Frequently Asked Questions

After more than two years of a thoughtful and thorough strategic planning process, the Williamson Health Board of Trustees (Board) has made its decision on securing a strong and sustainable future for our organization.

Having reviewed multiple options – including all avenues by which Williamson Health could remain independent – the Board determined the best path forward is a change of ownership, specifically to join Ascension Saint Thomas, a well-respected, nonprofit health system with the ability and desire to help us advance our community-focused mission.

In 2024, the Williamson Health Board of Trustees (Board) engaged in a strategic planning process to plan for the future of the health system. Based on multiple industry trends and financial considerations, it was determined that Williamson Health — despite our current strong financial position — would need an infusion of capital of approximately $150 million over the next five years, with continued funding required thereafter, to speed up the execution of operational and strategic opportunities and continue to meet our growing community’s needs.

Williamson Health was created in 1958 as a Private Act Hospital District, which was a forward-thinking, innovative structure allowing us to successfully and proudly fulfill our mission for nearly seven decades. With wisdom and resolve, the Board realized that Williamson Health was at a pivotal moment in time where we needed to identify the absolute best possible structure to carry us forward through many future generations. With that in mind, the Board set out to explore all potential pathways – those that could allow us to remain independent as well as a potential change in ownership.

To determine the best path forward toward securing the necessary additional capital, the Board created two subcommittees: one to explore all options related to remaining independent and another charged with researching options for a potential sale. The top priority for both subcommittees was to ensure Williamson Health continues to lead the way, strengthening our culture, clinical excellence and service to the community for generations to come.

Spring 2024 – The Williamson Health Board of Trustees (Board) began considering the need for long-term, comprehensive strategic planning.

July 14, 2025 – The Board publicly announced its intent to pursue a comprehensive strategic planning process, including the formation of two subcommittees – one to explore independent pathways and another to research options for a potential change in ownership.

Oct 2025 – The Strategic Planning Subcommittee issued a formal Request for Proposal (RFP) as it considered a potential change of ownership.

Nov 2025 – May 2026 – Potential partners submitted multiple rounds of RFP responses that were each reviewed by the RFP Subcommittee and other Board members, with each round continuing to drill deeper and clarify the major considerations.

Feb 2026 – May 2026 – Potential partners, RFP Subcommittee and Board members collaboratively participated in management meetings, Board presentations and reverse due diligence site visits.

July 6, 2026 – The Board voted to pursue selling Williamson Health to Ascension Saint Thomas and then presented its recommendation to Williamson County Board of Commissioners.

* The Board and its Independence and RFP strategic planning subcommittee members met monthly, often multiple times per month, to review and discuss progress.

The board established 11 goals and objectives by which to evaluate the potential new owner proposals:

• Build upon the culture of excellence, safety and compassion that attracts, retains and supports the best caregivers in healthcare and provides an exceptional patient experience
• Ensure the continuation and enhancement of Williamson Health’s legacy of providing high-quality healthcare services
• Maintain strong relationships with physicians and providers, including seeking additional ways to align with independent providers to improve the delivery of healthcare services in the community
• Operate from a position of long-term financial sustainability with sufficient resources to invest in our services, our caregivers and the community’s health and enables the health system to continue to grow and expand
• Expand breadth of services and expertise to become an advanced community health system, supercharging the investments made to date, expanding the health system’s network of access points and taking the healthcare platform to the next level
• Augment and accelerate access to capital and investment to fund medium-to-long term capital plans while maintaining reasonable financial metrics
• Keep best-in-class care in Williamson County, maintaining strong relationships with existing patients and the community at large
• Maintain Williamson Health’s legacy brand and further strengthen its reputation in the community
• Create meaningful proceeds to expand our impact by reinvesting in the health and wellness of the communities and patients we serve
• Ensure appropriate level governance and influence over strategic decisions
• Elevate all clinical technology systems to best in class platforms to support digital transformation of care

In addition to the evaluation of the Board’s foundational goals and objectives for a potential sale, the Board felt a unanimous and overwhelming sense of confidence in and connection with Ascension Saint Thomas. Sometimes the most important considerations during monumental decisions like this are the intangible instincts that emerge during the process.

The cultural fit, like-minded community-focused mission, commitment to our employees and medical staff, and plans to quickly invest capital to achieve our shared vision for how Williamson Health should evolve in the future while fiercely honoring our legacy all combined to make it clear that Ascension Saint Thomas is the best partner for us going forward. We look forward to sharing the exciting details as the process progresses.

The RFP was distributed to 28 local, regional and national healthcare organizations, including for-profit and nonprofit health systems, as well as faith-based and non-faith-based organizations. This group includes an extensive list of top national and regional systems. From this outreach, 11 organizations signed non-disclosure agreements and received RFP materials. Four organizations – Ascension Saint Thomas, HCA Healthcare (HCA), Optum and Wellstar Health System (Wellstar) – submitted first round proposals. Ultimately, Ascension Saint Thomas, HCA and Optum submitted final proposals.

The Board is extremely appreciative to HCA, Wellstar and Optum for the significant amount of time, resources and thoughtful planning they each put toward our strategic planning process. We have tremendous respect for each of their leadership teams and the impressive organizations they have built. Ultimately, though, the Board strongly believes that Ascension Saint Thomas is most closely aligned with our unique culture and community-focused mission, and it is encouraged and inspired by the partnership vision, plans and commitments Ascension Saint Thomas has conveyed for building on Williamson Health’s tremendous success and – together – forging a more promising future for our employees, medical staff and our community.

The Independence Subcommittee evaluated potential performance improvement initiatives and supplemental revenue streams – as well as the Optum partnership proposal – that could potentially enable Williamson Health to continue operating independently. Several categories of options were considered, including but not limited to:

• Opportunities for revenue growth
• Ability to pursue new funding sources
• Transformational philanthropy
• Creative structures for health system or select services (narrow networks, joint ventures, lease, unwind)
• Service line rationalization (i.e., elimination) and associated reduction in workforce
• Sources of public support (city and/or county)

Ultimately, the Independence Subcommittee concluded that the pathway to remain independent is exceedingly narrow and marked by significant challenges. It is more likely than not that changes to the regulatory environment and healthcare economy of Williamson County will continue to add pressures to the continued operations of the health system that will likely soon become insurmountable.

Generally, an announcement like this would not take place until a signed Letter of Intent (LOI) was in place. However, due to Williamson Health’s Private Act Hospital District status and our desire to involve the County Commission in the development of the LOI – not just the Definitive Agreement – we are announcing the Board’s decision for moving forward prior to finalizing the LOI. As such, there are no firm details to present at this point, but we look forward to sharing more as the process advances.

That said, we can say that the proposed transaction comes with an economic value of nearly $1 billion, which would be a historic deal that not only greatly benefits Williamson Health patients, employees and medical staff, but also the overall Williamson County community. As presented, the proposal includes a substantial purchase price, significant capital investments, upgrades to our electronic health records, service line enhancements and expansions, commitment to charity care, continuation of current community programs like emergency medical services (EMS), providing athletic trainers for local high schools and more.

What we are most excited about is the commitment Ascension Saint Thomas has expressed to fully supporting and further nurturing our unique culture, talented and dedicated workforce, exceptional medical staff and community-focused mission, as well as honoring our legacy brand.

The proposed transaction covers all assets and operations of the Williamson Health system, including the workforce, land, buildings, equipment and more for Williamson Medical Center, Bone and Joint Institute of Tennessee, Williamson Health Medical Group, Williamson Health Outpatient Imaging and Lab Services, as well as the Williamson Health Foundation (honoring all donor recognitions and requests made through transaction closing) and the continuation of Williamson Health Emergency Medical Services (EMS) through an interlocal agreement with the County. Ascension Saint Thomas expressed its praise for all aspects of our operations, including our multiple clinical partnerships, and we look forward to many ongoing discussions about how to collaboratively continue elevating the services offered to our community.

We will be formalizing all of the above details as we move toward the development of a non-binding LOI and ultimately a Definitive Agreement that will become the final and binding document that formalizes all details and commitments related to the transaction.

Ascension Saint Thomas has repeatedly expressed its praise for all aspects of our current operations, including our multiple clinical partnerships, and we look forward to many ongoing discussions about how to collaboratively continue elevating the services offered to our community.

In the meantime, Williamson Health will continue to operate as we do today – with the same commitment to our mission of caring for our patients while also supporting and investing in our team members.

Williamson Health Board of Trustees Chairman Bo Butler announced the decision to sell to Ascension Saint Thomas to the Williamson County Board of Commissioners on July 6, 2026. Over the next several weeks, Williamson Health and Ascension Saint Thomas will be working collaboratively with our teams of advisors and legal counsel – including the County Commission’s legal counsel – to draft the non-binding LOI that will be presented to the County Commission for approval.

Once the LOI is signed and approved by the County Commission, a similar process will occur for the Definitive Agreement. Upon the County Commission’s approval of the Definitive Agreement, the proposed transaction must then be subject to applicable regulatory review and approval processes. The timing for these approvals is yet to be determined but will likely be in the 2027 or 2028 calendar years before the transaction is completed.

The timing for the many required approval milestones is yet to be determined, but – if and when approved – the sale will likely be completed sometime in the 2027 or 2028 calendar years.

In the meantime, Williamson Health will continue to operate independently as we do today – with the same commitment to our mission of caring for our patients while also supporting and investing in our team members.

The top priority for the Board has always been – and continues to be – ensuring that Williamson Health continues to lead the way…strengthening our culture, clinical excellence and service to the community for generations to come.

Once the transaction closes, the community will continue to receive the same high standard of patient safety and quality combined with the compassionate care they have come to expect from Williamson Health and with an even more promising future as it relates to expanded access to care and elevated services. We look forward to collaborating with Ascension Saint Thomas to share more details as the process progresses.

Until the transaction closes, Williamson Health will continue to operate independently as we do today – with the same commitment to our mission of caring for our patients while also supporting and investing in our team member.

Williamson Health is a special place. Our greatest strength is found not in our buildings, technology or accolades, but in the people who bring our mission to life every day. Together, our employees and medical staff have built a culture grounded in compassion, teamwork, accountability and excellence and a shared belief that every person plays an important role in our mission.

Because our employees and medical staff are the reason Williamson Health has become the exceptional and nationally recognized provider of care that we are today, the Board has fiercely advocated for our team members throughout every step of this process. Each and every consideration and conversation has centered on commitments to support and invest in our people.

Ascension Saint Thomas shares our belief that our special workforce – that is not only talented, compassionate and deeply connected to our community – is the heart of what makes Williamson Health so unique, and the Ascension Saint Thomas leaders have made that abundantly clear through their commitment to invest in our employees and medical staff above and beyond what we have been able to do as an independent health system. We look forward to collaborating with Ascension Saint Thomas to share those exciting details with our staff as the process progresses.