The results of companies' annual shareholders' meeting votes often make for uneventful reading, but HCA Holdings' filing last week sure caught our eye. One number in particular jumped out: Investors withheld more than 103 million shares from director Thomas Frist III as part of a generally less emphatic endorsement of the board than last year's. (More on that below.) That amounted to almost 26 percent of all votes cast last week, an unusually large number especially since the Hercules Holding group comprising the Frist family, Bain Capital and Kohlberg Kravis Roberts still controls almost 40 percent of HCA's shares. Assuming that block voted as one in favor of sitting candidates, it suggests investors holding some 40 percent of the remaining stock aren't keen to keep Frist III on the board.

Frist, 45, has since 1998 been a principal at Frist Capital, one of the family's main investment vehicles. He joined the HCA board in 2006 and chairs its nominating and corporate governance committee. The Frist family still controls about 16 percent of HCA's shares and thus has the right to two seats at the directors' table. The other director is William R. Frist, Frist III's brother, from whom investors withheld about 65 million votes.

The rise in votes withheld from Frist was an extreme example of a broader trend at HCA — one that perhaps should be expected as Hercules has steadily trimmed its holdings since the company's 2011 IPO. Last year, the 13 candidates standing for re-election received an average of 89.1 percent of votes cast. This year, that was 76.2 percent. In 2012, no director candidate received fewer than 86 percent of votes cast in favor. Last week, Frist III, Michael Michelson (representing KKR) and Stephen Pagliuca (representing Bain) each got less than 70 percent.

Keep in mind that HCA shares (Ticker: HCA) have climbed 40 percent in the past 12 months. It seems there really might be people you just can't please...

Skyline Medical Center and Vanderbilt University Hospital have been named the area’s only hospital safety “superstars” in a survey conducted by and The Leapfrog Group.

The hospital safety score, which The Leapfrog Group conducts twice annually and for which the most recent effort AARP Magazine publicized, is a heavily researched project that rates hospitals on safety and efficient uses of resources.

There were 66 superstars named among 2,600 hospitals.

The survey is also meant to showcase what some of the most innovative hospitals are doing to prevent errors. For example, the safest hospitals in America use surgical checklists, have fully integrated electronic medical records and place a premium on transparency, according to Leapfrog.

Several other area hospitals received “A’s” on the survey, although they weren’t cited as superstars. Those hospitals are as follows: Baptist Hospital, Centennial Medical Center, Horizon Medical Center, Saint Thomas Hospital, StoneCrest Medical Center and Southern Hills Medical Center.

Middle Tennessee Hospitals given “B” grades on the survey are Hendersonville Medical Center, Maury Regional Hospital, Middle Tennessee Medical Center, NorthCrest Medical Center, Sumner Regional Medical Center and Williamson Medical Center.

University Medical Center in Lebanon received a “C”.

To view the survey or look up hospital scores, go here.

Nashville health care juggernauts HCA and Vanguard Health Systems are among 25 health care companies highlighted for sustainability initiatives in the just-released Healthier Hospitals Initiative 2012 Milestone Report.

HCA was recognized for recycling more than 59 million pounds of construction debris from hospital construction sites. The materials, which included items such as ceiling tiles, cement, cabinetry and bricks, would likely have ended up in landfills. The hospital operator was also recognized for reaching an average 87.59 percent recycling rate across hospital systems — easily topping its original goal of 80 percent.

Vanguard Health was cited for treating environmental conservation as a preventive health measure that can create healthier patients, staffs and communities. The health care provider was recognized for waste reduction, energy conservation and management of its purchasing. One Vanguard hospital partnered with a local organic farm to provide fresh food for patients and staff. Another created an education campaign to reduce consumption of sugary drinks.

The data in the report was collected from 370 HHI-member hospitals in six key areas: engaged leadership, healthier food, leaner energy, less waste, safer chemicals and smarter purchasing.

"HHI is a multi-year campaign and our first Milestone Report shows movement toward delivering a more sustainable hospital environment," Gary Cohen, president of Health Care Without Harm and founder of Healthier Hospitals Initiative, said in a press release. "This report is a baseline from which we can move forward and continue to measure our future successes by encouraging hospitals to purchase more environmentally-preferable supplies, serve healthier foods, use less energy, and reduce waste and more."

HHI launched in April 2012.

To see the entire report go here.

Bloomberg reported Thursday afternoon that HCA Holdings executives are hitting up the banking world for a $2 billion loan that would refinance some of their existing debt. The move, wrote Sridhar Natarajan, comes after the nation's largest for-profit hospital operator reworked the interest rate on its $2.37 billion term loan maturing in 2018.

Nashville-based HCA (Ticker: HCA) has two $2 billion loans on its books: One is a senior secured term loan maturing at the end of March 2017, the other a senior secured revolving credit facility maturing in November 2016 that was undrawn at the end of 2012. The company finished last year with almost $29 billion of long-term debt on its books.

If recent corporate finance history is any guide, look for HCA to land more than $2 billion. In the past few years, the company has repeatedly upsized debt sales.

National Seating & Mobility is acquiring for an undisclosed sum Virginia-based Rehab Health Care, a move that will allow the Franklin company to capitalize on the rehabilitation technology products and services RHC provides from locations in Norfolk, Richmond, Fishersville and Charlottesville. Read more here.

Whit Mayo at Robert W. Baird has upgraded Community Health Systems shares from 'neutral' to 'outperform' and hiked his price target for the Franklin-based company to $56 from $48. The move comes after CHS (Ticker: CYH) has given up about 10 percent this month.

At Avondale Partners, Richard Close isn't quite ready to make the same move on HealthStream shares. Following up on the company's Q1 earnings report — which were highlighted by better-than-expected revenues — Close told clients Tuesday he is sticking with his 'market perform' rating and $25 target, which is only just above where the stock (Ticker HSTM) now trades. He likes the company's growth story and its prospects in the coming quarters, but the timing just isn't quite right. "Considering we believe that HSTM can continue this level of growth in the near term, we would use a pullback to re-evaluate our rating on the stock," he wrote.