In November, Johnston Health invited larger hospital companies to detail their interest in the county-owned health system. The hospital board says it's willing to consider a variety of options, from selling the operation entirely to merging with a larger hospital to a lower-level alliance.

Rumors swirling around the hospital say WakeMed in Raleigh is among the suitors and that its leaders recently visited Johnston Medical Center in Smithfield. A spokeswoman for WakeMed said the private company would not comment, and she referred all questions to Johnston Health officials.

Hospital board chairman Ralph Stewart said he could not name the seven that submitted proposals because he and other hospital leaders had signed confidentiality agreements. Board members met on Jan. 10 to take a first look at the proposals, he said.

"We decided that we need to look at what our route would be legally," Stewart said. "If we do certain things, the county commissioners need to be involved. We are waiting on the legal advice at our next meeting. We aren't in no real big hurry."

The board will meet again this month, and from there, hospital leaders will take at least another month to pare the possibilities, Stewart said. "In a few months, I'm hoping we can divulge something," he said, adding that hospital leaders will seek public feedback before any final decision.

Cookie Pope, who's among three county commissioners on the hospital board, said she wants Johnston leaders to continue overseeing the hospital system, regardless of what happens. "I don't want somebody to come in who ties our hands," Pope said. "I would want the hospital board itself to have the control."

But Pope said the resources of a larger company could help patients here. "I don't think (Johnston Health) can build and continue to improve and grow as fast as the citizens of this county would like them to without having some financial assistance," she said. "I think maybe a larger facility might be able to survive ... We do need additional doctors; we need some additional health care."

Don Dalton of the N.C. Hospital Association said it's increasingly common for smaller hospitals to partner with larger ones. But the nature of the partnerships vary.

"We have everything from complete mergers to what I call OWAs, or Other Weird Arrangements," Dalton said. "It runs the gamut."

According to Dalton, major players in North Carolina getting involved with smaller hospitals are UNC Health Care, Duke Medicine, Novant Health and Vidant Health, which operates Pitt County Memorial Hospital and others in Eastern North Carolina.

Dalton said the smaller hospitals often pick partners where their doctors are already referring patients who need care the smaller hospitals cannot provide. Many Johnston County doctors sometimes treat patients at WakeMed.

Most public hospitals, though, don't sell their facilities entirely. "I think most of them retain some local input regardless of the fact that they are part of a larger system," Dalton said.

At Johnston Health, leaders have said an affiliation could help add beds at the Clayton hospital. The partnership could also improve the hospital's image, since a well-known name could be attractive to patients.

"I'm anxious to see it and review it," Pope said of the proposals.