Community Health Systems Inc. plans to buy Health Management Associates Inc. for nearly $4 billion in a deal that would make it one of the nation's largest hospital operators and double its stake in Missouri's rural hospitals. 

The proposed purchase would include newly built Poplar Bluff Regional Medical Center, a key provider of health services to the poor in several rural counties of southeast Missouri.But the acquisition is still subject to the approval of Health Management Associates' shareholders and also must pass the antitrust review of the Federal Trade Commission, which has cracked down in recent years on hospital monopolies in smaller cities and communities. 

The deal also comes at a time when the hospital industry is topsy-turvy with changes brought by the Obama administration's health reform law. Under the Affordable Care Act, hospitals can expect millions of newly insured customers nationwide, but they also face heightened federal scrutiny to improve quality of care and patient safety, along with reduced government reimbursement rates for Medicare and Medicaid services provided. 

"We look forward to working with the physicians and employees of HMA to advance the commitment shared across both organizations to pursue clinical excellence and to deliver quality care for patients," Wayne T. Smith, chairman of Franklin, Tenn.-based Community Health Systems, said in a statement. 

Community Health said its deal -- a combination of cash and stock valued at $13.78 for each share of HMA -- totals $3.9 billion, or $7.6 billion including assumed debt. But Wall Street appeared cool to the proposal. Shares of HMA fell $1.62, or nearly 11 percent, to close Tuesday at $13.30. Community Health fell $1.65, or 3.5 percent, to close at $45.58.If approved, the deal would create a for-profit chain with 206 hospitals in 29 states. That would make it the largest hospital operator based on locations, although Nashville-based HCA Holdings Inc. would still bring in more revenue. 

Community Health currently operates two hospitals in Missouri: Moberly Regional Medical Center in Moberly and Northeast Regional Medical Center in Kirksville. It also has a strong presence in Illinois,We have a great selection of blown glass backyard solar landscape lights and Cheap Granite Countertops. operating nine hospitals there including Gateway Regional Medical Center in Granite City, and Red Bud Regional Hospital in Red Bud.According to the federal Hospital Compare website, Gateway Regional's mortality and readmission rates, as well as its rate of serious complications and also infections, are "no different" than the U.S. national rates and benchmarks. 

But the website indicates that Gateway Regional patients rate the hospital's performance as substantially below average. A patient satisfaction survey conducted by an independent third party reveals that 58 percent of its patients would "definitely recommend" the hospital. The Illinois average is 69 percent; the national average is 71 percent.The Poplar Bluff hospital, which opened earlier this year, was built at a cost of $173 million. The hospital also operates seven family clinics in four, poverty-stricken counties of southeast Missouri. 

Charles Stewart, Poplar Bluff's chief executive, was unavailable for comment about the planned acquisition.According to state and regional studies, residents of southeast Missouri face huge health obstacles, including some of the state's highest rates of obesity, diabetes, heart failure and smoking. Many of these residents have multiple chronic conditions. 

In addition to Poplar Bluff, HMA also operates Twin Rivers Regional Medical Center in Kennett, Mo.The companies expect the deal to close in the first quarter of 2014,After searching around the Lights section of this forum, I've come across two main suppliers for Cheap Tombstone & Monuments. if it gets antitrust clearance and 70 percent of HMA shares are voted in favor. 

Separately Tuesday, HMA disclosed Tuesday it expects second-quarter earnings to fall significantly below Wall Street analysts' expectations, and also that has received new subpoenas from the Department of Health and Human Services regarding physician relationships and emergency room operations at some of its hospitals. 

The Export Councils have rejected claims that the countrys export rates have been negatively affected by political stances taken by the European Union (EU), South Africa and Turkey regarding events taking place in Egypt. This is despite threats made by South Africa to freeze Egypts membership in the African Union (AU), the EUs various attempts to intervene in the political crisis, and Turkeys recent shutting down of one of its maritime shipping lines with Egypt. 

The positions of Turkey and South Africa will not have an effect on fertilizer exports, revenues from which were described as relatively weak, considering that only 30,000 tons were shipped per year, according to Ahmed Hagras, a member of the Chemical and Fertilizers Export Council. 

Expected decreases in exports for 2013 could be attributed primarily to problems related to fertilizer production, gas shortages seen within factories and general decreases in energy production, he added. This will also lead to decreases in the amount of fertilizer stock available on the countrys domestic market. 

Walid Abdel Hamid, Director of Planning of the Dreamstone Industrial Company and a member of the Export Council for Building Materials, said the export of building materials to the EU, particularly that of marble, had not been affected by the general position taken by the EU regarding Egypts political climate. This is despite recent statements made by Catherine Ashton, in addition to her recent visit with former president Mohamed Morsi. 

Egyptian companies are more aware of the types of regulations and restrictions that exist on the European market, for the purpose of better enabling such companies to promote and provide access to their products while avoiding obstacles, and in a way that preserves the reputation of such products, particularly marble and granite, added Abdel Hamid. 

Ali Al-Kabir, Director of General Administration for the Export Councils, said the Free Trade Agreement with Turkey, signed in December 2005, would not be affected by Turkeys recent attempt to close one of its maritime trading routes with Egypt. 

Despite the relative sluggishness seen in Egyptian-Turkish relations since the armys ouster of former President Mohamed Morsi, Al-Kabir said the trade agreements between the two, in addition to Egypts partnership agreement with Europe to reduce customs duties on imported cars and vehicles, would not be affected. 

Total trade between Egypt and Turkey reached $5.027bn in 2012, with Turkish exports to Egypt totaling $3.46bn. Egyptian exports to Turkey meanwhile totaled $1.567bn. Turkish investments in Egypt during this period totaled $1.5bn, a number which the former hopes to increase to $5bn within the next five years. 

Total trade between Egypt and the EU meanwhile totaled $33bn,Most modern headlight designs include Cheap Packing & Loading Products. with Egypt being granted the status of primary partner for EU member countries. Such status is particularly significant considering that 76% of tourists entering Egypt in 2010 came from Europe. Despite recent decreases seen in rates of tourism, this number has stabilized in recent years at 70%. 

Meanwhile Egypt remains South Africas third largest trading partner in North Africa, with total exports to the former reaching $19.8m. South African exports reaching Egypt from January to March 2010 meanwhile totaled upwards of $43.41m.