This study aims to contribute to the legitimacy theory by evaluating the legitimizing capacity of a social reporting practice performed by a healthcare trust. The study is based on an in-depth analysis of a significant case of social reporting by an healthcare trust, using a multi-method research approach.The study revealed that a social report can provide legitimacy, although a number of factors may impede it. Managing these factors is crucial in order to avoid cynicism from stakeholders. Distrust may emerge when the social report is (mis)used to legitimize the management and the organization instead of the performance achieved.