Local representatives for a developer who wants to build a hospital at the southeast corner of State Road 60 and 66th Avenue say three major hospitals want to occupy the site. They won't reveal which three hospital systems they've been talking to, but there are several likely suspects.

Former county commissioner Tim Zorc, who assembled the local engineering and legal team for the project, would only describe them as "known names in Florida."

Considering geography, growth patterns, financial stability and interest in Vero Beach, AdventHealth, HCA Florida and Tenet Healthcare seem most likely to be courting the proposed deal.

AdventHealth was one of the four finalists when the Indian River County Hospital District chose Cleveland Clinic to operate Indian River Hospital, and it could be the best-case-scenario operator of a potential new west Vero hospital.

Founded in 1973 and based in Altamonte Springs, the company was previously called Adventist Health System and Florida Hospital. It's now the largest acute-care hospital system doing business in Florida with 56 hospitals in nine states and more than 300 outpatient, surgical, skilled nursing and hospice facilities. On its consolidated financials for 2025, AdventHealth posted $32 billion in assets and $23 billion in operating revenue.

AdventHealth's flagship Kissimmee Hospital was ranked the No. 1 hospital in Florida by U.S. News and World Report for 2026-27. Its Orlando hospital scored a perfect 120 out of 120 in the latest round of LeapFrog Health Safety Grades. Of its 44 hospitals being graded, Advent Health boasts 20 "Straight A" Leapfrog grade hospitals – meaning those facilities scored an A at least five grading periods in a row. It also owns eight grade A hospitals, 14 grade B hospitals and two grade C hospitals.

As a nonprofit, church-affiliated hospital with the ability to attract philanthropic dollars, AdventHealth could help shoulder a portion of the cost of indigent care in Indian River County, which amounts to tens of millions of dollars annually.

The new hospital's location would also serve a significant number of patients covered by Medicare plans, due to its proximity to Indian River Estates assisted-living and skilled nursing campus, The Brennity Senior Living, plus numerous active-lifestyle retirement condos and mobile home communities. Admitting and caring for Medicare patients creates an automatic financial loss for hospitals due to low reimbursement rates for medical services, surgical procedures and medications.

Those factors would actually help the two existing hospitals' bottom lines, even though the three facilities would still compete for the coveted minority of local residents with good private health insurance from employers like the county and city governments, the school district and Piper Aircraft.

Having three nonprofit hospitals operating in Indian River County would mean a level playing field in terms of doctor and nurse compensation, so if existing medical personnel left Cleveland Clinic or Orlando Health to join the new hospital, it would be for better working conditions or favorable corporate culture more than for vastly better pay offered by a for-profit hospital.

HCA Florida – which was one of the top two finalists considered to take over Indian River Hospital but lost out to Cleveland Clinic – is well-known to Vero Beach residents, many of whom already travel to HCA Florida Lawnwood Medical Center in Fort Pierce for care.

Lawnwood is also Vero's nearest Level One Trauma Center, so anyone who has been in a car crash or serious freak accident has likely rolled through Lawnwood's busy Emergency Department. HCA also operates a 24-hour standalone Emergency Department at 660 S. U.S. 1 just north of Oslo Road, with 12 beds and a trauma bay.

The behemoth for-profit hospital system based in Nashville posted $60.7 billion in assets at the end of 2025. It operates nearly 200 hospitals and more than 2,400 ambulatory care sites in 20 states. Its portfolio includes a nursing school, and HCA supports medical education through its separate nonprofit foundation.

Corporation founders opened their first hospital in 1961, later establishing the Health Corporation of America in 1968. In 2025, HCA was recognized for the 15th time as one of the World's Most Ethical Companies by Ethisphere, a global authority in leader in ethical business practices.

Since its IPO in 2011, HCA Healthcare has been publicly traded on the New York Stock Exchange. Moody's and Fitch both give HCA's stock a "BBB" rating, with a stable outlook.

Dallas-based Tenet Healthcare, also a publicly traded company, was founded in 1969. It operates five hospitals in Palm Beach County. In September 2025 Tenet expanded into the Treasure Coast market, opening Florida Coast Medical Center in Port St. Lucie, so it's possible it is looking for opportunities northward.

For-profit Tenet's finances are strong, after off-loading 14 hospitals in California, South Carolina and Alabama for $4.8 million. In 2021 Tenet sold five Florida hospitals to now-defunct Steward Healthcare for $1.1 billion and re-invested the proceeds in 45 Ambulatory Surgical Centers or ASCs, as reported by Becker's Healthcare.

Recent changes in Medicare regulations expanded the types of surgeries that can be performed on an outpatient basis, making surgery centers more popular. The lucrative surgery business enables Tenet to invest in robotic surgical systems used in orthopedics, urology and other surgical specialties.

Across 37 states, Tenet owns 49 acute-care hospitals, 26 surgical hospitals and more than 500 ASCs – and the company is still in growth mode, which could have it eying the Vero deal.

Tenet posted revenue of $21.3 billion in 2025, with a net income of $1.407 billion, according to the company's financial statements. The company's credit rating was boosted to "BB" this year by Fitch and S&P Global with positive and stable outlooks.

Tenet made headlines when it sued the Leapfrog Group over low hospital safety ratings given to its five Palm Beach County hospitals and won in federal court, forcing Leapfrog to temporarily rescind the unfavorable grades. Leapfrog temporarily suspended rating the Tenet hospitals and has appealed the ruling.

On Oct. 6 the Indian River Board of County Commissioners will consider the first of several zoning and land use measures necessary for the hospital plans to go forward.

Zorc said the development team continues to work with county staff in the lead up to that meeting.

"Mainly our work lately has been through the county attorney's office, where we've submitted what we think is the final proposal for limiting the height request. After going through some iterations we ended up with I think a very workable proposal. The commissioners will have to see if they feel the same way," Zorc said, adding that "community response has been, I would say 90 percent for and 10 percent against [the project]."