The Centurion Foundation, the Atlanta nonprofit trying to buy Roger Williams Medical Center and Our Lady of Fatima Hospital, appears undeterred by the state’s pursuit of an alternative buyer.
At least, that’s the image it presents in federal bankruptcy court hearings and media statements.
But internal emails to state regulators obtained by Rhode Island Current reveal the foundation’s distress over potential competitor Prime Healthcare, and its unhappiness with the state for allegedly standing in the way of the deal.
In a Nov. 7 email to the Rhode Island Attorney General’s Office and the Rhode Island Department of Health, Centurion CEO Ben Mingle asked the state to cease its discussions with Prime, which Mingle claims are making it harder for the foundation to close the deal. He also blamed the state for its “continued lack of support” in easing the financial conditions needed to secure its purchase.
“Over the course of much of 2025, we repeatedly requested direct financial support from Rhode Island and unfortunately that support did not materialize,” Mingle wrote. “We strongly believe that a show of meaningful financial support from the State during our prior financing attempts would have made them successful.”
Mingle’s letter set off a series of tense exchanges with Rhode Island Attorney General Peter Neronha, whose office has played a key role in regulating the sale of the state hospitals, including in federal bankruptcy court since January, when Prospect filed for Chapter 11 bankruptcy.
“Since approval, first by the State and then the Bankruptcy Court, the State and others have shown extraordinary patience and flexibility as Centurion has attempted to secure financing to complete the acquisition,” Neronha wrote in a Nov. 10 email response to Mingle. “The reasons for your inability to secure committed financing are irrelevant to the primary need to get the hospital transactions closed and to mitigate the current losses at the hospitals.”
Centurion received conditional approval to buy the hospitals from their now-bankrupt owner, Prospect Medical Holdings, in June 2024. But Centurion, and its local subsidiary, CharterCARE Health of Rhode Island, has struggled to secure the investor-backed bond financing needed to close the deal, despite multiple revisions by state regulators and the state’s quasi-public financing agency meant to ease the financial requirements.
Amid delays, Rhode Island Health and Human Services Secretary Richard Charest reached out to Prime, his former employer and owner of Landmark Medical Center in Woonsocket, to gauge the company’s interest. Gov. Dan McKee’s office condoned the courtship as a “Plan B” focused on keeping the safety net hospitals afloat, especially after Prospect signaled its intent to shutter the hospitals by the end of the year because of growing operating losses.
True feelings exposed
Centurion has repeatedly shifted questions about Prime back to its own commitment to the hospital sale. But Mingle’s email does not hold back in his criticism of the California hospital chain operator.
“Prime Healthcare has a very clear track record across many years in its ownership and management of hospitals, regardless of whether they are technically for-profit or ‘non-profit,’ Mingle wrote. “Rhode Island residents can expect another operator that calls the shots from California, one that will reduce the scope of services at [Fatima] and [Roger Williams,] and one that will significantly dwindle access to high quality physicians.”
Leaders with the union representing 1,200 hospital workers at the facilities have also expressed concern with Prime’s record, citing a trio of Justice Department settlements and cost-cutting measures at other hospitals nationwide.
Noel True, a spokesperson for Prime, touted Prime’s recognitions for safety and care at Landmark in an emailed response on Friday.
“As a nonprofit public charity, Prime Healthcare Foundation is honored that state leaders turned to us, recognizing our mission-driven work saving Landmark Medical Center from bankruptcy in 2013 and transforming it into a hospital recognized for award winning care with eight consecutive Healthgrades Patient Safety Excellence Awards, Leapfrog ‘A’ ratings, and the distinction of being ranked #1 in Rhode Island for social responsibility by the Lown Institute,” True wrote. “Our mission has saved hospitals across the nation, created thousands of jobs, uplifted communities and has never led to a single hospital closing — even in the most challenging times.”
In a rare moment of alignment, McKee and Neronha separately defended the state’s ability to consider alternative proposals.
“You, however, seem to think that conditional approval precludes the State from responding to interest expressed in the Rhode Island hospitals from other entities, especially when your ability to close after all this time remains speculative,” Neronha wrote. “Nothing in Rhode Island’s decisions or law provides you with the exclusive right to purchase the hospital or to be the only party with approval to do so or limits Rhode Island’s obligation to evaluate alternative transactions in accordance with the exercise of its regulatory authority.”
Backing up Neronha, McKee said the state’s precautionary steps were “the right and responsible course of action.”
“Waiting and doing nothing is simply not an option and would pose an unacceptable risk to the well-being of our health care system and the Rhode Islanders who rely on it,” McKee said in an emailed response Friday.
Neronha also underscored the urgency, concluding his letter by noting that “time is running out.”
Out of time
Avoiding the dire consequences of closing the hospitals appears to be one point of agreement between the feuding sides of the deal.
The hospitals offer 500 beds between them, including 104 beds for behavioral health patients, which represents more than one-fifth of the state’s behavioral health beds. They saw a combined 50,000 emergency room patients last year, while employing 2,400 people. Roger Williams houses the only fully accredited bone marrow transplant unit in the state.
“We strongly believe that Centurion and CharterCARE are best positioned to support the health care needs of these communities — truly nonprofit health care, locally controlled and in partnership with local physicians,” Mingle wrote in a second email to state regulators on Nov. 14.
With that in mind, Mingle proposed two “alternative scenarios,” with timelines, to close the deal, both of which extend beyond the Nov. 30 short-term financing plan for the hospitals, and may also require more leniency from state regulators.
In the first option, Centurion would still rely on investor-backed bond financing to buy the hospitals, closing no later than Jan. 15, 2026. The proposal relies upon the state and Prospect agreeing to share the tab for hospital operations until closing.
Alternatively, Centurion could close by Dec. 15 using a short-term loan from Bank of America, using the state-controlled hospital fund and other cash on its balance sheet as collateral. Bond financing finalized “on or about” Jan. 15, 2026, would pay off the bank loan and release the collateral.
“We are diligently pursuing both of the above Scenarios to bring this transaction to closure as soon as possible,” Mingle wrote. “In addition, we are willing to consider other proposals from the State or others to ensure that CharterCARE Health of Rhode Island’s ability to ensure that the health care needs of the communities that it will serve are fully preserved and maintained.”
Neronha was unpersuaded.
“It does not appear that you have any more certainty with respect to financing under either of the scenarios described in your November 14th letter than you did a week ago,” he wrote in a Nov. 17 emailed response.
He also noted that even if the state agreed to put up more money to keep the hospitals open until Centurion can close a deal, Prospect, and the federal bankruptcy court must also be convinced.
And he again made clear that Rhode Island is not locked in on Centurion as the only potential buyer until it satisfies the conditions tied to its approval.
“Rhode Island cannot give and has never given you any exclusivity because as regulator it reacts to requests for, or changes in, ownership or other changes based on the State’s evaluation of the facts relevant to the changes being requested and from the perspective of Rhode Island’s residents and their need for health care.”
Joseph Wendelken, a spokesperson for the Rhode Island Department of Health, also indicated the agency is not budging on the conditions tied to its approval of the Centurion deal.
“Our priority throughout this process has been to ensure that these two hospitals remain open,” Wendelken said in an email Friday. “That is critical for individual patients and for Rhode Island’s healthcare system as a whole. Centurion can still pursue the financing necessary to close the transaction that we approved.”
Neronha’s office met with representatives from Prime Healthcare on Thursday, according to news reports. Megan Skinner, a spokesperson for Neronha’s office, declined to comment when asked for an update on the meeting Friday.
Progress on Prime
However, attorneys for the AG and Prospect are scheduled to offer an update on the sale proceedings in federal bankruptcy court on Tuesday, Nov. 25. At a status conference earlier this week, Thomas Califano, an attorney for Prospect, said there was “progress” toward a deal, but did not offer specifics. Califano also indicated that Prospect and the AG’s office had tentatively agreed to extend their cost-sharing agreement for hospital operations through December to allow more time to finalize a buyer.
The existing agreement, which funds hospital operations through November, requires that whoever buys the hospitals repay Prospect’s bankruptcy estate and the state for money spent on hospital operations — about $6 million in total for November.
That’s roughly the same amount of money Centurion is seeking to recoup from Chartercare Foundation, a charitable foundation tied to the hospitals until 2014. But so far, Centurion’s requests to “return” donations made to the Chartercare Foundation have been rebuffed.
Mingle also sought Neronha’s help in forcing the Chartercare Foundation to relinquish assets which Mingle said were intended to support Roger Williams and Fatima, and can now be given back under the return to nonprofit status.
Neronha did not want to get involved.
“Centurion’s inability to persuade the Foundation to invest in its acquisition effort speaks for itself,” he wrote to Mingle. “The Attorney General’s regulatory role is limited to situations where the charitable funds are not properly used.”
Paula Iacono, the Chartercare Foundation’s executive director, declined to comment in an emailed response Friday.
This story was originally published by the Rhode Island Current.
