By 1913, the Sanatorium had built additional facilities, but still faced financial pressures.
Superintendent Estes Nichols wrote to Hiram Ricker, the chair of the Association board, reporting that he had cut the budget by delaying some maintenance, reducing the number of nurses and taken what steps he could to keep expenses low.
He expected to have many patients and said he hoped the Sanatorium could get to a point where it charged $7 a week without state help.
However, he wrote, if that could not be done in the next two years, the Sanatorium might have to be turned over to the state, a prospect he did not relish.
