As the economy spiraled downward in 2007, the board of directors at Virginia Gay Hospital debated whether to go ahead with a multimillion-dollar fundraising campaign to renovate the 25-bed critical-access facility.

It wasn't an easy decision. Board Chairman Mark Mossman relied on his skills as a negotiator and consensus builder, which he had honed as a local attorney, to bring the nine-member board to a decision.

“I think there was a legitimate question about whether in a down economy when people were losing jobs and losing money in their retirement accounts and being much more conservative in their giving and their spending—whether that was a good time to raise money and try to expand the hospital,” Mossman, 60, recalls. “We had some legitimate differences of opinion.”

“We are not a wealthy area by any means. We are an agricultural community and are not supported by a lot of industry or a large commercial base,” Mossman says, referring to Vinton, Iowa, population of about 5,100 and a total service area of about 25,000.

In the end, the board launched the campaign as originally conceived, raising nearly $2.2 million toward the $8.4 million renovation, which was completed in September. To cover the remaining costs, the hospital used savings and operating surpluses as well as partial reimbursement from the federal program for critical-access hospitals. The project added 20,000 square feet to the hospital and included a new inpatient wing and expanded and upgraded areas for therapy services, the emergency department and imaging.

“We felt like we got a brand-new hospital,” says Michael Riege, Virginia Gay's administrator.

For his accomplishments, Mossman has been selected as the 2011 Trustee of the Year for a small hospital—those with fewer than 100 beds.

The fact that residents of Vinton and surrounding communities supported the large project, despite the economy, illustrates how far the hospital has come since Mossman joined the board in 1994.

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In 1992, before Mossman's tenure, Virginia Gay opted out of a management contract with St. Luke's Hospital in Cedar Rapids, Iowa, choosing to hire its own administrator, Riege.

The next big change came in 1996, while Mossman was vice chairman. The hospital's board decided to take over management of its primary-care clinic, which had been leased to a for-profit subsidiary of St. Luke's, Riege says.

As part of the plan, three physicians and two physician assistants became employees of Virginia Gay. After regaining control of the hospital and clinic, the board pursued a course of modernization and expansion.

Virginia Gay bought two more physicians practices in 1999, and in 2002 built a clinic in nearby Urbana, bringing the total number of employed providers to five physicians and six physician assistants.

In addition, the hospital added two surgical suites and a new lobby in 1999 at a cost of $3 million.

The hospital's financial performance has improved during this period, as well. The hospital posted a profit of $10,421 on net revenue of just under $4.2 million in fiscal 1993 —the first profitable year in a decade. In 2009, it posted a profit just over $700,000 on about $16.5 million, which dropped to $183,170 on revenue of nearly $18.2 million in fiscal 2010 as a result of construction expenses.

Throughout all of the changes, Mossman has worked to keep the administration, medical staff and board aligned—not only for big decisions but small ones, as well.

For example, Mossman has arbitrated minor disputes between Riege and the hospital's employed physicians on occasion, according to Riege. In each situation, Mossman invited everyone to his law office. He would then put “me on one side of the table and the providers on the other side, and work through a solution that makes everybody feel good,” Riege says.