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Wikipedia

Steward Health Care System

Steward Health Care is a large private for-profit health system headquartered in Dallas, Texas. It utilizes an integrated care model to deliver healthcare across its hospitals and primary care locations, as well as through its managed care and health insurance services. As of the start of 2024, Steward operated 33 hospitals and employed 33,000 people in the United States.[5] Steward's international ventures include Steward Colombia, which operates four hospitals, and Steward Middle East, which operates in Saudi Arabia and the United Arab Emirates.[6]

Steward Health Care
Company typePrivate
IndustryHealthcare
PredecessorCaritas Christi Health Care
Founded2010; 14 years ago (2010) in Boston, Massachusetts, US
FounderRalph de la Torre
Headquarters,
US
Number of locations
31 hospitals (2024)
Areas served
Key people
  • Ralph de la Torre (CEO)
  • Mark Rich (President)
Services
Revenue~$8 Billion
Owner
Number of employees
>30,000 (2023)
Websitewww.steward.org
Footnotes / references
[1][2][3][4]

Steward began in 2010 in Massachusetts, when private equity firm Cerberus Capital Management acquired the failing non-profit Caritas Christi Health Care system. This move was led by Caritas CEO Ralph de la Torre, MD, a former cardiac surgeon who became founder and CEO of the new system, a position he still holds.[7] Today, Steward mainly operates in the United States, with locations across the country. Since 2016, Steward has fueled its national expansion with debt-driven mergers and acquisitions, largely financed through sale-leaseback deals with its landlord, Medical Properties Trust (MPT), in which Steward would buy hospitals and immediately sell the real estate to MPT in order to recoup costs, pay investors, and fuel further expansion, in turn entering into lease agreements with MPT to be paid by the hospitals.[8]

Cerberus, having made a profit of about $800 million over 10 years,[9] made its exit in 2020 by giving its shares in Steward to a group of Steward physicians in exchange for a convertible bond worth $350 million.[8] Today, Steward is owned by said physicians (90%) and MPT (10%).[8] While Steward says that selling and leasing their hospital properties (a practice they call "asset light") allows them to prioritize patient care,[10] experts have described it as a contributing factor to the system's later financial difficulties and resulting concerns regarding patient safety.[8][11][12] Following months of reported financial issues and billions in unpaid bills, Steward filed for Chapter 11 bankruptcy on May 6, 2024.[13]

History edit

 
St. Elizabeth's Medical Center in Brighton, MA, once referred to as Steward's flagship hospital

Steward Health Care was started in 2010, when Caritas Christi Health Care was sold to New York private equity firm Cerberus Capital Management, with Caritas CEO and former Beth Israel Deaconess Medical Center heart surgeon Ralph de la Torre continuing as CEO of the new company.[7] Caritas, founded in 1985 under the ownership of the Archdiocese of Boston, was previously a non-profit healthcare system comprising six financially beleaguered Eastern Massachusetts hospitals as well as a number of other non-acute healthcare facilities. The hospital system transitioned to for-profit following the transaction and was renamed Steward Health Care.

Prior to finalization, the deal needed approval from Massachusetts Attorney General Martha Coakley—required by state law for any changes in tax status from non-profit to for-profit. Coakley approved the deal with four main stipulations, requiring that Cerberus:[8]

  • pay off Caritas' debt of approximately $275 million and assume liability for the system's full pension valued at about $200 million
  • invest $400 million in capital expenditures
  • maintain majority ownership and not close or sell any hospitals for 3–5 years
  • not take on debt for the purpose of dividends

Cerberus agreed to these stipulations, which brought the cost of the deal to $895 million.

Being an outlier in a state known for non-profit healthcare, Steward was a controversial company from the beginning. De la Torre was regarded by many early on as an ambitious and highly influential figure in healthcare, having goals of building the company on a national level. He stood out as one of the few people willing to invest millions into the system's troubled hospitals, which mostly serve low-income populations who would struggle to access healthcare without them. However, three years later, Steward was reported to be continuing to lose money and multiple attempts to expand outside of Massachusetts had failed.[14] While Steward would eventually achieve its goal of expanding to other states, the first several years focused on in-state growth.

2010–2015: First acquisitions and closures edit

In September 2011, AG Coakley approved Steward's acquisition of Morton Hospital in Taunton and Quincy Medical Center, both of which were previously non-profit facilities at risk of closing due to financial struggles. The deal required, among other commitments, that both facilities stay open for at least 10 years.[15]

In November 2011, Steward took its first step into the type of sale-leaseback deals that would partially define its long-running business model when it put 11 of its medical office buildings up for sale with the intent of leasing the properties for continued use. Consistent with earlier deals with the state, Steward reported that all proceeds would go to hospital operations. Steward justified the sale by claiming that being a landlord to its own physicians created compliance issues, as well as stating that "we’re not a real estate company. Our focus is on running hospitals and taking care of our patients."[16] Thirteen properties were ultimately sold to Healthcare Trust of America, a real estate investment trust, the next year for $100 million.[17] The triple-net lease entered into by Steward would see doctors and hospitals pay rent for the buildings while still being responsible for property insurance, taxes, and maintenance.

Despite the 2011 agreement to keep Quincy Medical Center open, Steward announced in November 2014 that the hospital would close by the end of the year.[18] Steward cited operating losses mostly attributed to a surplus in patient beds in the region, coupled with patients being referred more often to nearby South Shore Hospital in Weymouth and Beth Israel Deaconess Hospital's Milton campus. The next month, Steward and the state Department of Public Health reached a deal to keep the hospital's emergency department open until the end of 2015.[19] The emergency room ultimately stayed open until November 2020, almost five years longer than planned.[20]

Operations at Steward's Carney Hospital in Dorchester appeared to benefit from Quincy Medical Center's closure, which saw 125 QMC employees transfer to Carney, including several physicians. Steward reported a 16 percent increase in admissions and a 21 percent increase in outpatient visits in 2015, and new hospital president Walter J. Ramos said the hospital was expecting to break even by the end of the year following several years of losses.[21]

2015–2020: Investment and national growth edit

The year 2015 ended in a milestone for Steward, as they saw their first-ever profitable year, attributed to a significant drop in expenses.[22] It also marked the end of the Attorney General's 5-year monitoring period, allowing Steward to become more flexible with spending, use of debt, and facility operations.[8]

In September 2016, Steward and Cerberus entered a $1.25 billion deal with Medical Properties Trust, in which MPT would purchase all of Steward's hospital properties for $1.2 billion and pay an additional $50 million for a 5 percent stake in the company. In return, Steward would lease the properties back from MPT. This influx of money would allow Steward to pay back the entirety of Cerberus' initial 2010 investment while the firm would remain a majority owner, in addition to allowing the company to pay back all of its $400 million in debt. Steward and Cerberus were further able to provide hundreds of millions of dollars in dividends to investors from this sale,[23] including to de la Torre,[24] and fund a massive national expansion.[8] The deal became final in September 2017,[25] and would mark the beginning of the company's strategy of funding further expansions by selling purchased facilities' real estate to MPT.[8] This strategy has widely been labeled as a significant factor in the system's later financial difficulties. Studies noted that while a large portion of the proceeds from the sales went toward expansion and investor dividends, the hospitals themselves received little from the sales and were left responsible for lease payments with built-in escalator clauses which saw rent payments increase annually.[12][8] In correspondence with The Boston Globe in 2024, de la Torre and Cerberus both distanced themselves from responsibility for deals with MPT, each pointing to the other as the driving force behind the deals.[26]

 
St. Joseph Medical Center in Houston, TX, which Steward acquired from Iasis Healthcare in 2017

2017 saw Steward finally expand beyond Massachusetts' borders, with the purchase in February of eight hospitals from Tennessee-based Community Health Systems across Ohio, Pennsylvania and Florida,[27] and the later acquisition in May of Tennessee-based Iasis Healthcare, which added 18 hospitals in Utah, Arizona, Texas, Louisiana, Arkansas, Colorado, Florida and Nevada.[3] The latter deal brought Steward's network up to 36 hospitals with estimated revenues of $8 billion, making it the largest private for-profit hospital operator in the United States at the time.[28]

In February 2018, Steward announced that its top management would move to Dallas, Texas from Boston.[4]

2020–present: Decline & bankruptcy edit

In June 2020, Cerberus exited the picture when Steward physicians, led by Steward founder del la Torre, acquired a 90 percent controlling stake in the company by buying out Cerberus' ownership.[29] The group of physicians was able to do this after borrowing $335 million from Medical Properties Trust, which retained 10 percent of the company.[23]

In August 2021, Steward closed a $1.1 billion deal to acquire five South Florida hospitals from Dallas-based Tenet Healthcare. In keeping with past financial strategy, they immediately sold the properties to MPT for $900 million in an agreement that Steward would lease the properties.[30]

Shortly following the Florida deal, in September Steward and HCA Healthcare announced an agreement wherein Steward would sell all of its Utah hospitals to HCA.[31] However, in June 2022 the Federal Trade Commission announced that it would sue to block the merger on antitrust grounds, alleging that it would allow HCA, a rival to Steward at the time, to raise healthcare costs in the region.[32] This would lead to Steward and HCA abandoning the proposed merger two weeks later.[33] Steward's second attempt to sell its Utah operations succeeded in May 2023 when they sold to CommonSpirit Health, a Catholic health system. The transaction included Steward's entire presence in the state, including "five hospitals, over 35 medical group clinics, imaging and urgent care centers, and other outpatient ventures."[34] This raised concerns that the region may lose access to reproductive health care given CommonSpirit's position on the matter, though Steward declined to say whether they had even offered this care at their locations prior.[35]

The year 2023 saw Steward downsize in several states: it completed the sale of its Utah operations to CommonSpririt,[36] it closed Texas Vista Medical Center in April, citing low reimbursement rates and 25 percent of patients not paying their bills (CBS News reported that Texas Vista owed more than $650,000 to various vendors),[37] and in December, it announced the 2024 shuttering of operations at New England Sinai Hospital, a long-term acute care hospital in Stoughton, Massachusetts, reporting operating losses of $22 million.[38]

In January 2024, an investigation by The Boston Globe revealed that Steward was facing significant financial difficulties, creating fears of possible hospital closures.[39] Part of this stemmed from a press release from Medical Properties Trust announcing that Steward owed MPT $50 million in unpaid rent on their properties,[40] in addition to owing several contractors and vendors for unpaid services and equipment.[41] MPT, after multiple months of partial rent payments from Steward, brought on financial and legal firms to come up with a plan to collect what Steward owed. The end result was an action plan designed, according to MPT, to "strengthen Steward’s liquidity and restore its balance sheet, optimize MPT’s ability to recover unpaid rent, and ultimately reduce MPT’s exposure to Steward." Steward agreed to pursue the sale of some hospital operations and to divest from non-core operations, in exchange receiving a bridge loan from MPT in the amount of $60 million and MPT writing off portions of Steward's unpaid rent. Of the agreement, MPT said "There can be no assurance that Steward will successfully execute its plans or that the Company will recover all of its deferred rent and loans outstanding to Steward."[40] In February, U.S. House Representative Stephen Lynch said after a meeting with Steward that the health care system was looking to sell four of its nine Massachusetts hospitals "as soon as possible," including St. Elizabeth's Medical Center in Brighton, Holy Family Hospital's two campuses in Haverhill and Methuen, Nashoba Valley Medical Center in Ayer, and Norwood Hospital, whose reconstruction would also be halted.[42]

The repossession by vendors of medical equipment for unpaid bills was linked to the death of a new mother at Saint Elizabeth's Medical Center in Brighton, Massachusetts, who in October 2023 suffered a liver bleed which staff were unable to treat due to the lack of equipment. She was then transferred to another hospital, where she later died. Steward, regarding the incident at St. Elizabeth's, said in part that "understanding that the demand for supplies and staff can fluctuate at any given moment due to changing and unpredictable volumes of patients, Steward is confident we have adequate supplies for our physicians, providers, and health care professionals to continue providing high-quality care to our patients."[43] In its investigation, the Massachusetts Department of Health found that the hospital had little control over what vendors were paid and when:[44]

During its investigation, DPH became aware from St. Elizabeth's president that the non-payment of the coils was in part due to the hospital's lack of control over its funds and authorization to make payments to its vendors. [...] According to the president, the hospital's corporate office determined which vendors to pay and made the payments (or not).

— Informational Brief of the Commonwealth of Massachusetts in Support of Responses to the Debtors' Emergency Motions, United States Bankruptcy Court for the Southern District of Texas Houston Division
 
Norwood Hospital mid-construction

Unpaid bills also led to work stoppages in multiple construction projects. In Texarkana, Texas, construction started in 2021 on a $227 million project to replace Steward's Wadley Regional Medical Center with a new campus 5 miles north of the current location.[45] On February 5, construction firm Robins & Morton sent a memo to subcontractors stating they had "requested evidence of [Steward] having made financial arrangements that will allow them to fulfill their payment obligations under the contract." Having not received proper evidence of financing, the firm ordered subcontractors to halt all work on the site.[46] And in Norwood, Massachusetts, construction to replace Norwood Hospital, which was fully evacuated and subsequently demolished[47] due to damage from flooding caused by an intense 2020 rainstorm,[48] was stopped due to nonpayment.[49]

On February 2, 2024, Steward announced to employees that they had agreed to a "significant financial transaction" that would allow their Massachusetts hospitals to continue operations while they continued to explore options for selling some facilities to other operators. The terms of the deal and the source of the funding were not immediately disclosed,[50] however later reporting indicated that the system refinanced its debt with a $600 million loan in 2023 and received a bridge loan of $150 million in January, the two loans coming from a group of asset management firms including Sound Point Capital Management, Oaktree Capital Management, WhiteHawk Capital Partners, Owl Creek Asset Management, MidOcean Partners, and Brigade Capital.[51]

In late March 2024, Steward announced a deal made to sell its physician network Stewardship Health to Optum, a subsidiary of UnitedHealth Group and already the largest employer of physicians in the United States. As of April, the deal was pending regulatory approval.[52]

On May 3, 2024, with no word from Steward regarding whether it met its April 30 deadline, the Massachusetts Executive Office of Health and Human Services (EOHHS) announced the activation of the Incident Command System to prepare for anticipated disruptions in health care access across the state.[53]

On May 5, 2024, The Wall Street Journal reported that Steward Health Care was expected to file for Chapter 11 bankruptcy protection within the coming days, blaming rising costs, insufficient revenue and cash crunches as part of the decision. Steward's bankruptcy is set to be one of the largest hospital bankruptcies in U.S. history, and the largest one in decades.[54] The next day, Steward announced that it had indeed filed voluntarily for Chapter 11 bankruptcy protection. The company stressed that its hospitals and medical offices would remain open during the proceedings. In its press release, Steward stated it was finalizing terms of a $75 million in new debtor-in-possession financing from MPT, with the possibility for $225 million more if it meets certain unspecified conditions set by MPT. The company's filing revealed approximately $9 billion in liabilities, including $6.6 billion in long-term rent obligations, $1.2 billion in loans, almost $1 billion in unpaid bills to vendors, and $290 million in unpaid wages and benefits to its employees. In listing its obligations to non-insiders, filings revealed twenty creditors who were owed in excess of $10 million, including a debt of $32 million to the federal government in "reimbursements for insurance overpayments".[13][55] During proceedings, the company stated it would be putting all 31 of its hospitals up for sale, with auctions scheduled for the summer.[56]

Future edit

Steward's future in individual locales and as a whole remains in question amid its bankruptcy filing in May. Prior to the filing, Massachusetts lawmakers all but committed to ruling out a bailout, stating that the system had already received $54 million in previous years in the form of COVID-19 relief aid. Also contributing to lawmakers' stance on the issue was Steward's repeated refusal to provide financial reports to the state, a requirement of all hospitals under state law and one which Steward has been battling the state over for years[57]—which was cited as a reason they were provided significantly less American Rescue Plan Act money in the third round of this aid.[58] Medical Properties Trust, in a February Securities and Exchange Commission report, reported operating losses of $664 million for the fourth quarter of 2023, specifically noting $772 million in "write-offs and impairments" which they attributed primarily to Steward.[59] Further, MPT deferred collection of full rent payments until June.[60] In addition, conditions of Steward's January 2024 bridge loan required that the company demonstrate an ability to begin paying its debts by April 30, the end of their forbearance period. While Steward in February said that it has a plan to come out of the forbearance period as a sustainable company, economic experts, specifically ones who have studied Steward for years, expressed doubt that the system would be able to achieve this given the amount of debt and further predicted that bankruptcy was likely.[61] While the proposed sale of its physician network to Optum would be expected to provide a significant windfall, it is not expected that a sale would be approved in the near future and there are doubts that the sale would obtain regulatory approval given federal scrutiny into Optum's alleged anticompetitive practices.[62]

Steward Health Care International edit

Steward Health Care International
 
 
Clínica San Rafael, a hospital built and operated by Steward in Pereira, Colombia
Company typePrivate
IndustryHealthcare
FounderRalph de la Torre
Headquarters,
Spain
Number of locations
4 hospitals
Areas served
  • Colombia
  • Saudi Arabia
  • United Arab Emirates
Key people
Armin Ernst (CEO, President)
Websitewww.stewardinternational.org

At the end of 2017, Steward announced an upcoming international expansion which was finalized in February 2018, in which they took over Vitals Global Healthcare of Malta, creating Steward Health Care International.[63] VGH, an embattled Maltese healthcare company, was the center of a controversial 2015 deal in which it was contracted with the government to take over administration of the island nation's hospitals. The 2015 deal with VGH was widely controversial especially among physicians, who raised concerns both about the government relinquishing control of the public healthcare system and about VGH's lack of experience in the healthcare sector.[64] In 2018, amid allegations of collusion between VGH and government officials, lack of progress in the rehabilitation of the hospitals, and accusations that VGH was siphoning money out of the country, parties agreed to a deal that would see Steward purchase VGH for just €1, while the Maltese government would pay VGH €50 million to accept the deal.[65] The transfer of Malta's hospitals to Steward did not sate the public's concerns, and Steward's presence remained unpopular until 2023 when Maltese courts annulled the 2018 deal amid allegations of fraud and continued lack of progress in hospital renovations and construction, ultimately returning control of the hospitals to the government.[66]

In the early 2020s, Steward Health Care International also expanded into Colombia[67] and the Middle East.[68]

In late 2020, Steward entered the Colombian healthcare market with the purchase of three hospitals in the country: Hospital Universitario Clínica San Rafael and Clínica Centenario in the capital city of Bogotá, and Clínica Los Nevados in Pereira. CEO Ralph de la Torre spoke about Steward's plans and goals in the nation, saying that COL$102.000 million (US$28 million) would be invested in the three hospitals, most of which would be spent on Los Nevados which had been closed following damage from an earthquake several years prior.[69] De la Torre expressed that Steward wanted to grow significantly in the region, hoping to eventually have "between 10 and 15 hospitals in the country."[70] In 2023, Steward opened two hospitals in Colombia: the new Clínica San Rafael in Popayán[71] and the fully renovated Clínica Los Nevados.[72]

In 2022, Steward International created Steward Middle East, which partnered with Saudi Arabian venture capital company Alfanar to create a joint venture named Steward alf Global Healthcare Company. That year, they signed a contract with the Red Sea Development Company to build and operate a new hospital as part of the Red Sea Project, a massive tourism development under construction on the nation's coast. The company would also be responsible for emergency response planning for the site.[73] Steward Middle East also reportedly included ventures in Riyadh as well as Dubai in the UAE.[68]

In 2023, a Steward representative expressed the company's interest in expanding into Egypt as well.[74]

As of 2024, Steward International was headquartered in Madrid, Spain.[75]

Operations edit

Business model edit

Steward intended to become a low-price leader in the provision of high quality care.[76] Consistent with this model, the System had taken steps to reduce the direction of surgical patients toward outside teaching hospitals in the Boston area.[76] The system has also worked with payers to negotiate patient group-oriented budget pricing.[citation needed]

Services edit

Steward Health Care directly manages a network of hospitals across several states. In addition, it comprises several subsidiaries which manage different aspects of its integrated healthcare model:

  • Steward Medical Group and Steward Health Care Network comprise the company's network of primary care and specialty providers.[77]
  • Steward Health Choice is a commercial Medicaid option offered in Massachusetts and formerly in Arizona.[78] Steward Health Choice of Arizona was sold to Blue Cross Blue Shield of AZ in 2020.[79]
  • Steward Health Care International administers several ventures overseas.

Criticism edit

Steward has received criticism for its approach to health care and transparency, especially following the revelation of significant financial struggles in the beginning of 2024. Health care officials have pointed to the concerns which Steward's financial condition and operations has raised about the role of private equity in healthcare.[80]

In 2017, Steward sued the Massachusetts Center for Health Information and Analysis (CHIA) to avoid providing financial information to the agency.[81] CHIA, an independent state agency charged with monitoring the financial condition of Massachusetts' hospital industry,[82] had been in talks with Steward since the previous year in an attempt to reach a deal over its financial disclosures, and had been imposing fines of $1000 per week for delinquency. At the time, Steward was the only hospital system in the state to repeatedly fail to submit required company-wide financial statements, not having fulfilled the requirement since 2015.[81] In its suit, Steward said that the financial statements "contain sensitive, proprietary business information related to long-term debt, relationships with investors, retirement plans, and significant transactions that is not otherwise publicly available [...] Steward keeps information contained in the notes [of its financial statements] confidential because releasing the notes would cause harm to Steward." Steward further stated that their concerns were related to CHIA's past publicization of their financial data, and argued that the agency had no authority to collect the information. In 2023, a judge ruled in favor of the state, confirming that CHIA had the authority to demand the information. Steward filed an appeal,[83] which was still pending into early 2024 and which state officials have highlighted—U.S. House Representative Stephen Lynch said in January, "we had not had advance notice prior to a week ago that they were in difficulty, or that they were contemplating exiting the Massachusetts health care market."[42]

Many have pointed to Steward's sales of its acquired hospitals' properties to Medical Properties Trust over the years as a key factor in their current financial state, given at least $50 million of their debt is in past-due rent payments on these properties.[84] In 2023, just before the closing of Steward's Texas Vista Medical Center, Steward officials stated that the lease payment on the hospital was $5 million per year, saying "[t]hat represents 3% of the annual operating budget and was absolutely not a factor in the decision to close the hospital."[85] However, audio obtained by CBS News of a Steward leadership meeting revealed that the system was "trying to get out of lease obligations."[37]

Further, Steward's debts to outside vendors have raised concerns for patient safety, especially after multiple adverse incidents across its hospitals relating to staffing and equipment availability. Following several patient deaths and safety incidents alleged to have been avoidable at two Massachusetts hospitals,[86] state officials in 2024 planned to place monitors at all Steward hospitals in the state to ensure quality care and safety.[87]

Steward has attributed much of its financial woes in Massachusetts to the COVID-19 pandemic, as well as their system mainly comprising community hospitals which serve low-income populations, where 70% of their patients are recipients of Medicare and Medicaid. They also complained of the gap between the reimbursement rates from public and private insurers pay community hospitals versus larger academic medical centers.[88] State officials, in response, raised questions regarding the use of tens of millions of dollars in pandemic relief provided to the company by the federal government. Bloomberg reported in September 2020 that at the time, the amount Steward had received in federal grants and loans stood at $675 million.[23]

Elsewhere, such as in Texas and Arizona, Steward has pointed to under-utilization as a factor in closures. In Phoenix for example, St. Luke's Medical Center's former CEO said the hospital's 2019 closure came as two out of three beds were routinely unoccupied.[89]

Massachusetts Governor Maura Healey, in a February 2024 letter to Ralph de la Torre, criticized the system's handling of the crisis, what brought them there, and their seeming opacity with state officials throughout.[90]

Massachusetts law requires disclosure of hospitals’ system-level audited financial statements to help us avoid precisely the situation you have created: we have no insight into your allocation of resources across operating units or states, and therefore no clear sense of the financial viability of the hospitals serving Massachusetts residents.

— Massachusetts Governor Maura Healey

Defending themselves, Steward responded in two press releases stating that they have "tried to be transparent, compliant and cooperative over the years in providing a significant amount of detailed and relevant financial documentation to various state agencies and regulatory bodies and moving forward it commits to do even better."[91] They also stated that "[w]e have played with our cards face up on these data requests," and that "at their request, we have provided the Attorney General (AGO) and Executive Office of Health and Human Services (EOHHS) 613 megabytes—running across tens of thousands of pages—of financial and operating materials over the last two months,"[92] despite their earlier appeal to avoid providing complete information.

Hospitals edit

Domestic (United States) edit

List of current and former Steward hospitals in the U.S.
Hospital Location Bed Count Emergency Department Founded Status Notes
Carney Hospital Dorchester, Massachusetts 159[93] Yes 1863 Open One of Steward's original facilities. Founded by Daughters of Charity of Saint Vincent de Paul and Andrew Carney.
First Catholic hospital in New England.
Coral Gables Hospital Coral Gables, Florida 245[94] Yes 1926 Open Founded as Tallman Hospital, renamed to Coral Gables Hospital after being purchased by Hospital Affiliates, Inc. in 1971.[95]
Purchased by Steward from Tenet Healthcare in August 2021[94]
Davis Hospital and Medical Center Layton, Utah Yes 1976[96] Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital - Davis.[35]
Florida Medical Center Fort Lauderdale, Florida 434[97] Yes Open Purchased by Steward from Tenet Healthcare in August 2021.[97]
Glenwood Regional Medical Center West Monroe, Louisiana 274[98] Yes Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[98]
Good Samaritan Medical Center Brockton, Massachusetts 294[93] Yes 1968[99] Open One of Steward's original facilities. Originally named Cardinal Cushing Hospital, was renamed after 1994 merger with Goddard Memorial Hospital.[100]
Hialeah Hospital Hialeah, Florida 340[101] Yes 1951 Open Purchased by Steward from Tenet Healthcare in August 2021.[101]
Hillside Rehabilitation Hospital Warren, Ohio 65[102] No 1963[103] Open Purchased by Steward from Community Health Systems in May 2017.[102]
Holy Family Hospital (Haverhill) Haverhill, Massachusetts 122[104] Yes 1887 Open One of Steward's original hospitals. Originally owned by the city of Haverhill and named Hale Hospital.
Renamed Merrimack Valley Hospital when city sold hospital to Essent Health Care.[105]
Integrated under the Holy Family Hospital name by Steward in 2014.[106]
Holy Family Hospital (Methuen) Methuen, Massachusetts 310[107] Yes 1950[108] Open One of Steward's original hospitals. Originally named Bon Secours Hospital.[108]
Jordan Valley Medical Center West Jordan, Utah Yes 1983[109] Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital - Jordan Valley.[35]
Jordan Valley Medical Center - West Valley Campus West Valley City, Utah Yes 1964[110] Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital - Jordan Valley West.[35]
Melbourne Regional Medical Center Melbourne, Florida 96[111] Yes 2002[112] Open Originally named Wuesthoff Medical Center.[112] Purchased by Steward from Community Health Systems in May 2017 and renamed.[111]
Morton Hospital Taunton, Massachusetts 108[93] Yes 1889[113] Open One of Steward's original facilities.
Mountain Point Medical Center Lehi, Utah Yes 2015[114] Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital - Mountain Point.[35]
Nashoba Valley Medical Center Ayer, Massachusetts 38[93] Yes 1965[115] Open Originally named Nashoba Community Hospital.
One of Steward's original facilities.
New England Sinai Hospital Stoughton, Massachusetts 203[116] No 1927[117] Closed April 2024[118] Founded as the Jewish Tuberculosis Sanatorium in 1927, originally in Rutland, MA.
Renamed New England Sinai when it moved to Jamaica Plain in 1954.
Moved to Stoughton in 1976.
Purchased by Steward in 2012[117]
North Shore Medical Center Miami, Florida 748[119] No 1953[120] Open Purchased by Steward from Tenet Healthcare in August 2021.[119]
Norwood Hospital Norwood, Massachusetts 185 (FY 2020)[93] Temporarily Closed 1917-1919[121][122] Temporarily Closed One of Steward's original facilities. Evacuated and demolished following flood in 2020, with replacement facility still under construction as of January 2024.[42]
Odessa Regional Medical Center Odessa, Texas 208[123] Yes 1975 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[123]
Palmetto General Hospital Hialeah, Florida 358[124] Yes 1971[125] Open Purchased by Steward from Tenet Healthcare in August 2021.[124]
Rockledge Regional Medical Center Rockledge, Florida 274[126] Yes 1941[112] Open Originally named Eugene Wuesthoff Memorial Hospital. Acquired and renamed by Steward in September 2017 as part of purchase of IASIS Healthcare.[126]
Salt Lake Regional Medical Center Salt Lake City, Utah Yes 1875[127] Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital - Salt Lake.[35]
Sebastian River Medical Center Sebastian, Florida 145[128] Yes 1974[129] Open Purchased by Steward from Community Health Systems in May 2017.[128]
Sharon Regional Medical Center Sharon, Pennsylvania 163[130] Yes 1896[131] Open Originally named Christian H. Buhl Hospital. Purchased by Steward from Community Health Systems in May 2017.[130]
St. Anne's Hospital Fall River, Massachusetts 187[93] Yes 1906[132] Open One of Steward's original facilities.
St. Elizabeth's Medical Center Brighton, Massachusetts 226[93] Yes 1868[133] Open One of Steward's original facilities.
St. Joseph Medical Center Houston, Texas 290[134] Yes 1887 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[134]
St. Luke's Behavioral Health Center Phoenix, Arizona 127[135] No 1969[135] Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[136]
St. Luke's Medical Center Phoenix, Arizona 219[137] Yes Closed 2019[137] Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[136] Ended normal operations in 2019, but was readied for potential use as a surge facility during the COVID-19 pandemic.[138]
Tempe St. Luke's Hospital Tempe, Arizona 64[136] Yes 1944[139] Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[136]
Texas Vista Medical Center San Antonio, Texas Closed 2023[37] Formerly named Southwest General Hospital
The Medical Center of Southeast Texas Port Arthur, Texas 216[140] Yes 2005[141] Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[140]
The Medical Center of Southeast Texas - Victory Campus Beaumont, Texas Yes 2013[142] Closed February 2024 Originally named Victory Medical Center Beaumont until purchase by The Medical Center of Southeast Texas in 2015.[143] Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[140]
Trumbull Regional Medical Center Warren, Ohio 214[144] Yes Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[144]
Wadley Regional Medical Center Texarkana, Texas 185[145] Yes 1900 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[145] Construction began in 2021 of future replacement facility at a different location in Texarkana.[146]
Wadley Regional Medical Center at Hope Hope, Arkansas Yes 1955[147] Open Originally named Hempstead County Memorial Hospital.[147] Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare.[148]

International edit

List of current and former Steward hospitals outside the U.S.
Hospital Municipality Country Emergency Department Founded Status Notes
Clínica Centenario Bogotá Colombia Open
Clínica Los Nevados Pereira Colombia Yes[149] Reopened 2023[150] Open
Clínica San Rafael de Popayán Popayán Colombia Yes[151] 2023[71] Open
Hospital Universitario Clínica San Rafael Bogotá Colombia Yes[152] Open
Gozo General Hospital Victoria Malta Open
Karin Grecht Hospital Pietà Malta Open
St. Luke's Hospital Pietà Malta Closed for refurbishment
Coastal Village Hospital The Red Sea Saudi Arabia Planned Future Being developed Planned for construction in a residential section of the Red Sea Project, a tourism project on the west coast of Saudi Arabia. Emergency department will be specialized for tourism, including having a hyperbaric chamber.[73]

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steward, health, care, system, steward, health, care, large, private, profit, health, system, headquartered, dallas, texas, utilizes, integrated, care, model, deliver, healthcare, across, hospitals, primary, care, locations, well, through, managed, care, healt. Steward Health Care is a large private for profit health system headquartered in Dallas Texas It utilizes an integrated care model to deliver healthcare across its hospitals and primary care locations as well as through its managed care and health insurance services As of the start of 2024 Steward operated 33 hospitals and employed 33 000 people in the United States 5 Steward s international ventures include Steward Colombia which operates four hospitals and Steward Middle East which operates in Saudi Arabia and the United Arab Emirates 6 Steward Health CareCompany typePrivateIndustryHealthcarePredecessorCaritas Christi Health CareFounded2010 14 years ago 2010 in Boston Massachusetts USFounderRalph de la TorreHeadquartersDallas Texas USNumber of locations31 hospitals 2024 Areas servedUnited StatesColombiaSaudi ArabiaUnited Arab EmiratesKey peopleRalph de la Torre CEO Mark Rich President ServicesHealthcareHealth insuranceRevenue 8 BillionOwnerSteward physicians 90 Medical Properties Trust 10 Number of employees gt 30 000 2023 Websitewww wbr steward wbr orgFootnotes references 1 2 3 4 Steward began in 2010 in Massachusetts when private equity firm Cerberus Capital Management acquired the failing non profit Caritas Christi Health Care system This move was led by Caritas CEO Ralph de la Torre MD a former cardiac surgeon who became founder and CEO of the new system a position he still holds 7 Today Steward mainly operates in the United States with locations across the country Since 2016 Steward has fueled its national expansion with debt driven mergers and acquisitions largely financed through sale leaseback deals with its landlord Medical Properties Trust MPT in which Steward would buy hospitals and immediately sell the real estate to MPT in order to recoup costs pay investors and fuel further expansion in turn entering into lease agreements with MPT to be paid by the hospitals 8 Cerberus having made a profit of about 800 million over 10 years 9 made its exit in 2020 by giving its shares in Steward to a group of Steward physicians in exchange for a convertible bond worth 350 million 8 Today Steward is owned by said physicians 90 and MPT 10 8 While Steward says that selling and leasing their hospital properties a practice they call asset light allows them to prioritize patient care 10 experts have described it as a contributing factor to the system s later financial difficulties and resulting concerns regarding patient safety 8 11 12 Following months of reported financial issues and billions in unpaid bills Steward filed for Chapter 11 bankruptcy on May 6 2024 13 Contents 1 History 1 1 2010 2015 First acquisitions and closures 1 2 2015 2020 Investment and national growth 1 3 2020 present Decline amp bankruptcy 1 4 Future 2 Steward Health Care International 3 Operations 3 1 Business model 3 2 Services 3 3 Criticism 4 Hospitals 4 1 Domestic United States 4 2 International 5 ReferencesHistory edit nbsp St Elizabeth s Medical Center in Brighton MA once referred to as Steward s flagship hospital Steward Health Care was started in 2010 when Caritas Christi Health Care was sold to New York private equity firm Cerberus Capital Management with Caritas CEO and former Beth Israel Deaconess Medical Center heart surgeon Ralph de la Torre continuing as CEO of the new company 7 Caritas founded in 1985 under the ownership of the Archdiocese of Boston was previously a non profit healthcare system comprising six financially beleaguered Eastern Massachusetts hospitals as well as a number of other non acute healthcare facilities The hospital system transitioned to for profit following the transaction and was renamed Steward Health Care Prior to finalization the deal needed approval from Massachusetts Attorney General Martha Coakley required by state law for any changes in tax status from non profit to for profit Coakley approved the deal with four main stipulations requiring that Cerberus 8 pay off Caritas debt of approximately 275 million and assume liability for the system s full pension valued at about 200 million invest 400 million in capital expenditures maintain majority ownership and not close or sell any hospitals for 3 5 years not take on debt for the purpose of dividends Cerberus agreed to these stipulations which brought the cost of the deal to 895 million Being an outlier in a state known for non profit healthcare Steward was a controversial company from the beginning De la Torre was regarded by many early on as an ambitious and highly influential figure in healthcare having goals of building the company on a national level He stood out as one of the few people willing to invest millions into the system s troubled hospitals which mostly serve low income populations who would struggle to access healthcare without them However three years later Steward was reported to be continuing to lose money and multiple attempts to expand outside of Massachusetts had failed 14 While Steward would eventually achieve its goal of expanding to other states the first several years focused on in state growth 2010 2015 First acquisitions and closures edit In September 2011 AG Coakley approved Steward s acquisition of Morton Hospital in Taunton and Quincy Medical Center both of which were previously non profit facilities at risk of closing due to financial struggles The deal required among other commitments that both facilities stay open for at least 10 years 15 In November 2011 Steward took its first step into the type of sale leaseback deals that would partially define its long running business model when it put 11 of its medical office buildings up for sale with the intent of leasing the properties for continued use Consistent with earlier deals with the state Steward reported that all proceeds would go to hospital operations Steward justified the sale by claiming that being a landlord to its own physicians created compliance issues as well as stating that we re not a real estate company Our focus is on running hospitals and taking care of our patients 16 Thirteen properties were ultimately sold to Healthcare Trust of America a real estate investment trust the next year for 100 million 17 The triple net lease entered into by Steward would see doctors and hospitals pay rent for the buildings while still being responsible for property insurance taxes and maintenance Despite the 2011 agreement to keep Quincy Medical Center open Steward announced in November 2014 that the hospital would close by the end of the year 18 Steward cited operating losses mostly attributed to a surplus in patient beds in the region coupled with patients being referred more often to nearby South Shore Hospital in Weymouth and Beth Israel Deaconess Hospital s Milton campus The next month Steward and the state Department of Public Health reached a deal to keep the hospital s emergency department open until the end of 2015 19 The emergency room ultimately stayed open until November 2020 almost five years longer than planned 20 Operations at Steward s Carney Hospital in Dorchester appeared to benefit from Quincy Medical Center s closure which saw 125 QMC employees transfer to Carney including several physicians Steward reported a 16 percent increase in admissions and a 21 percent increase in outpatient visits in 2015 and new hospital president Walter J Ramos said the hospital was expecting to break even by the end of the year following several years of losses 21 2015 2020 Investment and national growth edit The year 2015 ended in a milestone for Steward as they saw their first ever profitable year attributed to a significant drop in expenses 22 It also marked the end of the Attorney General s 5 year monitoring period allowing Steward to become more flexible with spending use of debt and facility operations 8 In September 2016 Steward and Cerberus entered a 1 25 billion deal with Medical Properties Trust in which MPT would purchase all of Steward s hospital properties for 1 2 billion and pay an additional 50 million for a 5 percent stake in the company In return Steward would lease the properties back from MPT This influx of money would allow Steward to pay back the entirety of Cerberus initial 2010 investment while the firm would remain a majority owner in addition to allowing the company to pay back all of its 400 million in debt Steward and Cerberus were further able to provide hundreds of millions of dollars in dividends to investors from this sale 23 including to de la Torre 24 and fund a massive national expansion 8 The deal became final in September 2017 25 and would mark the beginning of the company s strategy of funding further expansions by selling purchased facilities real estate to MPT 8 This strategy has widely been labeled as a significant factor in the system s later financial difficulties Studies noted that while a large portion of the proceeds from the sales went toward expansion and investor dividends the hospitals themselves received little from the sales and were left responsible for lease payments with built in escalator clauses which saw rent payments increase annually 12 8 In correspondence with The Boston Globe in 2024 de la Torre and Cerberus both distanced themselves from responsibility for deals with MPT each pointing to the other as the driving force behind the deals 26 nbsp St Joseph Medical Center in Houston TX which Steward acquired from Iasis Healthcare in 2017 2017 saw Steward finally expand beyond Massachusetts borders with the purchase in February of eight hospitals from Tennessee based Community Health Systems across Ohio Pennsylvania and Florida 27 and the later acquisition in May of Tennessee based Iasis Healthcare which added 18 hospitals in Utah Arizona Texas Louisiana Arkansas Colorado Florida and Nevada 3 The latter deal brought Steward s network up to 36 hospitals with estimated revenues of 8 billion making it the largest private for profit hospital operator in the United States at the time 28 In February 2018 Steward announced that its top management would move to Dallas Texas from Boston 4 2020 present Decline amp bankruptcy edit In June 2020 Cerberus exited the picture when Steward physicians led by Steward founder del la Torre acquired a 90 percent controlling stake in the company by buying out Cerberus ownership 29 The group of physicians was able to do this after borrowing 335 million from Medical Properties Trust which retained 10 percent of the company 23 In August 2021 Steward closed a 1 1 billion deal to acquire five South Florida hospitals from Dallas based Tenet Healthcare In keeping with past financial strategy they immediately sold the properties to MPT for 900 million in an agreement that Steward would lease the properties 30 Shortly following the Florida deal in September Steward and HCA Healthcare announced an agreement wherein Steward would sell all of its Utah hospitals to HCA 31 However in June 2022 the Federal Trade Commission announced that it would sue to block the merger on antitrust grounds alleging that it would allow HCA a rival to Steward at the time to raise healthcare costs in the region 32 This would lead to Steward and HCA abandoning the proposed merger two weeks later 33 Steward s second attempt to sell its Utah operations succeeded in May 2023 when they sold to CommonSpirit Health a Catholic health system The transaction included Steward s entire presence in the state including five hospitals over 35 medical group clinics imaging and urgent care centers and other outpatient ventures 34 This raised concerns that the region may lose access to reproductive health care given CommonSpirit s position on the matter though Steward declined to say whether they had even offered this care at their locations prior 35 The year 2023 saw Steward downsize in several states it completed the sale of its Utah operations to CommonSpririt 36 it closed Texas Vista Medical Center in April citing low reimbursement rates and 25 percent of patients not paying their bills CBS News reported that Texas Vista owed more than 650 000 to various vendors 37 and in December it announced the 2024 shuttering of operations at New England Sinai Hospital a long term acute care hospital in Stoughton Massachusetts reporting operating losses of 22 million 38 In January 2024 an investigation by The Boston Globe revealed that Steward was facing significant financial difficulties creating fears of possible hospital closures 39 Part of this stemmed from a press release from Medical Properties Trust announcing that Steward owed MPT 50 million in unpaid rent on their properties 40 in addition to owing several contractors and vendors for unpaid services and equipment 41 MPT after multiple months of partial rent payments from Steward brought on financial and legal firms to come up with a plan to collect what Steward owed The end result was an action plan designed according to MPT to strengthen Steward s liquidity and restore its balance sheet optimize MPT s ability to recover unpaid rent and ultimately reduce MPT s exposure to Steward Steward agreed to pursue the sale of some hospital operations and to divest from non core operations in exchange receiving a bridge loan from MPT in the amount of 60 million and MPT writing off portions of Steward s unpaid rent Of the agreement MPT said There can be no assurance that Steward will successfully execute its plans or that the Company will recover all of its deferred rent and loans outstanding to Steward 40 In February U S House Representative Stephen Lynch said after a meeting with Steward that the health care system was looking to sell four of its nine Massachusetts hospitals as soon as possible including St Elizabeth s Medical Center in Brighton Holy Family Hospital s two campuses in Haverhill and Methuen Nashoba Valley Medical Center in Ayer and Norwood Hospital whose reconstruction would also be halted 42 The repossession by vendors of medical equipment for unpaid bills was linked to the death of a new mother at Saint Elizabeth s Medical Center in Brighton Massachusetts who in October 2023 suffered a liver bleed which staff were unable to treat due to the lack of equipment She was then transferred to another hospital where she later died Steward regarding the incident at St Elizabeth s said in part that understanding that the demand for supplies and staff can fluctuate at any given moment due to changing and unpredictable volumes of patients Steward is confident we have adequate supplies for our physicians providers and health care professionals to continue providing high quality care to our patients 43 In its investigation the Massachusetts Department of Health found that the hospital had little control over what vendors were paid and when 44 During its investigation DPH became aware from St Elizabeth s president that the non payment of the coils was in part due to the hospital s lack of control over its funds and authorization to make payments to its vendors According to the president the hospital s corporate office determined which vendors to pay and made the payments or not Informational Brief of the Commonwealth of Massachusetts in Support of Responses to the Debtors Emergency Motions United States Bankruptcy Court for the Southern District of Texas Houston Division nbsp Norwood Hospital mid construction Unpaid bills also led to work stoppages in multiple construction projects In Texarkana Texas construction started in 2021 on a 227 million project to replace Steward s Wadley Regional Medical Center with a new campus 5 miles north of the current location 45 On February 5 construction firm Robins amp Morton sent a memo to subcontractors stating they had requested evidence of Steward having made financial arrangements that will allow them to fulfill their payment obligations under the contract Having not received proper evidence of financing the firm ordered subcontractors to halt all work on the site 46 And in Norwood Massachusetts construction to replace Norwood Hospital which was fully evacuated and subsequently demolished 47 due to damage from flooding caused by an intense 2020 rainstorm 48 was stopped due to nonpayment 49 On February 2 2024 Steward announced to employees that they had agreed to a significant financial transaction that would allow their Massachusetts hospitals to continue operations while they continued to explore options for selling some facilities to other operators The terms of the deal and the source of the funding were not immediately disclosed 50 however later reporting indicated that the system refinanced its debt with a 600 million loan in 2023 and received a bridge loan of 150 million in January the two loans coming from a group of asset management firms including Sound Point Capital Management Oaktree Capital Management WhiteHawk Capital Partners Owl Creek Asset Management MidOcean Partners and Brigade Capital 51 In late March 2024 Steward announced a deal made to sell its physician network Stewardship Health to Optum a subsidiary of UnitedHealth Group and already the largest employer of physicians in the United States As of April the deal was pending regulatory approval 52 On May 3 2024 with no word from Steward regarding whether it met its April 30 deadline the Massachusetts Executive Office of Health and Human Services EOHHS announced the activation of the Incident Command System to prepare for anticipated disruptions in health care access across the state 53 On May 5 2024 The Wall Street Journal reported that Steward Health Care was expected to file for Chapter 11 bankruptcy protection within the coming days blaming rising costs insufficient revenue and cash crunches as part of the decision Steward s bankruptcy is set to be one of the largest hospital bankruptcies in U S history and the largest one in decades 54 The next day Steward announced that it had indeed filed voluntarily for Chapter 11 bankruptcy protection The company stressed that its hospitals and medical offices would remain open during the proceedings In its press release Steward stated it was finalizing terms of a 75 million in new debtor in possession financing from MPT with the possibility for 225 million more if it meets certain unspecified conditions set by MPT The company s filing revealed approximately 9 billion in liabilities including 6 6 billion in long term rent obligations 1 2 billion in loans almost 1 billion in unpaid bills to vendors and 290 million in unpaid wages and benefits to its employees In listing its obligations to non insiders filings revealed twenty creditors who were owed in excess of 10 million including a debt of 32 million to the federal government in reimbursements for insurance overpayments 13 55 During proceedings the company stated it would be putting all 31 of its hospitals up for sale with auctions scheduled for the summer 56 Future edit Steward s future in individual locales and as a whole remains in question amid its bankruptcy filing in May Prior to the filing Massachusetts lawmakers all but committed to ruling out a bailout stating that the system had already received 54 million in previous years in the form of COVID 19 relief aid Also contributing to lawmakers stance on the issue was Steward s repeated refusal to provide financial reports to the state a requirement of all hospitals under state law and one which Steward has been battling the state over for years 57 which was cited as a reason they were provided significantly less American Rescue Plan Act money in the third round of this aid 58 Medical Properties Trust in a February Securities and Exchange Commission report reported operating losses of 664 million for the fourth quarter of 2023 specifically noting 772 million in write offs and impairments which they attributed primarily to Steward 59 Further MPT deferred collection of full rent payments until June 60 In addition conditions of Steward s January 2024 bridge loan required that the company demonstrate an ability to begin paying its debts by April 30 the end of their forbearance period While Steward in February said that it has a plan to come out of the forbearance period as a sustainable company economic experts specifically ones who have studied Steward for years expressed doubt that the system would be able to achieve this given the amount of debt and further predicted that bankruptcy was likely 61 While the proposed sale of its physician network to Optum would be expected to provide a significant windfall it is not expected that a sale would be approved in the near future and there are doubts that the sale would obtain regulatory approval given federal scrutiny into Optum s alleged anticompetitive practices 62 Steward Health Care International editSteward Health Care International nbsp nbsp Clinica San Rafael a hospital built and operated by Steward in Pereira ColombiaCompany typePrivateIndustryHealthcareFounderRalph de la TorreHeadquartersMadrid SpainNumber of locations4 hospitalsAreas servedColombiaSaudi ArabiaUnited Arab EmiratesKey peopleArmin Ernst CEO President Websitewww wbr stewardinternational wbr org At the end of 2017 Steward announced an upcoming international expansion which was finalized in February 2018 in which they took over Vitals Global Healthcare of Malta creating Steward Health Care International 63 VGH an embattled Maltese healthcare company was the center of a controversial 2015 deal in which it was contracted with the government to take over administration of the island nation s hospitals The 2015 deal with VGH was widely controversial especially among physicians who raised concerns both about the government relinquishing control of the public healthcare system and about VGH s lack of experience in the healthcare sector 64 In 2018 amid allegations of collusion between VGH and government officials lack of progress in the rehabilitation of the hospitals and accusations that VGH was siphoning money out of the country parties agreed to a deal that would see Steward purchase VGH for just 1 while the Maltese government would pay VGH 50 million to accept the deal 65 The transfer of Malta s hospitals to Steward did not sate the public s concerns and Steward s presence remained unpopular until 2023 when Maltese courts annulled the 2018 deal amid allegations of fraud and continued lack of progress in hospital renovations and construction ultimately returning control of the hospitals to the government 66 In the early 2020s Steward Health Care International also expanded into Colombia 67 and the Middle East 68 In late 2020 Steward entered the Colombian healthcare market with the purchase of three hospitals in the country Hospital Universitario Clinica San Rafael and Clinica Centenario in the capital city of Bogota and Clinica Los Nevados in Pereira CEO Ralph de la Torre spoke about Steward s plans and goals in the nation saying that COL 102 000 million US 28 million would be invested in the three hospitals most of which would be spent on Los Nevados which had been closed following damage from an earthquake several years prior 69 De la Torre expressed that Steward wanted to grow significantly in the region hoping to eventually have between 10 and 15 hospitals in the country 70 In 2023 Steward opened two hospitals in Colombia the new Clinica San Rafael in Popayan 71 and the fully renovated Clinica Los Nevados 72 In 2022 Steward International created Steward Middle East which partnered with Saudi Arabian venture capital company Alfanar to create a joint venture named Steward alf Global Healthcare Company That year they signed a contract with the Red Sea Development Company to build and operate a new hospital as part of the Red Sea Project a massive tourism development under construction on the nation s coast The company would also be responsible for emergency response planning for the site 73 Steward Middle East also reportedly included ventures in Riyadh as well as Dubai in the UAE 68 In 2023 a Steward representative expressed the company s interest in expanding into Egypt as well 74 As of 2024 Steward International was headquartered in Madrid Spain 75 Operations editBusiness model edit Steward intended to become a low price leader in the provision of high quality care 76 Consistent with this model the System had taken steps to reduce the direction of surgical patients toward outside teaching hospitals in the Boston area 76 The system has also worked with payers to negotiate patient group oriented budget pricing citation needed Services edit Steward Health Care directly manages a network of hospitals across several states In addition it comprises several subsidiaries which manage different aspects of its integrated healthcare model Steward Medical Group and Steward Health Care Network comprise the company s network of primary care and specialty providers 77 Steward Health Choice is a commercial Medicaid option offered in Massachusetts and formerly in Arizona 78 Steward Health Choice of Arizona was sold to Blue Cross Blue Shield of AZ in 2020 79 Steward Health Care International administers several ventures overseas Criticism edit Steward has received criticism for its approach to health care and transparency especially following the revelation of significant financial struggles in the beginning of 2024 Health care officials have pointed to the concerns which Steward s financial condition and operations has raised about the role of private equity in healthcare 80 In 2017 Steward sued the Massachusetts Center for Health Information and Analysis CHIA to avoid providing financial information to the agency 81 CHIA an independent state agency charged with monitoring the financial condition of Massachusetts hospital industry 82 had been in talks with Steward since the previous year in an attempt to reach a deal over its financial disclosures and had been imposing fines of 1000 per week for delinquency At the time Steward was the only hospital system in the state to repeatedly fail to submit required company wide financial statements not having fulfilled the requirement since 2015 81 In its suit Steward said that the financial statements contain sensitive proprietary business information related to long term debt relationships with investors retirement plans and significant transactions that is not otherwise publicly available Steward keeps information contained in the notes of its financial statements confidential because releasing the notes would cause harm to Steward Steward further stated that their concerns were related to CHIA s past publicization of their financial data and argued that the agency had no authority to collect the information In 2023 a judge ruled in favor of the state confirming that CHIA had the authority to demand the information Steward filed an appeal 83 which was still pending into early 2024 and which state officials have highlighted U S House Representative Stephen Lynch said in January we had not had advance notice prior to a week ago that they were in difficulty or that they were contemplating exiting the Massachusetts health care market 42 Many have pointed to Steward s sales of its acquired hospitals properties to Medical Properties Trust over the years as a key factor in their current financial state given at least 50 million of their debt is in past due rent payments on these properties 84 In 2023 just before the closing of Steward s Texas Vista Medical Center Steward officials stated that the lease payment on the hospital was 5 million per year saying t hat represents 3 of the annual operating budget and was absolutely not a factor in the decision to close the hospital 85 However audio obtained by CBS News of a Steward leadership meeting revealed that the system was trying to get out of lease obligations 37 Further Steward s debts to outside vendors have raised concerns for patient safety especially after multiple adverse incidents across its hospitals relating to staffing and equipment availability Following several patient deaths and safety incidents alleged to have been avoidable at two Massachusetts hospitals 86 state officials in 2024 planned to place monitors at all Steward hospitals in the state to ensure quality care and safety 87 Steward has attributed much of its financial woes in Massachusetts to the COVID 19 pandemic as well as their system mainly comprising community hospitals which serve low income populations where 70 of their patients are recipients of Medicare and Medicaid They also complained of the gap between the reimbursement rates from public and private insurers pay community hospitals versus larger academic medical centers 88 State officials in response raised questions regarding the use of tens of millions of dollars in pandemic relief provided to the company by the federal government Bloomberg reported in September 2020 that at the time the amount Steward had received in federal grants and loans stood at 675 million 23 Elsewhere such as in Texas and Arizona Steward has pointed to under utilization as a factor in closures In Phoenix for example St Luke s Medical Center s former CEO said the hospital s 2019 closure came as two out of three beds were routinely unoccupied 89 Massachusetts Governor Maura Healey in a February 2024 letter to Ralph de la Torre criticized the system s handling of the crisis what brought them there and their seeming opacity with state officials throughout 90 Massachusetts law requires disclosure of hospitals system level audited financial statements to help us avoid precisely the situation you have created we have no insight into your allocation of resources across operating units or states and therefore no clear sense of the financial viability of the hospitals serving Massachusetts residents Massachusetts Governor Maura Healey Defending themselves Steward responded in two press releases stating that they have tried to be transparent compliant and cooperative over the years in providing a significant amount of detailed and relevant financial documentation to various state agencies and regulatory bodies and moving forward it commits to do even better 91 They also stated that w e have played with our cards face up on these data requests and that at their request we have provided the Attorney General AGO and Executive Office of Health and Human Services EOHHS 613 megabytes running across tens of thousands of pages of financial and operating materials over the last two months 92 despite their earlier appeal to avoid providing complete information Hospitals editDomestic United States edit List of current and former Steward hospitals in the U S Hospital Location Bed Count Emergency Department Founded Status Notes Carney Hospital Dorchester Massachusetts 159 93 Yes 1863 Open One of Steward s original facilities Founded by Daughters of Charity of Saint Vincent de Paul and Andrew Carney First Catholic hospital in New England Coral Gables Hospital Coral Gables Florida 245 94 Yes 1926 Open Founded as Tallman Hospital renamed to Coral Gables Hospital after being purchased by Hospital Affiliates Inc in 1971 95 Purchased by Steward from Tenet Healthcare in August 2021 94 Davis Hospital and Medical Center Layton Utah Yes 1976 96 Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital Davis 35 Florida Medical Center Fort Lauderdale Florida 434 97 Yes Open Purchased by Steward from Tenet Healthcare in August 2021 97 Glenwood Regional Medical Center West Monroe Louisiana 274 98 Yes Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 98 Good Samaritan Medical Center Brockton Massachusetts 294 93 Yes 1968 99 Open One of Steward s original facilities Originally named Cardinal Cushing Hospital was renamed after 1994 merger with Goddard Memorial Hospital 100 Hialeah Hospital Hialeah Florida 340 101 Yes 1951 Open Purchased by Steward from Tenet Healthcare in August 2021 101 Hillside Rehabilitation Hospital Warren Ohio 65 102 No 1963 103 Open Purchased by Steward from Community Health Systems in May 2017 102 Holy Family Hospital Haverhill Haverhill Massachusetts 122 104 Yes 1887 Open One of Steward s original hospitals Originally owned by the city of Haverhill and named Hale Hospital Renamed Merrimack Valley Hospital when city sold hospital to Essent Health Care 105 Integrated under the Holy Family Hospital name by Steward in 2014 106 Holy Family Hospital Methuen Methuen Massachusetts 310 107 Yes 1950 108 Open One of Steward s original hospitals Originally named Bon Secours Hospital 108 Jordan Valley Medical Center West Jordan Utah Yes 1983 109 Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital Jordan Valley 35 Jordan Valley Medical Center West Valley Campus West Valley City Utah Yes 1964 110 Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital Jordan Valley West 35 Melbourne Regional Medical Center Melbourne Florida 96 111 Yes 2002 112 Open Originally named Wuesthoff Medical Center 112 Purchased by Steward from Community Health Systems in May 2017 and renamed 111 Morton Hospital Taunton Massachusetts 108 93 Yes 1889 113 Open One of Steward s original facilities Mountain Point Medical Center Lehi Utah Yes 2015 114 Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital Mountain Point 35 Nashoba Valley Medical Center Ayer Massachusetts 38 93 Yes 1965 115 Open Originally named Nashoba Community Hospital One of Steward s original facilities New England Sinai Hospital Stoughton Massachusetts 203 116 No 1927 117 Closed April 2024 118 Founded as the Jewish Tuberculosis Sanatorium in 1927 originally in Rutland MA Renamed New England Sinai when it moved to Jamaica Plain in 1954 Moved to Stoughton in 1976 Purchased by Steward in 2012 117 North Shore Medical Center Miami Florida 748 119 No 1953 120 Open Purchased by Steward from Tenet Healthcare in August 2021 119 Norwood Hospital Norwood Massachusetts 185 FY 2020 93 Temporarily Closed 1917 1919 121 122 Temporarily Closed One of Steward s original facilities Evacuated and demolished following flood in 2020 with replacement facility still under construction as of January 2024 42 Odessa Regional Medical Center Odessa Texas 208 123 Yes 1975 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 123 Palmetto General Hospital Hialeah Florida 358 124 Yes 1971 125 Open Purchased by Steward from Tenet Healthcare in August 2021 124 Rockledge Regional Medical Center Rockledge Florida 274 126 Yes 1941 112 Open Originally named Eugene Wuesthoff Memorial Hospital Acquired and renamed by Steward in September 2017 as part of purchase of IASIS Healthcare 126 Salt Lake Regional Medical Center Salt Lake City Utah Yes 1875 127 Sold 2023 Sold in 2023 to CommonSpirit Health and renamed Holy Cross Hospital Salt Lake 35 Sebastian River Medical Center Sebastian Florida 145 128 Yes 1974 129 Open Purchased by Steward from Community Health Systems in May 2017 128 Sharon Regional Medical Center Sharon Pennsylvania 163 130 Yes 1896 131 Open Originally named Christian H Buhl Hospital Purchased by Steward from Community Health Systems in May 2017 130 St Anne s Hospital Fall River Massachusetts 187 93 Yes 1906 132 Open One of Steward s original facilities St Elizabeth s Medical Center Brighton Massachusetts 226 93 Yes 1868 133 Open One of Steward s original facilities St Joseph Medical Center Houston Texas 290 134 Yes 1887 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 134 St Luke s Behavioral Health Center Phoenix Arizona 127 135 No 1969 135 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 136 St Luke s Medical Center Phoenix Arizona 219 137 Yes Closed 2019 137 Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 136 Ended normal operations in 2019 but was readied for potential use as a surge facility during the COVID 19 pandemic 138 Tempe St Luke s Hospital Tempe Arizona 64 136 Yes 1944 139 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 136 Texas Vista Medical Center San Antonio Texas Closed 2023 37 Formerly named Southwest General Hospital The Medical Center of Southeast Texas Port Arthur Texas 216 140 Yes 2005 141 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 140 The Medical Center of Southeast Texas Victory Campus Beaumont Texas Yes 2013 142 Closed February 2024 Originally named Victory Medical Center Beaumont until purchase by The Medical Center of Southeast Texas in 2015 143 Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 140 Trumbull Regional Medical Center Warren Ohio 214 144 Yes Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 144 Wadley Regional Medical Center Texarkana Texas 185 145 Yes 1900 Open Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 145 Construction began in 2021 of future replacement facility at a different location in Texarkana 146 Wadley Regional Medical Center at Hope Hope Arkansas Yes 1955 147 Open Originally named Hempstead County Memorial Hospital 147 Acquired by Steward in September 2017 as part of purchase of IASIS Healthcare 148 International edit List of current and former Steward hospitals outside the U S Hospital Municipality Country Emergency Department Founded Status Notes Clinica Centenario Bogota Colombia Open Clinica Los Nevados Pereira Colombia Yes 149 Reopened 2023 150 Open Clinica San Rafael de Popayan Popayan Colombia Yes 151 2023 71 Open Hospital Universitario Clinica San Rafael Bogota Colombia Yes 152 Open Gozo General Hospital Victoria Malta Open Karin Grecht Hospital Pieta Malta Open St Luke s Hospital Pieta Malta Closed for refurbishment Coastal Village Hospital The Red Sea Saudi Arabia Planned Future Being developed Planned for construction in a residential section of the Red Sea Project a tourism project on the west coast of Saudi Arabia Emergency department will be specialized for tourism including having a hyperbaric chamber 73 References edit Ralph de la Torre M D Bloomberg L P February 21 2019 Archived from the original on February 21 2019 Bartlett Jessica August 28 2018 Steward Health Care officially moves HQ to Dallas Boston Business Journal Archived from the original on October 28 2021 a b Kacik Alex October 2 2017 Steward closes 2B acquisition of Iasis 18 hospitals Modern Healthcare Archived from the original on October 4 2023 Retrieved October 3 2017 a b Dayal McCluskey Priyanka February 23 2018 Steward Health Care to move top executives to Dallas The Boston Globe Archived from the original on June 15 2018 Retrieved February 24 2018 Cass Andrew January 26 2024 10 things to know about Steward Health Care Archived from the original on February 28 2024 Retrieved March 21 2024 Steward Health Care International Steward Health Care Archived from the original on February 3 2024 Retrieved February 7 2024 a b McGrory Brian February 2 2024 As Steward hospitals teeter CEO s 40 million yacht is docked in the Galapagos Islands The Boston Globe Archived from the original on February 6 2024 Retrieved February 6 2024 a b c d e f g h i Hospital Ownership and Financial Stability A Matched Case Comparison of a Non Profit and Private Equity Owned Health System Center for Economic and Policy Research Report Emerald Publishing 2021 Archived from the original on February 14 2024 Retrieved March 21 2024 Weisman Robert April 2 2024 Cerberus says its investment in Steward hospitals yielded an 800 million profit The Boston Globe Archived from the original on April 3 2024 Retrieved April 9 2024 Steward Health Care Business Model Steward Corporate Archived from the original on January 31 2024 Retrieved March 21 2024 Appelbaum Eileen Batt Rosemary March 15 2020 Private Equity Buyouts in Healthcare Who Wins Who Loses PDF Center for Economic and Policy Research Report Archived from the original PDF on January 20 2024 Retrieved March 21 2024 a b Batt Rosemary Appelbaum Eileen Katz Tamar July 9 2022 The Role of Public REITs in Financialization and Industry Restructuring PDF Center for Economic and Policy Research Report Archived from the original PDF on February 28 2024 Retrieved March 21 2024 a b Weisman Robert Bartlett Jessica May 6 2024 Steward files for bankruptcy leaving its eight Massachusetts hospitals in limbo The Boston Globe Archived from the original on May 6 2024 Retrieved May 6 2024 Syre Steven October 1 2013 Ralph de la Torre s not quite health care empire The Boston Globe Archived from the original on February 2 2024 Retrieved February 6 2024 AG Enhances Approves Transactions with Steward Attorney General of Massachusetts Press release September 7 2011 Archived from the original on January 4 2024 Retrieved February 12 2024 Syre Steven November 22 2011 Hospital chain aims to exit real estate business The Boston Globe Archived from the original on February 27 2024 Retrieved April 15 2024 Steward building portfolio sold for about 100M South Coast Today April 20 2012 Archived from the original on April 15 2024 Retrieved April 15 2024 Quincy Medical Center to close The Boston Globe Retrieved February 12 2024 Quincy Medical Center closes its doors at midnight The Boston Globe Retrieved February 12 2024 Quincy Medical Center closes for good The Patriot Ledger Retrieved February 12 2024 Carney Hospital on verge of turning financial corner The Boston Globe Retrieved February 12 2024 Steward Health Care posts first ever profit in 2015 The Boston Globe Retrieved February 12 2024 a b c Willmer Sabrina May 27 2021 Cerberus Quadruples Money After Unusual Exit From Hospital Giant Bloomberg Archived from the original on July 26 2021 Retrieved February 14 2024 McGrory Brian February 2 2024 As Steward hospitals teeter CEO s 40 million yacht is docked in the Galapagos Islands Archived from the original on February 14 2024 Retrieved 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Norwood hospital construction on pause as vendors await payments from Steward The Boston Globe Archived from the original on February 22 2024 Retrieved April 4 2024 Steward announces significant funding to stabilize health care company keep hospitals open February 2 2024 Archived from the original on February 26 2024 Weisman Robert April 19 2024 Steward lenders identified as struggling hospital system faces payment deadline The Boston Globe Archived from the original on April 19 2024 Retrieved April 19 2024 McCluskey Priyanka Dayal March 27 2024 In distress Steward proposes sale of doctors group to Optum WBUR org Archived from the original on April 4 2024 Retrieved April 4 2024 State sets up incident command system amid Steward Hospitals financial struggles State House News Service May 3 2024 Retrieved May 3 2024 via WHDH 7 News Boston Steward Health Care to File for Bankruptcy as Soon as Sunday The Wall Street Journal May 5 2024 Retrieved May 5 2024 Schooly Matt Kaplan Michael May 6 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McCluskey Priyanka January 25 2024 Mass leaders scramble to plan for potential Steward hospital closures WBUR Archived from the original on February 21 2024 Retrieved February 23 2024 a b McCluskey Priyanka October 31 2017 Hospital chain Steward sues to keep finances private challenges agency s powers The Boston Globe Archived from the original on February 21 2024 Retrieved February 23 2024 MA Center for Health Information and Analysis CHIA About the Agency Archived from the original on February 6 2024 Retrieved February 23 2024 Lisinski Chris February 20 2024 Healey Time has come for Steward to transfer its hospitals The Dorchester Reporter Archived from the original on February 21 2024 Retrieved February 23 2024 Top House Democrats rule out Steward Health Care bailout WGBH org State House News Service February 12 2024 Archived from the original on February 12 2024 Retrieved February 13 2024 Ramos Henry April 26 2023 City leaders worry as south side hospital closes their doors KENS5 com Archived from the original on May 2 2023 Retrieved February 14 2024 Kowalczyk Liz February 14 2024 Sick patients collapsed waiting for care in overwhelmed Steward hospital s emergency department Retrieved February 14 2024 Laughlin Jason February 14 2024 Steward hospital crisis an urgent priority for Healey as state braces for potential closures The Boston Globe Archived from the original on February 14 2024 Retrieved February 14 2024 Steward Health Care says financial difficulties jeopardize care at Mass Facilities January 19 2024 They were more interested in profiting for struggling Steward Health Care challenges reach far beyond Massachusetts The Boston Globe MA Governor Maura Healey February 20 2024 Immediate actions required to protect quality and access to care Steward Health Care February 23 2024 Steward Health Care Announces Six Point Action Plan and Framework for Future System Press release Archived from the original on February 23 2024 Retrieved February 23 2024 Steward Health Care February 21 2024 Steward Is Committed to Continuing to Work With Governor Attorney General and State Regulators yahoo finance Archived from the original on February 23 2024 Retrieved February 23 2024 a b c d e f g Massachusetts Acute Hospital Profiles a b American Hospital Directory Coral Gables Hospital 100183 Free Profile Coral Gables Hospital Celebrates 85 Years of Service to the Coral Gables Community September 6 2011 About CommonSpirit Health Archived from the original on February 8 2024 a b American Hospital Directory Florida Medical Center 100210 Free Profile a b American Hospital Directory Good Samaritan Medical Center about to become Brockton s largest taxpayer Good Samaritan Medical Center Continues 50th Anniversary Celebration Good Samaritan Medical Center A Steward Hospital Brockton MA a b American Hospital Directory a b American Hospital Directory Hillside Rehabilitation Hospital BrainLine July 30 2010 American Hospital Directory 100 Locally Owned Radio Stations October 7 2021 Merrimack Valley Hospital and Holy Family Hospital to Merge Holy Family Hospital in Methuen amp Haverhill MA Steward Hospitals American Hospital Directory a b Holy Family Hospital marks 60th anniversary September 11 2010 Jordan Valley Medical Center Archived from the original on September 24 2023 Retrieved February 8 2024 West Valley History West Valley City Archived from the original on April 30 2007 a b American Hospital Directory a b c Wuesthoff hospitals to be renamed by recent buyer Morton Hospital highlights 125 year legacy of serving Taunton community Mountain Point Medical Center opens in Lehi ksl com May 29 2015 Archived from the original on February 8 2024 Retrieved February 8 2024 Patient demand drives the Boston Globe American Hospital Directory a b Steward to acquire Stoughton s New England Sinai the Boston Globe The Boston Globe Zokovitch Grace April 1 2024 A loss for the community New England Sinai Hospital set to close Boston Herald Archived from the original on April 2 2024 Retrieved April 2 2024 a b American Hospital Directory North Shore Medical Center Miami FL Rising from the flood Steward Health breaks ground on new Norwood Hospital Norwood Hospital Celebrates Centennial Norwood Hospital A Steward Family Hospital Norwood MA a b American Hospital Directory a b American Hospital Directory Palmetto General Hospital Celebrates 40th Anniversary March 2011 a b American Hospital Directory SALT LAKE CITY HOSPITALS CIRCA 1900 utah gov Archived from the original on December 1 2023 a b American Hospital Directory Sebastian River Medical Center a b American Hospital Directory Learn About Sharon Regional Medical Center Sharon PA St Anne s Hospital signs agreement with Dana Farber https www mass gov doc apaschedule809exhibit 2pdf download a b American Hospital Directory a b Learn About St Luke s Behavioral Health Center Phoenix AZ a b c d American Hospital Directory a b St Luke s Medical Center in Phoenix to close next month after 100 years Months later St Luke s Medical Center in Phoenix remains on standby January 9 2021 Tempe St Luke s Hospital Celebrates 72 Years of Providing Quality Patient Focused Care Tempe St Luke s Hospital A Steward Family Hospital Tempe AZ a b c American Hospital Directory Learn About the Medical Center of Southeast TX Port Arthur TX Medical Center of Southeast Texas Beaumont campus to shut down in February January 25 2024 Wallach By Dan Medical Center to acquire Victory Medical Beaumont Beaumont Enterprise a b American Hospital Directory a b American Hospital Directory Wadley Regional Medical Center groundbreaking to be held Wednesday morning behind Lafferty s Home Center on West Park Boulevard in Texarkana Texarkana Gazette September 12 2021 a b Learn About Wadley Regional Medical Center at Hope Hope AR American Hospital Directory Cierran servicios de urgencias hospitalizacion y quirofano en una clinica de Pereira W Radio August 19 2023 Archived from the original on February 6 2024 Retrieved February 6 2024 Steward Health Care International opens Clinica Los Nevados in Pereira Colombia Steward International July 26 2023 Archived from the original on February 6 2024 Retrieved February 6 2024 Clinica San Rafael de Popayan Steward Colombia July 20 2023 Archived from the original on February 6 2024 Retrieved February 6 2024 Servicios y Especialidades Steward Colombia Archived from the original on February 6 2024 Retrieved February 6 2024 Retrieved from https en wikipedia org w index php title Steward Health Care System amp oldid 1223993339, wikipedia, wiki, book, books, library,

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