In 2009, despite an endowment that declined from $8 billion to $5 billion in less than a year because of the poor economy, Douglas Maxwell, the hospitals' CEO said he and other Shriners are confident the hospital system will be able to remain solvent in the long term. Maxwell stated in July 2009 that some of the facilities may become outpatient surgical centers, and will begin accepting insurance payments (for most care) for the first time in the hospitals' 87-year history. Maxwell said children suffering from burns, orthopaedic conditions, spinal cord injuries and cleft palates will continue to be treated without charge to their families.