A Message from Bo Butler, Chairman, Williamson Health Board of Trustees
April 22, 2026
As interest around our comprehensive strategic planning process has grown, the Williamson Health Board of Trustees (“Board”) wants to call attention to a few important details.
As a Board, we have nearly 150 years of collective service to Williamson Health. We care deeply about the work we do on behalf of the health system’s 2,400-plus employees, more than 960 medical staff members, and the nearly 600,000 patient encounters our team supports each year—reflecting the many ways our patients rely on Williamson Health throughout the year.
Here are a few key details about this process that we want to highlight:
Goal – The top priority of this process remains – and has always been – securing the best possible future for Williamson Health for the benefit of our community, employees and medical staff. Healthcare organizations – particularly independent nonprofits like Williamson Health – are navigating mounting pressures in a rapidly changing environment, including financial constraints, workforce challenges, shifting care models and ongoing regulatory changes, such as the legislative restructuring of Tennessee’s certificate of need program. Our Board is doing the difficult work today to make informed and strategic decisions that ensure a healthy and favorable future for our entire community.
Scope – From day one, this endeavor has been a comprehensive strategic planning process to thoroughly, thoughtfully and appropriately explore all potential future pathways – those that would allow the health system to remain independent as well as a potential change in ownership. Our Board continues to evaluate a tremendous amount of information pertaining to many different approaches.
Timeline – When we announced the process in July 2025, we stated that the full process could take two to three years. That timeline has not changed. We announced the official process nine months ago, and the work on preparing for this process began months before that as the Williamson Health Board of Trustees strategic planning subcommittee evaluated current and future market realities affecting our ability to remain independent in a way that honors our community, employees and medical staff. This means that the process has already been underway for more than a year with no recommended decision yet.
Transparency – As a Private Act Hospital District, all of our strategic planning initiatives have always (and continue to) fall under the confidential strategic planning process as outlined by Tennessee state law. This confidentiality was established so that the hospital/health system can gain an objective picture of the market, the outlook for Williamson Health, and the value of the organization without outside pressures, including political, competitive or otherwise. The statute also allows the health system to plan on equal footing with its competitors who are not subject to the Open Meetings law. The benefit of this confidentiality protection remains true and necessary today. The Williamson Health Board of Trustees, along with our outside advisors and legal counsel, are strictly adhering to these clearly articulated rules and regulations. We have (and will continue) to provide updates as appropriate under the law.
Decision – No decision has been made – nor will it officially be made until the County Commission votes on the Williamson Health Board’s recommended decision. The Board continues to evaluate a wealth of information pertaining to all potential pathways, including ways to remain independent as well as a possible change in ownership. (The Request for Proposal project that was announced last fall is one set of data being evaluated.) As soon as a decision about our future is recommended by the Board, we will announce that milestone.
The next major milestone in our process is to decide the best possible pathway for our future. Whenever that recommended decision occurs – and if it is for a change in ownership – it could be another 12-24 months as additional milestones are met, including Williamson County Board of Commission approval, partnership negotiations, Tennessee Attorney General approval and, finally, Federal Trade Commission (FTC) approval.
County Participation – Five of the 12 Williamson Health Board of Trustees voting members are Williamson County elected officials. This includes four County Commissioners and the County Mayor. This means that 42% of the voting trustees overseeing our comprehensive strategic planning process directly represent Williamson County Government and are evaluating every data point against how it benefits/affects the residents of Williamson County. Additionally, Williamson Health and its advisors have regularly engaged with legal counsel that was engaged in November 2025 specifically by Williamson County to assist in the evaluation of any possible future Williamson Health transaction.
Funding Sources – Williamson Health is completely self-sustaining. It receives zero taxpayer dollars for any operations of the hospital, clinics or outpatient services. Williamson Health does receive funding from Williamson County/tax dollars to help subsidize a portion of the operational costs associated with the ground 911 Emergency Medical Services (EMS) we offer the community because, by law, the Williamson County Government is responsible for funding those emergency services for its residents. Williamson Health’s only sources of funding for all of its operations (aside from EMS) are from patient reimbursements from the services we provide, reimbursement from commercial and governmental insurance programs and related funding programs, philanthropic support and borrowed money in the form of loans (that Williamson Health completely services/pays for, not tax dollars).
Financial Health – Williamson Health is financially healthy today. The health system continues to experience revenue growth, expand its service lines, improve its technologies, receive a wide variety of prestigious accolades and recruit elite staff and providers to continue to meet the mission of the organization. Its strategic planning process is not about our current financial stability, but instead it’s about securing our long-term health amidst the increasing pressures on independent hospitals to ensure that Williamson County has access to high-quality healthcare for years to come.
Ownership - Williamson Health is not “owned” by Williamson County, nor does it receive county tax dollars/funding to run the hospital, clinic, and outpatient operations. The system is self-sustaining and only takes funds from the County to support EMS services which the County is responsible for by law. The County does own some of the many properties and buildings that the health system donated/deeded to the County decades ago, but the health system actually pays for all costs associated with maintaining, updating and expanding each of those facilities. In addition, Williamson Health gifted the current County Administrative Complex to the County free of charge when the health system built the new Williamson Medical Center facility. The operations of the health system, which provide services and generate revenue, are not owned by the County and never have been. All health system operations are delegated to the Williamson Health Board of Trustees according to our Private Act Hospital District designation that was created by the Tennessee General Assembly.
Debt - The County allowed Williamson Health to benefit from using the County’s AAA bond rating for the $150 million loan that the health system took out to pay for the recent expansion and renovation of Williamson Medical Center, but the residents/tax dollars do not service (pay for) any of that debt. Since those funds were secured in 2021 and 2022, Williamson Health has always (and continues) to fully cover the entire cost of that loan (principal and interest). If Williamson Health eventually moves forward with a potential change in ownership, that decision will not change any current tax/resident funding of Williamson Health because that’s simply not the reality of how we are structured, funded or operate.
Potential Proceeds – When our comprehensive strategic planning process officially began last year, state law outlined that any proceeds from a potential sale of Williamson Health (after debts were paid) were to be set in a trust/foundation for the sole use of healthcare-related needs in Williamson County. We support this concept as it would secure vital healthcare needs of Williamson County residents – things like EMS, athletic training programs for local student-athletes, mental health initiatives, judicial system healthcare services and a variety of other healthcare-related needs. That said, the Tennessee state law might be soon changing, giving the Williamson County Board of Commissioners the ability to also use any potential proceeds for other non-healthcare uses. The bottom line, the law will be followed – no matter the outcome of the proposed legislation – and the residents of Williamson County will be the sole beneficiaries of the proceeds in either scenario, whether the funds are used for healthcare or other uses entirely. As an organization that has worked hard to care for this community for nearly 70 years, we continue to hope that part of the proceeds from a potential sale of the health system will be set aside to provide for the healthcare needs of our beloved Williamson County for generations to come.
For additional context, please review the detailed information posted on the “Board of Trustees” section of the WiliamsonHealth.org website under the “About” tab. For now, please know that no recommended decision about our future has been made during the very measured, deliberate, professional and legally guided process being run by the Williamson Health Board of Trustees. We continue our commitment to be as transparent as appropriate as outlined by state law. Finally, the top priority of this process remains – and has always been – securing the best possible future for Williamson Health for the benefit of our community, employees, and medical staff.
Thank you for your trust and support during this emotional and important process.
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