The objective of this study was to determine if financially successful health service organizations are characterized by a limited number of configurations and less financially successful health service organizations are characterized by a different set of configurations. Data on 77 health service organizations were collected from case studies and Securities and Exchange Commission (SEC) documents. Organizations were scored according to environmental, strategy making, organization/structure variables and financial success. Three individuals with health care experience were provided detailed instructions and were asked to independently rate the 77 organizations relative to the variables. The financial success variable was separately rated by a third individual with extensive finance and health care expertise. Five financially successful and five financially less successful configurations were identified and described according to their major characteristics. The configurations were limited and consistent with configuration studies in industries other than health care with a few noteworthy exceptions. © 2002 Elsevier Science Inc. All rights reserved.