--- title: "Steward's hospital portfolio: acquisitions, holding companies, sales and closures" language: en canonical: https://dossiertwist.com/dossiers/steward-health-care/hospital-portfolio/ as_of: 2026-10-14 keywords: ["Steward Health Care System","Ralph de la Torre","Cerberus Capital Management","Medical Properties Trust","Caritas Christi Health Care","Steward Health Care Investors","Chapter 11","sale-leaseback","IASIS Healthcare","Tenet Healthcare","CareMax","TRACO captive insurer","Senate HELP Committee","contempt of Congress","Malta hospitals concession","Vitals Global Healthcare","SHC Creditor Litigation Trust","Massachusetts hospitals","Space Coast hospitals","Stewardship Health"] --- # Steward's hospital portfolio: acquisitions, holding companies, sales and closures **Question.** How did Steward build its hospital network, how was it organised, and what became of the hospitals? **Answer.** Steward Health Care System LLC, the 2010 purchaser of the Caritas Christi hospitals in Massachusetts, expanded in 2017 by acquiring hospitals from Community Health Systems and merging with IASIS Healthcare, and in 2021 by buying five Miami-area hospitals from Tenet Healthcare for about $1.1 billion; when it filed for Chapter 11 in May 2024 it described a network of 31 hospitals in 10 states. Its hospital companies sat under state and business-line holding companies, the IASIS hospital operating entities were limited partnerships, and in 2020 eight consolidated subsidiaries had third-party limited partners. A planned sale of five Utah hospitals to HCA was abandoned in June 2022 after the Federal Trade Commission moved to block it, and the Utah operations were sold to CommonSpirit Health in May 2023. Other businesses were sold and several hospitals closed before the filing; during the bankruptcy the Miami hospitals were transferred to Healthcare Systems of America-Florida in a settlement with Medical Properties Trust, according to the debtors, and the Stewardship Health physician group was sold. ## From the Caritas hospitals to a national network - Analysis: In 2010 Steward Health Care System LLC was the purchaser under an asset purchase agreement with Caritas Christi and its affiliates dated March 19, 2010 and amended on October 5, 2010. A draft enforcement agreement among the Massachusetts Attorney General, Caritas Christi and its affiliates and Steward, dated as of October 5, 2010, named as guarantors Steward Hospital Holdings LLC, Steward Operations Holdings LLC, Steward St. Elizabeth's Realty Corp. and six new hospital companies: Steward St. Elizabeth's Medical Center of Boston, Steward Holy Family Hospital, Steward Good Samaritan Medical Center, Steward St. Anne's Hospital Corporation, Steward Norwood Hospital and Steward Carney Hospital. [src-025] - Analysis: According to the debtors' first-day declaration of May 6, 2024, Steward, formed in 2010, expanded through a series of transactions: in early 2017 it acquired seven hospital facilities in Ohio, Pennsylvania and Florida from Community Health Systems in a single transaction; also in 2017 it merged with IASIS Healthcare LLC, adding 18 hospitals in Arizona, Arkansas, Colorado, Louisiana, Texas and Utah; and in 2021 it acquired five South Florida hospitals from Tenet Healthcare. The declaration states that the number of operating hospitals grew by 30 from 2017 to 2021. Medical Properties Trust's pro forma statements filed with the SEC count eight former Community Health Systems hospitals: on May 1, 2017 Medical Properties Trust bought their real estate for $301.3 million and leased it to Steward under its master lease. They were Wuesthoff Medical Center (Melbourne and Rockledge campuses), Sebastian River Medical Center, Northside Medical Center in Youngstown, the Trumbull Memorial and Hillside Rehabilitation hospitals in Warren, Sharon Regional Health System and Easton Hospital. A research institute's timeline dates Steward's purchase, funded by Cerberus and Medical Properties Trust, to February 2017. [src-009] [src-036] [src-064] - Analysis: Medical Properties Trust's pro forma statements record that Steward Health Care System LLC completed its acquisition of IASIS on September 29, 2017; a research institute's timeline puts the price at $2 billion. The IASIS hospitals Steward then operated included Davis Hospital and Medical Center (Layton), Jordan Valley (West Jordan), Salt Lake Regional and Mountain Point (Lehi) in Utah; Odessa Regional, Southwest General (San Antonio) and St. Joseph (Houston) in Texas; St. Luke's Medical Center, St. Luke's Behavioral Health Center and Tempe St. Luke's in Arizona; and Wadley Regional at Hope, Arkansas. [src-036] [src-064] - Analysis: On June 16, 2021 Steward Health Care System, LLC and Tenet Healthcare Corporation announced a definitive agreement under which Steward would buy Tenet's five hospitals in the Miami-Dade and southern Broward area - Coral Gables Hospital, Florida Medical Center, Hialeah Hospital, North Shore Medical Center and Palmetto General Hospital - and their associated physician practices for approximately $1.1 billion. The joint release stated that Steward, based in Dallas, then operated 39 hospitals, 34 of them across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas and Utah and five internationally in Malta and Colombia. It called the deal Steward's first acquisition since it finalised full physician control in summer 2020 and said it would bring Steward's hospital count to 44 worldwide. [src-007] [src-089] - Analysis: According to the debtors' adversary complaint of July 15, 2025, on or about March 11, 2021 Steward formed four Delaware corporations for the Miami hospitals - Steward CGH, Inc., Steward NSMC, Inc., Steward HH, Inc. and Steward PGH, Inc. - wholly owned by Steward Florida Holdings LLC, which Steward Health Care System LLC (SHCS) managed. On or about June 16, 2021 these subsidiaries, SHCS and Steward Medical Group, Inc. signed the final asset purchase agreement with Tenet and its affiliates, and SHCS guaranteed payment of the purchase price. The complaint states that the transaction closed on or about August 2, 2021, when SHCS transferred the entire purchase price to Tenet: SHCS funded $208,957,339.60 itself, and $925,000,000 came from funding provided by Medical Properties Trust, whose subsidiaries took the hospitals' land and leased it to Steward entities. [src-007] [src-064] ## Holding companies and hospital companies - Analysis: In the omnibus written consent of May 5, 2024 that authorised the Chapter 11 filings, Steward Health Care System LLC signed, acting through its member Steward Health Care Holdings LLC, as member and managing member of Steward Ohio Holdings LLC, Steward Pennsylvania Holdings LLC and Steward Operations Holdings LLC; it also signed as member and managing member of Steward Hospital Holdings LLC and Steward Medical Holdings LLC. Steward Hospital Holdings LLC signed as stockholder of the Carney, Good Samaritan, Holy Family, Norwood, St. Anne's and St. Elizabeth's hospital companies, and Steward Medical Holdings LLC as stockholder of the Morton, Nashoba Valley, New England Sinai, Quincy, Blackstone Medical Center and Blackstone Rehabilitation Hospital companies. Steward Ohio Holdings LLC signed as stockholder of Steward Hillside Rehabilitation Hospital, Inc. and Steward Trumbull Memorial Hospital, Inc. and as managing member of the SHC Youngstown Ohio service companies; Steward Pennsylvania Holdings LLC signed as stockholder of Steward Easton Hospital, Inc. and Steward Sharon Regional Health System, Inc. [src-001] - Analysis: An undated corporate organisational chart of Steward Health Care System LLC, marked 'Confidential' and published on the Massachusetts state government website, places, under Steward Health Care Holdings LLC and the system company, intermediate holding companies for hospitals, medical businesses, operations and imaging and radiology, Steward Medical Group, Inc., TRACO and the Massachusetts hospital companies, including St. Elizabeth's, Good Samaritan, Holy Family, St. Anne's, Norwood, Carney, Nashoba Valley, Morton, Quincy, New England Sinai and Blackstone. The chart's text layer is scrambled, so the partial-ownership percentages it shows cannot be matched to specific companies. [src-114] - Analysis: Steward Health Care System LLC also signed the May 5, 2024 consent as member and managing member of Steward Florida Holdings LLC, which signed as stockholder of the Florida hospital companies Steward CGH, Inc., Steward FMC, Inc., Steward HH, Inc., Steward NSMC, Inc., Steward PGH, Inc., Steward Melbourne Hospital, Inc., Steward Rockledge Hospital, Inc. and Steward Sebastian River Medical Center, Inc., and as member and managing member of Brevard SHC Holdings LLC. Brevard SHC Holdings LLC's 2019 annual report to the Florida Division of Corporations, filed March 22, 2019, records it as a foreign limited liability company (document number M17000002943, FEI number 82-1041977) with its principal place of business in Dallas and Steward Florida Holdings LLC as its member. A March 2024 newspaper report, not checked against transaction records, stated that Steward's two Brevard County, Florida hospitals had been operated as not-for-profits until 2010, when the for-profit Health Management Associates bought them for $145 million, and that Steward acquired them in 2017; a June 2021 Steward and Tenet release refers to Steward's Space Coast hospitals as Melbourne Regional Medical Center, Rockledge Regional Medical Center and Sebastian River Medical Center. [src-001] [src-024] [src-080] [src-089] - Analysis: Before Steward acquired it, the IASIS group's list of subsidiaries (Exhibit 21) filed with the SEC showed the hospital operating entities as Delaware limited partnerships, including Davis Hospital & Medical Center, LP, Jordan Valley Medical Center, LP, Mountain Vista Medical Center, LP, Mesa General Hospital, LP, Odessa Regional Hospital, LP, IASIS Glenwood Regional Medical Center, LP, Salt Lake Regional Medical Center, LP, Southwest General Hospital, LP, St. Luke's Behavioral Hospital, LP, St. Luke's Medical Center, LP and The Medical Center of Southeast Texas, LP, with SJ Medical Center, LLC listed as a Texas limited liability company. The same exhibit lists the Delaware corporations IASIS Healthcare Holdings, Inc., Beaumont Hospital Holdings, Inc., Davis Hospital Holdings, Inc. and Jordan Valley Hospital Holdings, Inc., the managed-care company Health Choice Management Co. and other Health Choice entities, and Harpeth Insurance Limited of Bermuda. For one of the partnerships, The Medical Center of Southeast Texas, LP, the annual report for the fiscal year ended September 30, 2003 states that its general partner, with about 1%, was IASIS Healthcare Holdings, Inc., a wholly owned subsidiary of IASIS Healthcare Corporation, and that Beaumont Hospital Holdings, Inc., another wholly owned IASIS subsidiary which had owned and operated Mid-Jefferson Hospital and Park Place Medical Center, contributed assets for 1,627 redeemable limited partner units in connection with the partnership's August 1, 2003 private placement of 206 units and held an 88.0% interest. [src-100] [src-090] - Analysis: In the May 5, 2024 consent Steward Health Care System LLC signed as stockholder of IASIS Healthcare Corporation, which signed as member of IASIS Healthcare LLC. IASIS Healthcare LLC in turn signed as member and managing member of Steward Texas Hospital Holdings LLC, which the petition's organisational chart shows as doing business as Scenic Mountain Medical Center, and as manager of SJ Medical Center, LLC. IASIS Healthcare Holdings, Inc. signed as general partner of the former IASIS hospital partnerships, among them Jordan Valley, Mountain Vista, Salt Lake Regional, Davis, St. Luke's Medical Center, St. Luke's Behavioral, Southwest General, Odessa Regional, Mesa General and The Medical Center of Southeast Texas. Limited partners signing included IASIS Healthcare LLC - for Salt Lake Regional, Southwest General, Mountain Vista and, together with Jordan Valley Hospital Holdings, Inc., Jordan Valley - as well as IASIS Healthcare Corporation, Davis Hospital Holdings, Inc. and Beaumont Hospital Holdings, Inc. [src-001] - Analysis: In the May 5, 2024 consent Steward Operations Holdings LLC, of which Steward Health Care System LLC was member and managing member, signed as stockholder of Stewardship Health, Inc. (itself the stockholder of Steward Health Care Network, Inc.), of Steward St. Elizabeth's Realty Corp. and of Steward New England Initiatives, Inc., as member of Steward Medical Ventures, Inc., and as member and managing member of Steward Health Care International LLC and Steward Fall River Management Care Services LLC. Steward Health Care System LLC signed as member of Steward Medical Group, Inc., which in turn signed as member of physician companies including Steward Physician Contracting, Inc., Steward Emergency Physicians, Inc. and anesthesiology, pathology and radiology physician groups. Steward Health Care System LLC also signed as member and managing member of Steward ASC Holdings LLC, the managing member of Steward TSC Investments LLC. [src-001] ## Minority holders, partners and an outside stake - Analysis: Not every subsidiary was wholly owned. In the consolidated corporate ownership statement filed with its May 6, 2024 petition, Steward Health Care System LLC stated that it owned, directly or indirectly, 100% of the other debtors except where non-debtors held 10% or more: Collom & Carney Clinic Association held about 11.62% of Brim Healthcare of Texas, LLC; Radiology Associates of Norwood, Inc. held 25% of Steward PET Imaging, LLC; and the group's captive insurer, TRACO International Group S. de R.L., held stakes in Davis Hospital & Medical Center, LP, Odessa Regional Hospital, LP and TRACO Investment Management LLC. Steward's audited 2020 financial statements state that the system consolidated eight subsidiaries in which third-party partners owned limited partnership units with redemption features. Under the partnership agreements Steward, as general partner, determines the redemption value (generally a multiple of EBITDA - earnings before interest, taxes, depreciation and amortisation - less long-term debt); most of the holders' put rights - rights to require Steward to buy units back - vest after a six-year holding period at 20 percent of a holder's units per year, and the system need not repurchase more than 25 percent of vested units in any fiscal year. [src-001] [src-003] - Analysis: According to a Schedule 13D filed with the SEC, on March 1, 2018 Steward Physician Contracting, Inc., whose direct parent was Steward Medical Group, Inc., bought 5,000,000 shares (15.5%) of First Choice Healthcare Solutions, Inc., a Delaware corporation based in Melbourne, Florida, for $7,500,000 paid from Steward Health Care System LLC's working capital, under a February 6, 2018 agreement between the issuer and Steward Health Care System LLC. The stated aim was to extend First Choice's orthopaedic and spine care to the Steward hospital network, and Steward Physician Contracting could name two of the five directors. [src-026] ## The Utah hospitals: HCA, the FTC and CommonSpirit - Analysis: According to the debtors' July 2025 complaint against former insiders and Tenet, a party's pleading rather than a court finding, Steward Health Care System LLC intended to fund the Miami purchase through a separate sale of five Utah hospitals to HCA Healthcare, Inc. The complaint states that negotiations began in early 2021 but that the final purchase agreement, under which HCA would pay approximately $850 million, was signed only in August 2021 (a research institute's timeline dates the HCA agreement to September 20, 2021), and that after the sale failed Steward could sell the five hospitals only on May 1, 2023, to CommonSpirit Health, for approximately $165 million less than HCA had agreed to pay. [src-007] [src-064] - Analysis: On June 2, 2022 the Federal Trade Commission issued an administrative complaint (Docket No. 9410) against HCA Healthcare, Inc., Steward Health Care System, LLC and Ralph de la Torre, M.D., named as a natural person, and authorised a federal court suit seeking a temporary restraining order and preliminary injunction to block the proposed combination of the two hospital systems in Utah. The Commission alleged that the deal would lead to higher prices and lower quality of inpatient general acute care in the Wasatch Front region around Salt Lake City. On June 16, 2022 the parties announced that they had abandoned the transaction, and on June 22, 2022 the Commission issued an order dismissing the complaint without a ruling on the merits; the FTC lists the case as closed. [src-007] [src-055] - Analysis: The debtors' first-day declaration states that on May 1, 2023 Steward sold the operations of all of its Utah hospitals to CommonSpirit Health. A February 2024 trade-press report lists them as Davis Hospital and Medical Center in Layton, Jordan Valley Medical Center, Jordan Valley Medical Center-West Valley Campus, Mountain Point Medical Center in Lehi and Salt Lake Regional Medical Center, since rebranded as Holy Cross Hospital locations; a research institute's timeline names the buyer as Catholic Health Initiatives Colorado. The sale covered the hospitals' operations: Davis Hospital & Medical Center, LP and Jordan Valley Medical Center, LP were still listed among the affiliates that filed for Chapter 11 on May 6, 2024. [src-086] [src-009] [src-064] [src-001] ## Sales and closures before the bankruptcy - Analysis: A research institute's timeline, whose dates and prices have not been checked against the transaction documents, records that Steward sold Pikes Peak Regional Hospital in Woodland Park, Colorado, to UCHealth on April 2, 2018, about half a year after acquiring it; acquired Scenic Mountain Medical Center in Big Spring, Texas, from Quorum Health for $22 million on April 12, 2019; and sold Easton Hospital in Pennsylvania, with affiliated physician practices, to St. Luke's University Health Network for $15 million on July 1, 2020. [src-064] - Analysis: Steward Health Care System LLC's audited 2020 financial statements report that on December 31, 2019 the system sold a portion of its managed care operations under Health Choice: assets of $270.7 million and liabilities of $241.4 million were sold for cash consideration of $416.6 million, producing a gain of $387.3 million, and Health Choice had pretax income of $20.0 million in the period before the sale. During fiscal 2020 the system also sold Health Choice Utah, a portion of its managed care operations, which reduced its medical claims payable to zero as of December 31, 2020. [src-003] - Analysis: A research institute's timeline, compiled from public reporting and not checked against regulatory closure filings, records five hospital closures by Steward: Quincy Medical Center in Massachusetts on December 26, 2014, citing financial losses and dwindling patients; Northside Regional Medical Center in Youngstown, Ohio, on September 20, 2018, with 468 layoffs; St. Luke's Medical Center in Phoenix in November 2019, with 655 layoffs; Texas Vista Medical Center in San Antonio on May 1, 2023; and New England Sinai Hospital in Stoughton, Massachusetts, on April 2, 2024. According to the timeline, Steward closed New England Sinai after telling Massachusetts regulators it could not afford to keep operating it. [src-064] - Analysis: The debtors' first-day declaration lists asset sales made before the May 2024 filing: in November 2022 the company sold its Medicare value-based businesses to CareMax; in May 2023 it sold its hospital operations in Utah; and in December 2023 it sold its clinical and anatomic pathology laboratories in Ohio and Pennsylvania and a medical office laboratory in Massachusetts. Between August and October 2023 it cut 514 full-time employees, which it said would save $34.9 million in salaries in 2024. [src-009] ## The network at the 2024 filing and disposals in the bankruptcy - Analysis: The debtors' first-day declaration of May 6, 2024 describes Steward as a national, integrated health care network across 10 states comprising 31 hospitals and over 400 facility locations, including physician practice offices, ambulatory surgical centres and diagnostic imaging centres, with over 4,500 primary and specialty care physicians and a workforce of nearly 30,000. Schedule 1 to Steward Health Care System LLC's Chapter 11 petition of the same day lists the affiliates that filed with it for joint administration, including its hospital companies in Massachusetts (Carney, Good Samaritan, Holy Family, Norwood, St. Anne's, St. Elizabeth's, Morton, Nashoba Valley, New England Sinai and Quincy), Florida (CGH, FMC, HH, NSMC, PGH, Melbourne, Rockledge and Sebastian River), Ohio and Pennsylvania, and former IASIS partnerships, among them Jordan Valley, Mountain Vista, Salt Lake Regional, Davis, Southwest General, St. Luke's and The Medical Center of Southeast Texas. [src-009] [src-001] - Analysis: According to the debtors' July 2025 complaint - a party pleading, partly made on information and belief, not a court finding - the debtors began marketing the Miami hospitals in April 2024 without the real property acquired by Medical Properties Trust affiliates and received only four bids by August 2024, with proposed prices from $0 to $10 million, compared with the more than $209 million Steward Health Care System LLC had funded for the hospitals three years earlier. The complaint states that the hospitals were not sold to any of those bidders but were transferred to Healthcare Systems of America-Florida LLC as part of a settlement between the debtors and Medical Properties Trust, the only consideration being that company's assumption of the debtors' liabilities associated with each Miami hospital; the sale approvals themselves are part of the bankruptcy court record. A trade-press tracker of Steward's hospitals reports that Healthcare Systems of America received bankruptcy court approval, at an October 25 hearing in the bankruptcy case, to purchase the Miami hospitals, including Florida Medical Center, Hialeah Hospital, North Shore Medical Center and Palmetto General Hospital. [src-007] [src-058] - Analysis: In a notice of material change dated March 26, 2024 to the Massachusetts Health Policy Commission, Steward Operations Holdings LLC reported a proposed transaction in which Collaborative Care Holdings, LLC, through its OptumCare business, would acquire all of the capital stock of Stewardship Health, Inc. from it, with an anticipated effective date in the second quarter of 2024 after approvals; the parties had made a Hart-Scott-Rodino antitrust filing. The May 6, 2024 first-day declaration still referred to finalising a stalking horse agreement - an opening bid that other offers must beat - with Optum for Stewardship Health. A research institute's timeline states that weeks after the March 2024 notice regulators confirmed Optum was no longer interested, and that on October 31, 2024 the private equity firm Kinderhook Industries Inc. completed a $245 million buyout of Stewardship Health, Steward's physician group. The declaration of independent manager Alan J. Carr supporting confirmation of the debtors' plan confirms the sale of Stewardship Health, without stating its price in the reviewed passage, and states that the debtors sold 28 hospitals and Stewardship Health and used approximately $600 million of sale proceeds to repay first-lien debt. [src-102] [src-009] [src-064] [src-038] ## Sources - [src-025] Statement of the Massachusetts Attorney General as to the Caritas Christi transaction, with the enforcement, assessment and pension agreements (filed as Exhibit M), Office of the Massachusetts Attorney General (copy on mass.gov), 2010-10-06 - [src-009] Court record source · src-009 - [src-036] Medical Properties Trust unaudited pro forma condensed consolidated financial statements for the Steward-IASIS transactions, Exhibit 99.1, U.S. Securities and Exchange Commission (EDGAR), 2017-12 - [src-064] Research source · src-064 - [src-007] Court record source · src-007 - [src-089] Joint Steward and Tenet press release of June 16, 2021, Exhibit 99.1 to Tenet Healthcare’s Form 8-K, U.S. Securities and Exchange Commission (EDGAR), 2021-06-16 - [src-001] Court record source · src-001 - [src-114] Corporate organizational chart of Steward Health Care System LLC filed with Massachusetts authorities, Commonwealth of Massachusetts (filer: Steward Health Care System LLC) - [src-024] 2019 foreign limited liability company annual report of Brevard SHC Holdings LLC filed in Florida, Florida Department of State, Division of Corporations, 2019-03-22 - [src-080] Media source · src-080 - [src-100] Subsidiaries of IASIS Healthcare LLC, Exhibit 21, U.S. Securities and Exchange Commission (EDGAR), 2015 - [src-090] The Medical Center of Southeast Texas, LP annual report on Form 10-K for fiscal 2003, U.S. Securities and Exchange Commission (EDGAR), 2003-12-24 - [src-003] Steward Health Care System LLC consolidated financial statements for 2020 and 2019 with auditors’ reports, Exhibit 99.1 to a Medical Properties Trust filing, U.S. Securities and Exchange Commission (EDGAR), 2021-06 - [src-026] Schedule 13D filed by Steward Health Care System LLC and affiliates on First Choice Healthcare Solutions, Inc., U.S. Securities and Exchange Commission (EDGAR), 2018-03-12 - [src-055] FTC case page: HCA Healthcare/Steward Health Care System, In the Matter of (Docket No. 9410, File No. 2210003), U.S. Federal Trade Commission, 2022-06-22 - [src-086] Media source · src-086 - [src-058] Media source · src-058 - [src-102] Notice of material change filed by Steward Operations Holdings LLC with the Massachusetts Health Policy Commission (proposed sale of Stewardship Health, Inc.), Massachusetts Health Policy Commission (filer: Steward Operations Holdings LLC), 2024-03-26 - [src-038] Court record source · src-038