Less than a two years after buying a 27 percent stake in Upstate Carolina Medical Center, Winston-Salem, N.C.,-based Novant Health has taken over the remainder.

On Friday, Novant Health and Upstate Carolina’s parent company, Florida-based Health Management Associates, announced major changes to a $300 million deal they entered into in March 2008, through which Novant initially purchased a 27 percent stake in seven HMA-owned hospitals in North and South Carolina.

Two of the major changes to that original agreement now put the Gaffney hospital, as well as Franklin Regional Medical Center in Louisburg, N.C., completely under Novant Health’s control.

Novant also slightly increased its stake in Lake Norman Regional Medical Center in North Carolina from 27 percent to 30 percent.

However, in exchange for complete control of the two hospitals and the increased stake in the third, Novant gave up its 27 percent stakes in the four remaining hospitals.

Davis Regional Medical Center in Statesville, N.C., Sandhills Regional Medical Center in Hamlet, N.C., Chester Regional Medical Center in Chester and Carolina Pines Regional Medical Center in Hartsville, will revert back to full ownership by HMA.

For now, Upstate Carolina Medical Center Chief Executive Officer Joe Howell says the change of ownership at the local hospital will be seamless. He sees it as a positive move for both the hospital and patients.

”Anytime there’s a change, it makes people a little anxious,” Howell said. “Today (Friday) is just like yesterday at the hospital in terms of operations.”

Howell, who has been with HMA for the past 16 years, said he will be staying at Upstate Carolina.

The change of ownership was announced Friday to the financial markets, as HMA is a publicly traded company, but department directors were advised the previous night.

Novant is a not-for-profit group of hospitals and physician practices.

Novant Health spokesman Jim Tobalski said the old agreement didn’t give Novant Health the opportunity to be involved in operations or management. “There wasn’t a role for us in having a major impact on the hospitals,” he said. “Since then, we have continued to have conversations with HMA about how we could do that.”

Novant Health not only wanted to be involved in operations and management, Tobalski said it also wanted to be more involved in the communities the hospitals serve.

“We can become more involved with the Franklin and Gaffney hospital medical staffs, management teams, employees and civic leaders,” Novant Health President Paul Wiles said in a prepared announcement. “Becoming more involved with these hospitals will allow us to impact patient care and safety, physician partnerships and better support community outreach.”

Tobalski said no immediate changes were planned and he expected that the long-term impact on jobs at the hospital would be “positive.”

“This (new agreement) just happened,” he added. “The restructuring was just signed (Thursday).”

Technically, HMA still has a 1 percent stake in Upstate Carolina Medical Center as Novant Health’s stake increased from 27 percent to 99 percent under the new agreement. Tobalski couldn’t explain the legal technicalities but said it simply was easier to change ownership by changing the terms of the March 2008 agreement.

Upstate Carolina was a good fit for Novant Health, Tobalski said.

“From a geographic standpoint, it’s about an hour from Charlotte. It makes travel and sharing resources easier. Another strong consideration, we have a number of Novant Physician Group practices already in Cherokee County.”

When the original deal was signed in March 2008, Novant not only gained its initial stake in Upstate Carolina, it also took over physician practices for the former HMA doctors.

A U.S. Securities and Exchange Commission filing shows HMA will be giving back some cash to Novant Health as part of the new agreement. HMA will pay Novant $6.2 million up front as well as $200,000 a year for the next 10 years. In addition, HMA will buy the assets used by physicians rejoining HMA physician practices at the other hospitals reverting back to full ownership by HMA.