Ardent Health is acquiring Boone Health, a mid-sized nonprofit system based in Columbia, Missouri, for $47 million in cash, the organizations announced Thursday. It marks Ardent’s first entry into the Missouri healthcare market.
The deal, expected to close in the first quarter of 2027, includes a 10-year, $200 million capital commitment on nonprofit Ardent’s part. That money will be invested in Boone’s facilities, workforce and, in the near term, an expansion in its emergency department, according to the announcement.
Ardent has agreed to maintain Boone’s essential hospital services while developing its 392-bed regional referral center, Boone Hospital Center. It also plans to maintain employment for existing Boone employees and providers, continue its charity care policy and establish a local advisory board.
“We are acquiring a strong asset in an attractive and growing midsize market with significant opportunity to drive operating and financial improvement, all while delivering high patient quality care and safety,” Ardent Health President and CEO Dave Caspers said during a Thursday afternoon investor call discussing the deal. “It also represents an effective use of capital at a compelling valuation that we expect will create long-term shareholder value.”
Alongside its main hospital, Ardent would be acquiring Boone’s medical group, 19 care sites including an outpatient campus and five medical office buildings, related ancillary services and real estate. The system is the second-largest provider in its region with about 30% market share and half a billion dollars of annual revenue, Caspers said, with a local population that is well insured (93% coverage) and growing well ahead of the national average (3.4% in the next five years).
“Boone expands our footprint into a new attractive market,” Caspers explained. “It diversifies our business and enhances scale. Further, adding Boone’s regional system to our portfolio is consistent with our strategy of building leading healthcare platforms in growing mid-sized communities. We’re highly aligned with Boone Health on culture and mission, including putting the patient at the center of everything we do, with an aim toward best-in-class clinical care, patient quality, safety, and access to services.”
The executive noted for investors that Boone’s facilities are relatively modern and well maintained, allowing Ardent to direct more capital toward its growth. The company has also identified “meaningful opportunities to optimize financial performance.” By leveraging its larger scale and expertise to tackle costs (supply chain procurement, vendor consolidation) and revenue cycle processes, Ardent executives said they expect to generate about $5 million to $10 million additional EBITDA within the deal’s first year, and at least $30 million of annual synergies three years after the deal’s close.
Boone Health has been independent since 2021, following more than three decades during which it operated as part of BJC HealthCare system. In 2025, its leadership kicked off a search for potential strategic partners “that could provide additional capital and resources to support the system’s continued growth. Ardent was selected after a comprehensive evaluation process led by an independent advisory firm,” according to Thursday’s announcement.
“In Ardent, we identified a partner that supports our mission, respects our culture and can accelerate our vision without compromising what makes Boone Health special,” Jerry Kennett, M.D., chair of Boone’s Board of Trustees, said in the announcement. “Following a thoughtful review, the Board is confident Ardent is the right long-term partner for Boone Health. This agreement protects what our community has built while giving Boone Health the resources it needs to grow.”
Ardent Health’s current operations include 30 acute care hospitals and over 280 care sites, several of which are run as part of a joint venture structure with other health system partners. In 2025, the company increased its revenues by 6% to $6.3 billion and grew its adjusted EBITDA to $545 million.
The company recently logged a strong third quarter off the back of solid demand for emergent care and progress on its ongoing performance improvement initiative. In September, it also officially divested from a joint venture with the University of Kansas Health System, a decision that leadership said is part of an ongoing review of its portfolio to ensure long-term strategic fit among its hospitals and partnerships.