(Story updated at 2:15 p.m. Central time.)
After winning overwhelming support from Health Management Associates' shareholders, Community Health Systems is projecting that a combined hospital chain will emerge in the coming weeks and will be much stronger financially than the sum of its parts. But legal and financial challenges remain on both sides of the deal.
Franklin, Tenn.-based Community's $3.9 billion offer received support from 98.7% of votes cast, which represented 81.7% of outstanding common shares of Naples, Fla.-based HMA. The strong support came despite a pre-meeting rally held by nurses represented by the American Federation of Teachers, which is also an HMA shareholder.
The deal, which required approval from at least 70% of shareholders, would create the largest chain by hospital count. While the transaction still needs regulatory approval—and received a “second request” for more documentation from antitrust regulators—a Community news release
said the deal is now expected to close before the end of the month.
Community also said Tuesday that it had obtained financing for the transaction
through a new credit facility and refinancing existing debt.
The AFT had raised concerns
about a potential conflict of interest since the same hedge fund holds a leading position in both HMA and Community. Hedge fund Glenview Capital Management holds stakes of 14.5% and 9.9%, respectively, and had been a vocal player throughout the takeover process, even orchestrating a change of control of HMA's board.
On Monday Community previewed another quarter of weak financial results
—including sharp dips in patient volume—but analysts were generally pleased with the earnings boost the chain is projecting from the merger this year. A news release said synergies are expected to total $100 million the first year, and $250 million over two years. Community is also aiming to close another three to four hospital buys.
Despite HMA's own struggles with volume, it has resolved some of its outstanding issues, such as a contract dispute with Blue Cross and Blue Shield in Mississippi. Its 10 hospitals in the state have been reinstated in the Mississippi Blues' network
HMA has yet to resolve several government investigations and whistle-blower lawsuits. During the past few weeks, HMA disclosed that the federal government intends to intervene
in as many as eight False Claims Act cases that allege violations of Medicare overbilling and improper financial relationships with physicians.
However, Community, which is working to resolve similar investigations of its own, has built into the purchase price a contingent-value right of $1 a share, or roughly $270 million, that would be paid depending on the resolution of the legal issues.Follow Beth Kutscher on Twitter: @MHbkutscher