid-sized hospital serving an exurb in the Mid-Atlantic region. It transitioned from nonprofit to for-profit status.
Location Characteristics
Mixed Market
U.S. Region
State Regulatory Environment
Hospital Characteristics
Bed Capacity
200-399 beds
Size of System
0-50 hospitals
Conversion of Profit Status
Nonprofit to For-profit
Community Characteristics
Type of Community
Racial & Ethnic Demographics
Median Household Income

History of Hospital A

Hospital A is a for-profit, mid-sized institution (200-399 beds) providing acute-care, general services to the Mid-Atlantic Northeast region. Founded in the late 1800s, Hospital A operated as a nonprofit until the 2000s when the hospital was sold to one of the US's largest for-profit health systems. This system entered into a stakeholder agreement for hospital operations with a local nonprofit network of health care providers. Consequently, Hospital A has a minority owner of operations that is nonprofit and a majority owner of operations that is for-profit.

Positioned in a mixed market, Hospital A has several nonprofit general hospital competitors. Hospital A is in a state with strict certificate-of-need laws, which are state regulations for establishing and expanding healthcare facilities and services. Most of the state's hospitals are nonprofit.

This hospital is in an affluent, majority-white community with high educational attainment. The town has a population of less than 50,000 residents. An average resident is between 40-50 years old, owns their own home, and has an average household income of $150,000-$200,000. When compared side by side to the rest of the US, residents outside of this hospital are considerably less racially diverse, more affluent, and more educated.

Hospital A as an Anchor Institution

Hospital A is a compelling case study as an anchor organization for several reasons.

First, anchor institutions are not restricted to economically distressed communities. This hospital is based in one of the wealthiest communities in the U.S. Most of its residents are insured and economically stable. Per interviews with hospital personnel, the hospital is motivated to provide community benefit services to individuals that are displaced, undocumented, lower income, or otherwise economically insolvent because it is an opportunity to remind residents of all incomes that they provide healthcare services.

Second, anchor institutions typically are examined in the realm of either a nonprofit or a for-profit institution. Hospital A transitioned from nonprofit to majority for-profit status in the early 2000s. The hospital fulfills obligations connected to both nonprofit and for-profit statuses. Hospital A funds the mandatory community health needs assessment and community benefit reports required to maintain 501C3 status. Yet, the hospital also pays the taxes required of for-profit hospitals. In this case, the hospital straddles two towns, so it pays taxes in two towns. The hospital staff experiences the advantages and disadvantages of a mixed status institution. Hospital A has access to the guidance provided by their nonprofit owner’s community health department, which is a rarity for for-profit hospitals. Yet hospital staff also contend with the financial barriers associated with not having access to grants and foundation support typically offered to support the outreach and engagement of nonprofit hospitals and other charitable organizations.

Hospital leadership opted to retain community health staff post-transition. Their positions were rebranded to marketing and public relations. These staff have decades of experience serving the surrounding area, providing continuity of relationships with community anchor institutions in addition to residents, social service agencies, and governmental departments. Staff pointed to the community benefit report as a tool to solicit feedback from community organizations, governmental agencies, and residents as to what types of programs are needed. They supported for-profit hospitals sharing similar information as a method for generating ideas for future programming.

Anchor Activities


  • Sponsor film festivals and parades.
  • Partner with supermarkets, food pantries, daycares, Salvation Army, churches, health department, first responders, community centers, federally funded clinics, national health programs.

Community Stability

  • Employ the local community as medical personnel.

Health Promotion

  • Promote health equity by employing diverse staff that provide bilingual outreach to undocumented and insured individuals. Provide monthly free screenings and educational programs at supermarkets, food pantries, daycares, Salvation Army, and churches.
  • Provide access to healthcare through physician residency programs at adult health and family practice clinics.
  • Act as a health provider by delivering preventative care, screening and diagnostic services.

Community Building

  • Develop the community by having an employee work as a community health coordinator with a team that includes a nurse, case manager, dietician, and health educator. Community health coordinator is on a homeless task force that collaborates with the health department, police, and community center to provide health assessments by physicians, haircuts and showers.
  • Community health coordinator educates first responders and community members about social services and accessing healthcare services.
  • Partner with the police to support National Night Out.
  • Fund community needs assessment and community benefits report. The CEO makes presentations to community stakeholders like governmental agencies and community groups about the survey results and solicits feedback.