Since its establishment as a not-for-profit organization in 1998, the Rosjo Dialysis Centre in Kochi, India, has been providing dialysis facilities to economically disadvantaged patients at a nominal fee. Rosjo has a capacity to offer 21 dialysis procedures in three shifts in a single day. Donations from well-wishers and corporate social responsibility (CSR) funds are the financial source of their operations. However, this source of funding fluctuates and is unreliable, forcing management to limit their operation to a single shift, leaving two shifts idle every day. Even after 20 years since their establishment, Rosjo managers have not been able to establish a financially sustainable model to survive and grow. Rosjo leadership members are in a dilemma, the solution to which students are asked to address in this case. Questions arising from this dilemma include: Are surplus or profits important for not-for-profit organizations? And should Rosjo aim to generate an operating surplus by making the idle capacity active? This case discusses how Rosjo could improve its financial situation with a thorough cost-volume-surplus analysis, by adopting a cross-subsidizing principle. This new approach could be implemented without compromising their mission of operating as a not-for-profit organization that offers charity and outreach services. The case discussion evaluates the possibilities of operating all three shifts, implementing differential pricing, and cross-subsidizing the operational costs.