It's a rich tradition that has seen the hospital through several evolutions. When it outgrew its original downtown location and a new building was constructed in the early 1950s, children "bought" bricks for a dime to 20 cents. During tours of the new Avenues building in 1952, a guide reported that a little boy wanted to see "his" brick. The guide randomly assigned him one, then had to do the same thing for other children who were in the crowd, Goodrich said.

"Charity care always has been a part of Primary Children's," spokeswoman Bonnie Midget said. "When a child comes to us for help, no one asks if they can afford it."

And like everything else about the hospital, that aspect has grown. Now a nationally respected medical center that provides the highest level of services to children in a five-state area, Primary Children's provided $8.6 million in charity care in 2007. The long-running Pennies by the Inch contributed $1.6 million to that total.

"That's significant," said Goodrich. "Most gifts are $25 or under. But many people do stand tall."

Although the LDS Church is no longer an official sponsor of the annual drive, held in September, a letter from the First Presidency traditionally has encouraged members to consider donations. In many wards, the Primary or a group of Young Men or Young Women is assigned to handle the local drive, which seeks contributions from everyone in a neighborhood, LDS Church members and others, alike.

Changes in medicine have vastly increased the costs for care, and at the Salt Lake hospital that care has expanded to include the most sophisticated of modern therapies, including organ transplants, newborn intensive care, the latest in cancer treatment, orthopedics and numerous other specialties. The symbiotic tie to neighboring University of Utah Medical Center on the U. campus also involves the children's center in training and dissemination of medical knowledge.

With the rising demands for charity support for little patients, Primary Children's has developed several high-profile fundraising efforts, including the Children's Miracle Network telethon, which raised more than $2 million for the Salt Lake hospital last year, and the Festival of Trees, which was the "best ever" last year, adding $1.6 million to the charity fund, Goodrich said.

The Salt Lake Christmas event has been copied in other places, but never as successfully, she said, attributing the local success to the charitable tradition of Utahns. But though the big events are crucial to meet current demands, there's still room for pennies, nickels and dimes.

In medical parlance today, "primary" denotes the lowest level of care. Some visitors who don't know the history have been puzzled as to why a cutting-edge medical institution would be called by that name, Midget said.

There has been some discussion about changing the designation, but "it's part of a rich history," she said. "We're proud of it. It's part of the flavor of the hospital. When people learn the history, they are quick converts."

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E-mail: tvanleer@desnews.com