A. The decision where to build is based on need, and approved by the Fisher House Foundation’s Board of Trustees, which meets twice a year. Normally, a need is identified and justification is submitted from the medical center to either the service Surgeon General (Army, Navy or Air Force) or the Secretary of Veterans Affairs for Fisher Houses at VA medical centers. The requesting medical center commander or director must demonstrate that the mission of his or her medical center is one that brings to its patients from beyond the normal daily commuting distance (at least 50 miles) for long periods of time. While the number of beds at a medical center is a consideration, the center must normally be a “center of excellence” or referral center for other smaller medical centers or hospitals.