Williamson Health will no longer operate as an independent, community-owned hospital following a vote by the hospital system’s board on Monday. 

Williamson Health Board of Trustees said there wasn’t “a clear path to remain independent.” County Mayor Rogers Anderson motioned to sell to Ascension Healthcare, which is based in St. Louis. The board voted unanimously to do so. 

The Williamson County Commission will have to vote on the sale of the hospital at a future date. The cost to sell the hospital is $700 million, with additional capital commitments to round it out at around $900 million. 

Ascension has agreed to keep Williamson Health employees for one year. 

One year ago, Williamson Health announced during a Williamson County Commission meeting that it was considering a sale, citing staffing shortages, an increase in operating costs and inadequate reimbursements from insurance companies, including Medicare and Medicaid, among other concerns.

Nashville Business Journal reported via a five-year financial projection document dated May 2025 that Williamson Health is predicting impact from the HCA Healthcare acute care hospital slated for Spring Hill, as well as Vanderbilt Health’s plans to add additional outpatient facilities in the area. With these changes, Williamson Health stands to lose $31.2 million in 2029. 

NBJ also reported that an attorney with the Reporters Committee for Freedom of the Press raised concerns that documents related to the Williamson County Commission special-called meeting Monday were not released to the public at least seven days before the vote, violating public records laws. 

During the state legislative session earlier this year, two Franklin Republicans Sen. Jack Johnson (R-Franklin) and Rep. Jake McCalmon (R-Franklin) passed legislation that allows for an exemption for hospitals worth more than $500 million to put some of their profits from a sale toward non-health-related initiatives. Under current state law, the proceeds from the sale of a government-owned public benefit hospital are required to go in a trust where the funds are earmarked for public health initiatives. 

Williamson Health, formerly known as Williamson Medical Center, is a rare independently operated health system. In April, it released a lengthy press release explaining various parts of its strategic planning process, which began in July 2025. Williamson Health confirmed that no decision on a sale had been made at that time, and that the hospital is financially stable. 

Local Leaders React

District 8 County Commissioner Drew Torres and District 5 Commissioner Mary Smith both told the Williamson Scene that they weren’t surprised by the board’s move to pursue the sale of the hospital.

“My perspective is this is step one, in what’s going to be a very long process. Ultimately, the commission has the final say,” Torres said. “I’d like to dig into the details of the responses [from the potential healthcare partners]. I know what we saw and heard today. I think there’s some things that you know, financially, I think they’re both equal. I want to understand all the other aspects of the proposals.”

“I think the county commission has a lot to ponder,” Smith said. “I’m thankful that they had this meeting today, but I’m looking forward to hearing back from members of the community with regards to what their thoughts are. This is a big decision. We’ve got a lot to think about, and there’s probably going to be more questions to come.”

“I would definitely be a proponent of just, let’s not go too quickly, let’s make sure we have a plan in place before we move forward with anything that’s going to change the community for generations to come,” Smith added. “So we need to be very, very thoughtful with what we do next.”

Other local leaders including Franklin Mayor Ken Moore were in the audience, with Moore telling the Williamson Scene that he is confident that if the sell proceeds that the county will “continue to have a great health system.”

“I think Ascension St. Thomas is a good fit,” Moore said. “It’s interesting that it came down about the same amount of money, but you’re always looking for what’s the best fit long term for your employees and for the health of the community, so I look forward to whatever the next part of the process is.

Hannah Herner contributed to this report.