ON ANY GIVEN day, national headlines decry the state of our healthcare system. challenges range from the financial strain of overcoming declining reimbursement and increased costs of acquiring technology to the critical nursing shortage and greater demand for healthcare services from an aging demographic. At the turn of the twentieth century, U.S. life expectancy was 47 years of age. A century later, we can expect to live an additional 30 years. Half of all the people who have ever lived to age 65 are alive today (National Center for Health Statistics). This graying of America is already starting to have a powerful impact on reimbursement. In the 19505, there were 16 workers per retiree. Within the next ten to 15 years, there will be approximately two workers per retiree (Matthews 2006; Social security Administration 2008). ability to shift costs is diminishing, and relying on employers to make up the difference will no longer be practical. To offset these financial challenges, hospital and healthcare administrators are increasingly looking to their local communities for support. Even during tough economic times like the present, philanthropy can serve as a key source of funding for hospitals. Competing for charitable dollars can be a challenge in any market, but with the right leadership, it is possible to create a thriving donor-hospital partnership that fulfills the needs of both. In his article, Philanthropy: A Priceless Lesson in Healthcare LeadershipThe Sanford Health Story, Kelby Krabbenhoft writes about how philanthropic leadership led to a $400 million gift, transforming the organization, the community, and beyond. This example points to the vast potential of untapped donor support that exists within all communities, big and small. It all starts with a vision. I currently serve on the board of Mission Hospital in Orange County, California. foundation was formed in 1994 when the Sisters of St. Joseph acquired the 301-bed acute care hospital. Although it is a relatively young foundation, Mission Hospital has raised more than $82 million in donations from the local community since its inception. It's worth examining why some communities contribute more to support their local hospitals and health systems than others. Uncovering the genesis for healthcare philanthropy is the key to building a reciprocal relationship with a community of potential donors. Do these generous communities have more wealth per capita? Do they give back because they feel grateful for services they or their loved ones have received? reasons for support are numerous, yet at the core is a very basic connection to the vision of the organization. I agree with William McGinly's observation in this issue's The Maturing Role of Philanthropy in Healthcare: CEOs have the ability to set the tone for the overall organization through their oversight, influence, and contacts with board members, physicians, staff, patients, individual donors and donor institutions, and the community at large. It is upon their shoulders that responsibility primarily falls to foster and maintain the philanthropic culture. To create a successful culture of philanthropy, an organization's CEO must recognize the need for a compelling vision and back it 100 percent. And in order to effectively sell the vision to potential donors, the executive management team, the board, and the entire staff also have to believe in the vision. McGinly describes this type of compelling vision as captur(ing) the imagination of donors. Focus on the 'impossible' and be amazed at the 'real' and very possible. At Mission Hospital, donor generosity has funded a major expansion that will increase the hospital's capacity to care for its growing community. Its new vision to provide the best diagnostic care in the world is helping to attract renowned specialists and motivate donors to invest in the future expansion of the hospital. …