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This hospital-based cost accounting case is unique in its lack of numerical information. The objective is to make students focus on the way the information should be structured and the way the information may be used rather than completing some financial reports. For most students this is far more challenging than it appears at first. Jamesville Hospital has grown rapidly, but its accounting system is still very basic. The financial records are adequate, but the hospital’s growth has challenged the management team to provide improved information about revenue and cost centers in preparation for developing information about the costs of the various procedures. The real issue in this case is that as the hospital grew, its accounting system did not evolve in a useful, practical or logical manner. Few departmental managers actually use the data generated by the current accounting system so the hospital has no real way to manage its costs. The primary subject matter of this case concerns structuring cost accounting information. A secondary issue is the focus on how the information might be used and to this end there are no numbers in the case.