The chairman and CEO of a large Nashville-area employer is stepping down after a yearslong struggle to turn around the company.

Wayne Smith has led the hospital chain Community Health Systems for 23 years. It briefly ran even more hospitals than HCA. But in recent years, the company has been forced to sell off dozens of them, including its largest hospital over the summer. But many of them were rural hospitals that had become difficult to make money on, including several hospitals in Tennessee that ultimately closed.

“Wayne and his team have reshaped and positioned Community Health Systems for long-term success, and he is making this important leadership transition at a time when the Company is on a very positive trajectory and optimistic about the future,” CHS lead director Julia North said in a statement after markets closed Tuesday.

A mountain of debt has dogged Smith ever since he led an aggressive expansion. That included the $7.6 billion acquisition of Florida-based HMA finalized in 2014. The combined company ran more than 200 hospitals in 29 states.

Even after years of downsizing, CHS remains the Nashville area’s second-largest publicly-traded health care company, according to the Nashville Business Journal. In recent years, it has employed nearly 5,000 people, though that number has declined through corporate layoffs and the sale of its Tennova hospital in Wilson County.

CHS opened a large corporate office in Antioch in 2017, and its executive offices and headquarters remain in Cool Springs.

Chief of operations Tim Hingtgen, who started with the company in 2008, will take over as CEO January 1. The statement calls the transition a long-standing succession plan. Smith says he is maintaining some “strategic and executive management responsibilities” with the company.

“Over more than two decades, my confidence in this Company has never wavered,” Smith said in the statement. “Our commitment to caring for patients and providing value for our communities has always come first — no matter the challenges — and we are proud that we have made a positive difference in the lives of millions of people.”