Building a hospital company from Nashville
Frist's fortune comes from HCA Healthcare, the for-profit hospital operator he helped start in Nashville in 1968. The idea was simple for its time: run community hospitals as a professionally managed chain, with shared purchasing, shared systems and access to public capital markets, instead of as stand-alone institutions. His father, Dr. Thomas Frist Sr., brought medical credibility, Jack Massey brought business and franchising experience from Kentucky Fried Chicken, and the younger Frist, a trained physician himself, became the operating partner who spent the most time on day-to-day expansion.
The company went public in 1969 and grew quickly by building and buying hospitals across the American South and later the rest of the country. Frist became chief executive in 1987. Two years later he led a management buyout that took HCA private, then brought it back to the stock market in 1992. In 1994 HCA merged with Columbia Hospital Corporation to form Columbia/HCA. When that combined company came under federal investigation over its billing practices in 1997, Frist returned as chief executive, settled the government cases and refocused the business on hospital operations. In 2006 his family joined private equity firms in a second buyout, and HCA listed again in 2011. His family's shares, held through those cycles, are the core of its wealth.
What the family owns today
The principal asset is a large stake in HCA Healthcare, which is listed on the New York Stock Exchange and operates well over a hundred hospitals and many outpatient sites in the United States and in Britain. The company is still headquartered in Nashville, and Frist has remained connected to it as a director and later as a significant shareholder rather than a manager.
Beyond HCA, Frist has backed a number of health care and technology ventures in Nashville over the years, often through family investment vehicles. Members of the next generation have pursued their own businesses: his son Thomas Frist III runs a private investment firm, and the family has invested in local real estate and in companies that grew out of the Nashville health care cluster that HCA helped create.
That cluster is arguably as important as any single holding. Executives trained at HCA went on to start dozens of other health services firms, which turned the city into one of the main centers of the American hospital and health management industry.
Medicine, the Air Force and the family business
Thomas Fearn Frist Jr. was born in Nashville in 1938 into a medical family. His father was a cardiologist who helped found Park View Hospital in the city, and his younger brother Bill later became a heart transplant surgeon and then a United States senator who served as Senate majority leader.
Frist studied at Vanderbilt University and earned his medical degree from Washington University in St. Louis. He then served as a flight surgeon in the United States Air Force, an experience he has described as an early lesson in how large organizations run. After military service he returned to Nashville, where his father was already thinking about how a group of hospitals might be run more efficiently than single institutions.
Frist was in his early thirties when HCA was formed. He oversaw much of its early construction and acquisition program, became president, and eventually chairman and chief executive. He stepped back from management in 2001 but stayed on the board for many years afterward.
Giving in Tennessee and beyond
Frist is one of the best known philanthropists in Nashville. The Frist Foundation, created by the family, has funded education, health and community organizations across Middle Tennessee for decades. The most visible result is the Frist Art Museum, which opened in 2001 in the city's former main post office building downtown. The museum does not hold a permanent collection and instead shows rotating exhibitions, many borrowed from major institutions abroad.
He and his wife, Patricia, have also supported Vanderbilt University, Montgomery Bell Academy and a range of civic causes, including the redevelopment of Nashville's downtown. Frist has served on the boards of several national nonprofit and business organizations and has been a member of the Giving Pledge.
He keeps a relatively low public profile compared with his brother, rarely giving interviews, though he has spoken about the history of the hospital industry and the role of investor-owned systems in it.