Background: Disparities in colorectal cancer (CRC) are longstanding. Previous studies show links between minority use of low quality hospitals, suggesting a role for location of care in disparities. No studies have linked the impact of hospital structure with processes of care in minority serving hospitals (MSH). The purpose of this study is to compare structural factors; financial characteristics and processes of care in MSH versus other settings. Hypothesis: MSH have fewer structural and financial resources for cancer care and lower adherence to evidence-based care. Methods: California Cancer Registry linked with patient discharge data and hospital characteristics identified all cases of CRC in California (2001-2006). MSH was defined by top quartile of minority discharges in the state. Structural characteristics included teaching hospital, CRC volume, rural location, NCI and Commission on Cancer (CoC) accreditation. Financial characteristics included disproportionate share; Medicaid utilization and ownership. Evidence based care was defined by the National Comprehensive Cancer Network (NCCN). Chi-square analysis tested for significant differences between hospital groups. Results: Of 354 hospitals, 96 (27%) were MSH. Compared to non-MSH, there was no difference in the proportion of academic MSH. A quarter of MSH were high volume versus non-MSH settings (39%, p = 0.04). Only 3% of MSH were rural versus non-MSH (16.3%, p < 0.001). There were no NCI accredited MSH (versus 9 non-MSH, p = 0.03); and only 20% were CoC accredited (versus 33.3% non-MSH; p = 0.03). The majority of MSH (68%) were disproportionate share hospitals (versus 16% of non-MSH; p = 0.001). More MSH were high Medicaid service settings (52% vs. 2.4%; p < 0.0001). There was no difference in hospital ownership. More MSH settings had low level compliance with delivery of appropriate surgery (50% versus 25.6%; p < 0.0001); delivery of indicated radiation (38.7% versus 31.2; p < 0.001). There was no difference in chemotherapy. Conclusions: Minority serving hospitals in California have limited infrastructure to deliver high quality cancer care which may explain low guideline adherence. MSH use may explain disparities in CRC and may provide targets for interventions to address them.