Table of Contents

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

Form 10-Q
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d)
OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 2013
Commission file number 001-15925
COMMUNITY HEALTH SYSTEMS, INC.
(Exact name of registrant as specified in its charter)

Delaware	 	13-3893191	
(State or other jurisdiction of
incorporation or organization)	 	(I.R.S. Employer
Identification Number)	
 	 	
4000 Meridian Boulevard
Franklin, Tennessee	 	37067	
(Address of principal executive offices)	 	(Zip Code)	
615-465-7000
(Registrant’s telephone number)

Indicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.  Yes  þ      No  ¨
Indicate by check mark whether the registrant has submitted electronically and posted on its corporate web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).  Yes  þ      No  ¨
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer x	  	Accelerated filer ¨	  	Non-accelerated filer ¨	  	    Smaller reporting company ¨	
 	  	 (Do not check if a smaller reporting company)	
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).  Yes  ¨  No þ
As of October 25, 2013, there were outstanding 94,972,160 shares of the Registrant’s Common Stock, $0.01 par value.

 

Table of Contents
Community Health Systems, Inc.
Form 10-Q
For the Three and Nine Months Ended September 30, 2013

 	 	 	 	 	 	 	
Part I.	  	Financial Information	  	Page	
 	 	 	 	
 	  	Item 1.	    	Financial Statements:	  	 	
 	 	 	 	
 	  	 	    	Condensed Consolidated Balance Sheets - September 30, 2013 and December 31, 2012 (Unaudited)	  	2	
 	 	 	 	
 	  	 	    	Condensed Consolidated Statements of Income - Three and Nine Months Ended September 30, 2013 and September 30, 2012 (Unaudited)	  	3	
 	 	 	 	
 	  	 	    	Condensed Consolidated Statements of Comprehensive Income - Three and Nine Months Ended September 30, 2013 and September 30, 2012 (Unaudited)	  	4	
 	 	 	 	
 	  	 	    	Condensed Consolidated Statements of Cash Flows - Nine Months Ended September 30, 2013 and September 30, 2012 (Unaudited)	  	5	
 	 	 	 	
 	  	 	    	Notes to Condensed Consolidated Financial Statements (Unaudited)	  	6	
 	 	 	 	
 	  	Item 2.	    	Management’s Discussion and Analysis of Financial Condition and Results of Operations	  	47	
 	 	 	 	
 	  	Item 3.	    	Quantitative and Qualitative Disclosures about Market Risk	  	69	
 	 	 	 	
 	  	Item 4.	    	Controls and Procedures	  	69	
 	 	
Part II.	  	Other Information	
 	 	 	 	
 	  	Item 1.	    	Legal Proceedings	  	69	
 	 	 	 	
 	  	Item 1A.	    	Risk Factors	  	74	
 	 	 	 	
 	  	Item 2.	    	Unregistered Sales of Equity Securities and Use of Proceeds	  	75	
 	 	 	 	
 	  	Item 3.	    	Defaults Upon Senior Securities	  	75	
 	 	 	 	
 	  	Item 4.	    	Mine Safety Disclosures	  	75	
 	 	 	 	
 	  	Item 5.	    	Other Information	  	75	
 	 	 	 	
 	  	Item 6.	    	Exhibits	  	76	
 	 	
Signatures	  	77	
 	 	
Index to Exhibits	  	78	
 
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Table of Contents
PART I FINANCIAL INFORMATION
Item 1. Financial Statements
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(In thousands, except share data)
(Unaudited)

 	  	  September 30, 2013  	 	  	    December 31, 2012    	 	
ASSETS	  	 	 	 	  	 	 	 	
Current assets	  	 	 	 	  	 	 	 	
Cash and cash equivalents	  	$	143,605 	 	  	$	387,813 	 	
Patient accounts receivable, net of allowance for doubtful accounts of $2,390,567 and $2,201,875 at September 30, 2013 and December 31, 2012, respectively	  	 	2,298,619 	 	  	 	2,067,379 	 	
Supplies	  	 	377,909 	 	  	 	368,172 	 	
Prepaid income taxes	  	 	26,730 	 	  	 	49,888 	 	
Deferred income taxes	  	 	117,045 	 	  	 	117,045 	 	
Prepaid expenses and taxes	  	 	148,762 	 	  	 	126,561 	 	
Other current assets	  	 	333,612 	 	  	 	302,284 	 	
 	  	 	 	 	  	 	 	 	
Total current assets	  	 	3,446,282 	 	  	 	3,419,142 	 	
 	  	 	 	 	  	 	 	 	
Property and equipment	  	 	10,439,250 	 	  	 	10,145,408 	 	
Less accumulated depreciation and amortization	  	 	(3,370,689)	  	  	 	(2,993,535)	  	
 	  	 	 	 	  	 	 	 	
Property and equipment, net	  	 	7,068,561 	 	  	 	7,151,873 	 	
 	  	 	 	 	  	 	 	 	
Goodwill	  	 	4,437,260 	 	  	 	4,408,138 	 	
 	  	 	 	 	  	 	 	 	
Other assets, net	  	 	1,770,140 	 	  	 	1,627,182 	 	
 	  	 	 	 	  	 	 	 	
Total assets	  	$	16,722,243 	 	  	$	16,606,335 	 	
 	  	 	 	 	  	 	 	 	
LIABILITIES AND EQUITY	  	 	 	 	  	 	 	 	
Current liabilities	  	 	 	 	  	 	 	 	
Current maturities of long-term debt	  	$	180,386 	 	  	$	89,911 	 	
Accounts payable	  	 	743,776 	 	  	 	825,914 	 	
Accrued interest	  	 	107,463 	 	  	 	110,702 	 	
Accrued liabilities	  	 	1,077,882 	 	  	 	1,116,693 	 	
 	  	 	 	 	  	 	 	 	
Total current liabilities	  	 	2,109,507 	 	  	 	2,143,220 	 	
 	  	 	 	 	  	 	 	 	
Long-term debt	  	 	9,368,293 	 	  	 	9,451,394 	 	
 	  	 	 	 	  	 	 	 	
Deferred income taxes	  	 	808,489 	 	  	 	808,489 	 	
 	  	 	 	 	  	 	 	 	
Other long-term liabilities	  	 	1,016,203 	 	  	 	1,039,045 	 	
 	  	 	 	 	  	 	 	 	
Total liabilities	  	 	13,302,492 	 	  	 	13,442,148 	 	
 	  	 	 	 	  	 	 	 	
Redeemable noncontrolling interests in equity of consolidated subsidiaries	  	 	366,787 	 	  	 	367,666 	 	
 	  	 	 	 	  	 	 	 	
EQUITY	  	 	 	 	  	 	 	 	
Community Health Systems, Inc. stockholders’ equity	  	 	 	 	  	 	 	 	
Preferred stock, $.01 par value per share, 100,000,000 shares authorized; none issued	  	 	- 	  	  	 	- 	  	
Common stock, $.01 par value per share, 300,000,000 shares authorized; 95,918,306 shares issued and 94,942,757 shares outstanding at September 30, 2013, and 92,925,715 shares issued and 91,950,166 shares outstanding at December 31, 2012	  	 	959 	 	  	 	929 	 	
Additional paid-in capital	  	 	1,231,186 	 	  	 	1,138,274 	 	
Treasury stock, at cost, 975,549 shares at September 30, 2013 and December 31, 2012	  	 	(6,678)	  	  	 	(6,678)	  	
Accumulated other comprehensive loss	  	 	(92,515)	  	  	 	(145,310)	  	
Retained earnings	  	 	1,857,014 	 	  	 	1,743,992 	 	
 	  	 	 	 	  	 	 	 	
Total Community Health Systems, Inc. stockholders’ equity	  	 	2,989,966 	 	  	 	2,731,207 	 	
Noncontrolling interests in equity of consolidated subsidiaries	  	 	62,998 	 	  	 	65,314 	 	
 	  	 	 	 	  	 	 	 	
Total equity	  	 	3,052,964 	 	  	 	2,796,521 	 	
 	  	 	 	 	  	 	 	 	
Total liabilities and equity	  	$	                  16,722,243 	 	  	$	                  16,606,335 	 	
 	  	 	 	 	  	 	 	 	
See accompanying notes to the condensed consolidated financial statements.
 
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Table of Contents
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF INCOME
(In thousands, except share and per share data)
(Unaudited)

 	 	Three Months Ended
September 30,	 	 	Nine Months Ended
September 30,	 	
 	 	      2013      	 	 	      2012      	 	 	      2013      	 	 	      2012      	 	
 	 	 	 	 	
Operating revenues (net of contractual allowances and discounts)	 	$	3,766,833 	 	 	  $	        3,696,661 	 	 	  $	        11,334,783 	 	 	  $	        11,226,580 	 	
Provision for bad debts	 	 	548,602 	 	 	 	484,631 	 	 	 	1,568,411 	 	 	 	1,474,541 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Net operating revenues	 	 	3,218,231 	 	 	 	3,212,030 	 	 	 	9,766,372 	 	 	 	9,752,039 	 	

Operating costs and expenses:	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Salaries and benefits	 	 	1,541,692 	 	 	 	1,525,111 	 	 	 	4,674,791 	 	 	 	4,547,532 	 	
Supplies	 	 	486,374 	 	 	 	484,212 	 	 	 	1,482,245 	 	 	 	1,472,520 	 	
Other operating expenses	 	 	721,957 	 	 	 	694,857 	 	 	 	2,159,728 	 	 	 	2,140,025 	 	
Government settlement and related costs reserve	 	 	98,000 	 	 	 	- 	  	 	 	98,000 	 	 	 	- 	  	
Electronic health records incentive reimbursement	 	 	(65,007)	  	 	 	(30,622)	  	 	 	(110,307)	  	 	 	(73,592) 	  	
Rent	 	 	71,646 	 	 	 	68,637 	 	 	 	215,020 	 	 	 	202,324 	 	
Depreciation and amortization	 	 	195,841 	 	 	 	182,207 	 	 	 	582,604 	 	 	 	536,362 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Total operating costs and expenses	 	 	          3,050,503 	 	 	 	2,924,402 	 	 	 	9,102,081 	 	 	 	8,825,171 	 	

Income from operations	 	 	167,728 	 	 	 	287,628 	 	 	 	664,291 	 	 	 	926,868 	 	
Interest expense, net	 	 	154,329 	 	 	 	158,565 	 	 	 	465,735 	 	 	 	462,347 	 	
Loss from early extinguishment of debt	 	 	- 	  	 	 	52,024 	 	 	 	1,295 	 	 	 	115,453 	 	
Equity in earnings of unconsolidated affiliates	 	 	(11,641)	  	 	 	(7,419)	  	 	 	(36,375)	  	 	 	(32,613)	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Income from continuing operations before income taxes	 	 	25,040 	 	 	 	84,458 	 	 	 	233,636 	 	 	 	381,681 	 	
Provision for income taxes	 	 	3,442 	 	 	 	25,700 	 	 	 	68,630 	 	 	 	121,038 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Income from continuing operations	 	 	21,598 	 	 	 	58,758 	 	 	 	165,006 	 	 	 	260,643 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Discontinued operations, net of taxes:	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Loss from operations of entities sold	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(466)	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Loss from discontinued operations, net of taxes	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(466)	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Net income	 	 	21,598 	 	 	 	58,758 	 	 	 	165,006 	 	 	 	260,177 	 	
Less: Net income attributable to noncontrolling interests	 	 	17,503 	 	 	 	14,525 	 	 	 	51,984 	 	 	 	57,111 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Net income attributable to Community Health Systems, Inc. stockholders	 	$	4,095 	 	 	$	44,233 	 	 	$	113,022 	 	 	$	203,066 	 	

Basic earnings (loss) per share attributable to Community Health Systems, Inc. common stockholders:	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Continuing operations	 	$	0.04 	 	 	$	0.50 	 	 	$	1.22 	 	 	$	2.29 	 	
Discontinued operations	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(0.01)	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Net income	 	$	0.04 	 	 	$	0.50 	 	 	$	1.22 	 	 	$	2.28 	 	

Diluted earnings (loss) per share attributable to Community Health Systems, Inc. common stockholders(1):	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Continuing operations	 	$	0.04 	 	 	$	0.49 	 	 	$	1.21 	 	 	$	2.27 	 	
Discontinued operations	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(0.01)	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Net income	 	$	0.04 	 	 	$	0.49 	 	 	$	1.21 	 	 	$	2.27 	 	

Weighted-average number of shares outstanding:	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Basic	 	 	93,259,027 	 	 	 	89,259,950 	 	 	 	92,384,270 	 	 	 	89,028,249 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Diluted	 	 	94,483,596 	 	 	 	90,009,113 	 	 	 	93,516,158 	 	 	 	89,464,987 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
(1) Total per share amounts may not add due to rounding.
See accompanying notes to the condensed consolidated financial statements.
 
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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
(In thousands)
(Unaudited)

 	  	Three Months Ended
September 30,	 	  	Nine Months Ended
September 30,	 	
 	  	      2013      	 	  	      2012      	 	  	      2013      	 	  	      2012      	 	
 	 	 	 	 	
Net income	  	$	21,598 	 	  	$	58,758 	 	  	$	165,006 	 	  	$	260,177 	 	
Other comprehensive income, net of income taxes:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Net change in fair value of interest rate swaps	  	 	10,850 	 	  	 	8,254 	 	  	 	47,759 	 	  	 	28,766 	 	
Net change in fair value of available-for-sale securities	  	 	1,171 	 	  	 	1,370 	 	  	 	2,841 	 	  	 	3,509 	 	
Amortization and recognition of unrecognized pension cost components	  	 	731 	 	  	 	1,202 	 	  	 	2,195 	 	  	 	3,483 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Other comprehensive income	  	 	12,752 	 	  	 	10,826 	 	  	 	52,795 	 	  	 	35,758 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Comprehensive income	  	 	34,350 	 	  	 	69,584 	 	  	 	217,801 	 	  	 	295,935 	 	
Less: Comprehensive income attributable to noncontrolling interests	  	 	17,503 	 	  	 	14,525 	 	  	 	51,984 	 	  	 	57,111 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Comprehensive income attributable to Community Health Systems, Inc. stockholders	  	$	          16,847 	 	  	$	55,059 	 	  	$	165,817 	 	  	$	238,824 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
See accompanying notes to the condensed consolidated financial statements.
 
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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(In thousands)
(Unaudited)

 	  	Nine Months Ended
September 30,	 	
 	  	                 2013                	 	  	                 2012                	 	
 	 	 	
Cash flows from operating activities	  	 	 	 	  	 	 	 	
Net income	  	$	165,006 	 	  	$	260,177 	 	
Adjustments to reconcile net income to net cash provided by operating activities:	  	 	 	 	  	 	 	 	
Depreciation and amortization	  	 	582,604 	 	  	 	536,362 	 	
Government settlement and related costs reserve	  	 	98,000 	 	  	 	- 	  	
Stock-based compensation expense	  	 	28,943 	 	  	 	30,708	 	
Loss from early extinguishment of debt	  	 	1,295 	 	  	 	115,453 	 	
Excess tax benefit relating to stock-based compensation	  	 	(6,573)	  	  	 	(1,545)	  	
Other non-cash expenses, net	  	 	48,387 	 	  	 	22,482 	 	
Changes in operating assets and liabilities, net of effects of acquisitions and divestitures:	  	 	 	 	  	 	 	 	
Patient accounts receivable	  	 	(231,134)	  	  	 	(227,814)	  	
Supplies, prepaid expenses and other current assets	  	 	(60,062)	  	  	 	(68,247)	  	
Accounts payable, accrued liabilities and income taxes	  	 	(205,913)	  	  	 	103,156	 	
Other	  	 	20,547 	 	  	 	7,133 	 	
 	  	 	 	 	  	 	 	 	
Net cash provided by operating activities	  	 	441,100 	 	  	 	777,865 	 	

Cash flows from investing activities	  	 	 	 	  	 	 	 	
Acquisitions of facilities and other related equipment	  	 	(33,935)	  	  	 	(312,927)	  	
Purchases of property and equipment	  	 	(420,917)	  	  	 	(557,469)	  	
Proceeds from sale of property and equipment	  	 	4,185 	 	  	 	4,808 	 	
Increase in other investments	  	 	(234,099)	  	  	 	(222,164)	  	
 	  	 	 	 	  	 	 	 	
Net cash used in investing activities	  	 	(684,766)	  	  	 	(1,087,752)	  	

Cash flows from financing activities	  	 	 	 	  	 	 	 	
Proceeds from exercise of stock options	  	 	108,546 	 	  	 	5,750 	 	
Repurchase of restricted stock shares for payroll tax withholding requirements	  	 	(14,696)	  	  	 	(9,165)	  	
Stock buy-back	  	 	(27,133)	  	  	 	- 	  	
Deferred financing costs	  	 	(12,960)	  	  	 	(135,647)	  	
Excess tax benefit relating to stock-based compensation	  	 	6,573 	 	  	 	1,545 	 	
Proceeds from noncontrolling investors in joint ventures	  	 	64 	 	  	 	535 	 	
Redemption of noncontrolling investments in joint ventures	  	 	(5,720)	  	  	 	(39,709)	  	
Distributions to noncontrolling investors in joint ventures	  	 	(60,282)	  	  	 	(60,676)	  	
Borrowings under credit agreements	  	 	813,732	 	  	 	3,974,399 	 	
Issuance of long-term debt	  	 	- 	  	  	 	3,825,000 	 	
Proceeds from receivables facility	  	 	320,000 	 	  	 	300,000 	 	
Repayments of long-term indebtedness	  	 	(1,128,666)	  	  	 	(7,441,360)	  	
 	  	 	 	 	  	 	 	 	
Net cash (used in) provided by financing activities	  	 	(542)	  	  	 	420,672 	 	

Net change in cash and cash equivalents	  	 	(244,208)	  	  	 	110,785 	 	
Cash and cash equivalents at beginning of period	  	 	387,813 	 	  	 	129,865 	 	
 	  	 	 	 	  	 	 	 	
Cash and cash equivalents at end of period	  	$	143,605 	 	  	$	240,650 	 	

Supplemental disclosure of cash flow information:	  	 	 	 	  	 	 	 	
Interest payments	  	$	                      446,124 	 	  	$	                      461,604 	 	
 	  	 	 	 	  	 	 	 	
Income tax paid, net of refunds received	  	$	72,482 	 	  	$	55,404 	 	
 	  	 	 	 	  	 	 	 	
See accompanying notes to the condensed consolidated financial statements.
 
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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED)
1.  BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES
The unaudited condensed consolidated financial statements of Community Health Systems, Inc. and its subsidiaries (the “Company”) as of September 30, 2013 and December 31, 2012 and for the three-month and nine-month periods ended September 30, 2013 and September 30, 2012, have been prepared in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). In the opinion of management, such information contains all adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of the results for such periods. All intercompany transactions and balances have been eliminated. The results of operations for the three and nine months ended September 30, 2013, are not necessarily indicative of the results to be expected for the full fiscal year ending December 31, 2013. Certain information and disclosures normally included in the notes to consolidated financial statements have been condensed or omitted as permitted by the rules and regulations of the Securities and Exchange Commission (the “SEC”). The Company believes the disclosures are adequate to make the information presented not misleading. The accompanying unaudited condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto for the year ended December 31, 2012, contained in the Company’s Annual Report on Form 10-K.
Noncontrolling interests in less-than-wholly-owned consolidated subsidiaries of the parent are presented as a component of total equity on the condensed consolidated balance sheets to distinguish between the interests of the parent company and the interests of the noncontrolling owners. Noncontrolling interests that are redeemable or may become redeemable at a fixed or determinable price at the option of the holder or upon the occurrence of an event outside of the control of the Company are presented in mezzanine equity on the condensed consolidated balance sheets.
Throughout these notes to the condensed consolidated financial statements, Community Health Systems, Inc. (the “Parent”), and its consolidated subsidiaries are referred to on a collective basis as the “Company.” This drafting style is not meant to indicate that the publicly-traded Parent or any subsidiary of the Parent owns or operates any asset, business, or property. The hospitals, operations and businesses described in this filing are owned and operated, and management services provided, by distinct and indirect subsidiaries of Community Health Systems, Inc.
Allowance for Doubtful Accounts. Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. Substantially all of the Company’s receivables are related to providing healthcare services to its hospitals’ patients.
The Company estimates the allowance for doubtful accounts by reserving a percentage of all self-pay accounts receivable without regard to aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. For all other non-self-pay payor categories, the Company reserves 100% of all accounts aging over 365 days from the date of discharge. The percentage used to reserve for all self-pay accounts is based on the Company’s collection history. The Company collects substantially all of its third-party insured receivables, which include receivables from governmental agencies.
Collections are impacted by the economic ability of patients to pay and the effectiveness of the Company’s collection efforts. Significant changes in payor mix, business office operations, economic conditions or trends in federal and state governmental healthcare coverage could affect the Company’s collection of accounts receivable and the estimates of the collectability of future accounts receivable. The process of estimating the allowance for doubtful accounts requires the Company to estimate the collectability of self-pay accounts receivable, which is primarily based on its collection history, adjusted for expected recoveries and, if present, anticipated changes in collection trends. The Company also continually reviews its overall reserve adequacy by monitoring historical cash collections as a percentage of trailing net revenue less provision for bad debts, as well as by analyzing current period net revenue and admissions by payor classification, aged accounts receivable by payor, days revenue outstanding, and the impact of recent acquisitions and dispositions.
 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Operating revenues, net of contractual allowances and discounts (but before the provision for bad debts), recognized during the three and nine months ended September 30, 2013 and 2012, were as follows (in thousands):

 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
 	  	Three Months Ended
September 30,	 	  	Nine Months Ended
September 30,	 	
 	  	        2013        	 	  	        2012        	 	  	        2013        	 	  	        2012        	 	
Medicare	  	$	910,767	  	  	$	953,603	  	  	$	2,835,547	  	  	$	2,968,647	  	
Medicaid	  	 	394,403	  	  	 	387,034	  	  	 	1,122,792	  	  	 	1,098,691	  	
Managed Care and other third-party payors	  	 	1,937,042	  	  	 	1,862,657	  	  	 	5,819,906	  	  	 	5,681,006	  	
Self-pay	  	 	524,621	  	  	 	493,367	  	  	 	1,556,538	  	  	 	1,478,236	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total	  	$	    3,766,833	  	  	$	    3,696,661	  	  	$	    11,334,783	  	  	$	    11,226,580	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Electronic Health Records Incentive Reimbursement. The American Recovery and Reinvestment Act of 2009 included provisions for implementing health information technology under the Health Information Technology for Economic and Clinical Health Act (“HITECH”). These provisions were designed to increase the use of electronic health records (“EHR”) technology and establish the requirements for a Medicare and Medicaid incentive payments program beginning in 2011 for eligible hospitals and providers that adopt and meaningfully use certified EHR technology. The Company utilizes a gain contingency model to recognize EHR incentive payments. Recognition occurs when our eligible hospitals adopt or demonstrate meaningful use of certified EHR technology for the applicable payment period and have available the Medicare cost report information for the relevant full cost report year used to determine the final incentive payment.
Medicaid EHR incentive payments are calculated based on prior period Medicare cost report information available at the time when eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology. Since the information for the relevant full Medicare cost report year is available, the incentive income from resolving the gain contingency is recognized when eligible hospitals adopt, implement or demonstrate meaningful use of certified EHR technology.
Medicare EHR incentive payments are calculated based on the Medicare cost report information for the full cost report year that began during the federal fiscal year in which meaningful use is demonstrated. Since the necessary information is only available at the end of the relevant full Medicare cost report year, the incentive income from resolving the gain contingency is recognized when eligible hospitals demonstrate meaningful use of certified EHR technology and the information for the applicable full Medicare cost report year to determine the final incentive payment is available.
In some instances, the Company may receive estimated Medicare EHR incentive payments prior to when the Medicare cost report information used to determine the final incentive payment is available. In these instances, recognition of the gain for EHR incentive payments is deferred until all recognition criteria described above are met.
Eligibility for annual Medicare incentive payments is dependent on providers demonstrating meaningful use of EHR technology. Initial Medicaid incentive payments were available to providers that adopt, implement or upgrade certified EHR technology; however, providers must demonstrate meaningful use of such technology in subsequent years to qualify for additional incentive payments. Medicaid EHR incentive payments are fully funded by the federal government and administered by the states; however, the states are not required to offer EHR incentive payments to providers.
 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
The Company recognized approximately $65.0 million and $30.6 million for the three months ended September 30, 2013 and 2012, respectively, and $110.3 million and $73.6 million for the nine months ended September 30, 2013 and 2012, respectively, of incentive reimbursement for HITECH incentives from Medicare and Medicaid related to certain of the Company’s hospitals and for certain of the Company’s employed physicians that have demonstrated meaningful use of certified EHR technology or have completed attestations to their adoption or implementation of certified EHR technology. These incentive reimbursements are presented as a reduction of operating costs and expenses on the condensed consolidated statements of income. The Company received cash related to the incentive reimbursement for HITECH incentives of approximately $22.6 million and $12.8 million for the three months ended September 30, 2013 and 2012, respectively, and $105.3 million and $41.6 million for the nine months ended September 30, 2013 and 2012, respectively. As of September 30, 2013 and 2012, $52.6 million and $6.5 million, respectively, were recorded as deferred revenue as all criteria for gain recognition had not been met.
Reimbursement Settlement. Included in net operating revenues for the nine months ended September 30, 2012 on a non-same store basis is approximately $101.8 million of net operating revenues from an industry-wide settlement with the United States Department of Health and Human Services and Centers for Medicare and Medicaid Services, based on a claim that acute-care hospitals in the U.S. were underpaid from the Medicare inpatient prospective payment system in federal fiscal years 1999 through 2011. The underpayments resulted from calculations related to the rural floor budget neutrality adjustments implemented in connection with the Balanced Budget Act of 1997. During the nine months ended September 30, 2012, the Company received approximately $101.8 million of cash from this settlement. Also included in net operating revenues for the nine months ended September 30, 2012 is an unfavorable adjustment of approximately $21.0 million related to the revised Supplemental Security Income ratios issued for federal fiscal years 2006 through 2009 utilized for calculating Medicare Disproportionate Share Hospital reimbursements.
2.  ACCOUNTING FOR STOCK-BASED COMPENSATION
Stock-based compensation awards have been granted under the Community Health Systems, Inc. Amended and Restated 2000 Stock Option and Award Plan, amended and restated as of March 20, 2013 (the “2000 Plan”), and the Community Health Systems, Inc. 2009 Stock Option and Award Plan, amended and restated as of March 20, 2013 (the “2009 Plan”).
The 2000 Plan allowed for the grant of incentive stock options intended to qualify under Section 422 of the Internal Revenue Code (the “IRC”), as well as stock options which do not so qualify, stock appreciation rights, restricted stock, restricted stock units, performance-based shares or units and other share awards. Prior to being amended in 2009, the 2000 Plan also allowed for the grant of phantom stock. Persons eligible to receive grants under the 2000 Plan include the Company’s directors, officers, employees and consultants. All options granted under the 2000 Plan have been “nonqualified” stock options for tax purposes. Generally, vesting of these granted options occurs in one-third increments on each of the first three anniversaries of the award date. Options granted prior to 2005 have a 10-year contractual term, options granted in 2005 through 2007 have an eight-year contractual term and options granted in 2008 through 2011 have a 10-year contractual term. The Company has not granted stock option awards under the 2000 Plan since 2011. Since the Company’s stockholders approved the March 20, 2013 amendment and restatement of the 2009 Plan, no further grants will be awarded under the 2000 Plan.
The 2009 Plan provides for the grant of incentive stock options intended to qualify under Section 422 of the IRC and for the grant of stock options which do not so qualify, stock appreciation rights, restricted stock, restricted stock units, performance-based shares or units and other share awards. Persons eligible to receive grants under the 2009 Plan include the Company’s directors, officers, employees and consultants. To date, all options granted under the 2009 Plan have been “nonqualified” stock options for tax purposes. Generally, vesting of these granted options occurs in one-third increments on each of the first three anniversaries of the award date. Options granted in 2011 or later have a 10-year contractual term. As of September 30, 2013, 4,134,303 shares of unissued common stock were reserved for future grants under the 2009 Plan.
The exercise price of all options granted is equal to the fair value of the Company’s common stock on the option grant date.
 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
The following table reflects the impact of total compensation expense related to stock-based equity plans on the reported operating results for the respective periods (in thousands):

 	  	Three Months  Ended
September 30,	 	  	Nine Months  Ended
September 30,	 	
 	  	      2013      	 	  	      2012      	 	  	      2013      	 	  	      2012      	 	
Effect on income from continuing operations before income taxes	  	$	        (9,514)	  	  	$	        (10,084)	  	  	$	        (28,943)	  	  	$	        (30,708)	  	

Effect on net income	  	$	(5,975)	  	  	$	(6,403)	  	  	$	(18,176)	  	  	$	(19,500)	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
At September 30, 2013, $39.7 million of unrecognized stock-based compensation expense was expected to be recognized over a weighted-average period of 23 months. Of that amount, $2.9 million related to outstanding unvested stock options was expected to be recognized over a weighted-average period of 10 months and $36.8 million related to outstanding unvested restricted stock and restricted stock units was expected to be recognized over a weighted-average period of 24 months. There were no modifications to awards during the three and nine months ended September 30, 2013.
No stock options were granted during the three and nine months ended September 30, 2013. The fair value of stock options granted during the three and nine months ended September 30, 2012 was estimated using the Black Scholes option pricing model with the following assumptions:

 	  	      Three Months Ended      
September 30, 2012	 	  	      Nine Months Ended      
September 30, 2012	 	
Expected volatility	  	 	59.8 %  	  	  	 	57.8 %  	  	
Expected dividends	  	 	-       	  	  	 	-       	  	
Expected term	  	 	4 years     	  	  	 	4.1 years     	  	
Risk-free interest rate	  	 	0.5 %  	  	  	 	0.7 %  	  	
In determining the expected term, the Company examined concentrations of option holdings and historical patterns of option exercises and forfeitures, as well as forward-looking factors, in an effort to determine if there were any discernible employee populations. From this analysis, the Company identified two primary employee populations, one consisting of certain senior executives and the other one consisting of substantially all other recipients.
The expected volatility rate was estimated based on historical volatility. In determining expected volatility, the Company also reviewed the market-based implied volatility of actively traded options of its common stock and determined that historical volatility utilized to estimate the expected volatility rate did not differ significantly from the implied volatility.
The expected term computation is based on historical exercise and cancellation patterns and forward-looking factors, where present, for each population identified. The risk-free interest rate is based on the U.S. Treasury yield curve in effect at the time of the grant. The pre-vesting forfeiture rate is based on historical rates and forward-looking factors for each population identified. The Company adjusts the estimated forfeiture rate to its actual experience.
 
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Options outstanding and exercisable under the 2000 Plan and the 2009 Plan as of September 30, 2013, and changes during each of the three-month periods following December 31, 2012, were as follows (in thousands, except share and per share data):

 	 	          Shares           	 	 	Weighted-
Average
    Exercise Price    	 	 	Weighted-
Average
Remaining
        Contractual        
Term	 	Aggregate
Intrinsic
Value as of
  September 30,  
2013	 	
Outstanding at December 31, 2012	 	 	7,104,113 	  	 	$	34.25 	  	 	 	 	 	 	 	
Granted	 	 	- 	  	 	 	- 	  	 	 	 	 	 	 	
Exercised	 	 	(2,248,891)	  	 	 	32.53 	  	 	 	 	 	 	 	
Forfeited and cancelled	 	 	(20,010)	  	 	 	35.93 	  	 	 	 	 	 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Outstanding at March 31, 2013	 	 	4,835,212 	  	 	 	34.98 	  	 	 	 	 	 	 	
Granted	 	 	- 	  	 	 	- 	  	 	 	 	 	 	 	
Exercised	 	 	(842,834)	  	 	 	35.73 	  	 	 	 	 	 	 	
Forfeited and cancelled	 	 	(7,339)	  	 	 	33.39 	  	 	 	 	 	 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Outstanding at June 30, 2013	 	 	3,985,039 	  	 	 	34.80 	  	 	 	 	 	 	 	
Granted	 	 	- 	  	 	 	- 	  	 	 	 	 	 	 	
Exercised	 	 	(143,670)	  	 	 	34.25 	  	 	 	 	 	 	 	
Forfeited and cancelled	 	 	(23,683)	  	 	 	33.52 	  	 	 	 	 	 	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Outstanding at September 30, 2013	 	 	3,817,686 	  	 	$	34.83 	  	 	4.4 years	 	$	25,449	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
Exercisable at September 30, 2013	 	 	              3,237,644 	  	 	$	                    35.53 	  	 	3.7 years	 	$	                    19,322	  	
 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
The weighted-average grant date fair value of stock options granted during the three and nine months ended September 30, 2012 was $12.51 and $9.19, respectively. No stock options were granted during the three and nine months ended September 30, 2013. The aggregate intrinsic value (the number of in-the-money stock options multiplied by the difference between the Company’s closing stock price on the last trading day of the reporting period ($41.50) and the exercise price of the respective stock options) in the table above represents the amount that would have been received by the option holders had all option holders exercised their options on September 30, 2013. This amount changes based on the market value of the Company’s common stock. The aggregate intrinsic value of options exercised during the three months ended September 30, 2013 and 2012 was $1.5 million and $1.8 million, respectively. The aggregate intrinsic value of options exercised during the nine months ended September 30, 2013 and 2012 was $30.4 million and $2.2 million, respectively. The aggregate intrinsic value of options vested and expected to vest approximates that of the outstanding options.
The Company has also awarded restricted stock under the 2000 Plan and the 2009 Plan to its directors and employees of certain subsidiaries. The restrictions on these shares generally lapse in one-third increments on each of the first three anniversaries of the award date. Certain of the restricted stock awards granted to the Company’s senior executives contain a performance objective that must be met in addition to any vesting requirements. If the performance objective is not attained, the awards will be forfeited in their entirety. Once the performance objective has been attained, restrictions will lapse in one-third increments on each of the first three anniversaries of the award date. Notwithstanding the above-mentioned performance objectives and vesting requirements, the restrictions will lapse earlier in the event of death, disability or termination of employment by the Company for any reason other than for cause of the holder of the restricted stock, or change in control of the Company. Restricted stock awards subject to performance standards are not considered outstanding for purposes of determining earnings per share until the performance objectives have been satisfied.
 
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Restricted stock outstanding under the 2000 Plan and the 2009 Plan as of September 30, 2013, and changes during each of the three-month periods following December 31, 2012, were as follows:

 	 	            Shares             	 	 	Weighted-
Average  Grant
      Date Fair Value      	 	
Unvested at December 31, 2012	 	 	1,744,564 	  	 	$	                             30.50 	  	
Granted	 	 	786,588 	  	 	 	41.49 	  	
Vested	 	 	(913,970)	  	 	 	32.38 	  	
Forfeited	 	 	- 	  	 	 	- 	  	
 	 	 	 	 	 	 	 	 	
Unvested at March 31, 2013	 	 	1,617,182 	  	 	 	34.79 	  	
Granted	 	 	- 	  	 	 	- 	  	
Vested	 	 	(7,053)	  	 	 	28.52 	  	
Forfeited	 	 	(4,355)	  	 	 	34.47 	  	
 	 	 	 	 	 	 	 	 	
Unvested at June 30, 2013	 	 	1,605,774 	  	 	 	34.81 	  	
Granted	 	 	37,500 	  	 	 	43.44 	  	
Vested	 	 	(10,756)	  	 	 	28.24 	  	
Forfeited	 	 	(3,689)	  	 	 	34.86 	  	
 	 	 	 	 	 	 	 	 	
Unvested at September 30, 2013	 	 	                    1,628,829 	  	 	 	35.06 	  	
 	 	 	 	 	 	 	 	 	
Restricted stock units (“RSUs”) have been granted to the Company’s outside directors under the 2000 Plan and the 2009 Plan. On February 23, 2011, each of the Company’s outside directors received a grant under the 2009 Plan of 3,688 RSUs. On February 16, 2012, each of the Company’s outside directors received a grant under the 2009 Plan of 6,645 RSUs. On February 27, 2013, each of the Company’s outside directors received a grant under the 2009 Plan of 3,596 RSUs. Vesting of these shares of RSUs occurs in one-third increments on each of the first three anniversaries of the award date.
RSUs outstanding under the 2000 Plan and the 2009 Plan as of September 30, 2013, and changes during each of the three-month periods following December 31, 2012, were as follows:

 	 	            Shares             	 	 	Weighted-
Average  Grant
      Date Fair Value      	 	
Unvested at December 31, 2012	 	 	62,886 	  	 	$	                             26.72 	  	
RSUs Granted	 	 	21,576 	  	 	 	41.71 	  	
Vested	 	 	(28,926)	  	 	 	29.04 	  	
Forfeited	 	 	- 	  	 	 	- 	  	
 	 	 	 	 	 	 	 	 	
Unvested at March 31, 2013	 	 	55,536 	  	 	 	31.33 	  	
RSUs Granted	 	 	- 	  	 	 	- 	  	
Vested	 	 	- 	  	 	 	- 	  	
Forfeited	 	 	- 	  	 	 	- 	  	
 	 	 	 	 	 	 	 	 	
Unvested at June 30, 2013	 	 	55,536 	  	 	 	31.33 	  	
RSUs Granted	 	 	- 	  	 	 	- 	  	
Vested	 	 	- 	  	 	 	- 	  	
Forfeited	 	 	- 	  	 	 	- 	  	
 	 	 	 	 	 	 	 	 	
Unvested at September 30, 2013	 	 	                        55,536 	  	 	 	31.33 	  	

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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Under the Directors’ Fees Deferral Plan, the Company’s outside directors may elect to receive share equivalent units in lieu of cash for their directors’ fees. These share equivalent units are held in the plan until the director electing to receive the share equivalent units retires or otherwise terminates his/her directorship with the Company. Share equivalent units are converted to shares of common stock of the Company at the time of distribution based on the closing market price of the Company’s common stock on that date. The following table represents the amount of directors’ fees which were deferred during each of the respective periods, and the number of share equivalent units into which such directors’ fees would have converted had each of the directors who had deferred such fees retired or terminated his/her directorship with the Company as of the end of the respective periods (in thousands, except share equivalent units):

 	  	Three Months  Ended
September 30,	 	  	Nine Months Ended
September 30,	 	
 	  	          2013           	 	  	          2012           	 	  	          2013           	 	  	          2012           	 	
Directors’ fees earned and deferred into plan	  	$	33 	  	  	$	28 	  	  	$	98 	  	  	$	83 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Share equivalent units	  	 	783 	  	  	 	944 	  	  	 	2,162 	  	  	 	3,161 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
At September 30, 2013, a total of 30,231 share equivalent units were deferred in the plan with an aggregate fair value of $1.3 million, based on the closing market price of the Company’s common stock at September 30, 2013 of $41.50.
3.  COST OF REVENUE
Substantially all of the Company’s operating costs and expenses are “cost of revenue” items. Operating costs that could be classified as general and administrative by the Company would include the Company’s corporate office costs at its Franklin, Tennessee office, which were $44.8 million and $49.4 million for the three months ended September 30, 2013 and 2012, respectively, and $137.8 million and $153.6 million for the nine months ended September 30, 2013 and 2012, respectively. Included in these amounts is stock-based compensation expense of $9.5 million and $10.1 million for the three months ended September 30, 2013 and 2012, respectively, and $28.9 million and $30.7 million for the nine months ended September 30, 2013 and 2012, respectively.
4.  USE OF ESTIMATES
The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements. Actual results could differ from these estimates under different assumptions or conditions.
5.  ACQUISITIONS AND DIVESTITURES
Acquisitions
The Company accounts for all transactions that represent business combinations using the acquisition method of accounting, where the identifiable assets acquired, the liabilities assumed and any noncontrolling interest in the acquired entity are recognized and measured at their fair values on the date the Company obtains control in the acquiree. Such fair values that are not finalized for reporting periods following the acquisition date are estimated and recorded as provisional amounts. Adjustments to these provisional amounts during the measurement period (defined as the date through which all information required to identify and measure the consideration transferred, the assets acquired, the liabilities assumed and any noncontrolling interests has been obtained, limited to one year from the acquisition date) are recorded as of the date of acquisition. Any material impact to comparative information for periods after acquisition, but before the period in which adjustments are identified, is reflected in those prior periods as if the adjustments were considered as of the acquisition date. Goodwill is determined as the excess of the fair value of the consideration conveyed in the acquisition over the fair value of the net assets acquired.
 
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NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Effective July 1, 2012, one or more subsidiaries of the Company completed the acquisition of Memorial Health Systems in York, Pennsylvania. This healthcare system includes Memorial Hospital (100 licensed beds), the Surgical Center of York, and other outpatient and ancillary services. As part of this purchase agreement, the Company has agreed to spend at least $75.0 million to build a replacement hospital within five years of the closing date. The total cash consideration paid for fixed assets and working capital was approximately $45.0 million and $2.6 million, respectively, with additional consideration of $12.5 million assumed in liabilities, for a total consideration of $60.1 million. Based upon the Company’s final purchase price allocation relating to this acquisition as of September 30, 2013, approximately $10.9 million of goodwill has been recorded.
Effective March 5, 2012, one or more subsidiaries of the Company completed a merger with Diagnostic Clinic of Longview, P.A., which is a multi-specialty clinic serving residents of Longview, Texas and surrounding East Texas communities. This merger was accounted for as a purchase business combination. The total cash consideration paid for the business, including net working capital, was approximately $52.3 million, with additional consideration of $6.9 million assumed in liabilities, for a total consideration of $59.2 million. Based upon the Company’s final purchase price allocation relating to this acquisition, approximately $41.8 million of goodwill has been recorded.
Effective March 1, 2012, one or more subsidiaries of the Company completed the acquisition of MetroSouth Medical Center (330 licensed beds) located in Blue Island, Illinois. The total cash consideration paid for fixed assets was approximately $39.3 million with additional consideration of $5.8 million assumed in liabilities as well as a credit applied at closing of $0.9 million for negative acquired working capital, for a total consideration of $44.2 million. Based upon the Company’s final purchase price allocation relating to this acquisition as of September 30, 2013, no goodwill has been recorded.
Effective January 1, 2012, one or more subsidiaries of the Company completed the acquisition of Moses Taylor Healthcare System based in Scranton, Pennsylvania, which is a healthcare system comprised of two acute care hospitals and other healthcare providers. This healthcare system includes Moses Taylor Hospital (217 licensed beds) located in Scranton, Pennsylvania, and Mid-Valley Hospital (25 licensed beds) located in Peckville, Pennsylvania. The total cash consideration paid for fixed assets and working capital was approximately $151.1 million and $13.1 million, respectively, with additional consideration of $9.4 million assumed in liabilities, for a total consideration of $173.6 million. Based upon the Company’s final purchase price allocation relating to this acquisition, approximately $54.6 million of goodwill has been recorded.
Additionally, during the nine months ended September 30, 2013, the Company paid approximately $28.8 million and assumed $4.6 million of noncontrolling interests in acquiring the operating assets and related businesses of certain physician practices, home care agencies, clinics and other ancillary businesses that operate within the communities served by its hospitals. In connection with these acquisitions, the Company allocated approximately $5.9 million of the consideration paid to property and equipment, assumed $0.2 million of negative net working capital, and the remainder, approximately $28.9 million consisting of intangible assets that do not qualify for separate recognition, was allocated to goodwill. These acquisition transactions were accounted for as purchase business combinations.
Approximately $5.4 million and $2.5 million of acquisition costs related to prospective and closed acquisitions were expensed during the three months ended September 30, 2013 and 2012, respectively, and approximately $10.1 million and $9.1 million of such costs were expensed during the nine months ended September 30, 2013 and 2012, respectively, and are included in other operating expenses on the condensed consolidated statements of income. For the three and nine months ended September 30, 2013, these acquisition costs include $4.2 million and $5.3 million, respectively, of expenses related to the anticipated acquisition of Health Management Associates, Inc.
 
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6.  INCOME TAXES
The total amount of unrecognized benefit that would affect the effective tax rate, if recognized, was approximately $0.5 million as of September 30, 2013. A total of approximately $0.4 million of interest and penalties is included in the amount of the liability for uncertain tax positions at September 30, 2013. It is the Company’s policy to recognize interest and penalties related to unrecognized benefits in its condensed consolidated statements of income as income tax expense. During the nine months ended September 30, 2013, the Company decreased liabilities for uncertain tax positions by $0.4 million.
The Company, or one of its subsidiaries, files income tax returns in the United States federal jurisdiction and various state jurisdictions. The Company has extended the federal statute of limitations through December 31, 2013 for Triad Hospitals, Inc. (“Triad”) for the tax periods ended December 31, 1999, December 31, 2000, April 30, 2001, June 30, 2001, December 31, 2001, December 31, 2002, December 31, 2003, December 31, 2004, December 31, 2005, December 31, 2006 and July 25, 2007. With few exceptions, the Company is no longer subject to state income tax examinations for years prior to 2009. The Company’s federal income tax returns for the 2009 and 2010 tax years are currently under examination by the Internal Revenue Service (“IRS”). The Company believes the results of these examinations will not be material to its consolidated results of operations or consolidated financial position. During the three months ended June 30, 2013, the IRS concluded its examination of the federal tax return of Community Health Systems, Inc. for the tax periods ended December 31, 2007 and 2008. The results of these examinations did not have a material effect on the Company’s consolidated results of operations or consolidated financial position. The Company has extended the federal statute of limitations through April 30, 2014 for Community Health Systems, Inc. for the tax periods ended December 31, 2007 and 2008, and through July 18, 2014 for the tax period ended December 31, 2009.
Cash paid for income taxes, net of refunds received, resulted in net cash paid of $2.1 million and $33.4 million for the three months ended September 30, 2013 and 2012, respectively, and $72.5 million and $55.4 million during the nine months ended September 30, 2013 and 2012, respectively.
7.  GOODWILL AND OTHER INTANGIBLE ASSETS
The changes in the carrying amount of goodwill for the nine months ended September 30, 2013 are as follows (in thousands):

Balance as of December 31, 2012	  	$	4,408,138 	  	
Goodwill acquired as part of acquisitions during current year	  	 	28,878 	  	
Consideration and purchase price allocation adjustments for prior year’s acquisitions and other adjustments	  	 	244 	  	
 	  	 	 	 	
Balance as of September 30, 2013	  	$	            4,437,260 	  	
 	  	 	 	 	
Goodwill is allocated to each identified reporting unit, which is defined as an operating segment or one level below the operating segment (referred to as a component of the entity). Management has determined that the Company’s operating segments and hospital management services operations meet the criteria to be classified as reporting units. At September 30, 2013, the hospital operations reporting unit, the home care agency operations reporting unit, and the hospital management services reporting unit had approximately $4.4 billion, $43.7 million and $33.3 million, respectively, of goodwill.
 
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Goodwill is evaluated for impairment at the same time every year and when an event occurs or circumstances change that, more likely than not, reduce the fair value of the reporting unit below its carrying value. There is a two-step method for determining goodwill impairment. Step one is to compare the fair value of the reporting unit with the unit’s carrying amount, including goodwill. If this test indicates the fair value is less than the carrying value, then step two is required to compare the implied fair value of the reporting unit’s goodwill with the carrying value of the reporting unit’s goodwill. The Company performed its last annual goodwill evaluation during the fourth quarter of 2012. No impairment was indicated by this evaluation. The next annual goodwill evaluation will be performed during the fourth quarter of 2013.
The Company estimates the fair value of the related reporting units using both a discounted cash flow model as well as an EBITDA multiple model. The cash flow forecasts are adjusted by an appropriate discount rate based on the Company’s estimate of a market participant’s weighted-average cost of capital. These models are both based on the Company’s best estimate of future revenues and operating costs and are reconciled to the Company’s consolidated market capitalization, with consideration of the amount a potential acquirer would be required to pay, in the form of a control premium, in order to gain sufficient ownership to set policies, direct operations and control management decisions.
Approximately $1.1 million of intangible assets other than goodwill were acquired during the nine months ended September 30, 2013. The gross carrying amount of the Company’s other intangible assets subject to amortization was $53.8 million at September 30, 2013 and $61.9 million at December 31, 2012, and the net carrying amount was $21.7 million at September 30, 2013 and $26.3 million at December 31, 2012. The carrying amount of the Company’s other intangible assets not subject to amortization was $49.5 million at September 30, 2013 and $48.1 million at December 31, 2012. Other intangible assets are included in other assets, net on the Company’s consolidated balance sheets. Substantially all of the Company’s intangible assets are contract-based intangible assets related to operating licenses, management contracts, or non-compete agreements entered into in connection with prior acquisitions.
The weighted-average amortization period for the intangible assets subject to amortization is approximately eight years. There are no expected residual values related to these intangible assets. Amortization expense on these intangible assets was $1.4 million and $2.0 million for the three months ended September 30, 2013 and 2012, respectively, and $4.3 million and $5.7 million during the nine months ended September 30, 2013 and 2012, respectively. Amortization expense on intangible assets is estimated to be $1.3 million for the remainder of 2013, $3.7 million in 2014, $3.3 million in 2015, $2.5 million in 2016, $2.2 million in 2017, $2.0 million in 2018 and $6.7 million thereafter.
The gross carrying amount of capitalized software for internal use was approximately $878.5 million and $654.4 million at September 30, 2013 and December 31, 2012, respectively, and the net carrying amount considering accumulated amortization was approximately $488.5 million and $354.4 million at September 30, 2013 and December 31, 2012, respectively. The estimated amortization period for capitalized internal-use software is generally three years, except for capitalized costs related to significant system conversions, which is generally eight to ten years. There is no expected residual value for capitalized internal-use software. At September 30, 2013, there was approximately $156.5 million of capitalized costs for internal-use software that is currently in the development stage and will begin amortization once the software project is complete and ready for its intended use. Amortization expense on capitalized internal-use software was $34.6 million and $22.8 million for the three months ended September 30, 2013 and 2012, respectively, and $99.7 million and $64.2 million during the nine months ended September 30, 2013 and 2012, respectively. Amortization expense on capitalized internal-use software is estimated to be $34.9 million for the remainder of 2013, $148.5 million in 2014, $113.4 million in 2015, $70.7 million in 2016, $31.7 million in 2017, $25.5 million in 2018 and $63.8 million thereafter.
 
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8.  EARNINGS PER SHARE 
The following table sets forth the components of the numerator and denominator for the computation of basic and diluted earnings per share for income from continuing operations, discontinued operations and net income attributable to Community Health Systems, Inc. common stockholders (in thousands, except share data):

 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
 	  	Three Months Ended
September 30,	 	  	Nine Months Ended
September 30,	 	
 	  	         2013          	 	  	         2012          	 	  	         2013          	 	  	         2012          	 	
Numerator:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Income from continuing operations, net of taxes	  	$	21,598 	  	  	$	58,758 	  	  	$	165,006 	  	  	$	260,643 	  	
Less: Income from continuing operations attributable to noncontrolling interests, net of taxes	  	 	17,503 	  	  	 	14,525 	  	  	 	51,984 	  	  	 	57,111 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Income from continuing operations attributable to Community Health Systems, Inc. common stockholders — basic and diluted	  	$	4,095 	  	  	$	44,233 	  	  	$	113,022 	  	  	$	203,532 	  	

Loss from discontinued operations, net of taxes	  	$	- 	  	  	$	- 	  	  	$	- 	  	  	$	(466)	  	
Less: Loss from discontinued operations attributable to noncontrolling interests, net of taxes	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Loss from discontinued operations attributable to Community Health Systems, Inc. common stockholders — basic and diluted	  	$	- 	  	  	$	- 	  	  	$	- 	  	  	$	(466)	  	

Denominator:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Weighted-average number of shares outstanding — basic	  	 	93,259,027 	  	  	 	89,259,950 	  	  	 	92,384,270 	  	  	 	89,028,249 	  	
Effect of dilutive securities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Restricted stock awards	  	 	521,460 	  	  	 	449,811 	  	  	 	381,893 	  	  	 	210,418 	  	
Employee stock options	  	 	681,991 	  	  	 	280,495 	  	  	 	733,923 	  	  	 	214,082 	  	
Other equity-based awards	  	 	21,118 	  	  	 	18,857 	  	  	 	16,072 	  	  	 	12,238 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Weighted-average number of shares
outstanding — diluted	  	 	    94,483,596 	  	  	 	    90,009,113 	  	  	 	    93,516,158 	  	  	 	    89,464,987 	  	

 	  	Three Months  Ended
September 30,	 	  	Nine Months  Ended
September 30,	 	
 	  	         2013          	 	  	         2012          	 	  	         2013          	 	  	         2012          	 	
Dilutive securities outstanding not included in the computation of earnings per share because their effect is antidilutive:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Employee stock options and restricted stock awards	  	 	      - 	  	  	 	        6,529,182 	  	  	 	      - 	  	  	 	        6,776,487 	  	

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9.  STOCKHOLDERS’ EQUITY
Authorized capital shares of the Company include 400,000,000 shares of capital stock consisting of 300,000,000 shares of common stock and 100,000,000 shares of preferred stock. Each of the aforementioned classes of capital stock has a par value of $0.01 per share. Shares of preferred stock, none of which were outstanding as of September 30, 2013, may be issued in one or more series having such rights, preferences and other provisions as determined by the Board of Directors without approval by the holders of common stock.
On December 14, 2011, the Company adopted an open market repurchase program for up to 4,000,000 shares of the Company’s common stock, not to exceed $100 million in repurchases. The repurchase program will conclude at the earliest of three years from the commencement date, when the maximum number of shares has been repurchased, or when the maximum dollar amount of repurchases has been expended. During the three months ended September 30, 2013, no shares were repurchased under this program. During the nine months ended September 30, 2013, the Company repurchased and retired 706,023 shares at a weighted-average price of $38.39 per share, which is the cumulative number of shares repurchased and retired under this program. No shares were repurchased under this program during the three and nine months ended September 30, 2012.
Historically, the Company has not paid any cash dividends. In December 2012, the Company declared and paid a special dividend of $0.25 per share to holders of its common stock at the close of business as of December 17, 2012, which totaled approximately $23.0 million. In the foreseeable future, the Company does not anticipate the payment of any other cash dividends. The Company’s Credit Facility limits the Company’s ability to pay dividends and/or repurchase stock to an amount not to exceed $150 million in the aggregate plus the aggregate amount of proceeds from the exercise of stock options. The indentures governing the 8% Senior Notes due 2019 and the 7  1 / 8 % Senior Notes due 2020 (collectively, the “Senior Notes”) and the 5  1 / 8 % Senior Secured Notes due 2018 also limit the Company’s ability to pay dividends and/or repurchase stock. As of September 30, 2013, under the most restrictive test under these agreements, the Company has approximately $259.8 million remaining available with which to pay permitted dividends and/or repurchase shares of stock or its Senior Notes.
 
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The following schedule presents the reconciliation of the carrying amount of total equity, equity attributable to the Company, and equity attributable to the noncontrolling interests for the nine-month period ended September 30, 2013 (in thousands):

 	 	 	 	 	Community Health Systems, Inc. Stockholders	 	 	 	 	 	 	 	
 	 	Redeemable
Noncontrolling
Interest	 	 	Common
Stock	 	 	Additional
Paid-In
Capital	 	 	Treasury
Stock	 	 	 
Accumulated
Other
Comprehensive
Income (Loss)	 	 	Retained
Earnings	 	 	Noncontrolling
Interest	 	 	Total
Stockholders’
Equity	 	
Balance, December 31, 2012	 	$	367,666 	 	 	$	929 	 	 	$	1,138,274 	 	 	$	(6,678)	  	 	$	(145,310)	  	 	$	1,743,992 	 	 	$	65,314 	 	 	$	2,796,521 	 	
 	 	 	 	 	 	 	 	 	
Comprehensive income	 	 	34,924 	 	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	52,795 	 	 	 	113,022 	 	 	 	17,060 	 	 	 	182,877 	 	
 	 	 	 	 	 	 	 	 	
Distributions to noncontrolling interests, net of contributions	 	 	(39,041)	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(21,177)	  	 	 	(21,177)	  	
 	 	 	 	 	 	 	 	 	
Purchase of subsidiary shares from noncontrolling interests	 	 	(4,410)	  	 	 	- 	  	 	 	(804)	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(507)	  	 	 	(1,311)	  	
 	 	 	 	 	 	 	 	 	
Other reclassifications of noncontrolling interests	 	 	2,291 	 	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(2,291)	  	 	 	(2,291)	  	
 	 	 	 	 	 	 	 	 	
Noncontrolling interests in acquired entity	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	4,599 	 	 	 	4,599 	 	
 	 	 	 	 	 	 	 	 	
Adjustment to redemption value of redeemable noncontrolling interests	 	 	5,357 	 	 	 	- 	  	 	 	(5,357)	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(5,357)	  	
 	 	 	 	 	 	 	 	 	
Repurchases of common stock	 	 	- 	  	 	 	(7)	  	 	 	(27,133)	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(27,140)	  	
 	 	 	 	 	 	 	 	 	
Issuance of common stock in connection with the exercise of stock options	 	 	- 	  	 	 	32 	 	 	 	108,527 	 	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	108,559 	 	
 	 	 	 	 	 	 	 	 	
Cancellation of restricted stock for tax withholdings on vested shares	 	 	- 	  	 	 	(3)	  	 	 	(14,696)	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	(14,699)	  	
 	 	 	 	 	 	 	 	 	
Excess tax benefit from exercise of stock options	 	 	- 	  	 	 	- 	  	 	 	3,432 	 	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	3,432 	 	
 	 	 	 	 	 	 	 	 	
Share-based compensation	 	 	- 	  	 	 	8 	 	 	 	28,943 	 	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	- 	  	 	 	28,951 	 	

Balance, September 30, 2013	 	$	              366,787 	 	 	$	        959 	 	 	$	     1,231,186 	 	 	$	     (6,678)	  	 	$	      (92,515)	  	 	$	             1,857,014 	 	 	$	                62,998 	 	 	$	        3,052,964 	 	

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The following schedule discloses the effects of changes in the Company’s ownership interest in its less-than-wholly-owned subsidiaries on Community Health Systems, Inc. stockholders’ equity (in thousands):

 	  	Nine Months  Ended
September 30, 2013	 	
Net income attributable to Community Health Systems, Inc. stockholders	  	$	113,022 	  	
Transfers to the noncontrolling interests:	  	 	 	 	
Net decrease in Community Health Systems, Inc. paid-in capital for purchase of subsidiary partnership interests	  	 	(804)	  	
 	  	 	 	 	
Net transfers to the noncontrolling interests	  	 	(804)	  	
 	  	 	 	 	
Change to Community Health Systems, Inc. stockholders’ equity from net income attributable to Community Health Systems, Inc. stockholders and transfers to noncontrolling interests	  	$	                           112,218 	  	
 	  	 	 	 	
10.  EQUITY INVESTMENTS
As of September 30, 2013, the Company owned equity interests of 27.5% in four hospitals in Las Vegas, Nevada, and 26.1% in one hospital in Las Vegas, Nevada, in which Universal Health Systems, Inc. owns the majority interest, and an equity interest of 38.0% in three hospitals in Macon, Georgia, in which HCA Inc. owns the majority interest.
Summarized combined financial information for these unconsolidated entities in which the Company owns an equity interest is as follows (in thousands):

 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
 	  	Three Months  Ended
September 30,	 	  	Nine Months  Ended
September 30,	 	
 	  	2013	 	  	2012	 	  	2013	 	  	2012	 	
Revenues	  	$	            306,336 	  	  	$	            294,461 	  	  	$	            942,013 	  	  	$	            926,886 	  	
Operating costs and expenses	  	 	284,105 	  	  	 	266,012 	  	  	 	835,533 	  	  	 	817,572 	  	
Income from continuing operations before taxes	  	 	22,204 	  	  	 	28,421 	  	  	 	106,405 	  	  	 	109,238 	  	
The summarized financial information was derived from the unaudited financial information provided to the Company by those unconsolidated entities.
The Company’s investment in all of its unconsolidated affiliates was $423.2 million and $432.1 million at September 30, 2013 and December 31, 2012, respectively, and is included in other assets, net in the accompanying condensed consolidated balance sheets. Included in the Company’s results of operations is the Company’s equity in pre-tax earnings from all of its investments in unconsolidated affiliates, which was $11.6 million and $7.4 million for the three months ended September 30, 2013 and 2012, respectively, and $36.4 million and $32.6 million for the nine months ended September 30, 2013 and 2012, respectively.
 
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11.  LONG-TERM DEBT
Long-term debt consists of the following (in thousands):

 	  	  September 30, 2013  	 	  	  December 31, 2012  	 	
Credit Facility:	  	 	 	 	  	 	 	 	
Term loan A	  	$	656,250 	  	  	$	712,500 	  	
Term loan B	  	 	3,412,584 	  	  	 	3,619,062 	  	
Revolving credit loans	  	 	87,000 	  	  	 	- 	  	
8% Senior Notes due 2019	  	 	2,020,986 	  	  	 	2,022,829 	  	
7 1/8% Senior Notes due 2020	  	 	1,200,000 	  	  	 	1,200,000 	  	
5 1/8% Senior Secured Notes due 2018	  	 	1,600,000 	  	  	 	1,600,000 	  	
Receivables Facility	  	 	482,000 	  	  	 	300,000 	  	
Capital lease obligations	  	 	47,857 	  	  	 	47,951 	  	
Other	  	 	42,002 	  	  	 	38,963 	  	
 	  	 	 	 	  	 	 	 	
Total debt	  	 	9,548,679 	  	  	 	9,541,305 	  	
Less current maturities	  	 	(180,386)	  	  	 	(89,911)	  	
 	  	 	 	 	  	 	 	 	
Total long-term debt	  	$	                    9,368,293 	  	  	$	                    9,451,394 	  	
 	  	 	 	 	  	 	 	 	
Credit Facility
The Company’s wholly-owned subsidiary CHS/Community Health Systems, Inc. (“CHS”) has obtained senior secured financing under a credit facility (the “Credit Facility”) with a syndicate of financial institutions led by Credit Suisse, as administrative agent and collateral agent. The Credit Facility includes a $750 million revolving credit facility for working capital and general corporate purposes. The revolving credit facility also includes a subfacility for letters of credit and a swingline subfacility. The Credit Facility requires quarterly amortization payments of each term loan B facility equal to 0.25% of the outstanding amount of such term loans. On November 5, 2010, CHS entered into an amendment and restatement of the Credit Facility. The amendment extended by two and a half years, until January 25, 2017, the maturity date of $1.5 billion of the existing term loans under the Credit Facility and increased the pricing on these term loans to LIBOR plus 350 basis points. The amendment also increased CHS’ ability to issue additional indebtedness under the uncommitted incremental facility to $1.0 billion from $600 million, permitted CHS to issue term loan A loans under the incremental facility, and provided up to $2.0 billion of borrowing capacity from receivable transactions, an increase of $0.5 billion, of which $1.7 billion would be required to be used for repayment of existing term loans. On February 2, 2012, CHS completed a second amendment and restatement of the Credit Facility to extend an additional $1.6 billion of the term loans due 2014 under the Credit Facility to match the maturity date and interest rate margins of the term loans due January 25, 2017.
On August 3, 2012, CHS entered into Amendment No. 1 to the Credit Facility to provide increased flexibility for refinancing and repayment of the term loans due 2014 and amend certain other terms. On August 17, 2012, the Company made a prepayment of $1.6 billion on the term loans due July 25, 2014, utilizing the proceeds from the issuance of $1.6 billion of 5  1 / 8 % Senior Secured Notes due 2018. On August 22, 2012, CHS entered into a loan modification agreement with respect to the Credit Facility to extend approximately $340 million of the term loans due 2014 to match the maturity date and interest rate margins of the term loans due January 25, 2017.
 
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On November 27, 2012, CHS entered into Amendment No. 2 to the Credit Facility to provide increased flexibility for the Company to make investments and restricted payments, incur debt related to acquisitions, amend certain other terms of the Credit Facility, including the maximum leverage ratio and interest coverage ratio financial coverage levels, and add a one year 1% prepayment premium payable in connection with a repricing of the term loans due in 2017. During the nine months ended September 30, 2013, the Company paid down $206.5 million of the term loans due 2014. The July 25, 2014 maturity date of the balance of the remaining non-extended term loans at September 30, 2013 of approximately $59.6 million remains unchanged.
On August 12, 2013, CHS entered into Amendment No. 3 to the Credit Facility to provide increased flexibility for CHS to incur debt by amending certain terms of the Credit Facility, including the maximum leverage ratio and secured leverage ratio covenant levels. In addition, the amendment includes pricing protection for certain term loans due January 25, 2017, which specifies an increased margin in certain instances. The amendment also provides for a total leverage-based step-up to the applicable margin of the term loans due January 25, 2017 and the term loans due July 25, 2014. The pricing of the loans under the Credit Facility will otherwise remain unchanged.
Effective March 6, 2012, the Company obtained a new $750 million senior secured revolving credit facility (the “Replacement Revolver Facility”) and a new $750 million incremental term loan A facility (the “Incremental Term Loan”) subject to the terms and conditions set forth in the Credit Facility. The Replacement Revolver Facility replaced in full the existing revolving credit facility under the Credit Facility. The net proceeds of the Incremental Term Loan were used to repay the same amount of the existing term loans under the Credit Facility. Both the Replacement Revolver Facility and the Incremental Term Loan have a maturity date of October 25, 2016, subject to customary acceleration events and to earlier maturity if the repayment, extension or refinancing with longer maturity debt of substantially all of the Company’s then outstanding term loans maturing July 25, 2014 and the now fully redeemed 8  7 / 8 % Senior Notes does not occur by April 25, 2014. The pricing on each of the Replacement Revolver Facility and the Incremental Term Loan is initially LIBOR plus a margin of 250 basis points, subject to adjustment based on the Company’s leverage ratio. The Incremental Term Loan amortizes at 5% in year one, 10% in years two and three, 15% in year four and 60% in year five.
The term loan facility must be prepaid in an amount equal to (1) 100% of the net cash proceeds of certain asset sales and dispositions by the Company and its subsidiaries, subject to certain exceptions and reinvestment rights, (2) 100% of the net cash proceeds of issuances of certain debt obligations or receivables-based financing by the Company and its subsidiaries, subject to certain exceptions, and (3) 50%, subject to reduction to a lower percentage based on the Company’s leverage ratio (as defined in the Credit Facility generally as the ratio of total debt on the date of determination to the Company’s EBITDA, as defined, for the four quarters most recently ended prior to such date), of excess cash flow (as defined) for any year, commencing in 2008, subject to certain exceptions. Voluntary prepayments and commitment reductions are permitted in whole or in part, without any premium or penalty, subject to minimum prepayment or reduction requirements.
The obligor under the Credit Facility is CHS. All of the obligations under the Credit Facility are unconditionally guaranteed by the Company and certain of its existing and subsequently acquired or organized domestic subsidiaries. All obligations under the Credit Facility and the related guarantees are secured by a perfected first priority lien or security interest in substantially all of the assets of the Company, CHS and each subsidiary guarantor, including equity interests held by the Company, CHS or any subsidiary guarantor, but excluding, among others, the equity interests of non-significant subsidiaries, syndication subsidiaries, securitization subsidiaries and joint venture subsidiaries.
The loans under the Credit Facility bear interest on the outstanding unpaid principal amount at a rate equal to an applicable percentage plus, at CHS’ option, either (a) an Alternate Base Rate (as defined) determined by reference to the greater of (1) the Prime Rate (as defined) announced by Credit Suisse or (2) the Federal Funds Effective Rate (as defined) plus 0.50% or (3) the adjusted London Interbank Offered Rate (“LIBOR”) on such day for a three-month interest period commencing on the second business day after such day plus 1%, or (b) a reserve adjusted LIBOR for dollars (Eurodollar rate) (as defined). The applicable percentage for Alternate Base Rate loans is 1.25% for term loans due 2014 and is 2.50% for term loans due 2017. The applicable percentage for Eurodollar rate loans is 2.25% for term loans due 2014 and 3.50% for term loans due 2017. The applicable percentage for revolving loans and the Incremental Term Loan is 1.50% for Alternate Base Rate loans and 2.50% for Eurodollar loans. The applicable percentage for the loans under the Credit Facility is subject to adjustment based on the Company’s leverage ratio. Loans under the swingline subfacility bear interest at the rate applicable to Alternate Base Rate loans under the Credit Facility.
 
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CHS has agreed to pay letter of credit fees equal to the applicable percentage then in effect with respect to Eurodollar rate loans under the revolving credit facility times the maximum aggregate amount available to be drawn under all letters of credit outstanding under the subfacility for letters of credit. The issuer of any letter of credit issued under the subfacility for letters of credit will also receive a customary fronting fee and other customary processing charges. CHS is obligated to pay commitment fees of 0.50% per annum (subject to reduction based upon the Company’s leverage ratio) on the unused portion of the revolving credit facility. For purposes of this calculation, swingline loans are not treated as usage of the revolving credit facility.
The Credit Facility contains customary representations and warranties, subject to limitations and exceptions, and customary covenants restricting the Company’s and its subsidiaries’ ability, subject to certain exceptions, to, among other things (1) declare dividends, make distributions or redeem or repurchase capital stock, (2) prepay, redeem or repurchase other debt, (3) incur liens or grant negative pledges, (4) make loans and investments and enter into acquisitions and joint ventures, (5) incur additional indebtedness or provide certain guarantees, (6) make capital expenditures, (7) engage in mergers, acquisitions and asset sales, (8) conduct transactions with affiliates, (9) alter the nature of the Company’s businesses, (10) grant certain guarantees with respect to physician practices, (11) engage in sale and leaseback transactions or (12) change the Company’s fiscal year. The Company is also required to comply with specified financial covenants (consisting of a leverage ratio and an interest coverage ratio) and various affirmative covenants.
Events of default under the Credit Facility include, but are not limited to, (1) CHS’ failure to pay principal, interest, fees or other amounts under the credit agreement when due (taking into account any applicable grace period), (2) any representation or warranty proving to have been materially incorrect when made, (3) covenant defaults subject, with respect to certain covenants, to a grace period, (4) bankruptcy events, (5) a cross default to certain other debt, (6) certain undischarged judgments (not paid within an applicable grace period), (7) a change of control, (8) certain ERISA-related defaults and (9) the invalidity or impairment of specified security interests, guarantees or subordination provisions in favor of the administrative agent or lenders under the Credit Facility.
As of September 30, 2013, the availability for additional borrowings under the Credit Facility, after consideration of the $87.0 million outstanding at that date, was approximately $663.0 million pursuant to the Replacement Revolver Facility, of which $19.3 million was set aside for outstanding letters of credit. CHS has the ability to amend the Credit Facility to provide for one or more tranches of term loans in an aggregate principal amount of $1.0 billion, which CHS has not yet accessed. As of September 30, 2013, the weighted-average interest rate under the Credit Facility, excluding swaps, was 4.2%.
As of September 30, 2013, the Company had letters of credit issued, primarily in support of potential insurance-related claims and certain bonds, of approximately $19.3 million.
Subsequent to the issuance of the Company’s Quarterly Report on Form 10-Q for the quarterly period ended September 30, 2012, the Company determined that the conversion of the term loans due 2014 to extended term loans resulting from the second amendment and restatement of its Credit Facility on February 2, 2012 and the loan modification agreement on August 22, 2012 should be presented as net financing activities in the condensed consolidated statement of cash flows. Such activities were presented in the previously issued Quarterly Report on Form 10-Q for the nine months ended September 30, 2012 as a gross-up of borrowings and repayments of debt in the condensed consolidated statement of cash flows. There was no impact on net cash flows provided by financing activities as previously presented. This correction is reflected in the consolidated statement of cash flows in this Quarterly Report on Form 10-Q. Management does not believe such correction is material to the previously issued condensed consolidated financial statements.
8 7/8% Senior Notes due 2015
On July 25, 2007, CHS completed its offering of approximately $3.0 billion aggregate principal amount of 8 7/8% Senior Notes due 2015 (the “8  7 / 8 % Senior Notes”), which were issued in a private placement. The 8  7 / 8 % Senior Notes were to mature on July 15, 2015. The 8  7 / 8 % Senior Notes bore interest at the rate of 8.875% per annum, payable semiannually in arrears on January 15 and July 15, commencing January 15, 2008. Interest on the 8  7 / 8 % Senior Notes accrued from the date of original issuance. Interest was calculated on the basis of a 360-day year comprised of twelve 30-day months.
 
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Pursuant to a registration rights agreement entered into at the time of the issuance of the 8 7/8% Senior Notes, as a result of an exchange offer made by CHS, substantially all of the 8  7 / 8 % Senior Notes issued in July 2007 were exchanged in November 2007 for new notes (the “8  7 / 8 % Exchange Notes”) having terms substantially identical in all material respects to the 8  7 / 8 % Senior Notes (except that the 8  7 / 8 % Exchange Notes were issued under a registration statement pursuant to the 1933 Act). References to the 8  7 / 8 % Senior Notes shall also be deemed to include the 8  7 / 8 % Exchange Notes unless the context provides otherwise.
On March 21, 2012, CHS completed the cash tender offer for $850 million of the then $1.8 billion aggregate outstanding principal amount of the 8  7 / 8 % Senior Notes.
On July 18, 2012, CHS completed the cash tender offer for $639.7 million of the then $934.3 million aggregate outstanding principal amount of the 8  7 / 8 % Senior Notes. On August 17, 2012, pursuant to its redemption option, CHS redeemed the remaining $294.6 million outstanding principal of the 8  7 / 8 % Senior Notes.
8% Senior Notes due 2019
On November 22, 2011, CHS completed its offering of $1.0 billion aggregate principal amount of 8% Senior Notes due 2019 (the “8% Senior Notes”), which were issued in a private placement. The net proceeds from this issuance, together with available cash on hand, were used to finance the purchase of up to $1.0 billion aggregate principal amount of CHS’ then outstanding 8  7 / 8 % Senior Notes and related fees and expenses. On March 21, 2012, CHS completed the secondary offering of $1.0 billion aggregate principal amount of 8% Senior Notes, which were issued in a private placement (at a premium of 102.5%). The net proceeds from this issuance were used to finance the purchase of approximately $850 million aggregate principal amount of CHS’ then outstanding 8  7 / 8 % Senior Notes, to pay related fees and expenses and for general corporate purposes. The 8% Senior Notes bear interest at 8% per annum, payable semiannually in arrears on May 15 and November 15, commencing May 15, 2012. Interest on the 8% Senior Notes accrues from the date of original issuance. Interest is calculated on the basis of a 360-day year comprised of twelve 30-day months.
Except as set forth below, CHS is not entitled to redeem the 8% Senior Notes prior to November 15, 2015.
Prior to November 15, 2014, CHS is entitled, at its option, to redeem a portion of the 8% Senior Notes (not to exceed 35% of the outstanding principal amount) at a redemption price equal to 108% of the principal amount of the notes redeemed plus accrued and unpaid interest, with the proceeds from certain public equity offerings. Prior to November 15, 2015, CHS may redeem some or all of the 8% Senior Notes at a redemption price equal to 100% of the principal amount of the notes redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the 8% Senior Notes indenture. On and after November 15, 2015, CHS is entitled, at its option, to redeem all or a portion of the 8% Senior Notes upon not less than 30 nor more than 60 days’ notice, at the following redemption prices (expressed as a percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any, to the redemption date (subject to the right of holders of record on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the periods set forth below:

Period	  	        Redemption Price         	 	
November 15, 2015 to November 14, 2016	  	 	104.000 %    	  	
November 15, 2016 to November 14, 2017	  	 	102.000 %    	  	
November 15, 2017 to November 15, 2019	  	 	100.000 %    	  	
Pursuant to a registration rights agreement entered into at the time of the issuance of the 8% Senior Notes, as a result of an exchange offer made by CHS, substantially all of the 8% Senior Notes issued in November 2011 and March 2012 were exchanged in May 2012 for new notes (the “8% Exchange Notes”) having terms substantially identical in all material respects to the 8% Senior Notes (except that the 8% Exchange Notes were issued under a registration statement pursuant to the 1933 Act). References to the 8% Senior Notes shall also be deemed to include the 8% Exchange Notes unless the context provides otherwise.
 
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7 1/8% Senior Notes due 2020
On July 18, 2012, CHS completed an underwritten public offering under its automatic shelf registration filed with the SEC of $1.2 billion aggregate principal amount of 7  1 / 8 % Senior Notes due 2020 (the “7  1 / 8 % Senior Notes”). The net proceeds from this issuance were used to finance the purchase of $934.3 million aggregate principal amount of CHS’ outstanding 8  7 / 8 % Senior Notes and related fees and expenses and for general corporate purposes. The 7  1 / 8 % Senior Notes bear interest at 7.125% per annum, payable semiannually in arrears on July 15 and January 15, commencing January 15, 2013. Interest on the 7  1 / 8 % Senior Notes accrues from the date of original issuance. Interest is calculated on the basis of a 360-day year comprised of twelve 30-day months.
Except as set forth below, CHS is not entitled to redeem the 7 1/8% Senior Notes prior to July 15, 2016.
Prior to July 15, 2015, CHS is entitled, at its option, to redeem a portion of the 7 1/8% Senior Notes (not to exceed 35% of the outstanding principal amount) at a redemption price equal to 107.125% of the principal amount of the notes redeemed plus accrued and unpaid interest, with the proceeds from certain public equity offerings. Prior to July 15, 2016, CHS may redeem some or all of the 7  1 / 8 % Senior Notes at a redemption price equal to 100% of the principal amount of the notes redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the 7  1 / 8 % Senior Notes indenture. On and after July 15, 2016, CHS is entitled, at its option, to redeem all or a portion of the 7  1 / 8 % Senior Notes upon not less than 30 nor more than 60 days’ notice, at the following redemption prices (expressed as a percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any, to the redemption date (subject to the right of holders of record on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the periods set forth below:

Period	  	        Redemption Price         	 	
July 15, 2016 to July 14, 2017	  	 	103.563 %    	  	
July 15, 2017 to July 14, 2018	  	 	101.781 %    	  	
July 15, 2018 to July 15, 2020	  	 	100.000 %    	  	
5  1/8% Senior Secured Notes due 2018
On August 17, 2012, CHS completed an underwritten public offering under its automatic shelf registration filed with the SEC of $1.6 billion aggregate principal amount of 5  1 / 8 % Senior Secured Notes due 2018 (the “5  1 / 8 % Senior Secured Notes”). The net proceeds from this issuance, together with available cash on hand, were used to finance the prepayment of $1.6 billion of the outstanding term loans due 2014 under the Credit Facility and related fees and expenses. The 5  1 / 8 % Senior Secured Notes bear interest at 5.125% per annum, payable semiannually in arrears on August 15 and February 15, commencing February 15, 2013. Interest on the 5  1 / 8 % Senior Secured Notes accrues from the date of original issuance. Interest is calculated on the basis of a 360-day year comprised of twelve 30-day months. The 5  1 / 8 % Senior Secured Notes are secured by a first-priority lien subject to a shared lien of equal priority with certain other obligations, including obligations under the Credit Facility, and subject to prior ranking liens permitted by the indenture governing the 5  1 / 8 % Senior Secured Notes on substantially the same assets, subject to certain exceptions, that secure CHS’ obligations under the Credit Facility.
Except as set forth below, CHS is not entitled to redeem the 5 1/8% Senior Secured Notes prior to August 15, 2015.
 
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Prior to August 15, 2015, CHS is entitled, at its option, to redeem a portion of the 5 1/8% Senior Secured Notes (not to exceed 35% of the outstanding principal amount) at a redemption price equal to 105.125% of the principal amount of the notes redeemed plus accrued and unpaid interest, with the proceeds from certain public equity offerings. Prior to August 15, 2015, CHS may redeem some or all of the 5  1 / 8 % Senior Secured Notes at a redemption price equal to 100% of the principal amount of the notes redeemed plus accrued and unpaid interest, if any, plus a “make-whole” premium, as described in the 5  1 / 8 % Senior Secured Notes indenture. On and after August 15, 2015, CHS is entitled, at its option, to redeem all or a portion of the 5  1 / 8 % Senior Secured Notes upon not less than 30 nor more than 60 days’ notice, at the following redemption prices (expressed as a percentage of principal amount on the redemption date), plus accrued and unpaid interest, if any, to the redemption date (subject to the right of holders of record on the relevant record date to receive interest due on the relevant interest payment date), if redeemed during the periods set forth below:

Period	  	        Redemption Price         	 	
August 15, 2015 to August 14, 2016	  	 	102.563 %    	  	
August 15, 2016 to August 14, 2017	  	 	101.281 %    	  	
August 15, 2017 to August 15, 2018	  	 	100.000 %    	  	
Receivables Facility
On March 21, 2012, CHS and certain of its subsidiaries entered into an accounts receivable loan agreement (the “Receivables Facility”) with a group of lenders and banks, Credit Agricolé Corporate and Investment Bank, as a managing agent and as the administrative agent, and The Bank of Nova Scotia, as a managing agent. On March 7, 2013, CHS and certain of its subsidiaries amended the Receivables Facility to add an additional managing agent, The Bank of Tokyo-Mitsubishi UFJ, Ltd., to increase the size of the facility from $300 million to $500 million and to extend the scheduled termination date. Additional subsidiaries of the Company also agreed to participate in the Receivables Facility as of that date. The existing and future non-self pay patient-related accounts receivable (the “Receivables”) for certain of the Company’s hospitals serves as collateral for the outstanding borrowings under the Receivables Facility. The interest rate on the borrowings is based on the commercial paper rate plus an applicable interest rate spread. Unless earlier terminated or subsequently extended pursuant to its terms, the Receivables Facility will expire on March 21, 2015, subject to customary termination events that could cause an early termination date. The Company maintains effective control over the Receivables because, pursuant to the terms of the Receivables Facility, the Receivables are sold from certain of the Company’s subsidiaries to CHS, which then sells or contributes the Receivables to a special-purpose entity that is wholly-owned by CHS. The wholly-owned special-purpose entity in turn grants security interests in the Receivables in exchange for borrowings obtained from the group of third-party lenders and banks of up to $500 million outstanding from time to time based on the availability of eligible Receivables and other customary factors. The group of third-party lenders and banks do not have recourse to the Company or its subsidiaries beyond the assets of the wholly-owned special-purpose entity that collateralizes the loan. The Receivables and other assets of the wholly-owned special-purpose entity will be available first and foremost to satisfy the claims of the creditors of such entity. The outstanding borrowings pursuant to the Receivables Facility at September 30, 2013 totaled $482.0 million and are classified as long-term debt on the condensed consolidated balance sheet. At September 30, 2013, the carrying amount of Receivables included in the Receivables Facility totaled approximately $994.4 million and is included in patient accounts receivable on the condensed consolidated balance sheet.
Loss from Early Extinguishment of Debt
The financing transactions discussed above relating to the repayment of the Company’s term loans under the Credit Facility and the 8 7/8% Senior Notes due 2015 resulted in a loss from early extinguishment of debt of $1.3 million and $115.5 million for the nine months ended September 30, 2013 and 2012, respectively, and an after-tax loss of $0.8 million and $72.8 million for the nine months ended September 30, 2013 and 2012, respectively. The loss from early extinguishment of debt and the after-tax loss was $52.0 million and $33.2 million for the three months ended September 30, 2012, respectively. There was no loss from early extinguishment of debt during the three months ended September 30, 2013.
 
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Other Debt
As of September 30, 2013, other debt consisted primarily of the mortgage obligation on the Company’s corporate headquarters and other obligations maturing in various installments through 2020.
To limit the effect of changes in interest rates on a portion of the Company’s long-term borrowings, the Company is a party to 18 separate interest swap agreements in effect at September 30, 2013, with an aggregate notional amount of $2.4 billion. On each of these swaps, the Company receives a variable rate of interest based on the three-month LIBOR in exchange for the payment of a fixed rate of interest. The Company currently pays, on a quarterly basis, a margin above LIBOR of 225 basis points for the outstanding balance of term loans due in 2014, 250 basis points for the Replacement Revolver Facility and the Incremental Term Loan and 350 basis points for term loans due in 2017 under the Credit Facility. See Note 12 for additional information regarding these swaps.
The Company paid interest of $149.9 million and $130.4 million for the three months ended September 30, 2013 and 2012, respectively, and $446.1 million and $461.6 million on borrowings during the nine months ended September 30, 2013 and 2012, respectively.
12.  FAIR VALUE OF FINANCIAL INSTRUMENTS
The fair value of financial instruments has been estimated by the Company using available market information as of September 30, 2013 and December 31, 2012, and valuation methodologies considered appropriate. The estimates presented are not necessarily indicative of amounts the Company could realize in a current market exchange (in thousands):

 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
 	  	September 30, 2013	 	  	December 31, 2012	 	
 	  	        Carrying        
Amount	 	  	    Estimated Fair    
Value	 	  	        Carrying        
Amount	 	  	    Estimated Fair    
Value	 	
Assets:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Cash and cash equivalents	  	$	                143,605  	  	  	$	                143,605  	  	  	$	                387,813  	  	  	$	                387,813  	  	
Available-for-sale securities	  	 	61,714  	  	  	 	61,714  	  	  	 	56,376  	  	  	 	56,376  	  	
Trading securities	  	 	39,072  	  	  	 	39,072  	  	  	 	34,696  	  	  	 	34,696  	  	
Liabilities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Credit Facility	  	 	4,155,834  	  	  	 	4,157,984  	  	  	 	4,331,562  	  	  	 	4,357,910  	  	
8% Senior Notes	  	 	2,020,986  	  	  	 	2,108,800  	  	  	 	2,022,829  	  	  	 	2,185,220  	  	
7 1/8% Senior Notes	  	 	1,200,000  	  	  	 	1,216,836  	  	  	 	1,200,000  	  	  	 	1,285,848  	  	
5 1/8% Senior Secured Notes	  	 	1,600,000  	  	  	 	1,632,608  	  	  	 	1,600,000  	  	  	 	1,674,480  	  	
Receivables Facility and other debt	  	 	524,002  	  	  	 	524,002  	  	  	 	338,963  	  	  	 	338,963  	  	
The estimated fair value is determined using the methodologies discussed below in accordance with accounting standards related to the determination of fair value based on the U.S. GAAP fair value hierarchy as discussed in Note 13. The estimated fair value for financial instruments with a fair value that does not equal its carrying value is considered a Level 1 valuation. The Company utilizes the market approach and obtains indicative pricing from the administrative agent to the Credit Facility to determine fair values, which are validated through publicly available subscription services such as Bloomberg where relevant.
Cash and cash equivalents. The carrying amount approximates fair value due to the short-term maturity of these instruments (less than three months).
 
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Available-for-sale securities. Estimated fair value is based on closing price as quoted in public markets.
Trading securities. Estimated fair value is based on closing price as quoted in public markets.
Credit Facility. Estimated fair value is based on information from the Company’s bankers regarding relevant pricing for trading activity among the Company’s lending institutions.
8% Senior Notes. Estimated fair value is based on the average bid and ask price as quoted by the bank who served as underwriters in the sale of these notes.
7 1/8% Senior Notes. Estimated fair value is based on the average bid and ask price as quoted by the bank who served as underwriters in the sale of these notes.
5 1/8% Senior Secured Notes. Estimated fair value is based on the average bid and ask price as quoted by the bank who served as underwriters in the sale of these notes.
Receivables Facility and other debt. The carrying amount of the Receivables Facility and all other debt approximates fair value due to the nature of these obligations.
Interest rate swaps. The fair value of interest rate swap agreements is the amount at which they could be settled, based on estimates calculated by the Company using a discounted cash flow analysis based on observable market inputs and validated by comparison to estimates obtained from the counterparty. The Company incorporates credit valuation adjustments (“CVAs”) to appropriately reflect both its own nonperformance or credit risk and the respective counterparty’s nonperformance or credit risk in the fair value measurements. In adjusting the fair value of its interest rate swap agreements for the effect of nonperformance or credit risk, the Company has considered the impact of any netting features included in the agreements.
The Company assesses the effectiveness of its hedge instruments on a quarterly basis. For the three and nine months ended September 30, 2013 and 2012, the Company completed an assessment of the cash flow hedge instruments and determined the hedges to be highly effective. The Company has also determined that the ineffective portion of the hedges do not have a material effect on the Company’s consolidated financial position, operations or cash flows. The counterparties to the interest rate swap agreements expose the Company to credit risk in the event of nonperformance. However, at September 30, 2013, each swap agreement entered into by the Company was in a net liability position so that the Company would be required to make the net settlement payments to the counterparties; the Company does not anticipate nonperformance by those counterparties. The Company does not hold or issue derivative financial instruments for trading purposes.
 
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Interest rate swaps consisted of the following at September 30, 2013:

          Swap #           	 	  Notional Amount  
(in 000’s)	 	 	 Fixed Interest Rate 	 	 	          Termination Date           	 	 	Fair Value of
 Liability (in 000’s) 	 	
1	 	 	$                  50,000 	  	 	 	3.586 %   	  	 	 	October 23, 2013	  	 	 	 $                        103 	  	
2	 	 	50,000 	  	 	 	3.524 %   	  	 	 	October 23, 2013	  	 	 	101 	  	
3	 	 	100,000 	  	 	 	5.050 %   	  	 	 	November 30, 2013	  	 	 	783 	  	
4	 	 	200,000 	  	 	 	2.070 %   	  	 	 	December 19, 2013	  	 	 	791 	  	
5	 	 	100,000 	  	 	 	5.231 %   	  	 	 	July 25, 2014	  	 	 	4,050 	  	
6	 	 	100,000 	  	 	 	5.231 %   	  	 	 	July 25, 2014	  	 	 	4,050 	  	
7	 	 	200,000 	  	 	 	5.160 %   	  	 	 	July 25, 2014	  	 	 	7,983 	  	
8	 	 	75,000 	  	 	 	5.041 %   	  	 	 	July 25, 2014	  	 	 	2,920 	  	
9	 	 	125,000 	  	 	 	5.022 %   	  	 	 	July 25, 2014	  	 	 	4,847 	  	
10	 	 	100,000 	  	 	 	2.621 %   	  	 	 	July 25, 2014	  	 	 	1,906 	  	
11	 	 	100,000 	  	 	 	3.110 %   	  	 	 	July 25, 2014	  	 	 	2,307 	  	
12	 	 	100,000 	  	 	 	3.258 %   	  	 	 	July 25, 2014	  	 	 	2,429 	  	
13	 	 	200,000 	  	 	 	2.693 %   	  	 	 	October 26, 2014	  	 	 	5,120 	  	
14	 	 	300,000 	  	 	 	3.447 %   	  	 	 	August 8, 2016	  	 	 	23,323 	  	
15	 	 	200,000 	  	 	 	3.429 %   	  	 	 	August 19, 2016	  	 	 	15,543 	  	
16	 	 	100,000 	  	 	 	3.401 %   	  	 	 	August 19, 2016	  	 	 	7,695 	  	
17	 	 	200,000 	  	 	 	3.500 %   	  	 	 	August 30, 2016	  	 	 	16,055 	  	
18	 	 	100,000 	  	 	 	3.005 %   	  	 	 	November 30, 2016	  	 	 	6,855 	  	
The Company is exposed to certain risks relating to its ongoing business operations. The risk managed by using derivative instruments is interest rate risk. Interest rate swaps are entered into to manage interest rate fluctuation risk associated with the term loans in the Credit Facility. Companies are required to recognize all derivative instruments as either assets or liabilities at fair value in the condensed consolidated statement of financial position. The Company designates its interest rate swaps as cash flow hedges. For derivative instruments that are designated and qualify as cash flow hedges, the effective portion of the gain or loss on the derivative is reported as a component of other comprehensive income (“OCI”) and reclassified into earnings in the same period or periods during which the hedged transactions affect earnings. Gains and losses on the derivative representing either hedge ineffectiveness or hedge components excluded from the assessment of effectiveness are recognized in current earnings.
Assuming no change in September 30, 2013 interest rates, approximately $65.6 million of interest expense resulting from the spread between the fixed and floating rates defined in each interest rate swap agreement will be recognized during the next 12 months. If interest rate swaps do not remain highly effective as a cash flow hedge, the derivatives’ gains or losses resulting from the change in fair value reported through OCI will be reclassified into earnings.
 
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The following tabular disclosure provides the amount of pre-tax loss recognized as a component of OCI during the three and nine months ended September 30, 2013 and 2012 (in thousands):

 	 	Amount of Pre-Tax Loss Recognized in  OCI (Effective Portion)	 	
Derivatives in Cash Flow Hedging
Relationships	 	Three Months Ended September 30,	 	 	Nine Months Ended September 30,	 	
 	 	2013	 	 	2012	 	 	2013	 	 	2012	 	
Interest rate swaps	 	$	(8,034	) 	 	$	(20,689	) 	 	$	(4,380	) 	 	$	(65,515	) 	
The following tabular disclosure provides the location of the effective portion of the pre-tax loss reclassified from accumulated other comprehensive loss (“AOCL”) into interest expense on the condensed consolidated statements of income during the three and nine months ended September 30, 2013 and 2012 (in thousands):

 	 	Amount of Pre-Tax Loss Reclassified from  AOCL
into Income (Effective Portion)	 	
Location of Loss Reclassified from AOCL
into Income (Effective Portion)	 	Three Months Ended September 30,	 	 	Nine Months Ended September 30,	 	
 	 	2013	 	 	2012	 	 	2013	 	 	2012	 	
Interest expense, net	 	$	25,013 	  	 	$	33,606 	  	 	$	79,120 	  	 	$	110,532 	  	
The fair values of derivative instruments in the condensed consolidated balance sheets as of September 30, 2013 and December 31, 2012 were as follows (in thousands):

 	  	Asset Derivatives	 	  	Liability Derivatives	 	
 	  	     September 30, 2013     	 	  	     December 31, 2012     	 	  	     September 30, 2013     	 	  	     December 31, 2012     	 	
 	  	Balance
Sheet
  Location  	 	Fair Value	 	  	Balance
Sheet
  Location  	 	Fair Value	 	  	Balance
Sheet
  Location  	 	Fair Value	 	  	Balance
Sheet
  Location  	 	Fair Value	 	
 
Derivatives designated as hedging instruments	  	Other
assets, net	 	$	                -    	  	  	Other
assets, net	 	$	                -    	  	  	 
Other long-
term
liabilities	 	$	     106,861    	  	  	 
Other long-
term
liabilities	 	$	     181,600    	  	
13.  FAIR VALUE
Fair Value Hierarchy
Fair value is a market-based measurement, not an entity-specific measurement. Therefore, a fair value measurement should be determined based on the assumptions that market participants would use in pricing the asset or liability. As a basis for considering market participant assumptions in fair value measurements, the Company utilizes the U.S. GAAP fair value hierarchy that distinguishes between market participant assumptions based on market data obtained from sources independent of the reporting entity (observable inputs that are classified within Levels 1 and 2 of the hierarchy) and the reporting entity’s own assumption about market participant assumptions (unobservable inputs classified within Level 3 of the hierarchy).
 
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The inputs used to measure fair value are classified into the following fair value hierarchy:

Level 1:	  	Quoted market prices in active markets for identical assets or liabilities.	
 	 	
Level 2:	  	Observable market-based inputs or unobservable inputs that are corroborated by market data.	
 	 	
Level 3:	  	Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities. Level 3 includes values determined using pricing models, discounted cash flow methodologies, or similar techniques reflecting the Company’s own assumptions.	
In instances where the determination of the fair value hierarchy measurement is based on inputs from different levels of the fair value hierarchy, the level in the fair value hierarchy within which the entire fair value measurement falls is based on the lowest level input that is significant to the fair value measurement in its entirety. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment of factors specific to the asset or liability.
The following table sets forth, by level within the fair value hierarchy, the financial assets and liabilities recorded at fair value on a recurring basis as of September 30, 2013 and December 31, 2012 (in thousands):

 	  	  September 30,  
2013	 	  	        Level 1        	 	  	        Level 2        	 	  	        Level 3        	 	
Available-for-sale securities	  	$	61,714 	  	  	$	61,714 	  	  	$	- 	  	  	$	- 	  	
Trading securities	  	 	39,072 	  	  	 	39,072 	  	  	 	- 	  	  	 	- 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total assets	  	$	100,786 	  	  	$	100,786 	  	  	$	- 	  	  	$	- 	  	

Fair value of interest rate swap agreements	  	$	106,861 	  	  	$	- 	  	  	$	106,861 	  	  	$	- 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total liabilities	  	$	106,861 	  	  	$	- 	  	  	$	106,861 	  	  	$	- 	  	

 	  	December 31,
2012	 	  	Level 1	 	  	Level 2	 	  	Level 3	 	
Available-for-sale securities	  	$	56,376 	  	  	$	56,376 	  	  	$	- 	  	  	$	- 	  	
Trading securities	  	 	34,696 	  	  	 	34,696 	  	  	 	- 	  	  	 	- 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total assets	  	$	91,072 	  	  	$	91,072 	  	  	$	- 	  	  	$	- 	  	

Fair value of interest rate swap agreements	  	$	181,600 	  	  	$	- 	  	  	$	181,600 	  	  	$	- 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total liabilities	  	$	181,600 	  	  	$	- 	  	  	$	181,600 	  	  	$	- 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Available-for-sale securities and trading securities classified as Level 1 are measured using quoted market prices.
The valuation of the Company’s interest rate swap agreements is determined using market valuation techniques, including discounted cash flow analysis on the expected cash flows of each agreement. This analysis reflects the contractual terms of the agreement, including the period to maturity, and uses observable market-based inputs, including forward interest rate curves. The fair value of interest rate swap agreements are determined by netting the discounted future fixed cash payments and the discounted expected variable cash receipts. The variable cash receipts are based on the expectation of future interest rates based on observable market forward interest rate curves and the notional amount being hedged.
 
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The Company incorporates CVAs to appropriately reflect both its own nonperformance or credit risk and the respective counterparty’s nonperformance or credit risk in the fair value measurements. In adjusting the fair value of its interest rate swap agreements for the effect of nonperformance or credit risk, the Company has considered the impact of any netting features included in the agreements. The CVA on the Company’s interest rate swap agreements at September 30, 2013 resulted in a decrease in the fair value of the related liability of $1.7 million and an after-tax adjustment of $1.1 million to OCI. The CVA on the Company’s interest rate swap agreements at December 31, 2012 resulted in a decrease in the fair value of the related liability of $3.6 million and an after-tax adjustment of $2.3 million to OCI.
The majority of the inputs used to value its interest rate swap agreements, including the forward interest rate curves and market perceptions of the Company’s credit risk used in the CVAs, are observable inputs available to a market participant. As a result, the Company has determined that the interest rate swap valuations are classified in Level 2 of the fair value hierarchy.
14.  OTHER COMPREHENSIVE INCOME
The following tables present information about items reclassified out of accumulated other comprehensive income (loss) by component for the three and nine months ended September 30, 2013 (in thousands, net of tax):

 	  	Change in Fair
Value of Interest
Rate Swaps	 	  	Change in Fair
Value of Available
for Sale Securities	 	  	Change in
Unrecognized
Pension Cost
Components	 	  	Accumulated Other
Comprehensive
Income (Loss)	 	
Balance as of June 30, 2013	  	 $	(79,473)	  	  	 $	6,258	  	  	 $	(32,052)	  	  	 $	(105,267)	  	
Other comprehensive (loss) income before reclassifications	  	 	(5,134)	  	  	 	1,171 	  	  	 	- 	  	  	 	(3,963)	  	
Amounts reclassified from accumulated other comprehensive income (loss)	  	 	15,984 	  	  	 	- 	  	  	 	731 	  	  	 	16,715 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Net current-period other comprehensive income	  	 	10,850 	  	  	 	1,171	  	  	 	731 	  	  	 	12,752 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Balance as of September 30, 2013	  	 $	(68,623)	  	  	 $	7,429 	  	  	 $	(31,321)	  	  	 $	(92,515)	  	

 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
 	  	Change in Fair
Value of Interest
Rate Swaps	 	  	Change in Fair
Value of Available
for Sale Securities	 	  	Change in
Unrecognized
Pension Cost
Components	 	  	Accumulated Other
Comprehensive
Income (Loss)	 	
Balance as of December 31, 2012	  	 $	(116,382)	  	  	 $	4,588 	  	  	 $	(33,516)	  	  	 $	(145,310)	  	
Other comprehensive (loss) income before reclassifications	  	 	(2,798)	  	  	 	2,841 	  	  	 	- 	  	  	 	43 	  	
Amounts reclassified from accumulated other comprehensive income (loss)	  	 	50,557 	  	  	 	- 	  	  	 	2,195 	  	  	 	52,752 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Net current-period other comprehensive income	  	 	47,759 	  	  	 	2,841 	  	  	 	2,195 	  	  	 	52,795 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Balance as of September 30, 2013	  	 $	(68,623)	  	  	 $	7,429 	  	  	 $	(31,321)	  	  	 $	(92,515)	  	

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The following table presents a subtotal for each significant reclassification to net income out of accumulated other comprehensive income (loss) and the line item affected in the condensed consolidated statement of income during the three and nine months ended September 30, 2013 (in thousands):

 	 	Amount Reclassified from AOCL	 	 	Affected line item in  the
statement where net
income is presented	
Details about accumulated other comprehensive
income (loss) components	 	Three Months Ended
September 30, 2013	 	 	Nine Months Ended
September 30, 2013	 	 	 	
Gains and losses on cash flow hedges	 	 	 	 	 	 	 	 	 	 	
Interest rate swaps	 	$	(25,013	) 	 	$	(79,120	) 	 	Interest expense, net	
 	 	 	9,029 	  	 	 	28,563 	  	 	Tax benefit	
 	 	 	 	 	 	 	 	 	 	 	
 	 	$	(15,984	) 	 	$	(50,557	) 	 	Net of tax	

Amortization of defined benefit pension items	 	 	 	 	 	 	 	 	 	 	
Prior service costs	 	$	(286	) 	 	$	(858	) 	 	Salaries and benefits	
Actuarial losses	 	 	(879	) 	 	 	(2,637	) 	 	Salaries and benefits	
 	 	 	 	 	 	 	 	 	 	 	
 	 	 	(1,165	) 	 	 	(3,495	) 	 	Total before tax	
 	 	 	434 	  	 	 	1,300 	  	 	Tax benefit	
 	 	 	 	 	 	 	 	 	 	 	
 	 	$	(731	) 	 	$	(2,195	) 	 	Net of tax	
 	 	 	 	 	 	 	 	 	 	 	
15.  SEGMENT INFORMATION
Prior to the quarter ended March 31, 2013, the Company operated in three distinct operating segments, represented by hospital operations (which includes its general acute care hospitals and related healthcare entities that provide inpatient and outpatient healthcare services), home care agency operations (which provide in-home outpatient care), and hospital management services (which provides executive management and consulting services to non-affiliated acute care hospitals). During the quarter ended March 31, 2013, the chief operating decision maker stopped receiving discrete financial information for the hospital management services, so it no longer meets the criteria as a separate operating segment. The Company operates in two operating segments, hospital operations and home care agency operations. Financial information for hospital management services is now presented as a component of the hospital operations segment. The financial information from prior years has been revised to reflect the change in the composition of the Company’s operating segments. Consistent with 2012, the Company presents two reportable segments, as noted below.
Only the hospital operations segment meets the criteria as a separate reportable segment. The financial information for the home care agency segment does not meet the quantitative thresholds for a separate identifiable reportable segment and is combined into the corporate and all other reportable segment.
 
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The distribution between reportable segments of the Company’s net operating revenues and income from continuing operations before income taxes is summarized in the following tables (in thousands):

 	  	Three Months Ended
September 30,	 	  	Nine Months Ended
September 30,	 	
 	  	2013	 	  	2012	 	  	2013	 	  	2012	 	
Net operating revenues:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Hospital operations	  	$	3,170,427 	  	  	$	3,169,622 	  	  	$	9,629,555 	  	  	$	9,625,299 	  	
Corporate and all other	  	 	47,804 	  	  	 	42,408 	  	  	 	136,817 	  	  	 	126,740 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total	  	$	    3,218,231 	  	  	$	    3,212,030 	  	  	$	    9,766,372 	  	  	$	    9,752,039 	  	

Income from continuing operations before income taxes:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Hospital operations	  	$	84,104 	  	  	$	143,474 	  	  	$	405,832 	  	  	$	560,032 	  	
Corporate and all other	  	 	(59,064)	  	  	 	(59,016)	  	  	 	(172,196)	  	  	 	(178,351)	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Total	  	$	25,040 	  	  	$	84,458 	  	  	$	233,636 	  	  	$	381,681 	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
16.  CONTINGENCIES
The Company is a party to various legal proceedings incidental to its business. In the opinion of management, any ultimate liability with respect to these actions will not have a material adverse effect on the Company’s consolidated financial position, cash flows or results of operations. With respect to all litigation matters, the Company considers the likelihood of a negative outcome. If the Company determines the likelihood of a negative outcome is probable and the amount of the loss can be reasonably estimated, the Company records an estimated loss for the expected outcome of the litigation and discloses that fact together with the amount accrued, if it was estimable. If the likelihood of a negative outcome is reasonably possible and the Company is able to determine an estimate of the possible loss or a range of loss, the Company discloses that fact together with the estimate of the possible loss or range of loss. However, it is difficult to predict the outcome or estimate a possible loss or range of loss in some instances because litigation is subject to significant uncertainties.
Reasonably Possible Contingencies
For the legal matter below, the Company believes that a negative outcome is reasonably possible, but the Company is unable to determine an estimate of the possible loss or a range of loss.
U.S. ex rel. Baker vs. Community Health Systems, Inc. (United States District Court for the District of New Mexico)
The Company’s knowledge of this matter originated in early 2006 with correspondence from the Civil Division of the Department of Justice requesting documents in an investigation it was conducting involving the Company. The inquiry related to the way in which different state Medicaid programs apply to the federal government for matching or supplemental funds that are ultimately used to pay for a small portion of the services provided to Medicaid and indigent patients. These programs are referred to by different names, including “intergovernmental payments,” “upper payment limit programs,” and “Medicaid disproportionate share hospital payments.” For approximately three years, the Company provided the Department of Justice with requested documents, met with its personnel on numerous occasions and otherwise cooperated in its investigation. During the course of the investigation, the Civil Division notified the Company that it believed that the Company and three of its New Mexico hospitals caused the State of New Mexico to submit improper claims for federal funds, in violation of the Federal False Claims Act. This investigation has culminated in the federal government’s intervention in the referenced qui tam lawsuit, which alleges that the Company’s New Mexico hospitals “caused to be filed” false claims from the period of August 2000 through June 2011. Two of the parent company’s subsidiaries are also defendants in this lawsuit. The Company continues to vigorously defend this action. The current posture of this case is that discovery is closed and both parties’ motions for summary judgment are pending. There is currently no hearing date on these motions and no trial date has been set.
 
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Probable Contingencies
Department of Justice Investigation of Medicare Short-Stay Admissions from Emergency Departments
In April 2011, the Company received a document subpoena from the United States Department of Health and Human Services (“OIG”) in connection with an investigation of possible improper claims submitted to Medicare and Medicaid. The subpoena was directed to all of the Company’s hospitals and requested documents concerning emergency department processes and procedures, including the hospitals’ use of the Pro-MED Clinical Information System, a third-party software system that assists with the management of patient care and provides operational support and data collection for emergency department management. The subpoena also sought information about the Company’s relationships with emergency department physicians, including financial arrangements. This investigation is being led by the Department of Justice. The Company is continuing to cooperate with the government with the ongoing document production, as well as conducting a joint medical necessity review of a sampling of medical records at a small number of hospitals. In 2013, the Company has met with the government twice to review and discuss the investigation. On July 9, 2013, shortly after a second meeting with the government, the Company was served with an additional document subpoena, as well as civil investigative demands to interview two of the Company’s current executives. In further discussions with the government, these additional requests do not reflect an expansion of the pending investigation. The Company will continue to cooperate with the government in their investigative efforts.
We are currently in negotiations with the Department of Justice about resolving its claims in connection with the Department’s investigation into the Company’s short stay hospital admissions for the years 2005-2010, as well as their investigation at our hospital in Laredo, Texas. Based on those negotiations, which are not final, we believe that a reserve of $98 million is sufficient to cover the federal government’s claims for Medicare admissions (including the claims described in the Legal Proceedings section in Part II Item 1 of this Form 10-Q related to United States ex rel. and Reuille vs. Community Health Systems Professional Services Corporation and Lutheran Musculoskeletal Center, LLC d/b/a Lutheran Hospital (United States District Court for the Northern District of Indiana, Fort Wayne Division) and the May 2011 subpoena identified as “Shelbyville, Tennessee OIG Subpoena”), certain claims specifically related to our hospital in Laredo, Texas, and on other related legal expenses. This reserve is not meant to include claims in this investigation arising from Tricare, Medicaid, or third party legal expense (including, without limitation, the matter identified in the Legal Proceedings section in Part II Item 1 of this Form 10-Q as “Texas Attorney General Investigation of Emergency Department Procedures and Billing”).
There are a number of other legal matters for which, based on information currently available, the Company believes that a negative outcome is known or is probable. In the aggregate, including the matter above, an estimate of these losses has been accrued in the amount of $112.2 million and $22.6 million at September 30, 2013 and December 31, 2012, respectively, and is included in accrued liabilities in the accompanying condensed consolidated balance sheets. Due to the uncertainties and difficulty in predicting the ultimate resolution of these contingencies, the actual amount could differ from the estimated amount; however, the Company does not believe a change in estimate for any of these matters would be material.
Matters for which an Outcome Cannot be Assessed
For all of the legal matters below, the Company cannot at this time assess what the outcome may be and is further unable to determine any estimate of loss or range of loss. Because the investigations are at a preliminary stage, there are not sufficient facts available to make these assessments.
 
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Multi-provider National Department of Justice Investigations
Implantable Cardioverter Defibrillators (“ICDs”). The Company was first made aware of this investigation in September 2010, when the Company received a letter from the Civil Division of the United States Department of Justice. The letter advised the Company that an investigation was being conducted to determine whether certain hospitals have improperly submitted claims for payment for ICDs. The period of time covered by the investigation was 2003 to 2010. The Company continues to fully cooperate with the government in this investigation and has provided requested records and documents. On August 30, 2012, the Department of Justice issued a document entitled, “Medical Review Guidelines/Resolution Model,” which sets out, for the purposes of this investigation, the patient conditions and criteria for the medical necessity of the implantation of ICDs in Medicare beneficiaries and how the Department of Justice will enforce the repayment obligations of hospitals. The Company is in the process of reviewing its medical records in light of the guidance contained in this document.
Investigations and Litigation Related to the Department of Justice Investigation of Medicare Short-Stay Admissions from Emergency Departments
SEC Subpoena. In May 2011, the Company received a subpoena from the SEC requesting documents related to or requested in connection with the various inquiries, lawsuits and investigations regarding, generally, emergency room admissions or observation practices at the Company’s hospitals. The subpoena also requested documents relied upon by the Company in responding to the Tenet litigation, as well as other communications about the Tenet litigation. As with all government investigations, the Company is cooperating fully with the SEC.
Class Action Shareholder Federal Securities Cases. Three purported class action cases have been filed in the United States District Court for the Middle District of Tennessee; namely, Norfolk County Retirement System v. Community Health Systems, Inc., et al., filed May 9, 2011; De Zheng v. Community Health Systems, Inc., et al., filed May 12, 2011; and Minneapolis Firefighters Relief Association v. Community Health Systems, Inc., et al., filed June 21, 2011. All three seek class certification on behalf of purchasers of the Company’s common stock between July 27, 2006 and April 11, 2011 and allege that misleading statements resulted in artificially inflated prices for the Company’s common stock. In December 2011, the cases were consolidated for pretrial purposes and NYC Funds and its counsel were selected as lead plaintiffs/lead plaintiffs’ counsel. The Company’s motion to dismiss this case has been fully briefed and is pending before the court. The Company believes this consolidated matter is without merit and will vigorously defend this case.
Shareholder Derivative Actions. Three purported shareholder derivative actions have also been filed in the United States District Court for the Middle District of Tennessee; Plumbers and Pipefitters Local Union No. 630 Pension Annuity Trust Fund v. Wayne T. Smith, et al., filed May 24, 2011; Roofers Local No. 149 Pension Fund v. Wayne T. Smith, et al., filed June 21, 2011; and Lambert Sweat v. Wayne T. Smith, et al., filed October 5, 2011. These three cases allege breach of fiduciary duty arising out of allegedly improper inpatient admission practices, mismanagement, waste and unjust enrichment. These cases have been consolidated into a single, consolidated action. The plaintiffs filed an operative amended derivative complaint in these three consolidated actions on March 15, 2012. The Company’s motion to dismiss was argued on June 13, 2013. On September 27, 2013, the court issued an order granting in part and denying in part the Company’s motion to dismiss. On October 14, 2013, the Company filed for a Motion for Reconsideration of the Order Granting in Part and Denying in Part the Motion to Dismiss, a Motion to Stay Discovery, and an unopposed Motion for Extension of Time to File an Answer. The Company believes all of the plaintiffs’ claims are without merit and will vigorously defend them.
The Company incurred the following pre-tax charges in connection with the government investigations and shareholder lawsuits of possible improper claims submitted to Medicare and Medicaid during the three and nine months ended September 30, 2013 and 2012 (in thousands):

 	 	 	  	          Three Months Ended           
September 30,	 	  	          Nine Months Ended           
September 30,	 	
 	 	 	  	        2013        	 	 	 	  	        2012        	 	  	        2013        	 	 	 	  	        2012        	 	
Professional fees and other related costs	 	 	  	$	            99,979 	  	 	 	  	$	                1,558 	  	  	$	            104,412 	  	 	 	  	$	                3,006 	  	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
17.  SUBSEQUENT EVENTS
Except for the events disclosed in Note 16 related to the Company’s negotiations with the Department of Justice in connection with its investigation of Medicare short stay admissions, the Company evaluated all material events occurring subsequent to the balance sheet date noting no events requiring disclosure or recognition in the condensed consolidated financial statements.
18.  SUPPLEMENTAL CONDENSED CONSOLIDATING FINANCIAL INFORMATION
The Senior Notes, which are senior unsecured obligations of CHS, and the 5 1/8% Senior Secured Notes are guaranteed on a senior basis by the Company and by certain of its existing and subsequently acquired or organized 100% owned domestic subsidiaries. The Senior Notes and the 5  1 / 8 % Senior Secured Notes are fully and unconditionally guaranteed on a joint and several basis, with exceptions considered customary for such guarantees, limited to the release of the guarantee when a subsidiary guarantor’s capital stock is sold, or a sale of all of the subsidiary guarantor’s assets used in operations. The following condensed consolidating financial statements present Community Health Systems, Inc. (as parent guarantor), CHS (as the issuer), the subsidiary guarantors, the subsidiary non-guarantors and eliminations. These condensed consolidating financial statements have been prepared and presented in accordance with SEC Regulation S-X Rule 3-10 “Financial Statements of Guarantors and Issuers of Guaranteed Securities Registered or Being Registered.”
The accounting policies used in the preparation of this financial information are consistent with those elsewhere in the condensed consolidated financial statements of the Company, except as noted below:
 
 	•	 	Intercompany receivables and payables are presented gross in the supplemental condensed consolidating balance sheets.	
 
 	•	 	Cash flows from intercompany transactions are presented in cash flows from financing activities, as changes in intercompany balances with affiliates, net.	
 
 	•	 	Income tax expense is allocated from the parent guarantor to the income producing operations (other guarantors and non-guarantors) and the issuer through stockholders’ equity. As this approach represents an allocation, the income tax expense allocation is considered non-cash for statement of cash flow purposes.	
 
 	•	 	Interest expense, net has been presented to reflect net interest expense and interest income from outstanding long-term debt and intercompany balances.	
The Company’s intercompany activity consists primarily of daily cash transfers for purposes of cash management, the allocation of certain expenses and expenditures paid for by the parent on behalf of its subsidiaries, and the push down of investment in its subsidiaries. This activity also includes the intercompany transactions between consolidated entities as part of the Receivables Facility that is further discussed in Note 11. The Company’s subsidiaries generally do not purchase services from one another; thus, the intercompany transactions do not represent revenue generating transactions. All intercompany transactions eliminate in consolidation.
From time to time, the Company sells and/or repurchases noncontrolling interests in consolidated subsidiaries, which may change subsidiaries between guarantors and non-guarantors. Amounts for prior periods are revised to reflect the status of guarantors or non-guarantors as of September 30, 2013.
 
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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Balance Sheet
September 30, 2013

 	  	Parent
     Guarantor    	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
  Guarantors  	 	  	  Eliminations  	 	  	 Consolidated 	 	
 	  	(In thousands)	 	
 	
ASSETS	  	
 	 	 	 	 	 	 	
Current assets:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Cash and cash equivalents	  	  $	- 	  	  	  $	- 	  	  	  $	16,995 	 	  	  $	126,610 	 	  	  $	- 	  	  	  $	143,605 	 	
 	 	 	 	 	 	 	
Patient accounts receivable, net of allowance for doubtful accounts	  	 	- 	  	  	 	- 	  	  	 	855,534 	 	  	 	1,443,085 	 	  	 	- 	  	  	 	2,298,619 	 	
 	 	 	 	 	 	 	
Supplies	  	 	- 	  	  	 	- 	  	  	 	259,939 	 	  	 	117,970 	 	  	 	- 	  	  	 	377,909 	 	
 	 	 	 	 	 	 	
Prepaid income taxes	  	 	26,730 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	26,730 	 	
 	 	 	 	 	 	 	
Deferred income taxes	  	 	117,045 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	117,045 	 	
 	 	 	 	 	 	 	
Prepaid expenses and taxes	  	 	- 	  	  	 	160 	 	  	 	117,535 	 	  	 	31,067 	 	  	 	- 	  	  	 	148,762 	 	
 	 	 	 	 	 	 	
Other current assets	  	 	- 	  	  	 	- 	  	  	 	254,263 	 	  	 	79,349 	 	  	 	- 	  	  	 	333,612 	 	

Total current assets	  	 	143,775 	 	  	 	160 	 	  	 	1,504,266 	 	  	 	1,798,081 	 	  	 	- 	  	  	 	3,446,282 	 	

Intercompany receivable	  	 	518,789 	  	  	 	9,629,656 	 	  	 	4,573,210 	 	  	 	3,643,775 	 	  	 	(18,365,430)	  	  	 	- 	  	

Property and equipment, net	  	 	- 	  	  	 	- 	  	  	 	4,662,040 	 	  	 	2,406,521 	 	  	 	- 	  	  	 	7,068,561 	 	

Goodwill	  	 	- 	  	  	 	- 	  	  	 	2,547,402 	 	  	 	1,889,858 	 	  	 	- 	  	  	 	4,437,260 	 	

Other assets, net	  	 	- 	  	  	 	152,731 	 	  	 	1,314,567 	 	  	 	797,202 	 	  	 	(494,360)	  	  	 	1,770,140 	 	

Net investment in subsidiaries	  	 	3,140,780 	  	  	 	9,049,963 	  	  	 	3,862,410 	 	  	 	- 	  	  	 	(16,053,153)	  	  	 	- 	  	

Total assets	  	  $	3,803,344 	 	  	  $	18,832,510 	  	  	  $	18,463,895 	 	  	  $	10,535,437 	 	  	  $	(34,912,943)	  	  	  $	16,722,243 	 	

LIABILITIES AND EQUITY	  	
 	 	 	 	 	 	 	
Current liabilities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Current maturities of long-term debt	  	  $	- 	  	  	  $	161,020 	 	  	  $	17,001 	 	  	  $	2,365 	 	  	  $	- 	  	  	  $	180,386 	 	
 	 	 	 	 	 	 	
Accounts payable	  	 	- 	  	  	 	11 	 	  	 	563,886 	 	  	 	179,879 	 	  	 	- 	  	  	 	743,776 	 	
 	 	 	 	 	 	 	
Accrued interest	  	 	- 	  	  	 	106,926 	 	  	 	120 	 	  	 	417 	 	  	 	- 	  	  	 	107,463 	 	
 	 	 	 	 	 	 	
Accrued liabilities	  	 	4,178 	 	  	 	- 	  	  	 	769,703 	 	  	 	304,001 	 	  	 	- 	  	  	 	1,077,882 	 	

Total current liabilities	  	 	4,178 	 	  	 	267,957 	 	  	 	1,350,710 	 	  	 	486,662 	 	  	 	- 	  	  	 	2,109,507 	 	

Long-term debt	  	 	- 	  	  	 	8,816,478 	 	  	 	52,220 	 	  	 	499,595 	 	  	 	- 	  	  	 	9,368,293 	 	

Intercompany payable	  	 	- 	  	  	 	6,006,078 	  	  	 	12,797,953 	  	  	 	8,220,831 	 	  	 	(27,024,862)	  	  	 	- 	  	

Deferred income taxes	  	 	808,489 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	808,489 	 	

Other long-term liabilities	  	 	711 	 	  	 	601,220 	 	  	 	694,607 	 	  	 	214,025 	 	  	 	(494,360)	  	  	 	1,016,203 	 	

Total liabilities	  	 	813,378 	 	  	 	15,691,733 	  	  	 	14,895,490 	  	  	 	9,421,113 	 	  	 	(27,519,222)	  	  	 	13,302,492 	 	
 	 	 	 	 	 	 	
Redeemable noncontrolling interests in equity of consolidated subsidiaries	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	366,787 	 	  	 	- 	  	  	 	366,787 	 	

Equity:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Community Health Systems, Inc. stockholders’ equity:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Preferred stock	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Common stock	  	 	959 	 	  	 	- 	  	  	 	1 	 	  	 	2 	 	  	 	(3)	  	  	 	959 	 	
 	 	 	 	 	 	 	
Additional paid-in capital	  	 	1,231,186 	 	  	 	1,138,420 	  	  	 	1,267,786 	  	  	 	549,584 	 	  	 	(2,955,790)	  	  	 	1,231,186 	 	
 	 	 	 	 	 	 	
Treasury stock, at cost	  	 	(6,678)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(6,678)	  	
 	 	 	 	 	 	 	
Accumulated other comprehensive (loss) income	  	 	(92,515)	  	  	 	(92,515)	  	  	 	(23,891)	  	  	 	- 	  	  	 	116,406 	 	  	 	(92,515)	  	
 	 	 	 	 	 	 	
Retained earnings	  	 	1,857,014 	 	  	 	2,094,872 	  	  	 	2,324,509 	  	  	 	134,953 	 	  	 	(4,554,334)	  	  	 	1,857,014 	 	

Total Community Health Systems, Inc. stockholders’ equity	  	 	2,989,966 	 	  	 	3,140,777 	 	  	 	3,568,405 	  	  	 	684,539 	 	  	 	(7,393,721)	  	  	 	2,989,966 	 	
 	 	 	 	 	 	 	
Noncontrolling interests in equity of consolidated subsidiaries	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	62,998 	 	  	 	- 	  	  	 	62,998 	 	

Total equity	  	 	2,989,966 	 	  	 	3,140,777 	 	  	 	3,568,405 	  	  	 	747,537 	 	  	 	(7,393,721)	  	  	 	3,052,964 	 	

Total liabilities and equity	  	  $	3,803,344 	 	  	  $	18,832,510 	  	  	  $	18,463,895 	 	  	  $	10,535,437 	 	  	  $	(34,912,943)	  	  	  $	16,722,243 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Balance Sheet
December 31, 2012

 	  	Parent
     Guarantor    	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
  Guarantors  	 	  	  Eliminations  	 	  	 Consolidated 	 	
 	  	(In thousands)	 	
 	
ASSETS	  	
 	 	 	 	 	 	 	
Current assets:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Cash and cash equivalents	  	  $	- 	  	  	  $	- 	  	  	  $	271,559 	 	  	  $	116,254 	 	  	  $	- 	  	  	  $	387,813 	 	
 	 	 	 	 	 	 	
Patient accounts receivable, net of allowance for doubtful accounts	  	 	- 	  	  	 	- 	  	  	 	676,649 	 	  	 	1,390,730 	 	  	 	- 	  	  	 	2,067,379 	 	
 	 	 	 	 	 	 	
Supplies	  	 	- 	  	  	 	- 	  	  	 	254,853 	 	  	 	113,319 	 	  	 	- 	  	  	 	368,172 	 	
 	 	 	 	 	 	 	
Prepaid income taxes	  	 	49,888 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	49,888 	 	
 	 	 	 	 	 	 	
Deferred income taxes	  	 	117,045 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	117,045 	 	
 	 	 	 	 	 	 	
Prepaid expenses and taxes	  	 	- 	  	  	 	115 	 	  	 	86,628 	 	  	 	39,818 	 	  	 	- 	  	  	 	126,561 	 	
 	 	 	 	 	 	 	
Other current assets	  	 	- 	  	  	 	- 	  	  	 	222,424 	 	  	 	79,860 	 	  	 	- 	  	  	 	302,284 	 	

Total current assets	  	 	166,933 	 	  	 	115 	 	  	 	1,512,113 	 	  	 	1,739,981 	 	  	 	- 	  	  	 	3,419,142 	 	

Intercompany receivable	  	 	406,534 	 	  	 	9,837,904 	 	  	 	3,723,120 	 	  	 	3,262,823 	 	  	 	(17,230,381)	  	  	 	- 	  	

Property and equipment, net	  	 	- 	  	  	 	- 	  	  	 	4,660,557 	 	  	 	2,491,316 	 	  	 	- 	  	  	 	7,151,873 	 	

Goodwill	  	 	- 	  	  	 	- 	  	  	 	2,544,195 	 	  	 	1,863,943 	 	  	 	- 	  	  	 	4,408,138 	 	

Other assets, net	  	 	- 	  	  	 	165,236 	 	  	 	1,273,347 	 	  	 	816,373 	 	  	 	(627,774)	  	  	 	1,627,182 	 	

Net investment in subsidiaries	  	 	2,974,965 	 	  	 	8,686,242 	 	  	 	3,427,182 	 	  	 	- 	  	  	 	(15,088,389)	  	  	 	- 	  	

Total assets	  	  $	3,548,432 	 	  	  $	18,689,497 	 	  	  $	17,140,514 	 	  	  $	10,174,436 	 	  	  $	(32,946,544)	  	  	  $	16,606,335 	 	

LIABILITIES AND EQUITY	  	
 	 	 	 	 	 	 	
Current liabilities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Current maturities of long-term debt	  	  $	- 	  	  	  $	75,679 	 	  	  $	11,103 	 	  	  $	3,129 	 	  	  $	- 	  	  	  $	89,911 	 	
 	 	 	 	 	 	 	
Accounts payable	  	 	- 	  	  	 	74 	 	  	 	583,865 	 	  	 	241,975 	 	  	 	- 	  	  	 	825,914 	 	
 	 	 	 	 	 	 	
Accrued interest	  	 	- 	  	  	 	110,091 	 	  	 	295 	 	  	 	316 	 	  	 	- 	  	  	 	110,702 	 	
 	 	 	 	 	 	 	
Accrued liabilities	  	 	7,580 	 	  	 	- 	  	  	 	748,010 	 	  	 	361,103 	 	  	 	- 	  	  	 	1,116,693 	 	

Total current liabilities	  	 	7,580 	 	  	 	185,844 	 	  	 	1,343,273 	 	  	 	606,523 	 	  	 	- 	  	  	 	2,143,220 	 	

Long-term debt	  	 	- 	  	  	 	9,079,392 	 	  	 	53,201 	 	  	 	318,801 	 	  	 	- 	  	  	 	9,451,394 	 	

Intercompany payable	  	 	- 	  	  	 	5,639,928 	 	  	 	11,693,119 	 	  	 	7,822,313 	 	  	 	(25,155,360)	  	  	 	- 	  	

Deferred income taxes	  	 	808,489 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	808,489 	 	

Other long-term liabilities	  	 	1,156 	 	  	 	809,372 	 	  	 	675,341 	 	  	 	180,950 	 	  	 	(627,774)	  	  	 	1,039,045 	 	

Total liabilities	  	 	817,225 	 	  	 	15,714,536 	 	  	 	13,764,934 	 	  	 	8,928,587 	 	  	 	(25,783,134)	  	  	 	13,442,148 	 	

Redeemable noncontrolling interests in equity of consolidated subsidiaries	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	367,666 	 	  	 	- 	  	  	 	367,666 	 	

Equity:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Community Health Systems, Inc. stockholders’ equity:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Preferred stock	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Common stock	  	 	929 	 	  	 	- 	  	  	 	1 	 	  	 	2 	 	  	 	(3)	  	  	 	929 	 	
 	 	 	 	 	 	 	
Additional paid-in capital	  	 	1,138,274 	 	  	 	1,176,342 	 	  	 	1,283,499 	 	  	 	690,929 	 	  	 	(3,150,770)	  	  	 	1,138,274 	 	
 	 	 	 	 	 	 	
Treasury stock, at cost	  	 	(6,678)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(6,678)	  	
 	 	 	 	 	 	 	
Accumulated other comprehensive (loss) income	  	 	(145,310)	  	  	 	(145,310)	  	  	 	(28,927)	  	  	 	- 	  	  	 	174,237 	 	  	 	(145,310)	  	
 	 	 	 	 	 	 	
Retained earnings	  	 	1,743,992 	 	  	 	1,943,929 	 	  	 	2,121,007 	 	  	 	121,938 	 	  	 	(4,186,874)	  	  	 	1,743,992 	 	

Total Community Health Systems, Inc. stockholders’ equity	  	 	2,731,207 	 	  	 	2,974,961 	 	  	 	3,375,580 	 	  	 	812,869 	 	  	 	(7,163,410)	  	  	 	2,731,207 	 	
 	 	 	 	 	 	 	
Noncontrolling interests in equity of consolidated subsidiaries	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	65,314 	 	  	 	- 	  	  	 	65,314 	 	

Total equity	  	 	2,731,207 	 	  	 	2,974,961 	 	  	 	3,375,580 	 	  	 	878,183 	 	  	 	(7,163,410)	  	  	 	2,796,521 	 	

Total liabilities and equity	  	  $	3,548,432 	 	  	  $	18,689,497 	 	  	  $	17,140,514 	 	  	  $	10,174,436 	 	  	  $	(32,946,544)	  	  	  $	16,606,335 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Income
Three Months Ended September 30, 2013

 	  	Parent
  Guarantor  	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
  Guarantors  	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Operating revenues (net of contractual allowances and discounts)	  	  $	- 	  	  	  $	(3,845)	  	  	  $	2,420,377 	 	  	  $	1,350,301 	 	  	  $	- 	  	  	  $	3,766,833 	 	
 	 	 	 	 	 	 	
Provision for bad debts	  	 	- 	  	  	 	- 	  	  	 	373,258 	 	  	 	175,344 	 	  	 	- 	  	  	 	548,602 	 	

Net operating revenues	  	 	- 	  	  	 	(3,845)	  	  	 	2,047,119 	 	  	 	1,174,957 	 	  	 	- 	  	  	 	3,218,231 	 	
 	 	 	 	 	 	 	
Operating costs and expenses:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Salaries and benefits	  	 	- 	  	  	 	- 	  	  	 	908,651 	 	  	 	633,041 	 	  	 	- 	  	  	 	1,541,692 	 	
 	 	 	 	 	 	 	
Supplies	  	 	- 	  	  	 	- 	  	  	 	316,598 	 	  	 	169,776 	 	  	 	- 	  	  	 	486,374 	 	
 	 	 	 	 	 	 	
Other operating expenses	  	 	- 	  	  	 	- 	  	  	 	468,293 	 	  	 	253,664 	 	  	 	- 	  	  	 	721,957 	 	
 	 	 	 	 	 	 	
Government settlement and related costs reserve	  	 	- 	  	  	 	- 	  	  	 	98,000 	 	  	 	- 	  	  	 	- 	  	  	 	98,000 	 	
 	 	 	 	 	 	 	
Electronic health records incentive reimbursement	  	 	- 	  	  	 	- 	  	  	 	(48,771)	  	  	 	(16,236)	  	  	 	- 	  	  	 	(65,007)	  	
 	 	 	 	 	 	 	
Rent	  	 	- 	  	  	 	- 	  	  	 	40,627 	 	  	 	31,019 	 	  	 	- 	  	  	 	71,646 	 	
 	 	 	 	 	 	 	
Depreciation and amortization	  	 	- 	  	  	 	- 	  	  	 	133,773 	 	  	 	62,068 	 	  	 	- 	  	  	 	195,841 	 	

Total operating costs and expenses	  	 	- 	  	  	 	- 	  	  	 	1,917,171 	 	  	 	1,133,332 	 	  	 	- 	  	  	 	3,050,503 	 	

Income from operations	  	 	- 	  	  	 	(3,845)	  	  	 	129,948 	 	  	 	41,625 	 	  	 	- 	  	  	 	167,728 	 	
 	 	 	 	 	 	 	
Interest expense, net	  	 	- 	  	  	 	(1,470)	  	  	 	139,796 	 	  	 	16,003 	 	  	 	- 	  	  	 	154,329 	 	
 	 	 	 	 	 	 	
Loss from early extinguishment of debt	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Equity in earnings of unconsolidated affiliates	  	 	(4,095)	  	  	 	(77,763)	  	  	 	(14,207)	  	  	 	- 	  	  	 	84,424 	 	  	 	(11,641)	  	

Income from continuing operations before income taxes	  	 	4,095 	 	  	 	75,388 	 	  	 	4,359 	 	  	 	25,622 	 	  	 	(84,424)	  	  	 	25,040 	 	
 	 	 	 	 	 	 	
Provision for (benefit from) income taxes	  	 	- 	  	  	 	71,293 	 	  	 	(70,777)	  	  	 	2,926 	 	  	 	- 	  	  	 	3,442 	 	

Income from continuing operations	  	 	4,095 	 	  	 	4,095 	 	  	 	75,136 	 	  	 	22,696 	 	  	 	(84,424)	  	  	 	21,598 	 	
 	 	 	 	 	 	 	
Discontinued operations, net of taxes:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Loss from operations of entities sold	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	

Loss from discontinued operations, net of taxes	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	

Net income	  	 	4,095 	 	  	 	4,095 	 	  	 	75,136 	 	  	 	22,696 	 	  	 	(84,424)	  	  	 	21,598 	 	
 	 	 	 	 	 	 	
Less: Net income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	17,503 	 	  	 	- 	  	  	 	17,503 	 	

Net income attributable to Community Health Systems, Inc. stockholders	  	  $	          4,095 	 	  	  $	          4,095 	 	  	  $	          75,136 	 	  	  $	          5,193 	 	  	  $	      (84,424)	  	  	  $	          4,095 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Income
Three Months Ended September 30, 2012

 	  	Parent
  Guarantor  	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
  Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Operating revenues (net of contractual allowances and discounts)	  	  $	- 	  	  	  $	(2,551)	  	  	  $	2,376,462 	 	  	  $	1,322,750 	 	  	  $	- 	  	  	  $	3,696,661 	 	
 	 	 	 	 	 	 	
Provision for bad debts	  	 	- 	  	  	 	- 	  	  	 	316,988 	 	  	 	167,643 	 	  	 	- 	  	  	 	484,631 	 	

Net operating revenues	  	 	- 	  	  	 	(2,551)	  	  	 	2,059,474 	 	  	 	1,155,107 	 	  	 	- 	  	  	 	3,212,030 	 	
 	 	 	 	 	 	 	
Operating costs and expenses:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Salaries and benefits	  	 	- 	  	  	 	- 	  	  	 	905,141 	 	  	 	619,970 	 	  	 	- 	  	  	 	1,525,111 	 	
 	 	 	 	 	 	 	
Supplies	  	 	- 	  	  	 	- 	  	  	 	317,263 	 	  	 	166,949 	 	  	 	- 	  	  	 	484,212 	 	
 	 	 	 	 	 	 	
Other operating expenses	  	 	- 	  	  	 	83 	 	  	 	459,377 	 	  	 	235,397 	 	  	 	- 	  	  	 	694,857 	 	
 	 	 	 	 	 	 	
Government settlement and related costs reserve	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Electronic health records incentive reimbursement	  	 	- 	  	  	 	- 	  	  	 	(20,587)	  	  	 	(10,035)	  	  	 	- 	  	  	 	(30,622)	  	
 	 	 	 	 	 	 	
Rent	  	 	- 	  	  	 	- 	  	  	 	38,559 	 	  	 	30,078 	 	  	 	- 	  	  	 	68,637 	 	
 	 	 	 	 	 	 	
Depreciation and amortization	  	 	- 	  	  	 	- 	  	  	 	120,620 	 	  	 	61,587 	 	  	 	- 	  	  	 	182,207 	 	

Total operating costs and expenses	  	 	- 	  	  	 	83 	 	  	 	1,820,373 	 	  	 	1,103,946 	 	  	 	- 	  	  	 	2,924,402 	 	

Income from operations	  	 	- 	  	  	 	(2,634)	  	  	 	239,101 	 	  	 	51,161 	 	  	 	- 	  	  	 	287,628 	 	
 	 	 	 	 	 	 	
Interest expense, net	  	 	- 	  	  	 	11,708 	 	  	 	132,381 	 	  	 	14,476 	 	  	 	- 	  	  	 	158,565 	 	
 	 	 	 	 	 	 	
Loss from early extinguishment of debt	  	 	- 	  	  	 	52,024 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	52,024 	 	
 	 	 	 	 	 	 	
Equity in earnings of unconsolidated affiliates	  	 	(44,233)	  	  	 	(82,526)	  	  	 	(20,074)	  	  	 	- 	  	  	 	139,414 	 	  	 	(7,419)	  	

Income from continuing operations before income taxes	  	 	44,233 	 	  	 	16,160 	 	  	 	126,794 	 	  	 	36,685 	 	  	 	(139,414)	  	  	 	84,458 	 	
 	 	 	 	 	 	 	
Provision for (benefit from) income taxes	  	 	- 	  	  	 	(28,073)	  	  	 	45,773 	 	  	 	8,000 	 	  	 	- 	  	  	 	25,700 	 	

Income from continuing operations	  	 	44,233 	 	  	 	44,233 	 	  	 	81,021 	 	  	 	28,685 	 	  	 	(139,414)	  	  	 	58,758 	 	
 	 	 	 	 	 	 	
Discontinued operations, net of taxes:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Loss from operations of entities sold	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	

Loss from discontinued operations, net of taxes	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	

Net income	  	 	44,233 	 	  	 	44,233 	 	  	 	81,021 	 	  	 	28,685 	 	  	 	(139,414)	  	  	 	58,758 	 	
 	 	 	 	 	 	 	
Less: Net income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	14,525 	 	  	 	- 	  	  	 	14,525 	 	

Net income attributable to Community Health Systems, Inc. stockholders	  	  $	          44,233 	 	  	  $	          44,233 	 	  	  $	          81,021 	 	  	  $	          14,160 	 	  	  $	      (139,414)	  	  	  $	          44,233 	 	

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Table of Contents
COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Income
Nine Months Ended September 30, 2013

 	  	Parent
  Guarantor  	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
  Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Operating revenues (net of contractual allowances and discounts)	  	  $	- 	  	  	  $	(11,149)	  	  	  $	7,266,525 	 	  	  $	4,079,407 	 	  	  $	- 	  	  	  $	11,334,783 	 	
 	 	 	 	 	 	 	
Provision for bad debts	  	 	- 	  	  	 	- 	  	  	 	1,080,631 	 	  	 	487,780 	 	  	 	- 	  	  	 	1,568,411 	 	

Net operating revenues	  	 	- 	  	  	 	(11,149)	  	  	 	6,185,894 	 	  	 	3,591,627 	 	  	 	- 	  	  	 	9,766,372 	 	
 	 	 	 	 	 	 	
Operating costs and expenses:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Salaries and benefits	  	 	- 	  	  	 	- 	  	  	 	2,744,614 	 	  	 	1,930,177 	 	  	 	- 	  	  	 	4,674,791 	 	
 	 	 	 	 	 	 	
Supplies	  	 	- 	  	  	 	- 	  	  	 	968,229 	 	  	 	514,016 	 	  	 	- 	  	  	 	1,482,245 	 	
 	 	 	 	 	 	 	
Other operating expenses	  	 	- 	  	  	 	239 	 	  	 	1,385,366 	 	  	 	774,123 	 	  	 	- 	  	  	 	2,159,728 	 	
 	 	 	 	 	 	 	
Government settlement and related costs reserve	  	 	- 	  	  	 	- 	  	  	 	98,000 	 	  	 	- 	  	  	 	- 	  	  	 	98,000 	 	
 	 	 	 	 	 	 	
Electronic health records incentive reimbursement	  	 	- 	  	  	 	- 	  	  	 	(76,349)	  	  	 	(33,958)	  	  	 	- 	  	  	 	(110,307)	  	
 	 	 	 	 	 	 	
Rent	  	 	- 	  	  	 	- 	  	  	 	121,278 	 	  	 	93,742 	 	  	 	- 	  	  	 	215,020 	 	
 	 	 	 	 	 	 	
Depreciation and amortization	  	 	- 	  	  	 	- 	  	  	 	393,959 	 	  	 	188,645 	 	  	 	- 	  	  	 	582,604 	 	

Total operating costs and expenses	  	 	- 	  	  	 	239 	 	  	 	5,635,097 	 	  	 	3,466,745 	 	  	 	- 	  	  	 	9,102,081 	 	

Income from operations	  	 	- 	  	  	 	(11,388)	  	  	 	550,797 	 	  	 	124,882 	 	  	 	- 	  	  	 	664,291 	 	
 	 	 	 	 	 	 	
Interest expense, net	  	 	- 	  	  	 	2,020 	 	  	 	416,190 	 	  	 	47,525 	 	  	 	- 	  	  	 	465,735 	 	
 	 	 	 	 	 	 	
Loss from early extinguishment of debt	  	 	- 	  	  	 	1,295 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	1,295 	 	
 	 	 	 	 	 	 	
Equity in earnings of unconsolidated affiliates	  	 	(113,022)	  	  	 	(194,526)	  	  	 	(45,868)	  	  	 	- 	  	  	 	317,041 	  	  	 	(36,375)	  	

Income from continuing operations before income taxes	  	 	113,022 	 	  	 	179,823 	  	  	 	180,475 	 	  	 	77,357 	 	  	 	(317,041)	  	  	 	233,636 	 	
 	 	 	 	 	 	 	
Provision for (benefit from) income taxes	  	 	- 	  	  	 	66,801 	  	  	 	(7,314)	  	  	 	9,143 	 	  	 	- 	  	  	 	68,630 	 	

Income from continuing operations	  	 	113,022 	 	  	 	113,022 	 	  	 	187,789 	  	  	 	68,214 	 	  	 	(317,041)	  	  	 	165,006 	 	
 	 	 	 	 	 	 	
Discontinued operations, net of taxes:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Loss from operations of entities sold	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	

Loss from discontinued operations, net of taxes	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	

Net income	  	 	113,022 	 	  	 	113,022 	 	  	 	187,789 	  	  	 	68,214 	 	  	 	(317,041)	  	  	 	165,006 	 	
 	 	 	 	 	 	 	
Less: Net income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	51,984 	 	  	 	- 	  	  	 	51,984 	 	

Net income attributable to Community Health Systems, Inc. stockholders	  	  $	        113,022 	 	  	  $	        113,022 	 	  	  $	          187,789 	  	  	  $	          16,230 	 	  	  $	      (317,041)	  	  	  $	        113,022 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Income
Nine Months Ended September 30, 2012

 	  	Parent
  Guarantor  	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
  Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Operating revenues (net of contractual allowances and discounts)	  	  $	- 	  	  	  $	(6,980)	  	  	  $	7,178,086 	 	  	  $	4,055,474 	 	  	  $	- 	  	  	  $	11,226,580 	 	
 	 	 	 	 	 	 	
Provision for bad debts	  	 	- 	  	  	 	- 	  	  	 	998,451 	 	  	 	476,090 	 	  	 	- 	  	  	 	1,474,541 	 	

Net operating revenues	  	 	- 	  	  	 	(6,980)	  	  	 	6,179,635 	 	  	 	3,579,384 	 	  	 	- 	  	  	 	9,752,039 	 	
 	 	 	 	 	 	 	
Operating costs and expenses:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Salaries and benefits	  	 	- 	  	  	 	- 	  	  	 	2,688,553 	 	  	 	1,858,979 	 	  	 	- 	  	  	 	4,547,532 	 	
 	 	 	 	 	 	 	
Supplies	  	 	- 	  	  	 	- 	  	  	 	968,505 	 	  	 	504,015 	 	  	 	- 	  	  	 	1,472,520 	 	
 	 	 	 	 	 	 	
Other operating expenses	  	 	- 	  	  	 	418 	 	  	 	1,387,034 	 	  	 	752,573 	 	  	 	- 	  	  	 	2,140,025 	 	
 	 	 	 	 	 	 	
Government settlement and related costs reserve	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Electronic health records incentive reimbursement	  	 	- 	  	  	 	- 	  	  	 	(45,732)	  	  	 	(27,860)	  	  	 	- 	  	  	 	(73,592)	  	
 	 	 	 	 	 	 	
Rent	  	 	- 	  	  	 	- 	  	  	 	113,014 	 	  	 	89,310 	 	  	 	- 	  	  	 	202,324 	 	
 	 	 	 	 	 	 	
Depreciation and amortization	  	 	- 	  	  	 	- 	  	  	 	356,196 	 	  	 	180,166 	 	  	 	- 	  	  	 	536,362 	 	

Total operating costs and expenses	  	 	- 	  	  	 	418 	 	  	 	5,467,570 	 	  	 	3,357,183 	 	  	 	- 	  	  	 	8,825,171 	 	

Income from operations	  	 	- 	  	  	 	(7,398)	  	  	 	712,065 	 	  	 	222,201 	 	  	 	- 	  	  	 	926,868 	 	
 	 	 	 	 	 	 	
Interest expense, net	  	 	- 	  	  	 	45,033 	 	  	 	379,004 	 	  	 	38,310 	 	  	 	- 	  	  	 	462,347 	 	
 	 	 	 	 	 	 	
Loss from early extinguishment of debt	  	 	- 	  	  	 	115,453 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	115,453 	 	
 	 	 	 	 	 	 	
Equity in earnings of unconsolidated affiliates	  	 	(203,066)	  	  	 	(287,320)	  	  	 	(107,110)	  	  	 	- 	  	  	 	564,883 	 	  	 	(32,613)	  	

Income from continuing operations before income taxes	  	 	203,066 	 	  	 	119,436 	 	  	 	440,171 	 	  	 	183,891 	 	  	 	(564,883)	  	  	 	381,681 	 	
 	 	 	 	 	 	 	
Provision for (benefit from) income taxes	  	 	- 	  	  	 	(83,630)	  	  	 	158,901 	 	  	 	45,767 	 	  	 	- 	  	  	 	121,038 	 	

Income from continuing operations	  	 	203,066 	 	  	 	203,066 	 	  	 	281,270 	 	  	 	138,124 	 	  	 	(564,883)	  	  	 	260,643 	 	
 	 	 	 	 	 	 	
Discontinued operations, net of taxes:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Loss from operations of entities sold	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(466)	  	  	 	- 	  	  	 	(466)	  	

Loss from discontinued operations, net of taxes	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(466)	  	  	 	- 	  	  	 	(466)	  	

Net income	  	 	203,066 	 	  	 	203,066 	 	  	 	281,270 	 	  	 	137,658 	 	  	 	(564,883)	  	  	 	260,177 	 	
 	 	 	 	 	 	 	
Less: Net income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	57,111 	 	  	 	- 	  	  	 	57,111 	 	

Net income attributable to Community Health Systems, Inc. stockholders	  	  $	        203,066 	 	  	  $	        203,066 	 	  	  $	          281,270 	 	  	  $	          80,547 	 	  	  $	      (564,883)	  	  	  $	        203,066 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Comprehensive Income
Three Months Ended September 30, 2013

 	  	Parent
    Guarantor    	 	  	        Issuer        	 	  	Other
   Guarantors   	 	  	Non -
    Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Net income	  	  $	4,095 	 	  	  $	4,095 	 	  	  $	75,136 	  	  	  $	22,696 	 	  	  $	(84,424)	  	  	  $	21,598 	 	
 	 	 	 	 	 	 	
Other comprehensive income (loss), net of taxes	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Net change in fair value of interest rate swaps	  	 	10,850 	 	  	 	10,850 	 	  	 	- 	  	  	 	- 	  	  	 	(10,850)	  	  	 	10,850 	 	
 	 	 	 	 	 	 	
Net change in fair value of available-for-sale securities	  	 	1,171 	 	  	 	1,171 	 	  	 	1,171 	 	  	 	- 	  	  	 	(2,342)	  	  	 	1,171 	 	
 	 	 	 	 	 	 	
Amortization and recognition of unrecognized pension cost components	  	 	731 	 	  	 	731 	 	  	 	731 	 	  	 	- 	  	  	 	(1,462)	  	  	 	731 	 	

Other comprehensive income (loss)	  	 	12,752 	 	  	 	12,752 	 	  	 	1,902 	 	  	 	- 	  	  	 	(14,654)	  	  	 	12,752 	 	

Comprehensive income	  	 	16,847 	 	  	 	16,847 	 	  	 	77,038 	  	  	 	22,696 	 	  	 	(99,078)	  	  	 	34,350 	 	
 	 	 	 	 	 	 	
Less: Comprehensive income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	17,503 	 	  	 	- 	  	  	 	17,503 	 	

Comprehensive income attributable to Community Health Systems, Inc. stockholders	  	  $	    16,847 	 	  	  $	    16,847 	 	  	  $	    77,038 	  	  	  $	    5,193 	 	  	  $	      (99,078)	  	  	  $	    16,847 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Condensed Consolidating Statement of Comprehensive Income
Three Months Ended September 30, 2012

 	  	Parent
     Guarantor    	 	  	        Issuer        	 	  	Other
  Guarantors  	 	  	Non -
   Guarantors  	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Net income	  	  $	44,233 	 	  	  $	44,233 	 	  	  $	81,021 	 	  	  $	28,685 	 	  	  $	(139,414)	  	  	  $	58,758 	 	
 	 	 	 	 	 	 	
Other comprehensive income (loss), net of taxes	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Net change in fair value of interest rate swaps	  	 	8,254 	 	  	 	8,254 	 	  	 	- 	  	  	 	- 	  	  	 	(8,254)	  	  	 	8,254 	 	
 	 	 	 	 	 	 	
Net change in fair value of available-for-sale securities	  	 	1,370 	 	  	 	1,370 	 	  	 	1,370 	 	  	 	- 	  	  	 	(2,740)	  	  	 	1,370 	 	
 	 	 	 	 	 	 	
Amortization and recognition of unrecognized pension cost components	  	 	1,202 	 	  	 	1,202 	 	  	 	1,202 	 	  	 	- 	  	  	 	(2,404)	  	  	 	1,202 	 	

Other comprehensive income (loss)	  	 	10,826 	 	  	 	10,826 	 	  	 	2,572 	 	  	 	- 	  	  	 	(13,398)	  	  	 	10,826 	 	

Comprehensive income	  	 	55,059 	 	  	 	55,059 	 	  	 	83,593 	 	  	 	28,685 	 	  	 	(152,812)	  	  	 	69,584 	 	
 	 	 	 	 	 	 	
Less: Comprehensive income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	14,525 	 	  	 	- 	  	  	 	14,525 	 	

Comprehensive income attributable to Community Health Systems, Inc. stockholders	  	  $	    55,059 	 	  	  $	    55,059 	 	  	  $	    83,593 	 	  	  $	    14,160 	 	  	  $	    (152,812)	  	  	  $	    55,059 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Comprehensive Income
Nine Months Ended September 30, 2013

 	  	Parent
     Guarantor    	 	  	        Issuer        	 	  	Other
   Guarantors   	 	  	Non -
    Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Net income	  	  $	113,022 	 	  	  $	113,022 	 	  	  $	187,789 	  	  	  $	68,214 	 	  	  $	(317,041)	  	  	  $	165,006 	 	
 	 	 	 	 	 	 	
Other comprehensive income (loss), net of taxes	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Net change in fair value of interest rate swaps	  	 	47,759 	 	  	 	47,759 	 	  	 	- 	  	  	 	- 	  	  	 	(47,759)	  	  	 	47,759 	 	
 	 	 	 	 	 	 	
Net change in fair value of available-for-sale securities	  	 	2,841 	 	  	 	2,841 	 	  	 	2,841 	 	  	 	- 	  	  	 	(5,682)	  	  	 	2,841 	 	
 	 	 	 	 	 	 	
Amortization and recognition of unrecognized pension cost components	  	 	2,195 	 	  	 	2,195 	 	  	 	2,195 	 	  	 	- 	  	  	 	(4,390)	  	  	 	2,195 	 	

Other comprehensive income (loss)	  	 	52,795 	 	  	 	52,795 	 	  	 	5,036 	 	  	 	- 	  	  	 	(57,831)	  	  	 	52,795 	 	

Comprehensive income	  	 	165,817 	 	  	 	165,817 	 	  	 	192,825 	  	  	 	68,214 	 	  	 	(374,872)	  	  	 	217,801 	 	
 	 	 	 	 	 	 	
Less: Comprehensive income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	51,984 	 	  	 	- 	  	  	 	51,984 	 	

Comprehensive income attributable to Community Health Systems, Inc. stockholders	  	  $	  165,817 	 	  	  $	  165,817 	 	  	  $	  192,825 	  	  	  $	  16,230 	 	  	  $	    (374,872)	  	  	  $	  165,817 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Condensed Consolidating Statement of Comprehensive Income
Nine Months Ended September 30, 2012

 	  	Parent
    Guarantor    	 	  	        Issuer        	 	  	Other
   Guarantors   	 	  	Non -
    Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Net income	  	  $	203,066 	 	  	  $	203,066 	 	  	  $	281,270 	 	  	  $	137,658 	 	  	  $	(564,883)	  	  	  $	260,177 	 	
 	 	 	 	 	 	 	
Other comprehensive income (loss), net of taxes	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Net change in fair value of interest rate swaps	  	 	28,766 	 	  	 	28,766 	 	  	 	- 	  	  	 	- 	  	  	 	(28,766)	  	  	 	28,766 	 	
 	 	 	 	 	 	 	
Net change in fair value of available-for-sale securities	  	 	3,509 	 	  	 	3,509 	 	  	 	3,509 	 	  	 	- 	  	  	 	(7,018)	  	  	 	3,509 	 	
 	 	 	 	 	 	 	
Amortization and recognition of unrecognized pension cost components	  	 	3,483 	 	  	 	3,483 	 	  	 	3,483 	 	  	 	- 	  	  	 	(6,966)	  	  	 	3,483 	 	

Other comprehensive income (loss)	  	 	35,758 	 	  	 	35,758 	 	  	 	6,992 	 	  	 	- 	  	  	 	(42,750)	  	  	 	35,758 	 	

Comprehensive income	  	 	238,824 	 	  	 	238,824 	 	  	 	288,262 	 	  	 	137,658 	 	  	 	(607,633)	  	  	 	295,935 	 	
 	 	 	 	 	 	 	
Less: Comprehensive income attributable to noncontrolling interests	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	57,111 	 	  	 	- 	  	  	 	57,111 	 	

Comprehensive income attributable to Community Health Systems, Inc. stockholders	  	  $	  238,824 	 	  	  $	  238,824 	 	  	  $	  288,262 	 	  	  $	  80,547 	 	  	  $	    (607,633)	  	  	  $	  238,824 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Cash Flows
Nine Months Ended September 30, 2013

 	  	Parent
     Guarantor    	 	  	        Issuer        	 	  	Other
    Guarantors   	 	  	Non -
  Guarantors  	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Net cash (used in) provided by operating activities	  	  $	(80,729)	  	  	  $	5,644 	 	  	  $	495,003 	 	  	  $	21,182	 	  	  $	- 	  	  	  $	441,100 	 	

Cash flows from investing activities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Acquisitions of facilities and other related equipment	  	 	- 	  	  	 	- 	  	  	 	(8,936)	  	  	 	(24,999)	  	  	 	- 	  	  	 	(33,935)	  	
 	 	 	 	 	 	 	
Purchases of property and equipment	  	 	- 	  	  	 	- 	  	  	 	(355,603)	  	  	 	(65,314)	  	  	 	- 	  	  	 	(420,917)	  	
 	 	 	 	 	 	 	
Proceeds from sale of property and equipment	  	 	- 	  	  	 	- 	  	  	 	1,441 	 	  	 	2,744 	 	  	 	- 	  	  	 	4,185 	 	
 	 	 	 	 	 	 	
Increase in other investments	  	 	- 	  	  	 	- 	  	  	 	(190,892)	  	  	 	(43,207)	  	  	 	- 	  	  	 	(234,099)	  	

Net cash used in investing activities	  	 	- 	  	  	 	- 	  	  	 	(553,990)	  	  	 	(130,776)	  	  	 	- 	  	  	 	(684,766)	  	

Cash flows from financing activities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Proceeds from exercise of stock options	  	 	108,546 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	108,546	 	
 	 	 	 	 	 	 	
Repurchase of restricted stock shares for payroll tax withholding requirements	  	 	(14,696)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(14,696)	  	
 	 	 	 	 	 	 	
Stock buy-back	  	 	(27,133)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(27,133)	  	
 	 	 	 	 	 	 	
Deferred financing costs	  	 	- 	  	  	 	(12,960)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(12,960)	  	
 	 	 	 	 	 	 	
Excess tax benefit relating to stock-based compensation	  	 	6,573 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	6,573 	 	
 	 	 	 	 	 	 	
Proceeds from noncontrolling investors in joint ventures	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	64 	 	  	 	- 	  	  	 	64 	 	
 	 	 	 	 	 	 	
Redemption of noncontrolling investments in joint ventures	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(5,720)	  	  	 	- 	  	  	 	(5,720)	  	
 	 	 	 	 	 	 	
Distributions to noncontrolling investors in joint ventures	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(60,282)	  	  	 	- 	  	  	 	(60,282)	  	
 	 	 	 	 	 	 	
Changes in intercompany balances with affiliates, net	  	 	7,439 	 	  	 	183,044 	 	  	 	(196,342)	  	  	 	5,859 	 	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Borrowings under credit agreements	  	 	- 	  	  	 	792,000 	 	  	 	21,046 	 	  	 	686 	 	  	 	- 	  	  	 	813,732 	 	
 	 	 	 	 	 	 	
Issuance of long-term debt	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Proceeds from receivables facility	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	320,000 	 	  	 	- 	  	  	 	320,000 	 	
 	 	 	 	 	 	 	
Repayments of long-term indebtedness	  	 	- 	  	  	 	(967,728)	  	  	 	(20,281)	  	  	 	(140,657)	  	  	 	- 	  	  	 	(1,128,666)	  	

Net cash provided by (used in) financing activities	  	 	80,729 	 	  	 	(5,644)	  	  	 	(195,577)	  	  	 	119,950 	 	  	 	- 	  	  	 	(542)	  	

Net change in cash and cash equivalents	  	 	- 	  	  	 	- 	  	  	 	(254,564)	  	  	 	10,356 	 	  	 	- 	  	  	 	(244,208)	  	
 	 	 	 	 	 	 	
Cash and cash equivalents at beginning of period	  	 	- 	  	  	 	- 	  	  	 	271,559 	 	  	 	116,254 	 	  	 	- 	  	  	 	387,813 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Cash and cash equivalents at end of period	  	  $	- 	  	  	  $	- 	  	  	  $	16,995 	 	  	  $	126,610 	 	  	  $	- 	  	  	  $	143,605 	 	

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COMMUNITY HEALTH SYSTEMS, INC. AND SUBSIDIARIES
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS (UNAUDITED) – CONTINUED
 
Condensed Consolidating Statement of Cash Flows
Nine Months Ended September 30, 2012

 	  	Parent
     Guarantor    	 	  	Issuer	 	  	Other
    Guarantors   	 	  	Non -
    Guarantors   	 	  	  Eliminations  	 	  	  Consolidated  	 	
 	  	(In thousands)	 	
 	 	 	 	 	 	 	
Net cash (used in) provided by operating activities	  	  $	(58,932)	  	  	  $	(33,958)	  	  	  $	736,312 	 	  	  $	134,443 	 	  	  $	- 	  	  	  $	777,865 	 	

Cash flows from investing activities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Acquisitions of facilities and other related equipment	  	 	- 	  	  	 	- 	  	  	 	(302,759)	  	  	 	(10,168)	  	  	 	- 	  	  	 	(312,927)	  	
 	 	 	 	 	 	 	
Purchases of property and equipment	  	 	- 	  	  	 	- 	  	  	 	(374,940)	  	  	 	(182,529)	  	  	 	- 	  	  	 	(557,469)	  	
 	 	 	 	 	 	 	
Proceeds from sale of property and equipment	  	 	- 	  	  	 	- 	  	  	 	2,281 	 	  	 	2,527 	 	  	 	- 	  	  	 	4,808 	 	
 	 	 	 	 	 	 	
Increase in other investments	  	 	- 	  	  	 	- 	  	  	 	(168,506)	  	  	 	(53,658)	  	  	 	- 	  	  	 	(222,164)	  	

Net cash used in investing activities	  	 	- 	  	  	 	- 	  	  	 	(843,924)	  	  	 	(243,828)	  	  	 	- 	  	  	 	(1,087,752)	  	

Cash flows from financing activities:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
 	 	 	 	 	 	 	
Proceeds from exercise of stock options	  	 	5,750 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	5,750 	 	
 	 	 	 	 	 	 	
Repurchase of restricted stock shares for payroll tax withholding requirements	  	 	(9,165)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(9,165)	  	
 	 	 	 	 	 	 	
Stock buy-back	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Deferred financing costs	  	 	- 	  	  	 	(135,647)	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(135,647)	  	
 	 	 	 	 	 	 	
Excess tax benefit relating to stock-based compensation	  	 	1,545 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	1,545 	 	
 	 	 	 	 	 	 	
Proceeds from noncontrolling investors in joint ventures	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	535 	 	  	 	- 	  	  	 	535 	 	
 	 	 	 	 	 	 	
Redemption of noncontrolling investments in joint ventures	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(39,709)	  	  	 	- 	  	  	 	(39,709)	  	
 	 	 	 	 	 	 	
Distributions to noncontrolling investors in joint ventures	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	(60,676)	  	  	 	- 	  	  	 	(60,676)	  	
 	 	 	 	 	 	 	
Changes in intercompany balances with affiliates, net	  	 	60,802 	 	  	 	(189,385)	  	  	 	248,311 	 	  	 	(119,728)	  	  	 	- 	  	  	 	- 	  	
 	 	 	 	 	 	 	
Borrowings under credit agreements	  	 	- 	  	  	 	3,955,000 	 	  	 	19,399 	 	  	 	- 	  	  	 	- 	  	  	 	3,974,399 	 	
 	 	 	 	 	 	 	
Issuance of long-term debt	  	 	- 	  	  	 	3,825,000 	 	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	3,825,000 	 	
 	 	 	 	 	 	 	
Proceeds from receivables facility	  	 	- 	  	  	 	- 	  	  	 	- 	  	  	 	300,000 	 	  	 	- 	  	  	 	300,000 	 	
 	 	 	 	 	 	 	
Repayments of long-term indebtedness	  	 	- 	  	  	 	(7,421,010)	  	  	 	(18,983)	  	  	 	(1,367)	  	  	 	- 	  	  	 	(7,441,360)	  	

Net cash provided by (used in) financing activities	  	 	58,932 	 	  	 	33,958 	 	  	 	248,727 	 	  	 	79,055 	 	  	 	- 	  	  	 	420,672 	 	

Net change in cash and cash equivalents	  	 	- 	  	  	 	- 	  	  	 	141,115 	 	  	 	(30,330)	  	  	 	- 	  	  	 	110,785 	 	
 	 	 	 	 	 	 	
Cash and cash equivalents at beginning of period	  	 	- 	  	  	 	- 	  	  	 	8,920 	 	  	 	120,945 	 	  	 	- 	  	  	 	129,865 	 	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Cash and cash equivalents at end of period	  	  $	- 	  	  	  $	- 	  	  	  $	150,035 	 	  	  $	90,615 	 	  	  $	- 	  	  	  $	240,650 	 	

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Item 2.  Management’s Discussion and Analysis of Financial Condition and Results of Operations
You should read this discussion together with our unaudited condensed consolidated financial statements and the accompanying notes included herein.
Throughout this Quarterly Report on Form 10-Q, Community Health Systems, Inc., the parent company, and its consolidated subsidiaries are referred to on a collective basis using words like “we,” “our,” “us” and the “Company”. This drafting style is not meant to indicate that the publicly-traded parent company or any subsidiary of the parent company owns or operates any asset, business, or property. The hospitals, operations and businesses described in this filing are owned and operated, and management services provided, by distinct and indirect subsidiaries of Community Health Systems, Inc.
Executive Overview
We are one of the largest publicly-traded operators of hospitals in the United States in terms of number of facilities and net operating revenues. We provide healthcare services through the hospitals that we own and operate in non-urban and selected urban markets throughout the United States. We generate revenues by providing a broad range of general and specialized hospital healthcare services and other outpatient services to patients in the communities in which we are located. As of September 30, 2013, we owned or leased 135 hospitals comprised of 131 general acute care hospitals and four stand-alone rehabilitation or psychiatric hospitals. In addition to our hospitals and related businesses, we own and operate home care agencies, located primarily in markets where we also operate a hospital. Also, through our wholly-owned subsidiary, Quorum Health Resources, LLC, or QHR, we provide management and consulting services to non-affiliated general acute care hospitals located throughout the United States. For the hospitals and home care agencies that we own and operate, we are paid for our services by governmental agencies, private insurers and directly by the patients we serve. For our management and consulting services, we are paid by the non-affiliated hospitals utilizing our services.
In March 2013, we announced a new strategic alliance with Cleveland Clinic, one of the nation’s leading academic medical centers with a reputation for innovative approaches to patient care and cost reduction. We believe this alliance will enable us to find new and collaborative ways to enhance quality, reduce costs and create greater value for the services provided to our patients. Key components of this alliance include the implementation of Cleveland Clinic quality programs in select markets in which we operate as well as the potential for future joint ventures, clinical research and shared innovations.
As previously announced, on July 29, 2013, we, one of our wholly-owned subsidiaries, and Health Management Associates, Inc., or HMA, entered into an Agreement and Plan of Merger (which was subsequently amended on September 24, 2013), pursuant to which we have agreed to acquire all the outstanding shares of Class A common stock of HMA, or HMA Common Stock, for approximately $7.6 billion, including the assumption of approximately $3.7 billion of indebtedness, consisting of a combination of cash and parent company common stock, with each share of HMA Common Stock issued and outstanding immediately prior to the effective time of the merger becoming converted into the right to receive $10.50 in cash, 0.06942 of a share of the parent company’s common stock, and one contingent value right, which would entitle the holder of each CVR to receive a cash payment of $1.00 per share, following and conditioned upon the final resolution of certain legal matters involving HMA, subject to downward adjustments relating to the amount of certain losses arising out of or relating to such legal matters. The transaction is expected to close by the end of the first quarter of 2014, subject to governmental approvals, approval of the holders of at least 70% of the outstanding shares of HMA Common Stock entitled to vote thereon, and other applicable closing conditions. During the three and nine months ended September 30, 2013, we recognized approximately $4.2 million and $5.3 million, respectively, of expenses related to the anticipated acquisition of HMA.
Our net operating revenues for the three months ended September 30, 2013 increased $6.2 million to approximately $3.218 billion, as compared to approximately $3.212 billion for the three months ended September 30, 2012. Income from continuing operations, before noncontrolling interests, for the three months ended September 30, 2013 decreased 63.2% to $21.6 million, compared to $58.8 million for the three months ended September 30, 2012, which includes the after-tax loss from early extinguishment of debt of $33.2 million. Included in income from continuing operations for the three months ended September 30, 2013, is a $61.0 million after-tax charge for the government settlement and related costs reserve that is further discussed in the Legal Proceedings section in Part II Item 1 of this Form 10-Q. Consolidated and same-store inpatient admissions for the three months ended September 30, 2013 decreased 6.8%, compared to the three months ended September 30, 2012, and consolidated and same-store adjusted admissions for the three months ended September 30, 2013 decreased 3.9%, compared to the three months ended September 30, 2012.
 
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Our net operating revenues for the nine months ended September 30, 2013 increased $14.3 million to approximately $9.766 billion, as compared to approximately $9.752 billion for the nine months ended September 30, 2012. Income from continuing operations, before noncontrolling interests, for the nine months ended September 30, 2013 decreased 36.7% over the nine months ended September 30, 2012 to $165.0 million, compared to $260.6 million. Included in income from continuing operations for the nine months ended September 30, 2013, is a $61.0 million after-tax charge for the government settlement and related costs reserve that is further discussed in the Legal Proceedings section in Part II Item 1 of this Form 10-Q. Included in income from continuing operations for the nine months ended September 30, 2012, is a $42.8 million after-tax benefit from the resolution of an industry-wide governmental settlement and a payment update related to prior periods, an $8.7 million after-tax charge for certain legal and regulatory matters and a $72.8 million after-tax loss from the early extinguishment of debt. Total inpatient admissions for the nine months ended September 30, 2013 decreased 5.4%, compared to the nine months ended September 30, 2012, and adjusted admissions for the nine months ended September 30, 2013 decreased 3.1%, compared to the nine months ended September 30, 2012. On a same-store basis, admissions for the nine months ended September 30, 2013 decreased 6.2% and adjusted admissions decreased 3.9%, compared with the nine months ended September 30, 2012.
Self-pay revenues represented approximately 13.9% and 13.3% of our net operating revenues, net of contractual allowances and discounts (but before provision for bad debts), for the three months ended September 30, 2013 and 2012, respectively, and 13.7% and 13.2% of our net operating revenues, net of contractual allowances and discounts (but before provision for bad debts), for the nine months ended September 30, 2013 and 2012, respectively. The amount of foregone revenue related to providing charity care services as a percentage of net operating revenues was approximately 5.4% and 5.6% for the three months ended September 30, 2013 and 2012, respectively, and 5.3% for both of the nine-month periods ended September 30, 2013 and 2012. Direct and indirect costs incurred by us in providing charity care services were approximately 0.9% and 1.0% of net operating revenues for both the three and nine-month periods ended September 30, 2013 and 2012.
The Patient Protection and Affordable Care Act, or PPACA, was signed into law on March 23, 2010. In addition, the Health Care and Education Affordability Reconciliation Act of 2010, or Reconciliation Act, which contains a number of amendments to PPACA, was signed into law on March 30, 2010. These two healthcare acts, referred to collectively as the Reform Legislation, include a mandate that requires substantially all U.S. citizens to maintain medical insurance coverage, which will ultimately increase the number of persons with access to health insurance in the United States. The Reform Legislation, as originally enacted, is expected to expand health insurance coverage through a combination of public program expansion and private sector health insurance reforms. We believe the expansion of private sector and Medicaid coverage will, over time, increase our reimbursement related to providing services to individuals who were previously uninsured, which should reduce our expense from uncollectible accounts receivable. The Reform Legislation also makes a number of other changes to Medicare and Medicaid, such as reductions to the Medicare annual market basket update for federal fiscal years 2010 through 2019, a productivity offset to the Medicare market basket update which began October 1, 2011, and a reduction to the Medicare and Medicaid disproportionate share payments, that could adversely impact the reimbursement received under these programs. The various provisions in the Reform Legislation that directly or indirectly affect reimbursement are scheduled to take effect over a number of years. Over time, we believe the net impact of the overall changes as a result of the Reform Legislation will have a positive effect on our net operating revenues. Other provisions of the Reform Legislation, such as additional requirements related to providing health insurance benefits to our employees are expected to increase our operating costs.
Also included in the Reform Legislation are provisions aimed at reducing fraud, waste and abuse in the healthcare industry. These provisions allocate significant additional resources to federal enforcement agencies and expand the use of private contractors to recover potentially inappropriate Medicare and Medicaid payments. The Reform Legislation amends several existing federal laws, including the Medicare Anti-Kickback Statute and the False Claims Act, making it easier for government agencies and private plaintiffs to prevail in lawsuits brought against healthcare providers. These amendments also make it easier for potentially severe fines and penalties to be imposed on healthcare providers accused of violating applicable laws and regulations.
 
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On June 28, 2012, the Supreme Court of the United States largely upheld the constitutionality of the Reform Legislation, though it overturned an aspect of the legislation that would have permitted the Federal government to withhold all Medicaid funding from a state if that state did not expand Medicaid coverage to the extent required by the Reform Legislation. The Supreme Court’s ruling instead held that only new incremental funding could be withheld from a state in such a situation. As a result, states will face less severe financial consequences if they refuse to expand Medicaid coverage to individuals with incomes below certain thresholds. Since the Supreme Court’s ruling, some states have suggested that, for budgetary and other reasons, they would not expand their Medicaid programs. If states refuse to expand their Medicaid programs, the number of uninsured patients at our hospitals will decline by a smaller margin as compared to our expectations when the Reform Legislation was first adopted. In response to the Supreme Court ruling, the previous estimates of the reduction in uninsured individuals as a result of the Reform Legislation have been revised, with approximately 25 million additional individuals expected to have health insurance coverage by 2016. Because of the many variables involved, including clarifications and modifications resulting from the rule-making process, the development of agency guidance and future judicial interpretations, whether and how many states decide to expand or not to expand Medicaid coverage, the number of uninsured who elect to purchase health insurance coverage, budgetary issues at federal and state levels, and the potential for delays in the implementation of some of the provisions of the Reform Legislation, we may not be able to realize the positive impact the Reform Legislation may have on our business, results of operations, cash flow, capital resources and liquidity. Furthermore, we cannot predict whether we will be able to modify certain aspects of our operations to offset any potential adverse consequences from the Reform Legislation.
In a number of markets, we have partnered with local physicians in the ownership of our facilities. Such investments have been permitted under an exception to the physician self-referral law, or Stark Law, that allows physicians to invest in an entire hospital (as opposed to individual hospital departments). The Reform Legislation changes the “whole hospital” exception to the Stark Law. The Reform Legislation permits existing physician investments in a whole hospital to continue under a “grandfather” clause if the arrangement satisfies certain requirements and restrictions, but physicians are now prohibited, from the time the Reform Legislation became effective, from increasing the aggregate percentage of their ownership in the hospital. The Reform Legislation also restricts the ability of existing physician-owned hospitals to expand the capacity of their facilities.
In addition to the Reform Legislation, the American Recovery and Reinvestment Act of 2009 included provisions for implementing health information technology under the Health Information Technology for Economic and Clinical Health Act, or HITECH. These provisions were designed to increase the use of electronic health records, or EHR, technology and establish the requirements for a Medicare and Medicaid incentive payments program beginning in 2011 for eligible hospitals and providers that adopt and meaningfully use certified EHR technology. These incentive payments are intended to offset a portion of the costs incurred to implement and qualify as a meaningful user of EHR. Rules adopted in July 2010 by the Department of Health and Human Services established an initial set of standards and certification criteria. Our hospital facilities have been implementing EHR technology on a facility-by-facility basis since 2011. We anticipate recognizing incentive reimbursement related to the Medicare or Medicaid incentives as we are able to implement the certified EHR technology, meet the defined “meaningful use criteria,” and information from completed cost report periods is available from which to calculate the incentive reimbursement. The timing of recognizing incentive reimbursement will not correlate with the timing of recognizing operating expenses and incurring capital costs in connection with the implementation of EHR technology which may result in material period-to-period changes in our future results of operations. Hospitals that do not qualify as a meaningful user of EHR technology by 2015 are subject to a reduced market basket update to the inpatient prospective payment system standardized amount in 2015 and each subsequent fiscal year. Although we believe that our hospital facilities will be in compliance with the EHR standards by 2015, there can be no assurance that all of our facilities will be in compliance and therefore not subject to the penalty provisions of HITECH. We recognized approximately $65.0 million and $30.6 million during the three months ended September 30, 2013 and 2012, respectively, and $110.3 million and $73.6 million during the nine months ended September 30, 2013 and 2012, respectively, of incentive reimbursement for HITECH incentive reimbursements from Medicare and Medicaid related to certain of our hospitals and for certain of our employed physicians, which are presented as a reduction of operating expenses.
As a result of our current levels of cash, available borrowing capacity, long-term outlook on our debt repayments, the refinancing of our term loans and our continued projection of our ability to generate cash flows, we do not anticipate a significant impact on our ability to invest the necessary capital in our business over the next twelve months and into the foreseeable future. We believe there continues to be ample opportunity for growth in substantially all of our markets by decreasing the need for patients to travel outside their communities for healthcare services. Furthermore, we continue to benefit from synergies from our acquisitions and will continue to strive to improve operating efficiencies and procedures in order to improve our profitability at all of our hospitals.
 
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Sources of Revenue
The following table presents the approximate percentages of operating revenues, net of contractual allowances and discounts (but before provision for bad debts), by payor source for the periods indicated. The data for the periods presented are not strictly comparable due to the effect that hospital acquisitions have had on these statistics.

 	 	        Three Months Ended         
September 30,	 	        Nine Months Ended         
September 30,	
 	 	        2013        	 	        2012        	 	        2013        	 	        2012        	
 	 	 	 	 	 	 	 	 	
Medicare	 	 	24.2	  	 	%	 	 	25.8	  	 	%	 	 	25.0	  	 	%	 	 	25.9	  	  	%  (1)	
Medicaid	 	 	10.5	  	 	 	 	 	10.5	  	 	 	 	 	9.9	  	 	 	 	 	9.9	  	  	 	
Managed Care and other third-party payors	 	 	51.4	  	 	 	 	 	50.4	  	 	 	 	 	51.4	  	 	 	 	 	51.0	  	  	 	
Self-pay	 	 	13.9	  	 	 	 	 	13.3	  	 	 	 	 	13.7	  	 	 	 	 	13.2	  	  	 	
 	 	 	 	 	 	 	 	 	 	 	 	 	
Total	 	 	                 100.0	  	 	%	 	 	                100.0	  	 	%	 	 	                100.0	  	 	%	 	 	                 100.0	  	  	%	

(1) Excludes the $80.8 million reimbursement settlement and payment update as discussed below.
As shown above, we receive a substantial portion of our revenues from the Medicare and Medicaid programs. Included in Managed Care and other third-party payors is operating revenues from insurance companies with which we have insurance provider contracts, Medicare managed care, insurance companies for which we do not have insurance provider contracts, workers’ compensation carriers and non-patient service revenue, such as rental income and cafeteria sales. In the future, we generally expect revenues received from the Medicare and Medicaid programs to increase due to the general aging of the population. In addition, the Reform Legislation, currently in effect, should increase the number of insured patients, which, in turn, should reduce revenues from self-pay patients and reduce our provision for bad debts. The Reform Legislation, however, imposes significant reductions in amounts the government pays Medicare managed care plans. The trend toward increased enrollment in Medicare managed care may adversely affect our operating revenue growth. Other provisions in the Reform Legislation impose minimum medical-loss ratios and require insurers to meet specific benefit requirements. Furthermore, in the normal course of business, managed care programs, insurance companies and employers actively negotiate the amounts paid to hospitals. There can be no assurance that we will retain our existing reimbursement arrangements or that these third-party payors will not attempt to further reduce the rates they pay for our services.
Net operating revenues include amounts estimated by management to be reimbursable by Medicare and Medicaid under prospective payment systems and provisions of cost-based reimbursement and other payment methods. In addition, we are reimbursed by non-governmental payors using a variety of payment methodologies. Amounts we receive for treatment of patients covered by these programs are generally less than the standard billing rates. We account for the differences between the estimated program reimbursement rates and the standard billing rates as contractual allowance adjustments, which we deduct from gross revenues to arrive at net operating revenues. Final settlements under some of these programs are subject to adjustment based on administrative review and audit by third parties. We account for adjustments to previous program reimbursement estimates as contractual allowance adjustments and report them in the periods that such adjustments become known. During the nine months ended September 30, 2012, we recognized a net after-tax benefit of $42.8 million from the resolution of an industry-wide governmental settlement and a payment update related to prior periods. Other than these items, contractual allowance adjustments related to final settlements and previous program reimbursement estimates impacted net operating revenues and net income by an insignificant amount in each of the three-month and nine-month periods ended September 30, 2013 and 2012.
The payment rates under the Medicare program for hospital inpatient and outpatient acute care services are based on a prospective payment system, depending upon the diagnosis of a patient’s condition. These rates are indexed for inflation annually, although increases have historically been less than actual inflation. On August 19, 2013, CMS issued the final rule to adjust this index by 2.5% for hospital inpatient acute care services that are reimbursed under the prospective payment system. The final rule also made other payment adjustments that, coupled with the 0.5% multifactor productivity reduction and a 0.3% reduction to hospital inpatient rates implemented pursuant to the Reform Legislation, yielded an estimated net 0.5% increase in reimbursement for hospital inpatient acute care services beginning October 1, 2013. Reductions in the rate of increase or overall reductions in Medicare reimbursement may cause a decline in the growth of our net operating revenues.
 
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Currently, several states utilize supplemental reimbursement programs for the purpose of providing reimbursement to providers to offset a portion of the cost of providing care to Medicaid and indigent patients. These programs are designed with input from Centers for Medicare and Medicaid Services, or CMS, and are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. Similar programs are also being considered by other states. After these supplemental programs are signed into law, we recognize revenue and related expenses in the period in which amounts are estimable and collection is reasonably assured. Reimbursement under these programs is reflected in net operating revenues and included as Medicaid revenue in the table above, and fees, taxes or other program related costs are reflected in other operating expenses.
In addition, specified managed care programs, insurance companies and employers are actively negotiating the amounts paid to hospitals. The trend toward increased enrollment in managed care may adversely affect our net operating revenue growth.
Results of Operations
Our hospitals offer a variety of services involving a broad range of inpatient and outpatient medical and surgical services. These include general acute care, emergency room, general and specialty surgery, critical care, internal medicine, obstetrics, diagnostic services, psychiatric and rehabilitation services. The strongest demand for hospital services generally occurs during January through April and the weakest demand for these services occurs during the summer months. Accordingly, eliminating the effect of new acquisitions, our net operating revenues and earnings are historically highest during the first quarter and lowest during the third quarter.
The following tables summarize, for the periods indicated, selected operating data.

 	  	Three Months Ended
September 30,	 	  	Nine Months Ended
September 30,	 	
 	  	2013	 	  	2012	 	  	2013	 	  	2012	 	
 	  	(Expressed as a percentage of net operating revenues)	 	
 	 	 	 	 	
Consolidated:	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Net operating revenues	  	 	100.0  % 	  	  	 	100.0  % 	  	  	 	100.0  % 	  	  	 	100.0  % 	  	
Operating expenses (a)	  	 	(88.7)     	  	  	 	(85.3)     	  	  	 	(87.3)     	  	  	 	(85.0)     	  	
Depreciation and amortization	  	 	(6.1)     	  	  	 	(5.7)     	  	  	 	(5.9)     	  	  	 	(5.5)     	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Income from operations	  	 	5.2      	  	  	 	9.0      	  	  	 	6.8      	  	  	 	9.5      	  	
Interest expense, net	  	 	(4.8)     	  	  	 	(5.0)     	  	  	 	(4.8)     	  	  	 	(4.7)     	  	
Loss from early extinguishment of debt	  	 	-      	  	  	 	(1.6)     	  	  	 	-      	  	  	 	(1.2)     	  	
Equity in earnings of unconsolidated affiliates	  	 	0.4      	  	  	 	0.2      	  	  	 	0.4      	  	  	 	0.3      	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Income from continuing operations before income taxes	  	 	0.8      	  	  	 	2.6      	  	  	 	2.4      	  	  	 	3.9      	  	
Provision for income taxes	  	 	(0.1)     	  	  	 	(0.8)     	  	  	 	(0.7)     	  	  	 	(1.2)     	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Income from continuing operations	  	 	0.7      	  	  	 	1.8      	  	  	 	1.7      	  	  	 	2.7      	  	
Loss from discontinued operations, net of taxes	  	 	-      	  	  	 	-      	  	  	 	-      	  	  	 	-      	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Net income	  	 	0.7      	  	  	 	1.8      	  	  	 	1.7      	  	  	 	2.7      	  	
Less: Net income attributable to noncontrolling interests	  	 	(0.6)     	  	  	 	(0.4)     	  	  	 	(0.5)     	  	  	 	(0.6)     	  	
 	  	 	 	 	  	 	 	 	  	 	 	 	  	 	 	 	
Net income attributable to Community Health Systems, Inc. stockholders	  	 	0.1  % 	  	  	 	1.4  % 	  	  	 	1.2  % 	  	  	 	2.1  % 	  	

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 	  	   Three Months Ended   
September 30, 2013	 	  	   Nine Months Ended   
September 30, 2013	 	
Percentage increase (decrease) from same period prior year:	  	 	 	 	  	 	 	 	
Net operating revenues	  	 	0.2 %  	  	  	 	0.1 %  	  	
Admissions	  	 	(6.8)      	  	  	 	(5.4)      	  	
Adjusted admissions (b)	  	 	(3.9)      	  	  	 	(3.1)      	  	
Average length of stay	  	 	-       	  	  	 	-       	  	
Net income attributable to Community Health Systems, Inc. (c)	  	 	(90.7)      	  	  	 	(44.3)      	  	
Same store percentage increase (decrease) from same period prior year (d)	  	 	 	 	  	 	 	 	
Net operating revenues	  	 	0.2 %  	  	  	 	0.2 %  	  	
Admissions	  	 	(6.8)      	  	  	 	(6.2)      	  	
Adjusted admissions (b)	  	 	(3.9)      	  	  	 	(3.9)      	  	

(a)	Operating expenses include salaries and benefits, supplies, other operating expenses, government settlement and related costs reserve, electronic health records incentive reimbursement and rent.	
(b)	Adjusted admissions is a general measure of combined inpatient and outpatient volume. We computed adjusted admissions by multiplying admissions by gross patient revenues and then dividing that number by gross inpatient revenues.	
(c)	Includes loss from discontinued operations.	
(d)	Includes acquired hospitals to the extent we operated them in both years.	
Three Months Ended September 30, 2013 Compared to Three Months Ended September 30, 2012
Net operating revenues increased $6.2 million to approximately $3.218 billion for the three months ended September 30, 2013, from approximately $3.212 billion for the three months ended September 30, 2012. Net operating revenues from hospitals owned throughout both periods increased $7.4 million, which were partially offset by a decrease in net operating revenues of $1.2 million by hospitals acquired in 2012 and were impacted by higher than anticipated provision for bad debts. On a same-store basis, net operating revenues increased 0.2%. The increase in the provision for bad debts is primarily due to a higher concentration of self-pay net operating revenues. Sequester-related reimbursement cuts, effective April 1, 2013, reduced reimbursement by approximately $16 million during the three months ended September 30, 2013, for Medicare fee-for-service, physician practices and home care agencies.
On a consolidated and same-store basis, inpatient admissions decreased by 6.8% and adjusted admissions decreased by 3.9% during the three months ended September 30, 2013. This decrease in same-store inpatient admissions was reflective of lower admissions from women’s services including obstetrics and gynecology, fewer flu and respiratory-related admissions, and lower admissions from primarily low intensity cardiology services during the three months ended September 30, 2013, as compared to the three months ended September 30, 2012.
Operating expenses, excluding depreciation and amortization, as a percentage of net operating revenues, increased from 85.3% for the three months ended September 30, 2012 to 88.7% for the three months ended September 30, 2013. Salaries and benefits, as a percentage of net operating revenues, increased from 47.5% for the three months ended September 30, 2012 to 47.9% for the three months ended September 30, 2013. This increase in salaries and benefits, as a percentage of net operating revenues, was primarily due to volume decline in net operating revenues and annual pay rate increases taking effect at the beginning of the quarter. Supplies, as a percentage of net operating revenues, remained consistent at 15.1% for both of the three months ended September 30, 2013 and 2012. Other operating expenses, as a percentage of net operating revenues, increased from 21.6% for the three months ended September 30, 2012 to 22.5% for the three months ended September 30, 2013. This increase in other operating expenses, as a percentage of net operating revenues, was primarily due to increased acquisition-related expenses, primarily related to the anticipated acquisition of HMA, as well as increased contributions to state supplemental payment programs and, to a lesser extent, expenses associated with a strike at one of our Ohio facilities. Government settlement and related costs reserve, as a percentage of net revenues, was 3.0% for the three months ended September 30, 2013. Rent, as a percentage of net operating revenues, increased from 2.1% for the three months ended September 30, 2012 to 2.2% for the three months ended September 30, 2013.
 
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Electronic health records incentive reimbursements represent those incentives under the HITECH Act for which the recognition criterion has been met. We have recognized approximately $65.0 million and $30.6 million of incentive reimbursements, or 2.0% and 1.0% of net operating revenues, for the three months ended September 30, 2013 and 2012, respectively. We received cash payments of $22.6 million and $12.8 million for these incentives during the three months ended September 30, 2013 and 2012, respectively. As of September 30, 2013 and 2012, $52.6 million and $6.5 million, respectively, were recorded as deferred revenue as all criteria for gain recognition had not been met. Operating expenses incurred related to the installation and adoption of electronic health records, including depreciation and amortization, totaled approximately 0.8% of net operating revenues, of which depreciation and amortization represented 0.5% of net operating revenues for the three months ended September 30, 2013. Operating expenses incurred related to the installation and adoption of electronic health records, including depreciation and amortization, totaled approximately 0.7% of net operating revenues, of which depreciation and amortization represented 0.3% of net operating revenues for the three months ended September 30, 2012.
Depreciation and amortization, as a percentage of net operating revenues, increased from 5.7% for the three months ended September 30, 2012 to 6.1% for the three months ended September 30, 2013. This increase was due primarily to depreciation and amortization expense related to electronic health records software and hardware and depreciation for the replacement hospital that opened in October 2012.
Interest expense, net, decreased by $4.3 million from $158.6 million for the three months ended September 30, 2012, to $154.3 million for the three months ended September 30, 2013. A decrease in interest rates during 2013, compared to 2012, resulted in a decrease in interest expense of $7.5 million. This decrease was partially offset by an increase in interest expense of $3.2 million as a result of less interest being capitalized during 2013, as compared to 2012, because the prior year period had more major construction projects.
The loss from early extinguishment of debt of $52.0 million was recognized during the three months ended September 30, 2012 after the purchase and redemption of the 8  7 / 8 % Senior Notes due 2015 and the repayment of existing term loans under the Credit Facility.
Equity in earnings of unconsolidated affiliates, as a percentage of net operating revenues, increased from 0.2% for the three months ended September 30, 2012 to 0.4% for the three months ended September 30, 2013.
The net results of the above mentioned changes resulted in income from continuing operations before income taxes decreasing $59.5 million from $84.5 million for the three months ended September 30, 2012 to $25.0 million for the three months ended September 30, 2013.
Provision for income taxes from continuing operations decreased from $25.7 million for the three months ended September 30, 2012 to $3.4 million for the three months ended September 30, 2013 due to the decrease in income from continuing operations before income taxes. Our effective tax rates were 13.7% and 30.4% for the three months ended September 30, 2013 and 2012, respectively. The decrease in our effective tax rate is primarily related to the impact of the government settlement and related costs reserve recorded during the three months ended September 30, 2013, partially offset by the recognition of some federal and state income tax credits and favorable audit adjustments during the three months ended September 30, 2012 that did not reoccur in 2013.
Each of income from continuing operations and net income, as a percentage of net operating revenues, decreased from 1.8% for the three months ended September 30, 2012 to 0.7% for the three months ended September 30, 2013.
Net income attributable to noncontrolling interests, as a percentage of net operating revenues, increased from 0.4% for the three months ended September 30, 2012 to 0.6% for the three months ended September 30, 2013. The increase in net income attributable to noncontrolling interests, as a percentage of net operating revenues, is primarily due to higher operating profits attributable to minority owners at joint venture and syndicated hospitals during the three months ended September 30, 2013, compared to the three months ended September 30, 2012.
Net income attributable to Community Health Systems, Inc. was $4.1 million compared to $44.2 million for the three months ended September 30, 2012, a decrease of 90.7%. This decrease was primarily attributable to the government settlement and related costs reserve recorded during the three months ended September 30, 2013, partially offset by the after-tax impact of the loss from early extinguishment of debt recorded in 2012 with the payment of our term loans and 8  7 / 8 % Senior Notes.
 
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Nine Months Ended September 30, 2013 Compared to Nine Months Ended September 30, 2012
Net operating revenues increased $14.3 million to approximately $9.766 billion for the nine months ended September 30, 2013, from approximately $9.752 billion for the nine months ended September 30, 2012. Included in 2012 net operating revenues on a non-same store basis is approximately $101.8 million of net operating revenues from an industry-wide settlement with the United States Department of Health and Human Services and CMS, based on a claim that acute-care hospitals in the U.S. were underpaid from the Medicare inpatient prospective payment system in federal fiscal years 1999 through 2011. The underpayments resulted from calculations related to the rural floor budget neutrality adjustments implemented in connection with the Balanced Budget Act of 1997. Also included in 2012 net operating revenues is an unfavorable adjustment of approximately $21.0 million, related to the revised Supplemental Security Income ratios issued for federal fiscal years 2006 through 2009 utilized for calculating Medicare Disproportionate Share Hospital reimbursements. Excluding the $80.8 million net effect of these two items on 2012, net operating revenues for the nine months ended September 30, 2013 increased $95.1 million. Growth from hospitals owned throughout both periods contributed $23.9 million of that increase and $71.2 million was contributed by hospitals acquired in 2012. On a same-store basis, net operating revenues increased 0.2%. The increased net operating revenues contributed by hospitals that we owned throughout both periods were primarily attributable to general rate and reimbursement increases, including revenues from states with provider assessment programs.
On a consolidated basis, inpatient admissions decreased by 5.4% and adjusted admissions decreased by 3.1% during the nine months ended September 30, 2013. On a same-store basis, inpatient admissions decreased by 6.2% and adjusted admissions decreased by 3.9% during the nine months ended September 30, 2013. This decrease in same-store inpatient admissions was significantly impacted by seasonality factors, including the loss of one day in 2013 as compared to 2012, which was a leap year, as well as additional holidays that fell on weekdays during the first quarter in 2013. The decrease was also reflective of lower admissions from women’s services including obstetrics and gynecology, fewer flu and respiratory-related admissions, lower admissions from primarily low intensity cardiology services and reductions due to the continued impact of involuntary turnover of employed physicians occurring at the end of 2012 and continuing through the six months ended June 30, 2013.
Operating expenses, excluding depreciation and amortization, as a percentage of net operating revenues, increased from 85.0% for the nine months ended September 30, 2012 to 87.3% for the nine months ended September 30, 2013. Salaries and benefits, as a percentage of net operating revenues, increased from 46.6% for the nine months ended September 30, 2012 to 47.9% for the nine months ended September 30, 2013. This increase in salaries and benefits, as a percentage of net operating revenues, was primarily due to volume decline in net operating revenues and annual pay rate increases taking effect during the nine months ended September 30, 2013. Supplies, as a percentage of net operating revenues, increased from 15.1% for the nine months ended September 30, 2012 to 15.2% for the nine months ended September 30, 2013. Other operating expenses, as a percentage of net operating revenues, increased from 22.0% for the nine months ended September 30, 2012 to 22.1% for the nine months ended September 30, 2013. This increase in other operating expenses, as a percentage of net operating revenues, was primarily due to higher payments for state supplemental Medicaid programs and higher acquisition-related costs, partially offset by a decrease in professional liability expense, as a percentage of net revenues, due to a decline in claim payments and expenses as well as declines in the volume of higher risk procedures. Government settlement and related costs reserve, as a percentage of net revenues, was 1.0% for the nine months ended September 30, 2013. Rent, as a percentage of net operating revenues, increased from 2.1% for the nine months ended September 30, 2012 to 2.2% for the nine months ended September 30, 2013.
Electronic health records incentive reimbursements represent those incentives under the HITECH Act for which the recognition criterion has been met. We have recognized approximately $110.3 million and $73.6 million of incentive reimbursements, or 1.1% and 0.8% of net operating revenues, for the nine months ended September 30, 2013 and 2012, respectively. We received cash payments of $105.3 million and $41.6 million for these incentives during the nine months ended September 30, 2013 and 2012, respectively. As of September 30, 2013 and 2012, $52.6 million and $6.5 million, respectively, were recorded as deferred revenue as all criteria for gain recognition had not been met. Operating expenses incurred related to the installation and adoption of electronic health records, including depreciation and amortization, totaled approximately 0.8% of net operating revenues, of which depreciation and amortization represented 0.5% of net operating revenues for the nine months ended September 30, 2013. Operating expenses incurred related to the installation and adoption of electronic health records, including depreciation and amortization, totaled approximately 0.5% of net operating revenues, of which depreciation and amortization represented 0.3% of net operating revenues for the nine months ended September 30, 2012.
 
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Depreciation and amortization, as a percentage of net operating revenues, increased from 5.5% for the nine months ended September 30, 2012 to 5.9% for the nine months ended September 30, 2013. This increase was due primarily to depreciation and amortization expense related to electronic health records software and hardware and three replacement hospitals opened in 2012.
Interest expense, net, increased by $3.4 million from $462.3 million for the nine months ended September 30, 2012, to $465.7 million for the nine months ended September 30, 2013. An increase in our average outstanding debt during 2013, compared to 2012, resulted in an increase in interest expense of $7.3 million. Additionally, interest expense increased by $12.5 million as a result of less interest being capitalized during 2013, as compared to 2012, because the prior year period had more major construction projects. These increases were partially offset by a decrease in interest rates during 2013, compared to 2012, resulting in a decrease in interest expense of $14.6 million and a decrease in interest expense of $1.8 million due to one additional day of interest expense in the prior year period since 2012 was a leap year.
The loss from early extinguishment of debt of $1.3 million was recognized during the nine months ended September 30, 2013 after the repayment of $206.5 million of the term loans due 2014. The loss from early extinguishment of debt of $115.5 million was recognized during the nine months ended September 30, 2012 after the purchase and redemption of the 8  7 / 8 % Senior Notes due 2015 and the repayment of existing term loans and revolving credit facility under the Credit Facility as further discussed in Liquidity and Capital Resources.
Equity in earnings of unconsolidated affiliates, as a percentage of net operating revenues, increased from 0.3% for the nine months ended September 30, 2012 to 0.4% for the nine months ended September 30, 2013.
The net results of the above mentioned changes resulted in income from continuing operations before income taxes decreasing $148.1 million from $381.7 million for the nine months ended September 30, 2012 to $233.6 million for the nine months ended September 30, 2013.
Provision for income taxes from continuing operations decreased from $121.0 million for the nine months ended September 30, 2012 to $68.6 million for the nine months ended September 30, 2013 due to the decrease in income from continuing operations before income taxes. Our effective tax rates were 29.4% and 31.7% for the nine months ended September 30, 2013 and 2012, respectively. The decrease in our effective tax rate is primarily related to the impact from the government settlement and related costs reserve recorded during the nine months ended September 30, 2013.
Each of income from continuing operations and net income, as a percentage of net operating revenues, decreased from 2.7% for the nine months ended September 30, 2012 to 1.7% for the nine months ended September 30, 2013.
Net income attributable to noncontrolling interests, as a percentage of net operating revenues, decreased from 0.6% for the nine months ended September 30, 2012 to 0.5% for the nine months ended September 30, 2013. The decrease in net income attributable to noncontrolling interests, as a percentage of net operating revenues, is primarily due to lower income from operations from our less than wholly-owned subsidiaries and also the reduction in hospital syndications as a result of the redemption of all of the physician ownership interests at several hospitals during 2012.
Net income attributable to Community Health Systems, Inc. was $113.0 million for the nine months ended September 30, 2013 compared to $203.1 million for the nine months ended September 30, 2012, a decrease of 44.3%. The decrease is primarily attributable to an increase in operating expenses as a percentage of net operating revenues, including the government settlement and related costs reserve, which were impacted by lower volumes during the nine months ended September 30, 2013.
 
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Liquidity and Capital Resources
Net cash provided by operating activities decreased $336.8 million, from approximately $777.9 million for the nine months ended September 30, 2012 to approximately $441.1 million for the nine months ended September 30, 2013. The decrease in cash provided by operating activities is due primarily to the $94.6 million of cash received, net of legal fees paid, related to the industry-wide settlement included in net income for the nine months ended September 30, 2012, as well as a net decrease in cash flows from accounts payable, accrued liabilities and income taxes, primarily as a result of the timing of payments of accounts payable and payroll-related accrued liabilities, which decreased cash flows from operating activities by $309.1 million, a decrease in cash generated from accounts receivable of $3.3 million and a decrease from the effect of the non-cash loss from early extinguishment of debt of $114.2 million. These decreases in cash flows were offset by an increase in cash flows from supplies, prepaid expenses and other current assets of $8.2 million, an increase in depreciation and amortization expense of $46.2 million, an increase from the effect of the non-cash expense for the reserve recorded for the government settlement and related costs of $98.0 million, an increase in cash flow from the change in other assets and liabilities of $13.4 million and an increase in all other non-cash expenses of $19.1 million. Included in net cash provided by operating activities for the nine months ended September 30, 2013 is $105.3 million of cash received for HITECH incentive reimbursements, compared to $41.6 million for the nine months ended September 30, 2012.
The cash used in investing activities decreased $403.0 million, from approximately $1.1 billion for the nine months ended September 30, 2012 to approximately $684.8 million for the nine months ended September 30, 2013. The decrease in cash used in investing activities was due to a decrease in cash paid for acquisitions of facilities and other related equipment of $279.0 million, since there were no hospital acquisitions in the current period compared to four hospitals and one large multi-specialty clinic acquired in the first nine months of 2012 and a decrease in the cash used for the purchase of property and equipment of $136.6 million. These decreases in cash outflows were partially offset by a reduction in the proceeds from sale of property and equipment of $0.6 million and a decrease in cash used for other investments of $12.0 million. Included in cash outflows for other investments for the nine months ended September 30, 2013 is approximately $59.3 million of capital expenditures related to the purchase and implementation of certified EHR technology. The remaining cash outflows for other investments consists primarily of purchases and development of other internal-use software and payments made under non-employee physician recruiting agreements of $174.8 million. We anticipate being able to fund future routine capital expenditures with cash flows generated from operations.
Our net cash used in financing activities was $0.5 million for the nine months ended September 30, 2013, compared to net cash provided by financing activities of $420.7 million for the nine months ended September 30, 2012. The change in cash used in financing activities, in comparison to the prior year, is primarily due to a decrease in borrowings of our long-term debt, net of repayments and deferred financing costs, and an increase in the buy-back of common stock, which was partially offset by an increase in proceeds from the exercise of stock options and a reduction in the redemption of noncontrolling interests in joint ventures.
Capital Expenditures
Cash expenditures for purchases of facilities and other related equipment were $33.9 million for the nine months ended September 30, 2013, compared to $312.9 million for the nine months ended September 30, 2012. The expenditures during the nine months ended September 30, 2013 were for the purchase of surgery centers, physician practices and other ancillary services. The expenditures during the nine months ended September 30, 2012 were for the purchase of three hospitals in Pennsylvania, one hospital in Illinois, a physician practice in Texas, surgery centers and other physician practices and the settlement of working capital items from prior acquisitions and divestitures.
Excluding the cost to construct replacement hospitals, our cash expenditures for routine capital for the nine months ended September 30, 2013 totaled $379.3 million, compared to $465.6 million for the nine months ended September 30, 2012. These capital expenditures related primarily to the purchase of additional equipment, minor renovations and information systems infrastructure. Costs to construct replacement hospitals for the nine months ended September 30, 2013 totaled $41.6 million, compared to $91.9 million for the nine months ended September 30, 2012. The costs to construct replacement hospitals for the nine months ended September 30, 2013 represent planning and construction costs for the two replacement hospitals discussed below. The costs to construct replacement hospitals for the nine months ended September 30, 2012 represent construction and equipment costs primarily for three replacement hospitals opened in 2012 located in Barstow, California; Valparaiso, Indiana; and Siloam Springs, Arkansas.
 
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Pursuant to a hospital purchase agreement in effect as of September 30, 2013, we have committed to build a replacement facility in York, Pennsylvania by July 2017. Construction costs, including equipment costs, for the York replacement facility is currently estimated to be approximately $100.0 million. In addition, in October 2008, after the purchase of the noncontrolling owner’s interest in our Birmingham, Alabama facility, we initiated the purchase of a site, which includes a partially constructed hospital structure, for a potential replacement to our existing Birmingham facility. In September 2010, we received approval of our request for a certificate of need from the Alabama Certificate of Need Review Board. This CON was challenged in the Alabama state circuit and appellate courts, but the CON was upheld by the Supreme Court of Alabama in May 2013, eliminating any further appeals. Our estimated construction costs, including the acquisition of the site and equipment costs, are approximately $280.0 million for the Birmingham replacement facility.
Capital Resources
Net working capital was approximately $1.337 billion at September 30, 2013, compared to $1.276 billion at December 31, 2012, an increase of $60.9 million, primarily the result of an increase in patient accounts receivable, partially offset by decreases in cash, accounts payable and employee compensation liabilities.
We obtained senior secured financing under the Credit Facility with a syndicate of financial institutions led by Credit Suisse, as administrative agent and collateral agent. A $750 million revolving credit facility was available to us for working capital and general corporate purposes under the Credit Facility. The revolving credit facility also includes a subfacility for letters of credit and a swingline subfacility. The Credit Facility requires quarterly amortization payments of each term loan facility equal to 0.25% of the outstanding amount of the term loans. On November 5, 2010, we entered into an amendment and restatement of the Credit Facility. The amendment extended by two and a half years, until January 25, 2017, the maturity date of $1.5 billion of our existing term loans under the Credit Facility and increased the pricing on these term loans to LIBOR plus 350 basis points. The amendment also increased our ability to issue additional indebtedness under the uncommitted incremental facility to $1.0 billion from $600 million, permitted us to issue term loan A loans under the incremental facility and provided up to $2.0 billion of borrowing capacity from receivable transactions, an increase of $0.5 billion, of which approximately $1.7 billion would be required to be used for repayment of our existing term loans. On February 2, 2012, we completed a second amendment and restatement of the Credit Facility to extend an additional $1.6 billion of our term loans due 2014 under the Credit Facility to match the maturity date and interest rate margins of the term loans due January 25, 2017. On August 3, 2012, we entered into Amendment No. 1 to the Credit Facility to provide increased flexibility for refinancing and repayment of the term loans due 2014 and amend certain other terms. On August 22, 2012, we entered into a loan modification agreement with respect to the Credit Facility to extend approximately $340 million of the term loans due 2014 to match the maturity date and interest rate margins of the term loans due January 25, 2017. On November 27, 2012, we entered into Amendment No. 2 to the Credit Facility to provide increased flexibility for us to make investments and restricted payments, incur debt related to acquisitions, amend certain other terms of the Credit Facility, including the maximum leverage ratio and interest coverage ratio financial coverage levels, and add a one year 1% prepayment premium payable in connection with a repricing of the term loans due in 2017. On August 12, 2013, CHS entered into Amendment No. 3 to the Credit Facility to provide increased flexibility for CHS to incur debt by amending certain terms of the Credit Facility, including the maximum leverage ratio and secured leverage ratio covenant levels. In addition, the amendment includes pricing protection for certain term loans due January 25, 2017, which specifies an increased margin in certain instances. The amendment also provides for a total leverage-based step-up to the applicable margin of the term loans due January 25, 2017 and the term loans due July 25, 2014. The pricing of the loans under the Credit Facility will otherwise remain unchanged. During the nine months ended September 30, 2013, we paid down $206.5 million of the term loans due 2014. The July 25, 2014 maturity date of the balance of the remaining non-extended term loans at September 30, 2013 of approximately $59.6 million remains unchanged.
 
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Effective March 6, 2012, we obtained a new $750 million senior secured revolving credit facility, or the Replacement Revolver Facility, and a new $750 million incremental term loan A facility, or the Incremental Term Loan subject to the terms and conditions set forth in the Credit Facility. The Replacement Revolver Facility replaced in full the existing revolving credit facility under the Credit Facility. The net proceeds of the Incremental Term Loan were used to repay the same amount of the existing term loans under the Credit Facility. Both the Replacement Revolver Facility and the Incremental Term Loan have a maturity date of October 25, 2016, subject to customary acceleration events and to earlier maturity if the repayment, extension or refinancing with longer maturity debt of substantially all of the then outstanding term loans maturing July 25, 2014 and the now fully redeemed 8  7 / 8 % Senior Notes does not occur by April 25, 2014. The pricing on each of the Replacement Revolver Facility and the Incremental Term Loan is initially LIBOR plus a margin of 250 basis points, subject to adjustment based on our leverage ratio. The Incremental Term Loan amortizes at 5% in year one, 10% in years two and three, 15% in year four and 60% in year five.
The term loan facility must be prepaid in an amount equal to (1) 100% of the net cash proceeds of certain asset sales and dispositions by us and our subsidiaries, subject to certain exceptions and reinvestment rights, (2) 100% of the net cash proceeds of issuances of certain debt obligations or receivables-based financing by us and our subsidiaries, subject to certain exceptions, and (3) 50%, subject to reduction to a lower percentage based on our leverage ratio (as defined in the Credit Facility generally as the ratio of total debt on the date of determination to our EBITDA, as defined, for the four quarters most recently ended prior to such date), of excess cash flow (as defined) for any year, commencing in 2008, subject to certain exceptions. Voluntary prepayments and commitment reductions are permitted in whole or in part, without any premium or penalty, subject to minimum prepayment or reduction requirements.
The obligor under the Credit Facility is CHS. All of our obligations under the Credit Facility are unconditionally guaranteed by Community Health Systems, Inc. and certain of its existing and subsequently acquired or organized domestic subsidiaries. All obligations under the Credit Facility and the related guarantees are secured by a perfected first priority lien or security interest in substantially all of the assets of Community Health Systems, Inc., CHS and each subsidiary guarantor, including equity interests held by us or any subsidiary guarantor, but excluding, among others, the equity interests of non-significant subsidiaries, syndication subsidiaries, securitization subsidiaries and joint venture subsidiaries.
The loans under the Credit Facility bear interest on the outstanding unpaid principal amount at a rate equal to an applicable percentage plus, at our option, either (a) an Alternate Base Rate (as defined) determined by reference to the greater of (1) the Prime Rate (as defined) announced by Credit Suisse or (2) the Federal Funds Effective Rate (as defined) plus 0.5% or (3) the adjusted LIBOR rate on such day for a three-month interest period commencing on the second business day after such day plus 1%, or (b) a reserve adjusted LIBOR for dollars (Eurodollar rate) (as defined). The applicable percentage for Alternate Base Rate loans is 1.25% for term loans due 2014 and 2.50% for term loans due 2017. The applicable percentage for Eurodollar rate loans is 2.25% for term loans due 2014 and 3.50% for term loans due 2017. The applicable percentage for revolving loans and the Incremental Term Loan is 1.50% for Alternate Base Rate loans and 2.50% for Eurodollar loans. The applicable percentage for the loans under the Credit Facility is subject to adjustment based on our leverage ratio. Loans under the swingline subfacility bear interest at the rate applicable to Alternate Base Rate loans under the Credit Facility.
We have agreed to pay letter of credit fees equal to the applicable percentage then in effect with respect to Eurodollar rate loans under the revolving credit facility times the maximum aggregate amount available to be drawn under all letters of credit outstanding under the subfacility for letters of credit. The issuer of any letter of credit issued under the subfacility for letters of credit will also receive a customary fronting fee and other customary processing charges. We are obligated to pay commitment fees of 0.50% per annum (subject to reduction based upon our leverage ratio), on the unused portion of the revolving credit facility. For purposes of this calculation, swingline loans are not treated as usage of the revolving credit facility.
The Credit Facility contains customary representations and warranties, subject to limitations and exceptions, and customary covenants restricting our and our subsidiaries’ ability, subject to certain exception, to, among other things, (1) declare dividends, make distributions or redeem or repurchase capital stock, (2) prepay, redeem or repurchase other debt, (3) incur liens or grant negative pledges, (4) make loans and investments and enter into acquisitions and joint ventures, (5) incur additional indebtedness or provide certain guarantees, (6) make capital expenditures, (7) engage in mergers, acquisitions and asset sales, (8) conduct transactions with affiliates, (9) alter the nature of our businesses, (10) grant certain guarantees with respect to physician practices, (11) engage in sale and leaseback transactions or (12) change our fiscal year. We and our subsidiaries are also required to comply with specified financial covenants (consisting of a leverage ratio and an interest coverage ratio) and various affirmative covenants.
 
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Events of default under the Credit Facility include, but are not limited to, (1) our failure to pay principal, interest, fees or other amounts under the credit agreement when due (taking into account any applicable grace period), (2) any representation or warranty proving to have been materially incorrect when made, (3) covenant defaults subject, with respect to certain covenants, to a grace period, (4) bankruptcy events, (5) a cross default to certain other debt, (6) certain undischarged judgments (not paid within an applicable grace period), (7) a change of control, (8) certain ERISA-related defaults and (9) the invalidity or impairment of specified security interests, guarantees or subordination provisions in favor of the administrative agent or lenders under the Credit Facility.
As of September 30, 2013, the availability for additional borrowings under our Credit Facility, after consideration of the $87.0 million outstanding at that date, was approximately $663 million pursuant to the Replacement Revolver Facility, of which $19.3 million was set aside for outstanding letters of credit. We believe that these funds, along with internally generated cash and continued access to the bank credit and capital markets, will be sufficient to finance future acquisitions, capital expenditures and working capital requirements through the next 12 months and into the foreseeable future.
On March 21, 2012, CHS completed the secondary offering of $1.0 billion aggregate principal amount of 8% Senior Notes, which were issued in a private placement (at a premium of 102.5%). The net proceeds from this issuance were used to finance the purchase of approximately $850 million aggregate principal amount of CHS’ then outstanding 8  7 / 8 % Senior Notes, to pay related fees and expenses and for general corporate purposes. On March 21, 2012, CHS completed the cash tender offer for $850 million of the then $1.8 billion aggregate outstanding principal amount of 8  7 / 8 % Senior Notes.
On July 18, 2012, CHS completed an underwritten public offering under our automatic shelf registration filed with the SEC of $1.2 billion aggregate principal amount of 7  1 / 8 % Senior Notes due 2020. The net proceeds of the offering were used to finance the purchase or redemption of the then outstanding $934.3 million principal amount plus accrued interest of the 8  7 / 8 % Senior Notes, to pay for consents delivered in connection therewith, to pay related fees and expenses, and for general corporate purposes.
On August 17, 2012, CHS completed an underwritten public offering under our automatic shelf registration filed with the SEC of $1.6 billion aggregate principal amount of 5  1 / 8 % Senior Secured Notes due 2018. The 5  1 / 8 % Senior Secured Notes are secured by a first-priority lien subject to a shared lien of equal priority with certain other obligations, including obligations under the Credit Facility, and subject to prior ranking liens permitted by the indenture governing the 5  1 / 8 % Senior Secured Notes on substantially the same assets, subject to certain exceptions, that secure CHS’ obligations under the Credit Facility. The net proceeds of the offering, together with available cash on hand, were used to finance the prepayment of $1.6 billion of the outstanding term loans due 2014 under the Credit Facility and related fees and expenses.
On March 21, 2012, through certain of its subsidiaries, CHS entered into an accounts receivable loan agreement, or the Receivables Facility, with a group of lenders and banks, Credit Agricolé Corporate and Investment Bank, as a managing agent and as the administrative agent, and The Bank of Nova Scotia, as a managing agent. On March 7, 2013, CHS and certain of its subsidiaries amended the Receivables Facility to add an additional managing agent, The Bank of Tokyo-Mitsubishi UFJ, Ltd., to increase the size of the facility from $300 million to $500 million and to extend the scheduled termination date. Additional subsidiaries also agreed to participate in the Receivables Facility as of that date. The existing and future non-self pay patient-related accounts receivable, or the Receivables, for certain of our hospitals serve as collateral for the outstanding borrowings under the Receivables Facility. The interest rate on the borrowings is based on the commercial paper rate plus an applicable interest rate spread. Unless earlier terminated or subsequently extended pursuant to its terms, the Receivables Facility will expire on March 21, 2015, subject to customary termination events that could cause an early termination date. We maintain effective control over the Receivables because, pursuant to the terms of the Receivables Facility, the Receivables are sold from certain of our subsidiaries to CHS, and CHS then sells or contributes the Receivables to a special-purpose entity that is wholly-owned by CHS. The wholly-owned special-purpose entity in turn grants security interests in the Receivables in exchange for borrowings obtained from the group of third-party lenders and banks of up to $500 million outstanding from time to time based on the availability of eligible Receivables and other customary factors. The group of third-party lenders and banks do not have recourse to us or our subsidiaries beyond the assets of the wholly-owned special-purpose entity that collateralizes the loan. The Receivables and other assets of the wholly-owned special-purpose entity will be available first and foremost to satisfy the claims of the creditors of such entity. The outstanding borrowings pursuant to the Receivables Facility at September 30, 2013 totaled $482.0 million and are classified as long-term debt on the condensed consolidated balance sheet. At September 30, 2013, the carrying amount of Receivables included in the Receivables Facility totaled approximately $994.4 million and is included in patient accounts receivable on the condensed consolidated balance sheet.
 
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As of September 30, 2013, we are currently a party to the following interest rate swap agreements to limit the effect of changes in interest rates on approximately 53% of our variable rate debt. On each of these swaps, we receive a variable rate of interest based on the three-month LIBOR, in exchange for the payment by us of a fixed rate of interest. We currently pay, on a quarterly basis, a margin above LIBOR of 225 basis points for revolving credit and term loans due 2014, 250 basis points for the Replacement Revolver Facility and the Incremental Term Loan and 350 basis points for term loans due 2017 under the Credit Facility.

 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	
            Swap #             	 	 Notional Amount 
(in 000’s)	 	 	 Fixed Interest Rate 	 	 	             Termination  Date             	 	 	Fair Value of
 Liability (in 000’s) 	 	
1 	 	 	 $                50,000 	  	 	 	3.586 %   	  	 	 	October 23, 2013	  	 	 	$                         103 	  	
2 	 	 	50,000 	  	 	 	3.524 %   	  	 	 	October 23, 2013	  	 	 	101 	  	
3 	 	 	100,000 	  	 	 	5.050 %   	  	 	 	November 30, 2013	  	 	 	783 	  	
4 	 	 	200,000 	  	 	 	2.070 %   	  	 	 	December 19, 2013	  	 	 	791 	  	
5 	 	 	100,000 	  	 	 	5.231 %   	  	 	 	July 25, 2014	  	 	 	4,050 	  	
6 	 	 	100,000 	  	 	 	5.231 %   	  	 	 	July 25, 2014	  	 	 	4,050 	  	
7 	 	 	200,000 	  	 	 	5.160 %   	  	 	 	July 25, 2014	  	 	 	7,983 	  	
8 	 	 	75,000 	  	 	 	5.041 %   	  	 	 	July 25, 2014	  	 	 	2,920 	  	
9 	 	 	125,000 	  	 	 	5.022 %   	  	 	 	July 25, 2014	  	 	 	4,847 	  	
10 	 	 	100,000 	  	 	 	2.621 %   	  	 	 	July 25, 2014	  	 	 	1,906 	  	
11 	 	 	100,000 	  	 	 	3.110 %   	  	 	 	July 25, 2014	  	 	 	2,307 	  	
12 	 	 	100,000 	  	 	 	3.258 %   	  	 	 	July 25, 2014	  	 	 	2,429 	  	
13 	 	 	200,000 	  	 	 	2.693 %   	  	 	 	October 26, 2014	  	 	 	5,120 	  	
14 	 	 	300,000 	  	 	 	3.447 %   	  	 	 	August 8, 2016	  	 	 	23,323 	  	
15 	 	 	200,000 	  	 	 	3.429 %   	  	 	 	August 19, 2016	  	 	 	15,543 	  	
16 	 	 	100,000 	  	 	 	3.401 %   	  	 	 	August 19, 2016	  	 	 	7,695 	  	
17 	 	 	200,000 	  	 	 	3.500 %   	  	 	 	August 30, 2016	  	 	 	16,055 	  	
18 	 	 	100,000 	  	 	 	3.005 %   	  	 	 	November 30, 2016	  	 	 	6,855 	  	
The Credit Facility and/or the Notes contain various covenants that limit our ability to take certain actions including; among other things, our ability to:
 
 	•	 	incur, assume or guarantee additional indebtedness;	
 
 	•	 	issue redeemable stock and preferred stock;	
 
 	•	 	repurchase capital stock;	
 
 	•	 	make restricted payments, including paying dividends and making investments;	
 
 	•	 	redeem debt that is junior in right of payment to the Notes;	
 
 	•	 	create liens without securing the Notes;	
 
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 	•	 	sell or otherwise dispose of assets, including capital stock of subsidiaries;	
 
 	•	 	enter into agreements that restrict dividends from subsidiaries;	
 
 	•	 	merge, consolidate, sell or otherwise dispose of substantial portions of our assets;	
 
 	•	 	enter into transactions with affiliates and	
 
 	•	 	guarantee certain obligations.	
In addition, our Credit Facility contains restrictive covenants and requires us to maintain specified financial ratios and satisfy other financial condition tests. Our ability to meet these restricted covenants and financial ratios and tests can be affected by events beyond our control, and we cannot assure you that we will meet those tests. A breach of any of these covenants could result in a default under our Credit Facility and/or the Notes. Upon the occurrence of an event of default under our Credit Facility or the Notes, all amounts outstanding under our Credit Facility and the Notes may become immediately due and payable and all commitments under the Credit Facility to extend further credit may be terminated.
We believe that internally generated cash flows, availability for additional borrowings under our Credit Facility of $663 million (consisting of a $750 million revolving credit facility, of which $19.3 million is set aside for outstanding letters of credit and $87.0 million was outstanding at September 30, 2013) and our ability to amend the Credit Facility to provide for one or more tranches of term loans in an aggregate principal amount of $1.0 billion, and our continued access to the bank credit and capital markets will be sufficient to finance acquisitions, capital expenditures and working capital requirements through the next 12 months, other than the anticipated acquisition of HMA, for which we have obtained commitments for separate financing. We believe these same sources of cash, borrowings under our Credit Facility as well as access to bank credit and capital markets will be available to us beyond the next 12 months and into the foreseeable future.
On May 24, 2012, we filed a universal automatic shelf registration statement on Form S-3ASR, as amended on June 7, 2012, that will permit us, from time to time, in one or more public offerings, to offer debt securities, common stock, preferred stock, warrants, depositary shares, or any combination of such securities. The shelf registration statement will also permit our subsidiary, CHS, to offer debt securities that would be guaranteed by us, from time to time in one or more public offerings. The terms of any such future offerings would be established at the time of the offering.
The ratio of earnings to fixed charges is a measure of our ability to meet our fixed obligations related to our indebtedness. The following table shows the ratio of earnings to fixed charges for the nine months ended September 30, 2013:

 	  	  Nine Months Ended  
September 30, 2013	 	
 	 	
Ratio of earnings to fixed charges (1)	  	 	1.46 x    	  	

(1)	Fixed charges include interest expensed and capitalized during the year plus an estimate of the interest component of rent expense. There are no shares of preferred stock outstanding. See Exhibit 12 filed as part of this Report for the calculation of this ratio.	
 
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Off-balance Sheet Arrangements
Our consolidated operating results for the nine months ended September 30, 2013 and 2012, included $119.7 million and $127.6 million, respectively, of net operating revenues and $2.2 million and $9.8 million, respectively, of income from continuing operations, generated from four hospitals operated by us under operating lease arrangements at September 30, 2013. In accordance with accounting principles generally accepted in the United States of America, or U.S. GAAP, the respective assets and the future lease obligations under these arrangements are not recorded on our condensed consolidated balance sheet. Lease costs under these arrangements are included in rent expense and totaled approximately $8.3 million and $7.9 million for the nine months ended September 30, 2013 and 2012, respectively. The current terms of these operating leases expire between May 2015 and June 2022, not including lease extension options. If we allow these leases to expire, we would no longer generate revenues nor incur expenses from these hospitals. The operating lease at our Barstow, California location terminated on November 30, 2012 in conjunction with the opening of the replacement facility that we constructed, which was a requirement of the operating lease agreement.
In the past, we have utilized operating leases as a financing tool for obtaining the operations of specified hospitals without acquiring, through ownership, the related assets of the hospital and without a significant outlay of cash at the front end of the lease. We utilize the same operating strategies to improve operations at those hospitals held under operating leases as we do at those hospitals that we own. We have not entered into any operating leases for hospital operations since December 2000.
Noncontrolling Interests
We have sold noncontrolling interests in certain of our subsidiaries or acquired subsidiaries with existing noncontrolling interest ownership positions. As of September 30, 2013, we have hospitals in 21 of the markets we serve, with noncontrolling physician ownership interests ranging from less than 1% to 40%, including one hospital that also has a non-profit entity as a partner. In addition, we have three other hospitals with noncontrolling interests owned by non-profit entities. During the three months ended March 31, 2012, one of our subsidiaries purchased the outstanding partnership interests not already owned by us that were held by physician investors in the limited partnership that owns and operates Longview Regional Medical Center in Longview, Texas. The purchase price for these partnership interests was $28.8 million. After acquiring these partnership interests, one or more of our subsidiaries collectively own 100% of the outstanding equity of the limited partnership that owns and operates this hospital. Redeemable noncontrolling interests in equity of consolidated subsidiaries was $366.8 million and $367.7 million as of September 30, 2013 and December 31, 2012, respectively, and noncontrolling interests in equity of consolidated subsidiaries was $63.0 million and $65.3 million as of September 30, 2013 and December 31, 2012, respectively. The amount of net income attributable to noncontrolling interests was $17.5 million and $14.5 million for the three months ended September 30, 2013 and 2012, respectively and $52.0 million and $57.1 million for the nine months ended September 30, 2013 and 2012, respectively. As a result of the change in the Stark Law “whole hospital” exception included in the Reform Legislation, we are not permitted to introduce physician ownership at any of our wholly-owned hospital facilities or increase the aggregate percentage of physician ownership in any of our existing hospital joint ventures.
Reimbursement, Legislative and Regulatory Changes
The Reform Legislation was enacted in the context of other ongoing legislative and regulatory efforts, which would reduce or otherwise adversely affect the payments we receive from Medicare and Medicaid. Within the statutory framework of the Medicare and Medicaid programs, including programs currently unaffected by the Reform Legislation, there are substantial areas subject to administrative rulings, interpretations and discretion which may further affect payments made under those programs, and the federal and state governments might, in the future, reduce the funds available under those programs or require more stringent utilization and quality reviews of hospital facilities. Additionally, there may be a continued rise in managed care programs and additional restructuring of the financing and delivery of healthcare in the United States. These events could cause our future financial results to decline. We cannot estimate the impact of Medicare and Medicaid reimbursement changes that have been enacted or are under consideration. We cannot predict whether additional reimbursement reductions will be made or whether any such changes would have a material adverse effect on our business, financial conditions, results of operations, cash flow, capital resources and liquidity.
 
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Inflation
The healthcare industry is labor intensive. Wages and other expenses increase during periods of inflation and when labor shortages occur in the marketplace. In addition, our suppliers pass along rising costs to us in the form of higher prices. We have implemented cost control measures, including our case and resource management program, to curb increases in operating costs and expenses. We have generally offset increases in operating costs by increasing reimbursement for services, expanding services and reducing costs in other areas. However, we cannot predict our ability to cover or offset future cost increases, particularly any increases in our cost of providing health insurance benefits to our employees as a result of the Reform Legislation.
Critical Accounting Policies
The discussion and analysis of our financial condition and results of operations are based upon our condensed consolidated financial statements, which have been prepared in accordance with U.S. GAAP. The preparation of these financial statements requires us to make estimates and judgments that affect the reported amount of assets and liabilities, revenues and expenses, and related disclosure of contingent assets and liabilities at the date of our condensed consolidated financial statements. Actual results may differ from these estimates under different assumptions or conditions.
Critical accounting policies are defined as those that are reflective of significant judgments and uncertainties, and potentially result in materially different results under different assumptions and conditions. We believe that our critical accounting policies are limited to those described below.
Third-party Reimbursement
Net operating revenues include amounts estimated by management to be reimbursable by Medicare and Medicaid under prospective payment systems and provisions of cost-reimbursement and other payment methods. In addition, we are reimbursed by non-governmental payors using a variety of payment methodologies. Amounts we receive for treatment of patients covered by these programs are generally less than the standard billing rates. Contractual allowances are automatically calculated and recorded through our internally developed “automated contractual allowance system.” Within the automated system, actual Medicare DRG data and payors’ historical paid claims data are utilized to calculate the contractual allowances. This data is automatically updated on a monthly basis. All hospital contractual allowance calculations are subjected to monthly review by management to ensure reasonableness and accuracy. We account for the differences between the estimated program reimbursement rates and the standard billing rates as contractual allowance adjustments, which we deduct from gross revenues to arrive at operating revenues (net of contractual allowances and discounts). The process of estimating contractual allowances requires us to estimate the amount expected to be received based on payor contract provisions. The key assumption in this process is the estimated contractual reimbursement percentage, which is based on payor classification and historical paid claims data. Due to the complexities involved in these estimates, actual payments we receive could be different from the amounts we estimate and record. If the actual contractual reimbursement percentage under government programs and managed care contracts differed by 1% at September 30, 2013 from our estimated reimbursement percentage, net income for the nine months ended September 30, 2013 would have changed by approximately $41.8 million, and net accounts receivable at September 30, 2013 would have changed by $68.2 million. Final settlements under some of these programs are subject to adjustment based on administrative review and audit by third parties. We account for adjustments to previous program reimbursement estimates as contractual allowance adjustments and report them in the periods that such adjustments become known. During the nine months ended September 30, 2012, we recognized a net after-tax benefit of $42.8 million from the resolution of an industry-wide governmental settlement and a payment update related to prior periods. Other than these items, contractual allowance adjustments related to final settlements and previous program reimbursement estimates impacted net operating revenues and net income by an insignificant amount in each of the three-month and nine-month periods ended September 30, 2013 and 2012.
 
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Allowance for Doubtful Accounts
Substantially all of our accounts receivable are related to providing healthcare services to our hospitals’ patients. Collection of these accounts receivable is our primary source of cash and is critical to our operating performance. Our primary collection risks relate to uninsured patients and outstanding patient balances for which the primary insurance payor has paid some but not all of the outstanding balance, with the remaining outstanding balance (generally deductibles and co-payments) owed by the patient. At the point of service, for patients required to make a co-payment, we generally collect less than 15% of the related revenue. For all procedures scheduled in advance, our policy is to verify insurance coverage prior to the date of the procedure. Insurance coverage is not verified in advance of procedures for walk-in and emergency room patients.
We estimate the allowance for doubtful accounts by reserving a percentage of all self-pay accounts receivable without regard to aging category, based on collection history, adjusted for expected recoveries and, if present, anticipated changes in trends. For all other non-self-pay payor categories, we reserve 100% of all accounts aging over 365 days from the date of discharge. The percentage used to reserve for all self-pay accounts is based on our collection history. We believe that we collect substantially all of our third-party insured receivables, which include receivables from governmental agencies.
Collections are impacted by the economic ability of patients to pay and the effectiveness of our collection efforts. Significant changes in payor mix, business office operations, economic conditions or trends in federal and state governmental healthcare coverage could affect our collection of accounts receivable. The process of estimating the allowance for doubtful accounts requires us to estimate the collectability of self-pay accounts receivable, which is primarily based on our collection history, adjusted for expected recoveries and, if available, anticipated changes in collection trends. Significant change in payor mix, business office operations, economic conditions, trends in federal and state governmental healthcare coverage or other third-party payors could affect our estimates of accounts receivable collectability. If the actual collection percentage differed by 1% at September 30, 2013 from our estimated collection percentage as a result of a change in expected recoveries, net income for the nine months ended September 30, 2013 would have changed by $26.4 million, and net accounts receivable at September 30, 2013 would have changed by $43.0 million. We also continually review our overall reserve adequacy by monitoring historical cash collections as a percentage of trailing net revenue less provision for bad debts, as well as by analyzing current period net revenue and admissions by payor classification, aged accounts receivable by payor, days revenue outstanding and the impact of recent acquisitions and dispositions.
Our policy is to write-off gross accounts receivable if the balance is under $10.00 or when such amounts are placed with outside collection agencies. We believe this policy accurately reflects our ongoing collection efforts and is consistent with industry practices. We had approximately $2.9 billion and $2.4 billion at September 30, 2013 and December 31, 2012, respectively, being pursued by various outside collection agencies. We expect to collect less than 3%, net of estimated collection fees, of the amounts being pursued by outside collection agencies. As these amounts have been written-off, they are not included in our gross accounts receivable or our allowance for doubtful accounts. Collections on amounts previously written-off are recognized as a reduction to bad debt expense when received. However, we take into consideration estimated collections of these future amounts written-off in evaluating the reasonableness of our allowance for doubtful accounts.
All of the following information is derived from our hospitals, excluding clinics, unless otherwise noted.
Patient accounts receivable from our hospitals represent approximately 95% of our total consolidated accounts receivable.
Days revenue outstanding was 66 days at September 30, 2013 and 58 days at December 31, 2012. Our target range for days revenue outstanding is from 53 to 63 days. Two days of the increase since December 31, 2012 are the result of slower billing and collections at certain of our hospitals that have undergone system conversions as part of compliance with EHR certification. Another approximately two days of the increase is from the growth in state Medicaid supplemental programs during the nine months ended September 30, 2013.
Total gross accounts receivable (prior to allowance for contractual adjustments and doubtful accounts) was approximately $10.7 billion as of September 30, 2013 and approximately $9.6 billion as of December 31, 2012.
 
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The approximate percentage of total gross accounts receivable (prior to allowances for contractual adjustments and doubtful accounts) summarized by payor is as follows:

 	  	September 30, 2013	 	  	December 31, 2012	 	
 	 	 	
Insured receivables	  	 	60.8 %  	  	  	 	61.5 %  	  	
Self-pay receivables	  	 	                          39.2      	  	  	 	                       38.5       	  	
 	  	 	 	 	  	 	 	 	
Total	  	 	                      100.0 %  	  	  	 	                    100.0 %  	  	
 	  	 	 	 	  	 	 	 	
For the hospital segment, the combined total of the allowance for doubtful accounts for self-pay accounts receivable and related allowances for other self-pay discounts and contractuals, as a percentage of gross self-pay receivables, was approximately 84% at both September 30, 2013 and December 31, 2012. If the receivables that have been written-off, but where collections are still being pursued by outside collection agencies, were included in both the allowances and gross self-pay receivables specified above, the percentage of combined allowances to total self-pay receivables would have been approximately 90% at both September 30, 2013 and December 31, 2012.
Goodwill and Other Intangibles
Goodwill represents the excess of the fair value of the consideration conveyed in the acquisition over the fair value of net assets acquired. Goodwill is evaluated for impairment at the same time every year and when an event occurs or circumstances change that, more likely than not, reduce the fair value of the reporting unit below its carrying value. There is a two-step method for determining goodwill impairment. Step one is to compare the fair value of the reporting unit with the unit’s carrying amount, including goodwill. If this test indicates the fair value is less than the carrying value, then step two is required to compare the implied fair value of the reporting unit’s goodwill with the carrying value of the reporting unit’s goodwill. We performed our last annual goodwill evaluation during the fourth quarter of 2012. No impairment was indicated by this evaluation. The next annual goodwill evaluation will be performed during the fourth quarter of 2013.
Impairment or Disposal of Long-Lived Assets
Whenever events or changes in circumstances indicate that the carrying values of certain long-lived assets may be impaired, we project the undiscounted cash flows expected to be generated by these assets. If the projections indicate that the reported amounts are not expected to be recovered, such amounts are reduced to their estimated fair value based on a quoted market price, if available, or an estimate based on valuation techniques available in the circumstances. The Company’s facilities in some instances have been unfavorably impacted by reductions in admissions, volumes of insured patients and reductions in reimbursement rates from governmental payors. A small number of facilities could be at risk for future impairments if these unfavorable trends continue or these facilities become unable to adjust their expenses accordingly. Such impairment charges could be material.
Professional Liability Claims
As part of our business of owning and operating hospitals, we are subject to legal actions alleging liability on our part. We accrue for losses resulting from such liability claims, as well as loss adjustment expenses that are out-of-pocket and directly related to such liability claims. These direct out-of-pocket expenses include fees of outside counsel and experts. We do not accrue for costs that are part of our corporate overhead, such as the costs of our in-house legal and risk management departments. The losses resulting from professional liability claims primarily consist of estimates for known claims, as well as estimates for incurred but not reported claims. The estimates are based on specific claim facts, our historical claim reporting and payment patterns, the nature and level of our hospital operations, and actuarially determined projections. The actuarially determined projections are based on our actual claim data, including historic reporting and payment patterns which have been gathered over approximately a 20-year period. As discussed below, since we purchase excess insurance on a claims-made basis that transfers risk to third-party insurers, the liability we accrue does include an amount for the losses covered by our excess insurance. We also record a receivable for the expected reimbursement of losses covered by our excess insurance. Since we believe that the amount and timing of our future claims payments are reliably determinable, we discount the amount we accrue for losses resulting from professional liability claims using the risk-free interest rate corresponding to the timing of our expected payments.
 
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The net present value of the projected payments was discounted using a weighted-average risk-free rate of 1.2%, 1.2% and 1.3% in 2012, 2011 and 2010, respectively. This liability is adjusted for new claims information in the period such information becomes known to us. Professional malpractice expense includes the losses resulting from professional liability claims and loss adjustment expense, as well as paid excess insurance premiums, and is presented within other operating expenses in the accompanying condensed consolidated statements of income.
Our processes for obtaining and analyzing claims and incident data are standardized across all of our hospitals and have been consistent for many years. We monitor the outcomes of the medical care services that we provide and for each reported claim, we obtain various information concerning the facts and circumstances related to that claim. In addition, we routinely monitor current key statistics and volume indicators in our assessment of utilizing historical trends. The average lag period between claim occurrence and payment of a final settlement is between four and five years, although the facts and circumstances of individual claims could result in the timing of such payments being different from this average. Since claims are paid promptly after settlement with the claimant is reached, settled claims represent less than 1.0% of the total liability at the end of any period.
For purposes of estimating our individual claim accruals, we utilize specific claim information, including the nature of the claim, the expected claim amount, the year in which the claim occurred and the laws of the jurisdiction in which the claim occurred. Once the case accruals for known claims are determined, information is stratified by loss layers and retentions, accident years, reported years, geography, and claims relating to the acquired Triad Hospitals, Inc., or Triad, hospitals versus claims relating to our other hospitals. Several actuarial methods are used against this data to produce estimates of ultimate paid losses and reserves for incurred but not reported claims. Each of these methods uses our company-specific historical claims data and other information. This company-specific data includes information regarding our business, including historical paid losses and loss adjustment expenses, historical and current case loss reserves, actual and projected hospital statistical data, a variety of hospital census information, employed physician information, professional liability retentions for each policy year, geographic information and other data.
Based on these analyses, we determine our estimate of the professional liability claims. The determination of management’s estimate, including the preparation of the reserve analysis that supports such estimate, involves subjective judgment of management. Changes in reserving data or the trends and factors that influence reserving data may signal fundamental shifts in our future claim development patterns or may simply reflect single-period anomalies. Even if a change reflects a fundamental shift, the full extent of the change may not become evident until years later. Moreover, since our methods and models use different types of data and we select our liability from the results of all of these methods, we typically cannot quantify the precise impact of such factors on our estimates of the liability. Due to our standardized and consistent processes for handling claims and the long history and depth of our company-specific data, our methodologies have produced reliably determinable estimates of ultimate paid losses.
We are primarily self-insured for these claims; however, we obtain excess insurance that transfers the risk of loss to a third-party insurer for claims in excess of our self-insured retentions. Our excess insurance is underwritten on a claims-made basis. For claims reported prior to June 1, 2002, substantially all of our professional and general liability risks were subject to a $0.5 million per occurrence self-insured retention and for claims reported from June 1, 2002 through June 1, 2003, these self-insured retentions were $2.0 million per occurrence. Substantially all claims reported after June 1, 2003 and before June 1, 2005 are self-insured up to $4 million per claim. Substantially all claims reported on or after June 1, 2005 are self-insured up to $5 million per claim. Management, on occasion, has selectively increased the insured risk at certain hospitals based upon insurance pricing and other factors and may continue that practice in the future. Excess insurance for all hospitals has been purchased through commercial insurance companies and generally covers us for liabilities in excess of the self-insured retentions. The excess coverage consists of multiple layers of insurance, the sum of which totals up to $95 million per occurrence and in the aggregate for claims reported on or after June 1, 2003, up to $145 million per occurrence and in the aggregate for claims incurred and reported after January 1, 2008 and up to $195 million per occurrence and in the aggregate for claims reported after June 1, 2010. For certain policy years, if the first aggregate layer of excess coverage becomes fully utilized, then the self-insured retention could increase to $10 million per claim for any subsequent claims in that policy year until our total aggregate coverage is met.
 
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Effective January 1, 2008, the former Triad hospitals are insured on a claims-made basis as described above and through commercial insurance companies as described above for substantially all claims occurring on or after January 1, 2002 and reported on or after January 1, 2008. Substantially all losses for the former Triad hospitals in periods prior to May 1, 1999 were insured through a wholly-owned insurance subsidiary of HCA Inc., or HCA, Triad’s owner prior to that time, and excess loss policies maintained by HCA. HCA has agreed to indemnify the former Triad hospitals in respect of claims covered by such insurance policies arising prior to May 1, 1999. From May 1, 1999 through December 31, 2006, the former Triad hospitals obtained insurance coverage on a claims incurred basis from HCA’s wholly-owned insurance subsidiary with excess coverage obtained from other carriers that is subject to certain deductibles. Effective for claims incurred after December 31, 2006, Triad began insuring its claims from $1 million to $5 million through its wholly-owned captive insurance company, replacing the coverage provided by HCA. Substantially all claims occurring during 2007 were self-insured up to $10 million per claim.
There have been no significant changes in our estimate of the reserve for professional liability claims during the three and nine months ended September 30, 2013.
Income Taxes
We must make estimates in recording provision for income taxes, including determination of deferred tax assets and deferred tax liabilities and any valuation allowances that might be required against the deferred tax assets. We believe that future income will enable us to realize certain deferred tax assets, subject to the valuation allowance we have established.
The total amount of unrecognized benefit that would impact the effective tax rate, if recognized, was approximately $0.5 million as of September 30, 2013. A total of approximately $0.4 million of interest and penalties is included in the amount of liability for uncertain tax positions at September 30, 2013. It is our policy to recognize interest and penalties related to unrecognized benefits in our condensed consolidated statements of income as income tax expense. During the nine months ended September 30, 2013, we decreased liabilities for uncertain tax positions by $0.4 million.
It is possible the amount of unrecognized tax benefit could change in the next twelve months as a result of a lapse of the statute of limitations and settlements with taxing authorities; however, we do not anticipate the change will have a material impact on our consolidated results of operations or consolidated financial position.
We, or one or more of our subsidiaries, file income tax returns in the United States federal jurisdiction and various state jurisdictions. We have extended the federal statute of limitations through December 31, 2013 for Triad for the tax periods ended December 31, 1999, December 31, 2000, April 30, 2001, June 30, 2001, December 31, 2001, December 31, 2002, December 31, 2003, December 31, 2004, December 31, 2005, December 31, 2006 and July 25, 2007. With few exceptions, we are no longer subject to state income tax examinations for years prior to 2009. Our federal income tax returns for the 2009 and 2010 tax years are currently under examination by the Internal Revenue Service, or IRS. We believe the results of these examinations will not be material to our consolidated results of operations or consolidated financial position. During the three months ended June 30, 2013, the IRS concluded its examination of the federal tax return of Community Health Systems, Inc. for the tax periods ended December 31, 2007 and 2008. The results of these examinations did not have a material effect on our consolidated results of operations or consolidated financial position. We have extended the federal statute of limitations through April 30, 2014 for Community Health Systems, Inc. for the tax periods ended December 31, 2007 and 2008, and through July 18, 2014 for the tax period ended December 31, 2009.
Recent Accounting Pronouncements
In February 2013, the Financial Accounting Standards Board issued Accounting Standards Update, or ASU, 2013-02, which requires additional disclosures on the effect of significant reclassifications out of accumulated other comprehensive income. The ASU requires a company that reports other comprehensive income to present (either on the face of the statement where net income is presented or in the notes) the effects on the line items of net income of significant amounts reclassified out of accumulated other comprehensive income. For other amounts that are not required to be reclassified in their entirety to net income in the same reporting period, an entity is required to cross-reference to other required disclosures that provide additional details about those amounts. This ASU is effective for fiscal years beginning after December 15, 2012, and was adopted by us on January 1, 2013. As it only requires additional disclosure, the adoption of this ASU had no impact on our consolidated financial position, results of operations or cash flows.
 
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FORWARD-LOOKING STATEMENTS
Some of the matters discussed in this report include forward-looking statements. Statements that are predictive in nature, that depend upon or refer to future events or conditions or that include words such as “expects,” “anticipates,” “intends,” “plans,” “believes,” “estimates,” “thinks,” and similar expressions are forward-looking statements. These statements involve known and unknown risks, uncertainties, and other factors that may cause our actual results and performance to be materially different from any future results or performance expressed or implied by these forward-looking statements. These factors include the following:
 
 	•	 	general economic and business conditions, both nationally and in the regions in which we operate,	
 
 	•	 	implementation and effect of adopted and potential federal and state healthcare legislation,	
 
 	•	 	risks associated with our substantial indebtedness, leverage and debt service obligations,	
 
 	•	 	demographic changes,	
 
 	•	 	changes in, or the failure to comply with, governmental regulations,	
 
 	•	 	potential adverse impact of known and unknown government investigations, audits, and Federal and State False Claims Act litigation and other legal proceedings,	
 
 	•	 	our ability, where appropriate, to enter into and maintain managed care provider arrangements and the terms of these arrangements,	
 
 	•	 	changes in, or the failure to comply with, managed care provider contracts, which could result in, among other things, disputes and changes in reimbursements, both prospectively and retroactively,	
 
 	•	 	changes in inpatient or outpatient Medicare and Medicaid payment levels,	
 
 	•	 	increases in the amount and risk of collectability of patient accounts receivable,	
 
 	•	 	increases in wages as a result of inflation or competition for highly technical positions and rising supply costs due to market pressure from pharmaceutical companies and new product releases,	
 
 	•	 	liabilities and other claims asserted against us, including self-insured malpractice claims,	
 
 	•	 	competition,	
 
 	•	 	our ability to attract and retain, at reasonable employment costs, qualified personnel, key management, physicians, nurses and other healthcare workers,	
 
 	•	 	trends toward treatment of patients in less acute or specialty healthcare settings, including ambulatory surgery centers or specialty hospitals,	
 
 	•	 	changes in medical or other technology,	
 
 	•	 	changes in U.S. GAAP,	
 
 	•	 	the availability and terms of capital to fund additional acquisitions or replacement facilities,	
 
 	•	 	our ability to successfully make acquisitions or complete divestitures,	
 
 	•	 	our ability to successfully integrate any acquired hospitals or to recognize expected synergies from such acquisitions,	
 
 	•	 	our ability to close the anticipated acquisition of HMA on the proposed terms and within the anticipated time period, or at all, which is dependent on the parties’ ability to satisfy certain closing conditions, including the receipt of governmental approvals and the approval of the holders of at least 70% of the outstanding shares of HMA Common Stock entitled to vote thereon,	
 
 	•	 	the fact that HMA is the subject of legal proceedings that, if resolved unfavorably, could have an adverse effect on us following the anticipated acquisition of HMA, and that HMA may be subject to other loss contingencies, both known and unknown,	
 
 	•	 	the impact of the anticipated acquisition of HMA on third-party relationships,	
 
 	•	 	our ability to obtain adequate levels of general and professional liability insurance and	
 
 	•	 	timeliness of reimbursement payments received under government programs.	
 
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Although we believe that these statements are based upon reasonable assumptions, we can give no assurance that our goals will be achieved. Given these uncertainties, prospective investors are cautioned not to place undue reliance on these forward-looking statements. These forward-looking statements are made as of the date of this filing. We assume no obligation to update or revise them or provide reasons why actual results may differ.
Item 3.  Quantitative and Qualitative Disclosures about Market Risk
We are exposed to interest rate changes, primarily as a result of our Credit Facility which bears interest based on floating rates. In order to manage the volatility relating to the market risk, we entered into interest rate swap agreements described under the heading “Liquidity and Capital Resources” in Item 2. We utilize risk management procedures and controls in executing derivative financial instrument transactions. We do not execute transactions or hold derivative financial instruments for trading purposes. Derivative financial instruments related to interest rate sensitivity of debt obligations are used with the goal of mitigating a portion of the exposure when it is cost effective to do so. As interest rate swap agreements expire throughout the year, we will become more subject to variable interest rates during 2013.
A 1% change in interest rates on variable rate debt in excess of that amount covered by interest rate swaps would have resulted in interest expense fluctuating approximately $5.4 million and $5.1 million for the three months ended September 30, 2013 and 2012, respectively, and $14.0 million and $15.0 million for the nine months ended September 30, 2013 and 2012, respectively.
Item 4.  Controls and Procedures
Our Chief Executive Officer and Chief Financial Officer, with the participation of other members of management, have evaluated the effectiveness of our disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Securities and Exchange Act of 1934, as amended, or the Exchange Act), as of the end of the period covered by this report. Based on such evaluations, our Chief Executive Officer and Chief Financial Officer concluded that, as of such date, our disclosure controls and procedures were effective (at the reasonable assurance level) to ensure that the information required to be included in this report has been recorded, processed, summarized and reported within the time periods specified in the Securities and Exchange Commission’s rules and forms and to ensure that the information required to be included in this report was accumulated and communicated to management, including our Chief Executive Officer and Chief Financial Officer, to allow timely decisions regarding required disclosure.
There have been no changes in our internal control over financial reporting during the quarter ended September 30, 2013, that have materially affected or are reasonably likely to materially affect our internal control over financial reporting.
PART II OTHER INFORMATION
Item 1.  Legal Proceedings
From time to time, we receive various inquiries or subpoenas from state regulators, fiscal intermediaries, the Centers for Medicare and Medicaid Services and the Department of Justice regarding various Medicare and Medicaid issues. In addition to the subpoenas discussed below, we are currently responding to subpoenas and administrative demands concerning certain cardiology procedures, medical records and policies at a New Mexico hospital; subpoenas to two Pennsylvania hospitals and the management Company concerning on call agreements and physician directorships; and a civil investigative demand concerning cardiology devices at a Pennsylvania hospital. In addition, we are subject to other claims and lawsuits arising in the ordinary course of our business. We are not aware of any pending or threatened litigation that is not covered by insurance policies or reserved for in our condensed consolidated financial statements or which we believe would have a material adverse impact on us; however, some pending or threatened proceedings against us may involve potentially substantial amounts as well as the possibility of civil, criminal, or administrative fines, penalties, or other sanctions, which could be material. Settlements of suits involving Medicare and Medicaid issues routinely require both monetary payments as well as corporate integrity agreements. Additionally, qui tam or “whistleblower” actions initiated under the civil False Claims Act may be pending but placed under seal by the court to comply with the False Claims Act’s requirements for filing such suits. Also, from time to time, we detect issues of non-compliance with Federal healthcare laws pertaining to claims submission and reimbursement practices and/or financial relationships with physicians. We avail ourselves of various mechanisms to address potential overpayments arising out of these issues, including repayment of claims, rebilling of claims, and participation in voluntary disclosure protocols offered by the Centers for Medicare and Medicaid Services and the Office of the Inspector General. Participating in voluntary repayments and voluntary disclosure protocols can have the potential for significant settlement obligations or even enforcement action, however, we are not aware of any such exposures that have not been reserved for in our condensed consolidated financial statements or which we believe would have a material adverse impact on us.
 
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U.S. ex rel. Baker vs. Community Health Systems, Inc. (United States District Court for the District of New Mexico)
Our knowledge of this matter originated in early 2006 with correspondence from the Civil Division of the Department of Justice requesting documents in an investigation it was conducting involving the Company. The inquiry related to the way in which different state Medicaid programs apply to the federal government for matching or supplemental funds that are ultimately used to pay for a small portion of the services provided to Medicaid and indigent patients. These programs are referred to by different names, including “intergovernmental payments,” “upper payment limit programs,” and “Medicaid disproportionate share hospital payments.” For approximately three years, we provided the Department of Justice with requested documents, met with its personnel on numerous occasions and otherwise cooperated in its investigation. During the course of the investigation, the Civil Division notified us that it believed that we and three of our New Mexico hospitals caused the State of New Mexico to submit improper claims for federal funds, in violation of the Federal False Claims Act. This investigation has culminated in the federal government’s intervention in the referenced qui tam lawsuit, which alleges that our New Mexico hospitals “caused to be filed” false claims from the period of August 2000 through June 2011. Two of our parent company’s subsidiaries are also defendants in this lawsuit. We continue to vigorously defend this action. The current posture of this case is that discovery is closed and both parties’ motions for summary judgment are pending. There is currently no hearing date on these motions and no trial date has been set.
Multi-provider National Department of Justice Investigations
Kyphoplasty. Kyphoplasty is a surgical spine procedure that returns a compromised vertebra (either from trauma or osteoporotic disease process) to its previous height, reducing or eliminating severe pain. We were first made aware of this investigation in June 2008, when two of our hospitals received document request letters from the United States Attorney’s Office for the Western District of New York. Subsequently, additional hospitals (a total of five) also received requests for documents and/or medical records. The investigation covers the period of January 1, 2002 through June 9, 2008. This investigation is part of a national investigation and is related to a qui tam settlement between the same United States Attorney’s office and the manufacturer and distributor of the Kyphon product, which is used in performing the kyphoplasty procedure. We are cooperating with the investigation and we are continuing to evaluate and discuss this matter with the federal government.
Implantable Cardioverter Defibrillators (ICDs). We were first made aware of this investigation in September 2010, when we received a letter from the Civil Division of the United States Department of Justice. The letter advised us that an investigation was being conducted to determine whether certain hospitals have improperly submitted claims for payment for ICDs. The period of time covered by the investigation was 2003 to 2010. We continue to fully cooperate with the government in this investigation and have provided requested records and documents. On August 30, 2012, the Department of Justice issued a document entitled, “Medical Review Guidelines/Resolution Model,” which sets out, for the purposes of this investigation, the patient conditions and criteria for the medical necessity of the implantation of ICDs in Medicare beneficiaries and how the Department of Justice will enforce the repayment obligations of hospitals. We are in the process of reviewing our medical records in light of the guidance contained in this document.
Laredo, Texas Department of Justice Investigation
In December 2009, we received a document subpoena from the United States Department of Health and Human Services, Office of the Inspector General, or OIG, requesting documents related to our hospital in Laredo, Texas. The categories of documents requested included case management, resource management, admission criteria, patient medical records, coding, billing, compliance, the Joint Commission accreditation, physician documentation, payments to referral sources, transactions involving physicians, disproportionate share hospital status and audits by the hospital’s Quality Improvement organization. In January 2010, we received a “request for information or assistance” from the OIG’s Office of Investigation requesting patient medical records from this facility for certain Medicaid patients with extended lengths of stay. We continue to cooperate fully with this investigation.
 
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Department of Justice Investigation of Medicare Short-Stay Admissions from Emergency Departments
In April 2011, we received a document subpoena from the United States Department of Health and Human Services, OIG, in connection with an investigation of possible improper claims submitted to Medicare and Medicaid. The subpoena was directed to all of our hospitals and requested documents concerning emergency department processes and procedures, including our hospitals’ use of the Pro-MED Clinical Information System, a third-party software system that assists with the management of patient care and provides operational support and data collection for emergency department management. The subpoena also sought information about our relationships with emergency department physicians, including financial arrangements. This investigation is being led by the Department of Justice. We are continuing to cooperate with the government with the ongoing document production, as well as conducting a joint medical necessity review of a sampling of medical records at a small number of hospitals. In 2013, we met with the government twice to review and discuss the investigation. On July 9, 2013, shortly after a second meeting with the government, we were served with an additional document subpoena, as well as civil investigative demands to interview two of our current executives. In further discussions with the government, these additional requests do not reflect an expansion of the pending investigation. We will continue to cooperate with the government in their investigative efforts.
We are currently in negotiations with the Department of Justice about resolving its claims in connection with the Department’s investigation into the Company’s short stay hospital admissions for the years 2005-2010, as well as their investigation at our hospital in Laredo, Texas. Based on those negotiations, which are not final, we believe that a reserve of $98 million is sufficient to cover the federal government’s claims for Medicare admissions, certain claims specifically related to our hospital in Laredo, Texas, and on other related legal expenses. This reserve is not meant to include claims in this investigation arising from Tricare, Medicaid, or third party legal expense.
The following matters, although initiated independently of the Department of Justice’s April 2011 subpoena, are factually related in some manner to that subpoena and are grouped here for clarity.
Texas Attorney General Investigation of Emergency Department Procedures and Billing. In November 2010, we were served with substantially identical Civil Investigative Demands (CIDs) from the Office of Attorney General, State of Texas for all 18 of our affiliated Texas hospitals. The subject of the requests concerns emergency department procedures and billing. We have complied with these requests and provided all documentation and reports requested. We continue to cooperate fully with this investigation.
United States ex rel. and Reuille vs. Community Health Systems Professional Services Corporation and Lutheran Musculoskeletal Center, LLC d/b/a Lutheran Hospital (United States District Court for the Northern District of Indiana, Fort Wayne Division) . This lawsuit was originally filed under seal in January 2009. The suit is brought under the False Claims Act and alleges that Lutheran Hospital of Indiana billed the Medicare program for (a) false 23 hour observation after outpatient surgeries and procedures, and (b) intentional assignment of inpatient status to one-day stays for cases that do not meet Medicare criteria for inpatient intensity of service or severity of illness. In December 2010, the government filed a notice that it declined to intervene in this suit. On April 22, 2011, a joint motion was filed by the relator and the Department of Justice to extend the period of time for the relator to serve us in the case to allow the government more time to decide if it will intervene in the case. The motion to stay was granted, as have subsequent joint motions, and the stay is currently continued until April 23, 2014. The original motion and subsequent filings gave insight to the fact that there are other qui tam complaints in other jurisdictions and that the government was consolidating its investigations and working cooperatively with other investigative bodies (including the Attorney General of the State of Texas). The government also confirmed that it considers the allegations made in the complaint styled  Tenet Healthcare Corporation vs. Community Health Systems, Inc., et al.  filed in the United States District Court for the Northern District of Texas, Dallas Division on April 11, 2011 to be related to the government’s consolidated investigation. We are cooperating fully with the government in its investigations.
Shelbyville, Tennessee OIG Subpoena. In May 2011, we received a subpoena from the Houston Office of the United States Department of Health and Human Services, OIG, requesting 71 patient medical records from our hospital in Shelbyville, Tennessee. We provided the requested records and have met with the government regarding this matter. We continue to cooperate fully with this investigation.
SEC Subpoena. In May 2011, we received a subpoena from the SEC requesting documents related to or requested in connection with the various inquiries, lawsuits and investigations regarding, generally, emergency room admissions or observation practices at our hospitals. The subpoena also requested documents relied upon by us in responding to the Tenet litigation, as well as other communications about the Tenet litigation. As with all government investigations, we are cooperating fully with the SEC.
 
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Class Action Shareholder Federal Securities Cases. Three purported class action cases have been filed in the United States District Court for the Middle District of Tennessee; namely, Norfolk County Retirement System v. Community Health Systems, Inc., et al., filed May 9, 2011; De Zheng v. Community Health Systems, Inc., et al., filed May 12, 2011; and Minneapolis Firefighters Relief Association v. Community Health Systems, Inc., et al., filed June 21, 2011. All three seek class certification on behalf of purchasers of our common stock between July 27, 2006 and April 11, 2011 and allege that misleading statements resulted in artificially inflated prices for our common stock. In December 2011, the cases were consolidated for pretrial purposes and NYC Funds and its counsel were selected as lead plaintiffs/lead plaintiffs’ counsel. Our motion to dismiss this case has been fully briefed and is pending before the court. We believe this consolidated matter is without merit and will vigorously defend this case.
Shareholder Derivative Actions. Three purported shareholder derivative actions have also been filed in the United States District Court for the Middle District of Tennessee; Plumbers and Pipefitters Local Union No. 630 Pension Annuity Trust Fund v. Wayne T. Smith, et al., filed May 24, 2011; Roofers Local No. 149 Pension Fund v. Wayne T. Smith, et al., filed June 21, 2011; and Lambert Sweat v. Wayne T. Smith, et al., filed October 5, 2011. These three cases allege breach of fiduciary duty arising out of allegedly improper inpatient admission practices, mismanagement, waste and unjust enrichment. These cases have been consolidated into a single, consolidated action. The plaintiffs filed an operative amended derivative complaint in these three consolidated actions on March 15, 2012. Our motion to dismiss was argued on June 13, 2013. On September 27, 2013, the court issued an order granting in part and denying in part our motion to dismiss. On October 14, 2013, we filed for a Motion for Reconsideration of the Order Granting in Part and Denying in Part the Motion to Dismiss, a Motion to Stay Discovery, and an unopposed Motion for Extension of Time to File an Answer. We believe all of the plaintiffs’ claims are without merit and will vigorously defend them.
Other Government Investigations
Easton, Pennsylvania – Urologist. On June 13, 2011, our hospital in Easton, Pennsylvania received a document subpoena from the Philadelphia office of the United States Department of Justice. The documents requested included medical records for certain urological procedures performed by a non-employed physician who is no longer on the medical staff and other records concerning the hospital’s relationship with the physician. Certain procedures performed by the physician had been previously reviewed and appropriate repayments had been made. We are cooperating fully with the government in this investigation.
Hattiesburg, Mississippi – Allegiance Health Management, Inc. On February 23, 2012, our hospital in Hattiesburg, Mississippi received a document subpoena from the United States Department of Health and Human Services, OIG relating to its relationship with Allegiance Health Management, Inc., or Allegiance, a company that provides intensive outpatient psychiatric, or IOP, services to its patients. The subpoena seeks information concerning the hospital’s financial relationship with Allegiance, medical records of patients receiving IOP services, and other documents relating to Allegiance such as agreements, policies and procedures, audits, complaints, budgets, financial analyses and identities of those delivering services. This is our only hospital that received services from this vendor. We are cooperating fully with this investigation.
Qui Tam Cases – Government Declined Intervention
On June 2, 2011, an order was entered unsealing a relator’s qui tam complaint in the matter of U.S. ex rel. Wood M. Deming, MD, individually and on behalf of Regional Cardiology Consultants, PC v. Jackson-Madison County General Hospital, an Affiliate of West Tennessee Healthcare, Regional Hospital of Jackson, a Division of Community Health Systems Professional Services Corporation, James Moss, individually, Timothy Puthoff, individually, Joel Perchik, MD, individually, and Elie H. Korban, MD, individually . The action is pending in the Western District of Tennessee, Jackson Division. Regional Hospital of Jackson is an affiliated hospital and Mr. Puthoff is a former chief executive officer there. The Order recited that the United States had elected to intervene to a limited degree only concerning the claims against Dr. Korban for false and fraudulent billing for allegedly unnecessary stent procedures and for causing the submission of false claims by the hospitals. On July 28, 2011, we were served by the relator. On June 12, 2013, the government and Dr. Korban filed an advisory that they had reached a “handshake” settlement of all claims pled by the government. There have been no additional filings since then. We believe the claims against our hospital are without merit and we are vigorously defending this case.
 
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On August 8, 2012, an order was entered unsealing a relator’s qui tam complaint in the matter of U.S. and N.M. ex rel. Sally Hansen v. Mimbres Memorial Hospital, et al . This action is pending in the United States District Court for New Mexico. This case cites alleged quality control failures as violations of the Clinical Laboratory Improvement Amendments of 1988 as the basis for a False Claims Act suit. Both the U.S. government and the New Mexico state government declined to intervene in this case. We filed a motion to dismiss and the relator filed an amended complaint. Both the U.S. government and the New Mexico state government have now declined to intervene on this amended complaint. On June 12, 2013, we filed a motion to dismiss the amended complaint. The relator also voluntarily dismissed Community Health Systems, Inc., without prejudice. We believe the claim against our hospital is without merit and we are vigorously defending this case.
Commercial Litigation and Other Lawsuits
Becker v. Community Health Systems, Inc. d/b/a Community Health Systems Professional Services Corporation d/b/a Community Health Systems d/b/a Community Health Systems PSC, Inc. d/b/a Rockwood Clinic P.S. and Rockwood Clinic, P.S. (Superior Court, Spokane, Washington).  This suit was filed on February 29, 2012, by a former chief financial officer at Rockwood Clinic in Spokane, Washington. Becker claims he was wrongfully terminated for allegedly refusing to certify a budget for Rockwood Clinic in 2012. On February 29, 2012, he also filed an administrative complaint with the Department of Labor, Occupational Safety and Health Administration alleging that he is a whistleblower under Sarbanes-Oxley; a response was filed on May 21, 2012. At a hearing on July 27, 2012, the court dismissed Community Health Systems, Inc. from this case and has subsequently certified the case for an interlocutory appeal of the denial to dismiss his employer and the management company. The appellate court has accepted the interlocutory appeal. We are vigorously defending this action.
HMA Consolidated Securities Case and Delaware Chancery Case. Three purported class action cases have been filed in the Circuit Court of Collier County, Florida: namely, Aliaga vs. Health Management Associates, Inc. et al., filed August 1, 2013; Lopriore vs. Health Management Associates, et al., filed August 5, 2013; and Copeland vs. Health Management Associates, et al., filed August 8, 2013. All allege a breach of fiduciary duty by the board members of HMA arising out of the approval of the proposed acquisition by us. Community Health Systems, Inc. and FWCT-2 Acquisition Corporation are named as aiding and abetting the alleged breaches of fiduciary duty. A fourth case, Smilow vs. Health Management Associates, Inc. et al., filed August 13, 2013 does not name us or FWCT-2 Acquisition Corporation as a defendant. Further, on August 5, 2013, a case styled Margolis & Horwitz vs. Health Management Associates, Inc. et al., was filed in Delaware Chancery Court also alleging a breach of fiduciary duty by the HMA board members arising out of the approval of the proposed acquisition by us. In that case, we and FWCT-2 Acquisition Company were named as aiding and abetting the alleged breaches of fiduciary duty. We are vigorously defending these actions.
Management of Significant Legal Proceedings
In accordance with our governance documents, including our Governance Guidelines and the charter of the Audit and Compliance Committee, our management of significant legal proceedings is overseen by the independent members of the Board of Directors and, in particular, the Audit and Compliance Committee. The Audit and Compliance Committee is charged with oversight of compliance, regulatory and litigation matters, and enterprise risk management. Management has been instructed to refer all significant legal proceedings and allegations of financial statement fraud, error, or misstatement to the Audit and Compliance Committee for its oversight and evaluation. Consistent with New York Stock Exchange and Sarbanes-Oxley independence requirements, the Audit and Compliance Committee is comprised entirely of individuals who are independent of Company management, and all three members of the Audit and Compliance Committee are “audit committee financial experts” as defined in the Exchange Act.
In addition, the Audit and Compliance Committee and the other independent members of the Board of Directors oversee the functions of the voluntary compliance program, including its auditing and monitoring functions and confidential disclosure program. In recent years, the voluntary compliance program has addressed the potential for a variety of billing errors that might be the subject of audits and payment denials by the CMS Recovery Audit Contractors’ permanent project, including MS-DRG coding, outpatient hospital and physician coding and billing, and medical necessity for services (including a focus on hospital stays of very short duration). Efforts by management, through the voluntary compliance program, to identify and limit risk from these government audits have included significant policy and guidance revisions, training and education, and auditing.
Since April 2011, our Audit and Compliance Committee and/or Board of Directors has met, on average, monthly to review the status of the lawsuits and investigations relating to allegations of improper billing for inpatient care at our hospitals and to oversee management in connection with our investigation and defense of these matters. At many of those meetings, the independent members of the Board of Directors have met in separate session, first with outside counsel handling the investigations and lawsuits, and then alone, to discuss their duties and oversight of these matters. The independent members of our Board of Directors remain fully engaged in the oversight of these matters.
 
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Item 1A.  Risk Factors
In addition to the risk factors disclosed under Item 1A to Part 1 of our Annual Report for the fiscal year ended December 31, 2012, the following risk factors should be read carefully in connection with evaluating our business and the forward-looking information contained within our Annual Report on Form 10-K and our Quarterly Reports on Form 10-Q. Other than the updates to our risk factors presented below, there have been no material changes in the risk factors previously disclosed in our Annual Report on Form 10-K.
The issuance of our common stock in connection with the anticipated merger with HMA could decrease the market price of our common stock.
The issuance of our common stock in the HMA merger may result in fluctuations in the market price of our common stock, including a stock price decline.
The parties to the anticipated acquisition of HMA may be unable to satisfy the conditions to the completion of the merger and the merger may not be completed.
Completion of the HMA merger is conditioned on, among other things, the adoption of the merger agreement by holders of at least 70% of HMA’s outstanding common stock entitled to vote thereon, the expiration or termination of the applicable waiting period under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, the absence of any law or judgment that prohibits the completion of the merger, the absence of certain governmental adverse events occurring with respect to HMA, the receipt of certain healthcare regulatory approvals, no acceleration of a material amount of HMA’s debt having occurred and the approval of the shares of our common stock to be issued in the merger for listing on the New York Stock Exchange. Each party’s obligation to close the merger is also subject to, among other conditions, the accuracy of the representations and warranties of the other party in the merger agreement (subject to certain specified standards of materiality), the compliance in all material respects with covenants of the other party in the merger agreement and the absence of a material adverse effect (as defined in the merger agreement) on the other party.
These and other conditions to the completion of the merger may fail to be satisfied. In addition, satisfying the conditions to and completion of the merger may take longer, and could cost more, than HMA and we expect. Any delay in completing the merger or any additional conditions imposed in order to complete the merger may materially adversely affect the synergies and other benefits that we expect to achieve if the merger and the integration of the companies’ respective businesses are completed within the expected timeframe.
Failure to achieve expected benefits of the HMA merger and to integrate HMA’s operations with ours could adversely affect us following the completion of the merger and the market price of our common stock.
Although we expect to realize strategic, operational and financial benefits as a result of the HMA merger, we cannot be certain whether, and to what extent, such benefits will be achieved in the future. In particular, the success of the merger will depend on achieving efficiencies and cost savings, and no assurances can be given that we will be able to do so. For example, costs associated with HMA’s legal proceedings and other loss contingencies may be greater than expected, and could exceed the amount of any reduction in payment under the contingent value rights being issued as partial consideration for the merger to HMA stockholders. In addition, in order to obtain the benefits of the merger, we must integrate HMA’s operations. Such integration may be complex and the failure to do so quickly and effectively may negatively affect earnings.
In addition, the market price of our common stock may decline as a result of the merger if our integration of HMA is unsuccessful, takes longer than expected or fails to achieve financial benefits to the extent anticipated by financial analysts or investors, or the effect of the merger on our financial results is otherwise not consistent with the expectations of financial analysts or investors.
HMA is the subject of legal proceedings that, if resolved unfavorably, could have an adverse effect on us following the merger, and HMA may be subject to other loss contingencies, both known and unknown.
 
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HMA is a party to various ongoing government investigations, legal proceedings and other related matters, including as described in the “Legal Proceedings” section of HMA’s Annual Reports on Form 10-K and Quarterly Reports on Form 10-Q. Those proceedings include, among other things, government investigations. In addition, HMA is and may become subject to other loss contingencies, both known and unknown, which may relate to past, present and future facts, events, circumstances and occurrences. Should an unfavorable outcome occur in some or all of HMA’s legal proceedings or other loss contingencies, or if successful claims and other actions are brought against HMA in the future, there could be a material adverse impact on our financial position, results of operations and liquidity following the merger and our ability to achieve expected benefits of the merger.
In particular, government investigations, as well as qui tam lawsuits, may lead to material fines, penalties, damages payments or other sanctions, including exclusion from government health care programs. The costs relating to these matters could exceed the amount of any reduction in payment under the contingent value rights being issued as partial consideration for the merger to HMA stockholders. Settlements of lawsuits involving Medicare and Medicaid issues routinely require both monetary payments and corporate integrity agreements, each of which could have a materially adverse effect on our business, financial condition, results of operations and/or cash flows following the merger.
We will incur substantial additional indebtedness in connection with the HMA merger.
In connection with the anticipated merger with HMA, we will enter into financing arrangements. We intend to use this financing to pay, in part, the cash portion of the merger consideration and a portion of the fees and expenses related to the merger, which may include the repayment of certain outstanding indebtedness of HMA. This additional indebtedness of ours may limit the combined company’s operating flexibility following the merger and may otherwise strain the company’s liquidity and financial condition.
As a result of the HMA merger, our goodwill, indefinite-lived intangible assets, and other intangible assets in our consolidated balance sheet will increase. If our goodwill, indefinite-lived intangible assets, or other intangible assets become impaired in the future, we would be required to record a material, non-cash charge to earnings, which would also reduce our stockholders’ equity.
Under U.S. GAAP, goodwill and indefinite-lived intangible assets are reviewed for impairment on an annual basis (or more frequently if events or circumstances indicate that their carrying value may not be recoverable) and other intangible assets if events or circumstances indicate that their carrying value may not be recoverable. If our goodwill, indefinite-lived intangible assets, or other intangible assets are determined to be impaired in the future, we will be required to record a material, non-cash charge to earnings during the period in which the impairment is determined.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
Historically, we have not paid any cash dividends. In December 2012, we declared and paid a special dividend of $0.25 per share to holders of our common stock at the close of business as of December 17, 2012, which totaled approximately $23.0 million. In the foreseeable future, we do not anticipate the payment of any other cash dividends. Our Credit Facility limits our ability to pay dividends and/or repurchase stock to an amount not to exceed $150 million in the aggregate plus the aggregate amount of proceeds from the exercise of stock options. The indentures governing our 8% Senior Notes, our 7  1 / 8 % Senior Notes and our 5  1 / 8 % Senior Secured Notes also limit our ability to pay dividends and/or repurchase stock. As of September 30, 2013, under the most restrictive test under these agreements, we have approximately $259.8 million available with which to pay permitted dividends and/or repurchase shares of stock or our Notes.
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
Not applicable.
Item 5. Other Information
None.
 
75

Table of Contents
Item 6. Exhibits

No.	 	  	Description	
 	4.1   	  	  	Sixth Supplemental Indenture relating to CHS/Community Health Systems, Inc.’s 8.000% Senior Notes due 2019, dated as of September 30, 2013, by and among CHS/Community Health Systems, Inc., the guarantors party thereto and Regions Bank, as successor Trustee	
 	 	
 	4.2   	  	  	Third Supplemental Indenture relating to CHS/Community Health Systems, Inc.’s 7.125% Senior Notes due 2020, dated as of September 30, 2013, by and among CHS/Community Health Systems, Inc., the guarantors party thereto and Regions Bank, as Trustee	
 	 	
 	4.3   	  	  	Third Supplemental Indenture relating to CHS/Community Health Systems, Inc.’s 5.125% Senior Secured Notes due 2018, dated as of September 30, 2013, by and among CHS/Community Health Systems, Inc., the guarantors party thereto and Regions Bank, as Trustee	
 	 	
 	12   	  	  	Computation of Ratio of Earnings to Fixed Charges	
 	 	
 	31.1   	  	  	Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002	
 	 	
 	31.2   	  	  	Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002	
 	 	
 	32.1   	  	  	Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002	
 	 	
 	32.2   	  	  	Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002	
 	 	
 	101.INS	  	  	XBRL Instance Document	
 	 	
 	101.SCH	  	  	XBRL Taxonomy Extension Schema	
 	 	
 	101.CAL	  	  	XBRL Taxonomy Extension Calculation Linkbase	
 	 	
 	101.DEF	  	  	XBRL Taxonomy Extension Definition Linkbase	
 	 	
 	101.LAB	  	  	XBRL Taxonomy Extension Label Linkbase	
 	 	
 	101.PRE	  	  	XBRL Taxonomy Extension Presentation Linkbase	
 
76

Table of Contents
SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this Report to be signed on its behalf by the undersigned thereunto duly authorized.

 	 	COMMUNITY HEALTH SYSTEMS, INC.	 	 	
 	 	                      (Registrant)	 	 	
 	 	 	 	
 	 	By:	 	/s/   Wayne T. Smith	 	 	
 	 	 	 	Wayne T. Smith	 	 	
 	 	 	 	Chairman of the Board,	 	 	
 	 	 	 	President and Chief Executive Officer	 	 	
 	 	 	 	(principal executive officer)	 	 	
 	 	 	 	
 	 	By:	 	/s/   W. Larry Cash	 	 	
 	 	 	 	W. Larry Cash	 	 	
 	 	 	 	Executive Vice President, Chief Financial	 	 	
 	 	 	 	Officer and Director	 	 	
 	 	 	 	(principal financial officer)	 	 	
 	 	 	 	
 	 	By:	 	/s/   Kevin J. Hammons	 	 	
 	 	 	 	Kevin J. Hammons	 	 	
 	 	 	 	Vice President and Chief Accounting Officer	 	 	
 	 	 	 	(principal accounting officer)	 	 	
Date: October 31, 2013
 
77

Table of Contents
Index to Exhibits

No.	 	  	Description	
 	4.1   	  	  	Sixth Supplemental Indenture relating to CHS/Community Health Systems, Inc.’s 8.000% Senior Notes due 2019, dated as of September 30, 2013, by and among CHS/Community Health Systems, Inc., the guarantors party thereto and Regions Bank, as successor Trustee	
 	 	
 	4.2   	  	  	Third Supplemental Indenture relating to CHS/Community Health Systems, Inc.’s 7.125% Senior Notes due 2020, dated as of September 30, 2013, by and among CHS/Community Health Systems, Inc., the guarantors party thereto and Regions Bank, as Trustee	
 	 	
 	4.3   	  	  	Third Supplemental Indenture relating to CHS/Community Health Systems, Inc.’s 5.125% Senior Secured Notes due 2018, dated as of September 30, 2013, by and among CHS/Community Health Systems, Inc., the guarantors party thereto and Regions Bank, as Trustee	
 	 	
 	12   	  	  	Computation of Ratio of Earnings to Fixed Charges	
 	 	
 	31.1   	  	  	Certification of Chief Executive Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002	
 	 	
 	31.2   	  	  	Certification of Chief Financial Officer pursuant to Section 302 of the Sarbanes-Oxley Act of 2002	
 	 	
 	32.1   	  	  	Certification of Chief Executive Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002	
 	 	
 	32.2   	  	  	Certification of Chief Financial Officer pursuant to 18 U.S.C. Section 1350, adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002	
 	 	
 	101.INS	  	  	XBRL Instance Document	
 	 	
 	101.SCH	  	  	XBRL Taxonomy Extension Schema	
 	 	
 	101.CAL	  	  	XBRL Taxonomy Extension Calculation Linkbase	
 	 	
 	101.DEF	  	  	XBRL Taxonomy Extension Definition Linkbase	
 	 	
 	101.LAB	  	  	XBRL Taxonomy Extension Label Linkbase	
 	 	
 	101.PRE	  	  	XBRL Taxonomy Extension Presentation Linkbase	
 
78

Exhibit 4.1
SIXTH SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2013, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “ Issuer ”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “ New Subsidiary Guarantor ”) and REGIONS BANK, as successor Trustee under the Indenture (the “ Trustee ”).
W I T N E S S E T H:
WHEREAS the Issuer has heretofore executed and delivered to the Trustee, as successor trustee, an Indenture (the “ Indenture ”), dated as of November 22, 2011, providing for the issuance of the 8.000% Senior Notes due 2019 (the “ Securities ”);
WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and
WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture.
NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows:
SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.
SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor.
SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby.
SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.
SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency of this Supplemental Indenture.
SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement.
SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture.
[Signature page follows]
 
1

IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 30 th  day of September, 2013.

CHS/Community Health Systems, Inc.,
a Delaware corporation	
 	 	
By:	 	/s/ Rachel A. Seifert	
 	 	Rachel A. Seifert
Executive Vice President, Secretary & General Counsel	
 	
New Subsidiary Guarantor:
 
Triad of Oregon, LLC,
a Delaware limited liability company	
 	 	
By:	 	/s/ James W. Doucette	
 	 	James W. Doucette
Vice President & Treasurer	
 	
Regions Bank, as Trustee	
 	 	
By:	 	/s/ Paul Williams	
 	 	Paul Williams
Vice President	
 
2

Exhibit 4.2
THIRD SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2013, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “ Issuer ”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “ New Subsidiary Guarantor ”) and REGIONS BANK, as Trustee under the Indenture (the “ Trustee ”).
W I T N E S S E T H:
WHEREAS the Issuer has heretofore executed and delivered to the Trustee an Indenture (the “Indenture”), dated as of July 18, 2012, providing for the issuance of the 7.125% Senior Notes due 2020 (the “ Securities ”);
WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and
WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture.
NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows:
SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.
SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor.
SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby.
SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.
SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency of this Supplemental Indenture.
SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement.
SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture.
[Signature page follows]
 
1

IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 30 th  day of September, 2013.

CHS/Community Health Systems, Inc.,
a Delaware corporation	
 	 	
By:	 	/s/ Rachel A. Seifert	
 	 	Rachel A. Seifert
Executive Vice President, Secretary & General Counsel	
 	
New Subsidiary Guarantor:
 
Triad of Oregon, LLC,
a Delaware limited liability company	
 	 	
By:	 	/s/ James W. Doucette	
 	 	James W. Doucette
Vice President & Treasurer	
 	
Regions Bank, as Trustee	
 	 	
By:	 	/s/ Paul Williams	
 	 	Paul Williams
Vice President	
 
2

Exhibit 4.3
THIRD SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of September 30, 2013, among CHS/COMMUNITY HEALTH SYSTEMS, INC., a Delaware corporation (the “ Issuer ”), the party identified as a New Subsidiary Guarantor on the signature pages hereto (the “ New Subsidiary Guarantor ”) and REGIONS BANK, as Trustee under the Indenture (the “ Trustee ”).
W I T N E S S E T H:
WHEREAS the Issuer has heretofore executed and delivered to the Trustee an Indenture (the “Indenture”), dated as of August 17, 2012, providing for the issuance of the 5.125% Senior Secured Notes due 2018 (the “ Securities ”);
WHEREAS, the undersigned New Subsidiary Guarantor has deemed it advisable and in its best interest to execute and deliver this Supplemental Indenture, and to become a New Subsidiary Guarantor under the Indenture; and
WHEREAS, pursuant to Section 9.01(4) of the Indenture, the Trustee, the Issuer and the New Subsidiary Guarantor are authorized to execute and deliver this Supplemental Indenture.
NOW THEREFORE, in consideration of the foregoing and for good and valuable consideration, the receipt of which is hereby acknowledged, the Issuer, the New Subsidiary Guarantor and the Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Securities as follows:
SECTION 1. Capitalized Terms. Capitalized terms used herein but not defined shall have the meanings assigned to them in the Indenture.
SECTION 2. Guaranties. The New Subsidiary Guarantor hereby agrees to guarantee the Issuer’s obligations under the Securities on the terms and subject to the conditions set forth in Article 10 of the Indenture and to be bound by all other applicable provisions of the Indenture as a Subsidiary Guarantor.
SECTION 3. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as expressly amended hereby, the Indenture is in all respects ratified and confirmed and all the terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental Indenture shall form a part of the Indenture for all purposes, shall inure to the benefit of the Trustee and every Holder of Securities heretofore or hereafter authenticated and the Issuer, the Trustee and every Holder of Securities heretofore or hereafter authenticated and delivered shall be bound hereby.
SECTION 4. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.
SECTION 5. Trustee Makes No Representation. The Trustee makes no representation as to the validity or sufficiency of this Supplemental Indenture.
SECTION 6. Counterparts. The parties may sign any number of copies of this Supplemental Indenture. Each signed copy shall be an original, but all of them together represent the same agreement.
SECTION 7. Effect of Headings. The Section headings herein are for convenience only and shall not effect the construction of this Supplemental Indenture.
[Signature page follows]
 
1

IN WITNESS WHEREOF, the parties have caused this Supplemental Indenture to be duly executed as of this 30 th  day of September, 2013.

CHS/Community Health Systems, Inc.,
a Delaware corporation	
 	 	
By:	 	/s/ Rachel A. Seifert	
 	 	Rachel A. Seifert
Executive Vice President, Secretary & General Counsel	
 	
New Subsidiary Guarantor:
 
Triad of Oregon, LLC,
a Delaware limited liability company	
 	 	
By:	 	/s/ James W. Doucette	
 	 	James W. Doucette
Vice President & Treasurer	
 	
Regions Bank, as Trustee	
 	 	
By:	 	/s/ Paul Williams	
 	 	Paul Williams
Vice President	
 
2

Exhibit 12
STATEMENT RE: COMPUTATION OF RATIO OF EARNINGS TO FIXED CHARGES
(DOLLARS IN THOUSANDS)

 	  	      Nine Months Ended      
 
September 30, 2013	 	
Earnings	  	 	 	 	
Income from continuing operations before provision for income taxes	  	  $	233,636 	  	
Income from equity investees	  	 	(36,375)	  	
Distributed income from equity investees	  	 	50,838 	  	
Interest and amortization of deferred finance costs	  	 	465,735 	  	
Amortization of capitalized interest	  	 	3,985 	  	
Implicit rental interest expense	  	 	53,755 	  	
 	  	 	 	 	
Total Earnings	  	  $	771,574 	  	

Fixed Charges	  	 	 	 	
Interest and amortization of deferred finance costs	  	  $	465,735 	  	
Capitalized interest	  	 	8,310 	  	
Implicit rental interest expense	  	 	53,755 	  	
 	  	 	 	 	
Total Fixed Charges	  	  $	527,800 	  	

Ratio of Earnings to Fixed Charges	  	 	1.46 	x 	

Exhibit 31.1
I, Wayne T. Smith, certify that:
1. I have reviewed this quarterly report on Form 10-Q of Community Health Systems, Inc.;
2. Based on my knowledge, this quarterly report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this quarterly report;
3. Based on my knowledge, the financial statements, and other financial information included in this quarterly report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this quarterly report;
4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and we have:
a) designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this quarterly report is being prepared;
b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
c) evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
d) disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and
5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors:
a) all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and
b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: October 31, 2013	 	 	 	/s/  Wayne T. Smith	 	 	
 	 	 	 	Wayne T. Smith	 	 	
 	 	 	 	Chairman of the Board, President
and Chief Executive Officer	 	 	

Exhibit 31.2
I, W. Larry Cash, certify that:
1. I have reviewed this quarterly report on Form 10-Q of Community Health Systems, Inc.;
2. Based on my knowledge, this quarterly report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this quarterly report;
3. Based on my knowledge, the financial statements, and other financial information included in this quarterly report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this quarterly report;
4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and we have:
a) designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this quarterly report is being prepared;
b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;
c) evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and
d) disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and
5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors:
a) all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and
b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: October 31, 2013	 	 	 	/s/  W. Larry Cash	 	 	
 	 	 	 	W. Larry Cash
Executive Vice President,
Chief Financial Officer and Director	 	 	

Exhibit 32.1
CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002
In connection with the Quarterly Report of Community Health Systems, Inc. (the “Company”) on Form 10-Q for the period ended September 30, 2013, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Wayne T. Smith, Chairman of the Board, President and Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that:
(1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
(2) The information contained in the Report fairly presents, in all material respects, the financial condition and result of operations of the Company.

 	 	/s/  Wayne T. Smith	 	 	
 	 	Wayne T. Smith	 	 	
 	 	Chairman of the Board, President and Chief Executive Officer	 	 	
October 31, 2013
A signed original of this written statement required by Section 906 has been provided to Community Health Systems, Inc. and will be retained by Community Health Systems, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.

Exhibit 32.2
CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350,
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002
In connection with the Quarterly Report of Community Health Systems, Inc. (the “Company”) on Form 10-Q for the period ended September 30, 2013, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, W. Larry Cash, Executive Vice President, Chief Financial Officer and Director of the Company, certify, pursuant to 18 U.S.C. § 1350, as adopted pursuant to § 906 of the Sarbanes-Oxley Act of 2002, that:
(1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and
(2) The information contained in the Report fairly presents, in all material respects, the financial condition and result of operations of the Company.

 	 	/s/  W. Larry Cash	 	 	
 	 	W. Larry Cash	 	 	
 	 	Executive Vice President, Chief Financial Officer and Director	 	 	
October 31, 2013
A signed original of this written statement required by Section 906 has been provided to Community Health Systems, Inc. and will be retained by Community Health Systems, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.