WakeMed tells Stein Atrium’s $2B is ‘legally binding.' But WakeMed will pay part.

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As part of a proposed merger between WakeMed and Atrium Health, officials from the health systems have said the deal would bring $2 billion in investments to Wake County over a decade and create more than 3,300 new healthcare jobs over the next five years.

But a letter from WakeMed CEO Donald Gintzig to Gov. Josh Stein’s office shows that WakeMed would fund part — if not all — of that investment itself, with Atrium promising to make up any shortfall.

Stein’s office sent a letter to WakeMed on Aug. 17, pressing for guarantees regarding the proposed merger. The letter from the Democratic governor’s office does not take a position on the deal, The News & Observer previously reported, and Stein has not staked out a public stance on the merger. The August letter followed one the governor’s office sent in June with numerous detailed questions about the proposed merger. WakeMed has replied to at least some of the questions.

Asked by Stein’s office in the Aug. 17 letter whether the $2 billion investment would be funded in part by WakeMed’s own revenue, Gintzig said the systems have a “legally binding commitment” that the full $2 billion investment will occur. But funding would come from “a variety of sources, including operating cash flow generated by WakeMed, debt financing, and other available resources.” He added that if those sources prove insufficient, Atrium has committed to covering the difference to ensure the full $2 billion is invested.

Gintzig argued in his response to Stein, as he has in the past, that the merger is necessary for WakeMed’s long-term future and to meet Wake County’s growing healthcare needs.

WakeMed, UNC Health and Duke Health have asked the state for approval to add almost 700 new hospital beds. Regulators say the state needs 233 additional beds.

WakeMed’s request was the largest of the three health systems. According to its proposal, it wants to:

“We believe that WakeMed and Atrium Health — together — will bring a new era and new level of health care to Wake County,” Gintzig wrote in the letter to the governor shared with The N&O by The NC Justice Center, a nonprofit advocacy group. The letter was dated Friday.

“Significant changes” had been made to the merger documents to address concerns raised by Stein’s office and others regarding Wake County commissioners’ control over the combined entity, Gintzig said.

WakeMed’s history as a formerly county-owned hospital means the deal cannot proceed without sign-off from commissioners, who must approve changes to the hospital’s articles of incorporation and a transfer agreement with the county. County spokesperson Dara Demi said the vote on those changes will not happen at the commissioners’ next meeting on Sept. 8, and she did not give another date for the vote.

The N&O has requested the updated merger documents, and asked WakeMed when it and Atrium decided to update them. WakeMed spokesperson Kristin Kelly said in an email on Wednesday that those “documents are not public at this time.”

Chris Berger, a spokesperson with Atrium, said the only changes made to the agreement are related to adjustments to the governance structure and commissioners’ role.

“Those changes are separate from, and do not affect, the $2 billion investment commitment, which has always been structured as described” in the letter to the governor, Berger said in an email. “The investment commitment and funding approach are not new elements of the proposed combination, nor were they changed as part of the governance updates,” he said.

A Stein spokesperson, Onotse Omoyeni, told The N&O on Wednesday, “We are reviewing the responses.”

The N&O also asked WakeMed when it would release the revised documents and whether Wake County commissioners had been informed of the details of the $2 billion agreement. The N&O also attempted to reach Wake County officials to ask whether they had received the revised documents.

Demi said that the county has “engaged in numerous discussions and negotiations” with WakeMed and Atrium on various parts of the deal, including ensuring access to healthcare for those who can’t afford it, controlling healthcare costs and maintaining local control.

“Those discussions have resulted and continue to result in a number of changes to both legal documents to address some of the Board’s concerns,” Demi wrote in an email to The N&O on Thursday.

But Demi added that the plan is to make the updated legal documents available only after they’re finalized.

The information Gintzig shared was more than WakeMed has previously been willing to say. Wake County Commissioner Vickie Adamson said at a meeting with WakeMed leadership earlier in the summer that she’d like the funding to be guaranteed in writing before she could vote to approve changes to the nonprofit’s governance structure required to let the deal move forward.

Opponents of the deal have consistently asked to see the actual text of WakeMed’s proposed agreements with Atrium, but have been rebuffed. A Wake County attorney has said that’s because state law prevents the county from sharing competitive information shared with them.

Hospitals have to negotiate with health insurers on rates that they charge the insurers for specific operations, procedures or medical care.

Stein’s office asked if WakeMed and Atrium would negotiate together with insurance companies.

Gintzig has previously told The N&O that WakeMed gets paid less by insurers for the same medical care as other area hospitals.

Combining Atrium and WakeMed together in negotiations might give both companies more leverage, which could mean they could charge insurance companies more. That could result in insurance companies charging consumers more.

Gintzig did not give a direct response to the question.

“WakeMed and Atrium Health have not had any discussions related to negotiations with insurers, as such discussions are premature prior to the transaction’s closing,” he wrote. “Both WakeMed and Atrium Health, however, are committed to fair, arm’s length negotiations with insurers in accordance with all regulatory requirements.”

WakeMed is currently required to devote 4.8% of its revenue to financial assistance for indigent patients. That’s not supposed to change with the merger.

However, WakeMed actually spends 12% of its revenue on indigent care.

Stein’s office asked whether Atrium had committed to maintaining that level of care.

Gintzig wrote: “Here is what we can guarantee: Without a strong partner like Atrium Health, it will be difficult for WakeMed to devote that large a percentage of revenue to indigent care.”

He added that the percentage of WakeMed’s revenue dedicated to indigent care fluctuates a lot year-to-year.

But he said that 12% would be a hard benchmark to maintain.

“With the changes sweeping health care today — especially the uncertainty of state and federal actions — it will be a challenge for WakeMed to sustain the 12% level,” Gintzig said.

News & Observer reporter Richard Stradling contributed to this story.

This story was originally published September 3, 2026 at 3:35 PM with the headline “WakeMed tells Stein Atrium’s $2B is ‘legally binding.’ But WakeMed will pay part..”