Letterman Army Medical Center (LAMC) began a phased downsizing in July 1991 which will lead to closure by June 30,1994. An analysis of the downsizing and closure process has yielded information which can be valuable to medical treatment facility managers faced with similar challenges in the future. By review and analysis of documentation, this case study extracted and interpreted pertinent information from historical records and from personnel involved in planning for the downsizing and closure of LAMC. This study provides managers of military hospitals that are downsizing or closing with a summary of issues for planning, compiled by their relative importance, and a description of methods employed by LAMC for managing these issues.