A major healthcare transformation in the United States is the conversion of nonprofit hospitals to for-profit entities, and the creation of hospital conversion foundations for the nonprofit charitable assets, which now exceeds $9 billion. Because less than 21% of the 525 hospitals converting from nonprofit to for-profit ownership have established a hospital conversion foundation, the public's monetary losses are considerable. This article examines some of the key legal and organizational issues related to hospital conversion foundations including factors related to establishing fair value of the converting hospital, foundation mission, use of conversion revenue, governance, and evaluation.