This month, the board of trustees for Williamson Health, a county-owned health system in Tennessee, voted unanimously to sell the organization to Ascension Saint Thomas, Ascension‘s Tennessee division.
Ascension plans to buy Williamson for $700 million — with the deal’s value estimated to total between $900-950 million once additional capital commitments are factored in. The Catholic nonprofit health system also pledged to invest $235 million over the next 10 years for Williamson’s facility improvements and EHR improvement, plus another $140 million for strategic projects over the first five years and $20 million for routine capital upgrades.
Williamson’s board said it contacted 28 healthcare organizations about a potential partnership or sale before narrowing to a short list of finalists, including HCA Healthcare and Optum. Both Ascension and HCA offered to pay the $700 purchase price, but Ascension edged out HCA with a larger 10-year capital commitment.
Ascension also agreed to pay Williamson $4 million annually for five years in lieu of property taxes — a commitment the board weighed against HCA’s estimated $1.9 million in annual tax contributions. Net proceeds to Williamson are projected at $477 million after outstanding debt and other obligations are paid off.
The transaction isn’t final yet. The Williamson County Commission still has to approve the sale, and the deal would also require sign-off from Tennessee’s attorney general.
If approved, the sale is expected to close sometime in 2027 or 2028. Ascension has committed to retaining Williamson employees for at least one year following completion of the deal.
The transaction would end nearly seven decades of county ownership of Williamson. Final approval still rests with the Williamson County Commission, which has not yet scheduled a vote.
This deal caps a two-year strategic review in which Williamson explored alternatives to selling itself — including sweeping cost cuts, new funding sources, higher payer reimbursements and adopting a different nonprofit structure. The system had cited staffing shortages, rising costs and inadequate reimbursement as pressures pushing it toward the sale.
A five-year financial projection showed the system could lose over $31 million by 2029, partly due to looming competition from a new HCA hospital that opened in nearby Spring Hill, Tennessee.
The acquisition is the latest in a string of deals for Ascension, which closed a $3.9 billion purchase of ambulatory surgery company AmSurg just last month, making it the third-largest ambulatory surgery center operator in the country.
Photo: amgun, Getty Images
