Lifepoint Health: Private equity joint venture hospitals

Private equity’s expansion into healthcare is increasingly happening through joint ventures with nonprofit health systems rather than traditional acquisitions. Our recent report, Private equity’s joint venture takeover of nonprofit healthcare, examines this growing ownership model and the questions it raises for patients, healthcare workers, and regulators.

An example we highlight is Apollo’s Lifepoint Health. Apollo and Lifepoint have relied heavily on joint ventures with nonprofit health systems to expand their hospital footprint

Lifepoint Health, owned by private equity firm Apollo Global Management, is one of the largest rural and nonurban hospital companies in the US, with 137 acute care, rehabilitation, and behavioral health hospitals.^[1]

Last year, Lifepoint Health was the focus of a bipartisan US Senate Budget Committee investigation which found that underinvestment by Apollo, Lifepoint, and Ottumwa (Iowa) Regional Health Center’s previous private equity owners “has resulted in declining conditions and quality of care that allowed egregious events to occur” even as Apollo “received benefits to the tune of millions of dollars annually from its fund’s investment in Lifepoint Health and its predecessors.”^[2]

Over the last several years, Apollo and Lifepoint have relied heavily on joint ventures with nonprofit health systems to expand their hospital footprint, drawing on the brand recognition and relationships of nonprofit health system partners to buy dozens of community hospitals and build several rehabilitation hospitals.

Lifepoint Health owns the majority (61%) of its hospitals through joint ventures with nonprofit and other healthcare providers.^[3]

Lifepoint Health’s largest joint venture partners are:^[4]

• Duke Health (17 facilities)
• Mercy Health (9 facilities)
• Ascension Health (8 facilities)
• Community Health Network (4 facilities)

Lifepoint Health also has joint ventures with Baptist Memorial Health Care, Baystate Health, Commonspirit Health, Dignity Health, El Camino Health, Hospital Sisters Health System, Loma Linda University Health, Methodist Health System, Northeast Georgia Health System, OhioHealth, Palomar Health, PeaceHealth, Penn Medicine, Providence Swedish, Tampa General Hospital, Trinity Health, UC Davis, UC Irvine, University of Alabama at Birmingham, University of Wisconsin Health, University of Washington Medicine, and several others.^[5]

Lifepoint’s strategy in using joint ventures has evolved over time. For example, in 2011, Lifepoint established a joint venture with Duke University Health System that went on to acquire sixteen mostly rural acute care hospitals in North Carolina, Virginia, Pennsylvania, and Michigan.^[7]

More recently, following Apollo Global Management’s 2018 buyout of Lifepoint, which merged the company with Apollo-owned RegionalCare Hospital Partners,^[8]

In 2023, Lifepoint significantly expanded its ownership of behavioral health hospitals by acquiring Springstone, a national behavioral health provider with 18 behavioral health hospitals and 35 outpatient locations across nine states.^[9] Lifepoint has also created multiple joint ventures with nonprofit health systems to develop and operate behavioral health hospitals.^[10]

^[11]

Duke Lifepoint joint venture

Lifepoint and Duke formed Duke Lifepoint Healthcare to own and operate community hospitals as well as to “improve the delivery of healthcare services.” Apollo-owned Lifepoint Health owns controlling interest in Duke Lifepoint Healthcare.[13] In 2018, Lifepoint noted of the joint venture with Duke:

“We believe this partnership, which combines our operational resources and experience with Duke’s expertise in the development of clinical services and quality systems, further strengthens our ability to acquire well-positioned hospitals. Since its formation in 2011 and through December 31, 2017, we have completed the acquisition of 14 acute care hospitals and ancillary facilities through Duke Lifepoint Healthcare.”^[14] 

When it was launched, Duke Health called the joint venture “one of the first joint ventures between an academic health system and a hospital operations company” and noted that it aimed to create “flexible affiliation options for community hospitals.” Its mission is to own and operate a “system of highly functioning community hospitals.”^[15]

“This is a challenging time for many community hospitals as the health care environment undergoes significant change and costs continue to rise,” said William F. Carpenter III, chairman and chief executive officer of Lifepoint Hospitals in 2011, when the joint venture was formed.^[16]

Duke Lifepoint hospitals

Duke reportedly offers Duke Lifepoint hospitals clinical quality and patient safety guidance with clinical experts experienced in leading clinical quality and patient safety initiatives.^[17]

Duke University Health System owns its 3% stake in Duke Lifepoint through an affiliated nonprofit, Duke Quality Network, Inc. Duke Quality Network states that the partnership was created “to implement clinical quality programs in rural hospitals or in hospitals in areas with underserved medical populations to support effective care, develop health professionals’ clinical skills, and improve patient safety.”^[18]

In 2013, Duke reported that it had contributed almost $700,000 for its 3% stake in the partnership.^[19] Duke University Health System now consolidates Duke Quality Network, Inc.’s financial results with its own and does not separately report the value of its stake in Duke Lifepoint Healthcare.^[20]

Duke Lifepoint was established and acquired its fifteen hospitals before Apollo acquired Lifepoint through Lifepoint’s merger with Apollo-owned RCCH.^[21]

Lifepoint reportedly provides a range of management, financial and operational resources, including access to capital for ongoing investments in new technology, facility renovations and additional sites of care.^[22]

Poor outcomes and unsafe conditions

Despite Lifepoint’s joint venture with “Duke Quality Network” and Duke Quality Network’s stated goal of implementing clinical quality programs and improving patient safety, some Duke Lifepoint hospitals have seen declining quality ratings and very serious patient safety issues.

According to the Lown Institute Hospital Index, which ranks hospitals and health systems based on health equity, value, and outcomes, multiple Lifepoint facilities rank among the worst hospitals in their states.^[23]

The Lown Institute ranks four Duke Lifepoint hospitals – Central Carolina Hospital, Frye Regional Medical Center, Maria Parham Health, and Person Memorial Hospital – among the ten worst hospitals in the state of North Carolina (out of 77 hospitals).^[24]

Duke Lifepoint’s Nason Hospital in Pennsylvania faced the maximum Medicare payment cut for FY 2022 as a penalty for its high readmission rates.^[25]

Wilson Medical Center quality issues

Duke Lifepoint acquired its stake in Wilson Medical Center, previously owned by Wilson County, North Carolina, in 2014 for about $60 million.^[28] Wilson is the only hospital in Wilson County, located about an hour east of Raleigh.^[29]

Duke Lifepoint’s Wilson Medical Center faced regulatory scrutiny in 2022 and 2023, including threats by CMS to revoke its Medicare payments and an investigation by the state’s attorney general.

On three separate occasions in under a year, compliance surveys by state regulators found that quality deficiencies warranted an “immediate jeopardy” designation for the hospital.^[30] According to CMS, immediate jeopardy represents a situation in which a hospital has “placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death.”^[31]

In June 2022, regulators found enough deficiencies at Lifepoint’s Wilson Medical Center that CMS threatened to terminate its Medicare contract.^[32] The investigation highlighted three incidents that occurred in early 2022—one patient died after a fall and sedation at the facility; another patient died shortly after his heart monitor was disconnected; and a suicidal patient locked himself in a bathroom in the hospital’s emergency room lobby and threatened to overdose on medication that regulators say the hospital should have confiscated.^[33]

In August 2022 the North Carolina Department of Justice began pursuing a separate investigation of Wilson. Assistant Attorney General Llogan Walters wrote to Lifepoint that the state’s Department of Justice was “extremely concerned about patients’ ability to access quality healthcare,’’ at Wilson, noting a decrease in available beds for inpatient care and allegations of chronic understaffing, a decrease in the treatment of low-income patients and the effective denial of care for patients who cannot pay for essential treatment.^[34] Denying care for patients in need of emergency treatment who do not have the ability to pay would violate the Emergency Medical Treatment and Labor Act (EMTALA).^[35]

Following the EMTALA investigation, CMS again placed Wilson on immediate jeopardy status in October 2022.^[36]

In March 2023, CMS issued a third immediate jeopardy citation to Wilson in under a year after identifying numerous care deficiencies during a February investigation. One incident involved “alleged inappropriate sexual interaction” between a nurse and a psychiatric patient that the hospital waited a month to report. Another involved a patient who was given a dye contrast for a CT scan against his physician’s orders, damaging his kidneys and making him dependent on dialysis.^[37]

Conemaugh service and job cuts

In central Pennsylvania, Duke Lifepoint’s Conemaugh Nason Medical Center announced it would end scheduled obstetrics deliveries beginning in October of 2022. In an email to employees announcing the discontinuance, Conemaugh Nason’s CEO Tim Harclerode told employees that because deliveries had declined over the several years prior, the limited demand for the services combined with “operational challenges” made it difficult for Nason to effectively provide obstetric services. Additionally, Conemaugh Nason’s OB/GYN stopped accepting new patients in August 2022 and closed October 2022, along with the hospital’s pediatric clinics. However, a new fourth operating room was expected to open.^[38]

The cuts to OB/GYN and pediatric services are consistent with a national trend, particularly in rural areas, of hospitals reducing those services in favor of more lucrative lines of service, which can exacerbate maternity and pediatric care deserts.^[39]

At Conemaugh Nason’s neighboring hospital, Conemaugh Memorial Medical Center in Johnstown, Pennsylvania (also owned by Lifepoint), hospital leadership announced in May 2023 that it was laying off two dozen employees, although the Medical Center stated that these were not direct care positions.^[40]

 Wage theft

In July 2023, the U.S. Department of Labor’s Wage and Hour Division ordered Duke Lifepoint to pay $97,209 in back wages after finding overtime pay violations for EMS workers at Duke Lifepoint-owned Central Carolina Hospital. The investigation found that the hospital used timekeeping software that deducted workers’ pay meant for breaks they did not get.^[41]

2025 Wilson Medical Center suit

The 2014 Duke Lifepoint Healthcare deal to acquire the Wilson hospital also established the Healthcare Foundation of Wilson, which provides grant funding to support local health care initiatives.^[42]

The nonprofit foundation decided in 2024 to exercise an option to sell its minority stake in the hospital to Duke Lifepoint Healthcare, which owns an 80% share in the facility. Although the nonprofit held seats on the governing board, it claimed in its lawsuit that it had “little actual power and almost no management power” over hospital operations.^[43]

However, the two sides disagreed over a key issue: the valuation date that would determine how much DLP Healthcare LLC — the Duke-Lifepoint joint venture — must pay to buy out the foundation’s stake.

In September 2025, the foundation filed a lawsuit against DLP Healthcare and DLP Partner LLC. In its complaint, the foundation describes DLP Partner as an indirect, wholly owned subsidiary of Lifepoint Health that owns 97% of DLP Healthcare. The foundation filed an amended complaint in February 2026 expanding and detailing its claims. The case is ongoing.^[44]

Lifepoint-Palomar Health joint ventures

Lifepoint and its predecessors have formed multiple joint ventures with Palomar Health, a Southern California public healthcare district.

In April 2021, Palomar Health and Kindred Healthcare opened the Palomar Health Rehabilitation Institute, a 52-bed inpatient rehabilitation hospital in Escondido, California.^[45] Just two months later, Apollo-owned Lifepoint announced that it was acquiring Kindred Healthcare.^[46] Lifepoint/Kindred is the majority owner of Palomar Health Rehabilitation Institute, with a 51% stake. Palomar Health owns the remaining 49%.^[47]

In 2022, Lifepoint/Kindred and Palomar Health announced a joint venture to develop a 120-bed behavioral health facility, also located in Escondido.^[48]

Lifepoint and Palomar Health broke ground on Palomar Health Behavioral Health Institute in 2024. Palomar Health is the majority owner of Palomar Health Behavioral Health Institute, with a 60% ownership stake. Lifepoint owns the remaining 40%.^[49]

“Our ongoing partnership with Palomar Health has proven our commitment to expanding access to vitally needed inpatient rehabilitation and behavioral health services to the communities we serve,” said Russ Bailey, president of Lifepoint Behavioral Health and Lifepoint Rehabilitation, at the groundbreaking.^[50] Palomar Health shut down its remaining dozen inpatient psychiatric beds mid-2024, saying in a statement that the move would “allow the health system to focus resources on building this new state-of-the-art facility.”^[51]

Yet the future of the Palomar Health Behavioral Health Institute is now in question after it lost a $50 million state grant last August. In May 2025, Palomar Health was conditionally awarded the grant, which was funded by California’s 2024 Proposition 1. Proposition 1 sets money aside for behavioral health treatment facilities.^[52]

The grant was rescinded just months later in August 2025. The state said it rescinded the grant because the public health care district, which applied through its charitable foundation, was unable to meet “match” requirements that would complete the funding plan for the stand-alone project, which has a total listed cost of $104 million.^[53]

“Palomar did not meet the match documentation requirements, which Palomar identified would be cash,” DHCS said in a statement. “As a result, DHCS informed Palomar that its conditional award was rescinded for the Palomar Health Behavioral Health Institute project.”^[54]

Given its large stake in the Palomar Health Behavioral Health Institute, it is unknown why Lifepoint did not provide the capital to match the $50 million state grant.

Palomar’s financial condition worsened in the last year, with the organization entering a forbearance agreement with lenders after breaching financial covenants on more than $700 million in debt and embarking on a turnaround plan that attempts to control costs and bring in new revenue. Belts have recently been tightened to the point where Palomar has been forced to delay payment of retention bonuses earned by nurses.^[55]

Lifepoint sale-leasebacks and long-term leases of joint venture-owned hospitals

One used by Lifepoint and other private equity owners of hospitals are sale-leasebacks of hospital real estate, where the hospital sells its real estate to a third party and leases it back. Sale-leasebacks are popular with private equity firms because they generate a short-term cash payout that can be used to pay a cash dividend to the private equity owner. The hospital, however, is then responsible for paying rent in perpetuity.^[56]

For example, in 2019, five years after Duke Lifepoint acquired the Conemaugh Health System in Pennsylvania^[57] and shortly after Apollo acquired Lifepoint^[58], it sold the hospital real estate to real estate investment trust (REIT) Medical Properties Trust as part of a $700 million sale-leaseback transaction. As part of the sale-leaseback deal, Lifepoint agreed to a 20-year lease with two five-year extension options and annual rent increases of up to 4%.^[59]

“Conemaugh Hospital/Apollo has also sold the health system buildings and properties to Medical Properties Trust in a purchase/lease back deal, which makes money via rent payments for shareholders of Apollo while putting Conemaugh Hospital in debt,” said Pennsylvania State Representative Frank Burns last year. Burns’ district includes Johnstown, where Lifepoint’s Conemaugh Health System is based. “Make no mistake that all these things are done to cut costs and maximize profits, while patient care and staff morale suffer,” Burns added.^[60]

Lifepoint has also actively used long-term leases in its more recent development of inpatient rehabilitation hospitals and behavioral health hospitals through joint ventures with nonprofit health systems. Such sale leasebacks play an important role in financing these joint venture facilities: by providing land on the front end to a for-profit developer with a long-term lease to the Lifepoint-nonprofit joint venture, the joint venture can develop a facility while putting in relatively little investment capital of its own.

For example, when Lifepoint (and predecessor Kindred Health) developed the Palomar Health Rehabilitation Institute,

While the development cost $44 million, according to an April 2021 media release by developer Pacific Medical Buildings (PMB),^[63] Harrison Street Capital and PMB a year later sold the Palomar Health Rehabilitation Institute property to Sila Realty Trust, a public-traded REIT that specializes in healthcare properties, for $63.4 million, a nearly $20 million or 44% profit.^[64]

Similarly, a joint venture between Lifepoint and PeaceHealth, a nonprofit Catholic health system, is currently building a 50-bed inpatient rehabilitation hospital in Vancouver, Washington.^[65] As with Palomar Health, Lifepoint and PeaceHealth are working with Pacific Medical Buildings (PMB) as the developer of the facility. The joint venture is 51% owned by the nonprofit PeaceHealth and 49% owned by Lifepoint. The partners anticipate that once it begins operations in 2027, the majority (75%) of revenue for the facility will come from Medicare and Medicaid.^[66] The facility will be managed by Lifepoint, which will receive a management fee.

PeaceHealth owns the underlying land, which it will lease to PMB under a 75-year lease.^[68] The certificate of need filing for the facility filed with the Washington State Department of Health notes that “The [PeaceHealth-Lifepoint joint venture] LLC’s capital expenditures are modest since PMB will build and lease the building to the LLC.”^[69] Lifepoint and PeaceHealth project that the facility will pay rent starting in 2027, with annual rent rising to more than $7.5 million by 2031.^[70]

By entering long term leases at the outset and partnering with nonprofit healthcare providers that contribute land and agree to work with Lifepoint, the private-equity owned hospital company has been able to expand its business in recent years with limited up-front investment.

^[1]https://www.Lifepointhealth.net/locations accessed March 29, 2026.

^[2] Private Equity in Health Care Shown to Harm Patients, Degrade Care and Drive Hospital Closures https://www.grassley.senate.gov/news/news-releases/private-equity-in-health-care-shown-to-harm-patients-degrade-care-and-drive-hospital-closures

^[3] “Private equity expands in healthcare through nonprofit joint ventures,” Private Equity Stakeholder Project, Apr 3, 2026, https://pestakeholder.org/news/private-equity-expands-in-healthcare-through-nonprofit-joint-ventures/.

^[4] “Private equity expands in healthcare through nonprofit joint ventures,” Private Equity Stakeholder Project, Apr 3, 2026, https://pestakeholder.org/news/private-equity-expands-in-healthcare-through-nonprofit-joint-ventures/.

^[5] Lifepoint January 2025 presentation https://doh.wa.gov/sites/default/files/2025-01/CN25-04-2025.01.30-PeaceHealthSouthwest-Lifepoint-OpeningRemarks.pdf

[6] Lifepoint 2018 10-K, p.43-44, https://www.sec.gov/Archives/edgar/data/1301611/000130161118000005/lpnt-20171231x10k.htm

^[7] Duke Lifepoint Healthcare  https://www.Lifepointhealth.net/duke-Lifepoint-healthcare-partnership

^[8] “Lifepoint Health and RCCH HealthCare Partners Announce Completion of Merger,” Media release, Nov 16, 2018. https://www.Lifepointhealth.net/news/Lifepoint-health-and-rcch-healthcare-partners-announce-completion-of-merger

^[9] Lifepoint Health Acquires Majority Ownership Interest in Springstone, Feb 7, 2023, https://www.Lifepointhealth.net/news/Lifepoint-health-acquires-majority-ownership-interest-in-springstone.

^[10] Baystate Health and Lifepoint Health Celebrate Opening of New Behavioral Health Hospital in Holyoke, Massachusetts https://www.Lifepointhealth.net/news/baystate-health-and-Lifepoint-health-celebrate-opening-of-new-behavioral-health-hospital-in-holyoke-massachusetts, TGH Behavioral Health Hospital https://jobs.Lifepointhealth.net/tgh-behavioral-health-hospital/, “Tampa General, Lifepoint Health and USF Health Celebrate Opening of Florida’s First Behavioral Health Teaching Hospital,” Lifepoint, Feb 25, 2025, https://www.lifepointhealth.net/news/floridas-first-behavioral-health-teaching-hospital.

^[11] Lifepoint January 2025 presentation https://doh.wa.gov/sites/default/files/2025-01/CN25-04-2025.01.30-PeaceHealthSouthwest-Lifepoint-OpeningRemarks.pdf

^[12] “Duke Lifepoint Healthcare,” accessed May 3, 2026. https://www.Lifepointhealth.net/duke-Lifepoint-healthcare-partnership

[13] Venerable Insurance and Annuity Company 2023 annual report, p.206, https://www.venerable.com/content/financialInformation/47_80942_38_l_2023_o_2_1_00_na_pbk.pdf.

^[14] Lifepoint 2018 10-K https://www.sec.gov/Archives/edgar/data/1301611/000130161118000005/lpnt-20171231x10k.htm

^[15] Duke University Health System and Lifepoint Hospitals Partner to Create Innovative Options for Community Hospitals https://corporate.dukehealth.org/news/duke-university-health-system-and-Lifepoint-hospitals-partner-create-innovative-options

^[16] Duke University Health System and Lifepoint Hospitals Partner to Create Innovative Options for Community Hospitals https://corporate.dukehealth.org/news/duke-university-health-system-and-Lifepoint-hospitals-partner-create-innovative-options

^[17] 2015 proposal re WRMC https://bloximages.newyork1.vip.townnews.com/journalpatriot.com/content/tncms/assets/v3/editorial/5/c1/5c1709a4-d1c6-11e5-ab35-cf291f19fbb0/56be3f361040a.pdf.pdf

^[18] Duke Quality Network, Inc 2024 Form 990 https://projects.propublica.org/nonprofits/organizations/461340679/202541349349309084/full

^[19] Duke Quality Network Inc 2012 990, p.12 https://projects.propublica.org/nonprofits/display_990/461340679/2014_06_EO%2F46-1340679_990_201306

^[20] Duke Quality Network Inc 2024 990 https://projects.propublica.org/nonprofits/organizations/461340679/202541349349309084/full, Duke University Health System 2025 audited financial statements https://corporate.dukehealth.org/sites/default/files/2025-10/FY25DUHSIssuedConsolidatedFinancialStatementsADA.pdf

^[21] A Big Merger Doesn’t Mean A Big Healthcare System Wants In On Rural Health, https://www.bpr.org/news/2018-09-04/a-big-merger-doesnt-mean-a-big-healthcare-system-wants-in-on-rural-health

^[22] 2015 proposal re WRMC https://bloximages.newyork1.vip.townnews.com/journalpatriot.com/content/tncms/assets/v3/editorial/5/c1/5c1709a4-d1c6-11e5-ab35-cf291f19fbb0/56be3f361040a.pdf.pdf

^[23] Lown Institute Hospitals Index – 2025-2026 Rankings, https://lownhospitalsindex.org/rankings/?type=HospTyp_ACH

^[24] Lown Institute Hospitals Index – 2025-2026 Rankings, https://lownhospitalsindex.org/rankings/?type=HospTyp_ACH

^[25] Ellison, Ayla. “The 39 Hospitals Facing Maximum Medicare Readmission Penalties.” Becker’s Hospital Review, October 29, 2021. https://www.beckershospitalreview.com/finance/the-39-hospitals-facing-maximum-medicare-readmission-penalties.html

^[26] Hospital General Information, CMS, Jan 26, 2026. https://data.cms.gov/provider-data/dataset/xubh-q36u

^[27] Hospital General Information, CMS, March 4, 2019. https://data.cms.gov/provider-data/archived-data/hospitals

^[28] Duke affiliate fights $55M hospital lawsuit, https://www.bizjournals.com/triangle/news/2026/03/23/duke-Lifepoint-wilson-medical-center-lawsuit-stake.html

^[29] Tyler Dukes, “Wilson hospital again facing federal threat to end Medicare contract,” News & Observer, November 5, 2022. https://www.newsobserver.com/news/local/article268249967.html

^[30] Mariah Taylor, “Duke Lifepoint hospital at risk of losing Medicare funding for 3rd time in 1 year,” Becker’s Hospital Review, March 31, 2023. https://www.beckershospitalreview.com/hospital-physician-relationships/duke-Lifepoint-hospital-at-risk-of-losing-medicare-funding-for-3rd-time-in-1-year.html

^[31] Centers for Medicare and Medicaid Services State Operations Manual, Appendix Q – Core Guidelines for Determining Immediate Jeopardy”, https://www.cms.gov/Regulations-and-guidance/Guidance/Manuals/downloads/som107ap_q_immedjeopardy.pd.

^[32] 2 Patient Deaths Threaten Federal Funding for Wilson Hospital,” WRAL News, July 8, 2022, https://www.wral.com/2-patient-deaths-threaten-federal-funding-for-local-hospital/20366151/

^[33] Tyler Dukes, “Two Patient Deaths Led to Threat to Cut off Funding for Wilson Hospital, Records Show,” News & Observer, July 8, 2022, https://www.newsobserver.com/news/local/article263219678.html.

^[34] Llogan Walters, “NC Department of Justice Letter to Duke Lifepoint,” August 23, 2022, https://www.documentcloud.org/documents/22186978-822-ago-letter-to-dlp.

^[35] Jakob Emerson, “Duke Lifepoint hospital at risk of losing its Medicare contract — again,” Becker’s Hospital Review, November 8th, 2022, https://www.beckershospitalreview.com/hospital-finance/duke-Lifepoint-hospital-could-lose-its-medicare-contract-again.html

^[36] Lisa Boykin Batts, “Wilson Medical Center returned to ‘immediate jeopardy’ Medicare status,” Wilson Times, October 29, 2022. https://restorationnewsmedia.com/articles/wilsontimes/wilson-medical-center-returned-to-immediate-jeopardy-medicare-status/

^[37] Mariah Taylor, “Duke Lifepoint hospital at risk of losing Medicare funding for 3rd time in 1 year,” Becker’s Hospital Review, March 31, 2023. https://www.beckershospitalreview.com/hospital-physician-relationships/duke-Lifepoint-hospital-at-risk-of-losing-medicare-funding-for-3rd-time-in-1-year.html

^[38] Rachel Floor, “Nason to End Scheduled Deliveries,” Altoona Mirror, August 24, 2022. https://www.altoonamirror.com/news/local-news/2022/08/nason-to-end-scheduled-deliveries

^[39] Brenna Miller, “Pediatrics and profits: Why children’s hospital units are closing,” Lown Institute, December 5, 2022. https://lowninstitute.org/pediatrics-and-profits-why-childrens-hospital-units-are-closing/

^[40] Griffith, Randy. “Conemaugh Memorial Confirms Layoffs, Says Affected Workers Weren’t Direct Care Personnel.” The Tribune-Democrat, May 13, 2023. https://finance.yahoo.com/news/conemaugh-memorial-confirms-layoffs-says-115100712.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAADwz8PIiQ9W3Fq9oC7lIfNs0q97grortVyLl8ld5cJkijExNCmG_xGcUB7oCe8QtHiLeBDEZDJ6LEpE5dq3l3HZmfyzAsrnT0RW7y7w0CxNPgyaYu-wL-3HhGaJQ604-0-_i_YuV-G92mUkmtgQxwcINIwC50SXap9e3aZCRc0TA.

^[41] US Department of Labor Recovers $97K in Back Wages for 41 Emergency Medical Service Workers after Finding Overtime Pay Violations | U.S. Department of Labor,” U.S. Department of Labor, July 19, 2022, https://www.dol.gov/newsroom/releases/whd/whd20220719-0.

^[42] Duke affiliate fights $55M hospital lawsuit, https://www.bizjournals.com/triangle/news/2026/03/23/duke-Lifepoint-wilson-medical-center-lawsuit-stake.html

^[43] “PE giant to take full ownership of Eastern NC hospital,” Triangle Business Journal, Aug 14, 2024. https://www.bizjournals.com/triangle/news/2024/08/14/wilson-medical-center-sale-Lifepoint-duke-apollo.html

^[44] 25CV033959-910, Healthcare Foundation of Wilson v. DLP Healthcare, LLC, Wake Superior Court, accessed May 23, 2026.

^[45] “Kindred Healthcare and Palomar Health Announce Opening of Palomar Health Rehabilitation Institute,” Media release, Apr 23, 2021. https://www.businesswire.com/news/home/20210423005494/en/Kindred-Healthcare-and-Palomar-Health-Announce-Opening-of-Palomar-Health-Rehabilitation-Institute.

^[46] “Lifepoint Health Announces Agreement to Acquire Kindred Healthcare,”  Jun 21, 2021, https://www.Lifepointhealth.net/news/Lifepoint-health-announces-agreement-to-acquire-kindred-healthcare.

^[47] Venerable Insurance and Annuity Company 2023 annual report, p.213, https://www.venerable.com/content/financialInformation/47_80942_38_l_2023_o_2_1_00_na_pbk.pdf.

^[48] Palomar Health Selects Kindred Behavioral Health as Partner to Build and Operate New Inpatient Behavioral Health Hospital, the Palomar Behavioral Health Institute, Jul 14, 2022. https://www.Lifepointhealth.net/news/palomar-health-selects-kindred-behavioral-health-as-partner-to-build-and-operate-new-inpatient-behavioral-health-hospital-the-palomar-behavioral-health-institute.

^[49] Venerable Insurance and Annuity Company 2023 annual report, p.213, https://www.venerable.com/content/financialInformation/47_80942_38_l_2023_o_2_1_00_na_pbk.pdf.

^[50] Palomar Health Breaks Ground on New, State-of-the-Art Behavioral Health Facility in Partnership with Lifepoint Behavioral Health, Sept 9, 2024. https://www.Lifepointhealth.net/white-papers/palomar-health-breaks-ground-on-new-state-of-the-art-behavioral-health-facility-in-partnership-with-Lifepoint-behavioral-health.

^[51] “State rescinds $50M grant awarded to Palomar Health for mental health hospital,” San Diego Union-Tribune, Sept 2, 2025, https://www.sandiegouniontribune.com/2025/09/02/state-rescinds-50-million-grant-awarded-palomar-health-for-mental-health-hospital/.

^[52] “State rescinds $50M grant awarded to Palomar Health for mental health hospital,” San Diego Union-Tribune, Sept 2, 2025, https://www.sandiegouniontribune.com/2025/09/02/state-rescinds-50-million-grant-awarded-palomar-health-for-mental-health-hospital/.

^[53] “State rescinds $50M grant awarded to Palomar Health for mental health hospital,” San Diego Union-Tribune, Sept 2, 2025, https://www.sandiegouniontribune.com/2025/09/02/state-rescinds-50-million-grant-awarded-palomar-health-for-mental-health-hospital/.

^[54] “Palomar Health loses state funding for mental health hospital,” KPBS, Sept 4, 2025. https://www.kpbs.org/news/health/2025/09/04/palomar-health-loses-state-funding-for-mental-health-hospital.

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^[56] “When Private Equity Sees Hospitals as Land, Not Care,” Health Leaders Media, Jul 7, 2025, https://www.healthleadersmedia.com/payer/when-private-equity-sees-hospitals-land-not-care.

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