I have a database on access and I want to add a value to a column at the end of each row based on which hospital they are in. This is a separate value. For example - the hospital called "St. James Hospital" has the id of "3" in a separate field. How do I do this using a query rather than manually going through a whole database? 
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Question: Why does SFDC create a Lead via the LMA, but Checkout creates an Account when a payment is processed
Answer: This behavior follows the methodology design of salesforce.com. A lead is an unqualified sale opportunity, and an account is a closed sale. The idea is that sales associates would follow up on LMA-created leads to try and close the deal, while those that subscribe would be listed as accounts (so you can track the opportunities, customer portal access to cases, and so on).