Currently, over 100,000 individuals in the Metro Nashville, TN area are either uninsured or underinsured, a statistic that is of grave concern in an increasingly prosperous and growing city . It is, however, unsurprising in a state that has not expanded Medicaid . In the absence of Medicaid expansion, public safety-net hospitals prove ever more vital in addressing the health needs of the community . Nashville's only public safety-net hospital-Nashville General Hospital (NGH) -faces challenges associated with financial growth as well as changes in the demographic profile of the patient population and in-service utilization . To combat the decline, NGH, like many similar hospitals around the country, may consider possible organizational and financial restructuring to achieve sustainability.