To decide where to open and close hospitals in the U.S., our society considers community needs for access to health care. Yet a hospital's choice of location is often a financial decision. We examine the conflict between concerns about access to care and financial considerations that occurred in one not-for-profit (NFP) hospital system that closed hospitals in poor, minority neighborhoods to open new hospitals in affluent suburban communities. A small-sample, empirical study shows that hospitals in this particular system were significantly more likely to close in areas with a high minority population and sicker patients. In a case study, we explain that the hospital offered reasons for relocation based on its NFP status, to better meet community needs and provide lower costs of care. In the end, the relocation proved to be a positive financial decision for the NFP system.

Data Availability: Data are available upon request.

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