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Purpose: The purpose of this study was to investigate the operational status and operational problems of health promoting model schools, particularly of the large-sized elementary schools in urban areas. Methods: The study analyzed the data of 14 large-sized elementary schools in urban areas selected from 85 health promoting model schools, an initiative led by the Ministry of Education from 2012 to 2014. Results: The study examined the operation process of health promoting schools in five stages; system development, needs survey & current status survey, school health policy development, program development & execution, and evaluation. In addition, the study discovered three key factors in operating health promoting schools and examined the status of each factor; connection with the curriculum, connection with the community, and consensus among members. Four problems were identified as operational problems: lack of research on faculty health issues, school physical environment and community resources, inadequate presentation of performance indicators, no close coordination in core task development and lack of linkage with the curriculum. Conclusion: It turned out the concept of health promoting school suggested by WHO was relatively faithfully realized in this study. Compared to small-sized elementary schools in rural areas, health promoting schools in this study showed better aspects overall. The connection with the community was good, but the connection with the curriculum was poor.