This chapter discusses the financial aspects of operating a hospital district. Specifically, it sets out the unique rules affecting a hospital district’s ability to obtain money to support its health care service goals. The chapter begins by setting out the general administrative requirements which hospital districts should follow in managing their financial affairs. Next, it provides an extensive description of a major potential benefit of district status: the use of property taxes as a revenue source and the many restrictions and complications affecting this source under Washington law. The chapter also describes some special issues affecting the collection of patient revenues by districts and the different ways that hospital districts may borrow funds. Finally, while hospital districts are generally authorized to expend funds on most anything consistent with their statutory powers, the chapter identifies and discusses a couple of unique issues relating to the flow of money out of a hospital district: restrictions on gifts and the payment of taxes by the district itself.