What We Know So Far About the Proposed Sale of Williamson Health

Williamson Health CEO Phil Mazzuca said he’s been through an emotional process in deciding whether to sell the independent, community-based hospital to a large healthcare company. 

This week, the Williamson Health Board opted to sell the hospital and its subsidiaries to Ascension Saint Thomas, which is based in Tennessee. The sale will total up to $950 million back to the Williamson County government if its commission decides to do so. 

Ascension has proposed annual payments of $4 million per year for five years to Williamson County in lieu of property taxes.

“We felt this great emotion through this decision, but a great sense of relief that the decision was made with a pure heart,” Mazzuca said. “We understand that the future of this hospital is great. I think throughout the entire two years there was tremendous emotion. No one wanted to sell when they started.”

The healthcare company received the board’s recommendation over HCA Healthcare and Optum, the three of which were finalists for the potential acquisition. This was after having been narrowed down from 28 to 11 healthcare companies and organizations after a two-year process that included the creation of three subcommittees that explored continued independence and possible changes in ownership.

Committee members started meeting in 2024. By the spring of this year, the committee whittled down those interested in purchasing Williamson Health to three companies. 

In a presentation to both the board and Williamson County Commissioners, Williamson Health said it would start losing money as soon as 2028 with the evolving changes in regulations and insurance premiums. 

“Economic analysis determined that the health system would need $150 million in additional capital over five years,” Board Vice Chair Brown Daniel later told the Williamson County Commission in a special-called meeting this week. “That is additional capital, not capital that we currently deal with.”

What patients can expect 

The sale of the hospital has a few more steps to take. 

Mazzuca said he didn’t anticipate any changes to patient care even if this hospital does sell. The sale would have to go through a letter of intent and a regulatory review process. 

Finality of everything could be as far as another year and a half away. 

“We don’t think there will be any difference,” Williamson Health Board of Trustees Chairman Bo Butler said. “We feel like we share values and beliefs that Ascension Saint Thomas has that they have in their facilities now. We find this is the best way to move forward.” 

Mazzuca said that Ascension Saint Thomas will maintain a medical staff, and that there’s no anticipation of changes to the medical staff or services. 

“Their goal is to add positions,” Mazzuca said. 

However, Ascension Saint Thomas said in its letter to Williamson Health that employees will receive full credit for years of recognized service and will be retained for a minimum of one year following closing.

Reaction to the proposed sale 

The commission and those involved in Williamson Health had varied opinions about the hospital’s future. 

“None of us wanted to consider a sale,” Commissioner Paul Webb, who also serves on the Williamson Health Board, said during Monday evening’s commission meeting. “As the process evolved, it became clear that in order to continue offering the health care that Williamson County citizens need and expect, and support all the talented employees and the medical staff at Williamson Health, we need access to capital, capital over the next five years, so that we can compete. Williamson Health simply can't access that capital on its own.” 

Former County Commissioner and former Williamson County Hospital CEO David White, who currently serves as a non-voting member of the board’s strategic advisory council, called the effort “an incredibly complex transaction dealing with an incredibly complex organization.”

“I think that what has been laid out here tonight gives us a clear path,” White said. “We have a clear path, not just for tomorrow. We have a clear path for not [just] this next week, not next year, but we have a clear path way into the future with this transaction.”

The proposed $700 million purchase would grow to an estimated $950 million in revenue, including the total capital commitment, and the potential to pay the $224 million in county debt related to the sale.

The Commission also heard from Williamson Health Chief of Staff Dr. Heather Rupe, who spoke in favor of the sale.

“This type of medical culture is rare and extraordinary,” she said. “Doctors working together cohesively for the benefit of our patients, regardless of whose name is on their sign. Once it became clear that there were no sustainable options for the hospital to remain independent, we had to open our minds to the possibility of finding a partner who shares our vision for the future and one that would truly respect the culture we have fostered over the decades, and we have found that partner in Ascension,” Rupe said.

Next steps in the process

Williamson County Commissioners have been provided with a packet of previously confidential information about the discussions and details of the search for a potential buyer, with the commission expected to ask more questions of the hospital board in August or September.

Voters will decide the new Williamson County Commission in office, along with a new mayor with the retirement of the current officeholder Rogers Anderson. 

Ascension Saint Thomas said they are looking forward to figuring out this process with the Williamson County government. 

“Ascension Saint Thomas is honored to have been selected by the Williamson Health Board of Trustees as the future partner for their health system,” the company said in a statement. “We commend the Board for their thoughtful approach throughout this strategic planning process and for their unwavering commitment to securing the long-term sustainability of high-quality healthcare in the community. 

“While this selection is a significant milestone, we respect the role of the Williamson County Commission in the approval process. We remain deeply committed to transparency and collaboration with the community, elected officials, physicians, and employees as we work to shape the future of healthcare in the region, building upon the remarkable legacy Williamson Health has established over the last seven decades.”