By the end of 1997 AHERF had transformed itself from a sole urban hospital into Pennsylvania's largest statewide integrated health and education system. But the rapid expansion came at a great cost, and soon AHERF was unable to meet debt obligations and keep up with capital improvement demands; health system leadership permitted “internal subsidies, hidden internal cash transfers and raids on hospital endowments.” The rapid financial deterioration meant that by spring of 1998, AHERF was losing nearly a million dollars a day. In July 1998, AHERF filed for bankruptcy, and the resulting $1.3 billion protection filing was the nation's largest nonprofit health care failure to date.