Many institutional investors are required to have an independent assessment of how they should vote on shareholder issues. The ISS endorsement was "the last piece of what Glenview needed," Skolnick said.
How will the board change affect the CHS/HMA merger? According to Skolnick, the deal was always going to be a tough sell because it requires the approval of 70% of HMA shareholder and not everyone is enamored with the $13.78 per share price.
Having a new HMA board in place will potentially make everything more challenging for CHS as it tries to move forward on a shareholder vote on the merger. Skolnick notes that the new board will need time to assess "what is going on inside of HMA" and how long it will take to fix things.
In addition, an interim CEO from Alvarez & Marsal, a consulting firm that specializes in turnarounds and interim management, will be put in place. An ongoing federal investigation into HMA's patient admission practices is another complication.
Ultimately, Skolnick expects CHS to stick with the deal. "I think [CHS] wants to become the largest hospital company—in terms of the number of hospitals—in the U.S."