At long last, the nation’s two largest for-profit hospital chains combine, forming Columbia/HCA. The final cost for Rick Scott, who had unsuccessfully sought to purchase the Frists’ company with Richard Ragsdale and Charlie Miller in 1987, is $5.7 billion in stock. (That figure actually increases to $7.6 billion due to gains in Columbia’s stock price over the months between the deal’s October announcement and February completion.)

For HCA execs, who have quietly downsized their hospital ownership from 376 to 96 over the previous 10 years, this agreement is a re-immersion into the world of aggressive expansion.

Although the company spends its first few months in Louisville, Ky., Nashville mayor Phil Bredesen incentivizes Columbia/HCA to settle in Nashville with some hefty tax breaks. This creates the largest company the city has ever known, with some $20 billion in annual revenue and nearly 200,000 employees.