In this article, we demonstrate the method of participatory causal modeling to map the interdependencies of critical performance variables in a complex nonprofit health care provider with considerable financial and operational control challenges. Critical performance variables are output performance dimensions that are fundamental indicators of organizational success. Causal modeling provides an approach for nonprofit leaders to examine how critical performance variables dynamically and recursively affect each other and thereby offers a path to identify key points of leverage for organizational action. Using a case study, we show that participatory system dynamics modeling revealed assumptions, choices, and complexities and so helped a nonprofit health care organization recognize possible strategic opportunities. This study demonstrates an approach that other nonprofits may deploy in situations where they are experiencing competing objectives and constraints in managing critical performance variables.