As summer moves into high gear on the Island, the Martha's Vineyard Hospital will launch the final push to raise the rest of the money for the construction of a new building.

Hospital chief executive officer Timothy Walsh said the building campaign has raised about $33 million of the $42 million required to rebuild the hospital at its Linton Lane campus in the Eastville section of Oak Bluffs.

Mr. Walsh said the hospital hopes to raise the remaining money and to obtain the necessary permits by Dec. 31, with construction to start soon after. The fund-raising campaign is the largest in the history of the Vineyard.

The hospital, a privately owned community institution, is pursuing the campaign in the midst of improved financial operating results. The hospital's 2006 annual report is included as a special supplement in today's edition of the Vineyard Gazette.

For the fiscal year ended March 31, the hospital posted a net operating gain of just over $1.5 million on revenue of $39.5 million, more than double the gain posted last year before gifts and other income. The affiliated Windemere Nursing Home, with a fiscal year ended last Dec. 31, also posted its second profitable year in a row, albeit doing so with a slender $4,000 surplus on revenue of $5.5 million.

The hospital launched its capital campaign at the start of last summer with the announcement that $20 million had been pledged toward the project. In the intervening months, the campaign has raised additional money from more donors, including year-round residents who have participated in what the hospital has dubbed the Islander Campaign.

Mr. Walsh said more fund-raising events are slated for private Vineyard homes this summer to encourage more seasonal residents to donate to the project.

"Our goal and our expectation is that we'll raise the bulk of the money by the end of the summer," Warren Spector, co-chairman of the capital campaign, said yesterday afternoon.

"I feel very good about our progress to date, but I also feel the last $10 million will be the hardest to raise," Mr. Spector said. "We've gone to a large number of people. There might still be some large gifts out there, but we don't know about them. I think it's going to be hard."

Mr. Spector said the final approval of the project as a development of regional impact by the Martha's Vineyard Commission likely will generate whatever remaining support the campaign needs.

"But it's going to be a lot of work - a lot of work," he said.

Cost estimates for the reconstruction project, Mr. Walsh said, have been calculated based on raising the necessary funds by the end of this year. Delaying the start of the construction beyond that time, he said, would lead to inflation, eroding the value of the promised funds and make more fund-raising necessary.

"We can't let this drag on," he said. "If it does, it's going to cut into what we've raised."

At the same time, he said, "We're very optimistic."

Hospital leaders have committed to having all of the needed funds either in hand or pledged before construction starts. Mr. Walsh said the hospital will not take on a mortgage to finance the project.

The plan calls for replacing the decrepit 19-bed hospital with a state-of-the-art, 25-bed clinical facility. The current hospital building dates to sections built in 1974 and 1929, and is in poor condition. The hospital's relatively few beds can quickly result in an overflow of demand.

Martha's Vineyard Hospital is proposing a new two-story wing, partial replacement of the 1929 section and renovation of the 1972 section. The new wing will house all inpatient rooms, surgery, imaging, outpatient services and the emergency department. The 1972 wing will house physician and hospital administration offices.

In another development related to the project, two firms have submitted proposals to the Martha's Vineyard Commission to conduct a risk assessment of rebuilding the hospital at its Linton Lane campus.

The commission's coordinator of developments of regional impact, Paul Foley, said Wednesday he anticipates that the commission will select one of the firms in the coming days. Their findings will be brought before Mr. Walsh and Mark London, the commission's executive director, to use in reviewing the proposed reconstruction project.

At several meetings last year and earlier this year, commissioners questioned the wisdom of keeping the hospital at its present location in light of potential damage from ocean storms, of traffic congestion along nearby Beach Road, and of the possible future failure of the Lagoon Pond drawbridge. A commission subcommittee subsequently prepared a report on possible alternate hospital sites.

Hospital officials have vigorously resisted moving the project to another site, saying that building at a new location would push the project cost to $60 million to $70 million.

In a compromise, the hospital agreed to fund a risk assessment of the Linton Lane site. The selected firm will examine both the potential threats to the site and measures that could be taken to mitigate the risks.

Mr. Foley said he anticipates that the risk assessment will proceed alongside the commission's review of the hospital project as a development of regional impact.

The project has yet to be formally referred to the commission as a DRI, although the hospital has proceeded in the expectation of a referral. Mr. Walsh said the hospital has received a letter from the Oak Bluffs building inspector, Jerry Wiener, that he intends to refer the project to the commission when the hospital files for its building permit.

The hospital already has filed proposed plans with the commission to give the staff an early start on reviewing the project.

Of the permits being sought by the hospital, Mr. Walsh describes the DRI approval as "the big one." The hospital also is or will be seeking a town building permit, a permit from the Oak Bluffs conservation commission, and a sign-off from the state on its construction plans.