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Objectives: In order to achieve long-term survival, interorganizational cooperation is the most effective way for many small- and medium-sized hospitals to go. The aim of this study was to explore the differences in business performance between periods of strategic alliance and acquisition in one local hospital. Methods: We selected a local teaching hospital in southern Taiwan as the study subject and used the case study method to carry out our analysis. We also collected secondary data about the hospital for performance analysis. There were two periods in which performance was observed: strategic alliance from September 2009 to August 2011 as the first and acquisition from September 2011 to August 2013 as the second. Results: The strategic alliance period was a contract-based relationship. There were no changes in ownership or the management team during this period. After being acquired by a Medical Center, the case hospital became one part of a Medical Foundation system. It became a new hospital. The ownership and management team changed. The results of performance analysis showed that the case hospital had superior input performance, financial performance, and non-financial performance during the period of acquisition than that during the period of non-equity strategic alliance. Conclusions: The involvement and strengthened relationship of interorganizational cooperation and the change in ownership and control affected hospital management. There were also significant differences in business performance between the periods of strategic alliance and acquisition. [ABSTRACT FROM AUTHOR]