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This paper summarizes commonly accepted theories of corporate governance and extends them to information technology governance in United States (US) hospitals. It goes on to argue that currently accepted theories of governance may not apply in rural US hospital settings. Rather, this work posits that governance is a pattern of social relations integrating organizational activities. This position is supported in the adjoining case study examining a small, rural US hospital's use of coordination and collaboration to integrate IT activities and to align IT strategy and functions with corporate strategy. Thus, contrary to the dominant paradigms of hierarchy, power, and resource based governance, coordination can provide an effective mechanism for information technology governance.