This study aims to determine the effect of budgetary participation, authentic leadership style, internal control, organizational commitment, and on managerial performance. This test uses managerial performance as the dependent variable, organizational commitment as a mediating variable, as well as budget participation variables, authentic leadership style, internal control as an independent variable. The sample used was a middle level manager or head of department at the Regional General Hospital (RSUD) Dr. Soedirman Kebumen, Prembun Regional General Hospital (RSUD Prembun), PKU Muhammadiyah Gombong and PKU Muhammadiyah Gombong, that located in Kebumen Regency, Central Java Province. This research uses purposive sampling method. The type of data used in this study is primary data. Based on the questionnaire distribution process, 77 respondents were obtained. Hypothesis testing in this study uses SEM (structural equation modeling) analysis based on variance or partial least squares by using SmartPLS V.3.2.8 software application. The results showed that budgetary participation and organizational commitment had a positive effect on hospital managerial performance. Authentic leadership style and internal control do not affect managerial performance. Internal control has a positive effect on managerial performance when associated with organizational commitment as a mediating variable.