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Despite the explosive growth of the nonprofit sector in recent years, many charitable organizations have closed their doors. Evolution of the health care delivery system in the Minneapolis-St. Paul metropolitan area in Minnesota has favored large, integrated service networks at the expense of small, church-based nonprofit organizations that have long served as a means of neighborhood organizing, social outreach, and the proliferation of community values. Interviews with three defunct church-based health care organizations provide the basis for the authors' observations that relatively sudden and wide-scale changes in the health care environment have legislated against small health care organizations, selecting them out for extinction.

Competing theories of organizational behavior offer a variety of reasons why organizations cease to exist. Some reasons are internal to the organization, such as losing control over financial matters and being unable to routinize procedures. Other reasons are environmental, such as changing market conditions, lacking social capital, outside regulation, and not being perceived as legitimate by external power holders. The authors interviewed representatives from dead nonprofit organizations to determine the extent to which these theoretical explanations match with respondent understandings of why their organizations closed. Respondents were more likely to attribute death to their smallness, youth, financial difficulties, personnel turnover, being perceived as unimportant, or decreased demand for their services. Organizations that said they were "too young" or "too small" were more likely to say that they were too disconnected from other organizations in the community, thus shedding light on why youth and smallness are such a liability for organizations.