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Depending on their needs for enhancing and sustaining their business and market values, some firms choose to operate with a corporate governance structure of CEO duality, in which an executive serves as the CEO and the chairperson of the board of directors. The problem addressed in this study is that past empirical and theoretical studies of the relationship between CEO duality and firm performance of organizations across different industries have generated ambiguous results, and no studies have focused specifically on the relationship between CEO duality and financial performance of not-for-profit hospitals. Based on agency and stewardship theories, and considering that CEO duality's effects on firms' financial performance are contextually specific to each type of industry and dependent on certain industry conditions, the purpose of this quantitative study was to answer 3 research questions that examine the relationship between CEO duality, presence of physicians on governance board, hospital size, hospital age, board size, and financial performance of not-for-profit hospitals. This study used multiple regression analyses of data of financial indicators from 146 U.S. not-for-profit hospitals selected from the Office of Statewide Health Planning and Development database of California, for the period from 2009 to 2012. The results of this study suggested CEO duality and presence of physicians on healthcare governance were not related to financial performance of not-for-profit hospitals. The outcomes of this study can promote positive social change by bringing awareness of appropriate healthcare governance structures that enhance organizational effectiveness and sustain hospitals' charitable missions of provision of community services and transformation of communities and society.